Dealing With Insurance Disputes And Complaints In South Africa: A Guide to Navigating The Ombudsman For Short-Term Insurance

No one likes rejection. 

From not making the sports teams to having your crush tell you they prefer your friend, rejection hurts. 

But you know what’s worse? Being rejected by your insurance. 

Thankfully, you have the option to dispute a denied insurance claim. And you wouldn’t be the first, or the only one. 

In 2024, the National Financial Ombud Scheme (NFO) handled roughly 38,855 insurance complaints. They managed to recover R328.5 million, much of which came from short-term claims, like car accidents. 

The best part? There’s no need to hire an expensive attorney; the NFO offers free, fair, and impartial assistance to clients seeking help in resolving their insurance issues. 

Read on to discover who the NFO are, get a detailed step-by-step guide of their processes and some Pineapple prevention tips to help you avoid disputes with your insurer.

Or, you can skip the admin and effort with a 90-second quote for Pineapple’s comprehensive cover. 

TL;DR – Our version of “I’m not reading all that, *SparkNotes pls.”

• The National Financial Ombud Scheme (NFO) is a free, impartial service that helps resolve disputes between policyholders and insurers.
• The NFO investigates claims rejections, poor service, and misleading policy communication and provides rulings that insurers must follow if you accept the decision, giving you a strong resolution option without court costs.
• Before going to the Ombudsman, try to resolve the issue directly with your insurance provider, following their formal complaints process.
• Gather documents such as your policy wording, correspondence records, insurer responses, and proof of financial loss to prepare your argument thoroughly.
• Communicate clearly and professionally with your insurer and the Ombudsman. Stick to facts, avoid emotional language, and follow up persistently.

What is the National Financial Ombud Scheme (NFO)?

Previously known as the Ombudsman for Short Term Insurance, the National Financial Ombud Scheme (NFO)’s role is to facilitate a resolution when things get ugly between you and your insurer. The Ombudsman primarily handles cases involving rejected claims, non-payment, and less-than-satisfactory service. 

The newly formed National Financial Ombuds Scheme (NFO) commenced operations on 1 March, following its recognition by the Ombud Council. 

The establishment of the NFO came after a 2021 World Bank Group review of the South African financial ombud system, which highlighted a fragmented system. They recommended consolidation into a single ombud, hence the NFO. 

The NFO absorbed the work carried out by the Ombudsman for Banking Services (OBS), the Credit Ombud (CO), the Johannesburg Stock Exchange (JSE), the Ombudsman for Long-Term Insurance (OLTI), and the Ombudsman for Short-Term Insurance (OSTI).

How Does the NFO Work?

Contrary to popular belief, the Ombudsman isn’t out to catch anyone out. 

Their primary goal is to achieve a mutually beneficial resolution that is fair to both parties. How it works is that the NFO’s office will receive and examine information and evidence sent to them by you and your insurance provider. 

From there, they’re involved in the dispute and will make a recommendation based on their findings. If the relevant Ombudsman rules in your favour (as the client), and you accept their decision, the insurance provider is legally bound to comply.

Thankfully, the Ombudsman’s services are free. This means a cost-effective solution for clients who might not have the means to pursue legal action against a financial services provider. 

NFO vs Old OSTI: What’s Changed?

Common Insurance Disputes in South Africa 2025

Depending on the insurance industry or the specific insurance policy, there are some common disputes that everyone and their mother has either experienced. The top issues include denied claims, coverage and liability disputes, as well as underinsurance or policy issues.

*These results were compiled after consulting various reputable websites and resources. 

Rising Fraud & Cyber Risks in 2025

Insurance fraud is on the rise, only now it’s become more sophisticated and costly. According to the Association for Savings and Investment South Africa (ASISA), losses linked to fraudulent activities increased by 128% (from R77.2 million in 2022 to R175.9 million in 2023).

Insurance fraud was once a case of an individual inflating their claim in an effort to receive a larger payout. 

Now, it has become more organised, deliberate, and often coordinated. Customers are known to manipulate electronic device claims, often with the assistance of repair shops or IT contacts.

The sad part? Insurance fraud affects everyone, even innocent policyholders.

Fraudulent claims force insurers to increase their premiums across categories considered high risk, including jewellery, electronics, and portable technology. This makes insurance pricier for all policyholders.

Spot Red Flags in Policies

If you’re found guilty of insurance fraud, the consequences are severe. Your policy will likely be cancelled, and your profile will be flagged across insurance industry records. This means that if you try to get a policy elsewhere, it won’t be so easy. 

You’re legally required to disclose this history, and once you do, many insurance providers may decline to cover you.

The insurance industry frequently collaborates to combat fraud by sharing data to identify repeat offenders and syndicate activity. Similarly, many internal forensic departments conduct investigations, sometimes even scanning social media to verify the details of a claim.

Here are some red flags that may lead to your insurance policy getting cancelled (like a controversial celebrity):

• Dishonesty or submitting inaccurate information.
• Not notifying your insurer of any material changes to your risk profile. 
• Omitting details, like a new address, any changes in how a vehicle is used or new drivers.

On the other hand, you may fall victim to fraudsters pretending to be your insurer. In that case, watch out for suspicious phishing emails and texts. These trick people into clicking on malicious links or disclosing sensitive information. 

Telltale signs of a scam are typically poor grammar, strange formatting and a sense of urgency.

Learn more in our 10 Things You Don’t Realise Were Insurance Fraud guide.

Preparing Your Case: Documents & Evidence

When filing an insurance complaint, you must ensure you’ve prepared a strong case. That can start with a comprehensive checklist of all the essential documents you’ll need. These include:

• Insurance policy documents
• A paper trail of the claim correspondence
• The insurance provider’s response
• Proof of financial loss (if applicable)

The policy documents will outline your insurance policy’s terms and conditions and any exclusions, in simple terms: what is and isn’t covered. 

The correspondence paper trail will include all communications between you and the insurer regarding your claim, including emails, text messages (WhatsApp, SMS, etc.), and recorded phone calls. 

That way, neither you nor your insurer can walk back on any statements made.

You’ll also need to record your insurance provider’s response; you must document their reasons if they’ve rejected your claim. If possible, also include supporting documents like images, videos, witness statements, and a police case number to strengthen your case. 

Be sure to organise your information logically and create a clear, easy-to-follow, and well-structured system. This demonstrates your diligence and seriousness in addressing the issue.

Lastly, if your loss has financial implications, provide proof of economic loss, such as invoices, repair costs, or receipts, to support your claim. 

Step-by-Step Guide: How to File a Complaint with NFO

Here’s a step-by-step process detailing how to resolve insurance disputes in South Africa:

1. Contact Your Insurer
   Contact your insurance provider directly to try and resolve the issue. If possible, ask for a written response, which can later serve as a paper trail of evidence.
2. File A Formal Complaint
   If direct communication gets you nowhere, follow your insurance provider’s official complaints process. Typically, you’ll have to submit your complaint in writing, detailing the issue and providing supporting documents to create a paper trail. This will prove that you followed all the necessary steps and cooperated with the insurer to reach a satisfactory resolution.
3. Escalate to the NFO
   You can complain in writing by completing the National Financial Ombud Scheme’s prescribed application form (P.S., they also offer a telephonic or walk-in service). You must provide the following information: your name, account or policy number, full contact details, a factual summary of your complaint and copies of all relevant correspondence or supporting documents referred to in the complaint.
4. The NFO Phases 

• You will receive a letter of acknowledgement from the NFO.
• You’ll have to submit a written response to the complaint within 21 working days if you have not previously complained.
• You will be allowed to comment on the insurer’s response.
• The NFO may, at any stage, request further information or comment from any of the parties.
• Once the investigation has been completed, the NFO may issue a ruling or make a recommendation.

Communicating Effectively: Tips for Success

The most effective way to communicate with your insurance provider and the ombudsman is to be professional yet persistent.

Here’s a Do’s and Don’ts list of how to effectively communicate with your insurer

Do

• Be professional yet persistent in all your communication.
• Back your statements up with cold, hard facts (evidence).
• Identify the core issue, using specific details about the claim, policy terms, and the insurance provider’s response.
• Follow up with your insurer and the ombudsman on your case’s status.
• Keep track of all feedback, responses, and your follow-up attempts.

Don’t

• Don’t be overly emotional (using accusatory language or being argumentative could work against you).
• Don’t make personal attacks or include subjective opinions.
• Don’t hesitate to follow up, but be sure to allow the NFO’s process to unfold (it typically takes 90 days, but could be longer depending on the case’s complexity).

If no information is provided to you, inquire politely yet firmly, for example: “I hope this email finds you before I do…” Just kidding. 

What you should do is maintain a record of your attempts to follow up and communicate with your insurer and the ombudsman.

Legal Options if NFO Doesn’t Resolve It

The NFO’s service is free, fair and impartial. But if you’re unhappy with the outcome of the case and the ombudsman’s decision, you can pursue legal action. 

Mediation, arbitration, or Small Claims Court (SCC) can handle civil disputes involving amounts up to R20,000 and provide you with legal recourse. Mediation is an alternative dispute resolution method that is less formal than traditional court cases. This option is also more budget-friendly than the average court proceeding. 

When to Choose SCC Over NFO

In South Africa, the Small Claims Court is designed to be informal and less intimidating than traditional courts, which allows you to present your case without a legal representative.

For extreme cases, clients can also pursue arbitration. Arbitration is a process where the parties involved in a dispute agree to have their case decided by an impartial arbitrator or panel, rather than going to court.

*Depending on the claim’s complexity

Whichever path you choose, ensure you’re not walking alone. 

Consult a legal professional before taking legal action. The last thing you want is to spend thousands of rands, and precious time, on a case you won’t win. A qualified legal professional will consider your specific circumstance and may provide helpful insight and advice.  

Preventing Insurance Disputes: Tips for Policyholders

You’re hoping never to find yourself in hot water with your insurance provider, and that’s so valid. Here are some tips to minimise the likelihood of insurance disputes:

• Please read the policy wording carefully. If any insurance jargon (big words) confuses you, ask a consultant or customer care agent to explain the meaning and implications.
• Stay informed about changes to your insurance agreement. Policies aren’t set in stone, so regularly review your policy document for any updates or amendments to your insurance coverage. 
• Finally, choose the right insurer. We’re not saying there will be no disputes. But, a reputable insurance provider (like Pineapple) will have transparent processes, a solid customer service history, and a proven track record of settling claims fairly and quickly. 

Why Transparent Insurance Providers Like Pineapple Reduce Disputes

A reliable insurance provider will likely communicate clearly, address your concerns carefully, and handle claims efficiently. This means there’s less chance of the misunderstanding spiralling into an even bigger fight that needs to be handled at the Ombudsman’s office.

Click here to get a comprehensive car insurance quote from just R570* p/m.

Frequently Asked Questions: The National Financial Ombudsman Scheme

1. How Long Does NFO Take?
   The National Financial Ombudsman Scheme’s initial assessment can take 90 days. But this depends on the case’s complexity. The process officially kicks off after your initial complaint has been lodged, and an acknowledgement letter has been sent. A request for a response from the service provider then follows this.
2. Is NFO Free for Short-Term Insurance?
   The National Financial Ombudsman’s services are free. The NFO’s dispute resolution services ensure that consumers in South Africa have access to free, independent and fair alternative dispute resolution processes when encountering disputes with their financial service providers.
3. What if My Car Claim is Rejected?
   If your insurance claim is rejected, consult the policy wording and rejection letter to understand the rejection. If the reasons provided are unclear, you can request a detailed explanation in writing. If you disagree with the insurer’s decision, you can file a complaint to your insurer’s internal dispute resolution department.
4. NFO Contact Details?
   The National Financial Ombud Scheme (NFO) has various contact details: 0860-800-900 (telephone ☎️), +27 (0)66 473 0157 (WhatsApp ✅), info@nfosa.co.za (email 📧) and nfosa.co.za (website). Their physical office is listed as 110 Oxford Road, Houghton Estate, Johannesburg, Gauteng, 2198.

Final Thoughts & Conclusion

The National Financial Ombud Scheme empowers fair resolution between financial services providers and their clients. 

They do this free of charge and efficiently; the NFO complaints procedure is designed to be straightforward and free of charge. This ensures that financial disputes can be resolved without adding to the financial burden.

In 2024 alone, the NFO handled roughly 38,855 insurance complaints. They also recovered R328.5 million, which mostly came from short-term claims, like car accidents.

Having the correct information, some professional advice, and some intentional organisation can help make dealing with your insurer and the ombudsman a little less stressful.  

It also helps to have an insurance provider who lives by the principles of honesty, transparency, and support is crucial.

Pineapple is an insurance provider that values clear communication, fair practices, and a commitment to resolving disputes in your best interest. And we haven’t even told you the best part: our comprehensive car insurance is affordable, starting from R570 per month for total vehicle protection. 

Quote Now: it takes just 90 seconds to achieve peace of mind!

Please Note: The information provided above is for informational purposes only; you should not construe any such information as legal or financial advice. 

Pineapple (FSP 48650) is underwritten by Old Mutual Alternative Risk Transfer Insure Limited, a licensed Non-Life Insurer and authorised FSP. T&Cs apply.