Scheme Number: S023742 never process the claim

FORMAL COMPLAINT IN TERMS OF THE FAIS ACT

AGAINST: SAFRICAN INSURANCE COMPANY

1. INTRODUCTION AND JURISDICTION

1.1 I hereby lodge a formal complaint with the Office of the FAIS Ombud against Safrican Insurance Company (“Safrican”) for ********, unfair, and unreasonable claims handling in relation to a funeral insurance policy.

1.2 This complaint arises from Safrican’s failure to process and pay a valid funeral insurance claim, its failure to provide written reasons for non-payment, and its reliance on undocumented and undisclosed administrative requirements.

1.3 The complaint falls squarely within the jurisdiction of the FAIS Ombud as it concerns the rendering of financial services, claims administration, non-compliance with statutory conduct standards, and unfair treatment of a policyholder and beneficiary.

2. PARTICULARS OF THE DECEASED AND THE CLAIM

2.1 Deceased: Skhumbuzo Bright Dlamini Identity Number: *** 080 Date of Death: 14 January 2026

2.2 Policy Type: Funeral Insurance Claim Number: WF.***0 Policy Benefit: R20,000

2.3 I am the uncle and informant of the deceased and a lawful representative with a direct, material, and legitimate interest in the proper settlement of this claim.

3. BACKGROUND AND COURSE OF DEALING

3.1 Ikhaya Funeral Home has maintained a long-standing funeral insurance scheme relationship with Safrican under Scheme Number S023742.

3.2 Multiple claims have historically been lodged and paid under this scheme, with the most recent successful claim paid on 22 March 2024.

3.3 This established a clear and reasonable legitimate expectation that Safrican would continue to administer the scheme lawfully, transparently, and in accordance with applicable insurance legislation and conduct standards.

4. CLAIM LODGEMENT AND SAFRICAN’S CONDUCT

4.1 Following the death of the deceased on 14 January 2026, the funeral claim was lodged at Safrican’s Durban office on 20 January 2026.

4.2 Safrican representatives advised that the claim would be finalised and paid within 48 hours, thereby creating a reasonable and lawful expectation of prompt settlement.

4.3 Proof of premium payments covering June 2025 to January 2026 was submitted in full on 22 January 2026.

4.4 Despite full compliance, Safrican has to date:

- Failed to pay the claim; - Failed to issue any written rejection; - Failed to provide written reasons for delay or non-payment; - Failed to cite any policy clause re**** upon.

4.5 A verbal delay or silence, without lawful written reasons, constitutes unfair and ******** claims handling.

5. ALLEGED “MONTHLY SCHEDULE” REQUIREMENT – ******** RELIANCE

5.1 Safrican informally alleged that the claim could not be processed due to outstanding “monthly schedules”.

5.2 At no stage was Ikhaya Funeral Home informed—verbally or in writing—that submission of monthly schedules constituted:

- A condition precedent to cover; or - A condition precedent to the payment of claims.

5.3 Historically, schedules were submitted only when members were added or removed and never as a recurring monthly obligation.

5.4 Safrican failed to:

- Point to any policy clause imposing such a requirement; - Provide proof that such a requirement was communicated in advance.

5.5 In terms of South African insurance law and the Policyholder Protection Rules:

- The onus rests on the insurer to prove that a repudiation or delay is lawful, reasonable, and procedurally fair. - Any ambiguity in policy wording or administrative requirements must be interpreted in favour of the policyholder.

5.6 Safrican is therefore legally barred from relying on an undisclosed and undocumented administrative requirement to defeat a valid claim.

6. ADMINISTRATIVE FAILURES AND COMMUNICATION BREAKDOWN

6.1 Safrican failed to notify the scheme of staff departures and internal administrative changes, despite those staff members being primary points of contact.

6.2 Email correspondence from April 2024 confirms internal administrative confusion on Safrican’s part, which Safrican undertook to rectify.

6.3 After April 2024, Safrican issued no compliance notices, no warnings, and no policy updates to the scheme.

6.4 Any internal administrative failure remains the responsibility of Safrican and cannot lawfully be shifted onto beneficiaries or claimants.

7. PREJUDICE AND CONSEQUENTIAL LOSS

7.1 Due solely to Safrican’s ******** delay and failure to pay, funeral arrangements could not be postponed.

7.2 I was compelled to obtain a loan of R20,000, incurring interest of R4,000.

7.3 The total financial prejudice suffered amounts to R24,000, which was foreseeable, avoidable, and directly caused by Safrican’s conduct.

8. STATUTORY AND CONSTITUTIONAL BREACHES

8.1 Safrican’s conduct constitutes breaches of:

- The FAIS Act (failure to render financial services honestly, fairly, with due skill, care, and diligence); - The Insurance Act 18 of 2017; - The Policyholder Protection Rules (claims handling obligations); - FSCA Conduct Standards; - Treating Customers Fairly (TCF) principles; - Section 33 of the Constitution (right to just administrative action).

8.2 Safrican’s failure to provide written reasons renders its conduct procedurally unfair and ********.

9. RELIEF SOUGHT

I respectfully request that the FAIS Ombud:

9.1 Direct Safrican Insurance Company to:

- Pay the funeral policy benefit of R20,000; - Pay consequential loss in the amount of R4,000; - Pay interest at the prescribed rate from the date of claim lodgement to date of final payment.

9.2 Alternatively, direct Safrican to issue a lawful written rejection citing:

- The exact policy clause re**** upon; and - Proof that such clause and requirement were communicated in advance.

9.3 Grant any further relief the Ombud deems just, equitable, and appropriate.