The outcome
Approved or rejected
Either way, you hear the reasons, and either way you are not left to deal with it alone.
If the claim is approved
- The insurer loads the payment, in full or in part, as decided
- The insurer confirms what it has approved and pays into the account on record, on its own payment run
- We confirm what was paid against what was claimed
If the claim is rejected
- The insurer sends a rejection letter with its findings: the description and date of loss, what your policy covers, and why the insurer holds that this incident falls outside it
- The letter names who you can escalate to if you want to dispute the decision, and the deadline for doing so, usually 90 days. Check the letter for the exact period
- We go through the letter with you and explain what the insurer is actually saying before you decide what to do
The independent route. If you dispute the insurer’s final decision, you can take the complaint to the National Financial Ombud Scheme South Africa (NFO), the independent industry ombud recognised by the Ombud Council. It costs you nothing to use. Call 0860 800 900, email info@nfosa.co.za or visit nfosa.co.za. Mind the deadlines in the rejection letter.
Two different routes. The NFO above is for a complaint about the insurer's decision on your claim. A complaint about CivilSure itself, our service or our advice, goes to the FAIS Ombud instead. Call 012 762 5000, email info@faisombud.co.za or visit faisombud.co.za. You are welcome to bring it to us first either way, and we will deal with it under our own complaints process.
Claims are decided by the insurer under your policy wording and schedule, not by CivilSure. This page is a plain language guide to the process, and nothing here changes what your policy says. General information only. It is not legal advice or advice on your contract.