Funeral Claim Declined: What You Can Do

A decline is the insurer's decision. It is not a court ruling and it is not the end. Some declines are correct for reasons you can check, and some are wrong.

The insurers' industry body, ASISA, reported a funeral payout rate of 93.2% for 2025 for its member insurers. That is an industry figure, and it means most funeral claims are paid. It also means some are not, and the National Financial Ombud sees many of those cases.

Do not sign anything that says you accept the decision until you have read the reasons and checked them against your policy and the rules below.

ASISA says the main reasons for declining funeral claims are waiting periods, fraud and unpaid premiums.

The National Financial Ombud's 2025 annual report tells the same story from the complaints side. Funeral insurance was the most complained-about life insurance product, at 46.2% of all life insurance complaints, and declined claims were the main driver of funeral complaints.

The last row is not a rule from the regulations. It is simply worth checking, because the policy schedule is the first thing an insurer looks at.

Funeral policies are covered by the Policyholder Protection Rules (PPR). Our checks of the published rules, as at 30 September 2026, found the following. The rules were published in 2018 and took effect on 1 October 2018. For the full set of buyer rules, see funeral cover rules in South Africa. We could not confirm whether they have been amended since, so ask the Ombud if a rule matters to your case.

• Waiting periods are limited. For a natural death, a funeral policy may not impose a waiting period longer than the shorter of one quarter of the policy term or six months. No waiting period may apply to death from an accident, or on renewal.
• Earlier cover can count. A new insurer may not impose a waiting period if you confirm that you had a policy with another insurer at least 31 days earlier, for similar risks and the same lives, and you had completed that waiting period.
• Health conditions and suicide. A funeral policy may not exclude pre-existing health conditions except through the waiting period. It may not exclude suicide for more than 12 months from the start of the policy.
• Non-disclosure. The insurer may not decline a funeral claim because you did not disclose information it did not specifically ask for before the policy started.
• Grace period. If a premium is unpaid, the insurer must tell you within 15 days. For monthly premiums, cover must stay in force for 15 days after the due date. A policy term that lets the insurer decline because a premium was paid late is void if you paid within the grace period. A valid claim for a death in the grace period may be reduced only by the unpaid premium.
• Reinstatement. If the insurer reinstates a policy that lapsed for non-payment, it must be on at least the same terms and with no new waiting period. A new policy with the same insurer within two months of a lapse also gets no new waiting period, except for any unfinished part of an earlier one.
• Decision time. The insurer must decide within two business days after it has received all the documents it requires. A disputed claim must be decided within 14 further business days. The rule sets a deadline for the decision. It does not name a deadline for the payment.

1. Ask for the reasons in writing. Ask which clause of the policy the insurer relied on, and for copies of the policy document and your application form. The letter below does this.
2. Check the reasons against the rules above and your records. Look at dates, premium payments and what the application asked.
3. Complain to the insurer in writing. Send it to the insurer's complaints department and keep proof that it was sent. Say what you want: that the decision is reviewed and the claim paid.
4. Go to the National Financial Ombud if the insurer does not answer, or confirms the decline and you still disagree.
5. Arrange the funeral in the meantime. Speak to the funeral parlour about a payment arrangement. A dispute with the insurer should not stop you from saying goodbye.

For how a normal claim should run, see how funeral cover payouts work. For the insurer's own claims lines, see funeral cover claims and contact numbers.

The National Financial Ombud (NFO) was established in March 2024. It brought four separate ombud offices into one body, including the former life insurance ombud. Its service is free to complainants. Insurers fund it.

You can complain in any of these ways:

• Online form: nfosa.co.za/submit-a-complaint/
• Phone: 0860 800 900
• Email: [email protected]
• WhatsApp: +27 76 574 8055

Complaints can be made orally, in writing or in person, in any official language.

Must you complain to the insurer first? The NFO's own pages disagree. Its how-to-complain page says you must first contact your insurer. Its FAQ and rules say that is not compulsory, and a complaint the insurer has not yet seen is referred back to it. Our advice is to complain to the insurer first anyway. It costs you nothing, it puts the reasons on paper, and it avoids a delay.

The three-year rule. The Ombud may dismiss a complaint if three or more years have passed since you knew, or should have known, that you had cause to complain. Once the Ombud receives your complaint, the running of the legal time limit (prescription) is suspended. We found no shorter deadline in the Ombud's current rules, but do not wait. Your policy may also have its own time limit for going to court, so ask the Ombud if that applies.

Put everything in one folder, on paper or on your phone.

• The policy document or schedule, and the application form if you have it.
• The decline letter, and the date you received it.
• Proof of premium payments, such as bank statements or debit order records.
• The death documents you gave the insurer, and proof of when you sent them.
• Every email, WhatsApp message and note of a call, with dates and the names of the people you spoke to.
• Funeral invoices, quotes and receipts.
• Your ID and the ID of the person who died.

If you are missing something, say so in your complaint. The Ombud can ask the insurer for its file.

Copy this into an email or a document and fill in the brackets. Keep it short and factual.

Subject: Complaint about declined funeral claim, policy number [policy number]

To: The Complaints Department, [insurer name]

Date: [date]

I am writing about the funeral claim for [full name of the person who died], who died on [date of death]. My claim, reference [claim number], was declined on [date of the decline letter].

I do not accept this decision at this stage. Please send me in writing:

• the full reasons for the decline, in plain language;
• the clause of the policy you relied on;
• a copy of the policy document and the application form;
• the documents and records you used to reach your decision.

I believe the claim should be paid because [one or two plain sentences, for example: the policy was in force and my premiums were up to date, or the death was an accident, or I was never asked about this on the application form].

Please treat this as a formal complaint and reply in writing by [date you choose]. If it is not resolved, I will take the matter to the National Financial Ombud.

Yours sincerely,

[your full name, ID number, phone number and email address]

If the decline was for a reason that involves a scam or a seller you do not trust, read funeral cover scams and your rights.

We are not lawyers and we do not know the details of your policy. This page explains the published rules and the Ombud's process as we checked them on 30 September 2026. It cannot say whether your claim should have been paid.

Waiting periods are the most common reason and they are lawful within the limits above. If you are choosing cover, see funeral cover with no waiting period to understand what waiting periods mean before you buy, and what a funeral policy is for the basics.