The South African Insurance Association (SAIA) Code of Conduct stipulates as follows:
10.2 Claims rejection
Insurers will only reject claims in the following circumstances:
• If evidence exists that there was material misrepresentation and/or non-disclosure by the policyholder.
• Evidence exists that the claim is fraudulent.
• The loss is specifically excluded in the policy contract.
• The loss is not covered by the policy contract.
• Conditions stipulated in the policy contract were not met by the policyholder.
• There was non-payment of the premium.
• In any other legally permitted circumstances.
Should an insurer make the decision to reject a claim, the following procedure will be followed:
• Reasons for the decisions will be provided by the insurer to the policyholder in writing.
• The insurer will inform the policyholder about its complaints procedure, as well as about other recourse avenues open to the policyholder.
• The insurer will provide the policyholder with copies of all available documents and information from third parties, that influenced the decision on request, that are not subject to legal privilege.