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MTHEMBU & CO ATTORNEYS
Practice Area
Advising on insurance disputes, claims, and policy interpretation.
Insurance law governs the contractual relationship between insurers and policyholders. When an insurer rejects a claim, delays payment, or disputes the terms of coverage, the policyholder may be left without the financial protection they paid for. P A Mthembu Attorneys represents policyholders in disputes with insurance companies, ensuring that claims are assessed fairly and that insurers honour their contractual obligations.
The firm handles disputes arising from both short-term insurance (motor vehicle, household, commercial property, and liability) and long-term insurance (life insurance, disability, and income protection). The firm also advises on regulatory matters under the Insurance Act 18 of 2017 and the Policyholder Protection Rules.
Insurance disputes often turn on the interpretation of policy wording specifically, the scope of coverage, exclusions, and the policyholder's disclosure obligations. The firm's litigation experience allows it to identify and pursue claims where insurers have acted unreasonably or in breach of the policy terms.
In many cases, disputes can be resolved through the Ombudsman for Short-Term Insurance (OSTI) or the Ombudsman for Long-Term Insurance, both of which provide free and independent dispute resolution services. The firm advises clients on the most appropriate forum for their dispute.
What should I do if my insurance claim is rejected?
Contact the firm for an assessment of your claim. The firm will review your policy wording, the insurer's reasons for rejection, and the facts of the claim to determine whether you have grounds to challenge the decision. This can be done through the insurer's internal dispute resolution process, the relevant Ombudsman, or litigation.
Can an insurer reject my claim for non-disclosure?
Yes. Policyholders have a duty to disclose material information when applying for insurance. If the insurer can show that the non-disclosure was material to their underwriting decision, they may be entitled to void the policy. However, the insurer must act reasonably, and the firm can assess whether the rejection was justified.
How long does an insurance dispute take to resolve?
This depends on the forum. Ombudsman complaints are typically resolved within 6 to 12 months. Litigation can take 1 to 3 years or longer, depending on the complexity of the matter and the court roll.
Is the Ombudsman process free?
Yes. Both OSTI and the Long-Term Insurance Ombudsman provide their services free of charge to policyholders. However, if the matter proceeds to litigation, standard legal costs will apply.
Whether you need representation or want to understand your options, get in touch.
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