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Practice area

Insurance Dispute Attorneys

PM & Co assists policyholders and businesses with rejected, delayed or disputed insurance claims.

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Legal context

Insurance Disputes

Insurance dispute law deals with claims and disputes under short-term, long-term, life, business, vehicle, property, liability and credit-related insurance policies. The correct procedure is often as important as the merits of the matter. A missed notice, incorrect court process or poorly drafted document can affect the client's legal position, costs and available remedies.

The main legal framework includes insurance contracts, the Insurance Act 18 of 2017, Policyholder Protection Rules, applicable long-term and short-term insurance legislation, FSCA regulatory framework, ombud schemes such as the National Financial Ombud Scheme, and court proceedings where necessary. Depending on the issue, the matter may involve an insurer's internal complaints process, an ombud process, FSCA-related considerations or court proceedings. The correct route must be selected at the start because policy wording, prescription and evidence requirements differ.

Clients usually need an attorney when an insurer rejects a claim, delays payment, alleges non-disclosure or misrepresentation, applies an exclusion, cancels cover, offers an inadequate settlement or disputes quantum. Early legal input helps identify the client's rights, the correct process, the evidence needed and whether negotiation, mediation, urgent relief or formal proceedings are appropriate.

How PM & Co can help

  • Review policy wording, schedules, endorsements and exclusions.
  • Assess rejection reasons and evidence required to challenge them.
  • Prepare representations to insurers or complaints to relevant ombud forums.
  • Advise on settlement offers, releases and prescription risk.
  • Represent clients in litigation where appropriate.

Common matters we assist with

  • Rejected vehicle, property and business interruption claims.
  • Non-disclosure and misrepresentation disputes.
  • Policy cancellation and premium disputes.
  • Quantum disputes and inadequate settlement offers.
  • Life, disability and credit life claim disputes.
  • Insurer delay and failure to provide reasons.
  • Ombud complaints and insurer appeals.

When to seek legal help urgently

  • A rejection letter gives a short period to object or escalate.
  • Prescription or policy time-bar deadlines are approaching.
  • The insurer alleges fraud, misrepresentation or non-disclosure.
  • You are asked to sign a full and final settlement.
  • A business cannot operate because the claim is unpaid.
  • Evidence, damaged property or documents may be lost.

Legal framework

The right route matters.

Legal matters often turn on the correct statute, court process, notice, evidence and deadline. PM & Co uses the consultation to understand your story first, then connects the legal framework to your specific facts and documents.

What happens next

A structured route from concern to action.

Ask PM & Co to review your rejection letter before deadlines or settlement pressure limit your options.

  1. 01

    Step 01

    We review the policy and identify the insurer's stated grounds.

  2. 02

    Step 02

    We assess what evidence is needed to respond.

  3. 03

    Step 03

    We prepare representations, settlement responses or ombud complaints.

  4. 04

    Step 04

    We advise whether litigation is commercially sensible.

  5. 05

    Step 05

    We help clients avoid statements or agreements that prejudice their claim.

Documents checklist

Documents that may later assist

For the first consultation, the most important thing is to explain what happened, what outcome you need and whether there are urgent dates. After we understand the matter, we will confirm which documents are actually required.

  • Policy wording, schedule, endorsements and renewal documents.
  • Claim form, claim number and all supporting documents submitted.
  • Rejection letter, reasons and internal appeal correspondence.
  • Broker advice, emails, needs analysis and disclosure documents.
  • Premium payment proof and policy history.
  • Photos, videos, assessor reports and expert reports.
  • Police case number, accident report or incident report, where applicable.
  • Invoices, repair quotes, replacement quotes and proof of loss.
  • Medical reports, death certificate or disability documents, if relevant.
  • Settlement offers, releases and time-bar notices.

This content is general information about South African insurance disputes. It is not legal advice and should not be relied on without reviewing the policy wording, claim documents, reasons for rejection and applicable deadlines.

Questions clients ask

Insurance Disputes FAQs

Can an insurer reject a claim based on an exclusion?

Yes, if the exclusion applies and is properly relied on under the policy. However, exclusions must be interpreted in context, and the insurer's reasons should be checked against the facts and wording. A rejection should not be accepted without reviewing the policy.

What is non-disclosure in insurance?

Non-disclosure means failing to disclose material information when applying for or changing cover. Insurers may rely on it to reject claims or avoid policies, but materiality and the questions asked must be assessed. Evidence of the application process is important.

What should I do after receiving a rejection letter?

Ask for full written reasons if they are unclear, diarise objection or escalation deadlines, preserve evidence and obtain advice before responding. A rushed response can weaken a claim. The policy wording and claim documents should be reviewed together.

Can I complain to an ombud?

Many insurance disputes can be referred to an ombud scheme, depending on the policy and insurer. Ombud processes can be useful, but they require proper documents and clear submissions. Some matters may still need court action.

What is a policy time-bar?

A time-bar is a policy clause requiring a claim, objection or legal action within a specific period. Missing it can prejudice the claim. Time-bars should be checked immediately after rejection or dispute.

Can an insurer delay payment while investigating?

Insurers may investigate claims, but unreasonable delay can be challenged depending on the policy, evidence and communication. Policyholders should keep written records, provide requested documents where appropriate and ask for reasons for delay.

Should I accept a settlement offer?

A settlement may be sensible, but a full and final settlement can prevent further claims. Before accepting, compare the offer to the policy entitlement, excess, exclusions, repair costs and future losses. Legal review is recommended.

What if my broker gave wrong advice?

Broker advice may raise separate issues under mandate, insurance and financial advisory rules. Documents showing the advice, disclosure and policy selection are important. A claim against an insurer and a complaint about broker conduct may require different processes.

Can business insurance claims be disputed in court?

Yes, if the policyholder has a legal claim and litigation is commercially justified. The policy wording, loss calculation, causation and evidence are critical. Alternative forums should also be considered.

What documents make an insurance claim stronger?

The full policy, proof of premium payments, incident reports, photos, expert reports, invoices, quotes and correspondence with the insurer or broker are important. A clear chronology helps show compliance with notification and claim requirements.

Let us help you choose the right next step.

Share the documents you have, the deadline you are facing and the outcome you need. PM & Co Inc Attorneys will guide you to the correct consultation route.

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