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Home insurance claim denied: what to do

Written by Chloe Adams Managing Editor Reviewed by Nomsa Dlamini RE5 qualified · 12 years in short-term insurance Updated 28 July 2026 Our editorial standards →

What can I do if my home insurance claim is denied?

If your home insurance claim is denied, first ask the insurer for the reason in writing, then lodge a formal complaint through their internal dispute process and request a final decision. If you're still unhappy, you can escalate free of charge to the National Financial Ombud Scheme (NFO), the independent body that resolves short-term insurance disputes in South Africa. Understanding why claims are rejected helps you build a stronger appeal.

Key takeaways

Ask for the reason for rejection in writing before you respond.
Non-disclosure, wear and tear, and unmet conditions are common reasons.
Use the insurer's internal complaints process first and get a final decision.
Escalate free to the National Financial Ombud (NFO) if still unresolved.
Some events are only covered by SASRIA, not the standard policy.

Common reasons home claims are rejected

Understanding why a claim was declined is the first step to challenging it. The most frequent reasons include:

Non-disclosure - a material fact, such as a home business or a previous claim, wasn't declared
Wear, tear and lack of maintenance - damage from gradual deterioration rather than a sudden event
Unmet policy conditions - for example, an alarm that wasn't armed during a burglary
Exclusions - the loss falls under something the policy specifically excludes
Lapsed cover - a missed premium meant the policy wasn't active
Under-insurance - the average clause reduces a payout when the sum insured is too low

Some of these are clear-cut; others are arguable, which is exactly where a well-prepared appeal can change the outcome.

Step one: get the reason in writing

Before you do anything else, ask the insurer to put the reason for the rejection in writing, with reference to the specific policy clause or exclusion they're relying on. A written reason does two things: it tells you precisely what you need to address, and it creates a record for any later dispute. Don't accept a vague verbal 'it's not covered' - you're entitled to a clear explanation tied to your policy terms.

Read that explanation against your policy schedule and wording. Sometimes the rejection rests on a factual misunderstanding - the cause of the damage, a date, whether a condition was met - that you can correct with evidence. Gather everything relevant: photos, reports, receipts, correspondence and quotes.

Step two: use the insurer's complaints process

Every South African insurer has an internal complaints and dispute-resolution process. Lodge a formal complaint in writing, set out clearly why you believe the decision is wrong, and attach your supporting evidence. Be specific: respond to the exact clause they cited and explain, with proof, why it shouldn't apply.

Ask the insurer to review the decision and provide a final response. This step matters, because the ombud generally expects you to have given the insurer a fair chance to resolve the complaint first. Keep copies of everything you send and receive, and note the dates - a clear paper trail strengthens your position and is often needed for the next step.

Step three: escalate to the National Financial Ombud

If the insurer's final decision still doesn't satisfy you, you can escalate to the National Financial Ombud Scheme of South Africa (NFO). The NFO brought together several former ombud schemes, including the one for short-term insurance, into a single independent body that resolves disputes between consumers and financial institutions. Its service is free to consumers.

To use the NFO, you generally need to have completed the insurer's internal process and received a final decision (or waited a reasonable time for one). You then submit your complaint with the supporting documents, and the NFO considers both sides independently. There are time limits for referring a complaint after the insurer's final response, so don't let it drift. The NFO can recommend or direct a resolution where it finds the rejection was unfair.

Don't overlook SASRIA cover

Occasionally a claim is declined not because you did anything wrong, but because the cause falls under SASRIA - the South African Special Risks Insurance Association. SASRIA covers specific 'special risks' such as riots, strikes, public disorder and civil commotion, which standard policies typically exclude. Most insurers offer SASRIA cover as a small add-on collected with your premium.

If your loss stems from unrest or a similar special risk, check whether it should be routed as a SASRIA claim rather than a standard one. Confirming which cover applies can turn an apparent rejection into a valid claim under the right heading.

Frequently asked questions

Why was my home insurance claim rejected?

Common reasons include non-disclosure of a material fact, damage from wear and tear or poor maintenance, unmet conditions such as an unarmed alarm, a specific exclusion, lapsed cover from a missed premium, or under-insurance triggering the average clause. Ask the insurer for the exact reason in writing so you can respond to it.

How do I appeal a denied home insurance claim?

First get the reason for the rejection in writing, then lodge a formal complaint through the insurer's internal dispute process with supporting evidence and ask for a final decision. If you're still unhappy, escalate free of charge to the National Financial Ombud. Keep a clear record of all correspondence throughout.

What is the National Financial Ombud?

The National Financial Ombud Scheme of South Africa (NFO) is an independent body that resolves disputes between consumers and financial institutions, including short-term insurers. It combined several former ombud schemes into one, and its service is free to consumers. You generally use it after the insurer's internal process.

Is the ombud free to use?

Yes. The National Financial Ombud provides its dispute-resolution service to consumers free of charge. You typically need to have gone through the insurer's internal complaints process and received a final decision first, and there are time limits for referring your complaint after that response.

What is SASRIA and when does it apply?

SASRIA, the South African Special Risks Insurance Association, covers special risks such as riots, strikes, public disorder and civil commotion that standard policies exclude. It's usually added to your policy for a small extra premium. If your loss stems from unrest, check whether it should be claimed under SASRIA rather than your standard cover.

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