- Momentum Life first denied a funeral claim, arguing that the deceased did not qualify as a parent.
- The Life Ombud found that the insurer’s advisor misrepresented the policy, creating a valid expectation of coverage.
- Since January 2025, the Life Insurance Division has recovered R140.6 million in reversed claims and compensation.
A grieving policyholder recently faced a tough situation. Her R20 000 funeral claim was rejected by Momentum Life after the insurer argued that the deceased, whom she described as her godfather and her mother’s former partner, did not meet the definition of a parent under the policy.
The policyholder relied on a Momentum financial advisor’s advice, who had listed the deceased as her “father” during the application. Trusting this guidance, she thought she had the right coverage. When the funeral claim was denied, she sought help from the National Financial Ombud Scheme (NFO).
The Life Insurance Division, led by Ombud Denise Gabriels, ruled that the advisor’s misrepresentation created a valid expectation of coverage. Gabriels stated, “An insurer cannot escape responsibility by blaming a policyholder if the policy was issued based on wrong information from its own representative.”
The panel also mentioned that a party cannot benefit from its own mistake at another's expense. Momentum Life accepted the ruling and paid the claim in full, providing the grieving family the relief they deserved.
Millions recovered through Life Ombud mediation
Since January 2025, the NFO Life Insurance Division has recovered R140.6 million in reversed claims and compensation for inadequate service. These efforts have helped policyholders whose funeral claims were denied or who were treated unfairly by insurers.
“These cases rarely make the news, but they have a huge personal impact,” Gabriels said. “Every payout restores trust, offers emotional closure, and reduces financial pressure for families during very hard times.”
Gabriels stressed that policyholders also have a duty to provide accurate information. She advised, “Always answer questions fully and honestly. Ask for and keep copies of your policy documents, read the terms carefully, and update your beneficiary nominations regularly.”
For disputes that remain unresolved after the insurer's final response, the NFO provides free, independent help. Gabriels added, “Fairness should not depend on wealth or influence. It is a right every policyholder deserves.”
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