Help, my funeral claim was rejected

Your funeral policy ensures you can give your loved ones the send-off they deserve. Funeral plans pay valid funeral claims quickly, often within 48 hours. The funds can be used to pay for services such as undertakers so you don’t have to worry about how you will pay for the burial. However, if your funeral claim is rejected, or declined, the emotional stress and frustration of wondering how to pay funeral expenses can be overwhelming. In order to successfully claim on a policy, you need to understand the reasons funeral insurance claims are rejected.

Understanding funeral claims

When a member insured on a funeral policy passes away, a claim should be made to the insurance company. The insurance company will explain the funeral claims process that needs to be followed, such as completing a claim form and submitting IDs and the death certificate, as well as confirmation of bank details for the account the proceeds should be paid into. Insurers should also have these details on their websites. For valid claims, this process can be a matter of a few days, sometimes even a few hours.

Common reasons why funeral claims are rejected

Over 90% of funeral insurance claims in South Africa are paid, however, some are rejected or declined for the following reasons:

A claim is made in the waiting period

Funeral policies usually have a waiting period during which time premiums must be paid but claims cannot be made, such as a six-month waiting period for death due to natural causes. This means that only after six months has passed and six premiums paid, can a claim be made where a member passes due to natural causes such as pneumonia, cancer or heart failure.

The policy has lapsed due to non-payment of premiums

Premiums for funeral policies are due every month. If they are not paid when due cover may be suspended and the policy may lapse, or be cancelled. South African insurers have to give you a grace period in which time to make up an unpaid premium, such as 31 days. If they don’t receive the missed premium in this time the policy may lapse and no insurance claim will be paid.

The cause of death is excluded from cover

An exclusion is where a specific cause of an event, such as the cause of a death, is not covered and no claim can be made. All policies have a general exclusion for illegal or criminal activities. If a death occurred while a member was committing a crime or under the influence of drugs or alcohol, or participating in a riot, for example, no claim can be made on the funeral policy.  Death due to suicide is also usually excluded for a period of time such as six or 12 months.

An additional member does not meet the insurers definitions for an additional or extended family member

Funeral insurance policies allow for the cover of extended family members such as parents, siblings, and cousins. However, each insurer has strict definitions of who can qualify as an extended family member, such as there must be a blood relation, or members must be related by marriage. If a family member does not meet these definitions the funeral claim will be declined.

Top tip: Funeral insurance claims may be delayed if:

• There is incomplete information on the claims form: insurers need all sections to be completed
• There is missing documentation: if a death certificate is not presented a claim cannot be paid

How to avoid funeral claim rejections

By ensuring you understand your policy terms and conditions and follow the claims process you can ensure your valid claims are paid quickly!

• Read your policy terms and conditions and ask your financial adviser or insurer to explain any terms that you don’t understand, including waiting periods, exclusions and who qualifies as an additional or extended family member
• Pay premiums when they are due and make up any missed premiums in the grace period, or talk to your insurance company if you are struggling to pay premiums on time or to afford your cover
• Ensure the beneficiary knows how to claim: tell your beneficiary who and what your policy covers and explain the claims process to them
• Follow the claims procedure: you can always ask the claims team exactly what you need to do, when and how, such as how to complete and submit forms

What to do if your funeral insurance claim is rejected

Your insurance company will inform you of their claims decision in writing, and the reason for their decision. Take some time to read their decision and see if you can resolve the issue, such as submitting outstanding documents. Or you can dispute the decision.

Disputing a rejected or declined funeral insurance claim

Licensed South African insurance companies are required to follow a formal complaints resolution procedure to resolve any claim queries or disputes. Details of the process are available in policy documents and should be on the insurer’s website.

There are three basic steps to formal complaints procedures:

1. Inform your insurance company in writing that you wish to dispute the decision and why. You should send this to the complaints officer, whose details should be on their website.
2. The insurance company is required to review the decision and inform you of any new decision or changes to their original decision.
3. If you are still unhappy with the decision you can approach the National Financial Ombud Scheme. They will assess and review your case and make a final decision.

1Life Insurance is committed to changing policyholder lives for the better

1Life Insurance is a licensed insurer and financial services provider and has been changing policyholders’ lives for nearly two decades. 1Life Insurance funeral cover policies can be tailored to your needs and budget, with cover up to R50 000 each for up to 16 members. You can buy funeral cover online and save 40% on premiums, as well as access and manage your policy safely and conveniently in your own time on the online policyholder services portal and WhatsApp service centre.

1Life Insurance has been voted an iconic brand 2 years in a row, in the 2022/2023 and 2023/2024 Ask Afrika Icon Brands Awards and recognised as South Africa’s #1direct life insurer in the annual Swiss Re Reports for 11 consecutive years! Our policyholders are always top of mind, and in 2023 and 2022, we had the highest net sentiment in the PWC SA Insurance Index Report. 

Know your policy terms and conditions to avoid rejection

Funeral insurance policy claim rejections are most often due to non-payment of premiums, or the policy terms and conditions not being met. Learn more about your policy by reading your policy documents and any correspondence your insurance company sends to you. Make sure you ask questions about any terms you don’t understand. When you know your policy terms and conditions, you’ll know how to avoid a rejected or declined funeral claim and have the funds for the funeral service your loved ones deserve.

We answer questions about rejected funeral policy claims

Why was my funeral insurance claim rejected?

Funeral insurance claims are commonly rejected because premiums were not paid, a claim was submitted during a waiting period, the cause of death was excluded by the policy, or the insured person did not meet the policy's eligibility requirements. Your insurer must explain in writing why a claim was declined.

Can a funeral claim be rejected during the waiting period?

Yes. If the insured person dies from a cause that is subject to a waiting period before that waiting period has ended, the claim may be declined. In most funeral policies, waiting periods commonly apply to death due to natural causes, while accidental death may be covered from the policy commencement date, subject to the policy terms and conditions. Always check your policy schedule and wording to understand which waiting periods apply to your cover.

Learn more about funeral cover waiting periods

What happens if I miss a premium payment on my funeral policy?

If you miss a premium payment, South African law grants you a strict 31-day grace period to pay the outstanding amount before your policy lapses and your cover is cancelled.

During this 31-day window, your cover remains active. However, if the premium remains unpaid after the grace period expires, the policy will officially lapse. Once a policy lapses, any subsequent claims will be automatically rejected. If you are struggling financially, you should contact your insurer immediately, as they may be able to offer alternative payment arrangements to keep your cover intact.

Can I dispute a rejected funeral insurance claim?

Yes, you have the legal right to formally dispute a rejected funeral claim by first submitting a written objection to your insurer's internal complaints department. If your claim is denied, you do not simply have to accept the decision. The correct dispute process follows these steps:

1. Internal Dispute: Submit a formal, written objection to your insurer’s complaints officer detailing exactly why you believe their decision is incorrect. They are legally required to review and respond to this.
2. External Escalation: If the insurer upholds their rejection and you remain unsatisfied, you can escalate the matter to the National Financial Ombud Scheme (NFO). The NFO provides free, independent resolution, and their final ruling is binding on the insurer.

Contact 1Life Insurance if you have any questions.

How long does a funeral insurance claim take to be paid?

A valid funeral insurance claim in South Africa is typically paid within 48 hours, provided that all the required documentation is completely and correctly submitted.

Because funeral policies are designed to cover immediate, short-term expenses, insurers prioritize rapid payouts. Delays almost always occur because of administrative errors, such as incomplete claim forms, missing signatures, or uncertified ID copies. Ensuring your document pack is perfect at the point of submission is the single best way to guarantee a 48-hour payout.

What documents are required to claim funeral cover?

To successfully claim funeral insurance, you generally need a completed claim form, the certified death certificate, certified ID copies of both the deceased and the claimant, and proof of banking details.

• Potential checklist:
• Death certificate
• Claim form
• Beneficiary ID
• Deceased ID
• Banking details
• Proof of relationship (where applicable)

Does funeral insurance cover suicide?

Funeral policies may include a suicide exclusion period. Once this period has passed, cover may apply subject to the policy terms and conditions. Always check your policy documentation for the applicable exclusion period.

Can a funeral policy claim be rejected because of how the person died?

Yes, an insurer is legally entitled to reject a funeral claim if the person died from a specific cause that is explicitly excluded in the policy contract, regardless of how long the policy has been active.

Insurance companies assess risk based on normal, lawful behavior. Therefore, they include permanent exclusions for deaths resulting from highly reckless or illegal actions. Common exclusions that will result in a rejected claim include:

• Death while actively committing or participating in a crime.
• Death resulting from driving under the influence of alcohol or drugs.
• Death caused by active participation in a riot, civil unrest, or an act of war.

Can an extended family member be covered under my funeral policy?

Yes, most funeral policies allow you to add extended family members such as parents, siblings, aunts, uncles, and cousins, provided they meet the insurer's specific qualifying criteria.

While you can consolidate your family's cover under one policy, you cannot simply add anyone. Insurers set strict definitions of what constitutes "extended family"—typically requiring a direct blood relationship or a relationship by legal marriage. If you add someone who does not meet this precise definition, you will pay premiums for them, but any future claim will be rejected. Always confirm eligibility with your insurer before adding a dependent.