Claims Complaints Procedure — X Underwriting Managers

01 — Definition

What Counts as a Claims Complaint?

A claims complaint is any expression of dissatisfaction relating to a claim — verbal or written — that has not been resolved immediately. If you are unhappy with any aspect of how your claim was handled, you have the right to lodge a formal complaint.

Claim Decision

Your claim was declined or only partially paid and you believe this is incorrect.

Claim Delay

Your claim or payment was unreasonably delayed without adequate communication.

Unfair Treatment

You were treated unfairly or the claims process was unclear, confusing or poorly administered.

Policy Terms

You believe the terms and conditions of your policy were incorrectly applied to your claim.

02 — Submission

How to Lodge Your Complaint

Complaints may be submitted by the policyholder, a beneficiary, or an authorised representative. We do not impose any unreasonable barriers to submission.

Email complaints@x-underwriting.co.za

Written Correspondence Post or hand-deliver to our registered address

Verbal Submission Recorded in writing by our Complaints Officer

Please include in your submission

Policy number

Claim number

Description of the complaint

Your desired outcome (if known)

03 — Process

What Happens Next

01

Acknowledgement

We confirm receipt of your complaint in writing within 3 business days. You will receive confirmation that your complaint is under investigation, the expected timeframe for resolution, and a reminder of your right to escalate if dissatisfied.

⏳ Within 3 business days

02

Independent Review

Your complaint is assigned to a reviewer who was not involved in the original claims assessment. They will examine the full claim file, policy terms, supporting documentation, and assess whether the claim was handled fairly. We may request additional information from you where necessary.

⏳ Fairness, objectivity & full file review

03

Resolution & Written Outcome

All outcomes are communicated to you in writing. If your complaint is upheld, any benefit due will be paid promptly and corrective steps will be implemented. If your complaint is not upheld, you will receive clear written reasons with policy terms and factual findings explained.

⏳ Full written explanation in all cases

04

Escalation (if required)

If you remain dissatisfied, you have the right to escalate your complaint to an independent regulatory body at no cost to you. Details are provided in your outcome letter, and your complaint remains open for six months after the outcome to allow for escalation.

⏳ Right to external recourse preserved

04 — Timeframes

Resolution Timeframes

3

Business Days

Written acknowledgement of your complaint issued from date of receipt.

15

Working Days

Target resolution for straightforward complaints. Progress updates provided every 15 working days where a matter is ongoing.

25

Working Days

Maximum timeframe for complex complaints requiring additional investigation. You will be kept informed throughout.

05 — Outcomes

Possible Outcomes

Complaint Upheld

The original claim decision is corrected where applicable
Any benefit due is paid without unreasonable delay
Compensation or goodwill payments are made where appropriate
Corrective actions are implemented to prevent recurrence

Complaint Not Upheld

Clear written reasons are provided for the decision
Relevant policy terms and factual findings are explained
Your right to escalate to an external body is confirmed
The complaint remains open for six months post-outcome

06 — External Recourse

Escalation Options

If you are dissatisfied with the outcome of your complaint, you have the right to refer your matter to an independent body at no cost to you. Contact details will be provided in your final response letter.

National Financial Ombud Scheme

For complaints related to the insurer — including claim decisions, payment disputes, and policy interpretation. This is an independent, free service available to policyholders.

FAIS Ombud

For complaints related to the conduct of an intermediary or financial adviser — including advice received and product recommendations. Also an independent, free service.