How to Claim on an Insurance Policy in Kenya (and Why Claims Get Declined)

An insurance policy is a promise to pay in defined circumstances. The circumstances are defined in a document almost nobody reads until the day they need it, which is the worst possible day to discover what it says.

This guide covers what to do when you need to claim, and — more usefully — the reasons claims are declined, most of which are decided long before the loss happens.

Why claims get declined

Very few claims fail because an insurer simply refused to pay. They fail for reasons that were built in earlier.

Non-disclosure at application. Insurance is a contract of utmost good faith. If you did not disclose something material when you applied — a medical condition, a previous claim, the real use of a vehicle, a prior refusal of cover — the insurer may treat the contract as invalid. This is the single biggest cause of catastrophic claim failure, and it is entirely avoidable: answer every question completely and truthfully, even where the honest answer raises your premium. A higher premium on a policy that pays beats a cheaper one that does not.

The premium lapsed. Cover stops when payment stops. Many people discover a policy lapsed months earlier because a standing order failed silently.

Late notification. Policies impose notification deadlines. They vary by insurer and product, so the only reliable instruction is to check your own wording — and in practice, to notify immediately regardless.

The peril was excluded. Every policy has exclusions. Political violence and terrorism, for example, is commonly excluded from base cover and offered as an extension. An excluded event is not a dispute; it is simply outside the contract.

Use outside the policy terms. The clearest motor example: carrying fare-paying passengers on a private policy. See comprehensive vs third party.

Under-insurance. If the sum insured is below the true value, you may be underpaid — and where a policy applies average, partial claims can be scaled down proportionately too.

No evidence. No receipts, no photographs, no police abstract, no serial numbers. The insurer is not obliged to take your word for what you owned.

Before anything happens: the five-minute audit

Do this now, not after a loss:

1. Find your policy documents and put a copy where you can reach them from your phone.
2. Confirm the premiums are actually being paid — check the last debit, not your memory.
3. Read the exclusions. Just the exclusions. It is the shortest, highest-value section in the document.
4. Check the sums insured are still realistic. Values drift; policies do not update themselves.
5. Confirm your beneficiary nominations on life cover are current after any marriage, birth or bereavement — see life insurance in Kenya.
6. Tell someone the policies exist. A policy your family cannot find does not pay.

When something happens

Make people safe first. Every other step waits.

Notify the insurer immediately, and in writing as well as by phone. Do not wait until you know the full extent of the loss — an early notification with incomplete detail is far better than a complete one filed late.

Get a police abstract (OB number) for theft, accidents, and anything with a criminal element. Insurers generally require it and obtaining one later is harder.

Photograph and document everything before anything is moved, cleaned or repaired. Wide shots and close shots. This is the evidence you cannot recreate.

Do not admit liability at the scene of an accident. State facts; leave conclusions to the insurers. Admitting fault can prejudice your own claim.

Do not start repairs before the insurer authorises them, and use an approved repairer where the policy requires one. Repairing first and claiming later is a common and expensive mistake — you have destroyed the evidence of the damage you are claiming for.

Complete the claim form fully and accurately. Inconsistencies between your form, your statement and the evidence are what turn a routine claim into an investigated one.

Keep a claim diary — dates, names, reference numbers, what was said. When a claim drags, this record is what moves it.

What happens next

For anything beyond a small claim, expect an assessor or loss adjuster. Their job is to establish what happened and what it costs. Cooperate fully, be consistent, and provide what is asked promptly — most claim delays are waiting on the claimant, not the insurer.

You will then receive a settlement decision. If an offer is lower than you expected, ask in writing how it was calculated. Frequently the gap is explained by the excess, by depreciation applied to replaced items, or by a sum insured that was too low. Sometimes it is a genuine error, and a specific, documented challenge is what corrects it.

If your claim is declined

Being declined is not the end of the process.

1. Ask for the decline in writing, with reasons and the specific policy clause relied on. Insist on the clause. A decline that cannot point to a clause is a decline worth challenging.
2. Read that clause against your own documents. Sometimes the insurer has the facts wrong; sometimes you will find they are right and you can stop spending energy.
3. Use the insurer's internal complaints process, in writing, attaching your evidence.
4. Escalate to the Insurance Regulatory Authority. The IRA regulates insurers and is the route for a complaint you cannot resolve directly.
5. Take legal advice for large claims, where the amount justifies it.

Throughout, keep everything in writing. A claim conducted by phone leaves you with nothing to escalate.

If your insurer collapses

This is the part most Kenyan insurance guides omit entirely, and it matters.

Kenya has a Policyholders Compensation Fund — a state corporation established in 2004 under the National Treasury, created after several insurer collapses in the years before 2005. Its stated purpose is providing compensation to claimants of an insurer that has been put under Statutory Management.

So an insurer failing does not automatically mean claimants get nothing. But two things are essential to understand:

You must act. The PCF's own material refers to compensation periods that have lapsed for claimants of a collapsed insurer. A compensation window can close. Waiting to see what happens is how eligible claimants end up with nothing.

Check the current position directly. Compensation arrangements and any limits are matters for the PCF and are not stated here. If your insurer is placed under statutory management, contact the PCF and the IRA promptly rather than relying on anything you read online.

The practical implication for choosing insurance: verify an insurer is licensed by the IRA before you buy. Price is a poor reason to choose an insurer whose ability to pay you have not considered.

The documents to keep, and for how long

Claims are won on paperwork, and the paperwork you need is almost always something you had at the time and did not keep.

Keep permanently, or for as long as you hold the policy:

• The policy schedule and full wording — not just the certificate. The wording is the contract; the certificate is only proof it exists.
• Every renewal notice, which is where terms quietly change between years.
• Premium payment evidence. A lapsed-premium dispute is settled by your bank statement, not by your recollection.
• Beneficiary nominations and any updates to them.

Keep for anything you might claim on:

• Receipts and proof of ownership for insured items, plus serial numbers for electronics. Photograph receipts when you get them — thermal paper fades to blank within a couple of years, which is precisely how long it takes for a claim to arise.
• Photographs of the property or vehicle in good condition. Evidence of what you had before the loss is impossible to create afterwards.
• Valuation reports, and the dates they were done.
• Any correspondence where the insurer confirmed cover, an extension or a pre-authorisation.

Keep for a live or recent claim:

• The claim form you submitted, the police abstract, the assessor's details, every reference number, and a dated note of every conversation.

Store copies somewhere that survives the loss itself. A household fire that destroys the documents proving what was in the house is a genuine, recurring problem — which is the entire argument for keeping a copy in email or cloud storage rather than only in a file at home.

A note on health cover

Health claims have their own rhythm — pre-authorisation for planned procedures, provider networks, waiting periods for pre-existing conditions, and annual limits that reset. Two habits prevent most disputes:

• Get pre-authorisation in writing for anything planned, and keep it.
• Confirm the provider is in-network before treatment, not after.

How private cover interacts with the statutory scheme is covered in SHA health insurance explained.

Frequently asked questions

Why was my insurance claim declined in Kenya? Most commonly: something material was not disclosed at application, the premium had lapsed, the claim was notified late, the event was excluded, or the loss could not be evidenced. Ask for the decline in writing with the specific clause relied on.

How long do I have to report a claim? Your policy sets the deadline and it varies by insurer and product — check your wording. In practice, notify immediately; there is no advantage in waiting.

Do I need a police abstract to claim? For theft, accidents and anything with a criminal element, generally yes. Obtain it as soon as possible.

Can I repair my car before the insurer sees it? Generally no. Repairing before authorisation can compromise your claim, and many policies require an approved repairer.

What can I do if I disagree with the settlement offer? Ask in writing how it was calculated, then use the insurer's internal complaints process, and escalate to the Insurance Regulatory Authority if it remains unresolved.

What happens if my insurer collapses? Kenya's Policyholders Compensation Fund exists to compensate claimants of an insurer placed under statutory management. Act promptly — compensation windows can lapse — and confirm the current position with the PCF and the IRA.

Does telling the truth on my application raise my premium? Sometimes, and it is still the right decision. A policy that pays at a higher premium is worth more than a cheaper one voided for non-disclosure.

Reviewed 29 August 2026. The Policyholders Compensation Fund's mandate is quoted from its own published material. Claim notification deadlines, exclusions and settlement terms are policy-specific — read your wording. Confirm any insurer is licensed with the Insurance Regulatory Authority. General information, not insurance or legal advice.