An insurer may reject an accident claim, offer less than expected, or take too long to decide it. The next step should not be a vague demand for payment. Start by identifying the exact reason for the disagreement, the policy term relied on, and the documents needed to answer it. This guide explains a practical route for policyholders in Kenya.
1. Ask for the insurer’s position in writing
Write to the insurer or claims handler and ask for a clear decision. If the claim is rejected or reduced, ask it to identify the policy clause, exclusion, condition, valuation or factual issue it relies on. Keep the claim form, policy schedule, policy wording, medical or police reports, repair estimates, receipts, photographs and every email in one dated file. A disputed claim is easier to assess when the evidence and correspondence are complete.
2. Check the issue before accepting or escalating
- Coverage: Does the event fall within the insuring clause, or is an exclusion said to apply?
- Notice and documents: Was the claim notified in the required way, and has the insurer identified what is still missing?
- Liability: Is fault, causation or the identity of the insured person in dispute?
- Value: Is the disagreement about repair costs, medical evidence, market value, excess, contribution or a settlement calculation?
Do not alter documents or exaggerate a loss. The Insurance Act addresses false or misleading statements made in support of an insurance claim, so the record provided must be accurate.
3. Use the insurer’s complaint process
Ask the insurer to treat the matter as a formal complaint and give a written response. State the policy number, date of loss, amount or decision disputed, the documents enclosed and the outcome sought. This creates a record for any later regulatory complaint, negotiation, mediation or proceedings. A settlement offer should be read carefully before it is accepted, particularly where it includes a release of future claims.
4. Consider a complaint to the Insurance Regulatory Authority
The Insurance Regulatory Authority’s complaint process covers disputes involving regulated insurers and intermediaries, including disagreements over liability, settlement amounts and delay. Section 204A of the Insurance Act allows an insurance customer to lodge a written complaint with the Commissioner; a party dissatisfied with the Commissioner’s determination may appeal to the Tribunal within the statutory period. The appropriate route depends on the claim and current procedure, so check the Authority’s current requirements before filing.
5. Get advice before litigation or settlement
Mediation, a regulatory complaint, negotiation and court proceedings are different tools. The policy wording, limitation periods, evidence, value of the claim and the prospect of recovery should be considered before choosing one. Our insurance law practice advises on policy interpretation, claim disputes and settlement documentation. This article is general information, not legal advice.