Receiving a repudiation letter on a claim you have paid premiums on for years is jarring. Kenyan policyholders have real rights, but they are time-sensitive and evidence-dependent. Here is the framework an advocate in our insurance practice applies when reviewing a contested claim.
On what grounds can an insurer decline a claim?
The common grounds are non-disclosure or misrepresentation at proposal stage, breach of policy conditions (for example late notification), exclusion clauses, and disputes over causation or valuation. The insurer bears the burden of establishing the ground it invokes, and Kenyan courts scrutinise exclusion clauses strictly, construing ambiguity against the insurer.
That burden is not theoretical. In Masari Distributors Limited v UAP Provincial Insurance Company Limited [2019] KECA 95 (KLR), the Court of Appeal upheld a repudiation based on an express exclusion for mechanical breakdown, while noting that an insurer must prove that the exemption it relies on applies.
What should a policyholder do first?
- Obtain the written grounds of repudiation, not a verbal explanation
- Re-read the proposal form and policy schedule against those grounds
- Preserve all correspondence, survey reports, and claim documentation
- Diary the limitation position, six years for contract claims, but contractual notification windows are far shorter
Which forum hears insurance disputes in Kenya?
Insurance disputes are litigated in the High Court and subordinate courts, with regulatory complaints possible through the Insurance Regulatory Authority for certain matters. Where the policy contains an arbitration clause, that route governs. Our Nairobi insurance law practice advises both policyholders and insurers on contested claims.
What a repudiation letter does and does not mean
A repudiation letter is the insurer’s stated position, not a final judgment. It may be based on a policy condition, an exclusion, an alleged non-disclosure or a dispute about causation or quantum. Read it against the policy schedule and the proposal form. Check whether the insurer has reserved its rights, whether it has asked for further information, and whether the letter identifies the precise clause relied on.
A general assertion that the claim is “not covered” is not enough. The insurer should identify the provision and explain why the facts fall within it. If the letter is vague, ask for the basis in writing. Keep the request factual and preserve the response.
The policy, the proposal and the claim record
Insurance disputes turn on documents. The proposal form records what was disclosed at inception. The policy schedule and wording define the cover, conditions, exclusions and notification obligations. The claim file shows what was reported, when, to whom, and what evidence was provided.
Common grounds for decline include:
- alleged non-disclosure or misrepresentation at proposal stage;
- breach of a policy condition, such as late notification or failure to cooperate;
- an exclusion clause said to apply to the loss;
- a dispute about causation, ownership, valuation or the amount claimed;
- an allegation that the loss was caused deliberately or by an excluded peril.
The policy wording governs, but an ambiguous exclusion is generally read against the party that drafted it. The insurer still has to prove the facts on which it relies. A policyholder should not assume that a decline is correct simply because it is in writing, and should not assume that a court will rewrite a clear condition.
Where the insurer relies on causation, test the chain between the excluded peril and the loss. A mechanical failure that causes a collision raises a different question from a loss caused by the failure itself, and the wording and the evidence must be read together. Where the dispute is about valuation, obtain an independent assessment and keep the original purchase, repair and replacement documents.
What to assemble
- The complete policy, schedule, endorsements and proposal form.
- The repudiation letter and all correspondence with the insurer, broker or agent.
- The claim form, supporting documents, photographs, reports, receipts and valuations.
- Evidence of premium payment and any renewal or variation.
- A chronology of the loss, the notification and the insurer’s responses.
- Any surveyor, loss adjuster or expert report obtained by either side.
Where the proposal was completed by a broker or agent, obtain the intermediary’s file as well. It may show what was disclosed, what was asked and what was explained, and that record often decides a non-disclosure dispute.
Complaint, mediation or court
Some policyholders can complain to the Insurance Regulatory Authority about market conduct, but a regulatory complaint is not a substitute for a civil claim and does not stop time running. Mediation may be appropriate where the dispute is about quantum or where the parties want to preserve the relationship. Court proceedings may be needed where the policy is disputed, the insurer has denied cover, or a declaration or payment is required.
The contract limitation period is generally six years, but policy notification conditions and complaint or arbitration clauses can impose much shorter practical deadlines. The first step is to diary the dates and take advice before corresponding further with the insurer.
Practical checklist
- Do not accept a verbal decline; ask for the grounds and the clause relied on.
- Check the policy schedule against the proposal form before responding.
- Preserve the claim file and do not alter documents.
- Check notification deadlines and any complaint or arbitration clause.
- Consider whether another insurer, broker or intermediary is responsible.
- Take advice before signing a release, settlement or discharge.
Our Nairobi insurance law practice advises policyholders and insurers on contested claims, coverage and recovery. Contact us for a confidential review of your repudiation letter.
Primary sources: Insurance Act (Cap 487); Insurance Regulatory Authority; Limitation of Actions Act (Cap 22); Masari Distributors Limited v UAP Provincial Insurance Company Limited [2019] KECA 95 (KLR). This article is general information, not legal advice.
