• By Raymond Momanyi

Insurance Claims in Kenya: Process, Documents & Help

Learn how insurance claims work in Kenya, documents required, assessment stages, excesses, settlement options, delays, declines and complaint escalation. 

An insurance policy is a promise on paper. A claim is the moment that promise is tested.

When an accident, illness, workplace injury, theft, fire, death or cargo loss occurs, customers often feel overwhelmed. They may not know whom to call, which documents to collect, what an assessor does or how long the process should take.

The first hours after a loss can shape the entire claim.

This Insurance Claims Knowledge Centre explains how insurance claims generally work in Kenya, what policyholders should do after a loss, why claims are delayed or declined and how Imana Insurance Agency Kenya Ltd assists customers through the process.

What Is an Insurance Claim?

An insurance claim is a formal request asking an insurer to provide compensation, repair, reimbursement, treatment approval or another benefit under an insurance policy.

A claim does not become payable merely because a loss occurred.

The insurer must establish that:

• The policy was active when the event happened
• The person, vehicle, property or interest was insured
• The event falls within the policy’s coverage
• The insured complied with the policy conditions
• The required documents have been provided
• No applicable exclusion prevents payment
• The claimed amount is supported
• The loss has been assessed or verified where necessary

Insurance claims should be handled promptly and fairly. Kenya’s financial consumer-protection framework requires insurers to provide reasonable guidance to customers making claims.

What Should You Do Immediately After a Loss?

Your first responsibility is safety.

Do not risk life, health or further property damage while attempting to protect a possible insurance claim.

1. Protect life and seek assistance

If anyone is injured:

• Call emergency services
• Arrange medical attention
• Move away from immediate danger
• Contact the police where necessary
• Inform the relevant employer or authority

2. Prevent further loss

Take reasonable steps to reduce additional damage.

This may include:

• Moving a vehicle away from danger where legally and safely possible
• Calling the fire brigade
• Switching off electricity after a fire or flood
• Protecting exposed stock
• Securing damaged premises
• Moving cargo away from water
• Obtaining emergency medical treatment

Do not undertake permanent repairs or dispose of damaged property before consulting the insurer unless emergency action is necessary to prevent further loss.

3. Record what happened

Collect evidence where safe and appropriate:

• Photographs
• Videos
• Names of witnesses
• Contact details
• Vehicle registration numbers
• Police details
• Location
• Date and time
• Description of events
• Receipts for emergency expenses

Write down the facts while they are still fresh.

Do not admit liability, negotiate compensation or sign an agreement with another party without guidance.

4. Notify Imana or the insurer

Report the incident as soon as possible.

You can submit a request through the Imana Insurance claims page or contact Imana through www.imanainsurance.com.

Call/WhatsApp: +254 796 209 402

How Quickly Should an Insurance Claim Be Reported?

Report the loss immediately or within the period stated in the policy.

Some policies use wording such as:

• Immediately
• As soon as reasonably possible
• Within 24 hours
• Within 48 hours
• Within seven days
• Within a specified number of days

The notification period differs according to the policy and type of loss.

Early notification allows the insurer to:

• Preserve evidence
• Appoint an investigator or assessor
• Inspect damaged property
• Approve treatment or repairs
• Recover stolen assets
• Contact third parties
• Control additional costs
• Protect recovery rights

Do not wait until every document is available before reporting.

Notify first, then ask for the complete document checklist.

General Documents Required for an Insurance Claim

Claim requirements vary, but policyholders may be asked to provide:

• Completed claim form
• Policy number or certificate
• National ID or passport
• KRA PIN
• Proof of premium payment
• Police abstract or police report
• Photographs or videos
• Witness statements
• Medical reports
• Treatment notes
• Invoices and receipts
• Repair estimates
• Valuation report
• Logbook
• Death certificate
• Burial permit
• Employer’s report
• DOSH forms
• Fire brigade report
• Stock records
• Purchase invoices
• Cargo documents
• Bill of lading
• Airway bill
• Survey report
• Correspondence relating to the incident
• Bank details for settlement

The insurer may request additional documents after reviewing the initial submission.

Providing documents does not automatically guarantee payment, but an incomplete file can bring an otherwise valid claim to a standstill.

The Insurance Claims Process in Kenya

Although products differ, most claims pass through several common stages.

Stage 1: Claim Notification

The insured informs the intermediary or insurer that an incident has occurred.

Initial information normally includes:

• Policyholder’s name
• Policy or certificate number
• Date of loss
• Location
• Nature of the incident
• People or property involved
• Immediate assistance required

The notification should be factual. If some details are unknown, state that they are still being established.

Stage 2: Claim Registration

The insurer registers the claim and may issue a claim reference number.

Keep this reference. It should appear in future emails, letters and follow-up messages.

Stage 3: Document Submission

The claimant completes the relevant form and provides supporting evidence.

Documents should be:

• Complete
• Legible
• Consistent
• Genuine
• Properly signed
• Submitted through an approved channel

Keep copies of everything submitted.

Stage 4: Assessment or Investigation

The insurer determines:

• What happened
• Whether the policy responds
• The extent of damage
• The value of the loss
• Whether another party is responsible
• Whether exclusions apply
• Whether fraud or misrepresentation is suspected
• Whether additional evidence is required

Stage 5: Decision

The insurer may:

• Approve the claim
• Approve part of the claim
• Request additional information
• Make a settlement offer
• Authorise repairs
• Provide medical pre-authorisation
• Decline the claim
• Keep the matter pending further investigation

A decline or partial settlement should be explained with reference to the policy terms and claim findings.

Stage 6: Settlement

Depending on the policy, settlement may take the form of:

• Repair
• Replacement
• Cash payment
• Medical payment
• Reimbursement
• Payment to a financier
• Payment to a beneficiary
• Liability settlement to a third party
• Reinstatement of damaged property
• Total-loss settlement

Stage 7: Recovery and Closure

After settlement, the insurer may pursue a responsible third party through subrogation.

The insurer may also take ownership of damaged property or salvage where permitted by the policy.

The claim is then closed once settlement, documentation and recovery issues are complete.

Who Is Involved in a Claim?

Several professionals may become involved. Their roles are different.

Insurance intermediary

The intermediary helps the customer:

• Notify the insurer
• Obtain the correct claim form
• Understand document requirements
• Communicate with the insurer
• Follow up on progress
• Understand policy terms
• Escalate unresolved service issues

An intermediary supports the claim but does not independently approve or pay it. The insurer remains responsible for the claim decision.

Motor assessor

A motor assessor inspects a damaged vehicle and evaluates:

• Cause and extent of damage
• Repair requirements
• Labour costs
• Parts required
• Pre-accident condition
• Vehicle value
• Possibility of repair
• Potential total loss
• Salvage value

Loss adjuster

A loss adjuster commonly handles property, fire, engineering, marine, business interruption and other complex losses.

The adjuster investigates the loss, examines documents, measures damage and makes recommendations to the insurer.

Investigator

An investigator may be appointed where facts require further verification.

Investigation does not automatically mean the claim is fraudulent. It may be required because:

• The circumstances are unclear
• Theft is involved
• Documents conflict
• A large amount is claimed
• Several parties are involved
• Liability is disputed
• The incident occurred soon after policy inception

Medical provider

A hospital, doctor or other provider supplies treatment records, medical reports and invoices. For cashless medical treatment, the provider may request pre-authorisation from the insurer or medical administrator.

Lawyer

A lawyer may become involved in:

• Third-party injury claims
• Liability disputes
• Recovery proceedings
• Court cases
• Complex policy disputes
• Claims requiring formal legal interpretation

What Is an Insurance Excess?

An excess is the portion of a covered loss that the policyholder must bear.

If an approved repair costs KSh 300,000 and an applicable excess of KSh 50,000 applies, the insurer may pay KSh 250,000 while the insured pays KSh 50,000.

The calculation depends on the policy wording.

A policy may contain:

• Basic excess
• Young-driver excess
• Inexperienced-driver excess
• Theft excess
• Windscreen excess
• Political Violence and Terrorism excess
• Voluntary excess
• Property-damage deductible

Some motor customers purchase Excess Protector, which may cover specified excesses. It does not necessarily remove every excess or policy contribution.

Check the Excess Protector wording carefully.

What Is Underinsurance?

Underinsurance occurs when property is insured below its correct value.

For example, a building worth KSh 20 million may be insured for only KSh 10 million. The property is therefore insured for half its value.

If a partial loss occurs, the insurer may apply the average clause and reduce the payment proportionately.

Using the simplified example, a KSh 4 million loss might produce an assessed settlement of approximately KSh 2 million before any excess or other adjustment.

The exact calculation depends on the policy.

Underinsurance can affect:

• Buildings
• Stock
• Machinery
• Household contents
• Commercial assets
• Motor vehicles
• Marine cargo
• Business interruption

Reducing the declared value to save premium can produce a much larger financial loss during a claim.

What Is the Average Clause?

The average clause allows an insurer to reduce a claim where the insured property’s declared value is below its actual value.

A simplified formula is:

Claim payment = insured value ÷ actual value × assessed loss

Other deductions, excesses and conditions may still apply.

Maintain updated valuations and review sums insured at every renewal.

Repair Versus Cash Settlement

An insurer may authorise repairs or offer a cash settlement, depending on:

• Type of policy
• Nature of damage
• Repairability
• Approved quotations
• Assessor’s report
• Parts availability
• Policy limit
• Insurer’s claims procedure
• Agreement with the insured
• Financier requirements

Repair settlement

The insurer authorises an approved repairer to restore damaged property or a vehicle.

Cash-in-lieu settlement

The insurer offers money instead of arranging repairs.

Before accepting, confirm:

• Whether the amount includes taxes
• Whether labour and parts are fully included
• What excess has been deducted
• Whether accepting the payment closes the claim
• Whether further damage discovered later can be considered
• Whether a financier must approve

Do not accept a cash settlement without understanding what it represents.

What Is a Total-Loss Settlement?

A total loss may be declared when:

• The property is destroyed
• The vehicle cannot reasonably be repaired
• Repair costs approach or exceed the applicable economic threshold
• The insured property is stolen and not recovered
• Recovery or repair is not commercially reasonable

A motor total-loss settlement may consider:

• Vehicle’s pre-accident market value
• Insured value
• Valuation report
• Policy limit
• Underinsurance
• Applicable excess
• Salvage
• Financier’s interest
• Outstanding premium
• Ownership documents

The sum insured is not always an automatic guaranteed payout. The settlement depends on the policy basis and supported value at the time of loss.

How Long Does an Insurance Claim Take?

There is no honest universal answer.

Claim duration depends on:

• Type of insurance
• Complexity of the incident
• Completeness of documents
• Whether liability is disputed
• Whether investigations are necessary
• Availability of repair parts
• Medical reports
• Police documents
• Court proceedings
• Third-party involvement
• Fraud concerns
• Reinsurance involvement
• Acceptance of the settlement offer

A straightforward windscreen, medical reimbursement or funeral claim may be processed faster than a theft, fatal accident, major fire, liability or business-interruption claim.

Kenyan insurance law and claims-management requirements establish obligations concerning claims handling and settlement, but the applicable period can depend on the claim class, investigation and completeness of the file.

Do not measure the timeline only from the accident date. Record:

• Date of notification
• Date the insurer acknowledged the claim
• Date each document was submitted
• Date the assessor was appointed
• Date the investigation began
• Date additional information was requested
• Date the complete file was confirmed
• Date an offer or decision was issued

Why Are Insurance Claims Delayed?

Common causes include:

• Late notification
• Incomplete claim forms
• Missing documents
• Inconsistent information
• Delayed police abstract
• Delayed medical reports
• Missing ownership documents
• Unclear cause of loss
• Disputed liability
• Pending assessment
• Investigation
• Repair-parts delays
• Underinsurance
• Unpaid premium
• Financier approval
• Beneficiary disputes
• Fraud concerns
• Large or technically complex losses
• Failure to respond to questions
• Court or third-party proceedings

Read Imana’s existing guide: Why Insurance Claims Are Delayed or Declined in Kenya.

Why Are Insurance Claims Declined?

A claim may be declined where:

• The policy had expired
• The loss happened before cover commenced
• Premium requirements were not met
• The event is excluded
• The asset or person was not insured
• The vehicle was used for an undisclosed purpose
• Material information was not disclosed
• Policy conditions were breached
• The claim was fraudulent
• Documents were falsified
• The claimant had no insurable interest
• The loss was deliberate
• The cause of loss is not covered
• The claim falls outside the geographical area
• The waiting period had not ended
• The claim exceeds an exhausted benefit
• An unauthorised driver was involved
• The insured failed to cooperate with reasonable investigations

A declined claim should not be treated casually. Ask for the decision and reasons in writing.

What Should You Do If a Claim Is Declined?

1. Obtain the decision in writing

Ask for:

• Reason for declinature
• Policy clause relied upon
• Relevant investigation findings
• Outstanding documents
• Internal review process

2. Review the policy

Check:

• Policy schedule
• Certificate
• Endorsements
• Exclusions
• Warranties
• Premium status
• Proposal form
• Correspondence
• Claim documents

3. Correct factual or documentary gaps

A decision may sometimes be reconsidered when missing or incorrect information is resolved.

Provide additional evidence in a clear, organised manner.

4. Submit a formal complaint to the insurer

State:

• Claim reference
• Policy number
• Chronology
• Disputed decision
• Supporting evidence
• Outcome requested

Keep proof of submission.

5. Seek assistance from the intermediary

Imana can help review the communication, organise supporting documents and present the customer’s concerns to the insurer.

The intermediary cannot guarantee reversal, but it can help ensure the complaint is clearly and professionally presented.

6. Escalate an unresolved complaint

If the matter remains unresolved after using the insurer’s complaint process, the customer may approach the Insurance Regulatory Authority of Kenya.

IRA provides consumer-complaint information and accepts complaints involving issues such as claim delays and claim denials.

Customers should use the latest contacts and complaint channels published on the official

Complex disputes may require independent legal advice.

How Imana Insurance Assists During Claims

Imana Insurance Agency Kenya Ltd supports clients by:

• Receiving initial loss notifications
• Providing the correct claim form
• Explaining required documents
• Helping organise the claim file
• Submitting documents to the insurer
• Following up on acknowledgements
• Coordinating assessment appointments
• Requesting progress updates
• Explaining excesses and policy conditions
• Helping clients understand settlement offers
• Escalating unresolved service concerns
• Guiding customers through insurer complaint channels
• Supporting communication until the claim is concluded

Imana does not manufacture evidence, determine liability or force an insurer to pay an uncovered claim.

The goal is to help customers present complete, accurate and properly documented claims while ensuring communication does not disappear into silence.

Product-Specific Claims Guides

This Claims Knowledge Centre connects to the following insurance areas.

Motor Insurance Claims

Motor claims can involve accidental damage, theft, windscreens, third-party liability, towing, total loss and recovery.

Explore Motor Insurance in Kenya or submit a claim request.

WIBA Claims

WIBA claims may involve workplace injuries, occupational illnesses, temporary incapacity, permanent incapacity, medical expenses or death.

Explore WIBA Insurance.

Medical Insurance Claims

Medical claims can involve pre-authorisation, cashless treatment, reimbursement, waiting periods, hospital networks and benefit limits.

Explore Health Insurance in Kenya and Imana Health.

PSV Insurance Claims

PSV claims may involve the insured vehicle, passengers, third parties, property damage, loss of use and vehicle recovery.

Explore PSV Insurance in Kenya.

Motorcycle Insurance Claims

Motorcycle claims can involve accident damage, theft, rider injury, passenger liability and third-party claims.

Explore Motorcycle Insurance.

Travel Insurance Claims

Travel claims may involve emergency medical treatment, baggage, cancellation, curtailment, evacuation, delay or loss of travel documents.

Explore Travel Insurance.

Marine and Cargo Claims

Marine claims may require immediate notice to carriers, cargo surveys, shipping documents, invoices and steps to preserve recovery rights.

Explore Marine Insurance.

Last Expense Claims

Funeral claims commonly require a claim form, identification documents, burial permit, death certificate and additional evidence depending on the cause of death.

Explore Last Expense Insurance.

Corporate and Liability Claims

Corporate claims may involve fire, burglary, public liability, Professional Indemnity, machinery, cyber incidents, money, fidelity or business interruption.

Explore Corporate Insurance.

Frequently Asked Questions

Should I report an incident even when I am unsure whether it is covered?

Yes. Report it promptly and allow the insurer to review the circumstances and policy.

Can I repair my vehicle before assessment?

Do not begin permanent repairs without insurer approval unless urgent action is necessary to prevent further loss. Unauthorised repairs can interfere with assessment.

Does reporting a claim mean it will automatically be paid?

No. The insurer must establish that the policy responds and that all conditions have been satisfied.

Who approves an insurance claim?

The insurer approves or declines the claim. An intermediary, assessor, investigator or loss adjuster may provide support or recommendations but does not replace the insurer’s decision-making role.

Can Imana guarantee payment?

No responsible intermediary should guarantee settlement before the insurer completes its assessment. Imana can help customers submit, document, follow up and escalate claims.

What happens if documents are missing?

Notify the insurer immediately and explain the situation. Ask whether alternative evidence can be accepted. Do not create or alter documents.

Can an insurer deduct an excess?

Yes, where the policy provides for an applicable excess or deductible.

Is the sum insured always the amount paid?

Not necessarily. Settlement may depend on the actual loss, market value, underinsurance, policy limit, excess and other conditions.

Can a declined claim be reviewed?

Yes. Request the reasons in writing, provide supporting evidence and follow the insurer’s internal complaint process. An unresolved complaint may be escalated to IRA.

Where can I request claims assistance?

Submit the Imana claims request form, visit www.imanainsurance.com or WhatsApp +254 796 209 402.

Request Insurance Claims Support

Imana Insurance Agency Kenya Ltd is a Westlands-based insurance intermediary helping individuals, families and businesses compare insurance quotations from licensed Kenyan insurers across Motor, Medical, WIBA, PSV, Travel, Motorcycle, Cyber, SME, Corporate and other insurance classes.

Whether the issue involves a vehicle, hospital admission, workplace injury, damaged cargo, funeral benefit or business loss, early notification and complete documentation can make the process smoother.

Contact Imana Insurance Agency Kenya Ltd

Office: 4th Floor, Krishna Centre, Woodvale Grove, Westlands, Nairobi
Call/WhatsApp: +254 796 209 402
Email: insurance@imana.co.ke
Claims request: https://imana.co.ke/claims-request
Quotation comparison: https://imanainsurance.com
Insurance authority platform: https://imana.co.ke
Travel and insurance: https://mykava.co.ke

Compare. Buy. Save. Claim with guidance.

About the Author

Raymond Momanyi is the Founder and CEO of Imana Insurance Agency Kenya Ltd. His areas of expertise include motor insurance, medical insurance, WIBA, PSV insurance comparison, claims support and business risk.

Disclaimer: This guide provides general insurance information and does not replace the wording of an individual policy, professional legal advice or a formal claim decision. Claims are assessed by the issuing insurer according to the policy, evidence, applicable law and circumstances of the loss.