• By Raymond Momanyi

Why Insurance Claims Are Delayed or Declined in Kenya

Learn why insurance claims are delayed or declined in Kenya, the documents insurers require, common policy breaches, how to follow up and when to complain to the Insurance Regulatory Authority.

Why Do Some Insurance Claims Take So Long?

Insurance is purchased with the expectation that financial support will be available when a covered loss occurs.

However, after an accident, illness, fire, theft or other incident, the policyholder may discover that the claim cannot be paid immediately.

The insurer may request additional documents, appoint an assessor, investigate the circumstances or question whether the loss falls within the policy.

Some delays are caused by legitimate verification requirements. Others arise from incomplete documents, communication failures or administrative inefficiency.

A claim may ultimately be declined where the insurer determines that:

• The event was not covered
• An exclusion applies
• The policy was inactive
• Material information was withheld
• A policy condition was breached
• The claimant did not prove the loss
• The insured activity differed from what was declared
• The claim involved fraud or deliberate misrepresentation

The Insurance Regulatory Authority recognises claim delays, claim denials, liability disputes and disagreements over settlement amounts as matters that insurance consumers may raise through its complaints process.

A delayed claim has not necessarily been rejected. A declined claim is one where the insurer has formally decided that it is not liable—or is not liable for part of the loss.

The Difference Between a Delayed and Declined Claim

A delayed claim

A claim is delayed when it remains under assessment or cannot progress because something is outstanding.

Possible causes include:

• Missing documents
• Incomplete claim form
• Pending police investigation
• Delayed medical report
• Vehicle or property assessment
• Disputed liability
• Missing repair quotations
• Unconfirmed ownership
• Additional fraud checks
• Court proceedings
• Slow internal processing

A delay may end when the required information is supplied or the investigation is completed.

A declined claim

A claim is declined when the insurer formally rejects responsibility for the loss.

The insurer should provide a written explanation identifying:

• The reason for rejection
• The relevant policy condition
• The applicable exclusion
• Material evidence considered
• Available review or complaints procedure

A policyholder who disagrees can ask the insurer to reconsider the decision and may later escalate the dispute.

What Does Kenyan Law Say About Claims Settlement?

Section 203 of Kenya’s Insurance Act provides that, once the claimant has submitted all relevant documents, an insurer should admit or deny liability, determine the amount due, establish the claimant’s identity and pay the claim within 90 days from reporting—or within 90 days of a court determination where liability depends on a court decision.

Where the insurer cannot pay within that period, it may apply to the Insurance Commissioner for an extension of up to 30 days. The law also provides for a penalty where an amount that is due remains unpaid after the prescribed period.

The phrase “where the claimant has submitted all the relevant documents” is important.

The 90-day period should not be interpreted as meaning that every claim must be settled within 90 days regardless of:

• Missing documents
• Unresolved liability
• Suspected fraud
• Court proceedings
• Medical assessments
• Lack of proof of loss

The insurer must still handle claims promptly and fairly and provide reasonable guidance to help consumers make claims. Kenya’s financial consumer-protection framework expressly identifies prompt and fair claims handling as an insurer responsibility.

Common Reasons Insurance Claims Are Delayed

1. Incomplete Claim Documents

This is one of the most common causes of delay.

An insurer cannot properly assess a claim when essential evidence is missing.

Depending on the policy, required documents may include:

• Completed claim form
• Policy schedule
• National ID or passport
• KRA PIN
• Police abstract
• Medical reports
• Treatment invoices
• Repair estimates
• Photographs
• Proof of ownership
• Logbook
• Death certificate
• Post-mortem report
• Witness statements
• Incident report
• Business financial records

Submitting some documents does not necessarily mean the file is complete.

Ask the insurer for a written checklist showing:

• Documents received
• Documents outstanding
• Whether any submitted document is incomplete
• What action is required next

2. Incorrect or Inconsistent Information

A claim may be delayed where information in different documents does not agree.

Examples include:

• Different accident dates
• Different descriptions of how the incident happened
• Registration number mismatch
• Incorrect claimant name
• Different medical histories
• Conflicting police and claim-form statements
• Incorrect policy number
• Vehicle ownership mismatch

Incorrect customer-identification information can create policy errors, repeated information requests and claim delays. The Association of Kenya Insurers has highlighted the importance of accurate and standardised customer information in reducing claims-processing problems.

Review every form before signing.

Where an error is discovered, correct it openly rather than trying to hide it.

3. Late Notification

Most policies require the insured to report a loss promptly or within a stated period.

Late reporting can make it difficult for the insurer to:

• Inspect the scene
• Assess damaged property
• Interview witnesses
• Trace stolen items
• Verify treatment
• Investigate liability
• Protect recovery rights

A minor incident can later become a substantial claim.

It is therefore advisable to notify the insurer even when:

• The full cost is not yet known
• A third party has not made a formal demand
• The vehicle appears repairable
• The injured person initially says they are fine
• Police investigations are continuing

Notification does not automatically mean the insured must proceed with the claim.

4. The Insurer Is Waiting for an Assessment

Insurers commonly appoint professionals such as:

• Motor assessors
• Loss adjusters
• Engineers
• Medical examiners
• Investigators
• Quantity surveyors
• Marine surveyors
• Forensic accountants

The assessor may need to determine:

• Cause of loss
• Extent of damage
• Repair cost
• Replacement cost
• Pre-existing damage
• Underinsurance
• Liability
• Salvage value
• Whether the damage matches the reported event

Kenya’s Insurance Act provides that where a claim assessment has been carried out, a copy of the assessment report should be made available to the claimant.

Where assessment is taking too long, ask:

• Has an assessor been appointed?
• When was the inspection done?
• Has the report been submitted?
• Is further information required?
• Can I receive a copy of the assessment report?

5. Police Investigations Are Incomplete

Police records may be needed for claims involving:

• Road accidents
• Theft
• Robbery
• Malicious damage
• Death
• Serious injury
• Fraud
• Fire suspected to involve criminal activity

A police abstract confirms that the incident was reported, but it does not necessarily establish legal liability.

The insurer may also require:

• Police investigation report
• Occurrence Book reference
• Charge sheet
• Court outcome
• Statement from investigating officers
• Recovery report

A claim may remain pending where the cause of loss or responsibility is unresolved.

6. Liability Is Disputed

This is common in third-party motor and public-liability claims.

The insurer may dispute:

• Who caused the accident
• Whether the insured was negligent
• Whether the claimant contributed to the loss
• Whether the amount demanded is reasonable
• Whether the insured person was involved
• Whether the policy covered the person responsible

Evidence may include:

• Police records
• Witness statements
• CCTV
• Photographs
• Vehicle-damage patterns
• Expert reports
• Court proceedings

Where liability must be determined by a court, the statutory settlement period may run from the court’s determination rather than the original incident date.

7. Repair Quotations or Spare Parts Are Delayed

A motor claim can remain open because:

• The garage has not supplied a quotation
• The assessor has not agreed on labour costs
• Spare parts are unavailable
• Parts must be imported
• The repair method is disputed
• Additional damage is discovered after dismantling
• The vehicle requires specialist calibration

A delay in physical repair is not always the same as a delay in the insurer’s claim decision.

Ask separately:

• Has liability been accepted?
• Have repairs been authorised?
• Is the garage waiting for parts?
• Who is responsible for sourcing the parts?
• Is a cash settlement available?
• What portion of the repair is not covered?

8. Medical Evidence Is Incomplete

Medical claims may require:

• Diagnosis
• Treatment notes
• Discharge summary
• Medical invoices
• Specialist report
• Disability assessment
• Laboratory results
• Proof of pre-authorisation
• Evidence that waiting periods had ended

WIBA, personal accident, medical and life claims may also require evidence showing the connection between:

• The accident and the injury
• The workplace and the occupational disease
• The diagnosis and the claimed disability
• The death and the insured event

The insurer may request an independent medical examination where permitted.

9. The Insurer Is Investigating Possible Fraud

Insurance fraud can involve:

• Staged accidents
• Inflated repair estimates
• False medical bills
• Invented theft
• Altered documents
• Duplicate claims
• Non-existent property
• Deliberately damaged assets
• False identities
• Backdated losses

Where legitimate concerns arise, an insurer may conduct additional investigations.

However, “investigation” should not become an indefinite explanation. The claimant should request written confirmation of:

• The issue being investigated
• Information required from the claimant
• Whether the investigation is still active
• The next review date

10. Third Parties Are Slow to Respond

Claims sometimes depend on information from:

• Hospitals
• Garages
• Police
• Employers
• Banks
• Asset financiers
• Other insurers
• Government departments
• Transporters
• Witnesses
• Courts

The claimant should follow up with both the insurer and the external party instead of assuming that each side is communicating efficiently.

11. Ownership Has Not Been Proved

The insurer must establish that the claimant had an insurable interest in the damaged or lost property.

Proof may include:

• Logbook
• Purchase receipt
• Sale agreement
• Import documents
• Asset register
• Lease agreement
• Title documents
• Financing documents
• Stock records

Informal ownership arrangements can complicate claims.

For example, a motor vehicle may be:

• Registered in a former owner’s name
• Financed by a bank
• Used by a company
• Insured in an individual’s name
• Subject to an incomplete transfer

These details should be corrected before a claim occurs.

12. The Claim Amount Is Disputed

The insurer and claimant may disagree about:

• Vehicle market value
• Building replacement cost
• Repair cost
• Medical expenses
• Lost income
• Disability percentage
• Depreciation
• Salvage
• Betterment
• Policy excess
• Underinsurance

The claimant should ask for a written calculation showing:

• Assessed loss
• Deductions
• Excess
• Depreciation
• Average or underinsurance adjustment
• Salvage deduction
• Final offer

Disagreements over the amount offered are among the complaints the IRA’s consumer-protection process handles.

Common Reasons Insurance Claims Are Declined

1. The Policy Had Expired

Insurance ordinarily responds only to incidents occurring within the active policy period.

A claim may be rejected where:

• The renewal was not completed
• Payment was made after the accident
• The certificate had expired
• A policy was cancelled
• The cover had not yet started

Always confirm:

• Effective date
• Expiry date
• Payment status
• Certificate status
• Policy schedule

2. The Premium Was Not Properly Paid

Cover may be affected where the required premium was not received according to the insurer’s terms.

Common problems include:

• Payment to an unauthorised person
• Reversed mobile payment
• Dishonoured cheque
• Instalment default
• Unverified receipt
• Incorrect payment reference
• Fraudulent intermediary

Keep an official receipt and confirmation from the underwriting insurer or licensed intermediary.

3. The Event Is Excluded

Every insurance policy contains exclusions.

Common examples include:

• Wear and tear
• Mechanical breakdown
• Gradual deterioration
• Deliberate damage
• War
• Fraud
• Illegal activity
• Poor maintenance
• Existing damage
• Undeclared business activity
• Treatment during a waiting period

An insurer should identify the precise exclusion relied on when declining a claim.

4. The Loss Falls Outside the Policy Scope

A policy covers specific risks—not every financial problem.

Examples include:

• Third-Party Motor Insurance being used to claim for damage to the insured’s own vehicle
• Fire Insurance being used for theft
• GPA being used for ordinary illness
• Public Liability being used for professional negligence
• Property Insurance being used for cyber loss
• WIBA being used for an accident unrelated to employment

The policyholder should confirm the insurance class and benefit before expecting payment.

5. Material Information Was Not Disclosed

Insurance depends on accurate disclosure.

A claim may be declined where the insured failed to disclose information that would have influenced the insurer’s decision.

Examples include:

• Previous claims
• Existing medical conditions
• Commercial vehicle use
• High-risk occupation
• Property used as an Airbnb
• Hazardous business activities
• Poor security
• Modified vehicle
• Previous damage
• Change of ownership

The importance of the undisclosed fact depends on the policy, applicable law and circumstances.

6. The Insured Risk Was Used Differently From What Was Declared

Examples include:

• Private car being used as a taxi
• Personal vehicle being used for commercial delivery
• Residential property being operated as a hotel
• Office premises being converted into a workshop
• Machinery being hired out without disclosure
• Goods being transported outside the approved territory

Notify the insurer whenever use changes.

7. A Policy Condition or Warranty Was Breached

A policy may require the insured to maintain specific safeguards.

Examples include:

• Functional alarm
• Approved safe
• Security guard
• Vehicle tracker
• Fire extinguishers
• Qualified machine operator
• Valid driving licence
• Approved storage facility
• Maintenance programme

The effect of a breach depends on the wording and its relevance to the loss.

Read warranties carefully before accepting a policy.

8. The Driver Was Not Properly Licensed or Authorised

A motor claim may be affected where the driver:

• Had no valid licence
• Held the wrong licence class
• Was below the permitted age
• Was excluded from the policy
• Used the vehicle without authority
• Was driving outside declared use

Vehicle owners should verify driver qualifications before handing over the vehicle.

9. The Claim Was Fraudulent or Exaggerated

An otherwise genuine claim can be endangered by exaggeration.

Examples include adding:

• Earlier vehicle damage
• Property that was not stolen
• Inflated treatment bills
• False lost income
• Unrelated repairs
• Invented items

Claim only for the actual insured loss and provide genuine documents.

10. The Claimant Failed to Prove the Loss

The policyholder must provide evidence that:

• The event happened
• The insured property existed
• They owned or had an interest in it
• The property was damaged or lost
• The amount claimed is reasonable

Poor documentation can prevent payment even where the claimant believes the loss is genuine.

Maintain:

• Receipts
• Photographs
• Asset registers
• Serial numbers
• Valuations
• Maintenance records
• Contracts
• Financial statements

11. The Damage Was Pre-Existing

Insurance does not normally repair damage that existed before cover started.

Insurers may compare:

• Pre-insurance photographs
• Inspection reports
• Valuation reports
• Previous claims
• Maintenance records
• Assessor findings

Pre-existing damage should be documented when the policy begins.

12. A Waiting Period Had Not Ended

Medical and other insurance policies may impose waiting periods for:

• Illness
• Maternity
• Surgery
• Chronic conditions
• Pre-existing conditions
• Cancer
• Dental treatment
• Certain life benefits

The policy may be active while a particular benefit is still unavailable.

13. The Claim Was Reported Too Late

Late reporting does not necessarily cause automatic rejection in every case.

However, the insurer may decline where the delay:

• Breached a clear policy condition
• Prevented proper investigation
• Increased the loss
• Destroyed recovery rights
• Allowed evidence to disappear

Report promptly and explain any unavoidable delay.

14. The Insured Failed to Prevent Further Loss

After an insured incident, the policyholder is generally expected to take reasonable steps to reduce additional damage.

For example:

• Moving undamaged goods away from water
• Securing broken windows
• Switching off damaged machinery
• Arranging emergency towing
• Protecting property from theft

Continuing to use damaged equipment or ignoring a worsening leak can increase the uninsured portion of a claim.

Why a Claim May Be Paid Only Partially

A partial settlement does not necessarily mean the insurer has declined the claim.

Payment may be reduced because of:

Policy excess

The claimant contributes the stated first portion.

Underinsurance

The asset was insured below its true value.

Benefit sublimit

The relevant benefit has a smaller limit than the overall policy.

Depreciation

A deduction may apply depending on the policy and type of property.

Betterment

The repair or replacement improves the property beyond its pre-loss condition.

Salvage

Remaining damaged property still has financial value.

Shared liability

The claimant contributed to the incident.

Uninsured damage

Part of the damage existed before the accident or arose from an excluded cause.

Ask the insurer for a complete settlement calculation before accepting the offer.

What to Do When Your Claim Is Delayed

1. Obtain the claim reference number

Every follow-up should quote the same reference.

2. Request a written document checklist

Confirm what is received and outstanding.

3. Ask for the current claim stage

Possible stages include:

• Registration
• Document verification
• Assessment
• Investigation
• Liability review
• Approval
• Repair
• Payment processing

4. Ask who is responsible for the next action

The next step may be required from:

• Claimant
• Insurer
• Assessor
• Garage
• Hospital
• Police
• Employer
• Lawyer
• Financier

5. Keep written records

Retain:

• Emails
• WhatsApp messages
• Letters
• Receipts
• Reports
• Call dates
• Names of officers
• Promised response dates

6. Set a clear follow-up date

Avoid receiving the repeated answer “we are working on it” without a next action.

Ask:

“What specific action remains outstanding, who is handling it and when should I expect the next written update?”

7. Escalate within the insurer

Escalation may proceed through:

1. Claims handler
2. Claims supervisor
3. Claims manager
4. Customer-service or complaints department
5. Senior management

Submit the complaint in writing.

What to Do When Your Claim Is Declined

Step 1: Request the decision in writing

Do not rely only on a telephone explanation.

Step 2: Request the policy clause

Ask the insurer to identify the precise exclusion, condition or warranty.

Step 3: Compare the decision with your documents

Review:

• Quotation
• Proposal form
• Schedule
• Policy wording
• Endorsements
• Receipt
• Claim evidence
• Assessment report

Step 4: Correct factual misunderstandings

The insurer may have relied on incomplete or incorrect information.

Provide evidence clearly and professionally.

Step 5: Submit a formal appeal

Explain:

• What decision you dispute
• Why you believe it is incorrect
• Which evidence supports your position
• What remedy you seek

Step 6: Escalate externally where necessary

Where the insurer does not resolve the issue, a consumer may lodge a complaint with the Insurance Regulatory Authority.

The IRA’s complaints portal specifically accommodates matters such as claim delay, claim denial and intermediary handling.

How to Lodge a Complaint With the IRA

The Insurance Regulatory Authority provides an online complaint process.

Prepare:

• Full name and contacts
• Insurer’s name
• Intermediary’s name
• Policy number
• Claim number
• Date of loss
• Complaint description
• Amount claimed
• Insurer’s written decision
• Supporting documents
• Correspondence showing attempts to resolve the matter

The Authority’s consumer-protection information explains that complaints may involve:

• Disagreement over liability
• Settlement amount
• Claim-processing delay
• Other insurance-service concerns

The insurer should generally be given an opportunity to address the complaint before or while it is escalated.

How Policyholders Can Prevent Avoidable Claim Problems

Before buying insurance

• Disclose all material information.
• Compare benefits and exclusions.
• Confirm the insurer and intermediary are licensed.
• Read the policy wording.
• Understand the excess.
• Use accurate insured values.
• Pay through an approved channel.

During the policy period

• Report material changes.
• Maintain the insured property.
• Follow security requirements.
• Renew before expiry.
• Keep receipts and records.
• Verify digital certificates.
• Update employee, vehicle and property schedules.

After a loss

• Protect people first.
• Prevent further damage.
• Notify the insurer promptly.
• Preserve evidence.
• Report to authorities where required.
• Complete forms accurately.
• Submit genuine documents.
• Avoid admitting liability.
• Do not repair or dispose of property before approval.
• Maintain written follow-up records.

How Imana Helps With Delayed or Declined Claims

Imana Insurance Agency Kenya Ltd helps policyholders coordinate claims with the underwriting insurance company.

Support may include:

1. Registering the initial claim notification.
2. Providing the relevant document checklist.
3. Assisting with claim-form completion.
4. Forwarding supporting documents.
5. Following up on assessment.
6. Identifying outstanding requirements.
7. Explaining policy excesses and exclusions.
8. Requesting written claim updates.
9. Helping the client understand a settlement calculation.
10. Guiding the customer through formal complaint channels where necessary.

The underwriting insurer remains responsible for:

• Investigating the claim
• Interpreting the policy
• Admitting or denying liability
• Approving repairs
• Determining settlement
• Paying eligible claims

An insurance intermediary cannot guarantee that a claim will be paid, but it can help the customer submit a complete and properly documented claim.

Insurance Claims Support in Westlands and Across Kenya

Imana Insurance Agency Kenya Ltd
4th Floor, Krishna Centre
Woodvale Grove, Westlands
Nairobi, Kenya

Website: www.imana.co.ke
Call or WhatsApp: +254 796 209 402

Report early. Submit complete documents. Follow up in writing. Let Imana help coordinate the process.

Frequently Asked Questions

How long should an insurance claim take in Kenya?

Where all relevant documents have been submitted, section 203 of the Insurance Act provides a 90-day period for the insurer to admit or deny liability, determine the amount, establish the claimant’s identity and pay the claim, subject to the statutory provisions and possible extension.

Does the 90-day period begin immediately after the accident?

Not necessarily. The law refers to the claimant having submitted all relevant documents. Liability may also depend on a court determination in some cases.

Can a claim be delayed because of missing documents?

Yes. Missing police records, medical reports, ownership evidence, repair quotations or claim forms can prevent assessment.

Must the insurer explain why it declined a claim?

A claimant should request a written decision identifying the relevant policy provision and the reason liability was denied.

Can I request the assessor’s report?

Yes. Kenya’s Insurance Act provides that where a claim assessment has been carried out, a copy should be made available to the claimant.

Can an insurer decline a genuine claim?

A loss may be genuine but still fall outside the policy because of an exclusion, inactive cover, non-disclosure, an incorrect insurance class or breach of conditions.

Can late reporting cause rejection?

It can affect a claim where it breaches the policy or prevents proper investigation. Notify the insurer as soon as reasonably possible.

What should I do when the insurer keeps requesting documents?

Ask for one consolidated written checklist and confirmation of which documents have already been received.

Can I complain about a low settlement offer?

Yes. Disagreements about settlement amounts are matters that can be raised through the insurer’s complaints procedure and, where unresolved, with the IRA.

Where can I complain about a delayed or rejected claim?

Begin with the insurer’s formal complaints process. Where unresolved, a complaint may be lodged through the Insurance Regulatory Authority’s complaints platform.

Can Imana force an insurer to pay?

No. Imana can coordinate documentation and follow-up, but the underwriting insurer is responsible for the claims decision.

Does submitting all documents guarantee payment?

No. It allows the insurer to complete assessment, but payment still depends on whether the loss is covered.

The Bottom Line

Insurance claims are most commonly delayed because:

• Documents are incomplete
• Information is inconsistent
• Assessment is pending
• Liability is disputed
• Police, medical or repair records are outstanding
• Further investigation is required

Claims may be declined because:

• The policy was inactive
• The event was excluded
• Material information was not disclosed
• The insured risk was used differently
• A policy condition was breached
• The loss was not proved
• Fraud or exaggeration was identified

A policyholder can improve the claims experience by understanding the policy, reporting promptly, preserving evidence and following up in writing.

A claim should not begin with arguments. It should begin with facts, documents, clear communication and a careful reading of the policy.

Imana Insurance Agency Kenya Ltd
Call or WhatsApp: +254 796 209 402
Website: www.imana.co.ke

Understand the policy. Document the loss. Follow the process. Let Imana help coordinate the claim.

Claims decisions depend on the selected insurer, policy wording, evidence, circumstances of the loss and applicable law. This article provides general information and does not replace legal advice, the insurer’s written claims decision or the complete insurance contract.