Complete guide to filing insurance claims in Kenya. Learn the step-by-step process, required documentation, and tips for successful claim settlement.
Filing an insurance claim in Kenya doesn't have to be overwhelming. This comprehensive guide walks you through every step of the claims process, from initial reporting to final payment, ensuring you receive the compensation you deserve.
Whether you're filing a medical, motor, property, or life insurance claim, understanding the process and requirements will help you navigate the system with confidence.
Contact your insurance company immediately after an incident occurs. Most insurers require notification within 24-48 hours for accidents and 7 days for other claims.
Collect comprehensive evidence to support your claim. Documentation is critical for successful claim approval.
Fill out the official claim forms accurately and completely. Incomplete forms cause delays.
Submit all required documents through your preferred channel. Keep copies of everything you submit.
The insurer assigns an adjuster to investigate and evaluate your claim.
The insurer reviews the adjuster's report and makes a decision on your claim.
Once approved, payment is processed according to policy terms.
Motor Insurance
Medical Insurance
Property Insurance
Life Insurance
Pre-authorization (also called pre-approval) is required for many medical procedures and high-value claims. Failure to obtain pre-authorization may result in claim denial or reduced payment.
Medical Procedures Requiring Pre-Auth
Surgeries, MRI/CT scans, maternity care, specialist consultations, hospitalization (non-emergency), physiotherapy, dental procedures
How to Request Pre-Authorization
Call insurer's helpline, provide doctor's recommendation, submit treatment plan, receive approval code before proceeding
Emergency Exemption
Life-threatening emergencies don't require pre-authorization, but notify insurer within 24-48 hours of admission
Once you submit your claim, the insurer conducts a thorough investigation to verify the claim's validity and determine the appropriate payout amount.
Verify Policy Coverage
Confirm the incident is covered under your policy terms
Inspect Damage
Visit site or vehicle to assess damage extent
Review Documentation
Examine all submitted evidence and reports
Interview Parties
Speak with claimant, witnesses, medical providers
Calculate Settlement
Determine fair compensation based on policy limits and damage
Simple claims: 7-14 days (windscreen, minor medical)
Moderate claims: 2-4 weeks (vehicle accidents, property damage)
Complex claims: 1-3 months (total loss, life claims, disputes)
*IRA regulations require insurers to settle claims within 90 days or provide written explanation for delays
90-Day Settlement Rule
Insurers must settle or decline claims within 90 days of receiving complete documentation
Complaint Escalation
If claim is unfairly denied, escalate to IRA Consumer Protection Department (complaints@ira.go.ke or 0800-721-999)
Policyholder Rights
Right to full disclosure, fair treatment, timely processing, and appeal
For certain claims, you must obtain a police abstract (P3 form for accidents or OB number for theft/burglary) from any police station.
When Police Reports Are Required:
Tip: Visit the nearest police station within 24 hours to file report and obtain OB number or P3 form
Life insurance and critical illness payouts exceeding KES 1,000,000 may be subject to withholding tax. The insurer will deduct this before payment. Beneficiaries need KRA PIN for large payouts.
Insurer pays provider directly. You don't pay upfront (except copay/deductible).
How It Works:
Advantages:
Common for:
You pay provider upfront, then submit claim to insurer for reimbursement.
How It Works:
Advantages:
Common for:
Important Notes:
Scenario: John suffers chest pain and is rushed to Aga Khan Hospital
Day 1: Emergency admission. Wife calls insurer hotline within 4 hours, provides policy number and hospital details. Insurer issues pre-authorization code to hospital.
Day 1-3: John receives treatment. Hospital bills insurer directly (cashless). Family pays KES 5,000 copay.
Day 4: Discharge. Wife collects discharge summary and treatment notes.
Day 5: Submits claim form via insurer app with discharge summary and copay receipt.
Day 12: Claim approved. Hospital receives payment directly. John receives SMS confirmation.
Total time: 12 days. Covered amount: KES 185,000.
Scenario: Sarah's car is hit by another vehicle on Thika Road
Day 1: Accident occurs at 2pm. Sarah exchanges details with other driver, takes photos, and calls police. Obtains P3 form. Calls insurer at 4pm to report accident.
Day 2: Takes car to insurer-approved garage for assessment. Adjuster inspects damage.
Day 3: Submits MAV 3 form, driving license copy, P3 form, photos, and repair estimate (KES 120,000) via email.
Day 5: Insurer requests additional photos of chassis number and vehicle documents. Sarah submits same day.
Day 10: Claim approved for KES 115,000 (assessed value after betterment). Garage begins repairs.
Day 17: Repairs completed. Sarah pays KES 10,000 deductible and collects car. Insurer pays garage directly.
Total time: 17 days. Covered amount: KES 115,000. Out-of-pocket: KES 10,000.
Scenario: Peter's house is burglarized, electronics and jewelry stolen
Day 1: Peter discovers burglary at 6am. Calls police immediately, obtains OB number. Reports to insurer at 9am.
Day 2: Insurer sends adjuster to inspect property. Peter provides list of stolen items with purchase receipts.
Day 4: Obtains police abstract from station. Submits claim form, OB number, police abstract, photos, receipts for stolen items (TV, laptop, gold chain worth KES 250,000 total).
Day 12: Insurer reviews claim. Requests additional proof of ownership for jewelry (bank statement showing purchase).
Day 14: Peter provides bank statements. Policy has KES 150,000 sub-limit for jewelry.
Day 28: Claim approved for KES 195,000 (TV + laptop fully covered, jewelry up to sub-limit, after depreciation).
Day 35: Payment received via bank transfer.
Total time: 35 days. Claimed: KES 250,000. Paid: KES 195,000 (due to sub-limits and depreciation).
Q: How long does claim processing take?
Simple claims: 7-14 days. Moderate claims: 2-4 weeks. Complex claims: 1-3 months. By law, insurers must settle within 90 days.
Q: What if my claim is denied?
Request written explanation. Review your policy to verify coverage. Provide additional evidence if available. Appeal the decision formally. If still denied unfairly, escalate to IRA (0800-721-999 or complaints@ira.go.ke).
Q: Can I choose my own garage/hospital?
For cashless claims, you must use network providers. For reimbursement, you can choose any provider but may face coverage limits or require pre-approval for certain procedures.
Q: What if I miss the notification deadline?
Report as soon as you realize the mistake. Explain the delay. Some insurers may still accept late notification with valid reason. However, significant delays may result in denial, especially for fraud prevention.
Q: Do I need original documents or are copies okay?
Most insurers accept clear scanned copies via email or app. However, for life/death claims, original death certificate is usually required. Always keep originals for your records.
Q: Can I claim for pre-existing conditions?
Generally no, unless specifically covered after waiting period (typically 1-2 years). Review your policy schedule for pre-existing condition exclusions.
Q: What happens if the other party is at fault?
For motor claims, your insurer pays your claim first, then pursues recovery from the at-fault party's insurer (subrogation). Your no-claims bonus may be protected if you're not at fault (varies by policy).
Q: How is claim payout calculated?
Based on: Policy limits, item value (replacement or market value), depreciation, deductibles/excesses, sub-limits for specific items. Always read your policy schedule to understand your coverage limits.
Q: Will filing a claim increase my premium?
Possibly, especially for motor insurance if you're at fault. You may lose no-claims bonus. Medical claims typically don't affect individual premiums (but may affect group rates). Multiple claims signal higher risk.
Q: Can I track my claim status?
Yes. Most insurers offer online portals or mobile apps where you can track claim progress. You can also call customer service with your claim reference number.
Document Everything
Take photos/videos immediately. More evidence is always better. Keep detailed records of all communications with your insurer.
Report Promptly
Don't delay notification. Late reporting is one of the top reasons for claim denial. Save insurer's hotline number in your phone.
Be Honest and Accurate
Never exaggerate or falsify information. Insurance fraud is a criminal offense and will result in claim denial and policy cancellation.
Read Your Policy
Know what's covered and what's not. Understand your deductibles, sub-limits, and exclusions. Don't assume coverage.
Keep Originals Safe
Store important documents (policy, receipts, valuables proof) in a safe place. Digital backups are helpful but keep physical originals.
Follow Up Regularly
Don't just submit and wait. Call weekly for updates. Respond quickly to any requests for additional information.
Don't Accept Low Offers Immediately
Review settlement offers carefully. Get independent assessments if needed. You have the right to negotiate. Provide evidence to support higher valuation.
Use Digital Channels
Email and mobile apps provide paper trails. Faster than physical submissions. You can track status online.
Maintain Good Records
Keep purchase receipts, service records, valuations. These prove ownership and value. Makes claims much smoother.
Know Your Rights
IRA protects policyholders. You have the right to fair treatment, timely processing, and appeal. Don't be intimidated by denials.
Remember: Insurance is a legal contract. Your insurer has obligations to you, but you also have obligations to them. Fulfill your part (timely premiums, honest disclosure, prompt reporting) and they must fulfill theirs.
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