Resolving Disputes

Disputes often arise at the point of claims and especially where the customer disagrees with the decision of the insurance company not to settle a claim.

Some of the common reasons disputes arise on claim includes;

  • Policy exclusions– Insurance policies contain a list of exclusions outlining specific situations, circumstances or events your insurer will not cover.
  • Conditions and responsibilities-You may not have met the conditions outlined in your policy
  • Cancellation or lapse of your policy- if you have not paid the premium due for the policy, if you have not renewed or have cancelled your policy you will not be able to make a claim
  • Non-disclosure- You are obliged to tell the insurer about anything that might affect your risk when you take out or renew an insurance policy. Failure to disclose may affect your ability to claim on your policy.
  • Failing to protect the insured item- Your claim may be turned down or affected because you did not try to safeguard the insured item to reduce risk. For example, if you left your car doors open and it was stolen, the insurer may refuse to pay or pay only a portion of the claim.

What can you do if your claim is rejected, or you are not satisfied with what how it was resolved?

There are mechanisms within the insurance industry to deal with complaints as outlined below;

  1. If you are unhappy with your insurance company’s decision on your claim or you have a complaint against the insurance company. The first thing to do is to communicate to them formally, through letter or e-mail.
  2. If the matter is not resolved to your satisfaction, the next port of call is the Insurance Regulatory Authority (IRA). Write to the IRA with your complaint via customercare@ira.go.ke or call the toll free number 0800724499. The Complaints Form that can be downloaded from their website