Experiencing an accident, falling ill, losing valuable property or dealing with unexpected damage can be stressful enough. After notifying your insurer, you may wonder what happens next, how long the process will take and whether your claim will be approved.
Understanding What happens after filing a claim? can help you prepare for each stage, avoid unnecessary delays and communicate effectively with your insurer.
In Kenya, the claims process varies depending on your policy, the nature of the loss and the documents required. A motor insurance claim, for example, may involve a vehicle assessment, while a medical claim may require invoices and treatment records. Similarly, a life insurance claim may require documents establishing the claimant’s entitlement to the benefit.
The Insurance Regulatory Authority (IRA) oversees the insurance industry in Kenya and provides a framework for claims management. Although every claim is different, knowing the usual steps can help you navigate the process with greater confidence.
What happens after filing a claim? Understanding the process
Once you notify your insurer, the claim typically moves through several stages. Some may happen simultaneously, while others depend on the information gathered earlier.
1. Your insurer acknowledges the claim
The first step is usually acknowledgement of your notification. Depending on the insurer, you may receive an email, SMS, reference number or other confirmation.
Under Kenya’s Insurance (Claims Management) Guidelines, 2022, insurers are required to acknowledge claim notification and provide the appropriate claim form and, where specific supporting documents are required, a list of those documents within two working days.
Your claim reference number is important because it helps the insurer identify your case during follow-ups.
What you should do:
- Save your claim number and acknowledgement.
- Confirm that the insurer has your correct contact details.
- Ask how to submit documents and receive updates.
- Note any deadlines or instructions provided.
If you reported the incident through an insurance intermediary, confirm that the notification has reached the insurer.
2. You submit the required documents
Next, the insurer needs information to establish what happened, confirm the relevant cover and assess the loss.
Common documents may include:
- Completed claim form
- Policy schedule or certificate
- Identification documents
- Receipts and invoices
- Photographs of damaged property
- Police abstract where applicable
- Medical reports or treatment records
- Repair estimates or assessment documents
- Proof of ownership or financial loss
The exact requirements depend on the policy and circumstances.
For example, after a motor accident, you may need to provide your driving licence, vehicle details, photographs and relevant police documentation. For a medical claim, the insurer may request treatment records, invoices and proof of payment.
Submit clear, accurate documents and keep copies for your records. If you cannot provide a requested document, explain why and ask whether acceptable alternative evidence is available.
3. The insurer checks your policy coverage
Before paying a claim, the insurer must determine whether the incident falls within the terms of your policy.
The claims team may check:
- Whether the policy was active when the incident occurred
- Whether the affected person or property was insured
- Whether the event is covered
- Whether exclusions apply
- The applicable coverage limits
- Any excess or deductible payable by you
- Whether policy conditions were followed
This stage is particularly important because insurance policies do not cover every possible loss.
For instance, a home insurance policy may cover certain accidental damage but exclude particular events or impose specific conditions. Likewise, a motor policy’s protection depends on the cover purchased and its terms.
If you are unsure why a particular document or detail is required, ask the claims handler to explain its relevance.
4. The insurer arranges an assessment or investigation
Depending on the claim, the insurer may appoint an assessor, request further evidence or investigate the circumstances.
An assessment helps establish the nature and extent of the damage and may provide an estimate of repair costs or the value of the loss.
For example, if your insured vehicle is damaged in a collision, the insurer may require an inspection before authorizing repairs. For property damage, an assessor may examine affected areas and review repair quotations.
Investigations may also be necessary where the circumstances are unclear, liability is disputed or additional information is needed to determine whether the claim is covered.
To avoid unnecessary delays:
- Respond promptly to reasonable requests.
- Make the damaged property available for inspection.
- Preserve relevant evidence.
- Follow instructions before arranging repairs or disposing of damaged items.
- Provide consistent and truthful information.
Where immediate action is necessary to protect people or prevent further damage, prioritize safety and contact your insurer as soon as possible for guidance.
5. The insurer makes a decision
After reviewing the policy, documents and assessment findings, the insurer determines the next step.
The outcome may be:
- Approval of the claim
- Approval of part of the claim
- A request for additional information
- Further investigation
- Repudiation, or rejection, of the claim
If the insurer approves the claim, the settlement may involve payment, repair authorization, replacement or another benefit permitted by the policy.
If the insurer declines the claim or offers less than you expected, request a written explanation. Review the relevant policy wording and ask for clarification about any exclusions, limits, excesses or assessment findings involved.
You should not assume that an initial decision cannot be challenged. If you disagree, use the insurer’s complaints procedure and seek further guidance where appropriate.
6. The insurer arranges settlement
Once the claim is approved and the applicable settlement requirements have been met, the insurer proceeds according to the policy.
Depending on the type of insurance, this could involve payment to you, payment to an approved service provider or authorization of repairs.
The amount payable may differ from the original amount claimed. For example, an excess, policy limit, depreciation provision or other policy condition may affect the final settlement.
Before accepting a settlement, check that you understand how the amount was calculated and whether acceptance requires you to sign a discharge or other document.
Keep the settlement confirmation, receipts and any related correspondence.
Typical stages of an insurance claim in Kenya
The following table summarizes the usual process. It is a general guide rather than a guaranteed timeline.
| Stage | What the insurer does | What you should do |
|---|---|---|
| Notification | Records the claim and acknowledges receipt | Save the reference number |
| Documentation | Identifies required information | Submit clear, complete documents |
| Coverage review | Checks policy terms and eligibility | Answer questions accurately |
| Assessment | Reviews damage, expenses or circumstances | Cooperate with inspections |
| Decision | Determines whether and how the claim is payable | Request clarification if needed |
| Settlement | Arranges payment, repair or another benefit | Review the settlement and retain records |
How long does the claims process take?
There is no single timeline for every insurance claim. Straightforward claims with complete documentation may be easier to process than those involving complex investigations, disputed liability, multiple parties or substantial losses.
Kenya’s Insurance Act contains a 90-day payment provision for claims covered by the relevant statutory section, measured from reporting the claim or, where liability is determined by a court, from that determination. The law also provides for a possible extension of up to 30 days in specified circumstances, subject to the Commissioner’s approval. Exceptions apply, so this should not be treated as a universal deadline for every insurance product or situation.
If your claim seems delayed, contact the insurer and ask:
- What stage has the claim reached?
- Is any information still outstanding?
- Has the assessment been completed?
- What is the next step?
- When should you follow up again?
Where an assessment has been carried out, the Insurance Act provides for a copy of the assessment report to be made available to the claimant.
What to do if your claim is delayed or rejected
A delay does not automatically mean your insurer has acted improperly. However, you should receive appropriate information about outstanding requirements and the status of your case.
Start by contacting the claims department or your insurance intermediary. Explain your concern clearly and request a written update.
If your claim has been rejected, ask for the reasons in writing and review the relevant policy conditions. Provide additional evidence if it addresses the stated reason for rejection.
If the issue remains unresolved, follow the insurer’s formal complaints process. You can also contact the Insurance Regulatory Authority through its official complaints channels for guidance on escalating an insurance dispute.
Keep copies of all correspondence, reports and supporting documents throughout the process.
How Up and Go Insurance Agency can help
Understanding your insurance cover before an incident occurs can make the claims process easier to navigate.
Up and Go Insurance Agency provides insurance guidance across motor, medical, travel, life, business, home and personal accident insurance. An insurance advisor can help you understand policy terms, identify important exclusions, clarify documentation requirements and consider cover suited to your circumstances.
Although no advisor can guarantee that every claim will be approved or settled within a particular timeframe, understanding your policy and following the correct procedures can help you avoid preventable mistakes.
Key takeaways
- Keep your policy documents and insurer’s contact details accessible.
- Notify the insurer promptly after an incident.
- Submit complete and accurate supporting documents.
- Cooperate with assessments and investigations.
- Understand your policy’s exclusions, limits and excesses.
- Ask for written explanations of delays, settlement amounts or rejected claims.
- Keep a record of communications and claim documents.
- Escalate unresolved complaints through the appropriate channels.
Frequently asked questions
1. What happens immediately after I submit an insurance claim?
The insurer generally records your notification, acknowledges receipt and explains the next documentation requirements. You should retain the claim reference number and follow the insurer’s instructions.
2. Can an insurer ask for additional documents after I submit my claim?
Yes. Additional information may be necessary to verify the circumstances, assess the loss or establish whether the policy covers the claim. Respond promptly and ask for clarification if a request is unclear.
3. Will every insurance claim be approved?
No. Approval depends on the policy terms, the circumstances of the loss, the evidence provided and whether applicable conditions and exclusions affect the claim.
4. Can I repair my car before the insurer assesses it?
You should normally contact your insurer and follow its assessment and repair procedures before undertaking major repairs. If urgent action is needed for safety or to prevent further damage, seek guidance and document the circumstances where possible.
5. What should I do if I disagree with the settlement amount?
Request a breakdown of the settlement and an explanation of any deductions. Review the policy and relevant assessment report, then raise your concerns with the insurer in writing.
6. Can an insurance intermediary help me during a claim?
Yes. An intermediary can help explain policy requirements and facilitate communication with the insurer, depending on their role and the arrangement in place.
7. What happens if my claim remains unresolved?
Follow up in writing, ask for the outstanding requirements and use the insurer’s complaints process if necessary. If the matter remains unresolved, consider contacting the Insurance Regulatory Authority for guidance.
Conclusion
Understanding What happens after filing a claim? helps you prepare for each stage, from notification and documentation to assessment, decision-making and settlement. While the process varies depending on your insurance policy and the nature of the loss, prompt communication, accurate information and organized records can help prevent avoidable delays.
The best time to understand your cover is before you need to claim. Up and Go Insurance Agency can help you explore suitable protection and understand the policy conditions relevant to your needs.
Contact Up and Go Insurance Agency today for expert insurance advice and personalized quotes.
Email: info@upandgoinsurance.com
Phone: +254741133544 / 0141778121
Whether you need motor, medical, travel, life, business, home or personal accident insurance, speak with Up and Go Insurance Agency to make an informed decision about protecting what matters most.
