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Top Six Reasons that lead to the Rejection of Insurance claims

By November 18, 2021Blog

Having an insurance claim rejected can have a  devastating effect at the organizational and personal levels. Here are some common mishaps and mistakes that lead to the rejection of claims in Kenya:  


1. Missing documentation

Imagine the mad rush before you leave the office at 5 pm. The traffic is building up. You need to run an errand or two before you get home. You suddenly remember that there is a claim you have not filed on behalf of the organization. You hastily read through the instructions, attach some files, and dash into the slow-moving traffic. A few days later, you get the call. Your claim has been delayed or worse, rejected. Filing the right paperwork seems like a relic from another era, but it can make or break the process of filing an insurance claim.


2. Lack of an understanding of the scope of the insurance cover

It may seem like a tedious exercise to read and understand a policy document, but this is no defense when it comes to insurance claims. For instance, the scope of the cover on an asset insured against accidental fire may not include fires caused by political riots or earthquakes. To guard against this, it’s necessary to engage a professional to help you to understand the fine print of an insurance policy.


3. Outdated details

A recent Gallup poll indicates that millennials are three times more likely to change jobs as compared to the previous generation. Workforces across the continent are increasingly made up of millennials on their second or third job. Changes in crucial details such as location,address, additional assets, and employee details (salary changes, additions, and separations) need to be declared as soon as they happen.


4. Fraudulent claims

A lie may be across the world before the truth wakes up, but it eventually gets halted in its tracks. Fraudulent claims based on gross overstatement of facts, alterations of the circumstances of loss, or cause of damage have been on the rise in Kenya. Insurance companies go to great lengths to verify the facts before processing a claim. Gaps in statements or shifting goal posts can lead to the rejection of a claim. Hidden pre-existing medical conditions can deny one access to insurance when they need it most. Provision of falsified documents during the processing of a claim can have devastating effects, including prosecution. 


5. Delays in filing the claim

It may seem like a good idea to wait for the right time to file a claim, but insurance companies have specific periods within which claims need to be filed. Doing due diligence such as gathering the right documentation should be done within the recommended period. As a rule of thumb, you should notify your agent/insurance company immediately  an incident happens. The notification period expires after 30 days. A window period of upto 90 days is allowed for the submission of documents to support the claim.  


6. Non-payment of premiums 

Insurance companies only settle claims if the insurance premiums are up to date. Insurance policies usually have a grace period to allow the policyholders to ensure that the premium is up to date. After this period elapses, the policy can lapse thus the beneficiary loses the benefits of the policy. To avoid this, talk to your agent/insurance company for insurance premium financing options.


We can help you ease your insurance dilemmas. Talk to us today and let us be your insurance department.