REASONS WHY YOUR MOTOR INSURANCE CLAIM MAY BE REJECTED

REASONS WHY YOUR MOTOR INSURANCE CLAIM MAY BE REJECTED

BY Daniel Enane (underwriting manager Kenya Orient Insurance Limited)

The expectation of a motorist insured in

Kenya is that whenever they are

involved in an accident or incident,

their insurer will compensate for the

loss suffered once they notify them.

However, there are instances where some

motorists have had their claims rejected

or declined by their insurance company,

forcing them to foot the costs of the

accidental repairs on their own.

It is prudent that when you buy an

insurance policy, always insist on

obtaining your insurance policy

document. An Insurance policy document

is proof of insurance. It is a legally

binding document for an insurance

contract and contains terms and

conditions. It is important that you pay

extra attention to the terms and

conditions as contained in the document

because these will be referred to in the

event of a claim. Any claim lodged by

you and is determined to be a breach of

the policy conditions will be declined

or rejected.

So, why would my motor insurance claim

be rejected by my insurance company?

1. Lack of insurable interest in the

motor vehicle

Insurable interest is a basic

requirement for any insurance policies

issued to protect an individual or

entity from financial loss should the

motor vehicle be lost or damaged. To

insure a motor vehicle, you would have

to own it or suffer a financial loss if

it was damaged or lost. In the absence

of insurable interest, your claim will

be rejected.

2. Breach of policy terms and conditions –

The motor insurance policy document

contains terms and conditions that must

be observed by the policyholder during

the currency of the policy. Some of

these conditions that will inform

rejection of your claim include: –

a) Failure to observe your duty or

obligations with regard to the insurance

contract; this refers to the accuracy

and completeness of information provided

in the proposal form; premium payment &

confirmation of compliance with the

terms and conditions of the policy.

b) Failure of duty of care with regards

to the motor vehicle – not maintaining

your motor vehicle at all times in a

roadworthy condition.

c) Late notification of any accident or

incident to the insurance company as is

reasonably possible

d) Failure to communicate any changes

affecting your vehicle under the policy

and/or its use.

e) The policy exclusions as provided

in your policy document. This is

because any accidental loss or damage

excluded from the policy will not be

compensated.

3.The scope of your cover

In Kenya, the motor insurance covers

available include Third party Only

(TPO), Third party Fire and theft

(TPF&T), and comprehensive (Comp). Your

policy document and the motor

certificate will expressly indicate the

type of cover your motor vehicle is

covered under. The scope of cover

defines what compensation your policy

will provide for accidental loss,

damage, or injury that happens within

the territorial limits during the period

of insurance. For example, where

insurance provided is “Comprehensive”,

all sections of the motor policy are

operative. Your insurance company will

not undertake repairs to your motor

vehicle if your cover was Third Party

Only.

4. Validity of your policy

The motor certificate displayed on your

vehicle’s windscreen provides for the

expiry date of your insurance cover. It

is important that this date matches with

the expiry date on your insurance

policy document. Whenever an accident

occurs and falls outside the cover

commencement and expiration dates, any

claim lodged under your policy will be

rejected.

5.Violation of traffic rules under

The Traffic Act Chapter 403

Any material damage claim lodged under

your policy and it is established that

you were either driving under the

influence of alcohol or was not a holder

of a valid driving license at the time

of the accident will be rejected.

6.Fraudulent claims

An insurance contract is based on utmost

good faith between the insurer and the

insured party. In the event of an

accident and your motor insurance claim

is found to be false or fraudulent, the

insurer will reject your claim and may

refer such cases to the law enforcers.

It is important to always be honest when

making claims for a seamless claim

process.

Understanding your motor insurance

policy provisions is important because

it will lessen your stress whenever

involved in an accident. Drive safely

and always ensure that you are aware of

the expiry date of your motor insurance

certificate, scope of cover, and its

validity.

As a policyholder, your expectation

after your vehicle is involved in an

accident is to make a claim to your

insurer for compensation. Sometimes,

insurance companies may reject motor

insurance claims from their customers if

established that the claim file is not

valid or fraudulent. In such cases, the

insurance provider fails to pay for the

damages to the insured car, and the car

owner is forced to bear all costs out of

their pocket.