Practice area
Insurance
Claim disputes, policy review and subrogation.
Overview
Insurance law governs the creation, interpretation, and enforcement of insurance contracts — the mechanisms by which individuals and businesses transfer risk to insurers in exchange for premiums. In Kenya, insurance is regulated by the Insurance Act (Cap 407), administered by the Insurance Regulatory Authority (IRA), and supplemented by the principles of contract law, the Law of Contract Act, and a substantial body of case law from the Kenyan courts and the broader common law tradition. For both insurers and insureds, the insurance relationship is one where the precise terms of the contract and the conduct of the parties at the claims stage determine whether coverage is available.
Advocates offering this service act for insurers, insurance brokers, and policyholders. For insurers, they advise on the drafting of policy wordings, the interpretation of coverage clauses, exclusions, and conditions, and the management of claims — including the investigation of claims, the taking of proofs of loss, the issuance of coverage positions, and the handling of disputes. Advocates defend insurers against claims for policy benefits, and they pursue subrogation recovery actions against third parties who are responsible for insured losses.
For policyholders — both individuals and businesses — they review insurance policies before placement to ensure that the coverage is adequate and that exclusions and conditions are understood. Advocates assist with the placement of complex insurance programmes, including property, liability, professional indemnity, directors and officers (D&O), marine, and construction insurance. When a claim arises, they guide the policyholder through the claims process, ensuring that notice is given on time, that proofs of loss are properly prepared, and that the insurer deals with the claim in good faith.
Advocates handle insurance dispute resolution through negotiation, mediation, arbitration, and litigation. Much of the work turns on the interpretation of policy wordings — an area where the precise meaning of a single word can determine whether a multi-million-shilling claim is covered or excluded. Advocates litigate coverage disputes before the High Court and the Court of Appeal, and they handle disputes before the Insurance Appeals Tribunal.
Advocates also advise on the regulatory dimension of insurance. For insurers and insurance intermediaries, they handle licensing and registration with the IRA, compliance with solvency and reporting requirements, and the management of regulatory inspections and enforcement actions. Advocates advise on the Insurance (Motor Vehicle Third-Party Risks) Act and the mandatory insurance requirements for motor vehicles, and they handle claims arising from the Protection of Insureds Fund.
For the growing microinsurance and insurtech sectors, they advise on the regulatory framework for innovative insurance products, digital distribution channels, and the use of mobile money for premium collection and claims payment. Advocates monitor developments in the Insurance (Microinsurance) Regulations and the IRA's approach to innovation, and they help clients navigate the regulatory requirements for pilot programmes and product launches.
What’s typically covered
- Review of policy wording and cover before you buy or renew
- Claims preparation and negotiation with insurers
- Challenges to declined, delayed or reduced claims
- Complaints to the Insurance Regulatory Authority
- Subrogation and recovery actions for insurers
- Defence of claims and coverage litigation for insurers
Typical scenarios
- A business whose fire claim was declined on the ground of non-disclosure.
- A road accident victim pursuing a claim against the at-fault driver’s insurer.
- An insurer recovering a paid motor claim from the third party responsible.
Legal services
What Insurance includes
Each service below has its own page with a detailed explanation of the work, the process and what to expect.
FAQs
Insurance: common questions
Ask for the reasons in writing and check them against the policy wording. You can complain to the insurer and then to the Insurance Regulatory Authority, and, where appropriate, pursue the claim through arbitration (if the policy requires it) or the courts.
An insurer may be able to avoid a policy for non-disclosure or misrepresentation of a fact that was material to the risk. Whether it can do so depends on what was asked, what you knew and how material the fact was — insurers do not have an unlimited right to reject claims on this basis.
Policies set notice periods for reporting claims, and court claims are subject to the Limitation of Actions Act. Late notice can jeopardise a claim, so report incidents promptly and keep evidence.
Not always, but serious injury claims are often contested on liability and on the amount of damages. An advocate can value the claim, gather medical and police evidence, and negotiate or litigate against the insurer’s advocates.
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