Step-by-Step Guide to Claiming Personal Accident Insurance in Kenya
Accidents don’t send invitations. One moment you’re going about your day, the next you’re in a hospital bed with unexpected bills, pain, and possibly time away from work.
That’s where Personal Accident (PA) Insurance steps in — covering you or your family financially when an accident leads to injury, disability, or death. But here’s the catch: in Kenya, many people buy this cover and later find themselves lost in complicated claim procedures, often missing out on benefits they were entitled to.
This detailed guide will walk you through the entire process of claiming Personal Accident Insurance in Kenya, ensuring you know exactly what to do when the unexpected happens.
1. Understanding Personal Accident Insurance
Before we get into claims, let’s clarify what PA insurance actually does.
Personal Accident Insurance is designed to provide financial compensation in cases of:
Accidental Death — a lump sum paid to your beneficiaries.
Permanent Total Disability (PTD) — compensation if you can no longer work due to the accident.
Permanent Partial Disability (PPD) — compensation for loss of specific body parts/functions.
Temporary Total Disability (TTD) — weekly or monthly payouts if you can’t work for a period.
Accidental Medical Expenses — reimbursement for hospital bills due to the accident.
Funeral/Last Expense Benefit — to assist with burial costs.
💡 Unlike medical insurance, which pays hospitals directly for treatment, PA cover focuses on cash benefits and reimbursements — helping you manage financial strain after an accident.
2. The Importance of Knowing the Claims Process
Many Kenyans miss out on payouts because:
They don’t report the accident in time.
They submit incomplete documentation.
They are unaware of exclusions in their policy.
Knowing the claims process before an accident happens means you can act quickly and avoid unnecessary delays.
3. Step-by-Step Process to Claim Personal Accident Insurance in Kenya
Step 1: Get Immediate Medical Attention
Your health always comes first.
If you are injured:
Visit the nearest hospital — ideally one approved by your insurer (check your policy’s hospital panel list).
Ensure the medical team records the injury as accident-related in your file.
Keep all medical reports, prescriptions, and payment receipts.
💡 Even minor injuries should be documented — complications can arise later, and you’ll need proof it was caused by the accident.
Step 2: Notify Your Insurance Provider
Time is critical. Most insurers in Kenya require accident reporting within 24–48 hours.
You can notify them via:
Phone call to the insurer’s hotline.
Email to the claims department.
Through your insurance intermediary (like Step by Step Insurance, who will guide you and handle follow-up).
Information to have ready when reporting:
Policy number.
Your full name and contact details.
Date, time, and location of the accident.
Brief description of what happened.
Name of the hospital or clinic you visited.
Step 3: Gather Required Documentation
Documentation is everything in insurance. Missing one document can delay your payout by weeks.
Typical documents needed include:
Completed Claim Form (from your insurer).
Medical Report from the attending doctor.
Hospital Discharge Summary (if hospitalized).
Receipts for all medical expenses.
Police Abstract — if the accident involved a road crash or criminal activity.
Copy of ID or birth certificate (for minors).
Death Certificate & Burial Permit (for fatal claims).
💡 Pro Tip: Keep photocopies of all documents and submit certified copies where possible.
Step 4: Submit Your Claim
Once you’ve compiled your documents:
Deliver them to your insurer’s branch office.
Email scanned copies (if accepted).
Submit through your insurance broker (Step by Step Insurance can check your documents before submission to ensure nothing is missing).
Some insurers now offer online claim portals where you can upload documents and track your claim status.
Step 5: Claims Assessment
Here’s what happens behind the scenes:
The insurer confirms your policy is active and your premiums are up to date.
They check that the accident falls within the scope of cover.
They assess medical reports to ensure the injury is consistent with the reported incident.
They verify there are no policy exclusions (e.g., self-inflicted injury, intoxication, participation in dangerous sports not covered).
If additional information is needed, you’ll be contacted.
Step 6: Claim Approval and Payment
If your claim is approved:
Lump Sum Payment — for death or permanent disability.
Reimbursement — for medical bills (within the cover limit).
Weekly/Monthly Benefits — for temporary disability.
Payments are usually made via:
M-Pesa.
Bank transfer.
Cheque.
💡 Well-prepared claims can be processed in 7–21 working days in Kenya.
Step 7: If Your Claim Is Rejected
If your claim is denied:
Request a written explanation.
Compare the reason with your policy terms.
If you feel the decision is unfair, escalate to the Insurance Regulatory Authority (IRA) or seek legal guidance.
4. Common Mistakes to Avoid When Claiming
Delaying accident reporting — always inform your insurer promptly.
Incomplete paperwork — double-check all required documents.
Not reading your policy — know your cover limits and exclusions.
Using non-approved hospitals when your policy specifies a provider network.
Failing to keep receipts — without proof of payment, claims may be rejected.
5. Why Work With Step by Step Insurance
Navigating the claims process can feel overwhelming — especially when you’re dealing with the stress of an accident.
At Step by Step Insurance, we:
Help you choose the right PA cover from the start.
Guide you step-by-step in accident reporting and documentation.
Handle follow-ups with insurers to speed up payouts.
Provide clarity on your benefits so there are no surprises.
💬 “We’ve seen too many Kenyans lose benefits they rightfully deserved because they didn’t understand the claims process. Our role is to protect you from that frustration.” — Faith Kimaru, Principal Officer, Step by Step Insurance
6. Final Word
Accidents are unpredictable — but your financial recovery shouldn’t be.
By knowing how to claim your Personal Accident Insurance in Kenya, you protect yourself from delays, denials, and unnecessary stress. The key is to act quickly, keep detailed records, and work with a trusted intermediary to guide you.
📞 Need help with a claim or want to get covered?
Call/WhatsApp 0729 712 200
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