Reasons why your motor insurance claim may be rejected

Any claim lodged by you that is determined to be a breach of the policy conditions will be declined or rejected. [iStockphoto]

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 to always insist on obtaining your insurance policy document upon purchase. 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 that is determined to be a breach of the policy conditions will be declined or rejected.

Mr Daniel Enane, the Underwriting Manager at Kenya Orient Insurance Limited, explains why your motor insurance claim could be rejected by the insurance company.

Daniel Enane, Underwriting Manager at Kenya Orient Insurance Limited. [Courtesy]

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:

1. 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.
2. b) Failure of duty of care with regards to the motor vehicle – not maintaining your motor vehicle at all times in a roadworthy condition.
3. c) Late notification of any accident or incident to the insurance company as is reasonably possible
4. d) Failure to communicate any changes affecting your vehicle under the policy and/or its use.
5. 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.
6. 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.