WIBA Compensation Claim Form (Kenya)

A WIBA Compensation Claim Form in Kenya is the formal document through which an employee who has suffered a work-related injury or occupational disease, or the dependant of a worker who has died as a result of a work-related accident, initiates a claim for compensation under the Work Injury Benefits Act No. 13 of 2007. The Act, which repealed the Workmen's Compensation Act Cap. 236, established a thorough no-fault compensation scheme administered by the Directorate of Occupational Safety and Health Services (DOSH) under the Ministry of Labour and Social Protection.

Section 23 of the Work Injury Benefits Act No. 13 of 2007 sets out the procedure for claiming compensation. An employee who sustains an occupational injury must give notice to the employer as soon as practicable after the accident under Section 22 of the Act. The employer is then required under Section 23 to report the accident to DOSH within 24 hours using the prescribed Accident Notification Form, and the injured employee or their dependants must subsequently file a formal compensation claim. The WIBA Compensation Claim Form captures all information required by DOSH to assess the claim, including the nature of the injury, the circumstances of the accident, the employer's insurance details, and the medical assessment of the degree of incapacity.

The Work Injury Benefits Act No. 13 of 2007 Section 5 provides that every employer in Kenya — whether in the formal or informal sector, whether employing one person or one thousand — must insure all employees against work injury with an insurer authorised by the Insurance Regulatory Authority (IRA) under the Insurance Act Cap. 487. A WIBA policy covers permanent total disablement, permanent partial disablement, temporary total disablement, and death. The compensation amounts are set out in the Second Schedule to the Act and are periodically reviewed by the Cabinet Secretary for Labour.

Section 10 of the Work Injury Benefits Act No. 13 of 2007 defines an occupational disease as any disease listed in the Third Schedule that results from conditions peculiar to a particular occupation or industry. Diseases including silicosis from mining, noise-induced hearing loss from industrial work, and dermatitis from chemical exposure are listed. A WIBA claim for occupational disease follows the same procedure as a claim for physical injury — the worker must submit a WIBA Compensation Claim Form supported by a medical report from a registered medical practitioner confirming the diagnosis and the occupational causation.

The National Hospital Insurance Fund (NHIF), now restructured as the Social Health Authority (SHA) under the Social Health Insurance Act No. 16 of 2023, provides medical cover for hospitalisation costs, but WIBA compensation is distinct from NHIF benefits — it covers lost earnings and permanent disability, not medical bills. An injured worker may simultaneously claim NHIF/SHA medical benefits and WIBA compensation without double-counting.

The NSSF Act No. 45 of 2013 and the National Social Security Fund (NSSF) provide retirement savings but do not cover work injury. WIBA compensation is the exclusive statutory remedy for work injury, and Section 16 of the Work Injury Benefits Act No. 13 of 2007 bars an injured employee from bringing a separate common law negligence claim against the employer once a WIBA claim is filed, except where the employer fails to insure as required by Section 5.

The Employment and Labour Relations Court (ELRC) has jurisdiction to hear appeals from DOSH compensation decisions under Section 52 of the Work Injury Benefits Act No. 13 of 2007. Where DOSH determines that no compensation is payable or determines an amount that the claimant disputes, the claimant may appeal to the ELRC within 60 days of the decision.

A WIBA Compensation Claim Form in Kenya is required whenever an employee sustains a work-related injury, contracts an occupational disease, or dies as a result of a work-related accident, and the employee or their dependants wish to claim statutory compensation under the Work Injury Benefits Act No. 13 of 2007.

A WIBA Compensation Claim Form is needed when a construction worker falls from scaffolding on a building site in Nairobi and sustains a fracture. The employer's WIBA insurer must receive the claim form, supported by the hospital medical report and the employer's accident notification to DOSH, before the insurer will assess the claim and make payment.

A WIBA Compensation Claim Form is required when a factory worker in Athi River develops occupational asthma after prolonged exposure to dust in a textile mill. The claim must be supported by a medical report from a doctor registered with the Kenya Medical Practitioners and Dentists Council (KMPDC) confirming the occupational causation, and filed with DOSH within the limitation period under Section 23 of the Work Injury Benefits Act No. 13 of 2007.

A WIBA Compensation Claim Form is needed when a domestic worker employed under a written or oral contract suffers burns in a kitchen accident. The Work Injury Benefits Act No. 13 of 2007 covers domestic workers, who are among the most vulnerable employees in Kenya, and the employer's obligation to insure under Section 5 extends to household employees.

A WIBA Compensation Claim Form is required when the dependants of a tea picker who died after falling from a truck on a Kericho farm seek the death benefit under the Second Schedule to the Act. The dependants — spouse, children, or other persons financially dependent on the deceased — must file the claim, attaching the death certificate, the KMPDC post-mortem report, and evidence of dependency.

A WIBA Compensation Claim Form is needed when a casual worker employed on a day-to-day basis at a flower farm in Naivasha sustains a hand injury from machinery. Casual workers are covered under the Act, and the employer's failure to insure them does not bar the claim — the employer becomes directly liable for the compensation amount.

A WIBA Compensation Claim Form is required when an employee who has suffered a noise-induced hearing loss over several years of employment in a quarry seeks compensation under the Third Schedule to the Act for a listed occupational disease. The claim must be filed within 12 months of the date the employee became aware of the disease and its occupational origin under Section 23(3) of the Work Injury Benefits Act No. 13 of 2007.

A Kenya WIBA Compensation Claim Form compliant with the Work Injury Benefits Act No. 13 of 2007 Section 23 must capture the following information to enable DOSH to assess and process the claim.

Claimant Details: Full name of the injured worker or, in a fatal case, the name of the dependant claimant; National Identity Card (NIC) number; date of birth; gender; residential address; mobile phone number; and relationship to the deceased (where the claimant is a dependant). The National Social Security Fund (NSSF) membership number should be included where available.

Employer Details: Full legal name and business address of the employer; Business Registration Service (BRS) certificate number; KRA PIN; nature of business; and the employer's WIBA insurance policy number and insurer name as authorised by the Insurance Regulatory Authority (IRA) under the Insurance Act Cap. 487.

Accident Details: Date, time, and exact location of the accident; a factual description of how the injury occurred; the task the worker was performing at the time; any machinery, equipment, or substance involved; names and contact details of any witnesses; and whether a DOSH accident notification was filed by the employer within 24 hours under Section 22 of the Work Injury Benefits Act No. 13 of 2007.

Injury or Disease Description: Nature and location of the injury or occupational disease; whether the injury resulted in temporary total disablement, permanent partial disablement, permanent total disablement, or death as defined in the Second Schedule; hospital or clinic where treatment was received; name and KMPDC registration number of the attending doctor; and the date of the medical examination.

Medical Assessment: Attachment of the medical report from a registered medical practitioner confirming the diagnosis, the degree of incapacity expressed as a percentage, and the medical opinion on causation — linking the injury or disease to the employment. For occupational diseases under the Third Schedule, the report must confirm that the disease appears on the schedule and results from the claimant's occupation.

Pre-Injury Earnings: The worker's average monthly earnings in the 12 months before the accident, used to calculate the compensation multiplier under Section 19 of the Work Injury Benefits Act No. 13 of 2007. Payslips, bank statements, or the employer's payroll confirmation should be attached.

Declaration and Signatures: The claimant's declaration that the information is true and correct; the employer's countersignature confirming employment and the accident details; the treating doctor's signature; and the date of filing with the DOSH regional office. The forms-legal.com Kenya WIBA Compensation Claim Form template incorporates all fields required by DOSH and includes a checklist of supporting documents to attach, reducing the risk of rejection for incomplete submissions.

Additional compliance elements for a WIBA Compensation Claim Form (Kenya) used in Kenya include: Under the Employment Act No. 11 of 2007, the Employment and Labour Relations Court (ELRC) adjudicates workplace disputes in Kenya. Section 35 of the Employment Act 2007 governs termination of employment. The National Social Security Fund Act No. 45 of 2013 mandates employer contributions to NSSF. The Social Health Insurance Fund (SHIF) replaced NHIF in 2024. The Kenya Revenue Authority (KRA) administers PAYE under the Income Tax Act (Cap. 470). Forms-legal.com provides this template as a starting point for Kenya-compliant documentation.