How to Appeal a Rejected SHA Claim to the Tribunal in Kenya (2026)
If your SHA claim has been rejected and SHA’s internal review hasn’t resolved it, the next formal step is the Social Health Insurance Dispute Resolution Tribunal — established under Section 44 of the Social Health Insurance Act, 2023. This guide covers the full escalation process: how to file your complaint, what happens after you file, representation options, and how long it takes.
To appeal a rejected SHA claim, file a written complaint at the SHA Dispute Resolution Tribunal’s registry. The Tribunal issues summons to SHA, who has 15 days to respond. You may represent yourself or use an advocate. The Tribunal targets hearing and determining complaints within six months of filing. Urgent cases can be filed under a certificate of urgency for expedited direction.
The Tribunal is an escalation step, not a shortcut. If you haven’t yet gone through SHA’s own internal complaint and review process, do that first. See our guide on why SHA claims get rejected and how to fix them. This page picks up after that process has been exhausted or ignored.
How to File a Complaint with the SHA Tribunal: Step by Step
Prepare your written complaint
Gather every supporting document: SHA correspondence, the rejected claim details, medical records, and any prior complaint reference numbers from SHA’s internal review. Set out the facts of your dispute clearly and chronologically before you file.
File your complaint at the Tribunal’s registry
Your complaint is registered as a formal Complaint Case at the Tribunal. Confirm the current registry address and any prescribed filing fee directly with the Tribunal before you attend — these are subject to change.
Summons are issued to the respondent
The Tribunal issues summons to SHA (or the other named party). They must enter an appearance within 15 days of being served. If they fail to appear within this window, the complaint may be heard in their absence.
Document review stage
The Tribunal determines which documents are required for the hearing. Respond promptly to any request for records — delays on your side can slow your own case.
Hearing, settlement, or formal decision
Both parties present their case at the hearing. If SHA and the complainant reach agreement during proceedings, the Tribunal can record a settlement on agreed terms. Otherwise, the Tribunal issues a formal determination.
Documents to Gather Before Filing
| Document | Why it matters |
|---|---|
| SHA claim rejection letter | Establishes the basis of the rejection you are appealing |
| Internal complaint reference number(s) | Demonstrates you exhausted SHA’s internal process first |
| Medical records & treatment summary | Supports the legitimacy and necessity of the treatment claimed |
| Hospital admission & billing documents | Shows the cost and nature of care covered (or denied) |
| SHA membership / contribution history | Confirms active cover status at the time of the claim |
| Any prior SHA written correspondence | Documents SHA’s responses (or non-responses) to your complaint |
Filing Under a Certificate of Urgency
If the normal Tribunal timeline would cause serious harm — for example, an ongoing treatment is being withheld while the dispute is unresolved — you can file under a certificate of urgency. This places the matter before the Tribunal’s Chairperson, who gives direction on how it should proceed given the urgency involved.
Do You Need a Lawyer?
Under the Tribunal Procedure Rules, you may represent yourself at the hearing, or be represented by a duly appointed legal representative. A lawyer is not required.
For straightforward disputes over documentation or claim processing errors, self-representation is workable. For claims involving complex medical determinations, disputed clinical guidelines, or significant sums, professional legal assistance is worth the cost.
How Long Does the SHA Tribunal Take?
The Dispute Resolution Tribunal Regulations set a target of six months from the date of filing for a complaint to be heard and determined. Treat this as the Tribunal’s own stated aim rather than a guarantee — actual timelines can vary with case complexity, whether SHA contests the matter, and the Tribunal’s caseload.
Legal advisories report that Tribunal decisions can be appealed further to the High Court on points of law. The exact appeal deadline was not independently confirmed from the primary Tribunal regulations at time of writing — confirm the current window directly with the Tribunal registry or a qualified advocate before relying on any secondhand figure.
Source Transparency
Not independently confirmed: The filing fee amount, and the “30 days to appeal to the High Court” figure (from a law firm blog only). We have not included fee or High Court appeal figures as confirmed facts.
Frequently Asked Questions
What is the SHA Dispute Resolution Tribunal?
It is the tribunal established under Section 44 of the Social Health Insurance Act, 2023, to hear and determine complaints and disputes relating to SHA — including rejected claims — once SHA’s own internal review process has been exhausted.
When should I appeal a rejected SHA claim to the Tribunal?
Go to the Tribunal after SHA’s internal complaint process has been exhausted — either SHA upheld the rejection on internal review, or it failed to respond within its statutory review period. The Tribunal is an escalation step, not a first resort.
How do I file a complaint with the SHA Dispute Resolution Tribunal?
File a written complaint at the Tribunal’s registry. It is registered as a Complaint Case. The Tribunal then issues summons to SHA (or the named respondent), who must enter an appearance within 15 days or risk the complaint being heard in their absence.
Do I need a lawyer to appeal to the SHA Tribunal?
No. Under the Tribunal Procedure Rules, a party may represent themselves or appoint a legal representative. A lawyer is not required but may help with complex or high-value claims.
How long does the SHA Tribunal take to decide a case?
The Dispute Resolution Tribunal Regulations set a target of six months from the date of filing for a complaint to be heard and determined. Actual timelines can vary depending on case complexity and caseload.
Can urgent SHA disputes be fast-tracked at the Tribunal?
Yes. File under a certificate of urgency, which is placed before the Tribunal Chairperson for direction on how to proceed given the urgency. This is for cases where the normal timeline would cause genuine harm, not simply cases you’d prefer resolved faster.
What happens after the SHA Tribunal decides?
Legal advisories indicate Tribunal decisions can be appealed to the High Court on points of law. Confirm the exact appeal window with the Tribunal registry or a qualified advocate — this was not independently confirmed from the primary regulations at time of writing.
Need Help Preparing Your Tribunal Complaint?
Send us the details of your rejected SHA claim on WhatsApp. We’ll help you pull together your documentation and understand your options before you file.
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