The government has been dragged to court over claims that thousands of families of teachers, police officers and other public servants have been denied insurance benefits for years, leaving unpaid claims worth more than Sh20 billion despite the existence of mandatory insurance schemes.
A petition filed at the High Court in Nairobi by John Gitonga accuses successive governments of failing to properly manage statutory insurance programmes meant to protect public servants who die, suffer disabilities or sustain injuries while on duty.
Named in the case are the National Treasury, the Ministry of Public Service, the Social Health Authority (SHA), Insurance Regulatory Authority (IRA), Public Service Superannuation Fund (PSSF), Public Service Commission, Teachers Service Commission (TSC), Judicial Service Commission, National Police Service Commission, the Attorney-General, the National Assembly and several leading insurance firms.
Gitonga argues that failures in administering the statutory insurance schemes have left hundreds of thousands of public servants and their dependants without benefits they are legally entitled to receive.
He estimates unpaid liabilities at Sh8.4 billion for civil servants, Sh3 billion for police and prison officers and at least Sh10 billion for teachers.
According to the petition, the outstanding amounts relate to Group Personal Accident cover, Work Injury Benefits Act claims, Group Life insurance and Last Expense insurance schemes that were established to provide financial support to public servants and their families.
The petitioner is asking the court to declare the current insurance arrangements unconstitutional.
“The petition specifically challenges, among other things, the unlawful operation of a self-insurance arrangement by the National Treasury and the Ministry of Public Service, contrary to the Insurance Act under which any person who’s not a licensed insurer is expressly prohibited from carrying on insurance business,” he says.
Filed before the Constitutional and Human Rights Division of the High Court, the petition also seeks payment of all pending claims, forensic audits into the handling of the insurance schemes, accountability orders against public officials and reforms in the administration of public servants' insurance benefits.
Gitonga says he decided to move to court after losing his sister, who worked for the Teachers Service Commission.
He says despite making several follow-ups, the insurance benefits due after her death have never been released to her children.
“I assumed personal responsibility for the care and upbringing of her children. To date, neither I nor the estate of my sister has received any of the death-in-service benefits, group life insurance entitlements or last expense benefits,” Mr Gitonga says in his affidavit.
He says his family's experience mirrors what many other families of public servants have endured.
“This failure has caused direct, personal and continuing financial hardship to my sister’s children, for whose welfare I remain personally responsible,” he says.
The petition states that the dispute dates back to 2006 when the government abandoned the use of licensed insurance companies and adopted a self-insurance system under a Group Personal Accident policy administered by the National Treasury.
Gitonga argues that the Treasury effectively carried out insurance business without obtaining a licence from the Insurance Regulatory Authority as required under the Insurance Act.
He further claims that responsibility for managing Group Personal Accident, Work Injury Benefits Act, Group Life and Last Expense insurance was later transferred to the former National Hospital Insurance Fund before those functions were taken over by the Social Health Authority.
According to the petition, SHA inherited those responsibilities despite lacking legal authority to conduct commercial insurance business.
Court documents state that insurance premiums amounting to Sh20.28 billion for civil servants were due between April 2022 and April 2025, but only Sh12.59 billion was remitted, leaving unpaid premiums of about Sh7.69 billion.
The petition also claims unpaid insurance premiums for police and prison officers stand at about Sh10.67 billion.
“The violations have resulted in unpaid claims in excess of Sh20 billion and have left hundreds of thousands of public officers without the statutory protections to which they are legally entitled,” the petition states.
The court papers further show that 1,968 Group Personal Accident and Work Injury Benefits Act claims worth Sh3.96 billion remained unsettled before 2022, alongside 874 Group Life and Last Expense claims valued at Sh1.20 billion.
Another 822 claims worth Sh2 billion are said to have accumulated during the 2022-2023 financial year, while a further 706 claims valued at Sh1.59 billion arose in the 2023-2024 financial year.
Gitonga also argues that Parliament approved billions of shillings for insurance cover even as many eligible claims remained unpaid.
He says the continued failure to settle the claims violates constitutional rights and legal obligations owed to public servants and their dependants.
The government and the other respondents are yet to file their responses before the court