CLAIMS NON LIFE-­‐ PROCESS AND DOCUMENTS

 

CLAIMS NON LIFE-­‐ PROCESS AND DOCUMENTS

Learning Outcome

1.            Intimation of claim

2.            Survey Report

3.            F.I.R

4.            Death Certificate & Post Mortem Report

5.            Policy Specific Documents

6.            KYC Documents

1.            Intimation of claim

In non life insurance if there is a claim under the policy the same needs to be immediately reported to the insurance company. This reporting or information is called ‘Claim Intimation’.

Few policies state specific time for intimation of a claim but all do state that the intimation is to be given forthwith i.e. at the earliest. Health insurance policies state time for intimation which is generally for planned hospitalization – before admission and for non planned hospitalization within 7 days of the admission.

1.2          Timely intimation of a claim, even intimation of a likely claim, is very important.

 

1.3          The intimation enables the insurers to take quick actions for:-­‐

i)             Loss minimization

ii)            Claim investigation

iii)           Survey and assessment of loss

iv)           Enforcing rights against third parties.

1.2.1      When intimation is received by the insurers they may send surveyor or their representative to see the loss. In case of property losses the insured is suggested to carry out loss minimizing  measures  like fire fighting ( fire loss),  shifting  of property to elevated  place ( flood loss), segregation of damaged property and shifting of property to a safer place etc.

 

Claims – The Moment of TRUTH

In case of cattle insurance, insured is advised to seek help of qualified veterinary doctor when to give treatment to the ailing animal. In case of spread of epidemic in the area, the insured may be advised to shift cattle to other area which is free from epidemic, carry out immunization of remaining animals who are healthy but likely to get infection if remain in the epidemic area.

1.2.2      Early intimation helps, as evidences may be at the place of loss and are not destroyed. In case of fire loss the cause of fire can be better investigated, if questions are asked to eye witness at the site. In case of flood losses the water flooding the place can be seen by the investigator and insurance company can be sure that rain water damage claim is not passed on to them as flood losses.

In case of epidemic in an area the investigator can collect the first hand data about the epidemic and can also see the dead insured animal, if the claim is for death.

In case of accident, early site inspection, becomes important as all the evidences and witnesses to the accident may be present there. .

1.2.3      Surveyor assess the loss and prepare an estimate of loss and prepare preliminary report, if he reaches early. If any item requires to be tested, samples can be collected and sent for laboratory test.

In case of cattle insurance in epidemic situation surveyor can advise the insurance company about the likely loss, due to epidemic. If the insurers wish they can take up the matter with appropriate government authorities to control the epidemic. In case of insurance of poultry or birds local animal husbandry department may be alerted and request to take appropriate action to avoid spread of the epidemic.

1.2.4      If any third party is responsible for the loss, steps may be initiated to take action against them for recovery of the loss.

Example: if a cow dies due to negligent driving of the truck owner, police complaint can be made against the owner and driver of the truck so in future recovery of loss from them becomes easy.

2.            Survey Report

2.1          Under Insurance Act 1938, if the amount of loss is Rs 20,000/-­‐ or more, a licensed surveyor is to be appointed to assess the loss.

Surveyor’s role is very important. In case of property insurance, Surveyor has to visit the place of loss, collect relevant information and document and submit a report. In case of motor insurance surveyor has to visit garage for inspection of damaged vehicle and submit his report on assessment of loss. In case of commercial vehicle surveyor has to visit spot of the accident and conduct spot survey and report to the insurers. In case of major vehicle losses he may required to do re inspection survey to report whether all the damaged parts have been replaced or not. He has to report whether the repair has been carried out or not.

2.2          Survey report contains following intermediaries:

i)             The cause of loss

ii)            The quantum of the loss

iii)           Comments on policy conditions to be followed for completion of claim.

iv)           Comments about admissibility of claim and compliance of terms and conditions of the policy by the insured

3.            First Information Report ( FIR)

First information report is information to police authorities about accident or claim.

It is generally done in following cases:

i)             Theft, burglary or housebreaking cases – Property Insurance

ii)            Major    vehicular              accident               injuring third   parties   or   damaging       their properties – Motor Insurance

iii)           Fire incident involving injuries to any persons or causing major property loss – Fire Insurance

iv)           Cases involving financial frauds by employees or others cause loss to the insured – Liability Insurance

v)            Death due to accident of an individual – Personal Insurance Policy

3.1          The information to police is required became on intimation police conducts an investigation and issue their report about the findings of investigation.

In case of thefts and frauds they arrest the culprits and try to recover from them the lost property or misappropriated money or goods.

3.2          In case of accidental death they conduct investigation and report whether it was genuine accident or case of suicide or murder.

3.3          For investigation police may take help of forensic department to establish exact cause of loss incase of fire losses. In case of death of individuals, insurance company may send dead body for post mortem to find out cause of death.

3.4          3.4 When investigation is completed the police authorities issue final report and if it takes longer than three months for police to issue the final report, by practice insurers settle claims on the strengths of FIR.

CSC-VLE TRAINING

4.            Death Certificate and Post Mortem Report

4.1          Death Certificate is required as a supporting document for claim under personal accident policy which covers death due to accident.

Death certificate is issued by Municipality or Grampanchayat of the area in which the deceased was residing or died. It gives the name, age, address and date of death of a person.

In case of death of insured person covered under health insurance policy, settlement of claim with nominee for hospitalization expenses incurred for the treatment of the deceased, the death certificate is necessary.

In case of cattle or other animal insurances, death certificate is also required. However the death certificate is issued by a veterinary surgeon treating the animal or who attended it at the time of the death.

4.2          Post Mortem report is examination of dead body of a person and testing various organs to find out the cause of death. Generally it is conducted in case of accidental death or doubtful death at any place. The post mortem is performed at government or local body’s hospital in nearby area by the surgeons trained for that.

In case of insurance of animals post mortem report is required, which is conducted by a veterinary surgeon.

5.2          Death Claims for Cattles: -­‐ Following documents are required for making claim for cattles.

1.            Claim form.

2.            Death Certficate on insurance company’s form.

3.            Post mortem report.

4.            Ear tag.

5.            Valuation certificate by veterinary doctor.

5.2.1      In case of death of animal insured under Integrated Rural Development Programme (IRDP) or other similar scheme, death certificate may be issued by Panchas consisting of any two of the following:-­‐

1.            Sarpanch of village.

2.            President or other senior officer of Co Op Credit Society.

3.            Official of milk collection centre.

4.            Supervisor or officer of banking or credit institution.

5.            DRDA or it’s authorized nominee.

6.            Secretary or vice president of panchayat.

7.            Village revenue officer/ village accountant.

8.            Headmaster of a primary school.

In case of claims for disablement veterinary doctor’s certificate with treatment details required.

 6.2.1     Proof of Identity

i.              Passport

ii.             Pan Card

iii.            Voter’s Identity Card

iv.           Driving License

v.            Letter from a recognizes Public Authority [as defined under section 2(h) of the Right to information Act, 2005] or Public Servant [as defined in section 2(c)] of the ‘The Prevention of Corruption Act,1988’] verifying the identity and residence of the customer

vi.           Personal identification and certification of the employees of the insurer for identity of the prospective policyholder.

vii.          Letter issued by Unique Identification Authority of India containing details of name, address and Aadhar number

viii.         Job card issued by NREGA duly signed by an officer of the State Government.

6.2.2      Proof of Residence

i.              Telephone bill pertaining to any kind of telephone connection like mobile, landline, wireless, etc. provided it is not older than six months from the date of insurance contract.

ii.             Current passbook with details of permanent/present residence address (updated up to the previous)

iii.            Current statement of bank account with details of permanent/present residence address(as downloaded)

iv.           Letter from any recognized public authority

v.            Electricity bill

vi.           Ration card

vii.          Valid lease agreement along with rent receipt, which is not more than three months old as a residence proof.

viii.         Employer’s certificate as a proof of residence (certificate of employers who have in place systematic procedures for recruitment along with maintenance of mandatory records of its employees are generally reliable)

 

6.2.3      Proofs of both Identity and Residence

Written confirmation from the banks where the prospects are a customer, regarding identification and proof of residence.

6.2.4      For Micro insurance policies, following documents are sufficient as proof of identity and address:-­‐

i.              Current passbook with details of permanent/present residence address (updated up to the previous month)

ii.             Current statement of bank account with details of permanent/present residence address