Insurance Training - CIC - Claims

CLAIMS

In addition to a competent surveyor , Company Official should visit.

Processing of Claims
Documents :
1) Copy of the policy complete with terms , conditions & warranties
2) Claim form duly completed by Insured
3) Survey report should include :
Indication of the cause of loss
Establishment of liability
Assessment of Loss
Confirmation of compliance of policy terms , conditions & warranties
Admissibility of Claim
Photographs !
Police report ! If necessary
Fire Brigade report !

Claims arising out of AOG Perils

Documents like Newspaper cutings , photographs & meteorological reports

Attention to be paid to concurrent policy & Fin. Inst. Clause

Losses of RSMTD perils



Disposal of Salvage



Disposal of Claims
If all the papers are destroyed in Fire:



LOP
To minimise period of indemnity


IAR :

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Engg Insuarnce:
Documents required as under:

a) Copy of the policy with full terms , conditions , warranties
b) Claimform
c) Survey report incl: Clear indication of the cause of loss , Extent of damage & loss,Establishment of liability , assessment of loss , confirmation of compliance
Of policy terms , conditions & warranties , Admissibility of loss
d) Photographs
e) Police Report
f) Fire Brigade Report

Items e & f may be waived where survey report is clear & does not cause any doubt on the occurrence as well as extent of loss.

1.1-Theft = FIR
1.2 Steps involved in loss-adjustment shoyuld be as under:
Gross loss assessed
a. Less Depriciation if any
b. Less: salvage
c. Less: underinsurance
d. Less :Excess
e. Net claim payable

2. MCE Policies:Marine practice to be followed for Marine
2.1 in case of mega projects , services of an on-site representative/outside project-monitoring agency could be retained, to:
a) Monitor progress of projecta-ctivity
b) Receive report on genearl conditions prevailing at site , from loss-minimisation point of view.
c) Co-ordinate with different authorities on site,
d) Collect required documents for claims already lodged to expedite disposal
e) Conduct survey of losses falling within self-survey limit
f) Preliminary survey of losses

2.2Inci Expenses like supervision/Storage to the extent they are included in S.I. & actually incurred. When replacement value is not ascertainable , assessment can be based on the original invoice value plus escalation if provided in the policy. However, it may be left to the surveyor to arrive at a value.

2.3 Loss under various extensions like additional custom duty , air freight,express freight , overtime wages etc are to beassessed sepaartely. Such Expenses will be available only when incurred by Insured. Liability under these extensions will be over & above the ones allowed under Std. Policy provided limit is not exhausted by earlier settled claims &/or Claims reported but pending settlement.

2.4 If the claim is assessed both under the main policy & extensions like additional custom duty , express freight , overtime wages etc. , specified excess will be applied for each of these sections separately.

C A R

Surveyor shall confirm that the damage is not due to faulty design as the policy completely excludes loss due to faulty design unlike the erection policy where only a particular portion is excluded & resultant damage is paid.

Excess as applicable.

C.P.M.

Being an annual policy , validity at the time of occurrence to be evrified.

Identification of damaged equipment / item should be asked for to confirm coverage under policy. This is necessary since selection of equipments for insurance is allowed.

Surveyor should confirm accidental damage to the equipment.
For items fabricated by the Contractor & replacement values not available , the surveyor should assess the loss on the basis of actual costs incurred by the Insured.

Machinery insurance:
1) Test reports of the admaged parts if demed necessary by the Surveyor & / or suggested by the Insurers is to be submitted to the insurer/surveyor.
2) Repairs / replacement to be confirmed by surveyor.

Claim payable may include costs of dismantling , transportation to the repairer’s shop repairs & re-transportation & re-erection & other incidental expenses. If damaged equipment being sent out is covered under a Marine transit policy , the cost of such insurance may also be reimbursed.

If repeated loses are reported on same equipment , U/W office can take help of outside expert to ascertain the precise cause of repeated loses & suggest measures for avoidance/minimisation of reoccurrence of break-down / loss.

The exclusion of damage to belts ., ropes, chains , Rubber tyres,dyes , moulds to be considered.As to the oil & other operating meduia in transformer & equipment , these may be reimbursed only when specifically covered under the policy.

Loses under other extensions like additional custom duty , air freight , express freight etc. are to be assessed separately & the u/w office should confirm the availability of additional s.i. specifically for such items of expenditure while recommending the claim for settlement. If the assessment involves additional expenses for repairs / replacement , surveyor should confirm that the expenses are reasonable.

Boiler Explosion Insurance

a) Copy of the certificate issued by Inspectorate of Boilers(Wherever applicable) for operation.
b) Boiler inspection report on the occurrence.


Elec. Equipment Insurance

Since the selection of equipment is allowed , u/w office should confirm existence of cover for the damaged item.
Avrious exclusions under the basis policy /./ It should be ensured that claim does not fall under any exclusions.

LOP Insurance

Claim admissible only if loss or damage to M/C or Boiler covered under corresponding policy is admissible.

Selection allowed.Reconfirm coverage.

Applicable time excess. Selection of indemnity period is made depending upon type of M/C.

MD surveyor & LOP Surveyor should report on steps