Insurance 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 : Claims to be dealt as per relevant sections

======================================================

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.




Electrical 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
======================================================
Misc. accid ent



Personal Accident
Generally scrutiny of following documents is esential.
a) Duly completed claim form.
b) Report of attending Doctor either as a sepaarte document or on the reverse of claim-form
c) Invest reports like Lab tests,X-ays & reports esential for confirmation of injury
d) Police reports wherever necessary.
e) Certificate of proof of age of dependent childin case claim is under Education grant provision.
f) Med Bill corresponding to doctor’s prescription where medical extension is granted.
In case of fatal accidents , following documents will be scrutinised
1) Death Certificate
2) Post-Mortem Report
3) Coroner’s report.
4) Inquest report

Original documents to be returned, only photocopies retained.
Bills/Receipts for Company records
Affidavit for legal heir to be obtained.

All Risk



Theft Claim
In case of personal efects , invoice / bill should not be insisted upon but Market value should be the basis of settlement.While final police report should be called for , where it is not forthcoming within 6 Months of the loss, claim may be settled on the basis of 1st Investigation report lodged providedother documents are in order. Indemnity bond is to be obtained before settlement.



Baggage Insurance
Following Documents:
1) Duly completed claim form
2) Final Investigation Report
3) Survey Report
4) Photographs

In case of small losses upto a specified amount by dealing office.


Burglary Insurance
1) Duly completed claim form
2) Final Investigation report of police
3) Survey report
4) Photos
In case of small losses , dealing office can settle the claim.It is preferable to appointan investigator to check up books of accounts involving assessment . This has to be a licensed surveyor.
Waiver of Final Invest Report can be considered at the discretion of competent authorityso long as report does not raise any doubt. Subrogation / Indemnity letter is a must.


Money Policy
Following documents are considered important while processing claims:
1) Duly completed claim form
2) Final investigation report from Police
3) Survey Report

Incase of losses reported from premises , procedure to be followed on similar lines of Burglary.

However if infidelity of the employee is involved, Dept proceedings & / or criminal action to be initiated against erring employee

Limit per sending declared will be max. indemnity & average will not apply if cash carried is more than limit intimated.
Since policy is on adjustment basis , annual estimate of carrying does not have any bearing on claim.


Fidelity Guarantee
Completed Claim Fiorm , Survey Report & / or inestogator’s report & Final Investigation report.It is necessary to verify with the employer whether any amt. Is due to defaulting employee which can be withheld by the employer & adjusted against claim.

However, Final investigation report may be waived where the surveyor / Investigator have not raised any doubts as to cause / quantum of loss. Settlement of claim to be effected after obtaining letter of indemnity / subrogation from the Insured.

Where Dept. inquiry by employer has established guilt of the employe & asessment report is clean , settlement may be effected after suitable indemnity / subrogation letter is received from Insured without waiting for the outcome of any criminal action pending in any court of law./


Shopkeepers’ Insurance
Package Policy- Various covers such as Fire , burglary , cash in Transit , PA &/or liability.Depending on section aplicasble , procedure for settlement of claim/guidelines may be followed.


Householders’ Comprehensive

Each specified class would be same as per respective class.











































CLAIMS