General insurance

Introduction:
Insuring anything other than human life is called general insurance. Examples are insuring property like house and belongings against fire and theft or vehicles against accidental damage or theft. Injury due to accident orhospitalisation for illness and surgery can also be insured. Your liabilities to others arising out of the law can also be insured and is compulsory in some cases like motor third party insurance.

Why should one insure?

One of the main reasons one should insure is to protect ones belongings and assets against financial loss. When one has earned and accumulated property, protecting it is prudent. The law also requires us to be insured against some liabilities. That is, in case we should cause a loss to another person, that person is entitled to compensation. To ensure that we can afford to pay that compensation, the law requires us to buy liability insurance so that the responsibility of paying the compensation is transferred to an insurance company.

Who should buy general insurance?

Anyone who owns an asset can buy insurance to protect it against losses due to fire or theft and so on. Each one of us can insure our and our dependents health and well being through hospitalization and personal accident policies. To buy a policy the person should be the one who will bear financial losses if they occur. This is called insurable interest.

Types of general insurance:

         Motor Home Health Travel Corporate Fire Insurance Marine Insurance Engineering Insurance Miscellaneous Insurance

Guidelines for claims settlement by IRDA

Proposal for insurance:

 Except in cases of a marine insurance cover, where current market practices do not insist on a written proposal form, in all cases, a proposal for grant of a cover, either for life business or for general business, must be evidenced by a written document. It is the duty of an insurer to furnish to the insured frees of charge, within 30 days of the acceptance of a proposal, a copy of the proposal form. Forms and documents used in the grant of cover may, depending upon the circumstances of each case, be made available in languages recognized under the Constitution of India. In filling the form of proposal, the prospect is to be guided by the provisions of Section 45 of the Act. Any proposal form seeking information for grant of life cover may prominently state therein the requirements of Section 45 of the Act. Where a proposal form is not used, the insurer shall record the information obtained orally or in writing, and confirm it within a period of 15 days thereof with the proposer and incorporate the information in its cover note or policy. The onus of proof shall rest with the insurer in respect of any information not so recorded, where the insurer claims that the proposer suppressed any material information or provided misleading or false information on any matter material to the grant of a cover. Wherever the benefit of nomination is available to the proposer, in terms of the Act or the conditions of policy, the insurer shall draw the attention of the proposer to it and encourage the prospect to avail the facility. Proposals shall be processed by the insurer with speed and efficiency and all decisions thereof shall be communicated by it in writing within a reasonable period not exceeding 15 days from receipt of proposals by the insurer.

 

Factors affecting the claims settlement

The factors that affect the claims settlement are as follows:      The policy should be in force on the date of the event. The risk and cause of event should be covered by the policy. The cause of loss or the event should be directly related to the loss. A remote cause has no place in the settlement. The loss should not have been caused with an intention to gain from the situation. The preconditions or warranties have to be compiled with. When conditions to be fulfilled before affecting the cover of the policy, are not performed, the cover of insurance will not come into effect even though the premium is paid and accepted by the insurance company. Presence of insurable interest, in case of the property insurances, at least at the time of happening of event or loss sufferings. Without having the insurable interest in the subject matter, no person can get benefit or compensation. The assured should suffer loss, actual or constructive, to get compensation. The assured should riot make benefits or gains out of the insurance contract as the insurance contract is of indemnity in nature. It only makes good the loss suffered by the assured and is not a source of gains. Sufficient documentary evidence of loss should be presented along with the application form. Multiple claims and reciprocal claims will be settled as per the terms of the contract of insurance. Right to appeal or file a petition with the tribunal or the courts cannot be withdrawn. If the terms of the policy insist upon arbitration, it is not the end of justice for the insurer or the assured.

 

The insured may opt for the following alternatives while settling the claims:

  

Pay the claims as reported by the surveyor or the claims made by the insurer whichever is less. Take help of the agent or some other persons and compromise or to come to an agreement with the assured in case of a disputed claim. If the claim is rejected there may be litigation on the insurer. The litigation will cost the insurer more, as the insurer has to pay the interest for the amount due if he losses the litigation. Pay ex-gratia, if the claim is totally baseless and non-acceptable, on humanitarian grounds and to avoid complications in future. Arrange to replace the asset either by repairing the same or by purchasing a similar asset from the market. Repair the asset to provide the similar type of services as provided before the happening of event.

  

Claims settlement
Claims settled during the year
Maturity Year Number Amount Death Number Amount

2007-08 2006-07 2005-06

134.22 129.29 115.58

31,873.35 32,101.92 24,724.58

6.73 6.02 5.27

5,138.12 4,383.99 3,748.58

Claim settlement in general insurance:

1. Motor Insurance:
Remember to always carry the following documents in your vehicle:  Registration Certificate  PUC Certificate  Insurance Certificate  Always carry your Driving License on your person. What to do in the event of an accident.  Please attend to bodily injury, if any.  Note the numbers of the other vehicle involved in the accident, if any.  Try to note the names and contact details of witnesses, if any.  Fill up the claim intimation form (attached to your policy) to keep your replies ready for the Call Centre. Please immediately contact their Toll Free help line in the event of any claim. Answer a few simple questions. Their Call Centre executives are there to help.  In case of property damage, theft or bodily injury claims, file a First Information Report with the Police. In other circumstances FIR is not necessary.

Documents required for smooth processing of your claim:  Download Claim Form.  Driving License of the person driving the vehicle at the time of loss.  FIR, if it is a case of property damage or bodily injury claims or theft.  Vehicle Registration Book.  We may request for additional documents, if required, depending on the case. What insurance company will do? In the event of a claim, they reach you fast and handle the case transparently. Their claims representative will contact you within 48 hours of intimation. They will:       Inform you of procedures and documents Guide you to a high quality repair facility. Draw out assessment of repairs with garages - no need for an estimate of repairs from you. Authorize repairs and inform you of extent and cost. If desired, consequent to repair, we will make payment of our share of the loss directly to the garage i.e. net of excess & depreciation, if any. As mentioned in the policy, all rubber and plastic parts will be subject to a depreciation of 50 percent, irrespective of age of the car. Fibre items will attract 30 percent depreciation. Other parts will be depreciated according to the age of the car, as mentioned in the Policy

They also offer the services of their auto repair partners, insurance companys Secure Garages, who offer superior quality:     Infrastructure Manpower & Training Repair processes & practices Materials

Do's:  Do maintain a copy of the driving license of the driver, in case he is not available after the accident.  In case of Total Loss, please keep the wreck safe, until your claim is finalized.  One has the right to information. Please do understand how the surveyor & garage have adjusted ones claim, and his/her portion of claim.  In case of the death of driver/cleaner/workmen, obtain and forward Police Report / post mortem reports to insurance company.  Any notice from Third Party / Motor Accidents Claims Tribunal / court of law or any summons received concerning the accident has to be forwarded to insurance company. Don'ts:  Do not hand over your vehicle to anyone who does not have a valid driving license. It is illegal and against their duty as fellow citizens. It is easier to say "NO" the first time and every time.  Do not repair / dismantle the vehicle before the inspection of the Company Representative / Final surveyor.  Do not compromise / promise anything without the consent of the Company.  In case of the death of driver/cleaner/workmen, obtain and forward Police Report / post mortem reports to them.  Do not ignore small damages on windshield glass. In select cities they can guide you to the latest technology in glass repair. For more details on this, contact their Call Centre or the Claims representative.

2. Home Insurance:
What to do in the event of an accident.  Please attend to bodily injury, if any.  Please protect the property in the best way possible. If required take photographs. Immediately alert their Call Center. Immediately contact their Toll free help line on 1800-11-9966, in the event of any claim. Answer a few simple questions. Their Call Centre executives are there to help.  Try to note the names and contact details of witnesses, if any.  In case of theft or bodily injury claims, file a First Information Report with the police. In other circumstances FIR is not necessary.  In case of fire attended by the Fire Brigade, please seek a copy of their report.
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Documents required for smooth processing of your claim:  Download Claim Form.  Allow their representative to inspect and assess the damaged property before carrying out repairs.  FIR, if it is a case of property damage or bodily injury claim or theft.  Do not make any compromises without the express sanction of the company. What insurance company will do? In the event of a claim, they reach you fast and handle the case transparently. Their claims representative will contact you within 48 hours of intimation. They will:  Inform you of procedures and documents  Consequent to the repair, they will make payment of their share of the loss, i.e. net of excess & depreciation, if any, to you within seven working days. Do's:  Do maintain a copy of the policy handy.  In case of Loss, please keep the damaged property safe and unchanged, until ones claim is surveyed. Post survey one may carry out repairs.  Please offer all help to the surveyor to fulfill his / her responsibility.  You have the right to information. Please do understand how the surveyor has adjusted your claim, and your portion of the claim.  In case of the death of employee and coverage chosen, obtain and forward Police Report / post mortem reports to them.  A notice from Third Party / court of law or any summons received concerning the incident has to be forwarded to them..  Please procure bills and cash memos of the repairs done and submit them to the insurance company.  In case one has the original receipts of the property purchase it will help smoothen the claim process. Don'ts:  Do not repair / dismantle the property before the company representative / final surveyor's inspection.  Do not compromise / promise anything without the consent of the company.  Do not hand over your vehicle to anyone who does not have a valid driving license. It is illegal and against our duty as fellow citizens. It is easier to say "NO" the first time and every time.  Do not repair / dismantle the vehicle before the inspection of the Company Representative / Final surveyor.  Do not compromise / promise anything without the consent of the Company.  In case of the death of driver/cleaner/workmen, obtain and forward Police Report / post mortem reports to them.  Do not ignore small damages on windshield glass. In select cities they can guide you to the latest technology in glass repair. For more details on this, contact their Call Centre or the Claims representative.

3. Health insurance:
Please contact their 24-hour Toll Free Call Center on 1-800-11-9966. Please intimate the Call Center as soon as a claim occurs, in order for there to provide you prompt and effective assistance. Please have the following information ready when one calls the Call Center:  Your Contact numbers  Policy Number  Name of Injured person (s.no. in the schedule of the policy)  Designation and grade of the person and since when he is covered under the policy  Date & Time of Loss  Location of accident  Nature of accident  Nature of injury  Place & contact details where insured person may be visited (home/hospital) The following is a general check list of documents required for processing ones claim: Hospital Cash / Medical Benefit Claims  Claim Form  Attending Doctor's report  Hospital discharge card/ proof of hospitalization with details of treatment.  Bills with prescriptions  Pathological Reports/ X-rays, X-ray Reports. Weekly Benefit Claims  Claim form  Attending Doctor's Report  Disability Certificate from the Doctor, if any  Investigation /Lab reports (x-rays &reports etc.)  Original Admission/discharge card, if hospitalized  Employers Leave Certificate, with grade/designation  Details of salary-Latest Salary Certificate. Death Claims  Claim form  Attending Doctor's report  Original Death Certificate  Original / Attested Post Mortem / Coroner's report  Attested copy of FIR / Panchanama  Police Inquest report, where applicable

4. Travel Insurance:
24 hour Assistance Contact:  For the Americas Policies

For example: Direct Dial Toll Free Fax E-mail : : : : 713-260-5519 1-866-866-2619 713-953-7506 tata.aig@aig.com

Address for submission of documents: Claims Department, General Insurance Company Limited. A-501, 5th Floor, Building Number 4 Infinity IT Park, Dindoshi Malad (East), Mumbai, India - 400097. For rest of the world policies excluding the Americas Phone Fax E-Mail: : : 0091-11-4189 8860 011-4189 8801

delhi.tata-aig@internationalsos.com

Insurance companys Service Center is equipped to provide you with the necessary guidance in your situation, and will direct you on claims procedure. Note: Failure to call this number in respect of Medical Accident & Sickness Claims (Travel) shall invalidate your claim, if any. In case of OPD treatment (where hospitalization is not required), please collect all bills and receipts and file for reimbursement with insurance companies, Claims Department, at the address mentioned above. This is a General checklist of documents; please check for availability of coverage under the policy.  Medical Accident & Sickness Expenses

Documents Required       Claim form Doctor's report Original Admission/discharge card Original Bills / Receipts/Prescription Original X-ray reports / Pathological / Investigative reports Copy of passport / Visa with Entry & exit stamp
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Procedure           Please contact insurance companys Service Center at the number given above and obtains a Claim Form from them and fills in. It is necessary to obtain the attending physician's signature on the Form. Please collect all bills/receipts/invoices3. Send all documents to their Corporate Office at the address given below Loss of Baggage Documents Required Claim form Copy of the passport/Visa with Entry & exit stamp Copies of Baggage Tags Original Bills / Receipts / Prescription Copies of Correspondence with the Airline authorities/Others about loss of checked baggage Property Irregularity Report (obtained from Airline) Details of compensation received from Airlines/Other authorities, if any

Procedure     Intimate the airline about your loss and lodge complaints Claim Form can be obtained from their Service Center Fill in the Claim Form and send all documents to insurance companys Corporate Office at the address given below. Delay of Baggage

Documents Required     Claim form Copy of the passport/Visa with Entry & exit stamp Property Irregularity Report (obtained from Airline) Original bills / receipts / invoices pertaining to expenses

Procedure     Intimate the airline about your loss and lodge complaints Claim Form can be obtained from their Service Center Fill in the Claim Form and send all documents to their Corporate Office at the address given below Trip Delay

Documents Required    Claim form Original Bills of purchases made/ Expenses incurred during the period of delay Copy of Ticket & Boarding Pass

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Copies of Correspondence with the Airline authorities/Others about loss of checked baggage

Procedure    Claim Form can be obtained from their Service Center. Fill in the Claim Form and send all documents to our Corporate Office at the address given below. Loss of Passport.

Documents Required     Copy of new passport. Copy of previous passport (if available). Original bills / invoices of expenses incurred for obtaining a new passport. Copy of FIR / Police Report.

Procedure     File a complaint with the local police. Contact with the Indian Embassy, where ever necessary. Submit all documents to their corporate office at the address given below, along with a detailed statement. Personal Liability.

Documents Required     Full statement of the facts in writing. Witness statements. Any other documents relevant to the incident, including Summons, Legal Notice etc. Any other information you would like to share with them.

Procedure    Inform their Corporate Claims Dept. immediately (at the address given below) giving full details of the incident. Do not commit any benefit/compensation or enter into any agreement. Hijack

Documents Required     Full statement of the facts in writing. Claim Form. Airline correspondence (copy of Passenger List etc.) Copy of ticket / Boarding Pass.

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Procedure    Claim Form can be obtained from their Service Center Fill in the Claim Form and send all documents to insurance companys Corporate Office at the address given below Accidental Death & Dismemberment

Documents Required  Insurance companys Claims Department will advise on documentation, upon receipt of claim notification.

Procedure   Collect all documents pertaining to the loss including correspondence with Carrier and send to Corporate Office at the address given below. Claim Form can be obtained from their Service Center.

5. Corporate Insurance:  Immediate Action upon a Loss  Take all steps to minimize loss (e.g. fire fighting/-shifting material to safe place    

following Fire/ Flood/Accident/ Transit loss etc.) Take few photographs of location and affected items. Call the Engineer / Contractor / Supplier to analyze actual loss / damage - obtain detailed estimate of repairs Fully co-operate with the Surveyor in loss minimization/ control and in arranging inspection of items damaged. In respect of LOP, take all reasonable steps to restore the "Normalcy" position.

6. Fire Insurance:
Basic Documents Required          Claim Form duly filled in & signed. F.I.R, if filed. Fire Brigade Report (internal or external or both as the case may be). Forensic Departments report, if applicable. Laboratory test report together with the mandate given, if applicable. Record of Labour involved in activities related to claim. Original Repair/ Replacement Bills with receipt. Photographs if arranged. Departmental Note on the incident.

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Fire Loss of Profits Insurance - Basic Documents Required:        Claim Form duly filled in & signed. F.I.R, if filed. Books of accounts. Activities carried out at other premises. Details of Savings in Standing Charges. Details of Increased Cost of Working Details of trends in business.

7. Marine Insurance:
Ocean Transit                 Claim Form duly filled in & signed. Original Policy/ Certificate. Short Landing Certificate / Landed But Missing Cargo / Damage Certificate (as applicable). Suppliers Invoice. Packing List. Quadruplicate copy of Bill of Entry. Original Policy / Certificate. Steamer Survey report in original. (if arranged) Copy of Claim Notice served on Carrier / Port authorities along with postal acknowledgement card. Copy of correspondence with the carrier/ Port authorities/ Customs authorities. Copies of Correspondence exchanged with the suppliers (reply from suppliers is a must) in connection with short packing (if applicable). Lost Overboard Certificate from the Port Trust countersigned by the master of the vessel or steamer agents (in respect of Loss Over Board/ Sling Losses). Original Repair Bills with receipt/ Proforma Invoice for value of items lost/ damaged. Copy of Application filed with Customs for refund of Duty (if applicable). Photographs if arranged. Letter of Subrogation cum special power of Attorney.

Inland Transit (Rail) Basic Documents Required    Claim Form duly filled in & signed. Original Policy/ Certificate. Open delivery Certificate or copy of application for open delivery, Reply received from the Railways refusing open delivery, Copy of the letter of protest sent to Railways with the acknowledgement there to and certified extract of the remarks made in the station delivery or complaints book. Suppliers Invoice. Packing List.
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Copy of Claim Notice served on Railway along with postal acknowledgement card. Original Policy/ Certificate. Copy of correspondence with the Railways. Copies of Correspondence exchanged with the suppliers (reply from suppliers is a must) in connection with short packing. (if applicable) Original Railway Receipt. Original Repair Bills with receipt/ Proforma Invoice for value of items lost/ damaged. Photographs if arranged. Letter of Subrogation cum special power of Attorney.

Air Transit Basic Documents Required               Claim Form duly filled in & signed. Original Policy/ Certificate. Original Airway Bill. Quadruplicate copy of bill of Entry. Suppliers Invoice. Packing List. Copy of Claim Notice served on carriers along with postal acknowledgement card. Copy of correspondence exchanged with the carriers. Copies of correspondence exchanged with the suppliers (reply from suppliers is a must) in connection with short packing (for short receipt claims). Original Non Delivery Certificate (for Non Delivery Claims). Original Short Delivery Certificate (for Short Delivery Claims). Original Repair Bills with receipt/ program invoice for value of items lost/ damaged. Photographs if arranged. Letter of Subrogation cum special power of Attorney.

Postal Transits Basic Documents Required           Claim Form duly filled in & signed. Original Policy/ Certificate. Original Post Parcel Receipt. Suppliers Invoice. Copy of Claim Notice served on Postal Authorities along with postal acknowledgement card. Copy of correspondence exchanged with the Postal authorities. Original Non Delivery Certificate (for Non Delivery Claims). Original Short Delivery Certificate (for Short Delivery Claims). Original certificate of damage/ loss issued by the postal authorities (for Shortage/Damage Claims). Letter of Subrogation cum special power of Attorney.

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8. Engineering Insurance:
Basic Documents Required        Claim Form duly filled in & signed Original Repair Bills with receipt. Photographs if arranged. Log book details / extracts. Repair agency's report detailing their findings on Cause and the repair procedure suggested. Departmental Note on incident and repairs to be undertaken. Specification of Repair form filled by the repairer.

Machinery Loss of Profits Insurance Basic Documents Required        Claim Form duly filled in & signed. Books of Accounts. Record of Labor involved in activities related to claim. Details of Savings affected in Standing Charges. Details of Savings affected in Standing Charges. Details of Increased Cost of Working. Details of Trends of Business.

Marine cum Erection All Risks Insurance Basic Documents Required       Claim Form duly filled in & signed. Record of Labor involved in activities related to claim. Inventory of Loss. Original Repair Bills with receipt. Photographs if arranged. Makers report detailing Extent of Loss, Cause and suggested repair procedure.

Contractors All Risks Insurance Basic Documents Required       Claim Form duly filled in & signed Record of Labor involved in activities related to claim. Inventory of Loss. Abstract of relevant portion of Running Account Bill. Original Repair Bills with receipt. Photographs if arranged.

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Boiler & Pressure Vessel Insurance Basic Documents Required      Claim Form duly filled in & signed. Original Repair Bills with receipt. Details of Third party Claims. Photographs if arranged. Boiler Inspectorate's report.

Electronic Equipment Insurance Basic Documents Required      Claim Form duly filled in & signed. Original Repair Bills with receipt. Photographs if arranged. AMC/ Repair agency's report detailing Extent of damage, Cause and suggested repair procedure. Report filed by the AMC in the visit immediately preceding the Loss Date.

9. Miscellaneous Insurance:
Burglary Insurance Basic Documents Required      Claim Form duly filled in & signed. Claim Bill with supporting documents. First Information Report / Final Investigation Report. Photographs if arranged. Letter of Indemnity.

Baggage Insurance Basic Documents Required      Claim Form duly filled in & signed. F.I.R / Final Investigation Report/ Certificate from transport agency. Claim Bill. Document to substantiate loss. Letter of Indemnity

Cash in Transit Insurance Basic Documents Required     Claim Form duly filled in & signed. Claim Bill. F.I.R / Final Investigation report. Statement of Witnesses, if any
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Document to substantiate loss. Records of Departmental proceedings where applicable. Letter of Indemnity.

Fidelity Guarantee Insurance Basic Documents Required         Claim Form duly filled in & signed. Details of amounts / deposits adjustable towards the claim. Claim Bill. F.I.R / Final Investigation report. Document to substantiate loss. Notarized written statements from the employee concerned/ other relevant persons. Records of Departmental proceedings where applicable. Letter of Indemnity

Workmen's Compensation Insurance Basic Documents Required Claim Form duly filled in & signed.  Claim Bill.

Temporary Disablement Claims:   Medical Certificate regarding Cause & Duration of Disablement. Medical Bills.

Permanent Disablement Claims:   Medical Certificate regarding Disablement. Memorandum of Agreement as per W.C Act between Insured and the injured workman.

Fatal Claims:      Death certificate. Copy of post Mortem report. F.I.R / Final Investigation report? Form A of W.C Act duly completed by the Insured. Statement of Witnesses, if any?

Note: The documents mentioned above are primary documents and further documents/Clarifications as deemed fit may have to be called.  Provisions relating to MODVAT to be understood and adjusted accordingly in the Claim.

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Fidelity Guarantee Insurance         Claim Form duly filled in & signed. Details of amounts / deposits adjustable towards the claim. Claim Bill. F.I.R / Final Investigation report. Document to substantiate loss. Notarized written statements from the employee concerned/ other relevant persons. Records of Departmental proceedings where applicable. Letter of Indemnity

Conclusion
The insurance business is major service oriented business in the world. The services offered by the insurance industry are well recognized and utilized by the general public and commercial sector of the world. The general insurance business has covered nearly 40% of the population of the world. Global players with strong brands in the insurance industry today set up their back office operation in low cost countries, manage capital on a global basis, make use of their special skills worldwide and use their superior managerial ability to secure leadership positions in the industry. The claims management is an integral part of insurance. It involves the storage, processing and transmission of information relating to settlement of insurance claims. The use of Information Technology also plays a very important role in claims settlement. In managing the claims handling function, insurers seek to balance the elements of customer satisfaction, administrative handling expenses, and claims overpayment leakages. As part of this balancing act, fraudulent insurance practices are a major business risk that must be managed and overcome. Disputes between insurers and insureds over the validity of claims or claims handling practices occasionally escalate into litigation which should be solved with due care. In this fast developing scenario it will not be enough if companies have the futuristic strategies. Implementation of the strategies, effectively adapting them to ongoing changes can spell success. The success of claim management depends on the satisfaction of the customers. The customers are attracted to an insurance company by its state of art claim service. Therefore, before designing an IT system for claim management, customers expectations are to be taken in to account. The customers, their needs, knowledge of how the market works, and what they want, these are the things that are important for an insurance company for serving the customers in a better manner through better technology.

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Bibliography

The information is taken from various sources such as books, magazines, articles, internet etc. Books:     Theories and Practices in Insurance Insurance watch Business world Business today

Webliography

    

www.insuremagic.com www.licindia.com www.icicprulife.com www.insurancewatch.com www.insuranceonline.com

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