2. LITIGATIONS
IN CASE OF SETTLEMENT AMICABLE TO
BOTH THE INSURED & THE INSURER,
MATTER GETS CLOSED. HOWEVER,
IF THERE IS ANY DISPUTE ON THE ADMISSIBILITY OR
THE QUANTOM OF CLAIM AMOUNT,
THE LITIGATION TAKES THE LEGAL PATH &
WILL BE CONCLUDED EITHER BY COURT OF LAW OR
BY ARBITRATION, AS PER THE PROVISIONS MADE
IN THE POLICY, WHICH ITSELF IS A LEGAL DOCUMENT
OUT OF COURT SETTLEMENTS
THE CLAIM CAN BE SETTLED
OUT OF COURT,
ON A/C PAYMENTS CAN BE MADE FOR IMMEDIATE RELIEFS
IN CASE OF BIG CLAIMS,
AFTER GETTING SATISFIED ON THE GENUINENESS & THE URGENCY
OF INDIVIDUAL CASES
OTHER AGENCIES INVOLVED
TPA’s, TAC, IRDA,
CONSUMER FORUM,
OMBADSMAN,
EXPERS IN LAW,
TECHNICAL EXPERTS
THE GAME
INSUANCE COMPANY’S JOBS
Issuing the policy document as per the
proposal form details
Endorsing the policy as per the intimation of
additions/deletions
Process the claim as per the Survey
report/Investigation report
In case of differences, corroborate the
Survey report & Insured’s versions
Speedy claims processing
Legally go on as per policy issued, in case of
litigation
INSURED’S JOBS
.Filling the proposal form details
.Intimating Additions/Deletions
.Declare Sum Insured adequately
.Wherever possible, selection of risk
.Complete the claim form properly
.Proper documentation as required by Insurance
Company, such as FIR, Police Report, Policy copy etc.
.Establishing the cause of accident with proper logical
reasoning with required documents.
.Substantiating the claim amount by proper bills &
documents
.Clarifying the surveyor’s doubts
SURVEYOR’ JOB
Assess the loss with proper documentation
as per policy conditions,
without any bias,
as a third party (legally)
&
Submit to the Insurance Company.
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3. Bridging the Gaps in business processes
Between
Client
&
Insurer
Based on the contract combining human &
digital skills
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4. Insurance Business involves
1. Underwriting
Identification of Risk
Evaluation of Risk
Pricing of Risk
Terms & conditions of Risk Coverage
2. Contract Administration
Preparation of Policy with proper terms & conditions
Endorsements for changes of conditions / alterations
Legal validation
3. Claims process
Intimation in prescribed claim form
Documentation to prove cause & extent of loss
Documentation to prove the adequacy of sum to get
proper Indemnity
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5. Basically Insurance Business deals with documents & in
business optimization process now a days IT enabled
services are used both by Insurers & Clients, as
digitalization has made the handling of documents
convenient to both.
However, Digitalized ITESs do not talk to each other
properly, meaning, EXCHANGING of required
INFORMATION is manual (& hence involves Human
skills), not electronic.
Whenever any information is required by the INSURER,
that is converted in to PDF or Paper form or
INTERPRETED by HUMAN skill (Resource) & entered in
to corresponding SYSTEMs.
This leads to “Interpretation of POLICY RULES at
various stages, leading to “Room for different
Analysis” of the same information.
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6. Systems of carriers & clients should be designed,
as far as possible, in such a way that they talk to
each other themselves on the INFORMATION
requirements & EXCHANGE themselves to speed
up INSURANCE BUSINESS involving, U/W, Policy
Admn. & Claims processing.
Aggregation & Risk Management plays an Important
role & needs to be embedded in the solution
design.
At the end, with HUMAN SKILLS, IDEA has to be
Insurance Digitalization Enhancement Ability to
optimize the Insurance Business Solution.
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