GENERAL INSURANCE CLAIMS MANAGEMENT

1. General insurance claims
Ram Awadh Singh-Research scholar
BSc.(IS), DME, PDTQM&ISO 9000, AIII, MBA, FIIISLA
If you are fortunate, You may never have to go your
insurer. However, when things may go wrong and you are
involved in an unexpected accident , disaster or other loss
that is covered by your insurance policy you can make a
claim with your insurer

2. What is a claim
• When you suffered a loss or damage that you believe is
covered under the policy taken from any insurer. You
make a claim that means you are formally notifying the
insurance company for action on the claim.
• The insurer will review your claim or see if the event or
circumstances are covered under the policy.
• You will need to provide the proof and Insurer will
need to be certain that the lodged claim satisfies the
terms and condition of the insurance policy .

3. Steps in making the claims.
• Making a claim is usually straight forward and
quick.
• Contact your insurance company soon after
the accident, event , misfortune happened
specially in cases of theft and serious accident.
• Step by step approach and don’t overlook any
of important steps in the process.

4. Before you claim
• Safety first: precautions in the event of
accident and damages.
• Contact the police in case of serious events/
damages, disaster.
• Review your policy and coverage, amount of
excess you may need to pay.
• See list of exclusions for your policy.

5. MAKING A CLAIM
• Contact your insurer or broker and collect as much
information as you can.
• Know the full extent of damage or loss and report
accordingly.
• Some type of claims can be lodged /made over the phone.
However in most of the claims you need to fill the claim
form and make claim through written intimation.
• Minimize the loss- It is safe to do so, take steps to protect
your property by undertaking temporary repairs or
removing undamaged possessions. Damaged or soiled
items that may be health hazard can be moved to a safe
area.

6. Records
• Provide evidence and keep a written records.
• Original receipts.
• Original police reports.
• Valuation reports .
• Medical certificates.
• Product make, model and serial number.
• Photographs or videos of property or item ot the
event it self.
• Keep records of all paper submitted to the
insurers.

7. Insurance surveyor and loss assessor
• The loss / claims exceeding Rs 20000.00 are
entrusted to the insurance surveyors and loss
assessors who examine the situation, your loss
its value and then they advice the insurers to
make decisions on your claim.
• SLA should be the members of Indian
Institute of surveyors and loss assessors
Hyderabad a body of surveyors.

8. INDIAN INSTITUTE OF INSURANCE
SURVEYORS AND LOSS ASSESSORS
• Insurance (Amendment) Act, 2015
• Section 82 is new section for substitution of
section 64UM (Surveyors or loss assessors)
Insurance Act, the following section shall be
substituted namely—
• 64 UM (I) Save as otherwise provided in this
section, no person shall act as a surveyor or loss
assessor in respect of general insurance business
after the expiry of a period of one year from the
commencement of the Insurance Laws
amendment Act, 2015 unless he-

9. SLA
• (a) Posses such academic qualification as may be
specified by the regulation made under this act
and
• (b) is member of a professional body of surveyors
and loss assessors, namely, The Indian Institute of
Insurance surveyors and loss assessors:
• Provided that in the case of a firm or company all
the partners or directors or other persons, who
may be called upon to make a survey or assess a
loss reported as the case may be , shall fulfill the
requirement of clauses a and b.

10. • (2) Every surveyor and loss assessor shall comply with
the code of conduct in respect of his duties,
responsibilities and other professional requirement as
may be specified by the regulation made under the
Act.
• (3) Not withstanding any thing contained in the for
going provisions , a class or class of persons acting as a
licensed surveyor or loss assessor prior to the
commencement of the Insurance (Amendment) Act,
2015 shall continue to act as such for such period as
may be specified by the regulation made under this
act.

11. (4) No claim in respect of a loss which has
occurred in India and requiring to be paid or
settled in India equal to or exceeding an
amount specified in the regulation by the
authority in value on any insurance policy of
insurance arising or intimated to an insurer at
any time after the expiry of period of one year
from the commencement of The insurance
Laws( Amendment) Act, 2015 shall unless
otherwise directed by the authority,

12. • Be admitted for payment or settled by the insurer
unless he has obtained a report , on the loss that
has occurred , from person who holds a license
issued under this section to act as surveyor and
loss assessor (“here after referred as approved
surveyor or loss assessor”).
• Provided that nothing in this sub-section shall be
deemed to take away or abridge the right of
insurer to pay or settle any claim differ from the
amount assessed by SLA.

13. IRDA AND REPORT
• (5) The authority may , at any time ,in respect of
any claim of the nature referred to in sub-section
(4), call for an independent reports from any
other approved surveyor or loss assessor
specified by him and such surveyor or loss
assessor shall furnish such report to the authority
within such time as may be specified by the
authority or if no time limit has been specified
by him within a reasonable time and the cost of
,or incidental to,suchreport shall be borne by the
insurer

14. • (6) Authority may , on receipt of report referred
to in sub section 5 issue such direction to insure
to settle the claim less than or more than at
which it is proposed to settle insurer shall be
bound to comply with such direction.
• Provided further amount already paid in excess
can not be recovered from t5he insured. Nothing
in this subsection relieves the insurer from any
liability , civil or criminal to which he would have
been subject .

15. Insurers can not pay fee for survey loss
assessment to other than SLA
• (7) No insurer shall , after the expiry of a
period of one year from the commencement
of the Insurance Laws (Amendment )Act,2015
pay to any person any fee or remuneration for
surveying , verifying or reporting on a claim of
loss under a policy of insurance unless the
person making such survey , verification or
report is an approved surveyor or loss
assessor.

16. Assessment of losses below the
amount specified
• (8) Where , in the case of claim of less than the
amount specified in subsection (4) in value on
any policy of insurance it is not practicable for an
insurer to employ an approved SLA without
incurring expenses disproportionate to the
amount of the claim , the insurer may employ any
other person( not being a person disqualified for
the time being for being employed as SLA for
surveying such loss and may pay such reasonable
fee or remuneration to the the person as he may
think fit.

17. • (9) The authority may in respect of any claim
of value of less than the amount specified in
subsection (4) on an insurance policy, if the
claim has not been or is not proposed to be
reported upon by a SLA , direct that such claim
shall be reported upon by an approved SLA
and where the authority makes such direction
, the provision of sub-section (5) and (6) shall
apply.

18. • (10) Where, in relation to any class of claim,
the authority is satisfied that it is customary to
entrust the work of survey or loss assessment
to any person other than a licensed surveyor
or loss assessor , or it is not practicable to
make any survey or loss assessment , it may ,
by an order , exempt such loss of claim from
the operation of this section .

19. SLA LICENSING PROCEDURE
• In exercise of the powers conferred by the
section 42D, 64 UM and 114 A of the
insurance Act, 1938( 4 of 1938) read with
section 14 and 26 of the IRDA Act, 1999(4 of
1999 the authority in consultation with the
Insurance Advisory committee here by makes
the following regulation to further amend the
Insurance surveyors and loss assessors (
Licensing professional requirement and code
of conduct) Regulation, 2000 namely.

20. Licensing procedure
• 1-Every person who is student member of the institute and
intending to act as a surveyor and loss assessor in respect of
general insurance business shall apply to the authority for grant of
license in form IRDA-1-AF as given in the schedule of regulation.
• The authority while considering the application made under sub
regulation (1) for grant of license as a SLA take in to consideration
all matters relating to the duties ,responsibilities and functions of
SLA and satisfy itself that the applicant is fit and proper person to
be granted a license. In particular and without prejudice to the for
going the authority shall satisfy it self that the applicant satisfy all
the requirement of section 64 UM read with section 42D of the Act,
and rule 56 A Of Insurance rules , 1939 and fulfils the eligibility
criteria set out in regulation 3 of these regulations.
• The applicant shall pay fee to the licentiate level of membership
through online /RTGS/NEFT/Demand draft in favour of IRDA and
furnish evidence of payment.

21. Documents to be enclosed
• 1 Application form IRDA 1-AF dully completed in all respect.
• Copy of membership certificate of IIISLA.
• Copy of recent photographs-1.
• Copy of PAN.
• Copy of proof of residence.
• Proof of qualification.
• Copy of training completion certificate.
• Copy of quarterly report 4 qtrs of the trainer SLA.
• Copy of mark sheet in proof of having passed the surveyor examination
conducted by Insurance institute of India provided under Reg -16.
• NOC from employer .
• Affidavit as stated in the form 1-AF.
• Self addressed envelops, Demand draft, other payment evidence copy

22. Application for grant of fresh corporate license
• Provided that none of the directors or partners suffers from any of the
disqualification mentioned in section 42D of the insurance Act, 19938 read
with 42(4) of the Act.
• There shall be at least two directors /partners in the company or the firm at
any point of time who are members of the institute and are licensed to act as
SLA . The department and level of membership of the directors /partners
under their individual surveyor license shall become the department and level
of membership of the company /firm. Any licensed SLA appointed as director
or partner of a firm /company seeking application for grant of corporate
license shall undertake survey jobs and issue survey reports only in the
capacity of director /partner of the applicant company/firm.
• Licensed surveyors who are working as employee of the company /firm shall
undertake survey jobs only of that company with whom he/she is employed
with . The employee shall undertake survey jobs only to those department and
level of membership allotted to him/ her under his her individual license .
• Upon grant of corporate license , the company firm can undertake survey jobs
only in those department and level of membership displace against each of
the director /partner in the corporate license issued by the authority.

23. Corporate SLA
• None of the director or partner of one corporate firm shall be
appointed as director or partner in another surveyor firm.
• The main object of the company /firm shall be to carryout
insurance survey and loss assessment and name of the company or
firm shall include the words “ Insurance surveyors and loss
assessors”.
• The aggregate holding of the equity shares held by a foreign
company shall be disclosed at the time of making the application
for grant of license which shall not at any time exceed 26(49)% of
the paid up equity capital of the applicant or such other percentage
as may be specified by the authority. The manner of calculation of
26(49)% FDI shall be identical to the one specified for Indian
insurance companies.
• Ensure that same promoter or subscriber of the applicant does not
have mote than one corporate license.

24. • Shall pay fees based on the highest level of
membership of any of the director /partner as
provide under regulation 5 through online net
banking /RTGS/NEFT/Demand draft ( in favor
of IRDA payable at Hyderabad) and furnish
evidence of payment made.

25. Document need to enclose
• Application in form –IRDA -3AF duly completed in all respect.
• Copy of membership certificate issued by the institute to the directors /partners.
• Copy of recent photos of directors / partners.
• Copy of surveyor license of directors /partners.
• Copy of certificate of incorporation issued by ROC in case of company.
• Copy of partnership deed in case of firm duly signed by all the partners.
• Copy of memorandum and article of association of the company.
• Copy of form no. 32 filed with ROC.
• Copy of form no. 18 filed with ROC.
• Copy of form no. 4 filed with ROC
• Copy of TAN.
• Proof of qualification of directors /partners .
• Affidavit as stated in the form IRDA-3 AF.
• Self addressed envelop, DD, evidence of payment.

26. disclosures
• (a) Submit a declaration that prier to joining corporate firm , the
individual surveyor shall complete all jobs entrusted to them
completed within the time lines provided under regulations 9 of
PPI, regulations, and that upon grant of corporate license, such
surveyor shall hence forth work only under the corporate license.
• Submit a declaration that they shall submit information about
resignation/ death/suspension of director or partner, Change in
share holding pattern and such other material changes to the
authority and apply in form 18 AF as given the schedule to these
regulations within 15 days of such change for grant of modified
license. The earlier license shall be surrendered along with the
application for modified license.
• Shall apply in form 3-AF and IRDA on being satisfied shall grant the
same in form IRDA-4 LF.

27. Regulation 5, Fee payable
• The fee payable to IRDA for grant of license.
• Fellowship -10000/- (Individual) Rs 25000/ -Corporate.
• Associate -7500/- (Individual ) Rs 20000/ Corporate.
• Licentiate - 5000/- (Individual ) Rs 15000 /-Corporate.
• Renewal of license
• Form IRDA 5-AF for individual
• Form IRDA 6-AF For corporate
• An application for renewal of license including online submission of the
application shall reach the authority at least 30 days before the expiry of
the period of validity thereof.
• Penalty for late renewal Rs 750/- for the period of 6 month after the
expiry .
• More than 6 month fresh license will be issued and level may be
maintained as earlier.