This document provides an overview of the claim process for SCE/CAR (sum insured/contractor's all risk) insurance claims. It discusses the major stages of the claim process including documentation requirements. Tips are also provided on speeding up the claims process and avoiding disputes. Common areas of dispute are outlined along with case studies and examples to illustrate potential issues. The goal is to provide a professional approach to navigating the claims process efficiently.

1. SCE/CAR/MCE CLAIMS :
PROFESSIONAL APPROACH
Vimal Goyal
FIII, ACII (London),
Chartered Insurance Broker,
Director
SMC Insurance Brokers P. Ltd.
vg@smcindiaonline.com
vkgnia@hotmail.com
Cell +919899699304

2. Tips
To avoid
Disputes
Claim
Process :
Major stages
Claim
Process :
Documentation
How to
Speed up
Process
Introduction
Case
Studies
Areas of
Dispute

3. INTRODUCTION :
Significance of claims
 Delivery of promise
 Displays attitude :
 You are with insured or take it as a burden
 You help at each step or do just postman’s job & leave to
mercy of surveyor and insurance co.
 Test of underwriting precautions, add-on covers
 Shows competence to service the insurance portfolio
 Trust of client in insurer
 Faith in the intermediary
 Can strengthen or demolish long term relationship
with the insurer and intermediary
 Publicity through word of mouth

4. CLAIM PROCESS :
Major stages in life cycle of a claim
 Intimation of claim: Policy no., Address, contact, Loss Estimate
 Deputation of surveyor by insurance co.
 Action for recovery from Carrier / shipping co. for marine part
 First visit of surveyor and on-site verifications
 Go ahead for further action : dismantle/repair/replacement
 Letter of requirements from surveyor (LOR)
 Submission of documents, discussions, response to queries of
surveyor, Request for on account payment
 Replacement / repair/strengthen, its verification by surveyor
 Salvage disposal process : Tender / auction
 Assessment, Consent and submission of survey report
 Processing by insurance co., addressing their queries
 Approval, discharge, NOC, Subrogation (marine), Payment

5. CLAIM PROCESS :
Documentation for SCE/CAR claims
General (List is not exhaustive)
 Copy of the written intimation to insurer
 Copy of the insurance policy
 Occurrence report & Statement of eye witnesses
 Segregation Report : damaged and undamaged
items, Extent of damage
 Proposal for loss minimization efforts and docs
 Profile of the Company
 A brief write up about the affected project: date of
start, specifications, bar chart, work completed
before DOL, bills raised to principal, past claims.
 Tender document and Bill of quantities (BOQ)

6. CLAIM PROCESS :
Documentation for SCE/CAR claims
General (contd…)
 Bills for repairs/ invoice for replacements, wherever
applicable with payment proof
 Photographs / Video at different stages
 Documentary evidence in support of the amounts
claimed
 Copy of the intimation of the loss to Police, Fire
Brigade and any other authority
 Fire Brigade report / Meteorological deptt. report (in
case of flood, cyclone etc.)
 Daily Diary report / FIR issued by the Police
 Photographs, Video, CCTV footage, News paper clips
 Duly completed claim form and Claim bill

7. CLAIM PROCESS :
Documentation for SCE/CAR claims
General (contd…)
 Test report by the Quality Control personnel
 Drawing layout of the Fire hydrant points and fire
fighting equipment
 Documents to establish adequacy of insurance : how
sum insured arrived at, total project cost
 Purchase invoices of all items above certain amt.
 GST, Import duty : Reversal / input credit, exemption
 Estimated quantities for salvage items
 Offer for salvage value / Docs as per Salvage process
 Final Survey report

8. CLAIM PROCESS :
Documentation for SCE/CAR claims
Building
 Complete dimensioned layout of the premises
marking the area affected by fire
 Structural engineers inspection report along with
results of the tests conducted giving the condition of
affected building and repair methodology
 Item wise estimate of the repairs of the damaged
portion of the affected building giving the item name,
qty, rate & amount for the material and labour
 BOQ separately for existing (damaged +
Undamaged) and new design, if there is any change
in the design / specifications.

9. CLAIM PROCESS :
Documentation for SCE/CAR claims
P&M and other assets
 Layout of the premises marking the installation of
the various machinery
 'Single Line Diagram (SLD)' showing the electrical
connections from the main to the end consumer P&M
 Service Engineer/OEM's Report with nature of
damage, cause of damage, method of restoration,
estimate of repairs
 Estimates/quotations of repairs and replacement
machine-wise with specifications duly supported with
copy of the original procurement invoice
 Technical data, specifications, operating parameters
before and after reported failure / damage.
 Original purchase invoice, Quote for replacement (if
second hand)

10. CLAIM PROCESS :
Documentation for SCE/CAR claims
Stocks (at site or off-site storage location)
 Stock ledger : Received and issued with supporting documents
 Itemized purchase ledger for specified period
 Purchase invoices, import documents, transportation documents
etc. to substantiate the claimed quantities and value.
 Estimate of loss in respect of the damaged stock, along with
cost supporting documents giving costing of each article
(Excluding profit element)
 Volumetric analysis of stocks for each type of material : Floor
plan, item name and quantity stored in each area
 Details of damaged and undamaged items (Quantities and
value) : items identified as affected / damaged from remains,
items saved
 Testing report after the loss with explanation on standard
parameters and deviations in test result

11. CLAIM PROCESS :
Documentation for Marine claim
Recovery Rights
 Intimation to carrier / shipping co. and invitation for joint
inspection (within 72 hours) : If loss observed after delivery
 Copy of monetary claim lodged on railways/road carriers/postal
authorities/shipping co. within time limit
 Postal Acknowledgement for monetary claim lodged (if received
back), otherwise proof of sending the letter by Regd. AD post.
 Reply to the monetary claim lodged, if any
 Original open delivery / short delivery / Non-delivery Certificate
/ Damage Certificate issued by Carrier (Insured obliged to make
best of efforts to obtain this)
 Letter of Subrogation & Special Power of Attorney

12. CLAIM PROCESS :
How to speed up the process
 Maintain and provide standard formats to the insured
 Take the claim as a project and make someone from client side
as Project in-charge
 Joint meeting of all concerned on insured side, earmark and
assign documentations in three categories:
 Readily available internally
 Can be prepared internally
 To be sourced from outside agencies
 Assigning of duties to concerned persons : Name, time-line
 Mark and Prioritize documents to get “Go ahead” for next
course of action
 Review to take updates every week : speak to concerned
persons / assignee directly to clarify his concerns / issues
 Discuss and brain-storm difficult areas and decide / ask client to
decide to make the choice out of different options
 Scrutinize documents from surveyors and insurer’s perspective

13. CLAIM PROCESS :
How to speed up the process
 Don’t hesitate to provide documents to surveyor in piecemeal :
give surveyor opportunity to review documents received
 Persistent follow-up with client, surveyor, insurer at least on
weekly basis : Follow-up telephonic discussions by email
 Regularly discuss and maintain cordial relations with surveyor
and insurers : Do not create any ego issues on either side.
 Correspondence and discussions : polite, does not help to be
offensive. Present differing point of view as academic discussion
 Keep legal aspects in mind but never use legal words
 Don’t manipulate documents : Surveyors have means to know
through scrutiny.
 Presentation : easy to co-relate, qualitative, makes a lot of
difference.
 Grey Areas : After informal discussions, present the view point
in a logical and forceful manner.

14. CLAIM PROCESS :
Areas of dispute
 Claim not payable / liability is denied
 Exclusions : Loss discovered at time of taking inventory, Faulty design
(CAR), Breakage of Glass, Testing done but principle not taken over
 Policy coverage : Duration - Loss after testing / 4 weeks of readiness,
Defect liability / extended maintenance cover : link to occurrence before
commissioning
 Breach of condition : Delay in intimation, fraudulent means
 Fear of damage, fear of liability, breach of regulation, Govt authority action
 Claim file closed as NO CLAIM: Non-compliance of requirements
 Deduction from claim amount :
 To the extent included in S.I. : BOQ, Excise, Freight (expediting cost)
 Loss during transit OR during storage / handling / erection
 Loss minimization expenses
 Burglary/theft in multiple events,
 Debris removal : Dismantling expenses, Foreign Debris
 Non-standard settlement of claim
 Breach of express warranty, Loss of recovery rights in marine
 Inordinate Delay in settlement of claim
 By surveyor : Busy in other assignments, piecemeal, response time
 By insurance co. : Queries in piecemeal, officials on leave/tour/busy

15. Examples of disputes and :
Tips to avoid disputes
 Photo / video at different stages (particularly wet risks)
 Maintenance Cost sheet, SI working and BOQ of each project
incl material supplied by principals
 Second hand machinery : declaration
 Cover for site office and its contents
 S.I. for Debris removal to cover dismantling expenses, external
/ foreign debris (To check link to percentage of claim amt.)
 Reusable scaffolding / shuttering material : CPM
 Additional or increased expenses cover as a result of insured
peril (Boulders to be removed to access project site)
 Put to use endorsement
 Amendment to fire fighting endorsement
 Additional duty cover
 Stretch warranty for road
 Transmission line exclusion by PSU insurers duty to treaty limits
 Building in course of construction, items lying in store
 Go through and understand tariff endorsements and warranties

16. CLAIM PROCESS :
Case studies
 Road and Bridge : Put to use / operation
 Flood linked to rainfall data on different dates : multiple excess
 Water leakage from overhead tank
 Theft by other contractors or their staff working at site
 Escalators : Truss, Chinese Engineers
 Transformer, Panel, Gilks for Sikkim Govt.
 Fire in temporary office
 Excise : Centvat credit Original purchase, Repl. purchase
 Theft of parts of transmission lines
 Storage in open along the long area of project
 Electrical cable damaged gradually : Extended maintenance
 Fire : absence of fire fighting equipment
 Bridge on River : to the extent included in original scope
 Natural topography damaged : artificial to be created after loss
 Temporary road for diversion after damage, signs / watchman
 Cause of damage in Road Bridge slip case

17. Any questions?

18. THANK YOU
Vimal Goyal
FIII, ACII (London),
Chartered Insurance Broker
vg@smcindiaonline.com
vkgnia@hotmail.com
Cell +919899699304