Folabi

1. Dammmm son
2. Claims
3.
4. The Settlement of claims constitutes one of the important functions in an insurance
organisation. The proper settlement of claims requires a sound knowledge of thee law,
principles and practices governing insurance contracts and in particular a thorough knowledge
of the terms and conditions of the standard policies and various extensions and modifications
there under. The procedure in respect of claim a under various classes of insurance follows a
common pattern and may be considered under 3 broad headings
5.
6. 1. Preliminary procedure
7. It is essential that early notification of the loss is received by insurance undue delay in
notification would adversely affect the position of the insurer. However if there is any delay in
notification or not or weather is material will be ultimately decided by the courts based on the
facts of the individual cases
8.
9. The notice of loss condition in liability policies provides for two aspects
10. a) Notification of the happening of the accident immediately followed by
11. b) Notification of the receipt of claim or suit filed against the insured.
12.
13. Under certain types of policies (e.g. Burglary) notice is also to be given to police authorities.
14.
15.
16. 2. Loss Minimization
17. At common law, there is a duty on the part of the insured to observe good faith .This duty of
good faith means that at all times the insured has to act as if he is uninsured.
18.
19. For E.g., the private car package policy provides , among other things , that the insured shall
take all reasonable steps to safeguard the motor car from loss or damage and to maintain it in
efficient condition. In the event of any accident or breakdown the motor car shall not be left
unattended without proper precautions being taken to prevent further damage or loss.
20.
21. 3. Procedural
22.
23. On receipt of intimation of loss or damage insurers check that:
24. a) the policy is in force on the date of occurrence of the loss or damage
25. b) The loss or damage is by a peril insured by the policy.
26. c) Notice of loss received without undue delay.
27.
28. After this check up the loss is allotted a number and entered in the claims register.
29.
30. 4. Claim Forms
31. The contents of the claim form vary with each class of insurance .In general the claim
in general the claim form is designed to elicit full information regarding the circumstances of
the loss such as date of loss, time, cause of loss, extent of loss etc claim forms are invariably
sued in fire and miscellaneous insurance.
32.
33.
34. 5. Investigation and Assessment
35. On receipt of the claim form duly completed from the insured the insurers decide
about the investigation and assessment of loss if the loss is small the investigation to
determine the cause and extent of loss is done by an officer of the insurers. Some times even
this may be waived and the loss settled he basis of the claim form only.
36. The investigation of larger or complicated claims is entrusted to independent
professional surveyors who are specialist in their line the appointment of a surveyor is
intimated to the claimant the surveyor is furnished with all relevant claim papers such as
claim form policy copy etc…However, many a times surveyor is appointed and survey is
carried immediately on receipt on notice of loss, that is even before claim form could be
issued.
37.
38. 6. Claims documents
39. In addition to the claim form independent survey report certain documents are
required to be submitted by the insurers to substantiate the claim for example for fire claims
for fire claims a report for the fire brigade for motor claims driving license registration copy
police report etc
40.
41. 7. Arbitration
42. It is distinct from litigation and is a method of settling disputes under contract in
accordance and conciliation act 1996.
43.
44.
45. 8. Settlement
46. The claim is processed on the basis of Claim form Independent report from Surveyors,
legal opinion, medical opinion etc as the case may be. Various documents furnished by the
insured. Any other evidence secured by the insurers. If the claim is in order settlement is
effected by cheque the payment is entered in claims register as well as in the relevant process
record. Appropriate recoveries are made from the insurers if any.
47.