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INSURANCE CLAIM

MANAGEMENT

INTRODUCTION
Insuranceis a means of protection from financial loss. It is a form of
risk managementprimarily used tohedgeagainst the risk of a contingent,
uncertain loss.
An entity which provides insurance is known as an insurer, insurance
company, or insurance carrier. A person or entity who buys insurance is
known as an insured or policyholder. The insurance transaction involves the
insured assuming a guaranteed and known relatively small loss in the form
of payment to the insurer in exchange for the insurer's promise to
compensate the insured in the event of a covered loss. The loss may or may
not be financial, but it must be reducible to financial terms, and must involve
something in which the insured has aninsurable interestestablished by
ownership, possession, or preexisting relationship. he insured receives a
contract, called theinsurance policy, which details the conditions and
circumstances under which the insured will be financially compensated. The
amount of money charged by the insurer to the insured for the coverage set
forth in the insurance policy is called the premium. If the insured
experiences a loss which is potentially covered by the insurance policy, the
insured submits a claim to the insurer for processing by aclaims adjuster.

MEANING

Aninsurance claimis a formal request to


aninsurancecompany asking for a payment
based on the terms of theinsurancepolicy.
Theinsurancecompany reviews theclaimfor
its validity and then pays out to theinsuredor
requesting party (on behalf of theinsured) once
approve.

DEFINITION

An arrangement by which a company or the state


undertakes to provide a guarantee of
compensation for specified loss, damage, illness,
or death in return for payment of a specified
premium.

SIX TYPES OF INSURANCE


CLAIM
Auto

Physical Damage

When your vehicle is damaged after an accident, call your insurance company and
report the loss. You must answer several questions about the details of the accident, and
wait for the inspector to come to inspect your car. Once he determines whether your
vehicle is repairable or a total loss, he will write you a check for the damages or begin
the total loss process, including towing the wrecked vehicle away.

Injury

Claims

If you or someone else is injured, whether in an auto accident or otherwise, you must
report it to your insurer and answer questions about the loss. The injured person must
typically submit medical reports to the insurer, and sometimes give personal interviews
to an adjuster. Injury claims are typically settled in a single lump sum, so settlements
can take a long time to come since all medical treatment must be finalized first.

Homeowner's

Claims

Like auto physical damage claims, your insurer must inspect your damaged home or
belongings before you receive a settlement check. Most homeowner's property claims
are settled as actual cash value, at least at first. The insurer depreciates your damaged
items according to their age and condition at the time of loss. If you have a replacement
cost endorsement, submit receipts for your replaced items to your insurer and it will
give you supplemental checks for the balance above what you had already received.

Health Insurance Claims


Health insurance claims are often submitted directly to the insurer by the
medical provider, so these are among the only claims you don't have to file
yourself. Health insurance contracts vary widely between companies and states,
but the basic principle is that the insurer pays for medical charges according to
your insurance contract, then the provider bills you for the balance. You are
responsible for all charges your insurer does not cover.
Life Insurance Claims
Unless you have an endorsement that provides some of the life insurance benefit
prior to death, you will always file a life insurance claim for someone else.
Therefore, you need the deceased person's policy information, as well as proof of
death and, often, details about the cause of death. The insurer will often provide
the death benefit by placing the money in a trust account, and providing you with
a check book or debit card with which to draw the funds, though other options are
available.
Commercial Claims
Commercial claims are often for large dollar amounts and involve many people.
The insurer will always investigate the circumstances of the claim before offering
a settlement, and you must cooperate with these investigations while also
managing your business after a loss. Your insurance agent can help you through
this process. Report the loss immediately, so you and the insurer can mitigate the
loss and gain as much control as possible over the circumstances.

TYPE OF ACT
Motor

Vehicles Act:- In todays world we can see existence of different types of claims viz.,

matrimonial claims, personal claims, health claims, equity claims, insurance claims etc. Of all these
claims we have oneaccidental claimswhich has increased in present time with the development of
civilization.
Before going further we should first understand the meaning of Accident. Accident means any
unintentional act, an act which is just by chance and without anypremeditation. Accidental Claims
means claim of right with respect to accident caused due to act of negligence of other. Act of negligence
have become actionable wrong.Motor vechicle act was passed in 1988 in this The courts can only grant
compensation for the pecuniary and monetary loss caused and some other expenses, but no court can
even attempt to grant compensation for loss of life or limb.

Act

Of God:- In 2012, there were many major natural disasters that rocked humanity across the

globe. These disasters were Hurricane Sandy in New York, Cyclone Nilam in Chennai, Typhoon Bopha
in Philippines, Flash flood in Uttarakashi, Flood in Assam and earthquakes at several other places.
Due to these natural calamities many families lost lakhs and crores on their assets/property. Not all of
them were insured, still there were few percentage of families with insurance coverage but didnt get
benefit. Since, their policy didnt cover losses incurring due to Act of God. Act of God means natural
calamities such as tsunami, floods, earthquakes, thunders or any other disaster caused due to the
nature by Almighty (God)..

Public

Liability Insurance Act 1991:-

The following Act of Parliament received the


assent of the President on the 22nd January, 1991, and is hereby published for general information:An Act to provide for public liability- insurance for the purpose of providing immediate relief to the
persons affected by accident occurring while handling any hazardous substance and for matters
connected therewith or incidental thereto. This Act may be called the Public Liability Insurance Act,
1991.

PRINCIPLES OF INSURANCE
Nature

of contract

Nature of contract is a fundamental principle of insurance contract. An


insurance contract comes into existence when one party makes an offer or
proposal of a contract and the other party accepts the proposal.A contract
should be simple to be a valid contract. The person entering into a
contract should enter with his free consent.

Principal

of utmost good faith

Principle

of Insurable interest

Under this insurance contract both the parties should have faith over
each other. As a client it is the duty of the insured to disclose all the facts
to the insurance company. Any fraud or misrepresentation of facts can
result into cancellation of the contract.
Under this principle of insurance, the insured must have interest in the
subject matter of the insurance. Absence of insurance makes the contract
null and void. If there is no insurable interest, an insurance company will
not issue a policy.An insurable interest must exist at the time of the
purchase of the insurance. For example, a creditor has an insurable
interest in the life of a debtor, A person is considered to have an unlimited
interest in the life of their spouse etc.

Principle

of indemnity

Principal

of subrogation

Indemnity means security or compensation against loss or damage. The


principle of indemnity is such principle of insurance stating that an
insured may not be compensated by the insurance company in an amount
exceeding the insureds economic loss.In type of insurance the insured
would be compensation with the amount equivalent to the actual loss and
not the amount exceeding the loss.This is a regulatory principal. This
principle is observed more strictly in property insurance than in life
insurance.The purpose of this principle is to set back the insured to the
same financial position that existed before the loss or damage occurred.
The principle of subrogation enables the insured to claim the amount
from the third party responsible for the loss. It allows the insurer to
pursue legal methods to recover the amount of loss, For example, if you
get injured in a road accident, due to reckless driving of a third party, the
insurance company will compensate your loss and will also sue the third
party to recover the money paid as claim.

CONCLUSION

Insuranceis a form is risk management in which the insured transfers


the cost of potential loss to another entity in exchange for monetary
compensation known as thepremium.

. The insurance contract is a legal document that spells out the coverage,
features, conditions and limitations of an insurance policy.
Property andcasualty insuranceis insurance that protects against
property losses to your business, home, or car and/or against legal
liability that may result from injury or damage to the property of others.
This type of insurance can protect a person or a business with an
interest in the insured physical property against losses.
An auto insurance policy typically covers you and your spouse,
relatives who live in your home and other licensed drivers to whom you
give permission to drive your car.
Anindemnity plan, sometimes called a fee-for-service plan, is a type of
insurance that reimburses you according to a schedule for medical
expenses, regardless of who provides the service.