claims management2

8/9/2019 Claims Management2

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ClaimsManagement


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MARINE INSURANCE CLAIMS

Marine insurance claims can be broadlycategorized into -

Marine cargoMarine hull

Ocean going esselsSundry hulls


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!IRE INSURANCE CLAIMS

"he main documents generally re#uired $or%rocessing &re claims are'-

Claim $orm duly com%leted by the insured(Co%ies o$ the %olicy com%lete )ith terms*conditions and )arranties(

+hotogra%hs ,i$ necessary +olice re%ort and ,i$ necessary

!ire brigade re%ort ,i$ necessary.here the loss estimate is more than Rs( /

crore* intimation is to be sent to tari0 Adisory committee , "AC


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MO"OR INSURANCE CLAIMS

Motor insurance claims are broadly categorized into' /( O)n-1amage claims* and2( "hird %arty claims(

Own-Damage claims-

Immediately on recei%t o$ intimation o$ loss* either in)riting or oer tele%hone* a sureyor should be

a%%ointed based on the estimate o$ re%airs(


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"he documents generally re#uired $or settlement o$ motorclaims are'

+hotogra%hs o$ the ehicle at the s%ot o$ the accident*sho)ing all

the e3ternal damages and the number %late o$ theehicle(

Claim $orm duly &lled in(

Registration Certi&cate 1riing LicenseLoad Challan4"ri% Sheet !itness Certi&cateCo%y o$ the !IR Surey Re%ort

In case o$ %artial loss claims* submission o$ bills can bedis%ensed )ith $or claims u% to Rs(56*OO6 in res%ect o$%riate cars and t)o )heelers only* sub7ect to'o "he Surey Re%ort indicating the cost o$ %arts allo)ed $or

re%lacement(


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"8E!" CLAIMS

"he$t claims are either total loss claims or %artial lossclaims( I$ claims settling authority is not $ully satis&ed*inestigation o$ the the$t to be arranged by an inestigator)ho may be a%%ointed )ith s%eci&c terms o$ re$erence(

"he $ollo)ing documents should be collected $rom the

insuredin addition to a certi&ed co%y o$ !IR'

Surrender o$ the Registration 9oo: and the "a3 9oo: tothe insurer duly trans$erred in the name o$ the insurers(

Ignition :eys o$ the ehicle Certi&cate o$ insurance and the original insurance %olicy*i$ not stolen )ith the ehicle( S%ecially )orded discharge oucher(

I$ the ehicle is recoered subse#uently the insured )illhae the o%tion to re%ay the claim amount already %aid


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"8IR1 +AR"; CLAIMS

"he %rocedure $or settling third %arty claims is broadly on the

$ollo)ing lines' Intimation o$ Claim' Intimation about an accident resulting into third%arty claim is receied through arious sources' Insured Claimant Courts by notice "hrough accident re%ort $rom %olice in !orm 5< %rescribed under

Central Motor =ehicle Rules* />?>(

Inestigation' Inestigation about the accident to collect the releantdata to #uanti$y reasonable and 7ust com%ensation as %er the $ormatsenclosed in res%ect o$ all third %arty claims is mandatory(

A%%ointment o$ Adocate' A com%etent adocate may be a%%ointed i$necessary to ensure that the %ro%er de$ence is ta:en )here necessary andno $riolous statements are made(

In the case )here the $ault o$ the drier is not %roed* com%any should ta:eimmediate ste%s to de%osit No !ault Liability amount as %er section /?>(


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MISCELLANEOUSINSURANCE CLAIMS

Miscellaneous Accident Insurance includes a number o$ coers*)hich are in the nature o$ %ac:age %olicies( In this situation s%eci&cguidelines a%%licable to the re%resentatie sections are to be$ollo)ed(

BURGLARY INSURANCE "he $ollo)ing documents are im%ortant )hile %rocessing burglaryinsurance' 1uly com%leted claim $orm !inal inestigation re%ort $rom the %olice

Surey Re%ort +hotogra%hs

It is considered %re$erable to a%%oint an inestigator )ith sureyor@slicense and :no)ledge o$ accounts as assessment o$ lossessometimes inoles chec:ing boo:s o$ accounts(


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.ORMENBS COM+ENSA"IONINSURANCE

"he necessary documents $or %rocessing )or:menBsCom%ensation claims include' Medical Certi&cate( .ages statement( +roo$ o$ age as recorded by the em%loyer(

!or the %ermanent total disablement claims* the memorandumo$ agreement is re#uired to be submitted to the )or:menBscom%ensation commissioner )hile dis%osing com%ensation as %er

.or:menBs Com%ensation Act(

!or total claims* the %erusal o$ death certi&cate and %ostmortemre%ort is im%ortant be$ore de%ositing the amount )ith )or:menBscom%ensation commissioner(


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ME1ICLAIM

"he $ollo)ing documents arere#uired'

1uly com%leted claim $orms 9ills* recei%ts and discharge

card$rom the hos%ital

Cash memos $rom thehos%ital

9ills $rom chemists su%%orted by %ro%er %rescri%tion Surgeon@s bills and recei%ts*

bills $rom %athologistsu%%orted by %ro%er

%rescri%tion

claims management2

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