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Technical Guide on
Internal Audit of
Life Insurance Business
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Technical Guide on
Internal Audit ofLife Insurance Business
The Institute of Chartered Accountants of India(Set up by an Act of Parliament)
New Delhi
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The Institute of Chartered Accountants of India
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form, or by any
means, electronic, mechanical, photocopying, recording, or
otherwise without prior permission, in writing, from the publisher.
Edition : July, 2011
Committee/Department : Internal Audit Standards Board
E-mail : [email protected]
Website : www.icai.org
Price : 230/-
ISBN : 978-81-8441-473-8
Published by : The Publication Department on behalf
of the Institute of Chartered
Accountants of India, ICAI Bhawan,
Post Box No. 7100, Indraprastha
Marg, New Delhi - 110 002.
Printed by : Sahitya Bhawan Publications,
Hospital Road, Agra - 282 003.
July/2011/1,000 Copies
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Foreword
In the current scenario, insurance market in India has witnessed
dynamic changes including entry of a number of global insurers.
Most of the private insurance companies are joint venturing with
recognized foreign institutions across the globe. Saturation of
markets in many developed economies has made the Indian marketeven more attractive for global insurance majors.
The Insurance Regulatory and Development Authority (IRDA)
regulate and develop the insurance sector in India through calibrated
policy initiatives, helps to improve disclosures. The role and
importance of internal control systems in good risk management
practice, with a particular emphasis on the internal audit and
compliance functions within such a framework has become
necessary. Introduction of mandatory quarterly internal audit for
insurer is one such step taken by the Insurance Regulatory and
Development Authority which would contribute towardsstrengthening controls and also reducing risks under volatile market
conditions.
I am happy to note that the Internal Audit Standards Board is issuing
this Technical Guide on Internal Audit of Life Insurance Business
for guidance of the members and other readers. I congratulate
CA. Rajkumar S. Adukia, Chairman, Internal Audit Standards Board
and members of the Board on issuance of this Technical Guide.
This Technical Guide comprehensively deals with the peculiar
aspects of life insurance business, including various regulatory
aspects and provides a step-wise approach for internal audit.
I am sure that this Technical Guide will assist the members and
others in efficiently discharging their responsibilities.
July 11, 2011 CA. G. Ramaswamy
New Delhi President, ICAI
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Preface
During the last two decades, the economic reforms have impacted
the growth of financial sector of India significantly. As an integral
part of financial sector reforms, insurance sector has emerged as
regulatory development sector. Insurance Regulatory and
Development Authority has issued various regulations with theobjective of improving market efficiency, enhancing transparency
and bringing the Indian market up to international standards. With
the very same objectives, the Insurance Regulatory and
Development Authority being insurance sector regulator has
mandated quarterly internal audit of insurer. This would not only
ensure compliance with the legal and regulatory norms but would
also prove instrumental in making the system more efficient.
Internal audit is core competence area of chartered accountants. It
is an important assignment being undertaken both by practising
members of the Institute as well as those in industry. This demandsthe internal auditor to have requisite skills and high level of knowledge
of the sector as well as its interrelationship with variables in its
operating environment.
The Internal Audit Standards Board is issuing this Technical Guide
on Internal Audit of Life Insurance Companies. This Guide would
provide to the members of the Institute as well as others an in-
depth understanding of the activities undertaken by the insurer and
the regulatory and legal framework in which they operate.
With a view to providing appropriate guidance in a manner that is
easily understood by all the readers, this publication is divided into
parts, dealing with the very fundamental concepts in Life Insurance
Companies, sequentially as introduction, regulatory framework and
internal audit of functional areas. It gives a brief overview on various
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aspects like, actuarial process, underwriting, reinsurance, premium
collection, claims and agency licensing, etc. It also contains detailedchecklist on internal audit that would help the readers in
understanding the various technicalities arising during the internal
audit of life insurance companies. The Guide also contains the list
of abbreviations for better understanding of the readers.
I am extremely grateful to CA. Neeta Shah and her entire team viz.,
CA. Venkatachalam Sekar, CA. Shailendra Kothavale,
CA. Sangramjit Sarangi, CA. Ramandeep Sahni, CA. Prasanna
Bharatan, CA. Kalpita Nasikkar, CA. Durga Prasad and CA. Anand
Dubey for squeezing out sometime out of their professional and
personal commitments and preparing the basic drafts of thisTechnical Guide.
I also wish to thank CA. G. Ramaswamy, President, ICAI and
CA. Jaydeep Narendra Shah, Vice President, ICAI for their
continuous support and encouragement to the initiatives of the
Board. I must also thank my colleagues from the Council at the
Internal Audit Standards Board, viz., CA. Rajendra Kumar P.,
CA. Amarjit Chopra, CA. Ravindra Holani, CA. Anuj Goyal,
CA. Nilesh S. Vikamsey, CA. Vijay Kumar Garg, CA. Atul C. Bheda,
CA. J. Venkateswarlu, CA. Shiwaji Bhikaji Zaware, CA. Abhijit
Bandyopadhyay, Smt. Usha Narayanan, Smt. Usha Sankar,Shri R. P. Singh, Shri Prithvi Haldea, Shri Sidharth Birla, Dr. T.V.
Somanathan for their vision and support. I also wish to place on
record my gratitude for the co-opted members on the Board, viz.,
CA. Madhu Sudan Goyal, CA. Rohit Choksi, CA. Ketan Vikamsey,
CA. Pankaj Kumar Adukia, CA. Umakant Balkrishna Joshi as also
special invitees on the Board for their invaluable guidance as also
their dedication and support to the various initiatives of the Board.
I am certain that the readers, especially members of the Institute,
working as internal auditors in insurance sector would find this
technical guide immensely useful.
July 14, 2011 CA. Rajkumar S. Adukia
Mumbai Chairman,
Internal Audit Standards Board
(vi)
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Abbreviations
AML Anti Money Laundering
ASM Available Solvency Margin
AUM Assets Under Management
BI Benefit Illustration
CA Corporate Agent
CIE Corporate Insurance Executive
COI Certificate of Insurance
CTR Cash Transactions Report
F & U File and Use
FLC Free Look Cancellation
FPR First Premium Receipt
GPM Gross Premium Method
KYC Know Your Customer
LOB Line of Business
MAD Margin for Adverse Deviations
MOU Memorandum of Understanding
NAV Net Assets Value
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Technical Guide on Internal Audit of Life Insurance Business
NDS Negotiated Dealing System
NSDL National Securities Depository Limited
OYRGTA One Year Renewable Pure Group Term
Assurance Business
PMS Policy Management System
PTC Pass Through Certificates
RSM Required Solvency Margin
SOP Standard Operating Procedures
SP Specified Person
STR Suspicious Transaction Report
TAT Turn Around Time
TAT Turn Around Time
UAT User Acceptance Test
UIN Unique Identification number
ULIP Unit Linked Insurance Plan
URN Unique Reference Number
(viii)
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Contents
Foreword ......................................................................................... iii
Preface ........................................................................................... v
Abbreviations .................................................................................vii
Chapter 1: Introduction ......................................................... 114
What is Insurance? .............................................................. 1
Life Insurance ....................................................................... 1
Evolution of the Insurance Sector ....................................... 2
The Last Decade: Post Libralisation Transformation .......... 6
Insurance Products and Distribution Structures ................. 7
Objective and Scope of the Technical Guide .................... 13
Chapter 2: Regulatory Framework for Life Insurance
Sector ........................................................................... 1517
The Insurance Act, 1938 .................................................... 15
Life Insurance Council ........................................................ 16
Insurance Regulatory Development Authority
(IRDA) Act, 1999 ................................................................ 16
INTERNAL AUDIT AREAS:
Chapter 3: Product Development and File and Use ...... 1828
Product Development ......................................................... 18
File and Use (F & U) ....................................................... 24
Chapter 4: Actuarial Process ............................................. 2941
Sub-process ....................................................................... 29
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(x)
Statutory Valuation Process .............................................. 31
Chapter 5: New Business ................................................... 4258
Sub-process ....................................................................... 42
Scope and Objective .......................................................... 43
Chapter 6: Underwriting ..................................................... 5972
Sub-process ....................................................................... 59
Scope and Objective .......................................................... 60
Chapter 7: Reinsurance ...................................................... 7382
Scope and Objective .......................................................... 73
Chapter 8: Policy Servicing .............................................. 83132
Renewal Premium Processing ........................................... 83
Free Look Cancellation (FLC)............................................ 92
Policy Lapse and Revival .................................................. 98
Policy Surrender ............................................................... 105
Nomination/ Assignment .................................................. 111
Change of Address (COA)/ Change of
Payment Mode (COP) ..................................................... 113
Fund Switch ...................................................................... 118
Top-up Premium ............................................................... 123
Loan Against Policy .......................................................... 128
Chapter 9: Premium Collection, Accounting and
Reconciliation ......................................................... 133141
Sub-process ..................................................................... 134
Scope and Objective ........................................................ 134
Chapter 10: Claims........................................................... 142149
Scope and Objective ........................................................ 142
Chapter 11: Investments ................................................. 150169
Regulations Pertaining to Investment Process ............... 156
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(xi)
Regulation 5 of IRDA (Investment) Regulations, 2000... 160
Section 27A of The Insurance Act, 1938 ........................ 163
Limits for Mutual Fund Approved and
Unapproved Investments ................................................. 164
Risks and Internal Audit Procedures ............................... 169
Chapter 12: Legal Framework and Compliance .......... 170198
Relevant IRDA Regulations ............................................. 172
Regulation for Commencing Insurance Business .......... 173
Grant of Certificate of Registration .................................. 173
Rural and Social Sectors ................................................. 173Corporate Governance ..................................................... 176
Chapter 13: Relationship and Complaint Handling .... 199209
Scope and Objective ........................................................ 199
Chapter 14: Agency Licensing ....................................... 210233
Tied Agency, Tied Agent .................................................. 210
Corporate Agent ............................................................... 221
Chapter 15: Commission ................................................. 234243
Scope and Objective ........................................................ 234
Chapter 16: Rewards and Recognition ........................ 244250
Sub-process ..................................................................... 244
Scope and Objective ........................................................ 244
Chapter 17: Advertisements ........................................... 251271
Sub-process ..................................................................... 251
Scope and Objective ........................................................ 251
Chapter 18: Management Expenses ............................. 272285
Sub-process ..................................................................... 272
Scope and Objective ........................................................ 273
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(xii)
Circulars/ Acts/ Regulations ............................................ 275
Chapter 19: Financial Closing Process ........................ 286299
Sub Processes ................................................................. 287
Scope and Objective ........................................................ 287
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