Page 42 - The Insurance Times November 2025

the Insurance Company lies in its claims settlement. No scenario of claim settlement of about 83% in the last financial
publicity of an Insurance Company is better than the publicity year is not too bad. The claims repudiation ratio on number
achieved through expeditious settlement of genuine claims. of claims has been quite good in the previous fiscal for almost
My personal view is that the private sector is handling cashless all the public sector companies ranging between 6.10% and
motor claims quite efficiently. For high end cars, the private 3.31% except for one Insurer. The position however did not
sector insurers are often found to be quite generous in appear so favourable for the private sector General Insurers
authorizing and allowing settlement of the claims which where the claim repudiation ratio has varied between 13%
perhaps makes motor workshop business more lucrative than and 38% except for few companies. The average claims
insurance business. repudiation ratio on number of claims was about 20%.

As an insurance professional, having worked in developed Q: Being in the industry for nearly 4 decades, please tell
economy, less developed Asian economies having settled us something about your impression on the functioning
more than perhaps 1,50,000 claims in my 38 years career, I of the surveyors and the element of empathy.
was perhaps not as generous in settling motor claims as I see A: In one of my articles in past, I had mentioned that the price
now in motor claims settlement in India. Having said that, I of insurance, called premium, is the most loved child of the
must also mention here that the settlement time is far more family, no matter how unethically he is brought up. The hated
than the 45 days mandate of the IRDAI. Any reimbursement child is the unwanted but the most helpful child of the family
claim takes on an average of 90 days. For high value claims, at the time of distress. His name is CLAIM. There was always
such timeline could be anything. The retail customers albeit a religious Guru for this family called the surveyor who has
with exception, view General Insurers of India not very become more powerful these days influencing the most
positively as far as claim settlement is concerned. helpful child not always in a positive manner. The surveyors
in past used to be guided by the insurance companies about
Simple questions at the time of taking the premium turn into proactive way they should approach a client and advise the
complex questions at the time of a claim. India understandably client about the way forward in assessment of the claim.
has 6 Crore SMEs with an insurance coverage less than 5%.
Apart from the individual claims, claims of these SMEs are Indeed the requirement of the documents used to be there
also a problematic area since documentation and other but I see the current practice of starting the story by way of
guidance are missing. While Third Party Administrators (TPA) dumping the policy holder with a requirement of documents
are an important entity in medical claims, the general more formally called LOR for documents. The documents
perception about their service is not good because of their become the mantra for this Guru and slowly the deity goes
perceived lack of empathy and robotic heartless approach to to oblivion. A property loss assessor has to rely on primarily
any medical claim where human touch is needed the most. the observation of physical loss minutely, measurement,
More often than not, the computers of the TPAs are the circumstances of the loss, verification of the prices of the
masters and human beings simply follow instructions of their affected items, local enquiry, methods and suggestions on loss
masters. mitigation and finally exploring the salvage market. Needless
to mention that he has to keep in view the central tenets of
In conclusion, I personally feel that apart from the delay in the worship which are the policy coverage and exclusions.
settlement and asking for too many documents, the overall
Unfortunately, the whole inputs for this assessment are
provided through various documents to be arranged by the
ß­ ¿² ·²­«®¿²½» °®±º»­­·±²¿´ô ¸¿ª·²¹ Insured. What is mentioned in the documents takes a front
©±®µ»¼ ·² ¼»ª»´±°»¼ »½±²±³§ô ´»­­ seat and what is seen loses its priority. What pains me the
most is the fact that now a days, surveyor's verdict in most of
¼»ª»´±°»¼ ß­·¿² »½±²±³·»­ ¸¿ª·²¹ the cases is final. No Insurer treats them as simply loss assessor
­»¬¬´»¼ ³±®» ¬¸¿² °»®¸¿°­ ïôëðôððð but as the final authority for settlement of the claim. This to
½´¿·³­ ·² ³§ íè §»¿®­ ½¿®»»®ô × ©¿­ my reckoning is not a healthy trend since the claimant is a
customer of the Insurance Company and not a customer of
°»®¸¿°­ ²±¬ ¿­ ¹»²»®±«­ ·² ­»¬¬´·²¹ the surveyor. The claim after all is paid by the Insurer and

³±¬±® ½´¿·³­ ¿­ × ­»» ²±© ·² ³±¬±® not by the surveyor. I have seen extremely non-empathetic
½´¿·³­ ­»¬¬´»³»²¬ ·² ײ¼·¿ò behaviour of the surveyors in case of simple fire claims for
residences that too towards senior citizens which eventually

38 November 2025 The Insurance Times