Page 15 - Life Insurance Today February 2018

15. Claim procedure in respect of a documents guiding the insured with regard to
submissions to be made. The insurer and/or
General Insurance Policy surveyor shall not call for any information/
1. An insured or the claimant shall give notice to the document that is not relevant for the claim.
insurer of any loss arising under contract of 5. (i) The surveyor shall, subject to sub-
insurance at the earliest or within such extended regulation 4 above, submit his final report
time as may be allowed by the insurer. On receipt to the insurer within 30 days of his
of such a communication, a general insurer shall appointment. A copy of the surveyor’s
respond immediately and give clear information report shall be furnished by the insurer to
to the insured on the procedures that he should the insured/claimant, if he so desires.
follow. In cases where a surveyor has to be Notwithstanding anything mentioned
appointed for assessing a loss/claim, it shall do
herein, in case of claims made in respect
so immediately, in any case within 72 hours of
of commercial and large risks the surveyor
the receipt of intimation from the insured.
shall submit the final report to the insurer
Insurer shall communicate the details of the within 90 days of his appointment.
appointment of surveyor, including the role, However, such claims shall be settled by
duties and responsibilities of the surveyor to the the insurer within 30 days of receipt of
insured by letter, email or any other electronic final survey report and/or the last relevant
form immediately after the appointment of the and necessary document as the case may
surveyor.
be.
2. The insurer / surveyor shall within 7 days of the
(ii) Where special circumstances exist in
claim intimation, inform the insured / claimant
respect of a claim either due to its special
of the essential documents and other / complicated nature, or due to difficulties
requirements that the claimant should submit in associated with replacement/
support of the claim. Where documents are reinstatement, the surveyor shall, seek an
available in public domain or with a public extension from insurer for submission of
authority, the surveyor/insurer shall obtain them.
his report. In such an event, the insurer
3. The surveyor shall start the survey immediately shall give the status to the insured/
unless there is a contingency that delays claimant fortnightly wherever warranted.
immediate survey, in any case within 48 hours of The insurer may make provisional/ on
his appointment. Interim report of the physical account payment based on the admitted
details of the loss shall be recorded and claim liability.
uploaded/forwarded to the insurer within the 6. If an insurer, on the receipt of a survey report,
shortest time but not later than 15 days from the finds that it is incomplete in any respect, he shall
date of first visit of the surveyor. A copy of the require the surveyor, under intimation to the
interim report shall be furnished by the insurer insured/claimant; to furnish an additional report
to the insured/claimant, if he so desires.
on certain specific issues as may be required by
4. Where the insured is unable to furnish all the the insurer. Such a request may be made by the
particulars required by the surveyor or where the insurer within 15 days of the receipt of the final
surveyor does not receive the full cooperation of survey report.
the insured, the insurer or the surveyor, as the Provided that the facility of calling for an
case may be, shall inform in writing to the additional report by the insurer shall not be
insured under information to the insurer about resorted to more than once in the case of a
the consequent delay that may result in the claim.
assessment of the claim. It shall be the duty
equally of the insurer and the surveyor to follow 7. The surveyor, on receipt of this communication,
up with the insured for pending information/ shall furnish an additional report within three

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Life Insurance Today February 2018 15

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