claims management3.pptx

8/9/2019 Claims Management3.pptx

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ClaimsManagement


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$%IDELI&E" '()CLAIM" "ETTLEME&T B

I)DA


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E+cept in cases of a marine insurance co,er wherecurrent mar-et practices do not insist on a written proposal

form in all cases a proposal for grant of a co,er either forlife !usiness or for general !usiness must !e e,idenced !ya written document. It is the duty of an insurer to furnishto the insured free of charge within /0 days of theacceptance of a proposal a copy of the proposal form.

'orms and documents used in the grant of co,er maydepending upon the circumstances of each case !e made a,aila!le in

languages recogni1ed under the Constitution of India. In 2lling the form of proposal the prospect is to !e guided

!y thepro,isions of "ection 34 of the Act. Any proposal form

see-inginformation for grant of life co,er may prominently state

therein

the requirements of "ection 34 of the Act.


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5here a proposal form is not used the insurer shallrecord the information o!tained orally or in writing andcon2rm it within a period of 64 days thereof with theproposer and incorporate the information in its co,ernote or policy.

5here,er the !ene2t of nomination is a,aila!le tothe proposer in terms of the Act or the conditions ofpolicy the insurer shall draw the attention of theproposer to it and encourage the prospect to a,ail thefacility.

7roposals shall !e processed !y the insurer with

speed and e8ciency and all decisions thereof shall !ecommunicated !y it in writing within a reasona!leperiod not e+ceeding 64 days from receipt of proposals!y the insurer.


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'ACT()" A''ECTI&$ T9E CLAIM"

MA&A$EME&T


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The policy should be in force on the date of the event.

The risk and cause of event should be covered by the policy.

The cause of loss or the event should be directly related to the loss. A remote cause has no place in

the settlement.

The loss should not have been caused with an intention to gain from the situation.


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"u8cient documentary e,idence of loss should !epresented along with the application form.

Multiple claims and reciprocal claims will !e settled as per the terms of the contract of insurance.

7resence of insura!le interest in case of the property insurances at least at the time of happening of e,ent

or loss su erings. 5ithout ha,ing the insura!leinterest in the su!;ect matter no person can get!ene2t or compensation.


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IM7()TA&CE (' TIMEELEME&T I& T9E CLAIM"

7A*ME&T


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The delay in the claims settlement will ha,e an ad,erse impacton the goodwill and mar-eting of the insurance.

The cost of claims will increase with the e+tension of time!ecause the insurer may !e as-ed to pay the interest on theunpaid insurance amount !ecause of the delay. The court maydirect the insurer to pay the costs of the case to the assuredwhich results in mounting up of costs.

The delay in payment may lead to litigation which is e+pensi,e. =%nproducti,e use of manpower to defend =e+penses incurred =waste of time =will a ect on the producti,e areas of the !usiness particularlyin the mar-eting of the insurance !usiness.

claims management3.pptx

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