general insurance topics

8/13/2019 General Insurance Topics

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FIRE INSURANCE COVERAGE-CONTD.• The fire policy may be extended to cover the following on

payment of extra premium. These add-on covers are:

i) Architect, surveyor’s consulting engineers’ fees , in excess of 3% ofthe claim amount.

ii) Removal of debris, in excess of 1% of the claim amount.iii) a) Deterioration of stocks in the cold storage premises due to an

accidental power failure consequent to damage at the premisesof the power station due to an insured peril.b) Depreciation of stocks in cold storage premises due to change

in temperature arising out of loss or damages to cold storagemachines in the insured’s premise due to operation of insuredperils.

iv) Forest fire2



FIRE INSURANCE COVERAGE-CONTD.•

V)Impact damage due to insured’s own rail/road vehicles, fork lifts,cranes, stackers and the articles dropped there from.• Vi) Spontaneous combustion• Vii) Omission to insure, addition, alteration•

Viii) Earthquake ( fire and shock)• Ix) Spoilage material damage cover• X) Leakage and contamination cover• Xi) Temporary removal of stocks clause•

Xii) Loss of rent clause• Xiii) Insurance of additional expense of rent for an alternative

accommodation• Xiv) Start- up expenses. The fire policy may also be modified to suit

the particular requirements of the client.3



CONSEQUENTIAL LOSS( FIRE) INSURANCE•

The indemnity provided by ordinary fire insurance is in respect ofmaterial damage i.e. loss of or damage to buildings, plants,machinery, fixtures, fittings, merchandized goods etc. by insuredperils. But, material damage may result in total or partialinterruptions of the insured’s business. As a result, he may suffer lossas follows:

• a) Net profit: is the margin of income over all other expenses. A totalor partial stoppage of production may altogether eliminate or reducethis net profit

• b) Standing charges: these are the overhead expenses for running thebusiness such as salaries, wages, taxes and interest payments etc.which may continue to be incurred in spite of the interruption of theproduction activities.

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CONSEQUENTIAL LOSS(FIRE)INSURANCE-CONTD.

• b) Property situated elsewhere: This extension coversinterruption of business as a result of damage to property – the insured’s own or belonging to others – at premises otherthan the insured’s premises e.g. at the suppliers’ premises orcustomers’ premises etc.

• The terms and conditions of this policy generally follow thesame pattern as those of the main fire policy.

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MARINE INSURANCE COVERAGES• Marine insurance has been defined as a contract between insurer

and insured whereby the insurer undertakes to indemnify the insuredin a manner and to the interest thereby agreed against marine lossesincident to marine adventure.

• ‘Marine insurance business’ means the business of effecting

contracts of insurance upon vessels of any description includingcargoes, freights and other interests which may be legally insured inor in relation to such vessels, cargoes and freights, goods, wares,merchandise and property of whatever description insured for anytransit by land or water or both and whether or not includingwarehouse risks or similar risks in addition or incidental to suchtransits and includes any risks customarily included among the risksinsured against in marine insurance policies.

• The above definition clearly lays down the following classification ofmarine insurance: 7



MARINE INSURANCE COVERAGES-CONTD.• i) Hull insurance: Insurance of the vessel and it s equipments are

included under hull insurance. There are a number of classification ofvessels such as ocean liners, sailing vessels, fishing trawlers, fleetsand so on.

• ii) Cargo insurance: It may be written under a single risk policy or afloating policies. The cargo may be of any description e.g. wares,merchandise, property, goods, spices, ammunitions, live stocks etc.

• iii) Freight insurance: Freight is the charge to be payable for thecarriage of cargoes or if the vessel is chartered, the money to be paidfor the use of the vessel. The carrier is unable to earn freight if the

goods or property , called cargoes, are not safely transported.• iv) Liability insurance: The marine insurance policy may include

liability hazards such as collision or running down. Insurance can alsobe taken for expenses involved in non-compliance of rules andregulations without any intention to deceive. It should be noted thatmarine insurance covers not only ocean but also inland perils. 8



MARINE INSURANCE COVERAGES-CONTD.

• The hull policy provides cover for loss or damage caused by:• i) Perils of the seas, rivers, lakes or other navigable waters• ii) Fire/explosion• iii)Violent theft by persons from outside the vessel.• iv) Jettisoning/abandoning• v) Piracy/armed robbery• vi) Breakdown of or accident to nuclear installation/reactors• vii) Contact with aircraft or similar objects• viii) Earthquake/volcanic eruption/lightning• ix) Accident while loading, discharging or shifting of cargo or fuel• x) Bursting of boilers• xi) Negligence of masters, officers, crew or pilot

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MARINE CARGO INSURANCE-CONTD.• iii) Overturning or derailment of vehicles iv)collision or contact of

vessel or conveyance with an external object v) discharge of cargo aspart of distress vi) general average and salvage charges andvi)jettisoning/abandoning

• In marine insurance parlance, an ‘average’ means a partial loss whichcan be particular or general. A particular average loss is a partial loss

of subject matter insured , caused by a peril insured against andwhich is not a general average loss. On the other hand, a generalaverage loss is one caused by any extraordinary sacrifice or expensesvoluntarily or reasonably made in time of peril for the sake ofpreserving the property imperiled in the common adventure.

• In a more comprehensive coverage( class B), the following additionalperils are included: i) earthquake, volcanic eruption and lightning,ii)washing overboard, iii) sling loss i.e. total loss of any package lost ordropped during loading or unloading, and iv) entry of sea, lake orriver water into the vessel or craft.

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MARINE CARGO INSURANCE-COVERAGE ANDEXCLUSIONS

•

These coverage can further be extended(class ‘A’) to include allphysical damage or loss to the insured cargo except those specificallyexcluded under the general exclusion clause described below:

• i) loss or damage due to willful misconduct of the insured.• ii) Ordinary leakage, breakage, wear and tear , ordinary reduction in

volume/ weight due to transit iii) loss due to insufficiency in packingiv) Inherent vice and delays v) loss due to financial default orinsolvency of the vessel owners, charterers or operators. vi) nuclearperils. vii)malicious damages. All policies are subject to exclusion ofwar/ strike/riot/civil commotion/terrorism risks to be additionallycovered.

• Hull policies are time policies, usually for a period of one year butcargo policies are voyage policies irrespective of the time taken. Theinsured has to act reasonably under all circumstances under his

control. 12



MOTOR INSURANCEInsurances not falling under fire and marine are called miscellaneous, as

per the insurance act 1938. In these category of insurances also, it isthe practice to issue standard contracts and then provide forcoverage for additional perils.

For purpose of motor insurance, motor vehicles are classified into

three broad categories: private cars, motorized two wheelers andcommercial vehicles. Commercial vehicles, again, are classified intothese four categories: i) goods carrying vehicles( private carrier)ii)goods carrying vehicles( public carriers) iii) passenger carrying

vehicles like taxis, motorized rickshaws, buses, tourist, school andairline buses, etc. iv) miscellaneous and special type as tractors,ambulances, cinema film recording and publicity vans, outdoorbroadcasting (OB) vans, mobile dispensaries, canteens, road rollers,excavators, levelers etc. These vehicles in each category may becovered under two types of policies: liability only and package. 13



MOTOR INSURANCE-CONTD.• iii) Death or bodily injury to any paid driver ,conductor or ticket

examiner in a public vehicle or employees carried in a goods vehicleunder the workman’s compensation act 1923.

• The policy provides for cover for third party death or personal injuryfor all classes of vehicles to the extent of the amount of liabilityincurred.

• Similarly, in respect of passengers carried for hire or reward inpassengers carrying vehicle, the limit of liability in respect of death ofor bodily injury to such passengers is the amount of liability incurred.

• The damage to property of third party, the limit is Rs. 7,50,000/= peraccident unless the insured opted for a lower limit. This limit appliesto all classes of vehicles.

• The policy also covers personal accident insurance of the ownerdriver for specified sum insured.

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PACKAGE MOTOR INSURANCE POLICIES• Broadly speaking, the package cover for private cars , motorized two

wheelers and commercial vehicles is more or less the same. Theterrorist risk is now in-built for own damage section of the packagepolicy for all classes of vehicles.

• There are three sections in private car and motorized two wheelers

policies; section I: own damage, section II: liability to third partiesand section III: personal accident insurance for owner/drivers.• In commercial vehicles, there are four sections; section I: own

damage, section II: liabilities to third parties, section III: towing ofdisabled vehicles, section IV: personal accident insurance forowners/drivers.

• The exclusions: consequential loss, depreciation, wear and tear,mechanical or electrical breakdowns, failures and breakages,damages to tires and tubes limited to 50% of the replacement cost,damages while driving under the influence of liquor/drugs. 16



PERSONAL ACCIDENT INSURANCES• Personal accident insurance is non –tariff and the cover may vary

from company to company. However, a common pattern is shownbelow. The policy provides cover for accidental bodily injury resultingin death or disablement. On payment of additional premium, thepolicy may be extended to cover medical expenses. The cover is asfollows: Accident cover Compensation

• i) Death only 100% capital sum insured• ii) Loss of two limbs or two eyes 100% capital sum insured• or one limb and one eye• iii) Loss of one limb or one eye 50% capital sum insured• Iv) Permanent total disablement 100% capital sum insured• from injuries other than mentioned above• V) permanent partial disablement As per the scale given in policy

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PERSONAL ACCIDENT INSURANCES-CONTD.• Vi) Temporary total disablement @ 1% of CSI per week up to 100

weeks , maximum weekly benefit

not exceeding Rs.3000/= per week.Medical expenses extension: Re-imbursement of medical /surgical /hospital / nursing home expenses necessarily incurred are coveredsubject to a limit of10% of CSI, or 25% of valid claim whichever is less.It is not necessary that all the six benefits have to be obtained by theproposer who may choose item ‘i’ only or ‘i’ to ‘iv’ or ‘i’ to ‘v’ etc. Additional benefits, free of cost, has been provided as part of thestandard cover, as follows:a) For reimbursement of expenses incurred for carriage of dead body( i.e. death due to accident of the insured) to the place of residencesubject to a maximum of 2% of the CSI or Rs.1000/= whichever islower.

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PERSONAL ACCIDENT INSURANCE-CONTD.• Premium payable will be on the total sum insured .A discount of 5%

may be granted on the gross premium under the family packagecover.

• Personal accident cover , if required only to cover employmentrelated accidents and not on 24 hours basis, reduced rate of premium

is applied. This cover is meant for employees only, taken out by theemployers for accidents arising out of and in the course ofemployment. Similarly, a cover is available for off-duty accidents only.A discount in premium is available for such covers.

• Group covers ( Type A) are available for covering employees of aninstitution, society, association, club etc. ( i.e. with employer-employee relationship). These, further, are divided into two types:

i) Named employee and ii) unnamed employeeType B covers are meant covering members of an institution i.e.

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MEDICAL INSURANCE• ‘Mediclaim ’ policy is one of the products in the health insurance

business. These policies are available to individuals, families and on

group basis for corporate firms etc.• The policy reimburses hospitalization and domiciliary hospitalization

expenses for treatment of disease or accidental injuries. The sumassured available ranges from Rs. 15,000 to Rs. 5 lakhs. The premiumis related to the age of the person and the sum assured chosen.Group discount is available.

• Further, for low claims ratio, bonus is available by way of reduction inpremium rate. Premium loading or ‘ Malus ’ is applied to high claimsratios.

•

Under social insurance scheme of Govt. of India, Jan Arogya Bimapolicy has been introduced. The policy designed for weaker section ofthe society covers medical expenses up to Rs. 5000/= per person andRs.20,000/= per family consisting of head of the family, spouse andtwo dependent children up to the age of25 years. This policy is very

similar to Mediclaim policy albeit for the poor. 22



CANCER AND UNIVERSAL HEALTH INSURANCE• Cancer insurance schemes are available to members of the ‘Indian

Cancer Society’ and ‘Cancer Patients Aid Association’ and provide for

expenses of treatment of cancer i.e. cost of diagnosis, biopsy, surgery,radio-therapy, chemo therapy, medicines, hospitalizations etc.

• ‘Universal Health Insurance Policy’, introduced by the public sectorinsurance companies under the auspices of the Govt. of India,

provides medical expenses and personal accident covers to poorfamilies inclusive of head, spouse, three dependent children anddependent parents. The sum insured is Rs.30,000/= and the premiumfor an individual is Rs. 1/= per day, i.e. Rs 365/= per annum.

•

Overseas medical policy, introduced in 1984, provide for medicalexpenses for illness or accident sustained by Indian residents duringtheir overseas trips for official or holiday purposes. In 1998, forcorporate business frequent travelers ‘Videsh Yatra Mitra’ wasintroduced. The policy covers accident, medical, loss and delay ofchecked baggage, loss of passport and personal legal liability. 23



ALL RISKS INSURANCE POLICIES

This policy is issued to cover personal valuables, articles like jewellery,

camera,watches, clocks, paintings, works of art etc. The cover is verywide and includes loss or damage by fire, burglary, theft or otheraccidental circumstances. The exceptions are:

i) Loss due to wear and tear or other inherent defects.

ii) Over winding or internal damage of watches and clocksiii) Loss arising from repairing, restoring, renovations, or cleaningiv) Loss to camera , telescope etc. by mechanical derangement or

breakage of lens etc.

v) Damage to gramophone records by cracking, scratching, chipping orbreakage etc.As an underwriting safeguard, small articles like fountain pens, cufflinks, cigarette cases etc. are not covered under this policy.

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MONEY POLICIES• The policy covers money including cash, cheques, postal orders,

against the risk of loss by robbery, theft during transit for payment ofwages or for day to day requirement of the business between thespecific places ( eg. Insured premises to bank and vice versa) andcollection of money within a specific geographical area by theemployees of the insured. The policy also covers loss of cash by hold

up in the premises during business hours or theft from locked safeoutside business hours.

• The policy excludes shortage of cash due to error or omission, lossdue to dishonesty of any employee, loss occasioned by riots, civil

commotion etc. However, on payment of additional premium, thepolicy can be extended to cover infidelity of cash carrying employeesand strike and riot risks.

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LEGAL LIABILITY INSURANCES• There are four major legal liability policies: Public liability, Products

liability, professional indemnity and Employers’ liability. The subjectmatter of these policies is potential legal liability towards thirdparties or employees as the case may be. If legal liability is incurred,there will be financial loss in the form of damages or compensation.

• Compulsory public liability policy: This policy is issued as per the

provisions of the public liability insurance act 1991 and coversliability of the owner to pay relief in the event of death or injury toany person other than that arising out of an accident while handlingany hazardous substance as specified in the act.

•

The amount of relief per person is fixed in the act at Rs. 25,000/- fordeath or permanent total disability, an amount based on percentageof disability for permanent partial disability, monthly relief up toRs.1000/- for three months for temporary partial disablement,medical expenses up to Rs. 12500/- and property damage up toRs.6000/-. 26



LEGAL LIABILITY INSURANCES-CONTD.• Public liability policy: This policy is issued on industrial and storage

risks and non-industrial risks such as hotels, cinemas, offices, schools,exhibitions, amusement parks, film studios, circus, zoos etc.

• The policy provides indemnity in respect of legal liability for claimsfrom third parties for death, injury or damage to property. Liabilityarising out of accidental pollution can be covered on payment of

extra premium. The policy is subject to limits of indemnity ‘ any oneaccident’ or ‘any one year of insurance’ etc.

• Product liability policy: This policy provides indemnity against legalliability for injury or damages to property arising out of defects in the

products sold as specified in the policy. Legal liability arising out ofproducts which are exported can be covered at an additionalpremium as an extension of the policy or under separate policy.

• Professional Indemnities: These policies are granted to:•

i) Medical practitioners 27



LEGAL LIABILITY INSURANCE-CONTD.• ii) Medical establishments( e.g. hospitals/nursing homes)• iii) Engineers, architects and interior decorators• iv) Chartered accountants, financial and management consultants• v) Lawyers, advocates, solicitors• These policies provide indemnity for legal liability to pay damages

arising out of negligence in the performance of professional duties.For example, professional negligence by a doctor ( wrong diagnosis,wrong treatment etc) may result in claims for death or injury.Professional negligence by a chartered accountant or a solicitor( e.g.wrong advice) may result in claims for financial losses.

• Workmen’s compensation insurance: This policy provides indemnityto the insured in respect of his legal liability to pay compensation tohis employees who sustain personal injury by accident or diseasearising out of and in the course of his employment.

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UNDERWRITING

UNDERWRITING BASICS



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UNDERWRITING BASICS

History of Underwriting

Understanding as an art began in the United Kingdom since Victorian times. Where upon agroup of sailors/traders began the practice to insure against the perils involved in a sea voyage,it included the insuring of the goods in transit against known perils such as piracy, weather perilsand goods getting destroyed in the voyage against the payment of a pre-agreed sum by thetraders(s). The practice evolved with the times and the insurance model took shape. In the earlydays of marine insurance, the details of a ship or cargo to be insured were described on a slip.This slip was taken to Lloyd’s and the person, who was to carry the risk read the details, thensigned the slip under the details of the risk. In this way, the person carrying the risk becameknown as the underwriter. The genesis of the insurance business also evolved from the UnitedKingdom and the first insurers were the Lloyd’s industries.



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Underwriting Defined

Underwriting is the prices of selecting and classifying exposures. It is directly related to rate-making or the pricing function of an insurer, because computed rates contemplates somecomposition of loss-producing characteristics to which they will be applied.

Underwriting is the insurance function that is responsible for assessing and classifying thedegree of risk is proposed insured or group represents and making a decision concerningcoverage of that risk.

Underwriting includes all the activities necessary to select risks offered to the insurer in such amanner that general company objectives are fulfilled.



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The person responsible for evaluation and acceptance/rejection of risks and computation ofpremium is called as the underwriter. Accordingly, the decision made by the underwriterconcerning risk classification and rating is called as the underwriting decision. Underwritingdecisions are crucial for insurers since they can make or mar an insurance company. Goodunderwriting helps the insurance companies in many ways it make them financially stronger andhelps secure competitive advantage. This is obvious in the sense that if risks are assessed

properly pricing will be effective and therefore the company can well compete and build upreputation.



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In life insurance business, underwriting is performed by home or regional office personnel, whoscrutinize applications for coverage and make decisions as to whether they will be accepted andby agents, who produce the applications initially in the field, but those decisions may be subjectto post underwriting at a higher level because the contracts are cancelable on the notice to theinsured. In life insurance, agents seldom have authority to make binding underwriting decisions.In all fields of Insurance, however, agency personnel usually do considerable screening of risksbefore submitting them to home office underwriters.



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The Trade-off

The underwriting exercise is a trade-off between the business and survival. If the insurancecompany sets high standards for risk which can be undertaken, the company may loose marketand consequently, the potential premium, income which can be threat to survival. If theinsurance company charges too much of premium in a fashion that is become excessive, the

company will loose competitive advantage. Also, if the company undertakes risk with looseassessment in a zeal to get business, it may be dangerous because the possibility of claims mayincrease substantially. Hence and therefore, a proper balance is to be maintained betweenbusiness and good business.



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The conflictThe conflict between production and underwriting are common to insurance company. Theunderwriting department may have turned down business that has been previously said by anagent, an apparent conflict of interest arises between these two areas. The problem is similar tothat which exists between credit and sales in other firms, with a good sale ruined becausecredit is not approved. Neither the agent nor the underwriter will profit long by underwritingthat is too strict or too loose. The former will choke off acceptable business and may create

unnecessary expenses in canceling business already bound by the agent, whereas the latterinvites such substantial losses that the company may be forced to withdraw entirely from agiven time, to the detriment of the agent.



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Twin Guiding PrinciplesThe two main principles of underwriting are Adverse Selection and Persistency. The underwritermust always guard himself against the adverse selection of risks. There is tendency on part ofthe potential insureds, those who are more likely to be affected by the happening of the adverseevent, to go for insurance cover compared to ones who are well off. For example – CeterisParibus, a healthy person is less likely is go for an Insurance cover than the one who becomesfrequently ill. Accordingly, the potential business for the insurers would represent these class.Therefore, the underwriter should carefully appraise the inherent risk in such cases and fix thepremium so as to avoid likely significant losses.



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In addition, the underwriter must not offer products which the consumers cannot afford. Alsothe premium fixed for the insureds must be consistent enough to support the cash flow modelof the insurers. The continuous renewal of policies is must to business retention. Theunderwriter should carefully examine the paying capacity of the potential customer before

offering a product, if large number of policies are surrendered or lapsed, the company will beruined.



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THE OBJECTIVES AND PRINCIPLES OFUNDERWRITING

The primary objective of underwriting is to see to that the applicant accepted will not have aloss experience i.e., very different from that assumed when the rates were formulated. To thisend, certain standards of selection relating to moral and physical hazards are set up when ratesare calculated and the underwriter must see that these standards are observed when a risk isaccepted. For example a company may decide that it will accept no fire exposures situated inareas where there is no fire department protection or will accept no one for life insurance whohas had cancer within the previous five years.



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When reviewing the application for property insurance for a piece of property, such as a farm,i.e., located where there is no fire department protection or when reviewing an application formfor life insurance in which the individual had cancer four and half years above, the underwriterasks the question, “ can I make an exception for this application, or must I reject it because itdoes not come within the technical limitations of my instructions ?“ In answering this questionthe underwriter visualizes to the company’s loss experience if a large number of identical riskswere accepted. If the aggregate experience would be unfavorable, the underwriter would

probably reject the application.



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The objectives of underwriting can be therefore expressed as follows:

1. Product Equitable to Customer: The underwriter should fairly assess the risk in a proposaland fix the premium justifiable to the consumer.

2. Deliverable to the Customer: Consumers are the final authority for buying the products. Ifthe marketers are not able to sell, so that the product becomes undeliverable, the onus ison the underwriters to carry an introspection of the various factors that caused differencesbetween the consumers and the company’s expectations.



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3. Financially Feasible To The Insurance Company:

The insurers are not in the business of charity. The underwriting benefit must be reflectedby the financial statements. Although, the underwriters are not directly involved in thepricing of insurance products, yet their contribution is as vital as that of actuaries becausethey operationalise the business of risk.



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Most of the insurance companies formulate underwriting policy which provides the frame workfor underwriting decisions. It is also called as underwriting philosophy. The underwriting policyspecifies the line of insurance that will be written as well as prohibited exposures, the amountof coverage to be permitted on various types of exposure, the area of the country in which eachline will be written, and similar restrictions. Generally, the individual who applies theunderwriting rules and guidelines, called the desk underwriter, do not involve in forming the

company underwriting.



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The underwriting philosophy describes in general terms how the underwriter will usereinsurance for its risk management. The underwriting philosophy can be translated into

underwriting guidelines which specify the general standards that specify which applicants are tobe assigned to the risk established for each insurance product.

In life insurance, the underwriter is assisted by medical reports from the physicians thatexamined the applicant, the information from the agent, by an independent report (calledinspection report) on the applicant prepared by an outside agency created for that purpose, and

by advice from the company’s own medical advisor. In property -liability (as well as lifeinsurance), the underwriter has the services of reinsurance facilities and credit departments toreport on the financial standing of applicants and also can review loss histories of applicant.



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UNDERWRITING IN LIFE INSURANCE

Life insurance underwriting is mainly concerned with mortality. Mortality risk for an insurer isthat the insured will die prior to the stipulated life. An impairment in any respect of an proposedinsured’s personal health, medical history, health habits, family history, occupation, or otheractivities that could increase that person’s expected mortality risk.

While underwriting risk of an individual in life insurance following factors are generallyconsidered by life insurance companies:

a) age



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) gb) Sexc) Height and Weightd) Health history (and often family health history – parents and siblings)e) The purpose of insurance (such as estate planning, or business or for family protection)

f) Marital status and number of childreng) The amount of insurance the applicant already has and any additional insurance he or sheproposes to buy

h) Occupation (some are hazardous and increase the risk of death)i) Income (health determine suitability)

j) Smoking or tobacco use this is an important factor, as smokers has shorter lives

k) Alcohol (excessive drinking seriously life expectancy)l) Certain hobbies (eg. Race, car driving, hang gliding, piloting non commercial aircraft)m) Foreign travel (certain foreign traveling is risky)



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In case of renewals the most important factor is the claims experienced

Underwriters plays the potential insureds in the appropriate risk class (based on variouscriterion) generally classified as follows:

i. Preferred Class: Where the happening of an adverse event or possibility of claims is theleast i.e., the inherent risk is lesser than average risk.

ii. Standard Class: Where the risk exposed is at par with the average risk. Most of the insuredbelong to this class

iii. Sub – Standard Class: Where the anticipated risk is higher than the average risk. Insurancecompanies typically establish this risk class for proposed insureds who have permanentimpairments or conditions, or recovering from serious illnesses or accidents, or haveoccupations or avocations that significantly increase their degree of risk



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The Underwriting Process

The underwriting of life insurance is in quite a different category from other forms of personalinsurances. This is because the underwriter assesses the risk at inception only. The company isthen guaranteeing cover for sometimes, up to 30 years, or even throughout life. Life assuranceunderwriting involves looking at medical, occupational and avocation factors as well as theindividual’s lifestyle. In particular, the extra risk posed by AIDS has led to an increased number of

questions on proposal forms, of on a separate questionnaire, about lifestyle which are designedto identify if the proposer is likely to be in a high risk group for AIDS or HIV.



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The underwriting process for life assurance involves – 1. performing field underwriting

2. Reviewing the application in the office3. Gathering additional information, If required4. Taking and underwriting decision.

Additional information is often required by the underwriter in order to reach a decision.This can be in the form of detailed questionnaires, a report from the proposer’s own doctor(Medical Attendant’s report), an examination by an independent doctor (MedicalExaminer’s Report) under specific tests.



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Following steps are generally followed by underwriters:

Receiving Proposals/ApplicationsThe application for insurance is the source of insurability information that the life insurancecompany’s underwriter will evaluate first. These are generally collected by the field

personnel, the agents. There are two basic parts to a typical life insurance application:

1. General Information2. Medical Information



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The Medical Report

The average medical examination (which is generally at no cost to the applicant except in case ofrevivals) may be conducted. Depending on the medical questions are answered an insurancecompany may ask the medical doctor(s) of the client for more detail on any conditions inquestion. This gathering of information is practically a standardized method used with alldomestic insurance companies. Life Insurance Companies generally have several sources ofinformation about medical and financial history to assist them in the underwriting process.These include personal medical records and doctor, the medical information Bureau, SpecialQuestionnaires, Inspection Reports and even Credit Records.

Underwriting Review



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Underwriting ReviewOnce all of the information has been gathered, an individual from the insurance company(called an underwriter) evaluates the data. At this evaluation, the underwriter is seeking classifythe risk presented to the company. In addition, the underwriter will determine the premium forthe policy based on the primary and secondary factors influencing the premium, an thepremium rates the company’s actuaries have set for your risk profile. As a consumer, here is thehard part to understand in getting a policy: insurance companies have different underwritingguidelines. This is why the least expensive policies are the most stringent on their guidelines.Throughout every step of the underwriting process, the life insurance agent normally provideswith details, keeps abreast of where the insured stand in the process and guide and answer tothe questions. Ultimately, making the underwriting process less intimidating and moremanageable.If the proposed insured presents a risk more than the risk which the insurance company iswilling to cover, the appl8cation will be declined by the underwriter.



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Policy WritingIn life insurance the policy is usually written in special department whose main task is to issuewritten contracts in accordance with instructions from the underwriting department and,because most policies are long term in nature, to keep a register of them for future reference.

Insurance companies generally use automated systems which generate the computerized clientrecord, records of payment of premium and they do verify that all the requirement ofunderwriting have been met.



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UNDERWRITING IN NON-LIFE INSURANCE

The underwriting of commercial, business insurance is a much more complicated and involvedtask. Commercial insurances range from small shops and factories to large multinationalcompanies, with operations in many countries throughout the world. The degree of complexityof the underwriting required would obviously vary with the sheer size of the risk, but certainbasic principles are still recognizable.



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The essence of the task is that the underwriter has to evaluate the hazard associated with therisk, which is being proposed. In small cases he may be able to do this from reading a proposalform and corresponding with the sponsor. It may be that a local inspector is asked to call andsee the shop or factory for himself. In large cases this is simply impossible. Detail of the riskcould not be confined in a proposal form since there is just too much information to condense,no matter how large the form may be. The insurance companies may take the help of brokers inthese cases. The broker in these cases will be in a position to prepare the case for theunderwriter. This may mean site inspection by the broker and the preparation of plans and

reports on the relevant aspects of the risk. This documentation, which may be extremelyextensive, is then passed to the underwriter and negotiation can commence on the terms,conditions, cover and price.



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Several sources of information are available in the underwriter regarding the hazards of acommercial applicant for property and liability insurance:

a. Application Containing the Insurers Statements: The basic source of underwritinginformation is the application, which varies for each line of insurance and for each type ofcoverage. The broader and more liberal the contract, usually more detailed information isrequired. The questions on the application are designed to give the underwriter theinformation needed to decide whether to accept the exposure, reject it or ask foradditional information.



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b. Information from the Agent or Broker: In some line of non-life insurance, the agent mayexercise his underwriting authority. For commercial insurance, the profit-sharing contractsare also entered with the agents, whereby the agent derives a special incentive if the

business brought by him has resulted in a profit to the company.

c. Prior Experience: The past history of claims is also a source of information. In case ofexisting clients where the claims experience has been unfavourable, the insurancecompany penalizes i.e., leads premium for new businesses or renewals of the existing ones.

d. Inspection: Surveys are also conducted by the company’s specialist/consultants to find outthe accuracy of information as contained in the proposal form.

Underwriting Practices



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Underwriting PracticesUnderwriting of non-life insurance in India is generally carried out by a department called as

“new -business department”. Most of the underwriting work is performed at Branch and

Divisional office level, of course, in accordance with the underwriting policy and rulesframed by the head office of the insurance company. The underwriting guidelines cove thefollowing:

a) acceptance of normal risks irrespective of sum insuredb) acceptance of normal risks upto specified sum insuredc) acceptance of normal classes of business with prior approval of the controlling office (the

controlling office may be head office/regional office).d) Acceptance of risks with prior approval for the controlling officee) Acceptance of risks subject to underwriting safeguardsf) Procedural matters



60

The risks in the fire, marine and motor insurance have generally high levels of limits of

acceptance. However, in some classes of insurances, the limits are fairly low. Some of theseare:

i. All risk insurance on jewellery etcii. Baggage insuranceiii. Personal Accident Insurance

iv. Special Contingency Insurance

For higher limits in these cases, the approval of controlling office is essential.



61

In case of the insurance, only standard fire and special perils policy with the permitted “Add – on” covers if any, can be issued premiums and specified by Tariff Advisory Committee.

a) Unless otherwise specifically provided for policy(ies) covering Buildings and/ or contents shallshow blockwise separate amount on

i. Buildingii. Machinery and Accessoriesiii. Stock and Stock in processiv. Furniture and other contents.



62

b) It is permissible to exclude Storm, Tempest, Flood and Inundation group of perils and or RiskStrike, Malicious and Terrorism. Damage perils at inception of the policy by deleting the relevantperils from the policy. The deletion should apply for the entire policy in onecomplex/compound/location covering the entire interest of the insured under one or morepolicy(ies) without any option for the selection. Reduction in premium rates for such deletion(s)may be allowed as shown under the relevant sections of the Tariff. When their perils are deletedfrom the scope of the policy, the general exclusions shall include these perils.

BOARD OF DIRECTORS

1.



63

BOARD OF DIRECTORS

LOCAL BOARD OFDIRECTORS(NON – EXECUTIVE)

COMPANYSECRETARY

CHIEF GENERAL MANAGER

ASSISTANT GENERAL MANAGERS

LIFE GENERAL OVERSEAS MANAGEMENTSERVICES

PERSONNEL ACCOUNTS INVESTMENTS

PERSONNEL

FORM

CHAIRMAN2.



64

CHAIRMAN

ZONAL OFFICES

DIVISIONAL OFFICES

BRANCH OFFICES

SUB - BRANCH OFFICES

DEVELOPMENT CENTRES

FOREIGN DEPT

FOREIGN OFFICES

CENTRAL OFFICE

GEOGRAPHICAL

FORM



65

BOARD MEMBERS

EXECUTIVECOMMITTEE

INVESTMENTCOMMITTEE

BUILDINGCOMMITTEE

SERVICES & BUDGETCOMMITTEE

PUBLIC RELATIONCOMMITTEE

3.

COMMITTEES

HEAD OFFICE

4. GEOGRAPHICAL



66

HEAD OFFICE

HEAD OFFICE ADMINISTRATION

REGIONAL OFFICE REGIONAL OFFICE REGIONAL OFFICE

MAINBRANCH

MAINBRANCH

MAINBRANCH

MAINBRANCH

MAINBRANCH

MAINBRANCH

SALESOFFICE

SALES

OFFICE

SALESOFFICE

SALES

OFFICE

SALESOFFICE

SALESOFFICE

SALESOFFICE

SALESOFFICE

SALESOFFICE

SALESOFFICE

SALESOFFICE

SALESOFFICE

FORM BREAK - UP

STOCK HOLDERS

5. ORGANISATION



67

BOARD OF DIRECTORS

PRESIDENT

EXECUTIVECOMMITTE

EXECUTIVEVICE - PRESIDENT

FINANCECOMMITTE

AUDITINGCOMMITTE

ACTUARIAL(VP) LA & G, CF& M

AGENCY(VP)LA & G, CF &M SALESPROMOTION,TRAINING,AGENCYSRVICE, CF &MADVERTISINGGROUP (VP)FIELD,

PENSION,UDERWRITINGLEGAL DEPT

MEDICAL DEPTEMPLOYEESHEALT,INDUSTRIALMEDICAL &SURGICAL LA&GMEDIC

FINANCE (VP)SECURITIES,INVESTMENTS

CLAIMS (VP)LA&G,CAUALTY,FIRE &MARINEUNDERWRITING (VP),LIFE & ACCIDENT,COMPREHENSIVELIABILITY, FIDELITY& SURETY,

CASUALITY,ENGINEERING & LOSSCONTROLFIRE & MARINEEASTERN, PACIFIC,SOUTHERN,WESTERNBROKERAGE AND RE-INSURANCEPLANNING &RESEARCH

ACCOUNTING (VP)CONTROLLER &AUDITOR,

PREMIUMACCOUNTING,CASUALTY, FIRE,GROUP, LIFE &ACCIDENTSERVICES (VP)HOME, OFFICE,LIBRARY,PURCHASING ,STENOGRAHPYSUPPLY &GENERALBRANCH OFFICEADMINISTRATION

PRSONNEL

LA&G: LIFE ACCIDENT & GROUP, LA&H: LIFE ACCIDENT & HEALTH,CF&M: CASUALTY, FIRE & MARINE

CHART OF AN ALL -

LINES INSURANCE

COMPANY



68

STOCK HOLDERS

BOARD OF DIRECTORS

PRESIDENT

EXECUTIVE

COMMITTE

EXECUTIVE

VICE -PRESIDENT

FINANCE

COMMITTE

AUDITING

COMMITTE



69

FINANCE COMMITTE

ACTUARIAL(VP) LA & G, CF & MAGENCY(VP) LA & G, CF & M SALESPROMOTION, TRAINING, AGENCY SRVICE,CF & M ADVERTISING

GROUP (VP) FIELD, PENSION, UDERWRITING

LEGAL DEPT

MEDICAL DEPT EMPLOYEES HEALT, INDUSTRIALMEDICAL & SURGICAL LA&G MEDICAL

LA&G: LIFE ACCIDENT & GROUP, LA&H: LIFE ACCIDENT &

HEALTH, CF&M: CASUALTY, FIRE & MARINE



70

FINANCE COMMITTE

FINANCE (VP) SECURITIES, INVESTMENTS

CLAIMS (VP) LA&G, CAUALTY, FIRE & MARINE

UNDERWRITING (VP), LIFE & ACCIDENT,COMPREHENSIVE LIABILITY, FIDELITY & SURETY,CASUALITY, ENGINEERING & LOSS CONTROL

FIRE & MARINE EASTERN, PACIFIC, SOUTHERN,

WESTERN BROKERAGE AND RE-INSURANCE

PLANNING & RESEARCH

LA&G: LIFE ACCIDENT & GROUP, LA&H: LIFE ACCIDENT &

HEALTH, CF&M: CASUALTY, FIRE & MARINE

AUDITING COMMITTE



71

AUDITING COMMITTE

ACCOUNTING (VP) CONTROLLER & AUDITOR,

PREMIUM ACCOUNTING, CASUALTY, FIRE,GROUP, LIFE & ACCIDENT

SERVICES (VP) HOME, OFFICE, LIBRARY,

PURCHASING , STENOGRAHPY, SUPPLY &GENERAL

BRANCH OFFICE ADMINISTRATION

PERSONNEL

LA&G: LIFE ACCIDENT & GROUP, LA&H: LIFE ACCIDENT& HEALTH, CF&M: CASUALTY, FIRE & MARINE

6. ORGANISATION STRUCTURE OF LIC



72

CORPORATE OFFICE(MUMBAI)

ZONAL OFFICE INTERNATIONAL

ZONALOFFICE

ZONALOFFICE

ZONALOFFICE

ZONALOFFICE

ZONALOFFICE

UK USA AFRICA RUSSIA



73

ZONALOFFICE

REGIONAL REGIONAL REGIONAL REGIONAL REGIONAL

BRANCHES BRANCHES BRANCHES BRANCHES

CEO7. ICICI PRUDENTIAL



74

VPHR

HEADCORPORATE

MD

VPOPERATIONS

VPMARKETING

VPSALES &

DISTRIBUTION

VPIT

HEADCUSTOMERSERVICDS

HEADADVISORSERVICING

HEADA / C

HEAD BANKASSURANCE

HEAD BUSINESSDEVELOPMENTS

HEAD PC

– AMC

HEAD RETAIL

MANAGER

ASST MANAGER

EXECUTIVE

MANAGER

ASST MANAGER

EXECUTIVE

LIFE INSURANCE



75

VP

HR

CEO

MD

VPOPERATIONS

VPMARKETING

VPSALES &

DISTRIBUTION

VP

IT

VP



76

VPOPERATIONS

HEADCUSTOMERSERVICES

HEADADVISORSERVICING

HEADA / C

HEAD BANKASSURANCE

HEAD BUSINESSDEVELOPMENTS



77

HEADCORPORATE

VPIT

HEAD PC – AMC HEAD RETAIL



78

HEAD CUSTOMER SERVICES

MANAGER

ASST MANAGER

EXECUTIVE

MANAGER

ASST MANAGER

EXECUTIVE



79

METHODS OFHANDLINGRISK

AVOIDANCE

RETENTION: SELFINSURANCE

TRANSFER

SHARING

REDUCTION



80

RISK MANAGEMENT:THE IDENTIFICATION,ANALYSIS &ECONOMIC CONTROLOF THOSE RISKSWHICH CAN THREATENTHE ASSET OREARNING CAPACITY OF

THE ENTERPRISE.

DETERMININGOBJECTIVES

IDENTIFICATION

ANALYSIS

ASSESSMENT

1. FINANCIAL: WITHFIANANCIAL CONSEQUENCES



81

2. NON-FINANCIAL: WITHOUTFINANCIAL CONSEQUENCES

3. STATIC: WITHOUT CHANGES IN THE ECONOMY,

WITHOUT GAIN TO THE SOCIETY, MOSTLYREGULAR & FAIRLY PREDICTABLE

4. DYNAMIC: ARISES FROM CHANGES IN THEECONOMY & GAINFUL TO THE SOCIETY

5. FUNDAMENTAL: IMPERSONAL IN ORIGIN& CONSEQUENCES & AFFECTS LARGESEGMENTS IN SOCIETY

6. PARTICULAR: ARISES OUT OFINDIVIDUALS & AFFECT THE INDIVIDUALS

7. SPECULATIVE: CAN CAUSEBOTH LOSS & GAIN

8. LOSS / NO LOSSPURE

PERSONAL

PROPERTY: DIRECT /CONSEQUENTIAL

LIABILITY: OWN FAILURE

OTHERS’ FAILURE

SUMMARY: INSURABLE RISKS ARE PURE RIKS WHETHER FUNDAMENTAL OR PARTICULARAND WHETHER STATIC OR DYNAMIC. FUNDAMENTAL RISKS ARE COVERED BY SOCIALINSURANCE, WHERE-AS PARTICULAR RISKS ARE COVERED BY PERSONAL INSURANCE

1 FINANCIAL: WITH FIANANCIAL



82

1. FINANCIAL: WITH FIANANCIALCONSEQUENCES

2. NON-FINANCIAL: WITHOUTFINANCIAL CONSEQUENCES

3. STATIC: WITHOUT CHANGES INTHE ECONOMY, WITHOUT GAIN

TO THE SOCIETY, MOSTLYREGULAR & FAIRLY PREDICTABLE

4. DYNAMIC: ARISES FROMCHANGES IN THE ECONOMY &GAINFUL TO THE SOCIETY



84

SUMMARY: INSURABLE RISKS ARE PURERIKS WHETHER FUNDAMENTAL ORPARTICULAR AND WHETHER STATIC ORDYNAMIC. FUNDAMENTAL RISKS ARECOVERED BY SOCIAL INSURANCE, WHERE-AS PARTICULAR RISKS ARE COVERED BYPERSONAL INSURANCE

CONCEPTS OF SERVICE MARKETING &



85

CO C S O S V C G &NATURE OF INSURANCE MARKET:

i. Service Characteristics: Intangibility, Inseparability, Heterogeneity, Perishability &Ownership.

ii. Eight P’s of service marketing: Products, price, promotion, place, packaging, people,process and physical evidence / proof of delivery.

iii. Marketing of Insurance Products: Challenges:a. Insurance is unpatented, subjective, requires prior experience & physical evidence is

difficult to establishb. There is an involvement of customers in production of services, mass production is

impossible.

c. The services can’t be inventoried & standarised.

MARKETING PROCESS



86

SATISFACTIONOF CUSTOMERWANTS ANDDESIRES

CUSTOMERS

KNOWLEDGEOF WANTS ANDDESIRES

OPERATING

RESULTS

COMPANYGOALS

RECOGNITIONOF RESULTSDESIRED



CSF of insurance marketing:



88

CSF of insurance marketing:

i. changing attitude of the population

ii. Open and transparent environment created by IRDA

iii. Well established distribution network

iv. Train professionals to build and sell products

v. Rational approach to investment criteria dictated by IRDA

vi. Stringent accounting practices to prevent failures amongst the insurer

vii. Level playing field for all the players.



2. BENEFITS OF BROKERAGE:



90

2. BENEFITS OF BROKERAGE: i. Improvement in customer services

ii. Transfer of Technology & Managerial Know – howiii. Benefits to Insurance companiesiv. Foreign Exchange consideration (Re-insurance brokerage)

3. New Distribution Channels:

The new channels of distribution for the Indian Insurance industry are:i. Direct marketing: Company owned sales team concept is now employed by a majority of

the new players and has proved effective in customer creation & retention.ii. Brokers / Corporate agent: Authorised by IRDA to sell and Customise products on behalf ofinsurance companies

iii. Independent financial advisors: Authorised agents of insurance companies with tie-upswith many companies



91

with many companies.

iv. Tele – marketing: Marketing thru’ telephonic device, generating leads thru’ phone calls &forwarding these leads to the main sales team of the company.

v. Work – site marketing: The seller sends teams to the target groups and explain the productand services suitable to them. HDFC, ICICI & Kotak Mahendra are using this distributionstrategy effectively.

vi. vi.Retail Chain: Cross selling of product thru’ retail outlets

vii. .Internet Marketing: Internet based product offering.

viii. Bankassurance: Distribution of insurance products by banks.

4) BANKASSURANCE:



92

4) BANKASSURANCE:A partnership between a life insurance co & a commercial bank, to exploit the large

customer base of commercial banks, 60,000 branches & customers served are15,000 / branch.

Key success areas for bankassurance are:• Both bank and insurance co need to improve effectiveness of the sales channel by identifyingand gaining assess to target customers.

• Products need to be tailored to meet the need of the customer base and for new distribution

channel.

• Communication need to be streamlined to address any cultural issue between bank andinsurance employees.



93

• Traditional banking process need to be re-designed.

• Information system needs to be reviewed.

• Fresh skills have to be developed and re-allocation of financial and human resources.

• Bank assurance styles: Using bank premises as marketing offices very effective collaborationwill be the key to make this new channels work. In fact, in India three different models ofBankassurance are already taking shape.

i) Leveraged Life Distribution: Life insurance Co. takes the lead while several bank acts as



94

i) Leveraged Life Distribution: Life insurance Co. takes the lead while several bank acts ascorporate agents to provide access to middle market leads.

ii) Leveraged Bank Distribution: Bank takes the lead while insurance companies supply products.

This model calls for large bank with a range of effective distribution channels (i.e.,branches, ATMs, mails, phones etc.)

iii) Bank / Life Joint venture: Based on equal partnership a bank with a well developed customerdata base together with a large life insurer with strong product & channel experience &develop a powerful new distribution model. The bank provides the lead, reputation &brand name, insurer brings products, underwriting & servicing experience.

Example: SBI Life: 12 crore term deposit holders thru’ 14000 branches.

MARKETING STRATEGY FOR INSURANCE PLAYERS IN IND



95

LIC of INDIA: ‘ Life is Beautiful’, ‘Jindagi Ke Saath Bhi Jindagi ke Baad Bhi’ Birla Sun Life: ‘Your Dreams, Our Commitment’ ICICI Prudential: ‘We Cover You at Every Step in Life’ / ‘SAR UTHAKE JIYO’HDFC Standard Life: Making Life Easier for You

Om Kothak Mahendra: ‘Jeene ki Azadi’ ING Vysya: ‘Adding Life to Insurance’

TATA AIG: ‘With You, Always’ MAX New York Life: ‘Your partner for Life’ / ‘Karo Jyada Ka Irada’ Bajaj Alliance: ’We cover almost everything’ AMP SANMAR: ‘Creating Better Futures’

JOB DESIGN AND BPR



96

JOB DESIGN AND BPR:

Introduction: While employee productivity is important for any organization, managers wouldensure that the workers are satisfied with their jobs. The degree to which the employees aremotivated while performing their work, is dependent to a large extent on the activities andresponsibilities entrusted to them in their jobs. Organizations should strive to incorporate newapproaches and methodologies to improve efficiency and productivity while designing job.

Job Design: Definition: Job design is the process of determining the specific tasks andresponsibilities to be carried-out by each worker in the organization. It encompasses thespecifications and expectations of a employee’s work related activities, including their structuraland inter-personnel aspects of the job.

RICHARD HACKMAN’S AND GRAG ORDHAM’S JOB



97

JOBCHARACTERISTICS

1. SKILLVARIETY

2. TASKIDENTITY

3.AUTONOMY

4. FEEDBACK

2. TASKSIGINFICANCE

CHARACTERISTICS MODEL:

RICHARD HACKMAN S AND GRAGORDHAM’S JOB CHARACTERISTICS



98

ORDHAM’S JOB CHARACTERISTICS

MODEL:Notes: an effective job design ensures that jobs are consistent with the organisation’s goals.

The objective is to boost employee motivation and morale to achieve performance standardsand to match the skills and abilities of each worker with the job requirements. Skill varietyindicates the level and range of skills, ability and talents needed to perform a job.Task identity defines clearly the identifiable tasks needed to complete the main task..



99

Task identity defines clearly the identifiable tasks needed to complete the main task.Task significance indicates the influence of the job on individuals inside and outside theorganization.Autonomy of a job indicates the flexibility, independence and discretion that is available to theemployee in performing the job.

Feedback indicates the level of information given to the employee regarding his / herperformance.

FACTORS IN JOB DESIGN



100

WHO WHAT WHERE WHY HOW

MENTAL &PHYSICALCHARACTERISTICS OF THE

WORKFORCE

TASKS TO BEPERFORMED

GEOGRAPHICLOCALE OF THEORGANISATION,LOCATION OF

WORK AREAS

ORGANISATIONALRATIONAL OF THEJOBS, OBJECTIVES& MOTIVAION OFTHE WORKERS

METHODS OFPERFORMANCES

ULTIMATEJOB

STRUCTURE

OBJECTIVES OF JOB DESIGN



101

OBJECTIVES OF JOB DESIGN

ECONOMICALLYFEASIBLETASKS

BEHAVIOURALLYFEASIBLE TASKS

TECHNICALLY

FEASIBLETASKS



APPLICATION OF JOB ANALYSIS & JOB DESCRIPTION



103

JOB DESIGN JOB ANALYSIS JOB DESCRIPTION& SPECIFICATIONS

RECRUITING,INTERVIEWING &SELECTING

ORIENTATION &TRAINING

PERFORMANCESTANDARDS & GOALSTATEMENTS

PERFORMANCEAPPRAISAL FORMS

JOB EVALUATION

CLASIFICATION & RE- NEGOTIATION OF ROLES

CAREER PROGRESSIONLADDERS

JOB DESIGN



104

JOB DESIGN

JOB ANALYSIS

JOB DESCRIPTION &SPECIFICATIONS

RECRUITING,INTERVIEWING& SELECTING

ORIENTATION& TRAINING

PERFORMANCESTANDARDS &GOALSTATEMENTS

PERFORMANCEJOB DESIGN



PERFORMANCEAPPRAISAL

FORMS

JOBEVALUATION

CLASIFICATION &RE-NEGOTIATIONOF ROLES

CAREERPROGRESSION

JOB DESIGN

JOB ANALYSIS

JOB DESCRIPTION &SPECIFICATIONS

general insurance topics

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