ABC Co. Ltd. which operates a wholesale warehouse, had a fire on its premises on 30th April, 2016 which destroyed most of the building and stock worth of ₹10,160 was salvaged. The company has a Fire Insurance Policy (wit
CS Professional · Insurance - Law and Practice · PYQS · December 2018
ABC Co. Ltd. which operates a wholesale warehouse, had a fire on its premises on 30th April, 2016 which destroyed most of the building and stock worth of ₹10,160 was salvaged. The company has a Fire Insurance Policy (with suitable average clauses) covering the assets as under: Assets Insured Insurance Cover (in ₹) Stock 6,50,000 Building 9,00,000 Loss of Profits Including standing charges of ₹2,50,000 with a six month period of indemnity. The Company's last Profit & Loss Account (year ended 31st March, 2016) is given below: Profit & Loss Account for the year ended 31st March, 2016 Dr. (₹) Cr. (₹) To Opening stock 5,23,500 By Sales 22,50,000 To Purchases 19,66,500 By Closing stock 6,45,000 To Insured standing charges 1,15,500 By Other income 11,000 To Other expenses 65,500 To Net Profit 2,35,000 29,06,000 29,06,000 The company's records show that the sales for April, 2016 had been at ₹1,50,000. Payments made to trade creditors in April, 2016 were ₹1,15,500 and the creditors increased by ₹4,500. The company's business was disrupted until the end of July, 2016 during which period the turnover fell by ₹2,20,000 compared with the same period in the previous year. It was agreed that 65% of the value of the building had been lost and at the time of fire it was worth ₹10,00,000. Questions: Explain the process of claim settlement followed by General Insurance Companies and the documents required to be submitted by ABC Ltd. for its claims.
Answer & Explanation:
General Insurance is basically an insurance policy that protects against losses and damages other than those covered by life insurance. The coverage for most general insurance policies is for one year. The risks covered by general insurance are: Property loss, for example stolen car or burnt house. Liability arising from damage caused by yourself or a third party. Accidental death or injury. General Procedure for Claim Settlement: The general procedure for seeking claim settlement is same in most forms of General Insurance. The procedure in detail is as explained below: (a) Intimation of submission of the claim by the insured: The insured would intimate the insurance company of the occurrence of a peril or risk which has caused loss or damage to the insured property. (b) Evaluation/Registration of Claims: The insurer would briefly initiate process check- Whether the policy has been issued by the insurer. Whether the policy is in existence. Whether the correct premium has been received by the insurer. Whether the peril causing loss/damage is an insured peril. If the insurer is not satisfied and the necessary elements of insurance are not present, it may repudiate the insurance claim and intimate the insured about the repudiation. In some cases, the insurer may ask for some other inputs about the insurance claim which he thinks necessary for processing the claim further. If on receipt of the additional inputs, the insurer is not satisfied, he may repudiate the claim and intimate the insured about repudiating of the claim. Only after getting satisfied about the claim, the insurer initiates the next step for claim processing. The insurer would immediately arrange for surveyor to be appointed who would look into the circumstances of the loss, assess the actual loss suffered in money terms and that which can be indemnified in terms of the contract, advise the insurer regarding compliance of the various terms conditions and warranties under the contract etc. The loss assessor has also to advise the client on various aspects of loss mitigation, limitation and salvage. Loss investigation including forensic investigation and analysis may also come under the purview of a professional investigator. Acid tests applied by the surveyor of the various principles - insurable interest, utmost good faith, proximate cause and of course contribution, help in deciding ultimately whether a claim is payable and the amount to be paid. If the claim is not paid within the same financial year in which it occurred then the surveyor's assessment would enable the adequate provisioning for the claim in its financials. (d) Settlement of Claims: The insurer would ensure claims are settled on receipt of the final report from the surveyor, generally within the Turnaround time (TAT) by various regulations and committed by the insurance company. (e) Recovery: The next step for the insurance company, in certain cases is initiating process for recovery from the third person who is party in the loss e.g. in marine cargo transit claims- recovery proceedings as per applicable statues are initiated against carriers. In motor third party liability claims -awards are settled with victims of any motor accident and action initiated against the vehicles for recovery. The various documents necessary for submitting the claim under Fire Insurance policy by ABC Co. Ltd. include: Copy of the original fire insurance policy. FIR Copy. Photographs of the loss/ fire accidents. Accounts reports, ledgers to show the loss of profit. Past year final accounts statement. Surveyors initial report. Claim notice copy.
Topics: General Insurance
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