Indian Express Claims Settlement an Equal Responsibility of Insurer and Customer Rajagopal G, Head of Operations and Claims, Bharti AXA General Insurance The insurance industry has long been accused of making promises that it does not keep at the time of a claim. Customers are often under the impression that all eventualities are covered under their insurance only to discover at the time of claim that either the loss is not covered under the policy or that the cover is limited and does not recompense them to the full extent of the loss. With some understanding of the essential elements that go into the insurance contract, customers can avoid the commonly encountered pitfalls in dealing with insurers. Most issues arise due to inadequate understanding of the importance of information provided to the insurer at the time of proposing for insurance or a failure to comply with duties expected of the insured person following a loss. We hope that the following few pointers would help in enhancing the understanding on the part of the insuring public and ensure that they get their just dues when claiming under the policy. For ease of understanding, this is classified according to the aspects that need to be taken care of during various stages of the contractual relationship. At the time of purchasing / proposing for insurance:
Complete disclosure of information pertinent to the subject matter of insurance (the thing insured). Example – existing insurance policies in case of Health / Personal Accident, nature of construction of building, existence / absence of fire-fighting equipment, pre-existing health conditions in the case of health policy etc.
Previous Insurance History – Claims made, No Claim Discount in Motor policy, special discounts / conditions on previous policy etc.
Always purchase insurance for the realistic value of the asset – there is hardly any savings to be had through under declaration, but the consequences of such undervaluation can be quite significant at the time of claim.
Always ensure that your policy is in force and is renewed well in time without waiting for expiry in order to avail of continued benefits of uninterrupted coverage. For example health policies typically cover pre-existing conditions after a specified period of uninterrupted coverage which benefit will be lost if there is a lapse in cover in the intervening period.
Please make it a point to acquaint yourself thoroughly with the coverage and exclusions of your policy and any special conditions / limitations mentioned therein.
During the duration of the policy:
Inform the insurer of any material alteration to the subject matter – modification of vehicle or asset, any improvement effected to the asset, any property / building that is going to be unoccupied for a length of time etc.
Any change / transfer of ownership - most insurance contracts are personal in nature and hence a change of ownership is a material fact for the insurer
Additions to the list of insured items.
At all times, the insured should exercise due regard to the safety of the property. The duty of reasonable care expects the insured person to act as though he is uninsured and exercise requisite caution. Leaving one’s car unlocked in a public place would certainly count as gross negligence which is not covered under the policy.
When claiming under the policy:
Notify the insurer immediately upon the occurrence of a loss / the loss coming to your notice.
Inform the appropriate authorities (Police / fire brigade) etc. immediately for their action.
Take all reasonably necessary measures to minimise the loss / prevent further damage. Damage incurred in the act of minimising the loss is covered under most policies.
Provide a comprehensive and truthful account of the circumstances surrounding the loss so that the insurer can quickly decide on admissibility of the claim. In the unfortunate event that the claim cannot be admitted, this will provide the insured an opportunity to take necessary action to try and minimise his outgo or otherwise deal with the issue.
Provide all necessary documentation and information as required by the insurer to quantify the loss / provide proof of repair / renovation etc. This will usually be informed at the time of loss by the appointed surveyor / adjuster or can be obtained from the insurer’s website.
Protect yours (and thereby, the insurerâ€™s) legal rights against any Third Parties who may have been responsible for the loss. Typical example in a marine policy is taking open delivery where there is suspected damage and giving notice within the specified period of 30 days as required by the relevant statute.
Lastly, whilst insurance can provide compensation for the monetary loss arising out of an unfortunate event, no amount of cover can make up for the mental agony and trauma that one may undergo following a loss. Hence, always act in a safe and responsible manner in all your activities. For more information visit http://www.bharti-axagi.co.in
The insurance industry has long been accused of making promises that it does not keep at the time of a claim. Customers are often under the...