There are some
guidelines that must be followed while settling the claims. These guidelines
are general in nature, and are not compiled to be the same always. Therefore,
the claim settling authority uses discretion and records reasons.
Appointment of surveyor
The Insurance Act states
that surveyor should survey claims above Rs. 20,000. The surveyor’s appointment
should be based on the following points:
· The surveyor should
have a valid license.
· The surveyor selected
should consider the type of loss and nature of the claims.
· Depending on the
situation, if technical expertise is required, a consultant having technical
expertise assists the surveyor.
· One surveyor can be
used for various jobs, if the surveyor’s competence is good for both.
Appointment of
investigator
Depending on
circumstances, it is necessary to appoint an investigator for verifying the
claim version of loss. The appointing letter of the investigator o mentions all
the reference terms to perform.
Guidelines for
Settlement of Claims by IRDA
The proposals for
insurance are:
· In all cases to claim
insurance, a proposal for grant of cover should be submitted with proof (a
written document). But a written proposal form is not required for marine
insurance markets.
· Depending on the
circumstances of the claim, forms and documents in the grant of cover can be
made available in the languages recognised by the constitution of India.
· The prospect is to
fill the form of proposal, under the guidance of the provisions of section 45
of the Insurance Act.
· If a proposal form is
not used, the insurer has to record the information obtained, orally or in
writing, and confirmation is to be done by the insurer within 15 days. If any
information is not recorded, the burden of the missing information lies on the
insurer, in case he claims that the insured is suppressing information or is
providing misleading information.
· The insurer is to
educate the proposer, concerning the facilities available, like appointing
nominee or any facility based on the terms of act or conditions of policy.
· The insurer has to
process the proposal quickly and efficiently. All the decisions and
confirmations should not exceed 15 days from the receipt of proposal by the 
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