CSC – VLE training

CLAIMS NON LIFE-‐ PROCESS AND DOCUMENTS

Learning Outcome
1. Intimation of claim
2. Survey Report
3. F.I.R
4. Death Certificate & Post Mortem Report
5. Policy Specific Documents
6. KYC Documents

1. Intimation of claim

In non life insurance if there is a claim under the policy the same needs to be immediately
reported to the insurance company. This reporting or information is called ‘Claim Intimation’.
Few policies state specific time for intimation of a claim but all do state that the intimation is to
be given forthwith i.e. at the earliest. Health insurance policies state time for intimation which
is generally for planned hospitalization – before admission and for non planned hospitalization
within 7 days of the admission.
1.2 Timely intimation of a claim, even intimation of a likely claim, is very important.

1.3 The intimation enables the insurers to take quick actions for:-‐
i) Loss minimization
ii) Claim investigation
iii) Survey and assessment of loss
iv) Enforcing rights against third parties.

1.2.1 When intimation is received by the insurers they may send surveyor or their
representative to see the loss. In case of property losses the insured is suggested to carry out
loss minimizing measures like fire fighting ( fire loss), shifting of property to elevated place
( flood loss), segregation of damaged property and shifting of property to a safer place etc.

Claims – The Moment of TRUTH

CLAIMS NON LIFE-‐ PROCESS AND DOCUMENT CSC-VLE
Training

In case of cattle insurance, insured is advised to seek help of

qualified veterinary doctor when to give treatment to the ailing
animal. In case of spread of epidemic in the area, the insured
may be advised to shift cattle to other area which is free from
epidemic, carry out immunization of remaining animals who
are healthy but likely to get infection if remain in the epidemic
area.
1.2.2 Early intimation helps, as evidences may be at the place of
loss and are not destroyed. In case of fire loss the cause of fire
can be better investigated, if questions are asked to eye witness
at the site. In case of flood losses the water flooding the place
can be seen by the investigator and insurance company can be
sure that rain water damage claim is not passed on to them as
flood losses.
In case of epidemic in an area the investigator can collect the
first hand data about the epidemic and can also see the dead
insured animal, if the claim is for death.
In case of accident, early site inspection, becomes important as
all the evidences and witnesses to the accident may be present
there. .
1.2.3 Surveyor assess the loss and prepare an estimate of loss
and prepare preliminary report, if he reaches early. If any item
requires to be tested, samples can be collected and sent for
laboratory test.
In case of cattle insurance in epidemic situation surveyor can
advise the insurance company about the likely loss, due to
epidemic. If the insurers wish they can take up the matter with
appropriate government authorities to control the epidemic. In
case of insurance of poultry or birds local animal husbandry
department may be alerted and request to take appropriate
action to avoid spread of the epidemic.

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CLAIMS NON LIFE-‐ PROCESS AND DOCUMENT CSC-VLE Training

1.2.4 If any third party is responsible for the loss, steps may be initiated to take action against
them for recovery of the loss.
Example: if a cow dies due to negligent driving of the truck owner, police complaint can be made
against the owner and driver of the truck so in future recovery of loss from them becomes easy.
2. Survey Report
2.1 Under Insurance Act 1938, if the amount of loss is Rs 20,000/ -‐ or more, a licensed
surveyor is to be appointed to assess the loss.
Surveyor’s role is very important. In case of property insurance, Surveyor has to visit the place
of loss, collect relevant information and document and submit a report. In case of motor
insurance surveyor has to visit garage for inspection of damaged vehicle and submit his report
on assessment of loss. In case of commercial vehicle surveyor has to visit spot of the accident
and conduct spot survey and report to the insurers. In case of major vehicle losses he may
required to do re inspection survey to report whether all the damaged parts have been replaced
or not. He has to report whether the repair has been carried out or not.
2.2 Survey report contains following intermediaries:

i) The cause of loss

ii) The quantum of the loss
iii) Comments on policy conditions to be followed for completion of claim.
iv) Comments about admissibility of claim and compliance of terms and conditions of the
policy by the insured

First information report – FIR is the document which gives

information about the intimation of crime to police by the insured. It gives
details ofOfImportancecircumstances and likely cause of loss and likely persons
involved. It also gives approximate value of loss.

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CLAIMS NON LIFE-‐ PROCESS AND DOCUMENT CSC-VLE Training

3. First Information Report ( FIR)

First information report is information to police authorities about accident or

claim.
It is generally done in following cases:
i) Theft, burglary or housebreaking cases – Property Insurance
ii) Major vehicular accident injuring third parties or damaging their
properties – Motor Insurance
iii) Fire incident involving injuries to any persons or causing major property
loss – Fire Insurance
iv) Cases involving financial frauds by employees or others cause loss to the
insured – Liability Insurance
v) Death due to accident of an individual – Personal Insurance Policy

3.1 The information to police is required became on intimation police conducts an

investigation and issue their report about the findings of investigation.
In case of thefts and frauds they arrest the culprits and try to recover from them
the lost property or misappropriated money or goods.
3.2 In case of accidental death they conduct investigation and report whether it was genuine
accident or case of suicide or murder.
3.3 For investigation police may take help of forensic department to establish exact cause of
loss incase of fire losses. In case of death of individuals, insurance company may send
dead body for post mortem to find out cause of death.
3.4 3.4 When investigation is completed the police authorities issue final report and if it
takes longer than three months for police to issue the final report, by practice insurers
settle claims on the strengths of FIR.

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CSC-VLE TRAINING

4. Death Certificate and Post

Mortem Report
4.1 Death Certificate is required as a
supporting document for claim under
personal accident policy which covers death
due to accident.
Death certificate is issued by Municipality or
Grampanchayat of the area in which the
deceased was residing or died. It gives the
name, age, address and date of death of a
person.
In case of death of insured person covered
under health insurance policy, settlement of
claim with nominee for hospitalization
expenses incurred for the treatment of the
deceased, the death certificate is necessary.
In case of cattle or other animal insurances,
death certificate is also required. However
the death certificate is issued by a veterinary
surgeon treating the animal or who attended
it at the time of the death.
4.2 Post Mortem report is examination of
dead body of a person and testing various
organs to find out the cause of death.
Generally it is conducted in case of accidental
death or doubtful death at any place. The
post mortem is performed at government or
local body’s hospital in nearby area by the
surgeons trained for that.
In case of insurance of animals post mortem
report is required, which is conducted by a
veterinary surgeon.
5.1 Motor Insurance Claims
In motor insurance, claim can arise due to injury or property damage to third party is
loss/damage to insured vehicle is known as Own Damage chain.

5.1.1 Third Party Claim

In a third party claim, it is necessary that accident is reported immediately to the polce and to
the insurance company.

5.1.2 Own Damage Claim

In the event of an own damage claim [damage due to accident, theft, etc] must be immediately
inform insurance company and police.

5.1.3 In Motor claim cases, following documents are required:-‐

i) Claim form
ii) Estimate of repairs, repair bills,
iii) Survey report
iv) Vehicle documents
v) FIR incase of theft of vehicle or injury or damage to third party/ property

5.2 Death Claims for Cattles: -‐ Following documents are required for making claim for cattles.

1. Claim form.
2. Death Certficate on insurance company’s form.
3. Post mortem report.
4. Ear tag.
5. Valuation certificate by veterinary doctor.
5.2.1 In case of death of animal insured under Integrated Rural Development Programme
(IRDP) or other similar scheme, death certificate may be issued by Panchas consisting of any
two of the following:-‐
1. Sarpanch of village.
2. President or other senior officer of Co Op Credit Society.
3. Official of milk collection centre.
4. Supervisor or officer of banking or credit institution.
5. DRDA or it’s authorized nominee.
6. Secretary or vice president of panchayat.
7. Village revenue officer/ village accountant.
8. Headmaster of a primary school.

In case of claims for disablement veterinary doctor’s certificate with treatment details
required.
5.3 Poultry Insurance: -‐
Following documents are required in Poultry Insurance claims cases:-‐
1. Claim form
2. Veterinary doctor post mortem report of sample birds
3. Daily records of mortality, feeding etc
4. Purchase invoice for birds
5. Photographs, medical bills etc.

5.4 Agricultural Pump set Insurance: -‐

Following documents are required in Agriculture Pump set Insurance claims cases:-‐

1. Claim intimation letter to insurer

2. Claim form
3. Repair estimate an bills ( in case of damage)
4. Police report ( in case of thefts)
5. Survey report.

5.5 Other package policies and property insurance: -‐

Following documents are required in other package policies and property Insurance claims
cases:-‐

i) Claim form
ii) Other documents as per type of loss: -‐
a. Damage-‐ repair estimate bills
b. Theft-‐ FIR
c. Survey report (wherever applicable)
d. Treating doctors certificate (accident claims)
e. Post mortem and death certificate (accidental death claims)
6. KYC Documents
In general insurance due to threats of money laundering at the claims stage. KYC norms are
carried out at settlement stage, where claim payout/premium refund is more than one lakh
per claim/premium refund. In cases where payments are made to service providers such as
hospitals/garages/repairers etc., the KYC norms are applied on the customers on whose
behalf they act.

Documents that are obtained from customer for KYC are:-‐

a) Proof of Identity
b) Proof of residence

The details are in the next page

6.2.1 Proof of Identity
i. Passport
ii. Pan Card
iii. Voter’s Identity Card
iv. Driving License
v. Letter from a recognizes Public Authority [as defined under section 2(h) of the Right to
information Act, 2005] or Public Servant [as defined in section 2(c)] of the ‘The
Prevention of Corruption Act,1988’] verifying the identity and residence of the
customer
vi. Personal identification and certification of the employees of the insurer for identity of
the prospective policyholder.
vii. Letter issued by Unique Identification Authority of India containing details of name,
address and Aadhar number
viii. Job card issued by NREGA duly signed by an officer of the State Government.

6.2.2 Proof of Residence

i. Telephone bill pertaining to any kind of telephone connection likemobile, landline, wireless,
etc. provided it is not older than six months from the date of insurance contract.
ii. Current passbook with details of permanent/present residence address (updated up to the
previous)
iii. Current statement of bank account with details of permanent/present residence address(as
downloaded)
iv. Letter from any recognized public authority
v. Electricity bill
vi. Ration card
vii. Valid lease agreement along with rent receipt, which is not more than three months old as a
residence proof.
viii. Employer’s certificate as a proof of residence (certificate of employers who have in place
systematic procedures for recruitment along with maintenance of mandatory records of its
employees are generally reliable)

6.2.3 Proofs of both Identity and Residence

Written confirmation from the banks where the prospects are a customer, regarding identification
and proof of residence.

6.2.4 For Micro insurance policies, following documents are sufficient as proof
of identity and address:-‐
i. Current passbook with details of permanent/present residence address (updated up to the
previous month)
ii. Current statement of bank account with details of permanent/present residence address