General Claims Procedure

All insurance contracts are based on the information provided by the Policy holder while buying Insurance and the Insurance Policy.

Some important points, which would help you in the claims procedure:

• The loss or damage should be reported to the Insurance Company and your Insurance Broker (alert@myinsurancepal.com) for assistance    immediately. Please do inform us the Insurance Policy number while intimating for speedy attention.
• Claim form can be downloaded from your broker’s site www.myinsurancepal.com  under “Form Download” section or the Insurance Company’s site. In case it is not available please let us know so that we can arrange to send you the claim form immediately.
• Please arrange to submit the completed claim form along with an estimate of the loss to the Insurance Company. It is preferable to submit an itemized estimate with separate values.
• The Insurance Company will arrange for inspection of the damaged items to assess the loss. In case of major losses, a specialist-licensed surveyor is deputed.
• The Policy holder has to provide the required documents to substantiate the extent of loss.
• In case the cause of loss is not established, it is for the Policy holder to prove that the loss or damage has occurred due to an insured peril.
• On agreement of claim amount between the Insurance Company and the Policy holder, the claim is settled as per the terms and condition of the policy.
• Excess (Deductable) as stated as per the Policy terms and condition will be deducted from the claim payable.

In view of varied nature of policies, certain points distinct to individual policies, in addition to the above, are listed below: (Please note that the documents mentioned are indicative and based on the circumstances of the claim, Insurance Company may request for additional documents)

Motor vehicle (Private & two wheelers) claims

Claims under Motor  policies

• Notice of an accident should be reported to the Insurance Company and your Broker.
• The Policy holder may be interested to pay compensation without going into whether he is liable to pay or not. It is therefore an express condition of the policy that no claim should be admitted or a compromise arrived at, without the approval of the Insurance Company.
• In case of major claims, the Insurance Company may be willing to defend criminal case against the driver also on the basis of which compensation claims may be decided in the civil courts.
• Every accident involving third parties is required to be reported to police. MV Act provides that a third party victim can proceed against the Insurance Company directly. If the alleged accident is not reported to the Insurance Company, the Insurance Company can consider this as violation of policy condition. In such circumstances, even if Insurance Companies are required to pay compensation by a court of law, they have an option of recovering such claim amounts from the policy holder for violation of specific policy condition.

Steps to be taken in case of an accident:

• Notice of accident should be filed with the Insurance Company and the Insurance Broker for assistance.
• If damage is a major one, the accident may be reported before the vehicle is removed from the spot so that the Insurance Company can arrange for spot inspection of damage.
• Try to take photographs of the vehicle from the accident spot from your Camera/Mobile if possible.
• The vehicle may then be moved to a workshop, preferably to authorized workshop, for estimation of repair charges.
• Accumulated claims are not entertained by most of the Insurance Companies.
• In case the vehicle needs to be towed, the invoice and the proof of payment need to be submitted for reimbursement as per the terms and conditions of the policy.
• On receipt of completed claim form and estimate of repairs the Insurance Company will arrange detailed inspection of damage and cost of repairs will be ascertained.
• The Insurance Company will ensure that a person duly licensed drove the vehicle at the time of accident and that the vehicle is the one insured in their books. To that end, they will verify the Registration Certificate and the Driving license of the driver who drove at the time of the accident.
• Upon completion of the above procedure, the repairers will be authorized to carry out repairs. The Insurance Company may undertake to settle the repair bills directly with the garage or reimburse the policy holder after submitting the relavent documents without any delay.

Motor claims Check list:

•  Intimation
• Spot  photograph by the policy holder if possible
• Claims form
• Verification of Original RC and Driving license along with a photo copies of each.
• Surveyor
• Repairs can be done only after the surveyor inspects the damaged vehicle
• Itemized estimate of Repairs with separate values
• FIR if applicable, Non traceable certificate from the police for theft cases.
• Cashless can be arranged if repairer has such tie up with the Insurance Company
• Else, Reimbursement can be done by submitting original invoice, payment proof and other relevant documents.
• Re inspection of the vehicle after repairs and before delivery from the workshop

Medi claim (for non-cashless claims)

• Notice of claim should be lodged within 24 hours to the Insurance Company and your Broker for assistance
• The Policy holder should submit 'discharge summary' of the hospital/nursing home along with original hospital/medical bills, reports of the labs, investigation reports and Doctors prescriptions. In other words every item in the claim bill should be supported.
• Leave certificate from the employer, wherever needed.
• Fitness certificate from the Doctor.

Travel Insurance claims

• The claim procedure varies from country to country and therefore the Policy holder should get in touch with the overseas claim settling agents of the Insurance Company immediately.
• The Policy holder should carry the policy document with him/her, which may be produced as evidence if necessary. The policy document also contains the full information as to how to get in touch with the claim settling agents for assistance.

Personal Accident Claims

• Immediate notification to the Insurance Company and your Broker for assistance
• In case of accidental death, the capital sum is paid to the legal nominee/assignee of the Policy holder. If the Policy holder fails to provide the name of the nominee, succession certificate from a court of law is necessary.In case of other claims, the Insurance Company may get the Policy holder examined by a specialist or refer the matter to medical board as is necessary, the cost of which will be borne by the Insurance Company.

Claims under ‘Standard Fire and Special Perils’ Insurance policies

• Firstly the Policy holder should take all possible steps to minimize the loss.
• The fire brigade must be intimated immediately.
• Lodge a police complaint in case of a fire arising out of - rioting mob, striking workers, malicious damage by third parties or terrorist damage.
• Inform Insurance Company and your Broker for assistance as early as possible , in no case later than 24 hours
• To co-operate with the surveyor appointed by the Insurance Company by relevant information.
• Obtain a meteorological report in case of loss due to cyclone, flood & inundation and like perils
• Submit News Paper Cutting  if available
•  If the policy is on 'Reinstatement basis', the claim is settled only after completion of repairs/replacement of the damaged items and submission of bills for claim payment.

Burglary Claims / Money Insurance / Fidelity

• Immediately report to the police and obtain a non-traceable certificate if the items are not found.
• Notify Insurance Company as early as possible.
• The Insurance Company will insist upon a letter of undertaking on a stamp paper of appropriate value - letter of Subrogation, for refunding the claim amount when the stolen property is recovered.
• Obtain a final report from Police and submit the same to the Insurance Company
• Policy holder has to provide the surveyor complete book of accounts and bills substantiating the loss on the day of incidence.

Machinery Breakdown Claims

• Immediate notification to the Insurance Company and your Broker for assistance
• Notice of claim and estimated cost of repairs should be filed with the Insurance Company to arrange for inspection.
• In case of partial losses, no depreciation is charged but when the items are not insured for its present day replacement value, the items are treated as underinsured and the claim amount is proportionately reduced. Depreciation is only applied for Total Loss claims.
• If machinery is partially damaged, it should be repaired (on approval from insurance company) before it is put to use, as otherwise further loss is not covered.

Electronic Equipments Insurance Claims

• Immediate notification to the Insurance Company and your Broker for assistance
• Notice of claim and estimated cost of repairs should be filed with the Insurance Company to arrange for inspection.
• In case of partial losses, No deduction shall be made for depreciation in respect of parts replaced, except those with limited life, but the value of any salvage will be taken into account.
• If an appliance is partially damaged, it should be repaired (on approval from insurance company) before it is put to use, as otherwise further loss is not covered

Marine Transit Loss Claims

• Original Invoice & packing List - if forming part of Invoice
• In case any damage is suspected in transit, open delivery should be insisted upon the carrier and their certificate should be obtained.
• Original Lorry receipt (LR)/ Bill of Lading (BL)- Qualified with remarks for the Quantity damaged or lost in the transit.
• In case of Declaration Policy - The consignment should be declared and the within the limit of balance Sum insured.
• In case of loss/damage in transit, a monetary claim should be lodged with the carrier within the time limit to protect recovery rights.
• Damage / Shortage Certificate from the carrier.
• A surveyor ( mutually agreed by the Insurer) must be appointed to determine the nature, cause and extent of loss/damage