Why An Insurance Surveyor Is Important

Modern life is replete with challenges and unforeseen situations which require protection and a security cover. Whether you’re a working professional, a businessman or a homemaker, fact is that in today’s world getting oneself insured along with one’s assets is a wise thing.

However, the insurance sector is not a one-way traffic. Just as prospective and existing policy holders need a security blanket, insurers also need the services of a professional who helps them run their business and deliver services in an efficient and simple manner. These professionals, commonly known as ‘insurance surveyors’ have a critical role that can make or break an insurance company. A surveyor has responsibilities in context of different types of insurance – like motor insurance, property insurance (fire, flood, etc.) This blog explores how it is in the best interest of the policy holder to make full disclosure to the surveyor.

What do surveyors do?

Essentially, surveyors are a bridge between policy holders and an insurance company. Their role is to make an assessment of the damage or loss incurred against a policy. Whenever a claim is filed by a policy holder, the concerned insurance company appoints a surveyor to assess the loss and submit a report quantifying the claim payable under the policy. In accordance to the Insurance Act, all the claims above Rs 20,000 have to be surveyed by an independent professional.

Basically, surveyors are independent professionals (not a part of the insurance company) licensed by IRDA. The whole concept of appointing a surveyor is to ensure that no false claims are filed and there is no business loss, as a consequence of those claims.

Role of Surveyors in different types of insurance categories

The role of an insurance surveyor is quite an extensive task. In fact, these professionals conduct surveys of everything from transport, buildings, machinery, other sites or art pieces/antiques or any other items that need to be insured. Their entire work depends upon their assessments which are formulated into reports. These, in turn, help decide the terms and conditions of insurance policies. Their areas of specialization include:

Accidents and Liability – assessing the possible risks to employees, customers and visitors to a building or site.

Fire and Perils – examining plans, construction and fire protection systems to assess the risks to a building and its contents.

Burglary and Theft – inspecting business premises to check how goods are stored and improve security.

Engineering Insurance – surveying mechanical and industrial plants, machinery and equipment for any faults and risks.

Art and Artifacts – surveying and valuing art objects

As a rule, the insurance business works on a simple principle. This is known as the ‘principle of indemnity.’ It means that the customer is put in the same position financially in which he was before he incurred a damage/loss. To avoid any sort of problem, the surveyor caps this possibility by assessing the loss. Then he gives a report to the company on whose basis the claim is settled.

It is always a good idea to make a full and accurate disclosure to the surveyor at the time of making a claim. This is because, if the insurance company detects any foul play, they would evoke the principle of ‘utmost good faith’ and may reject the claim.

How To File A Complaint Against An Insurance Company In Consumer Court

With the expansion of the insurance sector in the last two decades and the advent of more efficient client servicing, insurance companies are expected to follow rules on everything. When you buy any insurance policy, you expect to receive top class service along with peace of mind that you’re safe. But what if your insurer denies a claim fraudulently or defaults on service? You may face several issues like delay in claim settlement, non-receipt of your policy, dispute regarding premium paid or payable, dispute as to the sum payable, few terms and conditions may throw you off gear or even a claim rejection.

 It is certainly an unpleasant situation but not an impossible one. Your best recourse is to approach the IRDA or the insurance company or even an ombudsman. But if all these steps fail, then you have to head to a consumer court for a redressal and resolution of your problem.

What is the process of filing a consumer complaint?

There is a process to be followed depending upon the monetary value of the compensation of the consumer complaint, in case of an insurance company. In fact, if the value of goods and compensation is less than Rs 20 lakh, in that case, you have to approach the district consumer forum. As opposed to this, if the value of goods and compensation is more than Rs 20 lakh but definitely less than Rs 1 crore, a case can be filed in State Consumer Dispute Redressal Forum. If it exceeds Rs 1 crore then the case should be filed in the National Consumer Commission. Unlike other court cases, you don’t necessarily need to hire the services of a legal expert or a lawyer to file a consumer complaint. In fact, you can file it directly by yourself, clearly stating the fact, circumstances and the compensation demanded. It has to be filed within two years of the deficiency of service/ defrauding by the insurer. The necessary documents for a consumer court petition include the following:

·         The most obvious fact is while filing a complaint you have to enter the name, address, description of the complainant

·         Name of the insurance company/opposite party or parties against whom the complaint is being filed.

·         Cause and facts relating to the complaint should also be mentioned like the time and place of occurrence.

·         Alongwith your complaint, you must also furnish or attach documents in support of your petition that will take the case further.  

Till some years ago, arbitrary rejection of claims was fairly common, with many depictions of such scenarios in popular culture. John Grisham’s book “The Rainmaker” is based on a large insurance company rejecting a claim. But with strong regulation being put in place and active regulatory bodies operating in most countries, the situation has changed drastically in the last 10 years. Where customers have a plethora of options to choose from, insurance companies need to have a good claim record in order to attract customers. In fact, a good claim record is one of the selling points insurance companies use in their advertising. But, even with every measure in place, some claims still get fraudulently rejected. In such a scenario, it is extremely important for consumers to take the matter to the right authorities.

Insurance In India Gets More Innovative And Quirky

The insurance sector in India has boomed in the last two decades with more and more demand for insurance policies on life, health, personal accident cover, motor insurance, etc. But now the sector is expanding its horizons to unchartered territories which were traditionally, the bastion of their western contemporaries.

Taking cues from their Hollywood counterparts, our Bollywood stars too are not leaving any stone unturned. While reigning superstars like Aamir Khan and Rajnikanth have insured their films, India’s nightingale LataMangeshkar has insured her voice. Incidentally, Rajnikanth insured his voice too and even obtained a copyright for it, suggest reports.

Taking note of the fact that an unforeseen mishap can strike anyone, anything, anytime, insurance in India is slowly but surely coming of age as it is delving into unusual areas like art and antiques insurance, kidnapping insurance, wedding insurance, pet insurance, long term care insurance, disability insurance among others.

Most people harbour this erroneous belief that an art and antiques insurance policy would entail protecting their items from theft. While this is partially true, an insurance cover for these is much more than that. Here, a policy covers the antique or art work from everything like an accident, damage caused by fire and transportation risk among others.

Body part insurance is yet another segment which has caught the imagination of Bollywood celebrities. The latest to be bitten by this bug are starlets Mallika Sherawat and Minissha Lamba. The duo have spent lakhs insuring their assets while among male stars, John Abraham has jumped on the bandwagon.

Indian sports stars too are not far behind in this arena. There have been recent reports of tennis ace Sania Mirza getting her hands insured.

Wedding insurance is yet another unique policy that has found takers in India. Factors like theft/damage to wedding dress, jewellery, cancellation of wedding and damage caused by an unforeseen accident and fire are some of the primary reasons for which wedding insurance is done. Yet another segment is pet insurance where animal lovers are willing to pay a good premium to ensure the costs related to their pets in terms of accidents, maintenance and medical treatment are taken care of.

Long term care insurance is designed to keep the insured comfortable and happy in their sunset years. On the other hand, a disability insurance takes care of the insured where he may have incurred permanent or temporary disability that impacts his life.

Many of us have spent precious minutes or hours looking for the lost keys of our car or household. Now, it is the burden of the insurance company to provide a cover for these lost keys. What’s more is that in case your keys don’t get replaced in the first 24 hours then the insurer can provides you the cost of hiring a car.

The other interesting insurance policy is the personal identity protection. It covers your losses owing to a lost wallet, assault at an ATM and also a robbery at ATM after you’ve withdrawn the money from there. 

What Is Underwriting In Insurance And How Does It Work?

In the last two decades, India has seen a major emergence of the insurance sector in various segments like health, life, personal accident cover, travel and a host of other types of insurance policies where the demand of clients to safeguard themselves has gone up. Since the coming of private players, the insurance sector has witnessed an unprecedented boom, and this is just the tip of the iceberg with the Indian market presenting huge potential for exponential growth.

While this rapid growth is great news for the industry as a whole, insurance companies also have the responsibility to maintain sound work practices, avoidmis-selling and most importantly, to fix a fair price for their products. In other words, calculating the right premium for different policies.

The premium amount for any insurance policy is entirely dependent on the quantum of risk likely to be incurred. The process by which this risk is assessed and a premium calculated is called underwriting. This process would be applied to all types of insurance, be it life, personal accident, health, or a physical asset like a car or a house.

Since this is a complex process, insurance companies hire specialized underwriters for this function. So here is what underwriters do. They use actuarial data and special computer programs to calculate the probability and the extent of a claim taking place during the term of the policy.

Let us understand this in the light of health insurance. At the time of taking a policy, the policy holder is asked to furnish results of certain health tests and also furnish personal details like age, height, weight, medical history, lifestyle and habits. The underwriter will use this information to assess the extent of risk. For instance, if the policy holder is a male above the age of 50, is overweight, is a heavy smoker and has a family history of high blood pressure, he faces a high risk of heart and other related disease. Which means that there is a high possibility that he will make claim on his health insurance, perhaps multiple times. Since in this case, the risk assessment is high, the insurance company will charge a commensurately high premium for the policy. On the other hand, for a young man in his 20s who runs 12 kms a day, the risk will be far lower and therefore his health insurance will come at a much lower premium.

In the insurance sector, well thought and executed underwriting process can make a huge difference. Any prospective policy buyer judges an insurance policy on three parameters. The first and foremost parameter is whether it meets the needs of the buyer, is the coverage comprehensive and affordable. Lastly, whether the premium of the policy is at competitive pricing. These factors can truly make or break any policy.

But in the insurance sector, it’s not just the prospective policy buyer that is at risk but also the insurance company itself. On an average, every insurer has to tackle many major uncertainties like how many people will make claims and how much the insurer will have to pay to settle them. These subsequently, have a major impact on how much an insurance company will charge for the protection it provides and how much reserve has to be present to deal with any claims that may arise in the future. This is why, as a rule, all insurers include the clause of ‘Utmost Good faith’ or (Uberimma fides) where it is a client’s duty “to voluntarily disclose, accurately and fully all material facts pertaining to risk proposed, whether requested or not”.

Health & Personal Accident Cover Micro Insurance is a boon for the low income groups in Rural & Urban India

Often, micro insurance cover is associated with only those low-income groups that reside in rural areas and remote locations. In fact these policies are actually designed to provide a security blanket and helping hand to low income groups regardless of whether they reside in urban or rural areas. In the urban context, micro insurance targets groups like construction labourers, domestic help, daily wage earners and other groups that face risks in earning their livelihood and in their day-to-day life. Two micro insurance policies: Health and Personal Accident Cover Micro Insurance are a blessing in disguise for these groups. Let us explore how they make their life easier. 

In India’s healthcare roadmap, access to adequate and quality health care services is a huge challenge. In this tumultuous scenario, micro health insurance is now being increasingly recognized as a preferred mechanism to finance healthcare provision. Any unforeseen health calamity is a huge setback to low income groups. This is because it impacts their finances drastically often depleting their every last resource to pay for hospitalization, cost of medicines, diagnosis, transport and most importantly, loss of wages.

Advantages of Micro Health Insurance

 

·         Peace of mind.

·         Financial burden because of an unexpected illness or injury, is not incurred.

·         The low income groups do not need to take a loan/debt in case they have health micro insurance.

·         There is accessibility to good healthcare facility.

·         It also provides social security in the long run.

·         It also leads to reduction in infant/child mortality.

·         Positive impact on the health of women.

·         Quality of life is enhanced.

·         Protection at old age.

·         Health risks related to hazardous working conditions are taken care of.

Personal accident cover for low income groups as a part of micro insurance is also a blessing, considering that the risk of accident is higher for those staying in urban areas, than their rural counterparts. This types of cover come with a low insurance premium.

Advantages of PersonalAccident Cover Micro Insurance

·         Hospital and hospitalization expenses are taken care of.

·         Affordability is a huge advantage.

·         Compensation is paid when the insured person has sustained bodily injury ‘resulting solely and directly from accident caused by external, violent and visible means.’

·         This is a 24x7 cover, which means if an accident occurs on or off duty, insurance still applies.

·         Some insurance companies offer this policy to those as young as 10 years and the maximum age limit is 70 years.

·         Compensation is given in case of the death of an insured person.

·         It covers permanent total and partial disablement.

·         This type of policy also covers total and irrecoverable loss of sight of one
eye or loss of use of one hand or foot.

·         The sum insured can be as high as Rs 2,00,000.

Now Diabetics Can Opt For Insurance

Modern life has brought with it multiple stresses and overambitious demands that have taken a toll on the human body leading to a rapid escalation of lifestyle related diseases like the ‘silent killer’ - diabetes. If you are a diabetic, have a stressed lifestyle with poor eating habits or have a history of the disease in your family then it’s a good idea to buy a health insurance policy that will hold you in good stead, in case this disease strikes.

This is because, diabetes as a disease is not a single problem in itself but it ushers in a host of related ailments like the risk of a high blood pressure, brain stroke, heart attack and also impacts your eyes and kidneys in a big way. The good news is that diabetes is no longer excluded from health insurance.  In the early days of health insurance, insurance companies usually did not offer health cover to people with diabetes because of the perceived high risk. But times have changed now, and there are many companies offering health insurance which aims at diabetes and related ailments.

Benefits of health insurance policy for diabetics

·         Most companies offer this type of policy to anyone up to 65 years of age.

·         Some insurance companies also offer additional sops like a health coach who personally monitors and offers advice to the policy holder about important health milestones.

·         Peace of mind is restored as you are in good hands.

·         You are saved out of pocket expenses.

·         Other sops may include a special site or portal where the customer can keep track of all his health records, reports, diagnosis.

·         The insurer also gives a policy holder other benefits like a discount on medicines, health foods, medical equipment like glucometers, etc.

·         If you have bought a health policy then you can avail an Income tax benefit under Section 80D of the Income Tax Act, 1961.

·         A lot of insurance companies offer this policy to those who already have Diabetes Mellitus or are at risk for Diabetes Mellitus.

·         Pre hospitalization expenses are also covered under some policies.

·         These policies are available as a floater cover or on an individual basis.

·         Cashless hospitalization benefit is also available.

·         Some policies also cover post hospitalization expenses.

·         The good news is that a TPA may not really be required to settle your claim. This means claims get processed more easily and faster.

What is most important to note is that unlike conventional health policy premiums, the rate of premium for specific policies are generally higher. Also, you must take care of your health by controlling your diet and maintaining a regulated exercise regime. These efforts will have a positive impact on your health and bring down diabetes related risks, on a considerable scale.  Always buy this type of policy online as it gives you more choices and you are able to evaluate premium rates, sops, advantages and negatives of all existing policies available in the insurance sector.