Friday, January 25, 2013

The procedure for making an Insurance Claim

The procedure for making an Insurance Claim


As per IRDA regulations, all the policy documents issued by the Insurance Companies are required to contain the detailed procedure and documentation required in making the claim. The following procedure in general is required to be followed:

Life Insurance Policy

I. Death Claim

1. Claim intimation may be sent to the insurance company as soon as possible on death of the insured person. This could be done by the assignee of nominee under the policy or by any close relative or the agent who handle the policy.

2. The claim intimation should contain information like the date, place and cause of death. The insurance agent has the duty to help the life assured’s family / assignee to deal with the insurance company to comply with the formalities for a claim.

3. The insurance company will respond to this intimation and will ask for the following documents:

· Filled-up claim form (provided by the insurance company)

· Certificate of death

· Policy documents

· Deeds of assignments/ re-assignments if any

· Legal evidence of title, if any policy is not assigned or nominated

· Form of discharge executed and witnessed

II.  Maturity Claim

Where a life insurance policy is maturing, the insurance company will normally send intimation to the policyholder along with a discharge voucher at least two to three months in advance of the date of maturity giving details like the maturity amount payable. The policyholder is required to sign the discharge voucher – which is like a receipt - have his signature witnessed and send it back to the insurance company along with the original policy bond to enable it to make the payment. If the policy has been assigned in favour of any other person or entity like a housing loan company- the claim amount will be paid only to the assignee who will give the discharge.
Health Insurance Policy
The claim under Health insurance policy can be made in two ways:

1. On a Cashless basis: For a claim on cashless basis, the policy holder is required to undergo treatment only at a network hospital of the Third Party Administrator (TPA) who is servicing the policy. The policy holder is required to seek authorization for availing the treatment on a cashless basis as per procedures laid down and in the prescribed form.

2. A Reimbursement Claim: Read the clause relating to claims in the policy documents as soon as the same is received so as to ensure that one understand the procedure and the documents required for making a claim on reimbursement basis. When a claim arises, the policy holder should inform the insurance company as per procedures required. After hospitalization, one need to ensure to obtain and keep ready documents such as claim form, discharge summary, prescriptions and bills that are required to be submitted for a claim.

Motor Insurance Policy
A claim under a motor insurance policy could be

· For personal injury or property damage related to someone else. This person is called a third party in this context or

· For damage to your own, insured, vehicle. This is called an own damage claim and the policy holder who is having comprehensive policy is eligible for claim under this head.

Third Party Claim
In a third party claim, where your vehicle is involved, it is important to ensure that the accident is reported immediately to the police as well as to the insurance company.
On the other hand, if you are a victim of the loss from somebody else’s vehicle, you must obtain the insurance details of that vehicle and make intimation to the insurer of that vehicle.
Own Damage Claim
In the event of an own damage claim, that is, where vehicle of the policy holder is damaged due to an accident, the policy holder must immediately inform the police and the insurance company, to enable them to send a surveyor to evaluate the loss. One should not attempt to move the vehicle from the accident spot without the permission of police and the insurance company. The vehicle should be removed for repair only after getting permission from the police and Insurance Company.
If any policy provides for cashless service, which means the policy holder is not required to pay upfront for covered damages, the insurance company will pay the workshop directly. In either of these situations, the policy holder is required to intimate the insurance company immediately.
Theft Claim
As soon as the insured vehicle is stolen, the policy holder should inform the insurance company immediately. In addition the Transport Department must also be kept informed. Collect all the required documents and submit them along with the requisite claim from duly filled in, to the insurance company.
There may be certain specific documents requirements for specific types of claims. For instance in respect of a theft claim, there is a special requirement that you should surrender the vehicle keys to the insurance company.

Property Insurance
There could be several types of policies that cover property and the property itself could be stationery - like a building, or moving around – like your household goods being transported. The policy holder is advised to get familiarize with the documents required for a claim as well as the procedures to be followed.Whether or not a claim arises one must follow the various dos and don’ts in respect of property for the duration of the policy. These dos and don’ts are termed warranties and conditions in the policy document.In general losses and damages, including those due to theft, fire and flood need to be intimated to the relevant authorities such as the police, the fire brigade and so on. It is important to ensure that the insurance company is intimated to enable them to send a surveyor for surveying and assessing the loss. 
Travel Insurance 
A travel insurance policy is generally a package policy that includes different types of covers like hospitalization, personal accident, loss/damage to baggage, loss of passport and so on.The procedure and documents required for a claim would vary from cover to cover. All of them would be mentioned in the policy documents. For ease of procedure and convenience, insurers normally attach the claim from with the policy documents. This will contain the list of documents required in case of claim and also the contact details including phone numbers of the claims administrators either in the destination country to which the policy holder is travelling or in another country that is designated to receive and process your claim intimation. Since this is package policy with various covers and procedures it is very important that the policy holder familiarizes himself with the procedures and documentation in case of a claim.



Sunday, January 20, 2013

Why Airlines should complicate refund procedure for excess ADF

Why Airlines should feel hesitant in refunding the excess ADF??

As you may be knowing that Airports Economic Regulatory Authority (AERA) have reduced ADF w.e.f 1st January 2013 for the passengers embarking from Delhi Airports (DIAL). The ADF for domestic passengers has been reduced from Rs. 200/- to Rs. 100/- whereas for the international passengers it has been reduced from Rs. 1300/- to Rs. 600/-. The passengers who have booked their tickets prior to 31st December 2012 are entitled to a refund of Rs. 100/- and Rs. 700/- for domestic and international flights respectively. 
Times of India in their news published on 20th January 2013 that Airlines are delaying the refund of Excess amount charged under "Development fee" due to reduction in fee w.e.f 01/01/2013. The reason cited is inadequate staff deployed by Airlines.
I have failed to understand as to why the refund should be delayed on a/c of shortage in staff. First of all most of the tickets are booked electronically (e-ticketing)and the refund also need to be made electronically in the reverse path. This is exactly the same procedure as prescribed in cancellations and refunds by DGCA. The refunds should be an automatic process and no additional manpower is required. In any case even if any additional staff is required to be deployed it should be done as the company has no right to retain the money with them. Why the passengers are advised to claim through a mechanical process. It is a well known fact that with the mechanical process, most of the passengers would not make claim for the refund and the company expect to retain the excess amount charged from the passengers. Retaining the amount by the company due to no claim from the passengers would be a bad precedent and hence it is advised that :
1. All passengers who are entitled for the refund should make sure that the amount is refunded despite many hurdles that you may face. If you do not ensure that the money is refunded, the company would be having surplus of tens of crores extra.
2. The Airlines should make the refund electronically in the reverse path the way tickets were booked. This would make sure that the most of the passengers are refunded the amount
3. Get away with the mechanical submission of claim. Provide a link on the web-site to seek claim form from the passengers and ensure that the money is refunded immediately through post/ courier. Alternatively, consider refunding the amount by cash during the boarding process. It does not take time in refunding.
4. Even in case the money is still left with the Airlines due to no-claim from the passengers, the money should be transferred to the Govt. account for consumer welfare.

I would be forwarding this blog to the concerned authorities and the Airlines and expect that entitled amount is not retained by the Airlines.

Friday, January 18, 2013

Comments to Justice Usha Mehra Commission

Inquiry into various aspects of shocking incident of sexual rape and brutal assault to a woman in Delhi on 16th December 2012 and to identify lapses.

A rape reported through media  in a moving bus in Delhi on the night of 16th December 2012 has shaken the entire country and in fact the way the crime has been conducted is never heard in the life time and the culprits whosoever needs to be punished under rarest of the rare crime category.

There might have been several lapses or may not be by various stakeholders and could be known only after the trial of the case. Corruption prevailing in the agencies, complicated laws, insecurity among the public to extend their arms of help in the fear of being dragged by the Police later on. The public has lost confidence and don’t come forward to extend the help as many a times they have been victimised not only by the police but also by the persons falsely pretending to be in disaster due to malafide intention of robbing the person extending the help. No one like to stop the vehicle even if such a person seeking help is really in disaster.  One of the lapses in the system may be that we are not prepared for a disaster management and lack of sensitization in handling the issues. The major cause for such could be due to many factors like corruption, asserting rights without discharge of responsibilities, and most importantly could be a wrong image that has been created in the country that every call of such nature is a false call. It complies with a story of “Wolf and Shepherd” where the shepherd used to give a hoax call of attacking by wolf and one day the real call was not taken seriously. The fact could be substantiated that so many calls of similar crime after 16th December 2012 have been found to be false. The Acts have been legislated in such a way that the Act has been abused by the beneficiaries itself and the confidence of the law enforcers have been lost and a lot of time is wasted in presuming so many things before taking any corrective steps. Media gender biased trial also had reduced the confidence with the law enforcers which gets supplemented with the corrupt practices being followed in such Institutions.

In my view the Act need to be amended to ensure that none of its provision is misused by the beneficiaries and once we achieve zero tolerance in the misuse of rules and regulations, the law enforcers like Police and Judiciary need to be made 100% accountable. There need to be transparency which is the prime requirement for effective implementation of any rule. For example, if we consider refusal by Auto, the public still do not have confidence that if they complain to the authorities, action would be taken against the concerned Auto. This has resulted into rampant violations of rules and regulations. A fact that one violator produces hundreds violators cannot be disputed. In fact it is hearsay for all the people of this country that everything is purchase able with the money. Even now, the vehicles with tinted glasses are being plied in the capital. Some of the snaps which have been posted on my facebook account are the testimony to what I have stated above. A system need to be generated to be believed by the public that you cannot purchase injustice. The system of transparency would make sure that once a complaint has been made and its prosecution is made available on public domain that would encourage the public to come forward to ensure that their rights are protected. Whether it is violator or the person falsely implicated need a justice and should be visible. However as requested earlier before going ahead it need to be ensured that there are no false and frivolous complaints. Transparency in the system will make all stakeholders to be more accountable. There are no benchmarks for various associated activities like the police can drag the complaint for years together without any question being asked, judiciary can drag the cases for decades without any complaint system for redressal. This encourages real culprits to commit crimes as well as victimise the real innocent people being falsely implicated. In a situation where 98% cases of domestic violence are found to be false and may be 74% cases of rape and sexual assault are with malafide intention and then the accused getting implicated falsely are dragged into the litigations for decades, the heading of the society to which direction could be well imagined. Even such dragging attitude is not benefiting even those 2% of genuine cases of domestic violence and 26% of true victims of sexual assault as the “Justice delayed is Justice denied”

I am attaching a document dtd. 05/01/2013 submitted to Justice Verma Commission for your perusal. I feel the content of the document are pertinent to the present document also.
I would like to conclude that following factors responsible:
1.      Corruption prevailing in the legal and law enforcing agencies
2.      System opaqueness
3.      Gender biased laws
4.      Abuse of laws and no penal provisions for abusers
5.      Non-provision of bench marks and
6.  Non-accountability of Police and judicial authorities as all other associated services could be well tackled if point Nos. 1 to 6 as above are assured to be implemented.