CLAIMS MANUAL

FOR
GIPSA COMPANIES

MANAGEMENT
OF

MOTOR OD CLAIMS
MOTOR OD CLAIMS MGT….Contd.

GENERAL GUIDELINES :

• Guidelines given in the Claim Procedure

Manual are general in nature.
• Due to particular circumstances of any
individual case, non-compliance should
not make the claim as not payable.
• Claim passing authority may waive any
documents by recording reasons on file.
 MOTOR OD CLAIMS MGT….Contd.

• INTIMATION :
• Immediate intimation is required. If received orally or
telephonically, a suitable note should be prepared
and kept in file.
• Guide the client appropriately. Send Check List with
the Claims Form guiding him the Documents &
Procedures.
• Register the claim. Policy & 64 VB to be checked &
kept in file.
• In case of delayed intimation; the reasons for delay to
be examined & recorded.
MOTOR OD CLAIMS MGT….Contd.

SURVEYOR :

• Authority for deputation of Surveyor.

• Appointment of Surveyors on behalf of
other offices.
• Assessment of liability under the Policy.
• Compliance to terms, conditions &
warranties under the Policy.
• Code of conduct for the surveyors.
MOTOR OD CLAIMS MGT….Contd.

SURVEY :
• All claims of Rs.50,000/- and more must
be surveyed by a Licensed Surveyor.
• License (from IRDAI) to be valid; should
be a member of IISLA
• Surveyor must be appointed within 72
hours of receipt of intimation or as per Tie-
up MoU.
• Communicate the details of surveyor to
the client including his role, duties and
responsibilities.
MOTOR OD CLAIMS MGT….Contd .
• Surveyor should follow the IRDAI (SLA)
Regulations and IRDAI (PPI) Regulations
2015;

• The Surveyors are expected to submit

their Survey Report within SEVEN days
from the date of his appointment;

• In case of delay without assigning valid

reasons, explanations must be called.
MOTOR OD CLAIMS MGT….Contd .
• In case of delay, the surveyor must keep
the office informed every fortnight.

• A copy of the Survey report should be

given to the insured, if he so desires.

• Endeavour may be made to settled the

claim within THREE working days of
receipt of the final survey report and /or
the last relevant and necessary
document.
 MOTOR OD CLAIMS MGT….Contd .
• Survey fee must be paid immediately on
receipt of the report.

• Recommendations of the Final Surveyor

are not binding and final decision rests with
the insurer based on facts & correctness of
the claim.

• CLOSE PROXIMITY CASES – claims

within five days of fresh policy or a policy
after break in insurance.
 MOTOR OD CLAIMS MGT….Contd .
• RECTIFICATION OF POLICY AFTER A
LOSS : Rectification of a policy after a loss
is reported for reasons other than breach of
condition or warranty should be carried out
as under :
a) Where rectification involves collection of
additional premium, the additional premium
may be charged only on the affected policy
period in which the claim has arisen;
b) Rectification can be done by the Authority
Competent for settlement of the claim.
MOTOR OD CLAIMS MGT….Contd.

AUTHORITIES for claims :

• Claims settling authority.
• Repudiation of Claims – to be well
thought-out and done in a systematic
manner. Repudiation letter must state the
condition / provision of the policy under
which repudiation is necessitated.
• Closing of claims.
• Re-opening of Claims.
MOTOR OD CLAIMS MGT….Contd .
• After approval of claim, Insured should
be advised of the amount and an
advance voucher should be obtained;
• Even if the insured gives a qualified
discharge voucher, the claim as
approved has to be paid;
• For theft claims, a letter of Subrogation
& Indemnity should be obtained.
• On account payment up to 75% may be
considered subject to request of the
insured; liability being established.
MOTOR OD CLAIMS MGT….Contd.

MODES OF OD CLAIMS SETTLEMENTS :

Partial Loss Claims
• Repair Basis – Reimbursement / Cashless
payment.
• Cash Loss Repair Basis.
Total Loss Claims
• Total Loss Basis: TL / CTL.
• Cash Loss Basis : Net of Salvage Basis.
• Theft claims
MOTOR OD CLAIMS MGT….Contd.

• TOTAL LOSS CLAIMS :

• Theft of vehicle;
• CTL : Cost of repairs as per the terms and
conditions of the Policy (i.e. Assessed
Loss – cost of parts less depreciation less
salvage value of parts less excess)
EXCEEDS 75% of IDV
• Pay IDV Less Excess
• Vehicle taken over by the Company and
sold as per Salvage Disposal Guidelines.
MOTOR OD CLAIMS MGT….Contd.

• TOTAL LOSS : NET OF SALVAGE

• The claim must qualify to be a
Constructive Total Loss;
• Retrieval of vehicle / sale of vehicle is not
viable – burnt vehicles; vehicles on
superdari (involvled in crime; death in
accident etc - released on court order)
etc.
• Take second opinion for value of wreck.
• Pay IDV – Value of wreck – Excess
• Vehicle left with the Insured : take an
affidavit.
MOTOR OD CLAIMS MGT….Contd.

• Settlement of Total Loss (NOS) Claims

WITHOUT RC / DOCUMENTS – DCC /
RCC as per their Financial Authority;
• Settlement of Total Loss (NOS) Claims
WITH RC / DOCUMENTS – by RCC only:
- In cases where the insured vehicle is
realeased on Superdari;
- Accidental vehicle is at a place other than
its RTO where RTO insists for inspection
for cancellation of RC;
• Other NOS claims by HO only
MOTOR OD CLAIMS MGT….Contd.

INVESTIGATION :

• If deemed necessary.
• To verify the cause & circumstances of
loss – version of the insured.
• Verification of Documents etc.
• Close Proximity Claims.
• Visit to accident site / vehicle.
• PROMPTNESS.
MOTOR OD CLAIMS MGT….Contd .
CLAIM DOCUMENTS :
Accident Claims :
• Intimation.
• Claim Form
• Estimate of Repairs.
• Driving License.
• RC / Permit / Fitness / Loan Challan etc.
• Survey Report.
• Discharge Voucher.
 MOTOR OD CLAIMS MGT….Contd.

Theft Claims :
• Intimation.
• Claim Form
• Driving License / RC / Permit / Fitness /
Loan Challan etc
• Investigation Report.
• FIR
• Final Report
• Discharge Voucher
 MOTOR OD CLAIMS MGT….Contd.

• THEFT CLAIMS – Two Wheelers & Private Cars :

•In case of Non availability or Pending duly

accepted FINAL REPORT by court; the
Competent Authority may consider to sanction
100% of the admissible claim if
- the FR has been filed in Court more than 90
days ago but is still pending for approval;
- Claim is otherwise found to be genuine and
liability admissible
 MOTOR OD CLAIMS MGT….Contd.

• THEFT CLAIMS – Commercial Vehicles

•In case of Non availability or Pending duly
accepted FINAL REPORT by court; the
Competent Authority may consider to sanction
75% (ON ACCOUNT PAYMENT) of the
admissible claim if
- the FR has been filed in Court more than 90
days ago but is still pending for approval;
- Claim is otherwise found to be genuine and
liability admissible
•Balance 25% to be paid on receipt of Court
approved FR
MOTOR OD CLAIMS MGT….Contd.

IMPORTANT DOCUMENTS :
• Driving License
• RC
• Permit
• Fitness
• FIR / Final Report – for theft claims
MOTOR OD CLAIMS MGT….Contd.

RC
In case of no valid Regn of vehicle at the
time of accident / loss :
• If fee / documents already deposited with RTO
or dealer before the accident : settle the claim
as Standard Claim subject to submission of RC
at the time of settlement.
• Fee / documents not submitted – check the
circumstances
• Accident during validity of Temp RC : standard
claim
MOTOR OD CLAIMS MGT….Contd.

Fitness :
Absence of Fitness is a breach of MV Act,
claim can be repudiated. However :
• Accident related to mechanical defect /
failure, claim must be repudiated.
• Accident not related to mechanical defect
/ failure : Pay up to 75 % (maximum limit)
of assessed loss; subject to specific
opinion of the Surveyor in the technical
aspect of cause of accident.
MOTOR OD CLAIMS MGT….Contd.

Permit :
• Valid Permit is there but route violation :
Pay standard claim.
• No permit or expired permit not renewed
subsequently : REPUDIATE
• Accident after expiry of the permit but
renewed subsequently : consider non-
standard / compromised claim up to 75%
• Violation of permit condition : Private
Carrier Vs Public Carrier etc : Repudiate
MOTOR OD CLAIMS MGT….Contd.

Permit :
• Brand New Vehicle (not put to
commercial use) : Settle as standard
claim subject to production of a Permit
taken after the accident.
• Brand New Vehicle (not put to
commercial use) : stolen or accidental
TL / CTL Settle as standard claim
without production of a Permit.
• Specific violation of permit condition
like “Hill Endt” : Repudiate.
MOTOR OD CLAIMS MGT….Contd.

OVERLOADING OF GCCV :
• Upto 5% of Regd GVW : Pay full claim
• Exceeding 5% but not exceeding 7.5% :
Deduct 5% of admissible claim
• Exceeding 7.5% but not exceeding 10% :
Deduct 10%
• Exceeding 10% but not exceeding 12.5% :
deduct 25%
• Exceeding 12.5% : Repudiate
MOTOR OD CLAIMS MGT….Contd.

PROBLEMATIC AREAS :
• INCORRECT IDV UNDER THE POLICY.
• NCB CONFIRMATION.
• DELAY IN INTIMATION.
• SUPPLEMENTARY ESTIMATES.
• ABSENCE OF SPOT SURVEY.
• BREACH OF CONDITIONS /
WARRANTIES / DOCUMENTS.
• DELAY IN DECISION MAKING
 ANY QUESTIONS

PLEASE

Wishing you a shining

Thank career

you
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