Claim Settlement

S MURALI KARTHIK S RAMA KRISHNA REDDY M RAJESH P V L NIKHILESH R SAI PHANEENDRA G VENU KUMAR N SHANTHIKAR V V BRAHMA NAIDU V MUKESH BHARADWAJ K RAMESH 021 032 031 053 034 057 041 056 055 033

Flow of Presentation
What is a Claim Settlement? Why a Claim Settlement?

What is a Claim Settlement.?

A claim settlement is an agreement between two or more parties to settle a

legal claim with payment and other terms.

Claim settlements can come up in a number of legal contexts. It is important to be aware that settling a claim usually also eliminates the right to make future claims about the legal matter in the future.

If people are not satisfied with the terms of a settlement, they should

renegotiate, rather than accepting and resolving to pursue the matter further at a later date.

Types of Claims
Fire Policy claim: If a misfortune befalls, leave the worry to us but please intimate such loss / damage immediately so that a Competent Surveyor

may be deputed to minimise the loss.

give an account of all properties damaged or destroyed with estimated

amounts having regard to their values as on the date and place of loss. assessment of loss and establishing liability.

cooperate with surveyors by providing all the necessary documents for

cooperate with the insurer in all their activities of entering the premises,

taking possession of properties, their examining, sorting, removing or selling to your account, without prejudice. time of loss.

inform particulars of all other insurances existing on the property at the

Documents required for Fire Policy Claims

Fire Claims (additional documents)
Fire Brigade Report. First Information Report / Letter of intimation to the Police

Station duly endorsed / Police Panchnama. Forensic Laboratory Report on samples collected at affected site. Drug Inspector's Report on destruction of Drugs/ Pharmaceutical items (for claim on pharma products only). Final Investigation Report. Action taken on the suggestion of TAC/ LPA on loss minimisation of prevention.

Types of Policies
Jewelers block Policy: In case of any incident giving rise to a claim under the policy ,

the following steps should be taken :

Inform insurance company within 24 hrs. In case of burglary,theft etc. inform police immediately and

obtain FIR
Submit claim form and relevant documents to surveyor appointed

by Insurance Co. to substantiate loss. test

Personal Accident Policy

In the event of an accident giving rise to a claim the following steps should be taken: In case of death claim : Assignee under the policy should immediately notify the policy issuing office. Submit the claim form alongwith death certificate, post mortem report, police report and original policy.
In case of injury claim :-

Notify the policy issuing office immediately.

Submit Police report if any. Submit claim form alongwith medical certificate certifying the disablement. In case medical expenses extension has been taken, then the prescription

alongwith bills are to be submitted.

House Holders Policy

In case of any incident leading to a valid claim under the policy, following steps should be taken:

Take necessary steps to minimize the loss/damage. In case of fire, inform fire brigade immediately. In case of theft, larceny or burglary inform the police immediately along with a list of items stolen and their approximate value. Inform insurance company by phone or fax and in writing. Extend full co-operation to the surveyor appointed by the insurance Co. and provide necessary documents to the substantiate the loss. A claim form issued by the company is also to be submitted.

In case any rights of recovery exist against any other party responsible for the loss, your rights of recovery have to be subrogated to the insurance company on payment of claim.

Motor Policy
In case of accidental damage to the vehicle: Immediate intimation to the nearest office, which will issue a Claim Form. Claim Form duly filled in to be submitted along with copy of Registration

Certificate and driving license of the driver of the vehicle at the time of accident as also estimate of repairs.
Vehicle will be surveyed by a Surveyor, appointed by the insurance company, who

shall submit his report to the company. In case of a major damage to the vehicle, a spot survey, at the site of accident, would also be arranged by the company.
Final bills/cash memos are to be submitted duly signed by the insured. Salvage of the damaged parts may be required to be deposited with the insurance

company after approval of the claim.

Motor Policy
In case of theft of the vehicle: Lodge an F.I.R. with the police immediately. Inform the policy issuing office with a copy of FIR. Submit the Final Police Report as soon as it is received. Extend full cooperation to the surveyor and/or investigator appointed by

the company.
After approval of the claim by the company, get the Registration

Certificate transferred in the name of the company, hand over the keys of the vehicle, submit a letter of Subrogation and Indemnity on stamp paper duly notarized.

Motor Policy
In case of liability claim: Inform insurance company immediately of any incident likely to

give rise to liability claim.

On receipt of summons from Court, the same should be sent to

the company immediately.

Claim Form duly filled in along-with copies of Registration

Certificate, Diving License, FIR are to be submitted.

Medi claim Policy

Claims are administered through Third Party Administrators

(TPA) whose contact particulars appear on the policy document.

Insured can opt for cashless or reimbursement facility for their

claims.
The proposer has the option to avail TPA services, which is

cashless or direct service by Policy issuing Office, which is on reimbursement basis.

Marine Cargo Policy

The following steps should be taken in event of a loss or damage to goods insured : Take immediate steps to minimise loss. Inform nearest office of the insurance company or claim settling agent mentioned on

the policy.
In case of damage to goods whilst on ship or port , arrange for joint ship survey or port

survey.

Lodge monetary claim with carrier within stipulated time period.

Cntd..
Submit duly assigned insurance policy/certificate along with the original

invoice and other documents required to substantiate the claim such as :

Bill of Lading / AWB/GR Packing list Copies of correspondence exchanged with carriers. Copy of notice served on carriers along with acknowledgment/receipt. Shortage/Damage Certificate issued by carriers.

Survey fees is to be paid to the surveyor appointed by the insurance company.

This fees will be reimbursed along with the claim if the claim is otherwise admissible.

Bankers Indemnity Policy

In case of discovery of any loss falling under the scope of the policy, the

following steps should be taken:

Inform insurance co. by phone and/or fax/letter. In case of burglary/robbery/theft/hold-up etc. inform police and get FIR

registered.
In case of dishonest act of employee, inform police and initiate

departmental enquiry.
Submit claim form and relevant documents to substantiate loss to the

surveyor appointed by the insurance company.

Take reasonable steps to prevent further loss due to the same reason.

Shopkeepers Policy
In case of any incident giving rise to a claim under this policy, please take the following

steps:
Take necessary steps to minimize the loss/damage. In case of fire, inform fire brigade immediately. In case of theft, larceny or burglary inform the police immediately along with a list of items

stolen and their approximate value.

Inform insurance company by phone or fax and in writing. Extend full co-operation to the surveyor appointed by the insurance Co. and provide

necessary documents to substantiate the loss. A claim form issued by the company is also to be submitted.
In case any rights of recovery exist against any other party responsible for the loss, your

rights of recovery have to be subrogated to the insurance company on payment of claim.

Marine Hull policy

In the event of casualty likely to give rise to a claim - Immediate notice to policy issuing office. - Giving brief details as to name of vessel, place of occurrence,

date & time of casualty, circumstances leading to incident. - Seek appointment of surveyor to inspect and assess loss. - In case of theft please notify police. - In case of fire assistance of fire brigade to extinguish fire. - Appointment of adjuster in case of Oceangoing Vessels where necessary. - All steps to minimise loss as prudent uninsured.

Aviation Insurance
Claims: In case of claims following are illustrative documents that are generally called for from the

insured.
Documents in connection with aircraft details Documents in connection with flight details Documents in connection with the accident Certificate of airworthiness/registration Crew details Maintenance & engineering information Operational manual passenger documentation in case of claims

Other Misc Policies

Upon the happening of any event giving rise or likely to give rise to a claim under

this Policy:
The Insured shall give immediate notice thereof in writing to the nearest office

with a copy to the Policy Issuing Office of the Company as well as lodge forthwith a complaint with the Police. The Insured must also notify the Railways, Steamship Company, Airline, Hotel Proprietors, or the Authority in whose care the property vest at the time of the happening of any loss or damage.
The Insured shall deliver to the Company, within 14 days of the date on which the

event shall have come to his knowledge, a detailed statement in writing, of the loss or damage, with an estimate of the intrinsic value of the property lost and the amount of damage sustained. The Insured shall tender to the Company all reasonable information, assistance and proofs in connection with any claim hereunder and shall, if required, make an Affidavit or statutory declaration in substantiation of such claim.

Contractors All Risk Policy

In the event of any loss or damage giving rise to a claim under the

policy, the following steps should be taken : take necessary steps to minimise the loss. inform insurance company immediately.

extend full cooperation to the surveyor deputed by the company.

submit duly filled in claim form along with necessary documents to

substantiate the financial loss suffered as a result of the accident.

Contractor Plant and Machinery Policy

In the event of any loss or damage giving rise to a claim under the

policy, the following steps should be taken: take necessary steps to minimise the loss. inform insurance company immediately.

extend full cooperation to the surveyor deputed by the company.

submit duly filled in claim form along with necessary documents to

substantiate the financial loss suffered as a result of the accident.

Products Liability Policy

In case of any event likely to give rise to a liability claim as described above,

insurance company should be informed immediately. In case any legal notice or summons is received, it should be sent to the insurance company. The company has the option of arranging the defence of the case. The event giving rise to the claim should have occurred during the period of insurance or retroactive period and the claim first made in writing against the insured during the policy period. The maximum amount payable including defence cost will be the AOA limit selected. The Any One Year limit will get reduced by the amount of claim or indemnity paid for any one accident. Any number of such claims made during the policy period will be covered subject to the total indemnity not exceeding the Any One Year limit.

Professional Indemnity Policy

The term "liability" means responsibility and "legal liability" means

responsibilities which can be enforced by law. Legal Liability may be classified into Criminal Liability and Civil Liability. Only Civil Liability claims are payable.
Civil Liability claims will arise if there is prima facie evidence of negligence

by the insured resulting in injury or death to any third party or resulting in damage to property belonging to a person other than insured.
Negligence will be proved only when following conditions are satisfied:

Existence of duty of care Breach of this duty Injury suffered by a person or property damaged as a result of that breach.

Cntd..
The event giving rise to the claim should have occured during the period of

insurance or retroactive period and the claim first made in writing against the insured during the policy period. The maximum amount payable including defence cost will be the AOA limit selected.
The Any One Year limit will get reduced by the amount of claim or indemnity

paid for any one accident.

Any number of such claims made during the policy period will be covered

subject to the total indemnity not exceeding the Any One Year limit.
The policy will not pay for claims arising out of contractual liability,

intentional non-compliance of any statutory provision, loss of goodwill, slander , fines ,penalties , libel , false arrest , defamation , mental injury etc.

Universal Health Insurance Scheme

Claim settlement to be done through TPAS mentioned in

the schedule or by the insurance company. To be made cashless as far as possible through listed hospitals.

Conclusion
Phani mama add this atleast mama!!!! :P