Insurance claimsWaiting for the insurance surveyor to verify an insurance claim? At least, part of your problems may vanish with insurance regulator IRDAI new proposals. Motor insurance claims of up to Rs 75,000 will not require any assessment of losses by a surveyor, IRDAI has proposed. This is a 50% hike compared to the Rs 50,000 existing threshold. Also, the insurance regulator has proposed a revision of the timelines for submission of the survey report in order that they are aligned with those stipulated under IRDAI (Protection of Policyholders’ Interests) Regulations 2017. Read on to know more.

IRDAI has made the new proposals public as part of the exposure draft of IRDAI (Insurance Surveyors and Loss assessors) (Amendment) Regulations 2019. The need for the engagement of a surveyor is for assessing the loss/damage suffered without any bias or prejudice and by a professional/expert in the field. This often delays claim settlements because surveyors take their own sweet time to do their work. Plus, the use of surveyors and loss assessors in small claims causes bitterness between policyholders and insurers.

Claim payment is the moment of truth and the insurance surveyor and loss assessor plays a pivotal role in assessing the losses in case of general insurance claims. After a detailed analysis of various recommendations made by various committees as well as Working Group, IRDAI felt the need for revamping the regulatory framework for insurance surveyors and loss assessors.

Earlier, as per Regulation 12(2) a), b), surveyors and loss assessors were appointed either by insurers or insured to assess loss under a policy of insurance in respect of Motor insurance – above Rs 50,000 and other than motor insurance – above Rs 1 lakh.

Now, Regulation 12(2) a), b) is proposed to be substituted in such a way that surveyors and loss assessors are appointed for motor insurance claims above Rs 75,000 and other than motor insurance claims of above Rs 1,50,000.

“The limits to assess loss under a policy of insurance in respect of motor insurance and other than motor insurance needed a review as per regulations. The enhancement of limits for small claims will help to utilise the manpower available within the insurance company for survey work up to the loss limits so that such small claims are settled expeditiously,” IRDAI said.

Do remember that the insurers are not bound by the loss amount assessed by the surveyor. The insurer still retains the right to pay or settle any claim at any amount different from the amount assessed by the appointed surveyor.

Also, work timelines have been tweaked for insurance surveyors and loss assessors. Earlier, a surveyor or loss assessor whether appointed by the insurer or the insured was expected to submit his/her report to the insurer as expeditiously as possible, but no later than 30 days of his appointment, with a copy of the report to the insured. In special circumstances of the case, either due to its special and complicated nature, the surveyor could seek an extension of up to six months for submission of his/her report.

Typically, if you as a policyholder were unable to furnish all particulars required by the surveyor for assessment of the damage/loss, there will be a delay in assessment of the claim.

Under the new proposal, a surveyor and loss assessor will have to start the survey immediately, in any case within 48 hours of his appointment, unless there is a contingency that delays immediate survey. “The surveyor and loss assessor shall, within 7 working days of the claim intimation, inform insurer/claimant of the essential documents and other requirements that the claimant should submit in support of the claim. Where documents are available in public domain or with a public authority, the surveyor/insurer shall obtain them,” IRDAI says.

The new proposal also mandates that the surveyor submit an interim report of the physical details of the loss within 15 days from the date of the first visit of the site. They have to submit the final survey report to the insurer within 30 working days from the date of submission of the last relevant and necessary document by the insured. The fresh timelines are amended in accordance with Regulation 15 of IRDAI (Protection of Policyholders’ Interests) Regulations, 2017.

Author
Kumar Shankar Roy

Kumar Shankar Roy is contributing editor with RupeeIQ. He can be contacted on kumarsroy@rupeeiq.com