Claims are an integral part of insurance business. Claims are paid out of the insurance fund of the insurers. Insurance fund is a pool to which the members of the insuring public contribute by way of premium and from which the losses suffered by a few are indemnified. Hence, it is. Necessary for the insurers to ensure that the losses are kept to a minimum, if not eliminated altogether, not only from their business point of view but also from the point of view of national economy. while dealing with claims' therefore, the insurers have to discharge a three-fold obligation as follows :
- They have to be fair to the few unfortunate insured’s who are compelled to lodge claims;
- They have to be fair to the large majority of the insured’s who are fortunate enough not to have sustained losses;
- They have to ensure that the losses are kept to a minimum, so that the nation does not suffer.
In order to fulfil the above obligations, the insurers usually incorporate conditions and warranties in the policy which stipulate the duties to be performed by the insured in the event of a loss.
DUTIES OF THE INSURED IN THE EVENT OF A LOSS:
- The insured has to given written notice to the insurers, immediately after happening of any event.
- He has to follow up the notice with full details of the claim within the time limit prescribed by the policy
- He has to give to the insurers all such information and assistance as the insurers may reasonably require.
- Every correspondence with concerned has to be forwarded to the insurers immediately on receipt by the insured.
- He has to lodge immediately a complaint with the policy, if applicable.
- He cannot make or give any admission, offer, promise, payment or indemnity likely to affect the insurers without the written consent of the insurers.
- He has to ensure that the damaged property is not left unattended without proper precautions to prevent further damage or loss.
Besides the above duties, an obligation is also cast on him throughout the current of the insurance to take all reasonable steps to safe-guard the property insured and to maintain it in efficient condition.
DUTIES OF INSURERS IN THE EVENT OF A CLAIM:
The following duties are cost on the insurers:
- As soon as the claim intimation is received they should arrange to get full details of the claim.
- If considered the claim they should arrange for a prompt survey of the loss, either by a professional surveyor or by their own representative.
- iii) As per Sec 44A of insurance Act. 1938 no claim can be settled without appointing surveyors holding an appropriate and valid licence issued by controller of Insurance office. The law shall not apply:
- to all classes of losses upto Tk. 5000/-
- to losses under marine insurance policies for non-delivery of goods.
- to losses under motor insurance policies in respect of third party, workmen’s compensations and personal accident claim.
- to losses under consequential loss policies.
- They should deal with the insured promptly and reasonably, during all claim negotiations
- They should not delay the investigation or settlement of the claims unduly which may cause hardship to the insured.
On receiving intimation of a claim an entry is made in the claims intimated register. The particulars to be entered in this register are as follows:
- Serial number,
- Date of intimation,
- Claim number,
- Name of the insured,
- Policy number,
- Particulars of the risk,
- Date of loss,
- Nature of loss,
- Estimated amount of the loss,
- Amount paid and date of settlement,
The register assists the insurers in knowing the number and amount of claims intimated during a period, and in ascertaining on a particular day how many claims remained outstanding and for what amount. This helps keep a continuous watch over the outstanding claims, for their review and follow-up.
After allotting a claim number and making an entry in the claims intimate register, it has to be ascertained whether, prima facie, the claim falls within the scope of the policy. If this is not so, the claimant has to be advised promptly that the claim does not fall within the purview of the policy.
If the claim appears to fall within the policy, the insurers ask the insured to submit some papers/documents relating to the claim concerned. The papers varies in claim to claim considering its merits.
Some Important claim documents in certain classes of business:
Khondaker Fakrul Alam