Claims Settlement & Grievance Redressal Process for Home Insurance:
Home Insurance Claim Settlement Process helps you in making good the financial loss that occurred due to natural or man-made disasters. It helps you in restoring your dream home and priced possessions contained therein. It makes you resilient towards impending disasters and gives you hope to start afresh after a financial loss happens as a result of insured contingency. Claim Settlement process is regarded as somewhat intricate process wherein you need to be vigilant about the manner in which you report the cause and extent of financial losses. To get the exact amount of damages suffered on account of the eventuality, you need to make sure that all the facts have been reported fully and truly. Any discrepancy in your reporting or recording about the cause or amount of damages could prevent you from receiving the due claim.
Now let me take you through various steps that you may follow to claim the amount of loss caused by any insured peril:
1. Curb the Damage
In the case of any eventuality, you should take immediate measures to mitigate the damage. You should call upon the respective disaster management authorities to lower the severity of loss. Suppose your house building is on fire then apart from taking steps on your own to extinguish the fire you must call the fire brigade immediately. Prudent measures taken to prevent the fire from spreading will help in saving the remaining property.
In another scenario, if you find your house burgled then your next step should be to lodge a FIR immediately at the police station. In the case of house property being damaged by a natural disaster like flood or cyclone then without making much delay, you should call the disaster management personnel for help.
Any lapse on your part to take control of the situation may be interpreted as your lackadaisical attitude by the insurance company, and it may affect the indemnification to be received under the claim settlement process.
2. Notify the insurance company
Once you have taken control of the situation under loss mitigation measures, the next step is to inform your insurance company; within the time limit or deadline specified in the policy, about the eventuality by calling on their 24/7 toll-free helpline number. Your insurer would require basic information about what had happened, how it happened, whether only the house property is damaged or the contents have also been impaired and the extent of damage in monetary terms suffered by you to start the claim settlement process. It is a very crucial step, if you delay intimation to the insurer, you may face problems in settlement of the claim. Make sure to provide every reasonable detail because what has been left undocumented would not be considered in the calculation of the amount of indemnification. The right step taken at the right time goes a long way in expediting the matter.
3. Review your home insurance policy
Your home insurance policy not only forms documentary evidence of the contract between you and the insurance company but it also contains all the risk-related information. It tells you about the amount of sum insured, the type of risks covered and excluded, how to file the claim and the deadline to report a loss. In the case of financial loss, you should review your home insurance policy about the scope of coverage and whether the cause of loss falls within its purview or not. If you are unable to locate your policy then immediately contact your insurance broker or the insurer.
4. Document the damage
Once the disaster management team is over with mitigation of loss, you may find the house in a bad shape. Do not try to put things back in their proper place as it may amount to a manipulation of the location where the damage occurred. Instead, you may document the entire scene by taking photographs, and you may even make video recording to keep the evidence intact. Especially in the case of burglary, your recorded video may help you immensely in recovering the actual amount of damages at the time of settlement of the claim.
The insurance company would calculate the amount of loss after an inspection, but it will be prudent for you to do a preliminary evaluation of the damage on your own. Do not depend entirely on the loss estimates provided by the insurance company. It is so because there is always a tendency on the part of the insurer to undervalue the amount of liability that is to be paid to the insured. Thus, if you put in some efforts to evaluate how deep hole has been burnt in your pocket because of the calamity, then it will help you in getting the correct amount of claim.
5. Coordinate with the Surveyor
Based on the information which you provide to the insurer, the home insurance company would look forward towards an appointment of a licensed surveyor to assess and settle the loss. Surveyors are required to be appointed to conduct an unbiased inspection of the damage and to expedite the claim settlement process. Usually, it is not compulsory that an insurer will designate a surveyor every time you report a loss. However, if the estimated amount of loss is more than Rs. 20000, then the IRDA regulations makes this requirement mandatory.
So if your insurer tells you that your house would be visited by the surveyor, then you should be present on that particular day to assist the surveyor in conducting the investigation smoothly. For establishment of your identity and preparation of Surveyor Report, the surveyor would ask you to furnish the following documents:
– The home insurance policy
– Duly filled and signed Claim Form
– Police Panchnama/First Information Report (FIR)
– Fire Brigade Report (in case of loss by fire)
– Photographs of the Damaged Property showing extent of damage &/or video recording of the loss
– To substantiate quantum of loss, document showing value of damaged insured property just before the loss
Any lapse on your part to furnish the required documents may delay the loss assessment process. After a detailed inspection, the surveyor will prepare a report containing the following details:
– Cause of loss.
– Extent of loss
– Under-Insurance, if any
– Details and value of salvage, and how it has been disposed of or proposed to be disposed of
– Details of expenses (e.g. fire brigade expenses).
– Compliance with policy conditions and warranties.
– Details of other insurance policies on the same property, and the apportionment of the loss and expenses among co-insurers.
After the surveyors’ report has been prepared you should check it thoroughly for correct entry of the details of the loss. You should remember that any error in the preparation of report may jeopardise your chances of receiving the entire claim amount.
6. Follow-up with the insurer till you receive your claim
IRDA has prescribed a certain time limit for the general insurance companies concerning claim processing and settlement. In ordinary course, the surveyor needs to submit the Surveyor’s Report within 30 days of the date of his appointment. If your insurance company requires any additional report from the surveyor, then it should be submitted by the surveyor within 15 days. Afterwards, your insurer will provide you with an offer to settle the claim within 30 days from receipt of the report and all the other documents. Once you accept the offer, the insurer shall disburse the claim amount within seven days of such acceptance. If there is any delay on the part of your insurer in the disbursement of the claim amount, then you are entitled to an interest at the rate of 2% above the bank rate on the claim amount.
In the case of any discrepancy which amounts to a rejection of your claim, the insurer needs to provide you reasons in writing for such rejection within 30 days from receipt of the surveyor report and all the other documents.
Now let me take you through the Grievance Redressal Mechanism instituted by the IRDA that you may follow in case of any dissatisfaction with the Claim Settlement Process:
1. You should first approach your insurance company and register your grievance with them. If you are not satisfied with their response, then you may approach the IRDA.
2. You may register your complaint with the IRDA by using any one of the following channels:
– Visit www.igms.irda.gov.in and register your complaint on the Integrated Grievance Management System (IGMS), which is an online system for registering and tracking of policyholder’s grievances. or
– Write an e-mail to IRDA and send it on its e-mail id “firstname.lastname@example.org” or
– Write a complaint letter to IRDA and post it to the address “Consumer Affairs Department, Insurance Regulatory and Development Authority, 3rd Floor, Parishram Bhavan, Basheerbagh, Hyderabad:4” OR
– Call the IRDA Call Centre on its toll-free number 18004254732. The Call Centre is operational from 8 AM to 8 PM and from Monday to Saturday. You may get your complaint registered in Hindi, English or any other Indian Language.
3. After your complaint is registered with the IRDA, it will take up the matter with your insurer. The insurer will have to resolve your grievance within 15 days from the date of receipt of such complaint.
4. If your grievance remains unresolved, then IRDA may also advise you to approach the Insurance Ombudsman and seek redressal as per procedure outlined in Redressal of Public Grievances Rules, 1998.
Also read: Types of life insurance policies in India