The Important guidelines contained in IRDA (Protection of
Policyholders Interests) Regulations, 2002 are as under:
9. Claim procedure in respect of a general insurance policy
(1) An insured or the claimant shall give notice to the insurer of any loss
arising under contract of insurance at the earliest or within such extended
time as may be allowed by the insurer. On receipt of such a communication, a
general insurer shall respond immediately and give clear indication to the
insured on the procedures that he should follow. In cases where a surveyor has
to be appointed for assessing a loss/ claim, it shall be so done within 72
hours of the receipt of intimation from the insured.
(2) Where the insured is unable to furnish all the
particulars required by the surveyor or where the surveyor does not receive the
full cooperation of the insured, the insurer or the surveyor as the case may
be, shall inform in writing the insured about the delay that may result in the
assessment of the claim. The surveyor shall be subjected to the code of conduct
laid down by the Authority while assessing the loss, and shall communicate his
findings to the insurer within 30 days of his appointment with a copy of the
report being furnished to the insured, if he so desires. Where, in special
circumstances of the case, either due to its special and complicated nature,
the surveyor shall under intimation to the insured, seek an extension from the
insurer for submission of his report. In no case shall a surveyor take more
than six months from the date of his appointment to furnish his report.
(3) If an insurer, on
the receipt of a survey report, finds that it is incomplete in any respect, he
shall require the surveyor under intimation to the insured, to furnish an
additional report on certain specific issues as may be required by the insurer.
Such a request may be made by the insurer within 15 days of the receipt of the
original survey report. Provided that the facility of calling for an additional
report by the insurer shall not be resorted to more than once in the case of a
claim.
(4) The surveyor on
receipt of this communication shall furnish an additional report within three
weeks of the date of receipt of communication from the insurer.
(5) On receipt of the
survey report or the additional survey report, as the case may be, an insurer
shall within a period of 30 days offer a settlement of the claim to the
insured. If the insurer, for any reasons to be recorded in writing and
communicated to the insured, decides to reject a claim under the policy, it
shall do so within a period of 30 days from the receipt of the survey report or
the additional survey report, as the case may be.
(6) Upon acceptance of an offer of settlement as stated in
subregulation (5) by the insured, the payment of the amount due shall be made
within 7 days from the date of acceptance of the offer by the insured. In the
cases of delay in the payment, the insurer shall be liable to pay interest at a
rate which is 2% above the bank rate prevalent at the beginning of the
financial year in which the claim is reviewed by it.
