Just sharing-------------CNG kit fitment & Insurance Od CLAIMS.............
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Ashok Kumar Singh.
Mar 23, 2017, 3:49:53 AM3/23/17
to Insurance surveyors
Just only views:--------
I am sharing some my views on CNG kit fitment in vehicle cases & insurance OD claims.
Case 1.----In a motor od insurance claim,Vehicle has fitment of cng kit but not endorsed in R.C. & not endorsed in insurance policy.
Answer:- We should check the cng fitment date in vehicle as per bill, we should check, have insured been informed to insurance company about fitment of CNG KIT previously. We should check loss has due to cng kit involvement or other reasons. Then we should assess the loss as per policy contract wordings with terms, conditions & exclusions. We should not allow cashless facility in this type claim. We should give all findings related claim in out survey report to insurance company.
Case 2:- In a Motor OD claim, Vehicle has fitment of cng kit endorsed in R.C. but not endorsed in insurance policy.
Answer:- Same as above answer-01.
I am sharing some points as under,- I am sharing some types of cases.
A- case:- When insured purchased the car / insurance policy, vehicle had no fitment of CNG kit. After some time he took CNG kit fitment in his vehicle. It's mean there is no matter of disclosure of CNG kit.
B- case:- Insured had purchased a old car with CNG kit fitment as also endorsed in R.C. and after that he purchased a insurance policy from insurance company. At the time of insurance he submitted the R.C. copy to insurance company. It's mean there is no matter of disclosure of CNG kit.
C- case:- Policy has continuing from last many years & CNG kit fitment is also from many years.
Now I am sharing some other points:-
CNG kit was fitted in the vehicle but the same was not declared for insurance purpose. Only one matter can be arise in this type case as breech of Utmost good faith.
1. In during current insurance policy period, insured took a fitment of CNG kit in his car. He also endorsed it in Registration certificate by RTO. It's mean there is no violation of Motor vehicle act.
2. We should read the policy contract documents as all terms conditions and exclusions, We should find violation as per policy contract wordings.
3. We can not take instructions from insurers for loss assessment. We Surveyors are neutral person for both parties. Surveyor have to assess the loss only as per policy contract wording.
5. Surveyor should give the all findings related the claims in his survey report to insurance company.
6. Some insurers insist to Surveyors to substandard the claim amount. Why should claim be settled as substandard basis. Please ask from insurer under which conditions, as with condition number according to standard policy wordings.
As per Surveyor Regulations 2015-- Surveyors can assess the loss only as per policy contract wordings. He has no right to substandard the claim amount. As per point "k" of Surveyor Regulations 2015-- (k) assessing liability under the contract of insurance.
He should give all facts in his survey report. Still I have not been read any condition about substandard the claim amount in policy contract. So we should not assess the claim amount as substandard basis. We have no right to substandard the claim amount. substandard the claim. It is not right for all of us.
7. We should inform to insured that he should deposit the insurance premium money for risk coverage of cng kit ( to endorsement for cng kit in insurance policy).
8. Generally insured does not aware about CNG Endorsement in insurance policy. He does not knowledge about importance of CNG endorsement & process of CNG Endorsement. for CNG kit risk coverage.
9. CNG kit was fitted in the vehicle but the same was not declared for insurance purpose. We should check that ---- is it a unintentional or intentional matter. Some times it is due to lack of knowledge of insured.
.
Some Insurance terms:-
.
Insurance policy is a contract document with insured. I am sharing some points regarding contract.
Contract:-
The law relating to contracts in India is contained in INDIAN CONTRACT ACT, 1872. The Act was passed by British India and is based on the principles of English Common Law. It is applicable to all the states of India except the state of Jammu and Kashmir. It determines the circumstances in which promises made by the parties to a contract shall be legally binding on them.
A contract is a voluntary arrangement between two or more parties that is enforceable by law as a binding legal agreement. Contract law concerns the rights and duties that arise from agreements.A contract arises when the parties agree that there is an agreement. Formation of a contract generally requires an offer, acceptance,consideration, and a mutual intent to be bound. Each party to a contract must have capacity to enter the agreement.
1. Offer -- When one person signifies to another his willingness to do or to abstain from doing anything, with a view to obtaining the assent of that other to such act or abstinence, he is said to make a proposal.
2.' Acceptance:- When the person to whom the proposal is made, signifies his assent there to, the proposal is said to be accepted.
3. Promise :- A Proposal when accepted becomes a promise. In simple words, when an offer is accepted it becomes promise.
4. Promisor and promisee :- When the proposal is accepted, the person making the proposal is called as promisor and the person accepting the proposal is called as promisee.
5. Consideration:- When at the desire of the promisor, the promisee or any other person has done or abstained from doing or does or abstains from doing or promises to do or to abstain from doing something such act or abstinence or promise is called a consideration for the promise. Price paid by one party for the promise of the other Technical word meaning QUID-PRO-QUO i.e. something in return.
6. Agreement :- Every promise & set of promises forming the consideration for each other.
7. Contract :- An agreement enforceable by Law is a contract. Therefore, there must be an agreement and it should be enforceable by law.
8. Void agreement:- An agreement not enforceable by law is void.
9. Voidable contract:- An agreement is a voidable contract if it is enforceable by Law at the option of one or more of the parties there to ( the aggrieved party), and it is not enforceable by Law at the option of the other or others.
10. Void contract :- A contract which ceases to be enforceable by Law becomes void when it ceases to be enforceable.
Now I am sharing some points regarding insurance:-
1. Insurance:- Insurance may thus be defined as sharing of the losses of a few who are unfortunate to suffer such losses, amongst those exposed to similer uncertain events / situations.
2.Insured:- The insurer enters into an insurance contract with each person who seeks to participate in the scheme. each participant is known as the insured.
3. Principles of insurance:- Insurance work on the basis of some principles as under,-
I. Principles of insurable intrest.
II. Principles- Utmost good faith.
III. Principles- Indemnity.
IV. Principles- Subrogation and contribution.
V. Proximate cause.
I. Principle of indemnity:- The principle of indemnity arises under common law which requires that an insurance contract should be a contract of indemnity only and nothing more. this means that the loss or damage must be made good in such a manner that financially the insured should be neither better off nor worse off as a result of the loss.
the object of the principle is to place the insured after a loss in the same financial position as far as possible, as he occupied immediately before the loss. the effect of this principle is to prevent the insured from making a profit out of his loss or gaining any benefit or advantage.
Provided that the liability of the company shal in no case exceed in respect of each item the sum expressed in the said schedule to be insured thereon or IDV.
II. Utmost good faith:-
Utmost good faith is a common law principle (sometimes called Uberrimae Fidei). The principle means that every person who enters into a contract of insurance has a legal obligation to act with utmost good faith towards the company offering the insurance
It means that both the policyholder and the insurer need to disclose all material and relevant information to each other before commencement of the contract.
Under Section 45 of Insurance Act 1938 states that if within 2 years of commencement or revival of the insurance policy, the insurer get to know that there has been a non-disclosure or misrepresentation of material facts, then the insurer can call the policy null and void.
It simply means that if within 2 years the Insurance Company finds out that the policy holder has not stated the complete truth or has lied while filling up the proposal form, then it can cancel the policy and decline the claim. It is not necessary that they will definitely repudiate the claim, but it is also a possibility. The insurer may ask for the difference in premium or change the terms and conditions after the fact has been disclosed.
Thus, it is the duty of the proposer to make full disclosure. In the event of failure to disclose material facts, the contract can be held null and void.
Insurance Contract being a financial contract needs to follow Utmost Good faith. Commercial contracts are subject to the principle of Caveat Emptor i.e. let the buyer beware. Hence it becomes very important for the policyholder to disclose all relevant information at the time of commencement of the policy.
Breaches of utmost good faith-- a breach of good faith can arise in 02 ways,-
a. Non disclosure of :- Non disclosure may arise out of silence on the part of the insured in general to material facts because the insurer has made no specific inquiry.
b. Mis-representation:- Misrepresentation may be either innocent or fraudulent. various statements made by the proposer either orally or in writing during the negotiations are called representations.
Warranties:- Having accepted a risk for a certain rate of premium & subject to certain terms & conditions, the insurer would like to ensure that the risk remains, through out the duration of the policy, the same as it existed at the time of proposal, the insurer would like to be protected against the introduction of some feature which may increase the risk. For the purpose, warranties are inserted in the policy.
III. Insurable interest:-
Insurable interest exist when an insured person derives a financial or other kind of benefit from the continuous existence, without impairment or damage, of the insured object (or in the case of a person, their continued survival).
IV. Subrogation:-
The basic concepts are that the insured cannot make a profit out of a loss by recovering twice, the insurer can recover the amount paid in claim to the insured from the third-party responsible for the loss, and that subrogation only applies to contracts of indemnity not to benefit policies (such as life assurance
V. Principle of Contribution
Contribution is the right of an insurer to call upon others similarly, but not necessarily equally liable to the same insured to share the cost of an indemnity payment. This principle of contribution enables the total claim to be shared in a fair way.
VI. Proximate cause:- Proximate cause is a key principle of insurance and is concerned with how the loss or damage actually occurred and whether it is indeed as a result of an insured peril.
As per surveyor regulations 2015.
CHAPTER IV
DUTIES AND RESPONSIBILITIES OF A SURVEYOR AND LOSS ASSESSOR
13. It shall be the duty of every Licensed Surveyor and Loss Assessor to investigate, manage, quantify, validate and deal with losses (whether insured or not) arising from any contingency, and report thereon to the insurer or insured, as the case may be., All Licensed Surveyors and Loss Assessors shall carry out the said work with competence, objectivity and professional integrity and strictly adhere to the code of conduct as stipulated in these Regulations.
(1) The following, shall, inter alia, be the duties and responsibilities of a Surveyor and Loss Assessor:-
(a)
(b)
(c) maintaining confidentiality and neutrality without jeopardising the liability of the insurer and claim of the insured;
(d) conducting inspection and re-inspection of the property in question suffering a loss;
(e) examining, inquiring, investigating, verifying and checking upon the causes and the circumstances of the loss in question including extent of loss, nature of ownership and insurable interest;
(f) conducting spot and final surveys, as and when necessary and comment upon franchise, excess/under insurance and any other related matter;
(g) estimating, measuring and determining the quantum and description of the subject under loss;
(h) advising the insurer and the insured about loss minimisation, loss control, security and safety measures, wherever appropriate, to avoid further losses;
(i) commenting on the admissibility of the loss as also observance of warranty conditions under the policy contract;
(j) surveying and assessing the loss on behalf of insurer or insured;
(k) assessing liability under the contract of insurance;
(l) pointing out discrepancy, if any, in the policy wordings;
(m) satisfying queries of the insured/insurer and of persons connected thereto in respect of the claim/loss;
(n) recommending applicability of depreciation, percentage and quantum of depreciation;
(o) giving reasons for repudiation of claim, in case the claim is not covered by policy terms and conditions;
(p) taking expert opinion, wherever required;
(q) commenting on salvage and its disposal wherever necessary.
(2) ---
(3) --
(4) --
(5) --
CHAPTER VI
CODE OF CONDUCT
16. Every Surveyor and Loss Assessor shall-
(1) behave ethically and with integrity in the professional pursuits. Integrity implies not merely honesty but fair dealings and truthfulness;
(2) strive for objectivity in professional and business judgment;
(3) act impartially, when acting on instructions from an insurer in relation to a policy holder’s claim under a policy issued by that insurer;
(4) conduct himself with courtesy and consideration to all people with whom he comes into contact during the course of his work;
(5) --
(6)--
(7) carry out his professional work with due diligence, care skill and with proper regard to technical and professional standards expected of him;
(8) --
(9) --
(10) --
(11)--
(12) not perform any outsourced activity other than those permitted by the Authority’s Outsourcing Guidelines.
(13)--
(14) --
(15) --
(16) --
(17) --
(18) shall undertake survey jobs in a company /firm only as an employee/ director/ partner.
(19) Every Surveyor and Loss Assessor who is an employee of an insurer shall only survey and assess the loss and not involve himself/ herself in settlement of claim.
(20) --
(21) --
Some ombudsman decision for sharing:-
1. Chandigarh Ombudsman Centre CASE NO. GIC/493/Reliance/11/09 Gopal Gora Vs Reliance Gen. Insurance Co. Ltd. Order dated 05.02.09 MOTOR
FACTS: Shri Gopal Gora stated that his car met with an accident on 06.10.08 around 07.00 pm on Faridabad-Gurgaon road. The car was lifted to Super Parts Private Ltd, Faridabad for repair. The company was duly informed and a surveyor was deputed. The company had denied the claim because CNG kit was installed in the car.
He had got the same endorsed in RC but did not do so in the insurance policy. Parties were called for hearing on 05.02.09 at New Delhi.
FINDINGS: During the course of hearing the insurer clarified that the CNG cylinder was fitted in the car which was not endorsed on the insurance policy. Hence the claim was repudiated as full premium for alteration was not received.
DECISION: Held that the cause of accident is not related to fixing of CNG cylinder. Hence, the claim should not be repudiated. The claim is payable. It is hereby ordered that the admissible amount of claim should be paid by the insurer to the complainant by 28.02.2009 after deducting the extra premium if not already paid.
2. DELHI CENTRE
Case No.GI/47/UII/12 In the matter of Sh. Amit Kumar Vs United India Insurance Company Ltd.
AWARD DATED 30.5.2013 NON SETTLEMENT OF MOTOR CLAIM
1. This is a complaint filed by Sh. Amit Kumar (herein after referred to as the complainant) against the decision of United India Insurance Company Ltd. (herein after referred to as respondent Insurance Company) relating to non settlement of motor claim.
2. Complainant submitted that his Esteem car bearing registration no. DL7CB 5963 met with an accident on 04.07.2010. He filed the claim. Company had settled the claim after 6 months for an amount of Rs. 24728. He had not deposited the cheque so far as he was not satisfied with the settlement. He had incurred an amount of Rs. 77135 on account of repairs of his vehicle. Company had appointed surveyor. He further submitted that claim was not adequately settled by the company. He has come to this forum with request to instruct the insurance company to adequately compensate the loss sustained by him due to damage to his vehicle on account of accident.
3. Representative of the company pleaded that claim was correctly settled and a deduction of 25% was made on account of the fact that though CNG was fitted in the vehicle but the same was not declared for insurance purpose. Therefore, company paid the claim after deduction of 25% of the assessed loss by the surveyor due to non disclosure of CNG Kit while getting insure the vehicle.
4. I have considered the submissions of the complainant as well as of the representative of the company. I have also perused the surveyor report. After due consideration of the matter, I hold that company was not justified in deducting 25% of assessed loss on account of non declaration of CNG. Thus, company had, paid entire amount of assessed loss to the insured. Accordingly company is here by directed to make payment of assessed loss less 3 years premium relating to the CNG Kit as penalty.
5. The Award shall be implemented within 30 days of receipt of the same. The compliance of the same shall be intimated to my office for information and record.
6. Copies of the Award to both the parties.
Ashok Kumar Singh.
Surveyor & Loss Assessor.
104, L-1, Ansal Housing, Golf Link-01,
Sector Omega-01, Builders Area, Near Pari Chowk,
Greater Noida, U.P..
201308.
23.03.2017.
I am sharing some my views on CNG kit fitment in vehicle cases & insurance OD claims.
Case 1.----In a motor od insurance claim,Vehicle has fitment of cng kit but not endorsed in R.C. & not endorsed in insurance policy.
Answer:- We should check the cng fitment date in vehicle as per bill, we should check, have insured been informed to insurance company about fitment of CNG KIT previously. We should check loss has due to cng kit involvement or other reasons. Then we should assess the loss as per policy contract wordings with terms, conditions & exclusions. We should not allow cashless facility in this type claim. We should give all findings related claim in out survey report to insurance company.
Case 2:- In a Motor OD claim, Vehicle has fitment of cng kit endorsed in R.C. but not endorsed in insurance policy.
Answer:- Same as above answer-01.
I am sharing some points as under,- I am sharing some types of cases.
A- case:- When insured purchased the car / insurance policy, vehicle had no fitment of CNG kit. After some time he took CNG kit fitment in his vehicle. It's mean there is no matter of disclosure of CNG kit.
B- case:- Insured had purchased a old car with CNG kit fitment as also endorsed in R.C. and after that he purchased a insurance policy from insurance company. At the time of insurance he submitted the R.C. copy to insurance company. It's mean there is no matter of disclosure of CNG kit.
C- case:- Policy has continuing from last many years & CNG kit fitment is also from many years.
Now I am sharing some other points:-
CNG kit was fitted in the vehicle but the same was not declared for insurance purpose. Only one matter can be arise in this type case as breech of Utmost good faith.
1. In during current insurance policy period, insured took a fitment of CNG kit in his car. He also endorsed it in Registration certificate by RTO. It's mean there is no violation of Motor vehicle act.
2. We should read the policy contract documents as all terms conditions and exclusions, We should find violation as per policy contract wordings.
3. We can not take instructions from insurers for loss assessment. We Surveyors are neutral person for both parties. Surveyor have to assess the loss only as per policy contract wording.
5. Surveyor should give the all findings related the claims in his survey report to insurance company.
6. Some insurers insist to Surveyors to substandard the claim amount. Why should claim be settled as substandard basis. Please ask from insurer under which conditions, as with condition number according to standard policy wordings.
As per Surveyor Regulations 2015-- Surveyors can assess the loss only as per policy contract wordings. He has no right to substandard the claim amount. As per point "k" of Surveyor Regulations 2015-- (k) assessing liability under the contract of insurance.
He should give all facts in his survey report. Still I have not been read any condition about substandard the claim amount in policy contract. So we should not assess the claim amount as substandard basis. We have no right to substandard the claim amount. substandard the claim. It is not right for all of us.
7. We should inform to insured that he should deposit the insurance premium money for risk coverage of cng kit ( to endorsement for cng kit in insurance policy).
8. Generally insured does not aware about CNG Endorsement in insurance policy. He does not knowledge about importance of CNG endorsement & process of CNG Endorsement. for CNG kit risk coverage.
9. CNG kit was fitted in the vehicle but the same was not declared for insurance purpose. We should check that ---- is it a unintentional or intentional matter. Some times it is due to lack of knowledge of insured.
.
Some Insurance terms:-
.
Insurance policy is a contract document with insured. I am sharing some points regarding contract.
Contract:-
The law relating to contracts in India is contained in INDIAN CONTRACT ACT, 1872. The Act was passed by British India and is based on the principles of English Common Law. It is applicable to all the states of India except the state of Jammu and Kashmir. It determines the circumstances in which promises made by the parties to a contract shall be legally binding on them.
A contract is a voluntary arrangement between two or more parties that is enforceable by law as a binding legal agreement. Contract law concerns the rights and duties that arise from agreements.A contract arises when the parties agree that there is an agreement. Formation of a contract generally requires an offer, acceptance,consideration, and a mutual intent to be bound. Each party to a contract must have capacity to enter the agreement.
1. Offer -- When one person signifies to another his willingness to do or to abstain from doing anything, with a view to obtaining the assent of that other to such act or abstinence, he is said to make a proposal.
2.' Acceptance:- When the person to whom the proposal is made, signifies his assent there to, the proposal is said to be accepted.
3. Promise :- A Proposal when accepted becomes a promise. In simple words, when an offer is accepted it becomes promise.
4. Promisor and promisee :- When the proposal is accepted, the person making the proposal is called as promisor and the person accepting the proposal is called as promisee.
5. Consideration:- When at the desire of the promisor, the promisee or any other person has done or abstained from doing or does or abstains from doing or promises to do or to abstain from doing something such act or abstinence or promise is called a consideration for the promise. Price paid by one party for the promise of the other Technical word meaning QUID-PRO-QUO i.e. something in return.
6. Agreement :- Every promise & set of promises forming the consideration for each other.
7. Contract :- An agreement enforceable by Law is a contract. Therefore, there must be an agreement and it should be enforceable by law.
8. Void agreement:- An agreement not enforceable by law is void.
9. Voidable contract:- An agreement is a voidable contract if it is enforceable by Law at the option of one or more of the parties there to ( the aggrieved party), and it is not enforceable by Law at the option of the other or others.
10. Void contract :- A contract which ceases to be enforceable by Law becomes void when it ceases to be enforceable.
Now I am sharing some points regarding insurance:-
1. Insurance:- Insurance may thus be defined as sharing of the losses of a few who are unfortunate to suffer such losses, amongst those exposed to similer uncertain events / situations.
2.Insured:- The insurer enters into an insurance contract with each person who seeks to participate in the scheme. each participant is known as the insured.
3. Principles of insurance:- Insurance work on the basis of some principles as under,-
I. Principles of insurable intrest.
II. Principles- Utmost good faith.
III. Principles- Indemnity.
IV. Principles- Subrogation and contribution.
V. Proximate cause.
I. Principle of indemnity:- The principle of indemnity arises under common law which requires that an insurance contract should be a contract of indemnity only and nothing more. this means that the loss or damage must be made good in such a manner that financially the insured should be neither better off nor worse off as a result of the loss.
the object of the principle is to place the insured after a loss in the same financial position as far as possible, as he occupied immediately before the loss. the effect of this principle is to prevent the insured from making a profit out of his loss or gaining any benefit or advantage.
Provided that the liability of the company shal in no case exceed in respect of each item the sum expressed in the said schedule to be insured thereon or IDV.
II. Utmost good faith:-
Utmost good faith is a common law principle (sometimes called Uberrimae Fidei). The principle means that every person who enters into a contract of insurance has a legal obligation to act with utmost good faith towards the company offering the insurance
It means that both the policyholder and the insurer need to disclose all material and relevant information to each other before commencement of the contract.
Under Section 45 of Insurance Act 1938 states that if within 2 years of commencement or revival of the insurance policy, the insurer get to know that there has been a non-disclosure or misrepresentation of material facts, then the insurer can call the policy null and void.
It simply means that if within 2 years the Insurance Company finds out that the policy holder has not stated the complete truth or has lied while filling up the proposal form, then it can cancel the policy and decline the claim. It is not necessary that they will definitely repudiate the claim, but it is also a possibility. The insurer may ask for the difference in premium or change the terms and conditions after the fact has been disclosed.
Thus, it is the duty of the proposer to make full disclosure. In the event of failure to disclose material facts, the contract can be held null and void.
Insurance Contract being a financial contract needs to follow Utmost Good faith. Commercial contracts are subject to the principle of Caveat Emptor i.e. let the buyer beware. Hence it becomes very important for the policyholder to disclose all relevant information at the time of commencement of the policy.
Breaches of utmost good faith-- a breach of good faith can arise in 02 ways,-
a. Non disclosure of :- Non disclosure may arise out of silence on the part of the insured in general to material facts because the insurer has made no specific inquiry.
b. Mis-representation:- Misrepresentation may be either innocent or fraudulent. various statements made by the proposer either orally or in writing during the negotiations are called representations.
Warranties:- Having accepted a risk for a certain rate of premium & subject to certain terms & conditions, the insurer would like to ensure that the risk remains, through out the duration of the policy, the same as it existed at the time of proposal, the insurer would like to be protected against the introduction of some feature which may increase the risk. For the purpose, warranties are inserted in the policy.
III. Insurable interest:-
Insurable interest exist when an insured person derives a financial or other kind of benefit from the continuous existence, without impairment or damage, of the insured object (or in the case of a person, their continued survival).
IV. Subrogation:-
The basic concepts are that the insured cannot make a profit out of a loss by recovering twice, the insurer can recover the amount paid in claim to the insured from the third-party responsible for the loss, and that subrogation only applies to contracts of indemnity not to benefit policies (such as life assurance
V. Principle of Contribution
Contribution is the right of an insurer to call upon others similarly, but not necessarily equally liable to the same insured to share the cost of an indemnity payment. This principle of contribution enables the total claim to be shared in a fair way.
VI. Proximate cause:- Proximate cause is a key principle of insurance and is concerned with how the loss or damage actually occurred and whether it is indeed as a result of an insured peril.
As per surveyor regulations 2015.
CHAPTER IV
DUTIES AND RESPONSIBILITIES OF A SURVEYOR AND LOSS ASSESSOR
13. It shall be the duty of every Licensed Surveyor and Loss Assessor to investigate, manage, quantify, validate and deal with losses (whether insured or not) arising from any contingency, and report thereon to the insurer or insured, as the case may be., All Licensed Surveyors and Loss Assessors shall carry out the said work with competence, objectivity and professional integrity and strictly adhere to the code of conduct as stipulated in these Regulations.
(1) The following, shall, inter alia, be the duties and responsibilities of a Surveyor and Loss Assessor:-
(a)
(b)
(c) maintaining confidentiality and neutrality without jeopardising the liability of the insurer and claim of the insured;
(d) conducting inspection and re-inspection of the property in question suffering a loss;
(e) examining, inquiring, investigating, verifying and checking upon the causes and the circumstances of the loss in question including extent of loss, nature of ownership and insurable interest;
(f) conducting spot and final surveys, as and when necessary and comment upon franchise, excess/under insurance and any other related matter;
(g) estimating, measuring and determining the quantum and description of the subject under loss;
(h) advising the insurer and the insured about loss minimisation, loss control, security and safety measures, wherever appropriate, to avoid further losses;
(i) commenting on the admissibility of the loss as also observance of warranty conditions under the policy contract;
(j) surveying and assessing the loss on behalf of insurer or insured;
(k) assessing liability under the contract of insurance;
(l) pointing out discrepancy, if any, in the policy wordings;
(m) satisfying queries of the insured/insurer and of persons connected thereto in respect of the claim/loss;
(n) recommending applicability of depreciation, percentage and quantum of depreciation;
(o) giving reasons for repudiation of claim, in case the claim is not covered by policy terms and conditions;
(p) taking expert opinion, wherever required;
(q) commenting on salvage and its disposal wherever necessary.
(2) ---
(3) --
(4) --
(5) --
CHAPTER VI
CODE OF CONDUCT
16. Every Surveyor and Loss Assessor shall-
(1) behave ethically and with integrity in the professional pursuits. Integrity implies not merely honesty but fair dealings and truthfulness;
(2) strive for objectivity in professional and business judgment;
(3) act impartially, when acting on instructions from an insurer in relation to a policy holder’s claim under a policy issued by that insurer;
(4) conduct himself with courtesy and consideration to all people with whom he comes into contact during the course of his work;
(5) --
(6)--
(7) carry out his professional work with due diligence, care skill and with proper regard to technical and professional standards expected of him;
(8) --
(9) --
(10) --
(11)--
(12) not perform any outsourced activity other than those permitted by the Authority’s Outsourcing Guidelines.
(13)--
(14) --
(15) --
(16) --
(17) --
(18) shall undertake survey jobs in a company /firm only as an employee/ director/ partner.
(19) Every Surveyor and Loss Assessor who is an employee of an insurer shall only survey and assess the loss and not involve himself/ herself in settlement of claim.
(20) --
(21) --
Some ombudsman decision for sharing:-
1. Chandigarh Ombudsman Centre CASE NO. GIC/493/Reliance/11/09 Gopal Gora Vs Reliance Gen. Insurance Co. Ltd. Order dated 05.02.09 MOTOR
FACTS: Shri Gopal Gora stated that his car met with an accident on 06.10.08 around 07.00 pm on Faridabad-Gurgaon road. The car was lifted to Super Parts Private Ltd, Faridabad for repair. The company was duly informed and a surveyor was deputed. The company had denied the claim because CNG kit was installed in the car.
He had got the same endorsed in RC but did not do so in the insurance policy. Parties were called for hearing on 05.02.09 at New Delhi.
FINDINGS: During the course of hearing the insurer clarified that the CNG cylinder was fitted in the car which was not endorsed on the insurance policy. Hence the claim was repudiated as full premium for alteration was not received.
DECISION: Held that the cause of accident is not related to fixing of CNG cylinder. Hence, the claim should not be repudiated. The claim is payable. It is hereby ordered that the admissible amount of claim should be paid by the insurer to the complainant by 28.02.2009 after deducting the extra premium if not already paid.
2. DELHI CENTRE
Case No.GI/47/UII/12 In the matter of Sh. Amit Kumar Vs United India Insurance Company Ltd.
AWARD DATED 30.5.2013 NON SETTLEMENT OF MOTOR CLAIM
1. This is a complaint filed by Sh. Amit Kumar (herein after referred to as the complainant) against the decision of United India Insurance Company Ltd. (herein after referred to as respondent Insurance Company) relating to non settlement of motor claim.
2. Complainant submitted that his Esteem car bearing registration no. DL7CB 5963 met with an accident on 04.07.2010. He filed the claim. Company had settled the claim after 6 months for an amount of Rs. 24728. He had not deposited the cheque so far as he was not satisfied with the settlement. He had incurred an amount of Rs. 77135 on account of repairs of his vehicle. Company had appointed surveyor. He further submitted that claim was not adequately settled by the company. He has come to this forum with request to instruct the insurance company to adequately compensate the loss sustained by him due to damage to his vehicle on account of accident.
3. Representative of the company pleaded that claim was correctly settled and a deduction of 25% was made on account of the fact that though CNG was fitted in the vehicle but the same was not declared for insurance purpose. Therefore, company paid the claim after deduction of 25% of the assessed loss by the surveyor due to non disclosure of CNG Kit while getting insure the vehicle.
4. I have considered the submissions of the complainant as well as of the representative of the company. I have also perused the surveyor report. After due consideration of the matter, I hold that company was not justified in deducting 25% of assessed loss on account of non declaration of CNG. Thus, company had, paid entire amount of assessed loss to the insured. Accordingly company is here by directed to make payment of assessed loss less 3 years premium relating to the CNG Kit as penalty.
5. The Award shall be implemented within 30 days of receipt of the same. The compliance of the same shall be intimated to my office for information and record.
6. Copies of the Award to both the parties.
Ashok Kumar Singh.
Surveyor & Loss Assessor.
104, L-1, Ansal Housing, Golf Link-01,
Sector Omega-01, Builders Area, Near Pari Chowk,
Greater Noida, U.P..
201308.
23.03.2017.
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