GUIDELINES FOR SETTLEMENT OF CLAIMS – OWN DAMAGE
1. The documents generally required for settlement of motor claims are given below. However, depending on the merits of a case, a particular document may not be necessary or an alternate document could be used to serve the purpose of the company. However if the competent authority is satisfied that the loss is genuine and all efforts should be made to expedite settlement of the claim.
a) Claim Form duly completed
b) Registration certificate
The details usually verified from the RC can instead be obtained from purchase details of the vehicle if the circumstances so warrant.
c) Driving license
As per policy condition the driver is required to hold an ‘effective’ driving license both in terms of the period of validity and the class of vehicle that is being driven at the time of the accident.
The MV Act provides for a grace period of 30 days after expiry of a license during which period the license may be accepted as effective, provided the holder has not been disqualified from holding a license.
For loss sustained by parked vehicles, Driving License may not be relevant.
d) Lord challan / Trip Sheet
To verify that the load carried was within the permissible limits and the trip sheet giving the details of number of passengers carried in the vehicle.
e) Fitness certificate
The Fitness Certificate indicates the roadworthiness of a commercial vehicle.
f) Report to Police
A copy of First Information Report and Panchanama is required wherever third parties are involved in an accident.
g) Survey report
i) Surveyor should ascertain the damage, assess the quantum of payable claim, verify vehicular documents and confirm that the loss/damage being claimed for is in conformity with the narration of the accident.
ii) Where replacement of parts is allowed surveyors must physically verify serial nos. as appearing on major parts, which carry such numbers.
2. DAMAGE CLAIMS
2.1 Immediately on receipt of intimation of loss, in writing or ever telephone, a surveyor should be appointed based on the estimate of repairs.
2.2 In case of major accident, the insured would be asked to arrange for photographs of the vehicle at the spot of the accident, showing all the external damages and the Number Plate of the vehicle. The photo expenses are to be reimbursed upto Rs. 500/-. Alternatively, the insured may inform the nearest office of the insurer to arrange for such photographs.
2.3 DRIVING LICENSE :
a) If for any reason, to be specified, the driving license cannot be produced, the claim may be considered only on non-standard basis. However, for settlement of such claims the authority should be vested only with Managers and above in the RO.
b) Where the driving license is not endorsed for tourist taxes, since different practices prevail in different states. It is necessary to check the local practice. The claim is to be treated as standard or non-standard on the basis of the practice prevailing in the State where the accident occurs and this will be decided by a Manager and above in the RO.
2.4 REINSPECTION :
If re-inspection after repairs is considered necessary the same surveyor who has assessed the loss may conduct it.
2.5 PARTIAL LOSS CLAIMS :
2.5.1 Submission of bills/cash memos can be dispensed with for claims upto Rs. 50,000/- in respect of private cars and two wheelers only, subject to
a) the survey report correctly indicating the cost of parts allowed for replacement;
b) Claims being settled on the basis of a report of re-inspection after repairs by the surveyor, certifying that the repairs and replacements have been carried out as per assessment.
For other classes of vehicles bills/cash memos have to be obtained and verified.
2.5.2 If surveyor confirms replacement of the engine and chassis if allowed for replacement and indicates the new numbers, claims may be settled whilst simultaneously advising the insured that
a) As per the provisions of the Motor Vehicles Act, the new numbers have to be incorporated in the RC insurance-education.
b) Insurance company is informed about the incorporation of the new numbers in the RC insurance-education for endorsing on the policy document to facilitate settlement of future claims.
2.6 TOTAL LOSS :
a) Where the vehicle is totally damaged or when the net cost of repairs is almost close to the Market Value or the IEV the claim could be considered to be a total loss. Such total loss claims should be encouraged on net of salvage basis i.e. salvage being retained by the Insured and an appropriate amount towards salvage value as determined by the surveyor in consultation with the company be deducted from the Total Loss amount.
b) However, if the insured refuses to retain the salvage, arrangements should be made for the safe custody of the damaged vehicle to prevent further loss or damage. The R.T.O should be informed by Registered A.D. Post. An inventory of the major parts should be taken before taking possession of the vehicle. Immediate steps thereafter should also be taken for its disposal as per the Company’s guidelines for disposal of salvage.
3. THEFT CLAIMS
3.1 Partial Loss due to Theft :
Theft of parts/accessories from a vehicle should be reported to the police immediately by the insured. If parts are found missing or changed after recovery of stolen vehicle this be recorded in panchanama/recovery memo. Final police Investigation report will also be required. However, if the competent authority is satisfied about the genuiness of the loss, final investigation report may be waived provided the insured sends a registered A/D letter to the SP/ACP requesting that the Insurer should be informed of any recovery.
3.2 Total Loss due to Theft :
Unless the claims settling authority is fully satisfied investigation of the theft is to be arranged by an investigator who may be appointed with specific terms of reference.
3.3 The following documents should be collected from the insured in addition to a certified copy of the First Information Report, for considering “on account” payment of the admissible claim after expiry of 90 days from the date of loss.
(i) Surrender of the Registration insurance-education and the Tax insurance-education to the insurer duly transferred in the name of the insurers. The RTO is to be informed about the theft of the vehicle and this should be entered in Tax insurance-education so that further tax will not accrue.
(ii) Letter of Indemnity and Subrogation.
(iii) Ignition keys of the car.
(iv) Certificate of Insurance and the original Insurance policy, if not stolen with the vehicle.
(v) Specially worded discharge voucher.
3.4 The balance payment may be released on receipt of the Final Police Investigation Report or on expiry of a suitable waiting period from the date of the ‘on account‘ payment, after obtaining the discharge voucher in full and final’ settlement of the claim.
3.5 The police and the Registration authorities and the NCRB should be notified in writing about disposal of the claim on ‘Total Loss’ basis following theft of the vehicle. They should be requested to advise the Company if the vehicle is recovered subsequently. Immediately after receipt of advice from the Police regarding recovery of the vehicle, necessary steps for taking possession of the vehicle from the Police custody should be taken and, if necessary, an advocate should be appointed for filing recovery application in the court.
3.6 Municipal Authorities, where applicable, and the R.T.O. should be advised by Registered Letter with Acknowledgement Due to record ‘non use’ of the vehicle on account of theft and about the cancellation of the Insurance Certificate.
3.7 If the vehicle is recovered subsequently the insured will have the option to repay the claim amount already paid and retain the recovered vehicle. If the vehicle is found damaged, the Insured will be indemnified against loss of or damage. The Insured should be advised to obtain a recovery memo from the Police and to get the vehicle surveyed at the Police Station before taking delivery, as mentioned under partial loss theft claims.
3.8 In cases of criminal breach of trust each case should be dealt with on individual basis depending upon facts of each case and subject to legal opinion.