III IC-104 cheat sheet

The source does not enumerate sub-domains for III IC-104, so this sheet covers the core insurance-principles knowledge the subject area tests; treat each bullet as a fact or decision rule, not study advice.

Insurable interest: the assured must stand to lose financially from the event; it must exist at inception for life/personal covers and at the time of loss for property/marine covers.

Indemnity applies to property, liability and marine cargo; it does not apply to life, personal accident, or fixed-benefit covers, where the sum assured is paid regardless of actual loss.

Utmost good faith (uberrimae fidei) obliges both parties to disclose all material facts; non-disclosure or misrepresentation makes the contract voidable at the insurer's option.

Proximate cause: the nearest efficient cause of loss, not the last event; if an excluded peril is the proximate cause, the claim fails even where an insured peril also operated.

Subrogation transfers the assured's recovery rights against a third party to the insurer after indemnity is paid; it cannot exceed the amount actually paid and does not apply to life policies.

Contribution operates among insurers covering the same interest against the same peril for the same assured; each pays rateably, and no insurer pays more than its independent liability.

Risk classification uses objective, statistically relevant factors (age, occupation, health, sum insured, construction type); premium = expected claims + expenses + contingency margin + profit loading.

A valid insurance contract needs offer, acceptance, consideration (premium), capacity, lawful object, and consensus ad idem; the proposal form is usually the offer and the policy the acceptance.

Warranties are strict conditions; breach discharges the insurer from liability from the date of breach (English law), while representation of fact is judged for materiality.

Conditions precedent to liability (e.g., prompt notice, proof of loss) must be satisfied before the insurer's duty to pay arises; conditions subsequent affect continuation of cover.

Utmost good faith disclosure duty ends at inception unless a policy clause imposes continuing disclosure (e.g., material change in risk, claims notification).

Doctrine of waiver and estoppel: an insurer that knowingly accepts premium or defends a claim after breach may lose the right to repudiate.

Causa proxima non remota spectatur: only the proximate cause matters; concurrent causes are resolved by whether the insured peril is dominant and not expressly excluded.

Average clause in underinsurance: claim = (sum insured / value at risk) × loss, applied where the policy is subject to average and the sum insured is below the value.

Salvage and abandonment: in marine insurance, the assured may abandon the subject matter to the insurer where a constructive total loss occurs; salvage value reduces the indemnity.

Life insurance underwriting uses mortality tables (e.g., LIC/IRDAI published tables); premium = mortality cost + interest discount + expense loading; reserves are computed on a net premium or gross premium basis.

Mortality rating: standard lives (standard rates), substandard lives (extra premium, lien, or exclusion), and declined lives; numerical rating adds debits/credits to a base of 100.

Sum assured vs sum at risk: sum at risk = sum assured − accumulated reserve; reinsurance and risk cover are based on the sum at risk, not the full sum assured.

Health insurance: pre-existing disease waiting periods, moratorium periods, room-rent capping, co-payment and deductible clauses determine the actual claim payable.

Personal accident policies pay fixed benefits for death, permanent total disablement and permanent partial disablement as a percentage of the capital sum insured; temporary total disablement pays weekly indemnity.

Critical illness covers pay a lump sum on diagnosis of a listed condition subject to survival periods; they are fixed-benefit, not indemnity, and can be combined with indemnity health cover.

Nomination and assignment: a nominee receives the policy money as a trustee for legal heirs; an assignment transfers rights and is distinct from nomination.

IRDAI (Insurance Products) Regulations require product filing, benefit illustration and disclosure of charges for unit-linked and participating products.

Fire policy covers fire, lightning and explosion (domestic); allied perils (STFI, riot, malicious damage, terrorism) require specific extension and separate premium.

Fire insurance indemnity is subject to reinstatement value or market value basis; reinstatement covers replacement cost without depreciation, subject to sum insured adequacy.

Marine cargo: Institute Cargo Clauses A (all risks), B and C (named perils) differ in scope; C is the narrowest and covers major casualties only.

Marine hull and cargo policies are subject to the principle of indemnity, sue and labour, and the running down clause for hull collision liability.

Motor insurance: third-party liability is compulsory under the Motor Vehicles Act; own-damage cover is optional; no-claim bonus is a discount on own-damage premium for claim-free years.

Motor third-party claims are settled by the Motor Accident Claims Tribunal; the insurer's liability is unlimited for third-party death/injury and statutory for property damage.

Public liability and products liability policies cover legal liability for bodily injury or property damage to third parties, subject to limits of indemnity per occurrence and in aggregate.

Business interruption (consequential loss) cover indemnifies lost gross profit and increased cost of working following an insured material damage loss, subject to the indemnity period.

Underwriting cycle: soft market (capacity high, rates low, terms liberal) alternates with hard market (capacity tight, rates rise, terms restrictive); cycle length varies by line.

Claims process: intimation → registration → survey/investigation → assessment → settlement or repudiation; surveyors are licensed under IRDAI (Surveyors and Loss Assessors) Regulations.

Claims reserving: case reserves for reported claims, IBNR (incurred but not reported) and IBNER reserves; ultimate loss = paid + outstanding + IBNR.

Reinsurance: proportional (quota share, surplus) shares premium and loss pro rata; non-proportional (excess of loss, stop loss) responds above a retention or attachment point.

Facultative reinsurance is placed risk-by-risk; treaty reinsurance covers a class of business automatically under agreed terms.

Retention and cession: net retention is the amount the insurer keeps; ceded premium reduces net premium; reinsurance commission and profit commission affect net cost.

Solvency margin: IRDAI requires a control level of solvency (currently 1.5×) with admissible assets over liabilities; reinsurance recoveries are admissible assets subject to limits.

Fraud indicators in claims include early policy inception relative to loss, inconsistent statements, inflated inventories and repeated claims; investigation must comply with policy conditions and natural justice.

IRDAI (Insurance Regulatory and Development Authority of India) regulates licensing, product filing, solvency, market conduct and grievance redressal under the Insurance Act, 1938 and IRDA Act, 1999.

Insurance intermediaries include agents, brokers, corporate agents, web aggregators and TPAs; each requires IRDAI registration and must meet fit-and-proper and training requirements.

Commission and remuneration are capped by IRDAI regulations; differential commission and rebating of premium are prohibited practices.

Grievance redressal: insurer Grievance Redressal Officer → IRDAI Bima Bharosa portal → Insurance Ombudsman for eligible complaints within prescribed limits and timelines.

Anti-money laundering: insurers must apply KYC, customer due diligence, record-keeping and suspicious transaction reporting under PMLA, 2002 and IRDAI AML guidelines.

Code of conduct for insurers and intermediaries requires fair dealing, transparency in product disclosure, confidentiality of customer data and prohibition of mis-selling.

Insurance fraud and misrepresentation are offences under the Insurance Act and IPC/BNS provisions; the insurer may repudiate and recover paid claims.

Data protection and outsourcing: IRDAI guidelines require board-approved outsourcing policy, data security, business continuity and prior intimation for material outsourcing.

Gross premium = net premium + expense loading; net premium covers expected claims and is discounted for interest and mortality.

Life fund valuation: reserves = present value of future benefits − present value of future net premiums, using valuation mortality and interest assumptions.

General insurance accounting: earned premium = written premium − unearned premium reserve movement; incurred claims = paid claims + change in outstanding and IBNR.

Combined ratio = loss ratio + expense ratio; a ratio above 100% indicates underwriting loss; investment income is assessed separately.

Solvency ratio = available solvency margin / required solvency margin; IRDAI control level is 1.5× required margin.

Technical provisions include unearned premium reserve, outstanding claims reserve, IBNR and reserves for unexpired risks.

Investment regulations prescribe asset categories and exposure limits (government securities, corporate bonds, equities, real estate) to match liabilities and protect policyholders.

Reinsurance recoveries are recognised as assets only when recoverable and not doubtful; bad debt provisions apply to reinsurer exposures.

Distribution channels: individual agents, corporate agents, brokers, bancassurance, direct marketing, web aggregators and insurance marketing firms; each has distinct licensing and conduct rules.

Free-look period: policyholder may return a policy within the prescribed period (commonly 30 days for non-linked, 30 days for linked products under current rules) for a refund of premium less charges.

Policy servicing: premium payment, revival of lapsed policies (within 5 years for life), nomination changes, assignment, and maturity/survival benefit settlement timelines.

Claims service standards: cashless authorisation and reimbursement timelines for health, surveyor appointment for general insurance, and TAT under IRDAI (Health Insurance) and policyholder protection regulations.

Mis-selling and rebating are prohibited; the insurer is responsible for the conduct of its agents and intermediaries and must maintain a complaints register.

Customer grievance escalation: insurer Grievance Redressal Officer, then IRDAI Bima Bharosa, then Insurance Ombudsman; ombudsman awards are binding on the insurer within prescribed limits.

Vulnerable customers (senior citizens, persons with disabilities) require accessible disclosure and simplified complaint handling under IRDAI guidelines.

Persistency and renewal: renewal is not guaranteed in most general insurance lines; life policies have grace periods and revival rights that affect customer outcomes.

Risk management steps: identify, analyse/measure, evaluate, treat (avoid, reduce, retain, transfer), monitor and review; insurance is a transfer tool within this cycle.

Pure vs speculative risk: insurance covers pure risks (loss or no loss) and excludes speculative risks (loss or gain, e.g., trading, gambling).

Fundamental vs particular risk: fundamental risks (war, flood, earthquake) affect many; particular risks affect individuals and are generally insurable.

Moral hazard arises from dishonest intent (e.g., arson), morale hazard from carelessness; both are managed by deductibles, co-insurance and claims investigation.

Risk retention is appropriate for high-frequency, low-severity losses; transfer suits low-frequency, high-severity losses.

Deductibles and excesses reduce small claims and moral hazard; co-insurance shares loss between insurer and assured and aligns incentives.

Enterprise risk management for insurers covers underwriting, market, credit, liquidity, operational and reputational risk, with board-approved risk appetite and ORSA-type assessment.

Catastrophe risk is modelled using exposure, hazard and vulnerability data; reinsurance and cat bonds transfer peak exposures.

Proposal form, policy schedule, wording, endorsements and warranties together form the contract; the schedule prevails over general wording where specific terms conflict.

Standard policy conditions include premium payment, cancellation, alteration, claims notification, subrogation, arbitration and governing law clauses.

Endorsements amend cover mid-term and must be signed/dated; material changes (occupancy, sum insured, risk location) require endorsement to remain valid.

Utmost good faith and disclosure apply at renewal where the insurer asks specific questions; non-disclosure can void the renewed contract.

Limitation periods: Indian contract claims generally attract a three-year limitation under the Limitation Act; policy-specific clauses may impose shorter claims notification periods.

Arbitration and jurisdiction clauses determine dispute resolution; consumer complaints may be filed before Consumer Commissions under the Consumer Protection Act, 2019.

Insurable interest, indemnity, subrogation, contribution and proximate cause are legal principles applied by courts; policy wording is construed contra proferentem against the insurer.

Electronic insurance: e-insurance accounts, digital signatures and electronic policies are recognised under IRDAI e-insurance regulations.

Life products: term, whole life, endowment, money-back, ULIP and annuity; each has distinct premium, reserve and benefit structures.

ULIP: premium allocated to units after charges (allocation, mortality, fund management, policy administration); NAV-based fund value plus sum assured on death.

Annuities: immediate vs deferred; life annuity, annuity certain, joint life and with-return-of-purchase-price variants; pricing depends on longevity and interest rates.

Non-life products: fire, marine, motor, health, personal accident, liability, engineering, crop and credit insurance; each has standard policy wordings and tariff history.

Health products: indemnity, fixed-benefit, critical illness and hospital cash; waiting periods, sub-limits and pre-authorisation are key claim determinants.

Engineering insurance: contract works (CAR), erection all risks (EAR), machinery breakdown and boiler explosion; covers construction/erection phases and maintenance periods.

Crop insurance (PMFBY) and credit insurance (ECGC) involve government or state-supported schemes with distinct underwriting and claim processes.

Product design must satisfy IRDAI file-and-use or use-and-file requirements, with actuarial certification of pricing and solvency impact.

Mortality rate qx = deaths at age x / lives at age x; survival probability px = 1 − qx; life expectancy derived from the life table.

Premium calculation: net single premium = present value of expected benefits; level annual premium = net single premium / annuity factor.

Loss ratio = incurred claims / earned premium; expense ratio = expenses / written premium; combined ratio = sum of both.

Credibility theory blends individual experience with class experience; credibility factor Z increases with volume of credible data.

IBNR estimation methods: chain-ladder (development factors), Bornhuetter-Ferguson (expected loss + reported development) and frequency-severity models.

Discounting: present value = future cash flow / (1 + i)^n; reserves must use prudent discount rates matching asset returns.

Mortality and morbidity tables are published by IRDAI/actuarial bodies; insurers use their own experience where credible and file assumptions.

Solvency capital considers underwriting, market, credit and operational risk modules; stress testing assesses resilience to adverse scenarios.

Policyholder protection: IRDAI (Protection of Policyholders' Interests) Regulations mandate disclosure of product features, charges and claim procedures before sale.

Free-look period allows cancellation of a new policy within the prescribed days; refund is premium less proportionate risk and expenses.

Grievance Redressal Officer (GRO) at the insurer must acknowledge and resolve complaints within prescribed timelines; non-resolution allows escalation.

Bima Bharosa (IRDAI portal) registers and tracks complaints; insurers must respond within the stipulated turnaround time.

Insurance Ombudsman: complaints up to the prescribed monetary limit, no fee, award binding on insurer; complainant may reject and approach courts/consumer forum.

Claims rejection must be communicated in writing with reasons and reference to policy clauses; the insurer must provide claim documents and status on request.

Senior citizens and persons with disabilities have priority grievance handling and accessible communication under IRDAI guidelines.

Data privacy: customer data must be collected with consent, used only for stated purposes, and protected against unauthorised access under IRDAI and data protection norms.

Indian insurance market: life and general insurers, reinsurer (GIC Re), foreign reinsurance branches, Lloyd's India, and intermediaries regulated by IRDAI.

Agents: individual agents licensed after training and examination; corporate agents (banks, NBFCs, cooperatives) tied to insurers; brokers represent the customer and need IRDAI registration.

Bancassurance: banks distribute insurance under corporate agency or referral arrangements; open architecture allows multiple insurers subject to IRDAI norms.

Web aggregators and insurance marketing firms: comparison and lead generation; remuneration and disclosure rules apply.

TPAs (Third Party Administrators) manage health claims and cashless networks; they must be IRDAI-registered and follow TPA regulations.

Commission caps and remuneration: life and general insurance commission rates are prescribed; brokers are paid brokerage within limits; rebating is prohibited.

Market conduct: mis-selling, false promises of returns, and non-disclosure of charges are violations attracting penalties and licence action.

Foreign investment and listing: FDI limits and listing norms affect insurer capital structure; IRDAI regulates ownership and control changes.

Claim intimation should be prompt; policy conditions specify notice periods; late notice may prejudice the claim if it hampers investigation.

Surveyors are appointed for losses above the prescribed threshold; survey report is evidence, not binding on the insurer, and must be reasoned.

Loss assessment: establish the peril, verify sum insured and average clause, deduct salvage and excess, and apply depreciation where market value basis applies.

Total loss vs partial loss: total loss pays up to sum insured (or value at risk); partial loss pays the depreciated cost of repairs/replacement subject to limits.

Third-party liability claims: establish negligence, quantum (income, dependency, medical expenses) and the insurer's liability under the Motor Vehicles Act or policy limits.

Health claims: cashless authorisation through TPAs, pre-authorisation for planned treatment, and documentation for reimbursement; exclusions and waiting periods apply.

Fraud detection: inconsistent documents, exaggerated bills, prior claim history and collusion indicators; investigation must respect policy conditions and privacy.

Claim settlement timelines and interest for delay are prescribed; unreasonable delay can attract regulatory action and consumer forum compensation.

Utmost good faith is both a legal and ethical duty; both insurer and customer must disclose material facts relevant to the risk.

Conflicts of interest must be disclosed and managed; intermediaries cannot accept undisclosed inducements from insurers.

Suitability and needs analysis: products must be recommended based on the customer's needs, affordability and existing cover, not commission.

Confidentiality: customer information may be used only for the purpose collected and shared only with consent or legal requirement.

Fair treatment of customers includes clear disclosure of exclusions, waiting periods, charges and claim procedures before the contract is concluded.

Whistleblowing and fraud reporting: employees and intermediaries should report suspected fraud under the insurer's whistleblower policy.

Professional competence: agents and intermediaries must complete mandatory training and continuing professional development as prescribed.

Regulatory consequences: violations of conduct rules can lead to penalties, licence suspension/cancellation and reputational damage.

Liberalisation since 1999-2000 opened the market to private insurers and foreign participation; IRDAI was established as regulator in 1999-2000.

Insurance penetration = premium / GDP; density = premium per capita; India's penetration remains low relative to global averages, indicating growth potential.

Emerging risks: cyber, climate/catastrophe, pandemic, liability and technology-driven risks require new products and underwriting data.

Cyber insurance covers data breach, ransomware, business interruption and third-party liability, subject to exclusions for war, unpatched systems and intentional acts.

Climate risk: physical risk (floods, cyclones) and transition risk (policy, technology) affect underwriting and investment portfolios.

Insurtech: digital distribution, telematics, wearables and AI underwriting improve efficiency but raise data privacy and fairness concerns.

Pandemic and systemic risk: business interruption and event cancellation covers face aggregation and exclusion issues; parametric products are emerging.

Regulatory trends: risk-based capital, IFRS 17 reporting, and enhanced policyholder protection shape insurer strategy and disclosure.

Life insurers maintain a separate policyholders' fund and shareholders' fund; surplus distribution follows the prescribed profit-sharing rules.

General insurers prepare revenue account, profit and loss account and balance sheet under the Insurance Act and IRDAI format.

Premium income recognition: written premium at inception; earned premium over the policy period; unexpired risk reserve for the unexpired portion.

Taxation: GST applies to insurance premiums (exemptions for some covers); corporate income tax applies to insurer profits with specific deductions.

Investment income and capital gains are recognised per accounting standards; unrealised gains treatment depends on asset classification.

IFRS 17 (Ind AS 117) requires measurement of insurance contracts using fulfilment cash flows and contractual service margin, replacing existing accounting.

Reinsurance accounting: ceded premium, reinsurance recoveries and commissions are recorded separately; net technical account shows the retained result.

Disclosure requirements include solvency position, claims ratios, expense ratios and related-party transactions in annual reports.

Quota share: insurer cedes a fixed percentage of every risk; surplus: cedes amounts above a retention up to a limit per risk.

Excess of loss: reinsurer pays losses above the insurer's retention up to the limit; may be per risk, per occurrence or per event.

Stop loss: reinsurer covers aggregate losses above a percentage of premium; protects against frequency and severity accumulation.

Facultative-obligatory and facultative covers allow selective cession; treaties are automatic and cover defined classes.

Reinstatement provisions restore reinsurance cover after a loss, often for additional premium; number of reinstatements and cost are specified.

Reinsurance programme design considers retention capacity, solvency, cost and counterparty security (reinsurer rating).

Catastrophe cover protects against accumulation of losses from a single event; modelled using exposure and event data.

Reinsurance recoveries are subject to the reinsurer's credit risk; collateral and rating requirements apply for cross-border reinsurers.

Corporate governance: board-approved policies, risk management committee, audit committee and fit-and-proper criteria for directors and key management.

Solvency and capital: required solvency margin under IRDAI regulations; insurers must maintain admissible assets exceeding liabilities by the control level.

Product filing: file-and-use for most products, with actuarial certification of pricing and compliance with product regulations.

Market conduct and mis-selling: IRDAI conducts inspections and can impose penalties, suspend or cancel registration.

AML/CFT: KYC, customer due diligence, record retention and suspicious transaction reporting under PMLA and IRDAI guidelines.

Outsourcing and IT governance: board-approved policies, data security, business continuity and prior notification for material outsourcing.

Grievance redressal and policyholder protection: GRO, Bima Bharosa, Ombudsman and turnaround times are mandatory compliance areas.

Reporting: periodic returns to IRDAI (financial, solvency, claims, complaints) must be accurate and timely; misreporting attracts penalties.

Needs analysis: assess income, dependants, liabilities, existing cover and goals before recommending a product.

Suitability: recommend products consistent with the customer's risk appetite, time horizon and affordability; document the rationale.

Disclosure: explain premium, charges, exclusions, waiting periods, surrender values and claim procedure before sale.

Fact-finding and proposal accuracy: incomplete or incorrect answers can lead to repudiation; the customer must verify the proposal.

Anti-mis-selling: no guaranteed returns, no rebating, no false comparisons; illustrations must follow IRDAI benefit illustration norms.

Policy delivery and free-look: deliver the policy promptly and explain the free-look right and cancellation process.

Persistency and servicing: renewal reminders, address changes and nomination updates improve persistency and customer outcomes.

Complaint handling: route grievances through the insurer's GRO and escalate to Bima Bharosa or the Ombudsman if unresolved.

Fraud types: staged accidents, exaggerated claims, arson, fictitious policies, premium diversion and collusion with intermediaries.

Red flags: early claims, inconsistent statements, duplicate documents, repeated claims, and losses exceeding sum insured.

Investigation: gather evidence, interview, verify documents and use forensic or medical experts; comply with policy conditions and privacy.

Repudiation: must be based on policy terms, communicated in writing with reasons, and supported by evidence.

Recovery: insurers may recover fraudulent claims and report to law enforcement; fraud is an offence under the Insurance Act and penal law.

Prevention: underwriting controls, KYC, data analytics, fraud registers and industry information sharing.

Whistleblower and ethics: employees should report suspected fraud internally under the insurer's policy.

Regulatory expectations: IRDAI requires fraud monitoring, board oversight and reporting of fraud incidents.

Individual agents: licensed after mandatory training and examination; cannot represent more than the permitted number of life and general insurers.

Corporate agents: entities such as banks and NBFCs tied to insurers; must comply with IRDAI corporate agency regulations and disclosure norms.

Brokers: act for the customer, must be IRDAI-registered, maintain professional indemnity cover and disclose remuneration.

Web aggregators and insurance marketing firms: comparison and lead generation; must disclose insurer relationships and remuneration.

TPAs: manage health claims and cashless networks; must be IRDAI-registered and follow TPA regulations.

Commission and remuneration: caps prescribed by IRDAI; rebating prohibited; differential commission not allowed.

Conduct: fair dealing, suitability, confidentiality and no misrepresentation of policy terms.

Liability: intermediaries are responsible for their conduct and may face penalties, suspension or cancellation of registration.

Life pricing: net premium = present value of benefits / annuity factor; gross premium adds expense loading and margin.

Reserving: policy reserves = present value of future benefits − present value of future net premiums; valuation assumptions must be prudent.

General insurance: unearned premium reserve = unexpired portion of premium; unexpired risk reserve where experience is adverse.

Claims reserves: case reserves for reported claims; IBNR for incurred but not reported; IBNER for development of known claims.

Loss ratio and combined ratio measure underwriting performance; combined ratio above 100% indicates underwriting loss.

Discounting: reserves discounted at prudent rates; investment return assumptions must be supportable.

Experience rating: adjust premiums for individual risk experience where credible; credibility weighting blends class and individual data.

Solvency: capital requirements reflect underwriting, market, credit and operational risk; stress testing assesses resilience.

Insurance contract law: offer, acceptance, consideration, capacity, lawful object and consensus; proposal and policy form the contract.

Utmost good faith: material facts must be disclosed; non-disclosure or misrepresentation makes the contract voidable.

Indemnity: applies to property, liability and marine; not to life and personal accident fixed benefits.

Subrogation: insurer acquires the assured's rights against third parties after indemnity; cannot exceed the amount paid.

Contribution: insurers covering the same interest share the loss rateably; no insurer pays more than its independent liability.

Proximate cause: the nearest efficient cause determines whether an excluded peril applies.

Consumer Protection Act, 2019: consumer commissions hear insurance disputes; deficiency in service can lead to compensation.

Limitation: contract claims generally three years under the Limitation Act; policy notice conditions may impose shorter periods.

Fair treatment of customers: clear disclosure of product features, charges, exclusions and claim procedures before sale.

Suitability: recommend products based on needs, affordability and risk appetite; document the advice.

Anti-mis-selling: no guaranteed returns, no rebating, no false comparisons; illustrations must follow IRDAI norms.

Free-look period: policyholder may cancel a new policy within the prescribed period for a refund less charges.

Grievance redressal: GRO, Bima Bharosa and Ombudsman escalation with prescribed timelines.

Claims conduct: communicate decisions in writing with reasons; pay or repudiate within timelines; interest for delay.

Vulnerable customers: senior citizens and persons with disabilities require accessible disclosure and priority handling.

Data privacy: collect and use customer data only with consent and for stated purposes; protect against unauthorised access.

Policy administration: proposal processing, underwriting, issuance, endorsements, renewals and cancellations.

Claims operations: intimation, registration, survey, assessment, settlement and recovery; workflow systems track turnaround times.

Digital channels: online sales, e-insurance accounts, digital signatures and electronic policies recognised under IRDAI regulations.

Data analytics: underwriting, pricing, fraud detection and claims triage; data quality and privacy are critical.

Cybersecurity: board-approved policy, incident response, data encryption and third-party risk management.

Business continuity: disaster recovery and business continuity plans for critical operations and outsourcing.

Outsourcing: board-approved policy, due diligence, data security and prior notification for material outsourcing.

Customer service: CRM systems, complaint tracking and turnaround time monitoring for service quality.

Insurance market structure: life and general insurers, reinsurer (GIC Re), foreign reinsurance branches, Lloyd's India and intermediaries.

Penetration = premium / GDP; density = premium per capita; both measure insurance development.

Demand factors: income, risk awareness, price, distribution reach and regulatory environment.

Supply factors: capital, underwriting capacity, reinsurance and distribution networks.

Underwriting cycle: soft market (capacity high, rates low) alternates with hard market (capacity tight, rates rise).

Competition: price and product innovation, distribution reach and service quality determine market share.

Foreign investment and listing: FDI limits and listing norms affect insurer capital structure.

Regulatory trends: risk-based capital, IFRS 17 and enhanced policyholder protection shape strategy.

Claim intimation: prompt notice per policy conditions; late notice may prejudice the claim if investigation is hampered.

Surveyors: appointed for losses above the prescribed threshold; survey report is evidence, not binding on the insurer.

Loss assessment: establish peril, verify sum insured and average clause, deduct salvage and excess, apply depreciation where market value basis applies.

Total loss: pays up to sum insured or value at risk; partial loss pays depreciated cost of repairs subject to limits.

Third-party liability: establish negligence, quantum and the insurer's liability under the Motor Vehicles Act or policy limits.

Health claims: cashless authorisation through TPAs, pre-authorisation for planned treatment, and documentation for reimbursement.

Fraud detection: inconsistent documents, exaggerated bills, prior claim history and collusion indicators.

Settlement timelines: prescribed turnaround times; unreasonable delay attracts regulatory action and consumer forum compensation.

Risk management cycle: identify, analyse, evaluate, treat (avoid, reduce, retain, transfer), monitor and review.

Pure vs speculative risk: insurance covers pure risks (loss or no loss) and excludes speculative risks.

Moral hazard: dishonest intent; morale hazard: carelessness; both managed by deductibles, co-insurance and investigation.

Retention: appropriate for high-frequency, low-severity losses; transfer suits low-frequency, high-severity losses.

Deductibles and excesses: reduce small claims and moral hazard; co-insurance shares loss and aligns incentives.

Underwriting: assess risk, classify, price and decide terms; use objective, statistically relevant factors.

Reinsurance: proportional (quota share, surplus) and non-proportional (excess of loss, stop loss) transfer risk.

Catastrophe risk: modelled using exposure, hazard and vulnerability data; reinsurance and cat bonds transfer peak exposures.

Life insurers: separate policyholders' and shareholders' funds; surplus distribution follows prescribed profit-sharing rules.

General insurers: revenue account, profit and loss account and balance sheet under the Insurance Act and IRDAI format.

Premium recognition: written premium at inception; earned premium over the policy period; unexpired risk reserve for the unexpired portion.

Taxation: GST applies to insurance premiums (with exemptions); corporate income tax applies to insurer profits with specific deductions.

Investment income: recognised per accounting standards; unrealised gains treatment depends on asset classification.

IFRS 17 (Ind AS 117): measurement using fulfilment cash flows and contractual service margin, replacing existing accounting.

Reinsurance accounting: ceded premium, recoveries and commissions recorded separately; net technical account shows retained result.

Disclosure: solvency position, claims ratios, expense ratios and related-party transactions in annual reports.

IRDAI regulates licensing, product filing, solvency, market conduct and grievance redressal under the Insurance Act, 1938 and IRDA Act, 1999.

Intermediaries: agents, brokers, corporate agents, web aggregators and TPAs require IRDAI registration and fit-and-proper compliance.

Commission and remuneration: capped by IRDAI regulations; differential commission and rebating prohibited.

Grievance redressal: insurer GRO → IRDAI Bima Bharosa → Insurance Ombudsman for eligible complaints.

AML/CFT: KYC, customer due diligence, record-keeping and suspicious transaction reporting under PMLA and IRDAI guidelines.

Code of conduct: fair dealing, transparency, confidentiality and prohibition of mis-selling.

Fraud and misrepresentation: offences under the Insurance Act and penal law; insurer may repudiate and recover paid claims.

Data protection and outsourcing: board-approved policies, data security, business continuity and prior intimation for material outsourcing.