Claims Management and Loss Assessment
Claims Management and Loss Assessment
This domain tests the claims lifecycle, loss quantification, fraud control and recovery rights.
Core process
- Notification: immediate intimation, claim registration, policy verification.
- Survey and investigation: appointment of licensed surveyors for property and motor losses; checking cause, liability and quantum; fraud indicators.
- Documentation: claim form, FIR, bills, medical records, proof of loss, subrogation letter, salvage offer.
- Assessment: indemnity methods include market value, reinstatement, depreciation and betterment. Apply the average clause for underinsurance.
- Settlement: cash, repair, replacement or reinstatement; observe turnaround times and grievance channels.
- Recovery: subrogation, salvage, contribution and recovery from third parties.
Worked example
A motor own-damage claim has a repair estimate of INR 80,000, including INR 10,000 for plastic parts. The policy has a INR 2,000 deductible; depreciation on plastic is 50%. Depreciation = INR 5,000. Claim = 80,000 − 5,000 − 2,000 = INR 73,000. If salvage is INR 5,000, the net settlement is INR 68,000. The insurer takes a subrogation letter before paying if a third party is liable.
Traps
- Late intimation without reasonable cause.
- Missing documents or breach of policy conditions.
- Applying depreciation to the whole claim instead of eligible parts.
- Forgetting salvage deduction.
- Paying without subrogation or salvage rights.
- Ignoring the average clause in underinsurance.