 "How to negotiate with your insurance surveyor")
Your car meets with an accident. You make an insurance claim for Rs 60,000, but get only Rs 40,000. The insurance company informs you the amount was based on the report by the surveyor. You decide to appoint your own surveyor, whose report suggests you are entitled to a higher claim. However, the company rejects this report. What can you do?
As a first step, you can request the insurance company to review its decision. If that does not work, you can approach the insurance ombudsman and then the Insurance Regulatory and Development Authority (Irda). If you still do not get a satisfactory response, you can take the legal route by approaching a court of law.
In such cases, however, a resolution might not be easily forthcoming. According to law, a surveyor should be appointed for any claim above Rs 20,000 related to vehicle or building damage. Irda allows either the insurance company or the policyholder to appoint one. It is not common for policyholders to appoint surveyors on their own, says K K Mishra, chief executive officer of Tata AIG General Insurance Company. Ideally, surveyors are independent authorities who work on behalf of either the insurer or policyholder. Whoever appoints one has to pay the surveyor's fees.
How can customers ensure disputes don't arise over claims and how to get a better deal from the surveyor's report?
Leave the damaged articles or accident site untouched
Even if you want to replace the articles in your house after a fire or flood, it is safe to do so only after the surveyor's inspection. Else, the insurance company may not accept the claims. "Repair your articles or replace them only after the surveyor says you can do so. Don't dispose any damaged goods before the inspection," says Divya Gandhi, head (general insurance) and principal officer at Emkay Insurance Brokers. In a car accident, do not tow away the vehicle from the site before the surveyor inspects it.
Be thorough with your claims report
Your claims report should be thorough and there should be proper justification, says B P Shah of B P Shah & Associates, Surveyors and Loss Assessors.
"In case of a claim for fire, get a structural engineer's report. This will show if there is any damage to the pillar or to the RCC (reinforced cement concrete) structure. Similarly, list in detail various items separately such as lifts, pump rooms, etc," says Shah.
In case of vehicle damage, describe the various damages in detail, says Gandhi. "If you leave out some dents and report these separately, the insurance company might treat these as a separate claim and refuse to pay you."
In case of an accident, you can also attach medical bills or the copy of the First Information Report (FIR) with the report, especially if there is third-party injury. This will also serve as proof of the nature and extent of the accident and work to your advantage in a dispute over the claims amount. Photographs of the incident and your own injuries, plus records of people who have witnessed the accident, can be part of your claims report.
Keep records of dealings with insurance agent & surveyor
It is advisable to keep a written account of the discussions on your claims report with your insurance agent and surveyor. Any emails or correspondence in this regard should also be saved. If the surveyor changes the valuation at a later stage, these can be useful.
Differentiate between recent and old damage
While making the claim report, the onus to prove the latest damage is on the insured. For instance, if there are cracks on the building walls due to a recent earthquake, then you must specify in your report. Otherwise, the insurance company can say it is an earlier crack and reject the claim, says Shah. Any structural engineer would be able to verify this.
Know prevailing market rates in your locality
In case of building damage, if there is a dispute over the construction cost, ensure the material cost and labour cost estimated by you is not off-mark. For this, it is important to know the prevailing market rates in your area, says Shah.
You can also consult a lawyer who has experience in handling accident claims (in case of motor claims) to strengthen your case.
As a first step, you can request the insurance company to review its decision. If that does not work, you can approach the insurance ombudsman and then the Insurance Regulatory and Development Authority (Irda). If you still do not get a satisfactory response, you can take the legal route by approaching a court of law.
In such cases, however, a resolution might not be easily forthcoming. According to law, a surveyor should be appointed for any claim above Rs 20,000 related to vehicle or building damage. Irda allows either the insurance company or the policyholder to appoint one. It is not common for policyholders to appoint surveyors on their own, says K K Mishra, chief executive officer of Tata AIG General Insurance Company. Ideally, surveyors are independent authorities who work on behalf of either the insurer or policyholder. Whoever appoints one has to pay the surveyor's fees.
Also Read
In case policyholders are not happy with the valuation of the surveyor appointed by the insurance company, will it help if the policyholder appoints his own surveyor? Maybe. However, it is not binding on the insurer to accept that report.
How can customers ensure disputes don't arise over claims and how to get a better deal from the surveyor's report?
Leave the damaged articles or accident site untouched
Even if you want to replace the articles in your house after a fire or flood, it is safe to do so only after the surveyor's inspection. Else, the insurance company may not accept the claims. "Repair your articles or replace them only after the surveyor says you can do so. Don't dispose any damaged goods before the inspection," says Divya Gandhi, head (general insurance) and principal officer at Emkay Insurance Brokers. In a car accident, do not tow away the vehicle from the site before the surveyor inspects it.
Be thorough with your claims report
Your claims report should be thorough and there should be proper justification, says B P Shah of B P Shah & Associates, Surveyors and Loss Assessors.
"In case of a claim for fire, get a structural engineer's report. This will show if there is any damage to the pillar or to the RCC (reinforced cement concrete) structure. Similarly, list in detail various items separately such as lifts, pump rooms, etc," says Shah.
In case of vehicle damage, describe the various damages in detail, says Gandhi. "If you leave out some dents and report these separately, the insurance company might treat these as a separate claim and refuse to pay you."
In case of an accident, you can also attach medical bills or the copy of the First Information Report (FIR) with the report, especially if there is third-party injury. This will also serve as proof of the nature and extent of the accident and work to your advantage in a dispute over the claims amount. Photographs of the incident and your own injuries, plus records of people who have witnessed the accident, can be part of your claims report.
Keep records of dealings with insurance agent & surveyor
It is advisable to keep a written account of the discussions on your claims report with your insurance agent and surveyor. Any emails or correspondence in this regard should also be saved. If the surveyor changes the valuation at a later stage, these can be useful.
Differentiate between recent and old damage
While making the claim report, the onus to prove the latest damage is on the insured. For instance, if there are cracks on the building walls due to a recent earthquake, then you must specify in your report. Otherwise, the insurance company can say it is an earlier crack and reject the claim, says Shah. Any structural engineer would be able to verify this.
Know prevailing market rates in your locality
In case of building damage, if there is a dispute over the construction cost, ensure the material cost and labour cost estimated by you is not off-mark. For this, it is important to know the prevailing market rates in your area, says Shah.
You can also consult a lawyer who has experience in handling accident claims (in case of motor claims) to strengthen your case.