IRDA

Role of Surveyor in Insurance Claim

The Insurance Surveyor and Loss assessor play a crucial role in the insurance claim process when it comes to a claim against any insurance policy or in General insurance or reimbursement of any claim. They are authorized under IRDAI (Insurance Regulatory Development Authority) as per the latest Regulations 2015 to carry out a survey when an insurance claim is made and estimate the losses incurred in case of an accident or an untoward event. A surveyor connects the Insurer, and the Insured in an Insurance Policy and examines the damage or loss incurred.

Hence, they are appointed by insurance companies to determine the amount of actual loss in happening of events that are beyond the control of the parties. He must maintain neutrality and works efficiently for fair settlement of claims.

IRDAI has provided specific eligibility criteria for different kinds of surveyors. For motor insurance, one must have mechanical or automobile engineering qualifications. Similarly, marine insurance requires qualifications in marine engineering or naval architecture, crop insurers require a degree in agricultural sciences, and so on.

However, he must be appointed when estimated losses in motor insurance worth Rs 50,000 and over Rs1 lakh in other insurance claims, like fire or marine insurance. IRDAI^[1] reviews these limits every three years and can be appointed by the Insurer or the insured. However, a survey report is not binding on the Insurer. If the insured is unsatisfied with the final settlement offered by an insurer, one can approach the insurance ombudsperson.

The appointed Authority may submit the report to the Insurer within 30 days of being appointed and give comments on the assessment of loss. If required, you can seek an extension while informing the insured about the same. However, regardless of any extensions, one must submit the report within six months from the appointment date.

If the insurance company finds a report incomplete, he can be asked for an additional report, submitted within three weeks. And also, an additional report may provide only once during a single claim cycle.

Role and Responsibilities

Every Licensed Surveyor and Loss Assessor has to manage, investigate, quantify, and deal with losses of the Insurer or insured, as the case may be. They shall carry out their duties with competence and professional integrity while maintaining the code of conduct stipulated in these Regulations.

Conflict of interest: –

To declare whether the party has any interest in the subject matter.  If he has any personal interest in the incidence or the Insured, they must declare the same to the Insurer before assessment. Any personal relationship may affect the neutrality of the Surveyor and his report being rejected on the grounds of conflict of interest.

Explanation: For this clause, ‘relatives’ shall mean any relatives as defined in Sub-section (77) of Section 2 of the Companies Act, 2013.

Notice: –

The Surveyor may notify the Insurer about the change in the information or particulars given at the time of issuance of a license within fifteen days.

Neutrality and Confidentiality: –

To maintain confidentiality and neutrality without jeopardizing the Insurer’s liability and the insured’s claim.

Investigate and Assess –

• Inspecting the property in question suffering a loss;
• Examining, inquiring, investigating, verifying, and checking up on the causes of the loss, including the extent of loss, nature of the ownership, and insurable interest claim ;
• When necessary, conduct spot and final surveys, commenting upon the excess or under an insurance claim and any other relevant issue.
• Measuring, estimating, and determining the quantum and description of the subject under loss.
• Assess the loss on behalf of an insurer or insured;
• Assessing liability under the contract of insurance;

Damage Control: –

• Advise the Insurer and the insured about loss minimizations control, security, and safety measures, wherever appropriate, to avoid further losses;
• Comment on the admissibility of the loss as also the observance of warranty conditions under the policy contract.

Mention discrepancy: –

To point out discrepancies or ambiguities in the policy rhetoric that one has come across.

Suggest the Depreciation:

To make recommendations of applicability of depreciation, percentage, and quantum of depreciation.

Maintain Timeline:

He must submit their report within 30 days and a copy of the report to the insured or Insurer and give their opinion about the loss assessment. In exceptional circumstances of the case, due to its unique and complicated nature, he intimates to the insured or Insurer and may ask for an extension of time, not exceeding six months from the after submission of the survey report.

 Where the survey report is pending due to the non-completion of documents, the Authority may issue the final report independently based on the available documents on record, giving the insured a minimum of three written reminders. After receipt of a report,  if it is found incomplete in any respect, he shall be required to furnish an additional report on such issues. The Insurer may request this within 15 days of receiving the original survey report and may ask for an additional report by the Insurer shall only be resorted to once in the case of a claim.

 After receipt of the communication, he shall furnish an additional report within three weeks of communication from the Insurer.

Other Reliefs: –

• To provide reasons for repudiation of the claim in case policy terms and conditions do not cover the claim;
• Taking expert opinion, wherever required,
• Comment on salvage and its disposal wherever necessary.

Conclusion

The Insurance surveyors or Loss assessors are independent professionals who survey the claims assigned to them against a specific policy purchased by the policyholder. They prepare a report to assess the actual loss and verify the amount claimed by the insured. Thus, insurance companies settle claims based on the reports submitted by the Authority.

Read Our Article: Insurance Surveyors and Loss Assessors Licence: Detailed Procedure