Insurance Process and Types Notes
Insurance Process and Types Notes
STEP 1 — Proposal
The insurance process begins with the prospective insured (the proposer) initiating contact with an
insurance company.
• The proposer conducts market research to identify an insurer whose products and terms meet
their requirements.
• The proposer explains the nature of the risk to the insurer — what is to be insured, its value,
its location, and its characteristics.
• The insurer, using their team of underwriters, actuaries, and surveyors, conducts a physical
inspection of the risk where required.
• Based on the inspection and risk assessment, the insurer decides: (a) whether they are willing
to cover the risk, (b) how much cover they can offer, and (c) the premium they will charge.
ℹ At the proposal stage, the duty of Utmost Good Faith applies fully. The proposer must
disclose all material facts about the risk, whether or not they are specifically asked.
Once the proposer has decided to proceed, the formal process of offer and acceptance begins.
• The proposer fills in a printed Proposal Form — the insurer’s standard application form —
providing all details about themselves and the risk to be insured.
• Submitting the completed proposal form constitutes the OFFER by the proposer.
• The insurer verifies the information provided in the proposal form — this may involve further
questions, surveys, or medical examinations (for life insurance).
• If the insurer is satisfied with the risk, they ACCEPT the offer, and the two parties reach an
AGREEMENT — the foundation of the insurance contract.
Counter Offer: If the insurer is unwilling to accept the risk on the proposer’s original terms, the
insurer may propose modified terms (different premium, different sum assured, or additional
exclusions). This is called a Counter Offer. The original offer is rejected and replaced by the counter
offer. If the proposer then accepts the counter offer, acceptance is complete.
ℹ In contract law, a counter offer destroys the original offer. Once a counter offer is
made, the proposer cannot revert to the original terms without the insurer’s agreement.
After the offer has been accepted, the insurer must issue a policy document. However, preparing
and printing a formal policy document takes time. To ensure the insured is protected from the
moment of acceptance, the insurer issues a Cover Note.
• A Cover Note is a temporary insurance document that provides immediate, interim cover while
the formal policy is being prepared.
• It contains all the key details from the proposal form: the insured’s name, the subject matter,
the sum assured, the premium, and the period of cover.
• The Cover Note provides the same legal protection as the policy during the interim period.
• The Cover Note automatically becomes void (ceases to have effect) once the formal policy is
issued and delivered to the insured.
ℹ Cover Notes are particularly important in motor insurance and marine insurance,
where cover may be needed immediately — for example, to drive a newly purchased
vehicle or to ship a consignment at short notice.
The insurance policy is the formal, written document that serves as the legal evidence of the
insurance contract. It is issued by the insurer to the insured and sets out all the terms and
conditions of the agreement.
1. Heading
• The name of the insurance company.
• The registered address and contact details of the insurer.
• The policy number and type of insurance.
2. Preamble
The preamble is the introductory statement of the policy. It confirms three key matters:
• The proposal form submitted by the insured has been considered as the basis of the contract
— meaning that any misrepresentation in the proposal form may void the entire contract.
• The contract is conditional on payment of the premium — if the premium is not paid, the
contract is not in force.
• The insurer’s promise to pay the cover if the insured event occurs.
3. Operative Clause
• States the specific cover the insurer is providing — the risks covered, the sum assured, and
the circumstances under which the insurer will pay.
• This is the heart of the policy — the insurer’s promise in precise legal language.
4. Exceptions / Exclusions
• Lists all events, perils, or losses that are specifically NOT covered under the policy.
• Example: ‘We will not cover losses caused by war, nuclear radiation, or deliberate act of the
insured.’
• Exclusions define the limits of the insurer’s promise and must be read carefully by the
policyholder.
5. Conditions
The conditions section sets out the ongoing obligations of both parties during the policy period.
These typically cover:
• The principles of insurance that apply to the contract (Utmost Good Faith, Insurable Interest,
etc.).
• Procedures for reporting a loss (prompt notification requirements).
• Procedures for making a claim and the documentation required.
• The insurer’s right to inspect the property and to conduct surveys.
• Dispute resolution procedures.
6. Policy Schedule
The Policy Schedule is the personalised section of the policy — it sets out the specific details of this
particular insured and this particular risk:
• Full name and address of the insured.
• Description of the subject matter insured (property address, vehicle registration, name of life
assured).
• Sum assured and premium payable.
• Period of cover (commencement date and expiry date).
• Any special conditions or endorsements specific to this policy.
8. Renewal Clause
• Sets out the procedure for renewing the policy at the end of the term.
• Confirms that if the renewal premium is not paid by the due date (and within any applicable
grace period), the policy will lapse and cover will cease.
ℹ The Proposal Form is the basis of the contract. Any false or incomplete statement in
the proposal form can void the entire policy — even for losses unrelated to the false
statement — because the proposal forms the foundation of the insurer’s acceptance.
PART B: Essentials of a Valid Insurance Contract
An insurance contract is a special type of contract. Like all contracts in India, it must satisfy the
requirements of the Indian Contract Act, 1872 (Section 10) to be legally valid. In addition, it must
satisfy requirements specific to insurance law.
ℹ A contract that does not satisfy these essentials is either void (has no legal effect at
all) or voidable (can be set aside by the aggrieved party).
In insurance, free consent is closely connected to the principle of Utmost Good Faith. Any
misrepresentation or non-disclosure of material facts by the insured undermines the insurer’s free
consent and gives the insurer the right to void the policy.
IRDAI and the Dave Committee have recommended the introduction of a voluntary pension scheme
for the unorganised sector. Key proposals include:
◦ Any institution — including Mutual Funds — with capital of ₹50–75 crores should be
eligible to offer pension products.
◦ The pension market should be expanded to include EPF, EPS, GPF, PPF, and voluntary
organisations.
ℹ The UK government adopted the principle: ‘take care of its citizens from cradle to the
grave.’ India, despite being one of the fastest-growing economies in the world, still lacks
a comparable national safety net for its elderly population.
Bancassurance: The sale of insurance products through a bank’s branch network, using the bank’s
existing customer relationships and infrastructure to distribute insurance.
Issue 3: Alternative Distribution Channels
Beyond the traditional agent model and bancassurance, the insurance industry is increasingly
exploring alternative and digital distribution channels:
Channel Description
Direct Response Telemarketing, direct mail, newspaper advertisements, and
television campaigns that generate leads and direct policy
applications.
High Street / Bank Bank branches and financial houses acting as insurance
Branches distribution points.
Electronic / Internet Online platforms where customers can research, compare,
and purchase insurance directly. Web aggregators like
Policybazaar have transformed price transparency.
Agency Traditional individual agents who sell face-to-face and
provide personalised advice.
Financial Advisors Stock and securities brokers who offer insurance as part of
a broader financial planning service.
Post Offices and Trade Government and worker organisations that reach deep into
Unions rural and informal worker communities with customised
insurance products.
The internet has changed consumer behaviour: customers now research and compare products
online before approaching an agent. For life insurance, however, the bank channel has a practical
limitation — frequent transfer of bank employees means relationship continuity is difficult to
maintain.
Private insurance companies have consistently demanded a ‘level playing field’ — i.e., the same tax
concessions to be extended to their policyholders. The Government has been called upon to take
the initiative to align tax treatment across all licensed insurers.
1. Fire Insurance
Fire Insurance: A named-peril policy that covers physical loss or damage to property caused by fire
and a range of associated perils.
Standard Exclusions
• War, invasion, and civil commotion (these require separate cover or endorsements).
• Nuclear risks.
• Losses caused by the insured’s own deliberate act.
2. Burglary Insurance
Burglary Insurance: A policy that covers contents (stock, cash, equipment) against loss or damage
caused by burglary, housebreaking, theft, and robbery.
• Available to commercial establishments, shops, offices, and industrial premises.
• Covers loss or damage by: burglary, housebreaking, theft, and robbery.
The Critical Condition for a Claim
For a claim to be triggered under a burglary policy, the following must be established:
• Actual, forcible, and violent entry into or exit from the premises; OR
• Hold-up (i.e., robbery with threat of violence).
▶ Case: Two shoplifters in Ms. Saraswati’s shop pocketed high-value items without breaking
in, then broke through a display window to escape. Question: Is the claim payable? Analysis:
The entry was NOT forcible or violent — they entered as normal customers. However, the EXIT
through the display window constitutes forcible and violent exit. The claim for the stolen items
and the broken window is likely payable on that basis.
ℹ The forcible and violent entry/exit condition distinguishes burglary insurance from
shoplifting losses. Ordinary theft by stealth without force is typically NOT covered under
a standard burglary policy.
3. Money Insurance
Money Insurance: A policy that covers cash and other monetary instruments against loss during
transit or while held on the insured’s premises.
• Covers money in transit between the insured’s premises and banks or other specified
locations (including branch offices).
• Also covers money in safe / strong room on the premises.
• Particularly important for businesses that handle large cash sums — retailers, financial agents,
salary disbursement operations.
Fidelity Guarantee Insurance: A policy that covers an employer against direct financial loss
resulting from the dishonesty (fraud, theft, embezzlement) of an employee.
• Covers only DIRECT financial loss caused by the employee’s dishonesty — not indirect or
consequential losses.
• May cover individual employees (specific fidelity guarantee) or all employees (blanket fidelity
guarantee).
• Requires the employer to have adequate supervision and internal controls — absence of
controls may give the insurer grounds to reduce or deny a claim.
Bankers’ Indemnity Insurance: A comprehensive package policy designed specifically for banks,
covering multiple risks relating to money, securities, and fraud.
Covers losses involving:
• Money and securities on the bank’s premises.
• Money and securities in transit.
• Forgery or alteration of cheques, drafts, and other instruments.
• Dishonesty of any bank employee.
• Fraud by employees in respect of hypothecated (pledged) goods.
• Fraud by appraisers (valuers appointed by the bank).
• Money in the hands of Janata agents (rural banking agents).
• Losses during despatches by registered post.
Jewellers’ Block Insurance: An all-risks policy specifically designed for establishments dealing in
jewellery, diamonds, and precious stones.
• Originally devised for diamond establishments; now extended to all jewellery shops.
Covers:
• Loss or damage to specified jewellery and precious stone property by fire and allied perils.
• Loss by burglary when property is on the premises.
• Loss when property is in the custody of persons not in the regular employment of the insured
(e.g., on loan to a customer for approval).
• Property in transit (being transported for sale, exhibition, or repair).
7. Engineering Insurance
Engineering Insurance: A group of specialist policies covering risks unique to engineering and
construction projects.
Engineering insurance encompasses several distinct policy types:
Policy Type What It Covers
Contractors All Risk (CAR) All-risk cover for civil engineering contractors building
bridges, roads, tunnels, dams, and buildings during
construction.
Erection All Risk (EAR) All-risk cover for the erection of electrical plants,
equipment, machinery, and structures.
Machinery Breakdown (MB) Sudden and unforeseen physical damage to
machinery caused by mechanical or electrical
breakdown.
Boiler Explosion Loss or damage caused by explosion of boilers and
pressure vessels.
Machinery Loss of Profits Loss of gross profit during the period a machine is
(MLOP) under repair following a breakdown.
Advance Loss of Profits (ALOP) Loss of anticipated profits during a delay in the
commencement of a project due to an insured peril.
▶ A bottle manufacturer importing automated machinery from Germany should take: (1)
Marine Cargo insurance for the machinery in transit from Germany to India; (2) Erection All Risk
insurance during the installation of machinery at the plant; (3) Contractors All Risk insurance for
the civil construction of the plant by M/s Hankeman and Sons; (4) Machinery Breakdown
insurance once the plant is operational; (5) Fire insurance for the completed plant.
9. Marine Insurance
ℹ Cargo (goods by sea or air) and Freight (goods by rail or truck, or the charges for
carriage) are distinct terms. Marine cargo insurance covers both, but the description of
the subject matter in the policy must be precise.
Liability Insurance: Policies that indemnify the insured against their legal obligation to pay
compensation to third parties for injury to their persons or damage to their property.
Major types of liability insurance:
Type Who It Protects What It Covers
Public Liability Any person or Legal liability to pay damages to third
business. parties for bodily injury or property
damage caused by the insured’s
activities or premises.
Professional Indemnity Doctors, hospitals, Legal liability arising from professional
engineers, lawyers, errors, negligence, or omissions in the
architects. course of professional practice.
Products Liability Manufacturers and Legal liability for injury or damage
sellers. caused by a defective product
manufactured or supplied by the
insured.
Directors & Officers Company directors Legal liability for wrongful acts (errors,
(D&O) Liability and senior officers. misstatements, breaches of duty)
committed in the performance of their
management duties.
Employers’ Liability / Employers. Compensation payable to employees
Workmen’s who suffer injury, disease, or death in
Compensation the course of employment.
ℹ Public Liability Insurance Act, 1991: This Act makes public liability insurance
COMPULSORY for any person or enterprise handling hazardous goods. Failure to
maintain this cover is a statutory offence.
PART E: Applied Case Studies
The following case studies test the ability to apply insurance knowledge to practical business
situations — exactly the type of application questions that appear in examinations and professional
practice.
MN Limited has been contracted by a bank to collect large sums of money and distribute them in
small amounts to farmers in remote rural areas, using employees and commission agents. The
following insurance programme is recommended:
⚖ CASE STUDY: Refrigeration & Cooling Systems Pvt. Ltd. — SME Insurance
Programme
Mr. Bhatia’s SME operates from two industrial galas, employs 15 persons, owns computers and a
pickup truck, dispatches goods to five cities, and holds significant cash on salary day. A
comprehensive insurance programme would include:
Soma has stock worth ₹200 crores distributed across 2 factories and associated warehouses, with
values fluctuating significantly by location. The challenge: cover all stock comprehensively while
managing fluctuation.
Recommended Structure:
• Floater Policy: A single policy with one combined sum assured of ₹200 crores covering all
stocks at all four locations (2 factories and 2 warehouses). The sum assured ‘floats’ across
locations. If one location suffers a total loss, the full sum assured is available.
• Declaration Policy: Since stock values at individual locations fluctuate significantly, a
Declaration Policy allows Soma to declare actual stock values periodically (monthly) and pay
premium based on the average of those declarations. This prevents over-paying premium on
locations that are temporarily low in stock.
• Combined approach: A Floater cum Declaration Policy — the sum assured floats across all
locations AND the premium adjusts based on periodic declarations. This is the most efficient
and cost-effective structure for Soma’s situation.
• Open Policy (Marine) for Transit: Soma’s components are being transported to four client
factories. An Open Marine Policy covers all transits throughout the year under a single policy
with periodic premium declarations as each consignment is despatched.
Quick Revision Summary
ℹ Remember: Cargo = goods by sea or air. Freight = goods by rail or truck (or the
charges for carriage). Marine insurance covers both, but the subject matter must be
precisely described in the policy.