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Insurance Principles and Duties Explained

The document provides a comprehensive overview of insurance principles, obligations of both insured and insurer, and various types of fire insurance policies. Key principles include utmost good faith, insurable interest, indemnity, and loss minimization, while the obligations cover duties to cooperate, disclose information, and handle claims fairly. It also details specific fire insurance policies such as agreed valued, specific, average, floating, comprehensive, and consequential loss policies.

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0% found this document useful (0 votes)
14 views34 pages

Insurance Principles and Duties Explained

The document provides a comprehensive overview of insurance principles, obligations of both insured and insurer, and various types of fire insurance policies. Key principles include utmost good faith, insurable interest, indemnity, and loss minimization, while the obligations cover duties to cooperate, disclose information, and handle claims fairly. It also details specific fire insurance policies such as agreed valued, specific, average, floating, comprehensive, and consequential loss policies.

Uploaded by

Rajwinder SIngh
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

VALUATION

OF
LAND AND BUILDING
FOR IBBI EXAMINATION

By:
CEV INTEGRAL APPRAISERS FOUNDATION
REGISTERED VALUERS ORGANISATION

Page 1 of 497
Chapter INSURANCE 248
12
12.1 What is Insurance 248
12.2 Principle of Insurance 248
12.3 Requirement of an Insurance Contract 250
12.4 Duties of the Insured 251
12.5 Duties of the Insurer 256
12.6 Obligations of the Insurer 261
12.7 Obligations of the Insured 262
12.8 Kinds of Policies are generally for Fire Insurance 263
12.9 Fire Insurance 265
12.10 Standard Fire and Special Perils Policy 267
12.11 Sum Insured 272
12.12 Condition of Average 274
12.13 Over Insurance 275
12.14 Under Insurance 276
12.15 Main differences between under and over insurance 276
12.16 Fire Claim Procedure 277
12.17 Common documents required for filing claims under a 278
Standard Fire and Special Peril Policy are

Page 2 of 497
INSURANCE

CHAPTER 12 :INSURANCE
WHAT IS INSURANCE

Insurance is a contract, represented by a policy, in which an individual or entity receives


financial protection or reimbursement against losses from an insurance company.

It is an agreement between Insured and Insurer to compensate the losses suffered due to
uncertainties in future, for a consideration called premium.

PRINCIPLES OF INSURANCE

 Utmost Good Faith

 Insurable Interest

 Indemnity

 Subrogation and Contribution

 Proximate Cause
 Principle Of Loss Of Minimization

12.1.1 Utmost Good Faith

Utmost good faith is a common law principle. The principle means that every person who
enters into a contract of insurance has a legal obligation to act with utmost good faith
towards the company offering the insurance. A person must, therefore, always be honest
and accurate in the information they give to the insurance company. The insurance
company also has a responsibility to act with good faith in all its dealings with the insured.

Insurable Interest

It exists when an insured person derives a financial or other kind of benefit from the
continuous existence, without impairment or damage, of the insured object (or in the case
of a person, their continued survival). A person has an insurable interest in something

Page 3 of 497
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when loss of or damage to that thing would cause the person to suffer a financial or other
kind of loss.

Typically, insurable interest is established by ownership, possession, or direct relationship.


For example, people have insurable interests in their own homes and vehicles, but not in
their neighbors' homes and vehicles, and almost certainly not those of strangers.

Indemnity

Indemnity means a guarantee or assurance to put the insured in the same position in which
he was immediately prior to the happening of the uncertain event. The insurer undertakes
to make payment of actual loss incurred by the insured.

The insurer agrees to pay no more than the actual amount of the loss.

Subrogation

Subrogation is a term describing a legal right held by most insurance carriers to legally
pursue a third party that caused an insurance loss to the insured. This is done in order to
recover the amount of the claim paid by the insurance carrier to the insured for the loss.

Contribution

The principle holding that two or more insurers each liable for a covered loss should
participate in the payment of that loss. Having paid its share of a loss, an insurer may be
entitled to equitable contribution—a legal right to recover part of the payment from
another insurer whose policy was also applicable.

Page 4 of 497
INSURANCE

Proximate Cause

Principle of Proximate (i.e. Nearest) Cause, means when a loss is caused by more than one
causes, the proximate or the nearest or the closest cause should be taken into consideration
to decide the liability of the insurer.

Principle of Loss Minimization

Under this principle it is the duty of the insured to take all possible steps to minimize the
loss to the insured property on the happening of uncertain event.

According to the Principle of Loss Minimization, insured must always try his level best to
minimize the loss of his insured property, in case of uncertain events like a fire outbreak or
blast, etc.

Requirements of an Insurance Contract

To be legally enforceable, an insurance contract must meet four requirements:

 Offer and acceptance of the terms of the contract

 Consideration – the values that each party exchange

 Legally competent parties, with legal capacity to enter into a binding


contract

 The contract must exist for a legal purpose

Duties Of The Insured

1. Obligation To Pay Premiums

2. Requirement Of Notice Of Loss

3. Notice Of Loss And Proof Of Loss


Page 5 of 497
INSURANCE

4. Requirement Of Cooperation By The Insured

5. Misstatements By The Insured

6. Collusion Between The Insured And Claimant

7. Keep Your Information Current

Obligation to Pay Premiums

The obligation to pay premiums, however, may itself be subject to certain terms and
conditions. In particular, insurance may be procured on credit or procured with a promise
to pay the premium. In such circumstances, coverage may exist even though actual
payment has not been received.

Requirement of Notice of Loss

It also provides the insurer with an opportunity to investigate the claim and determine its
rights and liabilities in the action. Policyholder must therefore give timely notice of a loss
or claim by providing sufficient information to appraise the insurer of the nature of the
loss or claim.

Page 6 of 497
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Notice of Loss and Proof of Loss

Written proof of loss of time on account of disability or of hospital confinement for which
claim is made must be furnished to the company within ninety days after the termination
of the period for which claim is made. Written proof of any other loss on which claim may
be based must be furnished to the company not later than ninety days after the date of such
loss.

Requirement of Cooperation by The Insured

Page 7 of 497
INSURANCE

Liability insurance policies generally contain clauses requiring the insured to cooperate
with the insurer in the conduct of the action by assisting settlement efforts, attending
hearings and trials, and securing and giving needed evidence. The purpose of these
cooperation clauses is to protect the insurer in its defense of the insured by obligating the
insured not to deliberately or intentionally take any action which would adversely affect
the insurer’s settlement or other handling of the claim.

Misstatements by The Insured (Application honesty)

Misstatements or misrepresentation can void a policy, especially if company can show it


would not have issued policy if it had known the facts.

Page 8 of 497
INSURANCE

Collusion between the insured and claimant

Every insurer has at some point faced a situation in which it knows or suspects that its
insured has collaborated with a third-party claimant in order to influence the availability of
insurance coverage for the claims against it. While such conduct may seem wholly
improper to the insurer, the reality is that the law tolerates a certain degree of
collaboration, particularly in cases where the insurer has refused to defend.

Page 9 of 497
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Keep your information current

If you move, change your beneficiaries, or you no longer own the property that you had
insured, make sure you let your insurance provider know.

Keep down exposure to risk

If insurance companies discover you’ve been behaving recklessly, in a way that could
increase your chances of a claim, they’ll consider discontinuing your insurance coverage.

Page 10 of 497
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Duties of the Insurer

1. Duty to defend the insured

2. Duty to gain the insured’s cooperation

3. The insurer’s duty of good faith and fair dealing

4. The duty to settle claims and the effect of failure to settle

5. Privacy Protection

6. Pay Benefits

7. Risk Assessment

8. Reserves for Policy

Duty to defend the Insured

Moreover, an insurer may owe a duty to defend its insured against a claim in which
ultimately no damages are awarded, and any doubt as to whether the facts support a duty
to defend is usually resolved in the insured's favor.

Page 11 of 497
INSURANCE

Duty to gain the Insured’s Cooperation

The issue of how much information can or should be shared among an insurer, its insured,
the relationship between an insurance company and policyholder must be a partnership.
Each party must be able to rely on one another and abide by the guidelines of their end of
the agreement, regardless of whether they legally have to or not.

The insurer’s duty of good faith and fair dealing

Page 12 of 497
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Generally, the insurer owes a duty to deal fairly and in good faith with its insured’s; this
duty emanates from the special relationship which exists between the parties, not
necessarily from the terms of the contract.

Duty to Settle Claims

Where the covered damages alone could exceed policy limits, an insurer would be well-
advised to settle the case, even if the settlement includes non-covered damages.

Protection

Page 13 of 497
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In order to protect your privacy, insurance companies have to abide by privacy. Therefore,
they have to keep and give out your information in accordance with strict rules for your
protection. In case you want someone else to have access to your information, that person
may be required to have a power of attorney or written proof of authorization on file,
according to whatever’s dictated by the privacy guidelines.

Pay Benefits

Once an insurable accident happens and the damages have been reviewed, if it’s found that
the claim qualifies based on the benefits, time periods and exclusions given in your policy,
your insurance provider has to pay you (beneficiaries too, if applicable) within the
financial limitations of your policy. Remember that your insurer isn’t liable for the
deductible of your policy and that they have the option of paying only the replacement
value or actual value, based on the type of coverage you have. Also if you have a life
insurance policy with cash values, your benefits may decrease if you have any outstanding
loans.

Page 14 of 497
INSURANCE

Risk Assessment

Underwriters are hired by insurance companies to figure out the amount of risk that each
potential insured person presents and to charge a premium in accordance to that. If they
don’t do this then they risk having more claims than premiums and not being able to hold
up there end of the bargain for policy holders.

Reserves for Policy

Insurance companies have to set aside a certain amount of their income for policy
reserves. Policy reserves mirror the potential amount of claims they’ll be required to pay.
Because the money is in reserves, it ensures they’ll be able to pay it out.

Page 15 of 497
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OBLIGATIONS OF THE INSURER

 Should not follow unfair claim settlement practices.

 Misrepresenting facts or policy provisions to claimants.

 Failing to respond to communications about claims within a reasonable time.

 Failing to follow reasonable standards for prompt investigation and claim


processing.

 Failing to allow or deny claims within a reasonable period of time.

 Failing to act in good faith to reach prompt, fair and equitable settlements where
liability is reasonably clear.

 Compelling policyholders to sue to recover insurance benefits by offering


substantially less to settle a claim than what is ultimately recovered.

 Trying to settle claims for less than what a reasonable person would believe he or
she was entitled to because of advertising material that accompanied the
application.

Page 16 of 497
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 Trying to settle claims based on applications that were changed without the
knowledge or consent of the insured.

 Failing to tell insureds or beneficiaries of coverage under which payment was


made.

 Letting insureds know that it is the insurer's practice of appealing arbitration


awards in favor of insureds as a way to compel the insured to accept a lower
settlement.

 Delaying the investigation or payment of claims by requiring an insured to submit


a preliminary claim report plus a formal proof of loss that contains substantially
the same information.

 Failing to promptly settle claims where liability is clear as a way to influence the
insured to settle a claim under another portion of the policy.

 Failing to reasonably explain the denial of a claim in a prompt manner.

 Telling an insured not to retain an attorney.

 Misleading an insured about the applicable statute of limitations.

OBLIGATIONS OF THE INSURED

Duty to disclose information

The Insured must inform the Insurer of any events relevant to the contingent risk
transferred to the Insurer. This includes disclosing information in the application for policy
coverage and disclosing incidences of damage to the insured person or property or harms
resulting from the insured’s conduct. A failure to disclose such information may lead to
the loss of insurance coverage.

Page 17 of 497
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Duty to Co-operate

An insured has a duty to co-operate with the insurer in the identification, investigation and
resolution of any event or circumstances giving rise to losses born by the insurer.

Kinds of policies are generally issued for fire insurance:

Agreed Valued Policy:

In this policy the value of the subject-matter is agreed upon at the time of taking up the
policy. The insurer agrees to pay a pre-determined amount if the subject-matter is
destroyed or damaged by fire.

The principle of indemnity is not applicable to this policy. The agreed value may be more
or less than the market value at the time of loss. These policies are generally issued for
those goods or property whose value cannot be determined after their loss or damage.
These goods may include works of art, jewellery, paintings, etc.

Specific Policy:

Under this policy the risk is insured for a specific sum. In case of loss of property, the
insurer will pay the loss if it is less than the specified amount.

For Example: An insurance policy is taken for Rs. 50,000 and the value of the property is
Rs. 80,000. If the property worth Rs. 40,000 is lost, the insured will get the whole amount
of loss. If the loss is up to Rs. 50,000, it will be paid in full. In case loss exceeds Rs.
50,000, say it is Rs. 60,000, the indemnity will only be up to the amount insured i.e. Rs.
50,000. Under this policy the insured is not punished for getting a policy for lesser sum.
The actual value of property is not taken into consideration.

Average Policy:

If the ‘average clause’ is applicable to a policy, it is called Average Policy. Average clause
is added to penalise the insured for taking up a policy for a lesser sum than the value of
Page 18 of 497
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the

Page 19 of 497
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property. The compensation payable is proportionately reduced if the value of the policy is
less than the value of the property.

Suppose a person takes up a fire insurance policy of Rs. 20,000 and the value of the
property is Rs. 30,000. If there is a loss of property is estimated at Rs. 15,000, the
underwriter will pay compensation of Rs. 10,000 (15,000 x 20,000/30,000) - not Rs. 15,000.

It discourages the insured to get under-valued policy.

Floating Policy:

A floating policy is taken up to cover the risk of goods lying at different places. The goods
should belong to the same person and one policy will cover the risk of all these goods.
This policy is useful to those businessmen who are engaged in import and export of goods
and the goods lie in warehouses at different places. The premium charged is generally the
average of the premium that would have been paid, if specific policies would have been
taken for all these goods. Average clause always applies to these policies.

Comprehensive Policy:

A policy may be taken up to cover up all types of risks, including fire. A policy may be
issued to cover risk like fire, explosion, lightening, burglary, riots, labour disturbances etc.
This is called a comprehensive policy or All Risk Policy.

Consequential Loss Policy:

Fire may disturb the work in factory. Production may go down while the fixed expenses
continue at the same rate. A policy may be taken up to cover up consequential loss or loss
of profit.

Page 20 of 497
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The loss of profit is calculated on the basis of loss of sales.

A separate policy may be taken up for standing charges

also.

Replacement Policy:

The underwriter provides compensation on the basis of market price of the property.

The amount of compensation is calculated after taking into account the amount of
depreciation.

When Re-instatement clause is there, there will be no deduction for Depreciation

Fidelity Insurance

Fidelity policy protects your business from financial losses in the event of a breach of trust
by an employee

FIRE INSURANCE

Fire insurance is that insurance contract which take place against fire and other risk which
are mentioned in the fire insurance contract.

CONDITION OF GETTING CLAIM

1. There must be actual loss.

Page 21 of 497
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2. Fire must be accidental and non-intentional

PERIOD OF INSURANCE
Fire insurance policy is for a period of one year, after which it is to be renewed
form time to time.

Premium may be paid in lump sum or installments.

12.9.1 Standard Fire and Special Perils Insurance Policy


The Standard Fire & Special Perils (SFSP) Insurance, designed to cover loss or
damage to Buildings, Plant & Machinery, Tools, Instruments and accessories,

Page 22 of 497
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Furniture, Fixtures and Fittings, Electrical Installations, Stocks in trade including


work in progress, etc. due to Fire and Act of God perils..

Standard Fire and Special Perils Policy

This is a package insurance which covers the following set of perils:

Perils Covered:

a) Fire

b) Lightning

c) Explosion / Implosion

d) Aircraft damage

e) Riot, Strike, Malicious damage (RSMD Perils)

f) Storm, Tempest, Flood, Inundation, Hurricane, Cyclone, Typhoon and Tornado. (STFI)

g) Impact by any Rail/ Road vehicle or animal belonging to third parties

h) Subsidence / Landslide including rockslide.

i) Bursting and / or overflowing of water tanks, apparatus.

j) Leakage form Automatic Sprinkler Installation.

k) Missile Testing Operation.

l) Pollution or contamination resulting from any of the above perils

m) Any insured peril resulting from pollution and contamination.

n) Bush Fire

What Fire Policy Covers


Page 23 of 497
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 Buildings

 Machinery and Accessories

 Stock and stock in process

 Contents including furniture

ADD ON COVERS

1. Architects, Surveyors and Consulting Engineers Fees

(in excess of 3% claim amount)

2. Removal of Debris (in excess of 1% claim amount)

3. (A) Deterioration of Stocks in Cold Storage premises due to accidental power failure
consequent to damage at the premises of Power Station due to an insured peril

(B) Deterioration of stocks in cold storage premises due to change in temperature


arising out of loss or damage to the cold storage machinery (ies) in the Insured’s premises
due to operation of insured peril

4. Forest Fire

5. Impact Damage due to Insured’s own Rail/Road Vehicles, Fork lifts, Cranes,
Stackers and the like and articles dropped therefrom

6. Spontaneous Combustion

7. Omission to Insure additions, alterations or extensions

8. Earthquake

9. Spoilage Material Damage Cover

10. Leakage and Contamination Cover

11. Temporary Removal of Stocks Clause, e.g. taken for fabrication etc.

Page 24 of 497
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12. Loss of Rent clause

13. Insurance of Additional Expenses of Rent foran Alternative Accommodation

14. Start-up Expenses

Significant Exclusions:

Losses/ Expenses not covered:

i. 5% of each and every claim subject to minimum of Rs. 10,000 resulting from Lightning,
STFI and Subsidence and Landslide including Rockslide (AOG Perils)

ii. Rs. 10,000 in respect of all other perils.

iii. Expenses incurred on Architects, Surveyors' Consultant Engineers fees and Debris
Removal in excess of 3% and 1% of claim amount respectively.

iv. Loss of earnings, loss by delay, loss of market or other consequential or indirect loss or
damage of any kind.

v. If the building insured or containing the insured property becomes unoccupied and so
remains for a period of more than 30 days.

vi. Loss or damage caused to insured property by its own fermentation, natural heating or
spontaneous combustion.

vii. Loss or damage caused to insured property by its undergoing any heating or drying
process.

Perils not covered:

i. War and allied perils

ii. Nuclear and allied perils

iii. Pollution or Contamination

iv. Earthquake, Volcanic eruption or other convulsions of nature.

Page 25 of 497
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v. ‘Aircraft’ damage arising out of pressure waves

vi. Loss by theft during or after the occurrence of any insured peril

vii. Riot, Strike or Malicious Damage losses arising out of:

a. total or partial cessation of work

b. Permanent or temporary dispossession resulting from order of the

Government.

c. Permanent or temporary dispossession resulting from the unlawful

Occupation by any person.

d. Theft, larceny or omission by any person, in a malicious act.

viii. Costal or river erosion

Ix. Forest Fire

x. Loss, or damage by spoilage resulting from the retardation of any process caused by
operation of any insured perils

[Link]. Properties not covered:

i. Items like bullion or unset precious stones, any curios or works of art for an amount
exceeding Rs.10000/‐, manuscripts, plans, drawings, securities, obligations or documents
of any kind, stamps, coins or paper money, cheques, books of accounts or other business
books, computer systems records, explosives manuscripts etc. unless specifically declared.

ii. * Cold storage stocks due to change of temperature.

iii. Loss / damage/ destruction of any electrical and/or electronic machine, apparatus,
fixture or fitting arising from over running, excessive pressure, short circuiting, arcing,
self heating or leakage of electricity, from whatever cause (including lightning).

Page 26 of 497
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iv. * Loss / damage / destruction of Boilers, Economizers or other Vessels, machinery or


apparatus in which steam is generated, by its own explosion/implosion.

v. * Caused by Centrifugal force (the outward force on a body moving in a curvedpath


around another body)

Note :

a) Some of the above exclusions (marked *) can be covered at an additional premium.

Terms and conditions apply.

Add on covers

In addition to the perils/ expenses covered, the proposer can opt to seek cover in respect of
the following perils/ expenses at inception or during currency of the policy on payment of
additional premium.

Perils:

a) Loss/ damage/ destruction of the property caused by

b) Deterioration of Stocks in Cold Storage premises due to power failure following


damage

due to an insured peril

c) Forest Fire

d) Impact Damage due to Insured's own Vehicles, Fork lifts and the like and articles
dropped there from

e) Spontaneous Combustion

f) Omission to insure additions, alterations or extensions

g) Earthquake (Fire and Shock).

h) Spoilage material damage cover.

Page 27 of 497
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i) Leakage and contamination cover.

j) Temporary removal of stocks.

k) Terrorism

Sum Insured:

a) Property can be insured on depreciated cost (market value) or replacement cost basis.

b) In order to get better protection, insurance on reinstatement (replacement) basis is


recommended. The sum insured selected should be adequate for reinstatement.

c) In case the value of a property may increase due to factors like increase in prime cost,
Exchange rate etc. during the currency of the policy, the corresponding sum insured may
be increased up to 25% maximum by opting for the ‘Escalation Extension’.

d) Similarly, any reduction in sum insured during currency may be effected for which
refund of premium will be allowed on short period basis.

e) Following guidelines, though not exhaustive, are provided for arriving at the sums to be
insured for various properties.

How to decide the sum insured under a fire insurance policy?

The most important aspect of a fire insurance policy is the sum insured. The sum insured,
should ideally represent the market value of the property/asset. If more than one property
is insured in the policy, values for each block should be provided and divided into:

 Stocks,

 Buildings

 Plant and Machinery, furniture, or other capital assets for personal use

Page 28 of 497
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 Valuables, antiques, and precious materials

Each of these properties will be insured based on the type of insurance available for it:

Buildings, capital goods (plant and machinery) and personal assets like furniture,
etc.:

Depreciated Value Based: Material and labour cost (landed cost for insured in case of
machinery) after inflation and depreciation for age, or

Reinstatement Value Based: Material and labour cost after inflation but without
depreciation

Under construction building: Material and labour cost only

Valuables, Antiques and Precious Materials: Such assets cannot always be valued at
market value. Therefore, a value is agreed upon between the insurer and the insured for the
insurance. This is called Agreed Value Basis insurance.

Therefore, below-mentioned guidelines are provided for the calculation of the value of
property:

Building: If the construction of the building is completed, the value is determined on the
depreciated value basis or the reinstatement value basis. If the building is under
construction, the total value of material and labour is estimated.

Furniture, Fixtures, and Fittings: For determination of the value of furniture, fixtures
and fittings, the value is either market value or the reinstatement value basis.

Any items other than mentioned above are to be insured on an agreed value basis.

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Condition of average

Condition of average, also called underinsuranceor principal of average, or pro rata


condition of averageis the insurance term used when calculating a payout against a claim
where the policy undervalues the sum insured. In the event ofpartial loss, the amount paid
against a claim will be in the same proportion as the value of the underinsurance.

The formula used is

Page 30 of 497
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where Payout is the amount paid out by the policy, Claim is the amount claimed against
the policy after a loss, Sum Insured is the maximum amount to be paid out by the policy,
and Current Value is the value the policy should be insured for. Underinsurance occurs
when Sum Insuredis less than Current Value.

Sum Insured is the maximum amount that can be paid out and is only paid out in cases
of total destruction. Where partial destruction occurs (a more common occurrence than
total destruction), Payout is pro rata in line with the underinsurance. This is due to
insurance companies basing the premiums on their risk of losing the full Sum
Insured against total destruction events.

If the declared sum insured is found to be less than the value of the property insured, then
the claim amount is proportionately reduced.

For example: If the value of the property is Rs.50 Lacs, but the Sum Insured is declared
as Rs.40 Lacs and a fire loss of Rs.10 Lacs has taken place, the claim amount payable will
be proportionately reduced:

10 x 40 / 50 = Rs.8.00 Lacs.

OVER INSURANCE:

Over insurance can be defined as the situation where an insured has bought so much
coverage that it exceeds the actual cash value (or the replacement cost) of the risk or
property insured.

UNDER INSURANCE :

Underinsurance refers to inadequate insurance coverage held by a policyholder. While


underinsurance may result in lower premiums paid by the policy holder, the loss arising
from a claim may far exceed any marginal savings in insurance premiums.

Page 31 of 497
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Main differences between under and over insurance

The major differences between under and over insurance can be summarized as follows:

 Through under insurance you are insured for less than market value whereas with
over insured you are insuring for an amount above market value.

 Your risk with under insurance manifests itself when you claim – and find that
less than the insurance claim will be paid as you would have to cover part of the
damage yourself.

 With over insurance you are at risk of paying too much in premiums from the
moment that the market value of insured property is less than the amount insured.

The sum insured and its adequacy

The sum insured under an insurance policy serves three purposes:

1) It is the amount on which premium is charged

2) It is the maximum liability of the insurer within the policy

3) It is basis for the calculation of under insurance in the event of claim Insurance can
provide full protection only when the sum insured is adequate both when the insurance is
first purchased as also at every subsequent renewals. Thus the adequacy of sum insured is
very critical to the insured if the policy is “subject to condition of average.” The following
implications should be noted.

a) If the sum insured is too low (under insurance) and if there is a big claim, the insured
would end up receiving a settlement which would be substantially less than the full
settlement of the claim thereby defeating the very purpose of taking insurance.

b) Over insurance would only mean over payment of premium. No benefits will accrue at
the time of claim. Hence this is over payment without corresponding benefit.

The adequacy of sum insured is thus very important and critical for the insured.

Page 32 of 497
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It is important for the insurer also in the sense that the insured feels cheated if he does not
get adequate indemnity because of under insurance and it may strain the insurer’s
relationship with clients. Clients expect necessary advice on this account from the insurer
who they believe are experts and must exhibit professionalism. However, there is tendency
on the part of the insured also to save on premium. But the insurers must do their part of
the duty on rendering advice on sum insured to avoid stress in relationship at the time of
claim.

Fire Claim Procedure

Immediate Steps to Follow:

 Inform losses or damages immediately to the insurance company so that a


competent surveyor can come to ascertain the losses

 Give the estimated figures of damages

 Give full corporation to surveyors by giving them all the necessary documents for
assessment of the loss

 Corporate with the insurer or their surveyor in all their activities of entering the
premises, taking possession of properties, sorting, removing, etc.; without
prejudice

 Give information about all other insurance policies existing on the properties at the
time of loss

Common documents required for filing claims under a Standard Fire and Special
Peril Policy are:

 Duly certified copy of the insurance policy along with the schedule and
endorsements

 Duly filled claim form

 Newspaper report on the incident, if there is any


Page 33 of 497
 Photographs

 Previous claim experience

In case of fire claim, here are some additional documents which are required:

 Report submitted by the internal committee, which was constituted


for investigating the cause of fire

 Fire Brigade report

 First Information Report (FIR)/Letter of intimation to the police station duly


endorsed/Police Panchnama

 Forensic reports on samples collected from the affected site

 Final Investigation Report (FIR)

 Metrological Report

In Explosion Claims (additional document)

Factory Inspector’s Report

Page 34 of 497

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