Insurance Surveyors and Loss Assessors

Contents:

1. About this handbook

2. Insurance Surveyors

3. Frequently Asked Questions

4. Policyholder Servicing TATs

5. If you have a grievance

1. About this book

This handbook is designed by the InsuranceRegulatory and Development Authority ofIndia (IRDAI) as a guide on Insurance Surveyorsand gives generic information only. NoInformation given herein replaces or overridesthe relevant provisions of the Insurance Act,1938 and Regulations/guidelines/circularsissued by IRDAI in this regard.

Please approach a duly licensed surveyor orInsurance Company registered with IRDAI forspecific information regarding a claim on policyor for any other additional information.

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2. Insurance Surveyors and Loss Assessors

Regulation 12 of the IRDAI (Insurance Surveyors andLoss Accessors) Regulations, 2015 mandatesappointment of Surveyors and Loss Assessors either byInsurance or Insurer to assess loss under a policy ofInsurance in respect of (a) Motor Insurance - aboveRs. 50,000/- (b) other than Motor Insurance aboveRs. 1,00,000/-. Further the required qualification tobecome surveyor has also laid down in Annexure-I ofschedule I of the above said Regulation. A surveyor &Loss Assessor shall assess losses of only thosedeparments which are specified in his/her license.

IRDAI (Insurance Surveyors and Loss Accessors)Regulations, 2015

The enactment of IRDA Act, 1999, authorized IRDAIto licence eligible persons to act as Surveyor and LossAssessors (SLA). IRDAI framed the (InsuranceSurveyors & Loss Assessors) Regulations, 2015 underpowers vested under Section 42D, 42E, 64 UM and 114Aof the Insurance Act, 1938 and section 14 and 26 ofIRDA Act, 1999. The said regulations, specifies theeligibility criteria, training and examination

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requirements for grant of licence to applicants to act asSurveyor and Loss Assessors. The said regulations alsospecify the Duties and Responsibilities & Code ofConduct for surveyors licensed by IRDAI. The Code ofConduct specifies the professional and ethicalrequirements for conduct of their professional work. Itelaborates on the code which, inter alia, stipulates that asurveyor and loss assessor shall behave ethically andwith integrity in professional pursuits, shall strive forobjectivity in professional and business judgment, actimpartially when acting on instructions from an insurerin relation to a policyholder’s claim under a policyissued by that insurer, conduct himself with courtesyand consideration to all people with whom he comesinto contact during the course of his work.

Licenses are issued to both individuals andfirms/companies to act as Surveyor and Loss Assessors.There are eight areas in which surveyors could belicensed to work, depending on their qualifications.These are Fire, Motor, Miscellaneous, Engineering,Marine cargo, Marine Hull, Loss of Profit and CropInsurance.

IRDAI is empowered to cancel the licence of Surveyors& Loss Accessors where it is found that he/she suffersfrom any of the disqualifications mentioned in section

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42D of the Insurance Act, 1938 or has knowinglycontravened any provisions of the Insurance Act1938 or the IRDA Act, 1999 or the Rules andRegulations made under there Acts. The regulationsare available on our website: www.irda.gov.in.

Further the IRDA (Protection of Policyholders’Interests) Regulations, 2002 also stipulates the timelimit for appointment of surveyors, which is 72hours from date of intimation of claim to insurers/occurrence of the event resulting in loss or damageand submission of survey report by surveyors,which is one month from the date of appointmentby insurer.

The said regulation casts responsibility on thepolicyholder to co-operate with the surveyor andprovide him with all the information/ documentsto enable him to assess the loss.

Delay, if any, in the submission of the report by thesurveyor should be communicated to the insurerand insured.

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3. FAQ’S

1. Is it mandatory for an insurer to appointsurveyor for each and every loss reportedunder a policy of general insurance?

2. What is the need to engage an InsuranceSurveyor?

3. What will happen if I am not in a position tofurnish the details required by the surveyor?

No. It is not mandatory for an insurer to appointa surveyor for each and every loss reported by apolicy of general insurance. "Only where theestimated loss exceeds Rs. 50,000/- in case ofMotor Insurance and loss exceeds Rs.1,00,000/-in case of other than Motor Insurance business, itis mandated to appoint a licensed surveyor toassess and settle the loss".

The need for the engagement of a surveyor is forassessing the loss/damage suffered without anybias or prejudice and by a professional/expert inthe field.

If you are unable to furnish all particularsrequired by surveyor for assessment of thedamage/loss, there will be delay in assessment ofthe claim.

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4. Can the surveyor delay submission of hisreport beyond 30 days?

5. Can the insurer ask additional report fromSurveyor?

6. If the surveyors are appointed by the insurancecompany, do they favour insurancecompanies?

In exceptional circumstances, there could be adelay in submission of survey report by asurveyor, beyond 30 days from the date of hisappointment, in which case he has to necessarilyseek extension of time from insurer underintimation to the insured.. However, in no case,the time limit for submission of report can exceeda period of 6 months from the date of hisappointment.

Yes. Wherever the insurer finds the surveyor’sreport incomplete in any respect, he can ask thesurveyor to furnish additional report within 15days of receipt of the original report. In such acase, the surveyor shall furnish the additionalreport within 3 weeks of the receipt of suchcommunication.

This is a false notion that surveyors are therepresentatives of insurance companies and so

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they favour insurers. A surveyor and loss assessors h a l l a c t i m p a r t i a l l y a n d m a i n t a i nconfidentiality, neutrality without jeopardizingthe liability of the insurer and the claim of theinsured.

Section 64 UM of the Insurance Act, 1938stipulates requirements to act as Surveyor andLoss Assessor.

IRDAI (Insurance surveyors and Loss Accessors)regulations 2015 prescribe the procedure forobtaining the license of Insurance Surveyor &Loass Accessors.

The following are the documents to be submittedfor grant of licence to an individual to act asSurveyor and Loss Assessor:

• Application form – IRDAI - Form-I AF

Copy of Membership certificate issued by IIISLA

7. Who can become a surveyor and loss assessor?What is the procedure for obtaining asurveyor licence?

8. What are the documents to be submitted by anapplicant for grant of surveyor licence?

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• Copies of educational qualification certificatesduly notarized

No objection certificate from employer ifemployed.

• Copy of mark sheet

• Copies of four quarterly reports

• Training completion certificate (in original)

• Details of fees paid.

• Affidavit on Rs.10 stamp paper

Yes. An applicant needs to submit his application forgrant of surveyor licence through an onlineportal i.e. www.irdabap.org.in (link availablefrom www.irda.gov.in) and upload all requireddocuments in the portal in soft form. The saidportal provides an end to end solution andenables the applicant to know the status ofapplication from submission till its approval andgrant of licence by IRDAI. FAQ's, Demo etc.are provided in the portal

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9. How to make an application for becoming aSurveyor?

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10. How do I know whether the surveyorappointed is an authorized person to take upthe assignment of loss assessment or not?

11. Is the loss amount assessed by surveyorbinding on insurer/s?

12. What is the time limit for the insurer to take adecision on the claim, after submission ofsurveyor report or additional survey report bythe surveyor and loss assessor?

The list of licensed and categorized surveyors andloss assessors is placed in the IRDA website i.e.www.irda.gov.in from time to time from whichone can know whether the surveyor appointed isa licensed Surveyor or not.

No. The insurers are not bound by the loss amountassessed by the surveyor. The insurer has theright to pay or settle any claim at any amountdifferent from the amount assessed by theappointed surveyor.

An insurer has to take a decision on the claimwithin 30 days of receipt of surveyor report oradditional survey report by the surveyor. Theinsurer must either offer a settlement of claim orgive reasons for rejection of a claim in writing.

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13. Can a policyholder claim interest in case of anydelay in settlement of claim?

Once an offer of claim settlement given byinsurer is accepted by a policyholder in writing,claim settlement amounts should be disbursedwithin 7 days from the date of acceptance bypolicyholder. In case of any delay indisbursement of the claim amount, the insurer isliable to pay interest @ 2% rate above the bankrate prevalent on 1st April of that financial year.

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4. Policyholder Servicing Turnaround Times asprescribed by IRDA

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5. If you have a grievance:

The Consumer Affairs Department of the InsuranceRegulatory and Development Authority of India(IRDAI) has introduced the Integrated GrievanceManagement System (IGMS) which is an online systemfor registration and tracking of grievances. You mustregister your grievance first with the insurance companyand in case you are not satisfied with its disposal by thecompany, you may escalate it to IRDAI through IGMSby accessing www.igms.irda.gov.in. In case you are notable to access the insurer’s grievance system directly,IGMS also provides you a gateway to register yourgrievance with the insurer.

Apart from registering your grievance through IGMS(i.e., web), you have several channels for grievanceregistration—through e-mail (complaints@irda.gov.in),through letter (address your letter to Consumer AffairsDepartment, Insurance Regulatory and DevelopmentAuthority of India, 3rd Floor, Parishram Bhavan,Basheerbagh, Hyderabad:4) or simply call IRDAI CallCentre at Toll Free 155255 through which IRDAI shall,free of cost, register your complaints against insurancecompanies as well as help track its status. The CallCentre assists by filling up the complaints form on thebasis of the call. Wherever required, it will facilitate in

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filing of complaints directly with the insurancecompanies as the first port of call by giving informationrelating to the address, telephone number, websitedetails, contact number, e-mail id etc. of the insurancecompany. IRDAI Call Centre offers a true alternativechannel for prospects and policyholders, withcomprehensive tele-functionalities, serving as a 12 hoursx 6 days service platform from 8 AM to 8 PM, Mondayto Saturday in Hindi, English and various Indianlanguages.

When a complaint is registered with IRDAI, it facilitatesresolution by taking it up with the insurance company.The company is given 15 days time to resolve thecomplaint. If required, IRDAI carries out investigationsand enquiries. Further, wherever applicable, IRDAIadvises the complainant to approach the InsuranceOmbudsman in terms of the Redressal of PublicGrievances Rules, 1998.

11,000 Nos./May 2016