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September 29, 2015

Motor Car Insurance

Car Accident Insurance Claim Procedure
1.    Click as many pictures as you can from all angles even for undamaged area (as some damages may occur during repair at workshop).
2.    If there is third party injury it is advisable to file an FIR. In case of major accident do not try to remove the vehicle as there will be spot survey.
3.    After you deposit your car to workshop (Please make sure to sign only the claim intimation form and not satisfaction/discharge form) , the workshop/dealer will send a repair estimate to you and insurance company. Insist on computerised repair estimated from the dealer to rule out any manual intervention.
4.    According to the Insurance Act Section 64(2) it is mandatory that only an independent surveyor can do the assessment for all claims above Rs.50, 000/20,000. This way a fair assessment of the extent of the damage is ensured paving way for an amicable settlement between the insurer and the insured rather than depending on employees of Insurance Company for Survey report.  The law also states that the adjuster/surveyor should submit the damage assessment report within 30 days of the surveying the damage.
5.    You can get details of Surveyor by googling the name or you can check with website of IRDA and Indian Institute Of Insurance Surveyors & Loss Assessors (IISLA).
6.    It is the insurance company that makes the first move to offer you a settlement on your claim which could be all, or part, or in worst cases even nothing none, will typically be on the low side. After all, it is the job of the adjuster/surveyor to save the employer's money.
7.    Check the reasons for components denied against your insurance policy wording.
8.    It is always better to keep a written account of the conversations/discussions on the claims dealings with your insurance agent and with adjuster/surveyor and any other people involved in the claims process.
9.    If you prefer negotiations on your own without a lawyer (Motor accident specialist), you could write to the insurance company explaining the situation and strengthening your claim amount with more additional documentation and/or information not previously provided.
10.  You could also talk to the adjuster/surveyor directly or if required seek an appointment with his superior. Else, you have the option to request for an alternative dispute resolution like mediation or arbitration.
11.  In case of any complaints you will have first approach the Grievance Redressal Cell of Insurance Company.
12.  To bring the communication from insurer via IRDA you will have to launch the online compliant at
13.  If you are still not satisfied with the response then you can file the compliant to Ombudsman.

Insurance Surveyors and Loss Assessors (Licencing, Professional Requirements and Code of Conduct) Regulations, 2000

Regulations 13: Duty of Surveyor
13 (viii) commenting on the admissibility of the loss as also observance of warranty conditions under the policy contract;
13(xii) satisfying queries of the insured/insurer and of persons connected thereto in respect of the claim/loss;

13 (xiv) Giving reasons for repudiation of claim, in case the claim is not covered by policy terms and conditions;
Regulations 15: Code of Conduct
15 (3) act impartially, when acting on instructions from an insurer in relation to a policy holder’s claim under a policy issued by that insurer;

Insurance Regulatory and Development Authority (Protection of Policyholders’ Interests) Regulations, 2002. (PPI)
Sec 9 (2) Where the insured is unable to furnish all the particulars required by the surveyor or where the surveyor does not receive the full cooperation of the insured, the insurer or the surveyor as the case may be, shall inform in writing the insured about the delay that may result in the assessment of the claim. The surveyor shall be subjected to the code of conduct laid down by the Authority while assessing the loss, and shall communicate his findings to the insurer within 30 days of his appointment with a copy of the report being furnished to the insured, if he so desires. Where, in special circumstances of the case, either due to its special and complicated nature, the surveyor shall under intimation to the insured, seek an extension from the insurer for submission of his report. In no case shall a surveyor take more than six months from the date of his appointment to furnish his report.
Sec 9 (5) On receipt of the survey report or the additional survey report, as the case may be, an insurer shall within a period of 30 days offer a settlement of the claim to the insured. If the insurer, for any reasons to be recorded in writing and communicated to the insured, decides to reject a claim under the policy, it shall do so within a period of 30 days from the receipt of the survey report or the additional survey report, as the case may be.

Grounds on which complaint can be made to IRDA at
1. Insurer refusing to register the claim
2. Insurer asking for irrelevant claim documents
3. Insurer asking for claim documents on piecemeal basis.
4. Delay in appointment of surveyor
5. Insurer not issued claim form.
6. Delay in conducting of survey
7. Surveyor delayed issue of his report
8. Survey report copy not issued to the insured by the surveyor
9. Difference between the assessed loss and amount settled by insurer
10.            Insurer reduced quantum of claim for Reasons not indicated in policy.
11.            Insurer failed to make offer of settlement to insured after receipt of survey report.
12.            Insurer not disposed of the claim
13.            Insurer not issued claim cheque inspite of offer of settlement.
14.            Cheque issued by insurer is bounced
15.            Name of insured wrongly written in the claim cheque
16.            Insurer paid claim to wrong person
17.            Insurer closed the claim without informing the reasons
18.            Dispute on rate of depreciation applied
19.            Dispute on labour charges applied
20.            Dispute on deduction of Salvage value
21.            Dispute on total loss/Cash loss vis a vis repair basis
22.            Dispute on obsolete factor
23.            Claim denied due to alleged non-cooperation of insured
24.            Insurer repudiated claim due to due to delay in intimation of claim by insured.
25.            Insurer repudiated claim due to due to delay in submission of documents by insured.
26.            Insurer repudiated claim due to due to 2nd surveyor recommendation.
27.            Insurer repudiated claim due to alleged breach of policy condition
28.            Insurer repudiated claim due to dispute on premium paid.
29.            Insurer repudiated claim due to alleged fraud.
30.            Insurer repudiated claim without giving any reasons.
31.            Insurer repudiated claim due to alleged carelessness of insured
32.            Delay by TPA to provide cashless facility
33.            TPA refuses to offer cashless facility

a) Please note that once you register a compliant for one policy by selecting any of the aforesaid options, then you can't register the complaint again on that policy number under any different head till the time insurer does not attend the first complaint.

b) Although the complaint window lets you type endlessoly but it records only first 1000 characters so prioritize and  type most imp things first.

c) My personal experience says that does not work well with Internet Explorer 11 and Chrome, i would suggest to use Firefox 47 and above for smooth submission of communication at the website.
Also they won't be sending you any e-mail/SMS when the insurance company has replied. So you have to login and check after few days to see if the complaint has been resolved.  

Some relevant judgement in this regard are:-
Insurance Company cannot appoint one surveyor after another without assigning specific reason for not accepting the report of the previous surveyors

If the surveyor's assessment is not in line with the terms of the contract, or all material facts are not considered, it is likely to be set aside. Thus even after signing the discharge form you can sue the insurance company.

If there is any ambiguity in the terms of the policy, interpretation will be against the insurer since it drafts the policy wording. "Thus, it is important for an insurer to ensure that the policy terms and conditions are communicated to the insured and any special conditions/warranties are clear and free of ambiguity
A customer can also appoint a surveyor at his own expense and the second surveyor's report too is acceptable in the court of law

 Address for Insurance Ombudsman are 

Contact details
Jurisdiction of Office
Union Territory,District)
AHMEDABAD - Shri. / Smt.
Office of the Insurance Ombudsman,
2nd floor, Ambica House,
Near C.U. Shah College,
5, Navyug Colony, Ashram Road,
Ahmedabad – 380 014.
Tel.: 079 - 27546150 / 27546139
Fax: 079 - 27546142
Dadra & Nagar Haveli,
Daman and Diu.
BENGALURU - Shri. M. Parshad
Office of the Insurance Ombudsman,
Jeevan Soudha Building,PID No. 57-27-N-19
Ground Floor, 19/19, 24th Main Road,
JP Nagar, Ist Phase,
Bengaluru – 560 078.
Tel.: 080 - 26652048 / 26652049
BHOPAL - Shri/Smt........
Office of the Insurance Ombudsman,
Janak Vihar Complex, 2nd Floor,
6, Malviya Nagar, Opp. Airtel Office,
Near New Market,
Bhopal – 462 003.
Tel.: 0755 - 2769201 / 2769202
Fax: 0755 - 2769203
Madhya Pradesh
BHUBANESHWAR - Shri. B. N. Mishra
Office of the Insurance Ombudsman,
62, Forest park,
Bhubneshwar – 751 009.
Tel.: 0674 - 2596461 /2596455
Fax: 0674 - 2596429
Office of the Insurance Ombudsman,
S.C.O. No. 101, 102 & 103, 2nd Floor,
Batra Building, Sector 17 – D,
Chandigarh – 160 017.
Tel.: 0172 - 2706196 / 2706468
Fax: 0172 - 2708274
Himachal Pradesh,
Jammu & Kashmir,
CHENNAI - Shri/Smt........
Office of the Insurance Ombudsman,
Fatima Akhtar Court, 4th Floor, 453,
Anna Salai, Teynampet,
CHENNAI – 600 018.
Tel.: 044 - 24333668 / 24335284
Fax: 044 - 24333664
Tamil Nadu,
Pondicherry Town and
Karaikal (which are part of Pondicherry).
DELHI - Smt. Sandhya Baliga
Office of the Insurance Ombudsman,
2/2 A, Universal Insurance Building,
Asaf Ali Road,
New Delhi – 110 002.
Tel.: 011 - 23239633 / 23237532
Fax: 011 - 23230858
GUWAHATI - Sh. / Smt.
Office of the Insurance Ombudsman,
Jeevan Nivesh, 5th Floor,
Nr. Panbazar over bridge, S.S. Road,
Guwahati – 781001(ASSAM).
Tel.: 0361 - 2132204 / 2132205
Fax: 0361 - 2732937
Arunachal Pradesh,
Nagaland and Tripura.
HYDERABAD - Shri/Smt........
Office of the Insurance Ombudsman,
6-2-46, 1st floor, "Moin Court",
Lane Opp. Saleem Function Palace,
A. C. Guards, Lakdi-Ka-Pool,
Hyderabad - 500 004.
Tel.: 040 - 65504123 / 23312122
Fax: 040 - 23376599
Andhra Pradesh,
Yanam and
part of Territory of Pondicherry.
JAIPUR - Shri. Ashok K. Jain
Office of the Insurance Ombudsman,
Jeevan Nidhi – II Bldg., Gr. Floor,
Bhawani Singh Marg,
Jaipur - 302 005.
Tel.: 0141 - 2740363
ERNAKULAM - Shri. P. K. Vijayakumar
Office of the Insurance Ombudsman,
2nd Floor, Pulinat Bldg.,
Opp. Cochin Shipyard, M. G. Road,
Ernakulam - 682 015.
Tel.: 0484 - 2358759 / 2359338
Fax: 0484 - 2359336
Mahe-a part of Pondicherry.
KOLKATA - Shri. K. B. Saha
Office of the Insurance Ombudsman,
Hindustan Bldg. Annexe, 4th Floor,
4, C.R. Avenue,
KOLKATA - 700 072.
Tel.: 033 - 22124339 / 22124340
Fax : 033 - 22124341
West Bengal,
Andaman & Nicobar Islands.
LUCKNOW - Shri. N. P. Bhagat
Office of the Insurance Ombudsman,
6th Floor, Jeevan Bhawan, Phase-II,
Nawal Kishore Road, Hazratganj,
Lucknow - 226 001.
Tel.: 0522 - 2231330 / 2231331
Fax: 0522 - 2231310
Districts of Uttar Pradesh :
Laitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar.
MUMBAI - Shri/Smt........
Office of the Insurance Ombudsman,
3rd Floor, Jeevan Seva Annexe,
S. V. Road, Santacruz (W),
Mumbai - 400 054.
Tel.: 022 - 26106552 / 26106960
Fax: 022 - 26106052
Mumbai Metropolitan Region
excluding Navi Mumbai & Thane.
NOIDA - Shri. Ajesh Kumar
Office of the Insurance Ombudsman,
Bhagwan Sahai Palace
4th Floor, Main Road,
Naya Bans, Sector 15,
Distt: Gautam Buddh Nagar,
Tel.: 0120-2514250 / 2514252 / 2514253
State of Uttaranchal and the following Districts of Uttar Pradesh:
Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kanooj, Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozbad, Gautambodhanagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur.
PATNA - Shri. Sadasiv Mishra
Office of the Insurance Ombudsman,
1st Floor,Kalpana Arcade Building,,
Bazar Samiti Road,
Patna 800 006.
Tel.: 0612-2680952
PUNE - Shri. A. K. Sahoo
Office of the Insurance Ombudsman,
Jeevan Darshan Bldg., 3rd Floor,
C.T.S. No.s. 195 to 198,
N.C. Kelkar Road, Narayan Peth,
Pune – 411 030.
Tel.: 020-41312555
Area of Navi Mumbai and Thane
excluding Mumbai Metropolitan Region.

Format for lodging complaint   with Insurance Ombudsman is available here

You have to send signed scanned copy for registration of complaint.

What I liked About Dealership
1.       Courteous and Polite staff.
What I disliked: About Dealership
1.       Replacement of Door not requested/considered by Dealer while framing the estimate whereas I have insisted replacement not repair.
2.       My own car was used to drop me off from Dealership.
3.       Surveyor decision of rejection of claim was neither contested nor communicated to me. However, the updation and follow up improved after I made reference to
4.        Tried to get my signature on satisfaction form at the time of lodging the car.

What I disliked: About Honda Assure
1.       Horrible waiting time at Honda Assure Helpline no 180026662666. Expected much better and priority service for paying opting Honda Assure. Royal Sundram Helpline attended my call more promptly as Normal customer.
2.       No website/email address to contact Honda Assure. Honda is spoiling its goodwill by attaching its name to this SMC Brokerage Pvt Ltd. This company cannot match even the fraction of service quality of Honda.
3.       Ford assure has got No repair policy and even minor damage to car is acceded with REPLACEMENT. No doubt the products of Honda are much superior than Ford however, Honda Assure has failed to negotiate replacement policy with insurance companies like Ford. 

What i disliked about Royal Sundram : Everything from start to end. Horrible and unprofessional 

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