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 http://igms.irda.gov.in.
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 http://igms.irda.gov.in
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 http://igms.irda.gov.in 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 Email: bimalokpal.ahmedabad@gbic.co.in |
Gujarat,
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 Email: bimalokpal.bengaluru@gbic.co.in |
Karnataka.
|
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 Email: bimalokpal.bhopal@gbic.co.in |
Madhya Pradesh
Chattisgarh. |
BHUBANESHWAR
- Shri. B. N. Mishra
Office of the Insurance Ombudsman, 62, Forest park, Bhubneshwar – 751 009. Tel.: 0674 - 2596461 /2596455 Fax: 0674 - 2596429 Email: bimalokpal.bhubaneswar@gbic.co.in |
Orissa.
|
CHANDIGARH
-
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 Email: bimalokpal.chandigarh@gbic.co.in |
Punjab,
Haryana, Himachal Pradesh, Jammu & Kashmir, Chandigarh. |
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 Email: bimalokpal.chennai@gbic.co.in |
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 Email: bimalokpal.delhi@gbic.co.in |
Delhi.
|
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 Email: bimalokpal.guwahati@gbic.co.in |
Assam,
Meghalaya, Manipur, Mizoram, 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 Email: bimalokpal.hyderabad@gbic.co.in |
Andhra Pradesh,
Telangana, 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 Email: Bimalokpal.jaipur@gbic.co.in |
Rajasthan.
|
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 Email: bimalokpal.ernakulam@gbic.co.in |
Kerala,
Lakshadweep, 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 Email: bimalokpal.kolkata@gbic.co.in |
West Bengal,
Sikkim, 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 Email: bimalokpal.lucknow@gbic.co.in |
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 Email: bimalokpal.mumbai@gbic.co.in |
Goa,
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, U.P-201301. Tel.: 0120-2514250 / 2514252 / 2514253 Email: bimalokpal.noida@gbic.co.in |
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, Bahadurpur, Patna 800 006. Tel.: 0612-2680952 Email: bimalokpal.patna@gbic.co.in |
Bihar,
Jharkhand. |
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 Email: bimalokpal.pune@gbic.co.in |
Maharashtra,
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 Hondacarindia.com.
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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