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Pre-post hospital expenses are either paid as a percentage of hospital claims or a
sub limit whichever is higher. In some policies they follow the typical indemnity
plans such as expenses falling within specified period of 30/ 60 days or 60/ 90
days.IRDAI has mandated that all health insurers and TPAs shall establish a... | Final IC 38 -IMF_Composite -English.md | null | F. | Final IC 38 -IMF_Composite -English_119 | {
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"CRITICAL ILLNESS POLICY",
"HOSPITAL DAILY CASH POLICY",
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have resulted in death. However surviving a major illness entails huge expense
for treatment as well as for living expenses post treatment. Onset of critical
illness threatens the financial security of a person. A basic health insurance policy
may not be sufficient to cover all medical costs in such cases.Critical illn... | Final IC 38 -IMF_Composite -English.md | d-19 | Disease Specific Products | Final IC 38 -IMF_Composite -English_120 | {
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June 2020:1. Hospitalization Expenses incurred for the treatment of Covid-19 on Positivediagnosis of Covid-19 in a government authorized diagnostic centre covering236the following: (Expenses on Hospitalization for a minimum period of 24 hours
are admissible.)a. Room, Boarding, Nursing Expenses as provided by the Hospit... | Final IC 38 -IMF_Composite -English.md | d-19 | Standard Vector Borne Disease Health Policy: | Final IC 38 -IMF_Composite -English_121 | {
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cover benefits with indemnity policies and even life insurance policies and
hospital daily cash benefits with indemnity policies.**Travel Insurance:**Travel insurance policy is also offered as a package policy covering not only health
insurance but also accidental death/ disability benefits along with Medical
expenses ... | Final IC 38 -IMF_Composite -English.md | null | Travel Insurance: | Final IC 38 -IMF_Composite -English_122 | {
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savings bank account on the prescribed forms will be required to be given by 31 [st]
May of every year,Joining subsequently on payment of full annual premium may be possible on
specified terms. Individuals who exit the scheme at any point may re-join the
scheme in future years through the above modality.Benefits under ... | Final IC 38 -IMF_Composite -English.md | r2 | Premium | Final IC 38 -IMF_Composite -English_123 | {
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at the time of claim. Thus, if a person has more than one policy with different
insurers, claims would be paid under all the policies.**4.** **Scope of cover**These policies are often extended to cover medical expenses, i.e. reimbursement
of hospitalization/ medical costs incurred following the accident.**5.** **Value ... | Final IC 38 -IMF_Composite -English.md | f241 | Scope of cover | Final IC 38 -IMF_Composite -English_124 | {
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where premium has to be paid in dollars. The plans are usually of two types: World-wide excluding USA/ Canada World-wide including USA/ Canada242Some products provide cover for a group of countries. Examples are travel to
Asian countries only, European countries only or travel to a particular country
only.**Corporate... | Final IC 38 -IMF_Composite -English.md | a242 | Corporate Frequent Flyer plans | Final IC 38 -IMF_Composite -English_125 | {
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of a family member. In such situations, if the buffer cover is opted for it brings
relief, whereby the excess expenses over and above the family sum insured are
met from this buffer amount.Amounts are drawn from the buffer, once a family’s sum insured is exhausted.
However this utilization is usually restricted to majo... | Final IC 38 -IMF_Composite -English.md | d-19 | O. | Final IC 38 -IMF_Composite -English_126 | {
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services of independent organizations for managing health insurance claims.
These agencies are known as the TPAs. In India, a TPA is engaged by an insurer
for provision of health services which includes among other things:i. Providing an identity card to the policyholder which is proof of hisinsurance policy and can be... | Final IC 38 -IMF_Composite -English.md | s245 | Hospital | Final IC 38 -IMF_Composite -English_127 | {
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Moreover, if a claim is made in any particular year, the cumulative bonus accrued
can only be reduced at the same rate at which it is accrued.**Example**A person takes a policy for Rs. 3 lacs at a premium of Rs. 5,000. In the second
year, in case of no claims in the first year, he gets a sum insured of Rs. 3.15 lacs
(5... | Final IC 38 -IMF_Composite -English.md | H-04 | Example | Final IC 38 -IMF_Composite -English_128 | {
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insurance. Underwriting is a very important aspect of any type of insurance and
plays a vital role in issuance of an insurance policy. In this chapter, you will get
an understanding about basic principles, tools, methods and process of
underwriting. It will also provide you the knowledge about group health insurance
un... | Final IC 38 -IMF_Composite -English.md | n249 | Learning Outcomes | Final IC 38 -IMF_Composite -English_129 | {
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frequent. Hence, it is quite logical that the underwriting norms and guidelines
are much tighter for health coverage than death coverage.**3.** **Underwriting – Risk Assessment**In health insurance, there is a higher focus on medical or health findings than
financial or income based underwriting. However, the latter ca... | Final IC 38 -IMF_Composite -English.md | s252 | Underwriting – Risk Assessment | Final IC 38 -IMF_Composite -English_130 | {
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I. Marketing insurance products
II. Collecting premiums from customers
III. Risk assessment and risk pricing
IV. Selling various insurance products**B.** **Underwriting – Basic concepts****1.** **Purposes of Underwriting**
There are two main purposes for Underwriting.i. To prevent anti-selection, that is selection agai... | Final IC 38 -IMF_Composite -English.md | s252 | B. | Final IC 38 -IMF_Composite -English_131 | {
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gathering by an agent or company representative to decide whether an
applicant is suitable for granting insurance coverage. The agent plays this
critical role of **primary underwriting** . He is in the best position to know
whether prospective client is insurable.Some insurance companies require the agents to provide a... | Final IC 38 -IMF_Composite -English.md | s255 | Moral Hazard report | Final IC 38 -IMF_Composite -English_132 | {
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decided by the new insurance company. Procedurally, the request for porting
should be made by the insured to the old insurer at least 45 days before the
renewal, specifying the company to which the policy has to be ported. The policy
has to be renewed without a break (there is a 30 day grace period if porting is255unde... | Final IC 38 -IMF_Composite -English.md | s255 | E. | Final IC 38 -IMF_Composite -English_133 | {
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Knowing the financial status of the proposer is particularly relevant for
benefit products and to reduce the moral hazard. However, normally the
financial documents are only asked for in cases of:a) Personal accident covers or
b) High sum assured coverage or
c) When the stated income and occupation as compared to the c... | Final IC 38 -IMF_Composite -English.md | k258 | Medical reports | Final IC 38 -IMF_Composite -English_134 | {
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class, build etc. The process is speedy but the premiums may be relatively higher.**3.** **Numerical rating method**This is a process adopted in underwriting, wherein numerical or percentage
assessments are made on each component of the risk.
Factors like age, sex, race, occupation, residence, environment, build, habit... | Final IC 38 -IMF_Composite -English.md | e260 | Numerical rating method | Final IC 38 -IMF_Composite -English_135 | {
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h) Difference in healthcare costs across regions in case of multiple locationsspread in different geographical locations
i) Preference of the group holder for administration of the group insuranceby a third party administrator (of his choice or one selected by the insurer)
or by the insurer itself
j) Past claims experi... | Final IC 38 -IMF_Composite -English.md | null | Example | Final IC 38 -IMF_Composite -English_136 | {
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respectively.**Age Limits**General age limits for the working population (employer employee) is 1870.However for students Minimum age could be 5 years too.
The minimum and maximum age for being covered and renewed varies from
company to company.262**Family Package Cover**The Personal accident policy also has a family p... | Final IC 38 -IMF_Composite -English.md | H-05 | Age Limits | Final IC 38 -IMF_Composite -English_137 | {
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e) Discuss personal accident claims
f) Understand the concept and role of TPAs265**A.** **Claims Management in Insurance**It is very well understood that insurance is a ‘ **promise’** and the policy is a
‘ **witness’** to that promise. The occurrence of an insured event leading to a claim
under the policy is the true t... | Final IC 38 -IMF_Composite -English.md | s265 | A. | Final IC 38 -IMF_Composite -English_138 | {
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(hospitalization) indemnity products which form the major part of health
insurance business.
The general process and supporting documents for a claim under fixed benefit
product or critical illness or daily cash product etc. would be quite similar, except
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nature of the illness/ injury involved.Earlier every TPA/ insurer had its own list of non-payable items, now the same
has been standardized under IRDAI Health Insurance StandardizationGuidelines.**c)** **Payment of claim**Once the payable claim amount is arrived at, payment is done to the customer
or the hospital as th... | Final IC 38 -IMF_Composite -English.md | l270 | Payment of claim | Final IC 38 -IMF_Composite -English_140 | {
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|---|---|
|**Step 3**|~~~~ The TPA studies the information provided in the_cashless authorization_<br>_form_ and takes a decision on whether the cashless authorization could<br>be provided and if so, for how much amount it should be authorized<br>and it is communicated to the hospital without delay.|
|**Step 4**| The... | Final IC 38 -IMF_Composite -English.md | y272 | Step 3 | Final IC 38 -IMF_Composite -English_141 | {
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about the condition of the patient and the line of treatment and helps the claim
processing person immensely to understand the illness/ injury and the line of
treatment. Where the patient unfortunately does not survive, the discharge
summary is termed **Death Summary** in many hospitals. The discharge summary is
always... | Final IC 38 -IMF_Composite -English.md | g274 | Death Summary | Final IC 38 -IMF_Composite -English_142 | {
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c) The TPA enrols the members (while the proposer is the person taking thepolicy, members are those covered under the policy) and may issue a
membership identification in the form of a card, either physical or
electronic.
d) The membership with the TPA is used for availing cashless facility as wellas processing of clai... | Final IC 38 -IMF_Composite -English.md | null | Customer relationship and contact management | Final IC 38 -IMF_Composite -English_143 | {
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h) Medical certificate from treating doctor mentioning the type of disabilityand disability period. Leave certificate from employer giving details of
exact leave period, duly signed and sealed by the employer.
The above list is only indicative, further documents (including photographs of scar
marks, site of accident et... | Final IC 38 -IMF_Composite -English.md | r277 | Test Yourself 4 | Final IC 38 -IMF_Composite -English_144 | {
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valid travel insurance policy.v. Hospitals usually contact the assistance companies/ insurers on the callcentre numbers to check the validity of the policy and verify coverages.vi. Once the policy is accepted by the hospital the insured would undergotreatment in the hospital on a cashless basis.vii. Some basic informat... | Final IC 38 -IMF_Composite -English.md | t2 | Reimbursement of medical expenses and other non-medical claims: | Final IC 38 -IMF_Composite -English_145 | {
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consumer Commissions or even the legal authorities.j) Frauds occur mostly in hospitalization indemnity policies but Personalaccident policies also are used to make fraud claims.k) The TPA provides many important services to the insurer and getsremunerated in the form of fees.280## SECTION **GENERAL INSURANCE**281## CHA... | Final IC 38 -IMF_Composite -English.md | G-01 | GENERAL INSURANCE | Final IC 38 -IMF_Composite -English_146 | {
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profession, occupation or business are of importance as they could have a
material bearing on the risk.**iv.** **Details and identity of the subject matter of insurance**The proposer is required to clearly state the subject matter that is proposedfor insurance.**Example**The proposer is required to state if it is:**i.*... | Final IC 38 -IMF_Composite -English.md | f284 | Details and identity of the subject matter of insurance | Final IC 38 -IMF_Composite -English_147 | {
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the company has to process the proposal within 15 days’ time. The agent is
expected to keep track of these timelines, follow up internally and communicate
with the prospect/ insured as and when required by way of customer service. This
entire process of scrutinizing the proposal and deciding about acceptance is
known a... | Final IC 38 -IMF_Composite -English.md | t-1938 | Test Yourself 1 | Final IC 38 -IMF_Composite -English_148 | {
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name of the steamer, number of packages, or exact value etc. are not known.
Even in respect of exports, a cover note may be issued e.g. a certain quantity of
cargo meant for shipment is sent by the exporter to the docks. It may happen
that, owing to difficulty of securing adequate shipping space, shipment of the
cargo ... | Final IC 38 -IMF_Composite -English.md | y288 | Clauses: | Final IC 38 -IMF_Composite -English_149 | {
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d) Date of expiry of insurance
e) Persons or classes of persons entitled to drive
f) Limitations as to use
g) Additional risks, if any288The Motor Cover Note incorporates a certificate to the effect that it is issued in
accordance with the provisions of Chapters X and XI of the Motor Vehicles Act,
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e) Sums insured;
f) Perils covered and exclusions ;
g) Any excess/ deductible applicable;
h) Premium payable and where the premium is provisional subject toadjustment, the basis of adjustment of premium ;
i) Policy terms, conditions and warranties;
j) Action to be taken by the insured upon occurrence of a contingency l... | Final IC 38 -IMF_Composite -English.md | n290 | Test Yourself 2 | Final IC 38 -IMF_Composite -English_151 | {
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complied with.**Test Yourself 3**Which of the following statements is correct with regards to a warranty?I. A warranty is a condition which is never stated in the policy
II. A warranty forms part of a policy document
III. A warranty is always communicated to the insured separately and cannot bepart of the policy docume... | Final IC 38 -IMF_Composite -English.md | null | Test Yourself 3 | Final IC 38 -IMF_Composite -English_152 | {
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f) Clauses attached or pasted to the policy override both marginal clausesand the clauses in the body of the policy.
g) Printed wording is over-ridden by typewritten wording or wordingimpressed by an inked rubber stamp.
h) Handwriting takes precedence over typed or impressed wording.
i) Finally, the ordinary rules of g... | Final IC 38 -IMF_Composite -English.md | y295 | Important | Final IC 38 -IMF_Composite -English_153 | {
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c) Insurance companies usually add a declaration at the end of the Proposal formto be signed by the insurer
d) Elements of a proposal form include:i. Proposer’s name in full
ii. Proposer’s address and contact details
iii. Proposer’s profession, occupation or business
iv. Details and identity of the subject matter of in... | Final IC 38 -IMF_Composite -English.md | G-02 | Key Terms | Final IC 38 -IMF_Composite -English_154 | {
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are some examples of physical hazard in various classes of insurance.**a)** **Fire****i.** **Construction:** Construction refers to the building materials used in wallsand roof. A concrete building is superior to a timber building.**ii.** **The height:** Greater the number of storey’s, the greater the hazard becauseof ... | Final IC 38 -IMF_Composite -English.md | null | Fire | Final IC 38 -IMF_Composite -English_155 | {
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may decide to charge an extra premium before acceptance of the same. By
loading the premium the higher probability of claims or occurrence of large claims
is taken into consideration.**Example**Normal rate of premium is charged for cargo shipped by liners or other vessels,
which comply with the prescribed standards. Ho... | Final IC 38 -IMF_Composite -English.md | null | Example | Final IC 38 -IMF_Composite -English_156 | {
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limit to the maximum bonus that can be availed. It is allowed by way of deduction
on the total premium at renewal only, depending upon the incurred claim ratio
for the entire group or to Motor vehicle Own damage policy holders for claim freeyears.**No claim bonus is a powerful strategy to improve underwriting experienc... | Final IC 38 -IMF_Composite -English.md | f303 | No claim bonus is a powerful strategy to improve underwriting experience and | Final IC 38 -IMF_Composite -English_157 | {
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In that case refund is made keeping the premium on short period scale for the
period Insurer was in risk.**Minimum premium**It is the practice to charge minimum premium under each policy so that
administrative expenses of issuing the policy are covered.**Test Yourself 1**What is expected of an agent when she detects a ... | Final IC 38 -IMF_Composite -English.md | null | Minimum premium | Final IC 38 -IMF_Composite -English_158 | {
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in the market to replace the damaged raw material, after the loss.**e)** **Marine cargo insurance:** It is an agreed valued policy and the sum insured isas per the agreement between insurer and insured at the time of contract.
Normally it would consist of the sum of cost of the commodity plus Insurance
+ freight i.e. C... | Final IC 38 -IMF_Composite -English.md | s306 | Marine cargo insurance: | Final IC 38 -IMF_Composite -English_159 | {
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channels that deal with personal lines of insurance as the buyers also are
essentially from the same consumer segment.**B.** **'All Risks' and ‘Named Perils’ Insurance Policy**Non-life insurance policies can be broadly classified into two categories: Named peril policies
All risk policiesi. "All risks" typically mea... | Final IC 38 -IMF_Composite -English.md | s310 | B. | Final IC 38 -IMF_Composite -English_160 | {
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A till (box/ drawer/ counter) at the business premises
**v.** **Baggage** : Compensates for loss of baggage while on travel for officialpurposes
**vi.** **Fixed Plate Glass and Sanitary Fittings covers accidental loss of damage****to:** Fixed plate glass
Sanitary fittings
Neon Sign/ Glow Sign/ Hoarding
**vii.** ... | Final IC 38 -IMF_Composite -English.md | s310 | Baggage | Final IC 38 -IMF_Composite -English_161 | {
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declared by a policyholder is less than what ought to have been declared for the
property in question, the policyholder’s claim will not be settled proportionately
but upto the Sum Insured that is declared.**F.** **Sum Insured and Premium**Industrial units or offices will maintain books of accounts showing therein valu... | Final IC 38 -IMF_Composite -English.md | g313 | F. | Final IC 38 -IMF_Composite -English_162 | {
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synonymous with ‘larceny’.**Test Yourself 2**Under the shopkeeper package policy, the insured may opt for an additional ‘Fixed
plate glass and sanitary fittings’ cover. This will cover accidental loss of damage to
which of the following?I. Fixed plate glass
II. Sanitary fittings
III. Neon signs
IV. All of the above**G.... | Final IC 38 -IMF_Composite -English.md | g313 | Test Yourself 2 | Final IC 38 -IMF_Composite -English_163 | {
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party. Third-party insurance is purchased by the insured (first party) from an
insurance company (second party) for protection against another party's claims
(third party) for liability arising out of the action of the insuredThird party insurance is called ‘Liability Insurance’ as well.**Two important types of covers ... | Final IC 38 -IMF_Composite -English.md | s316 | Two important types of covers that are popular in the market are discussed | Final IC 38 -IMF_Composite -English_164 | {
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from Regional Transport Authority
III. In the name of any family member of the vehicle owner, including the vehicleowner, subject to approval from the Regional Transport Authority
IV. If the vehicle will be driven by anyone other than the owner, then primarypolicy should be in the name of the vehicle owner and addition... | Final IC 38 -IMF_Composite -English.md | s316 | Summary | Final IC 38 -IMF_Composite -English_165 | {
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stocks and stock in process, including stocks at suppliers/ customer's premises,Stocks held in trust, if specifically declared, machinery temporarily removed from
the premises for repairs can be insured. Monetary relief is essential to rebuild
and renew the property damaged to bring back the business to its normal cour... | Final IC 38 -IMF_Composite -English.md | n319 | What does the Standard Fire policy cover? | Final IC 38 -IMF_Composite -English_166 | {
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industries, storage risks and so on. The policy underinsurance to the extent of32015% is waived. Bharat Sookshma Udyam Policies allow increase in Sum Insurer
during the policy tenure by endorsement.**ii.** **Bharat Laghu Udyam Suraksha(meant for enterprises where the total****value at risk is more than Rs. 5 Crore and ... | Final IC 38 -IMF_Composite -English.md | f32015 | Bharat Laghu Udyam Suraksha(meant for enterprises where the total | Final IC 38 -IMF_Composite -English_167 | {
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called fire floater policies as the sum insured ‘floats’ over multiple locations.**vi.** **Premium rating depends on:**a) The type of occupancy, whether industrial or otherwise.
b) All property located in an industrial complex will be charged one ratedepending on the product(s) made.
c) Facilities outside industrial co... | Final IC 38 -IMF_Composite -English.md | e322 | Premium rating depends on: | Final IC 38 -IMF_Composite -English_168 | {
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when the cash is secured in a safe, which is burglar proof and is of an approved
make and design. The common conditions applicable for granting cash cover are
given below:a) Cash lost from the safe following the use of the original key to open, it iscovered only where such key has been obtained by violence or threats o... | Final IC 38 -IMF_Composite -English.md | y324 | First Loss Insurance | Final IC 38 -IMF_Composite -English_169 | {
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amount in transit and adjust this premium at the time of expiry of the policy,
based on actual amount in transit during the policy period, as declared by the
insured.**b)** **Premises section:** This section covers loss of cash from one’s premises/locked safe due to burglary, housebreaking, hold up etc. Other features ... | Final IC 38 -IMF_Composite -English.md | s325 | Premises section: | Final IC 38 -IMF_Composite -English_170 | {
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Etc.) that are to be guaranteed for a specified amount and the name are
not mentioned.**e)** **Blanket policy:** This policy covers the entire staff without showing namesor positions. No enquiries about the employees are made by the insurers.
Such policies are only suitable for an employer with a large staff and the
or... | Final IC 38 -IMF_Composite -English.md | s2 | Blanket policy: | Final IC 38 -IMF_Composite -English_171 | {
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d) Number of branches.**Test Yourself 6**Which of the below can be covered under a bankers indemnity insurance policy?I. Money securities lost or damaged whilst within the premises due to fire
II. Forgery or alteration of cheques
III. Dishonesty of employees with reference to money
IV. All of the above**G.** **Jewelers... | Final IC 38 -IMF_Composite -English.md | y329 | Test Yourself 6 | Final IC 38 -IMF_Composite -English_172 | {
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electrical breakdown by any cause (subject to excepted risks) to the insured
property:a) While it is at work or at rest.
b) While being dismantled for cleaning or overhauling
c) During cleaning or overhauling operations and during reassemblythereafter.
d) When being shifted within the premise.330Premium is charged on t... | Final IC 38 -IMF_Composite -English.md | t331 | Boiler and Pressure Plant Policy: | Final IC 38 -IMF_Composite -English_173 | {
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storage on lease or hire for storage of perishable commodities. The cover is
against the risk of deterioration and contamination following breakdown of
the refrigeration plant and machinery and also due to rise in temperature and
sudden and unforeseen escape of refrigerants into the cold storage rooms.**6.** **Civil En... | Final IC 38 -IMF_Composite -English.md | d332 | Civil Engineering Completed Risk: | Final IC 38 -IMF_Composite -English_174 | {
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accidental damages during the project. It is suitable for the insured who is
deprived of the anticipated earning and for the financial institutions to the extent
of their interest in the project. It is issued as an extension to the MCE/ EAR/ CAR
Policy before the actual commencement of project.The policy also covers fi... | Final IC 38 -IMF_Composite -English.md | d333 | Test Yourself 8 | Final IC 38 -IMF_Composite -English_175 | {
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whilst in transit from one place to another. However, the insured is required to
always act with reasonable care in all circumstances within his control. The main
feature of this policy is that it's an Agreed Value Policy. The valuation is agreed
between the insurer and insured and is not subject to revaluation later u... | Final IC 38 -IMF_Composite -English.md | t335 | Important | Final IC 38 -IMF_Composite -English_176 | {
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period have to be declared by the insured to the insurer as agreed between
them on a fortnightly, monthly or quarterly basis.**iii.** **Open Cover**The open cover is a contract for a year giving the Insured continuous
protection to cover a large number of shipments/ despatches. The
premium on the consignments would be ... | Final IC 38 -IMF_Composite -English.md | null | Open Cover | Final IC 38 -IMF_Composite -English_177 | {
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compensation or meeting expenses involved in defending the suits filed by the
claimants. In other words there is a financial loss arising from a liability to pay.
The existence of such a liability and the amount of compensation to be paid would
be decided by a civil court which would go into the aspect of alleged negli... | Final IC 38 -IMF_Composite -English.md | l2 | Statutory liability | Final IC 38 -IMF_Composite -English_178 | {
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accident and any one year.5. **Professional Liability**Professional indemnities are designed to provide insurance protection to
professional people against their legal liability to pay damages arising out of
negligence in the performance of their professional duties. Such covers are
available for doctors hospitals; eng... | Final IC 38 -IMF_Composite -English.md | s340 | Professional Liability | Final IC 38 -IMF_Composite -English_179 | {
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policyholders on the happening of a loss event. Insurer fulfils this promise by
providing prompt, fair and equitable service in either paying the policyholder or
paying claims made against the insured by a third party.One of the non-life insurance companies had the inscription “Pay if you can;
repudiate if you must” in... | Final IC 38 -IMF_Composite -English.md | null | Settling claims professionally is regarded the biggest advertisement for an | Final IC 38 -IMF_Composite -English_180 | {
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investigation to determine the cause and extent of loss is done, by an officer ofthe insurers.**The investigation** of other claims is entrusted to independent licensed
professional surveyors who are specialists in loss assessment. The assessment of
loss by independent surveyors is based on the principle that since bot... | Final IC 38 -IMF_Composite -English.md | e2 | The investigation | Final IC 38 -IMF_Composite -English_181 | {
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Insurance Rules 1939 and specific regulations issued by IRDAI.Claims made outside the country in case of ‘Travel Policy’ or ‘Marine Open
Cover’ for exports, are assessed by the claims settling agents abroad named in
the policy. These agents may assess the loss and make payment, which is
reimbursed by the insurers along... | Final IC 38 -IMF_Composite -English.md | f346 | Important | Final IC 38 -IMF_Composite -English_182 | {
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comprehensive policy. Which among the following is most appropriate for Raj todo?I. Notify the insurer of the loss as soon as reasonably possibleII. Notify the insurer at the time of insurance renewalIII. Damage the car further so as to receive a bigger compensationIV. Ignore the damage347**Test Yourself 3**Which of th... | Final IC 38 -IMF_Composite -English.md | e347 | ANNEXURESThese annexures are provided so that the students get a better idea of proposal | Final IC 38 -IMF_Composite -English_183 | {
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## IC - 38 **CORPORATE AGENTS** **SECTION-COMMON****ACKNOWLEDGEMENT****This course is based on revised syllabus prescribed by Insurance Regulatory and**
**Development Authority of India (IRDAI) and prepared by Insurance Institute of**
**India, Mumbai.****AUTHORS/ REVIEWERS (in Alphabetical order)**Dr. R. K. Duggal
Dr. ... | Final IC-38 - Corporate Agent _Common _ English.md | C-46 | CORPORATE AGENTS | Final IC-38 - Corporate Agent _Common _ English_000 | {
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wishes all interested in studying the material a successful career in insurance
marketing.iii## CONTENTS|Chapter no.|Title|Page no.|
|---|---|---|
|**SECTION **|**COMMON CHAPTERS **|**COMMON CHAPTERS **|
|C-01|Introduction to Insurance|2|
|C-02|Core Elements of Insurance|18|
|C-03|Principles of Insurance|27|
|C-04|Feat... | Final IC-38 - Corporate Agent _Common _ English.md | C-01 | CONTENTS|Chapter no.|Title|Page no.| | Final IC-38 - Corporate Agent _Common _ English_001 | {
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Losses arising from the demise of a member were shared by various family
members so that each member of the family continued to feel secure.The break-up of the joint family system and emergence of the nuclear family in
the modern era, coupled with the stress of daily life has made it necessary to
evolve alternative sys... | Final IC-38 - Corporate Agent _Common _ English.md | null | Lloyds | Final IC-38 - Corporate Agent _Common _ English_002 | {
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"Test Yourself 1"
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insurance. 6General Insurers deal only in Health insurance. 2 are specialised
insurers - Agricultural Insurance Company [AIC] and Export Credit and
Guarantees Corporation [ECGC], both set up as Public sector entities.c) There is one Reinsurance Company – The General Insurance Corporation ofIndia [GIC Re] and 11 foreign... | Final IC-38 - Corporate Agent _Common _ English.md | null | Test Yourself 1 | Final IC-38 - Corporate Agent _Common _ English_003 | {
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result of being exposed to a given loss situation/ event.**Diagram 3:** **Risk burdens that one carries**There are two types of risk burdens that one carries – **primary and secondary** .7**a)** **Primary burden of risk**The **primary burden of risk** consists of losses that are actually suffered by
households (and bus... | Final IC-38 - Corporate Agent _Common _ English.md | t8 | Diagram 3: | Final IC-38 - Corporate Agent _Common _ English_004 | {
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|Funds flow from one source to many<br>destinations.|Funds flow from many sources to one.|**Diagram 4:** **Mutuality -** Mutuality (Funds flow from many sources to one)The Principle of Mutuality is what gives insurance contracts their power and
uniqueness. By paying a small contribution (the premium), an insured immedi... | Final IC-38 - Corporate Agent _Common _ English.md | null | Diagram 4: | Final IC-38 - Corporate Agent _Common _ English_005 | {
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locations; (ii) fixing fire proof doors in hazardous areas of factories.**4.** **Risk financing**This refers to the provision of funds to meet losses that may occur.**a)** **Risk retention through self-financing** involves bearing losses oneself as theyoccur. The firm assumes and finances its own risk, either through i... | Final IC-38 - Corporate Agent _Common _ English.md | null | Risk financing | Final IC-38 - Corporate Agent _Common _ English_006 | {
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transferring the risk [the insurance premium] against the cost of bearing it oneself.
Insurance would be most required where the loss impact could be very high, but the
probability (and hence the premium), is very low. E.g. (i) the chance of an
earthquake; (ii) the chance of a ship sinking.**a)** **Do not risk a lot fo... | Final IC-38 - Corporate Agent _Common _ English.md | null | Do not risk a lot for a little | Final IC-38 - Corporate Agent _Common _ English_007 | {
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their contributions are given below.a) Insurance is founded on the principle of Mutuality, in which the collectivepower of the community is brought together to support its unfortunate fewmembers who suffer an economic loss. There are no substitutes forinsurance.b) Insurance companies collect small amounts of premium an... | Final IC-38 - Corporate Agent _Common _ English.md | s1 | Information | Final IC-38 - Corporate Agent _Common _ English_008 | {
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common pool of funds it is known as pooling.Apart from insurance, other risk management techniques include: Risk avoidance,16 Risk control,
Risk retention,
Risk financing and
Risk transfer- The thumb rules of insurance are: Do not risk more than one can afford to lose,
Consider the likely outcomes of the ris... | Final IC-38 - Corporate Agent _Common _ English.md | k2 | Key Terms | Final IC-38 - Corporate Agent _Common _ English_009 | {
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accept the goods or defaulted on payments. **Life insurance**What about our lives? There is indeed nothing as valuable to us as our own lives and
those of our loved ones. Our lives can be seriously affected when subjected to anaccident or an illness.This can impact in two ways: Firstly there are costs of treatment of... | Final IC-38 - Corporate Agent _Common _ English.md | null | Life insurance | Final IC-38 - Corporate Agent _Common _ English_010 | {
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may be reversible to some extent. Critical losses would include those resulting
in serious financial losses, compelling a firm to borrow to continue operations.**Example: Critical** A fire in the plant of a large multinational company at Gurgaon destroysinventory worth Rs 1 crore. The loss is heavy but not so high as ... | Final IC-38 - Corporate Agent _Common _ English.md | null | Example: Critical | Final IC-38 - Corporate Agent _Common _ English_011 | {
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onset of a major ailment.**c)** **Legal hazard** is more prevalent in cases involving a liability to pay for damages.It arises when certain features of the legal system or regulatory environment
can increase the incidence or severity of losses.**Example**The enactment of law governing workmen’s compensation in the case... | Final IC-38 - Corporate Agent _Common _ English.md | null | Legal hazard | Final IC-38 - Corporate Agent _Common _ English_012 | {
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size of the pool of risks, the actual average of losses would be closer to the
estimated or expected average loss.24**c)** **Insurance Companies to remain Solvent:**If the pools of risks and the premium pools created are not sufficient to meet
the liabilities towards paying claims (in case they occur), the system of ri... | Final IC-38 - Corporate Agent _Common _ English.md | C-03 | Insurance Companies to remain Solvent: | Final IC-38 - Corporate Agent _Common _ English_013 | {
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b) Risk
c) Hazard
d) Risk pooling
e) Offer and acceptance
f) Lawful consideration**Answers to Test Yourself****Answer 1** - The correct option is II.26## CHAPTER C-03## PRINCIPLES OF INSURANCE**Chapter Introduction**In this chapter, we discuss the principles, based on which the mechanism ofinsurance works.a) Utmost Goo... | Final IC-38 - Corporate Agent _Common _ English.md | C-03 | Answers to Test Yourself | Final IC-38 - Corporate Agent _Common _ English_014 | {
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of premium and the terms and conditions. The insured has an obligation to fully
and accurately disclose all facts that are material to an insurance contract.Whether an undisclosed fact was material or not would depend on the
circumstances of the individual case and could be decided ultimately only in a
court of law. Th... | Final IC-38 - Corporate Agent _Common _ English.md | l28 | Example | Final IC-38 - Corporate Agent _Common _ English_015 | {
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answers were incomplete.**b.** **Duty to Disclose:** In the case of insurance contracts, the duty to disclose ispresent throughout the entire period of negotiation until the proposal is accepted
and a Life Insurance policy is issued.Once the Life Insurance policy is accepted, there is no further need to disclose any
ma... | Final IC-38 - Corporate Agent _Common _ English.md | null | Duty to Disclose: | Final IC-38 - Corporate Agent _Common _ English_016 | {
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of revival of the policy or (d) the date of the rider to the policy, whichever islater.The insurer needs to communicate the reasons on which the policy is questioned
in writing to the insured or his/ her legal representatives, nominees or assignees.The expression "fraud" means any act committed by the insured, with the... | Final IC-38 - Corporate Agent _Common _ English.md | null | B. | Final IC-38 - Corporate Agent _Common _ English_017 | {
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insurable interest should be present both at the time of taking the policy and at
the time of claim with some exceptions like marine policies in which case itmust exist at the time of claim.In case of fire and accident insurance, insurable interest should be present both
at the time of taking the policy and at the time... | Final IC-38 - Corporate Agent _Common _ English.md | e34 | C. | Final IC-38 - Corporate Agent _Common _ English_018 | {
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was due to the ‘normal wear and tear’ of the car and the air-conditioning system,
which was an excluded peril in the insurance policy. Mr Ajay approached the Court
and after examining the survey report which said that the car was 12 years old and
neither the car nor the air-conditioning had been serviced/ repaired duri... | Final IC-38 - Corporate Agent _Common _ English.md | e34 | Scenario 2: | Final IC-38 - Corporate Agent _Common _ English_019 | {
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insurer and insured agree on the value of the property to be insured, at the
beginning of the insurance contract. In the event of total loss, the insurer agrees
to pay the agreed amount of the policy. This type of policy is known as “ **Agreed**
**Value Policy** ”.**b)** **Underinsurance:** Consider a situation now whe... | Final IC-38 - Corporate Agent _Common _ English.md | e37 | Agreed | Final IC-38 - Corporate Agent _Common _ English_020 | {
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Hence, it is also called a ‘corollary’ of Indemnity. Contribution is a principle that
arises in general insurance contracts. It tells us how the liability is to be met when
the insured has taken insurance from more than one insurer. Contribution implies
that if the same property is insured with more than one insurance ... | Final IC-38 - Corporate Agent _Common _ English.md | e37 | Test Yourself 2 | Final IC-38 - Corporate Agent _Common _ English_021 | {
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the Indian Contract Act, 1872 govern all contracts in India, including insurancecontracts.An insurance policy is a contract entered into between two parties, viz., the
company, called the **insurer**, and the policy holder, called the **insured** and fulfils
the requirements enshrined in the Indian Contract Act, 1872.*... | Final IC-38 - Corporate Agent _Common _ English.md | d43 | Diagram 1: | Final IC-38 - Corporate Agent _Common _ English_022 | {
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in advance in the prescribed manner. This is an important feature of the insurance
industry in India.The Insurance Rules, 1939, provide certain exceptions to this condition of advance
payment of premium, in respect of particular categories of insurances. Section 59
of the Insurance Rules allows accepting premiums in in... | Final IC-38 - Corporate Agent _Common _ English.md | d43 | Solicitation | Final IC-38 - Corporate Agent _Common _ English_023 | {
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before the due date. Grace period for paying the premium do not apply. In case
a comprehensive policy lapses for more than 90 days, the accrued No Claim
Bonus (NCB) benefit would also be lost.In the interest of smooth operation of affairs during the Covid-19 pandemic,
IRDAI permitted the following relaxations:i. In cas... | Final IC-38 - Corporate Agent _Common _ English.md | d-19 | Free-Look Period introduced by “IRDAI” | Final IC-38 - Corporate Agent _Common _ English_024 | {
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known as the premium.
ii. A contract is an agreement between parties, enforceable at law.iii. The elements of a valid contract include:Offer and acceptanceConsideration,Consensus ad-idem,- Free consentCapacity of the parties and46Legality of the object**Key Terms**1. Offer and Acceptance2. Lawful consideration3. Consen... | Final IC-38 - Corporate Agent _Common _ English.md | d46 | Key Terms | Final IC-38 - Corporate Agent _Common _ English_025 | {
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medical aspects, fitness levels and family history and measure the effect of each
factor affecting the risk.**Sources of information for underwriting**The first stage in any numerical (or statistical) analysis is the collection of data.
When pricing a risk, an underwriter should gather as much information as possibleto... | Final IC-38 - Corporate Agent _Common _ English.md | null | Sources of information for underwriting | Final IC-38 - Corporate Agent _Common _ English_026 | {
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made on each component of the risk. Factors like age, race, occupation, habits etc.
are examined and scored numerically based on predetermined criteria.The amount of premium to be paid by each depends on a rate, which is determined
by two factors; The probability of loss due to a loss event (caused by an insured peril... | Final IC-38 - Corporate Agent _Common _ English.md | r10 | Example | Final IC-38 - Corporate Agent _Common _ English_027 | {
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5,00,00,000] x 100 = 0.5%Therefore the rate of premium that a motor cycle owner pays is half a percent of
Rs. 50,000/ - i.e. Rs. 250/ - per year. This is called the **‘Pure’ premium,** also known
as ‘Burning Cost’.At the rate of Rs. 250 per motor cycle, Rs. 2.5 lakhs is collected which is paid outin claims on total los... | Final IC-38 - Corporate Agent _Common _ English.md | d53 | Therefore, the ‘pure premium’ is suitably loaded or increased by adding | Final IC-38 - Corporate Agent _Common _ English_028 | {
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ensure that he/ she takes due care. For instance, health insurers may insist on a
deductible so that insured would not overspend on costly hospital rooms just
because insurance is there. Some Insurers also may not prefer spending time on
processing small claims. Also, in certain situations, insurers may not want to get... | Final IC-38 - Corporate Agent _Common _ English.md | C-06 | Franchise: | Final IC-38 - Corporate Agent _Common _ English_029 | {
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following: The extent of the insured’s insurable interest in the property affected
The value of salvage
Application of underinsurance
Application of contribution and subrogation conditionsIn the matter of claims relating to life insurance, the insurer checks whether1) Conditions of policy have not been breached
... | Final IC-38 - Corporate Agent _Common _ English.md | r1 | B. | Final IC-38 - Corporate Agent _Common _ English_030 | {
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arising directly or indirectly in respect of the said claim.Date (Signature)vi. **Post settlement action**The action taken after settlement of the non-life claim in relation to underwritingvaries from one class of business to another.**Example**Sum insured under a fire policy stands reduced to the extent of the amount ... | Final IC-38 - Corporate Agent _Common _ English.md | o59 | Post settlement action | Final IC-38 - Corporate Agent _Common _ English_031 | {
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parties to the dispute themselves. In the event of a single arbitrator, the parties
have to agree about that person. Many commercial insurance policies contain an
**arbitration clause** stating that disputes will be subject to arbitration. Fire and most
miscellaneous policies also contain an arbitration clause which pr... | Final IC-38 - Corporate Agent _Common _ English.md | o60 | Example | Final IC-38 - Corporate Agent _Common _ English_032 | {
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and the important documents, commonly applicable for practically all
policiesImportance of Age Proof and acceptable documents.63**A.** **Prospectus**Prospectus is a proposal stage document. The prospectus is a formal legal document
used by insurance companies that provides details about the product. It can mean
a docum... | Final IC-38 - Corporate Agent _Common _ English.md | s5 | A. | Final IC-38 - Corporate Agent _Common _ English_033 | {
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conditions of the cover to be granted.The Principle of Utmost Good Faith and the Duty of Disclosure of material
information begin with the Proposal Form for insurance. The proposer must provide
all information correctly and completely as this document becomes the basis of
granting insurance and any wrong or concealed i... | Final IC-38 - Corporate Agent _Common _ English.md | null | Proposal Form - Details | Final IC-38 - Corporate Agent _Common _ English_034 | {
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