Weak option for insured

After a road accident, when an insurance surveyor assessed that Ashwin Trivedi should get 75 per cent of the claim for damage to his car, he was satisfied. But, the insurance company wasn’t happy. So, it sent a second surveyor, who reduced it to 60 per cent. Then, a third brought it down to 40 per cent, which the insurer agreed to pay.

After three sessions with surveyors, Trivedi was exasperated. “My car’s bonnet has been completely damaged. Yet, the insurance company has been unwilling to pay,” he said.

For those like Trivedi, there is some good news. “If one is not satisfied with the assessment by the company-provided surveyor, he/she can appoint an independent surveyor,” J Hari Narayan, chairman, Insurance Regulatory and Developmental Authority, said at a recent Business Standard Insurance Round Table, But, there are a lot of bottlenecks. For one, most industry players, including agents, are not aware of this. “We know that only insurance companies can appoint surveyors. We are not aware that the claimant can also appoint a surveyor,” said an insurance agent. Surveyors are independent professionals hired by insurance companies to assess losses. They give their opinion when claims are made.

When a policyholder files a claim, a surveyor is appointed to assess the loss. The insurance company settles the claim on the basis of the report submitted by the surveyor. But, many times, insurance companies ignore reports submitted by surveyors.

“While surveyors are supposed to be independent, many insurers have them on their rolls,” said an industry expert. Even when independent surveyors are appointed, the insurers have the option of re-appointing surveyors till they get the report that suits them.

While the claimant has the choice of appointing a surveyor, the insurer is likely to take the opinion of its own employee before deciding. “Though the regulator has made a provision for both the insurance company and the claimant to have their own surveyors, most companies do not accept assessments by surveyors appointed by claimants,” said a Mumbai-based surveyor. In case of a partial loss, most companies approve 40-50 per cent of the claimed amount while total loss claims are settled up to 75 per cent of the claim. “Reports assessing more than this range are not honoured in most cases,” the surveyor added.

The industry, on its part, says that having too many surveyors can complicate things. KG Krishnamoorthy Rao, managing director and chief executive officer, Future Generali India Insurance, said, “The process of settling claims will get a little difficult if both the company and the client appoint a surveyor each. A claimant can inform the company if he/she is not satisfied with the report and the company will appoint another surveyor.”

Even after repeated assessments by different surveyors, if the claimant is still not satisfied, he/she should first approach the grievance redressal department of the insurance company. If the company says the claim is not tenable under the policy terms and conditions, the claimant can approach the Insurance Ombudsman or a consumer court. If the dispute is over the quantum of the claim, the policyholder can resort to arbitration.