Page 223 - DCOM309_INSURANCE_LAWS_AND_PRACTICES

Insurance Laws and Practices

Notes
Home and Motor
Alongside the loss of life has been huge destruction of personal property as well. The
claims procedure becomes difficult as the policy documents won’t be available in most
cases.

“The surveyor may rely either on other documentary evidence of existence or ownership
like the sale deed in case of property or physical evidence at the scene to access the loss,”
says Amarnath Ananthanarayanan, MD & CEO Bharti AXA General Insurance.

Cases where the house or vehicle has been completely washed will be categorised under
‘complete loss’ and full sum insured will be claimable, otherwise, the surveyor will put
the case under partial loss and one will get refund for repair or reinstatement. Regular
deductibles will apply as in case of jewellery and domestic appliances (usually up to 20%
of contents sum insured).
Health Insurance
If one survives the calamity, there might be need for medical care, which in the immediate
aftermath may be funded by the government. However, there may be situations when
one may not receive assistance from the authorities. In such situations, if the insurance
documents are not available or the policyholder gets treatment in a non-network hospital,
one can always take the reimbursement route when the insured recovers.

“In emergency situations, we are liberal and proactive. In the past, during the Mumbai
floods, there were cases where policyholders had lost their documents, but claims have
been processed without any hassle on the basis of policy numbers and basic verification
documents,” says Antony Jacob, Chief Executive Officer, Apollo Munich Health Insurance.
The claims are processed in the same way as it would be in a normal situation; that is, the
customer has to pay the bill and then send in the claim for reimbursement up to the level
of sum insured, for the medical expenses incurred. Therefore original medical bills will
the proof for getting any reimbursement. “It is only in the case of a personal accident that
a claimant is advised to produce a government issued death certificate for verification,”
adds Jacob.
Question
What are the difficulties that appear in order to claim insurance in times of natural disaster?
Source: http://indiatoday.intoday.in/story/uttarakhand-disaster-insurance-claim-settlement-natural-
disaster/1/285402.html
12.6 Summary

The policy should provide for reimbursement of hospitalisation/domiciliary
hospitalisation expenses for illness/disease suffered or accidental injury sustained during
the policy period.
The term Hospital/Nursing Home shall not include an establishment which is a place of
rest, a place for the aged, a place for drug addicts or place for alcoholics, a hotel or a similar
place.
Any one illness means continuous period of illness and it includes relapse within 105 days
from the day of last consultation with the Hospital/Nursing Home where treatment may
have been taken. Occurrence of same illness after a lapse of 105 days will be considered as
fresh illness for the purpose of this policy.

218 LOVELY PROFESSIONAL UNIVERSITY