GIC Agent (IRDA) - 2

In personal accident insurance, the principle of indemnity is not strictly applied as human life cannot be measured in terms of money.

The purpose of a deductible clause is to:

-eliminate small claims that are expensive to handle and process

-reduce premiums paid by the insured

-reduce moral hazard and attitudinal hazard

The maximum limit of the amount under dispute for which the Ombudsman can entertain a complaint is up to Rs. 20 lakhs.

In case, the customer is not satisfied with the decision taken by the officer in respect to a service, he/she can appeal against the decision in the following manner:
(a) If not satisfied with the decision taken by the dealing officer, he/she can appeal to the Branch manager.
(b) In case not satisfied with the reply given by the Branch manager, matter may be brought to the notice of Grievance Cell, HO, headed by a senior executive which will be directly under the control of the MD.
(c) If customer is not satisfied with the complaint redressal procedure or complaint /resolution from the company, he/she can approach the Insurance Ombudsman located in his/her region.

Both Health check-up and Cumulative Bonus provisions are applicable only in respect of continuous insurance without break. However in exceptional circumstances, the break for a maximum of seven days is approved as a special case subject to medical examination and exclusion of disease during the break period. Health check-up benefit will be accrued after completion of four years continuous claim free insurance.

A fact that would be important to a reasonable person in deciding whether to engage or not to engage in a particular transaction; an important fact as distinguished from some unimportant or trivial details.

In order to become eligible to make a claim under health policy, minimum stay in the hospital is necessary for a certain number of hours. Usually this is 24 hours. This time limit may not be applicable for the treatment of accidental injuries and for certain specified treatments.

Risks covered under Institute Marine Cargo Clauses are :- 

• fire or explosion
  -vessel or craft being stranded, grounded, sunk or capsized
• overturning or derailment of land conveyance
• collision or contact of vessel craft or conveyance with any external object other than water
• discharge of cargo at a port of distress
  -earthquake ,volcanic eruption or lightning

It is not mandatory for an insurer to appoint a surveyor for each and every loss reported by a policy of general insurance. Only where the estimated loss exceeds Rs.20,000/-, the insurers are mandated to appoint a licensed surveyor to assess and settle the loss.

For a home insurance policy, that only provides coverage on losses incurred to your property from hazards or events named on the policy, named peril policies may be purchased as less expensive alternatives to comprehensive coverage or broad policies, which are the policies that tend to offer coverage to most perils.

Unlike other policies where the period of insurance is one year, in this policy the period of insurance should be equivalent to the period of contract, commencing from the date of unloading of the first batch of materials at the site of construction and expiring on the date of handing over of the contract work to the principal.

Deferred annuity is an annuity under which the annuity payment period is scheduled to begin at some future date. They enable people to increase their income stream later in life for less money because the insurance company is not on the hook as long when income payments are deferred.

Insured's declared value in motor insurance includes manufacturer's selling price. In case of motor insurance, the sum insured is the insured's declared value [IDV]. It is the value of the vehicle, which is arrived at by adjusting the current manufacture's listed selling price of the vehicle with depreciation percentage as prescribed in the IRDA regulations. Manufacturer's listed selling price will include local duties / taxes excluding registration and insurance. 

An open cover is an agreement (not a policy) whereby the insurer will accept insurance of all shipments made by the assured, within the terms of the cover for a fixed period, usually for 12 months. Being an agreement, it is not stamped. However, stamped policies or certificates of insurance are issued against the declaration made by the assured. The open cover is of great convenience to the clients engaged in regular import/export trade.

A net premium is the premium calculated on the basis of the valuation assumptions to provide the contractual benefits at outset. Its calculation only allows explicitly for interest and mortality. Thus, the net premium covers the risk factor as well as interest earned on investment of fund by the insurers. Net premium is always less than the risk premium.

Rescission is the termination of an insurance contract by the insurer when material misrepresentation has occurred. Insurers have the right to rescind an insurance policy due to concealment, material misrepresentation, or material breach of warranty. Generally, to rescind, an insurer will send a notice to the insured and tender a check in the amount of the premium paid for the relevant policy period.

There are five requirements for a valid insurance contract. These are: 
-insurable interest

-legal capacity

-consideration

-meeting of the minds

-offer and acceptance

Thus, option 2 is the correct answer. 

In fire insurance, the principle of indemnity can be modified in the case of building, machinery and other fixed assets whereby, subject to the sum insured representing the value of similar new property, it can be insured under ‘Reinstatement Value’ clause. In case of reinstatement value policy, the basis of loss settlement is the value of new property without taking any depreciation into account. This type of insurance enables the owner to replace his property without any financial strain on his own resources and is quite commonly taken by industrialists and building owners.

Variants of fire policy include:
-Market value basis policy
-Reinstatement value policies
-Declaration policy
-Floater policy

Renters insurance is a form of property insurance that covers a policyholder's belongings against perils. It also provides personal liability coverage and additional living expenses. Possessions can be covered for their replacement cost or the actual cash value, which includes depreciation.

General insurance cannot be used to make windfall gains on the occurrence of a contingent event.

Correct Answer: The risk may be assumed on the date on which the cheque is posted.

Underwriting is a process of risk selection which is based upon the characteristics of a group or an individual. Here based on the degree of the risk, the underwriter decides the selection as well as the price of risk.

A rate is the price per unit of insurance for each exposure unit, which is a unit of liability or property with similar characteristics. Rate decides the premiums.So it is not same as premium.

A Third party administrator is the felicitator between the policy holder and the policy provider. He is the one who offers claims services on behalf of the insurer. So it is always necessary to have contact numbers and all other details of the third party provider, for he will be the sole point of contact when some unforeseen circumstances are met during the course of travel.

Hull insurance includes the insurances related to :
i. inland vessels such as barges, launches, passenger vessels etc.
ii. dredgers (mechanized or non-mechanized)
iii. fishing vessels (mechanized or non-mechanized)
iv. sailing vessels (mechanized or non-mechanized)
v. jetties and wharves
vi. vessels in the course of construction 

Overriding commission:- In insurance, a commission paid by an insurer to an agent or managing general agent for premium volume produced by other agents in a given geographic territory. In reinsurance, it is the commission paid to an intermediary in return for placing a retrocession of reinsurance.

Blanket policy covers the entire staff without showing names or 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 organization makes adequate enquiries into the antecedents of employees. The references that the employer obtains must be available to the insurers in the event of a claim. The policy is granted only to large firms of repute.

In an insurance, Proximate cause is the immediate effective cause of an insured loss. It was defined in the case of Pawsey v. Scottish Union & National as “the active efficient cause which sets in motion a train of events, which brings about a result, without the intervention of any force, started and working actively from a new and independent source”.

Rural hospitals have been set up and these include the sub-district hospitals which are known as the sub-divisional / taluk / specialty hospitals (estimated to be about 2000 in the country).

IRDAI has mandated special provisions for insured persons who are senior citizens:

1. The premium charged for health insurance products offered to senior citizens shall be fair, justified, transparent and duly disclosed upfront.
2. The insured shall be informed in writing of any underwriting loading charged over and above the premium and the specific consent of the policyholder for such loadings shall be obtained before issuance of a policy.
3. All health insurers and TPAs shall establish a separate channel to address the health insurance related claims and grievances of senior citizens.

Correct Answer: A warranty is a condition which is implied without being stated in the policy.

The value of premiums that could be derived by persuading the customer to buy additional products is known as Potential value. Potential value is defined as the profit or value delivered by a customer if he behaves ideally, i.e., the customer purchases all products or services he currently buys in the market at full price at the focal company.

Liability insurance can insure the doctor against claims of negligence. In case of liability policies, the sum insured is the liability exposure of the industrial units based on the degree of exposure and geographical spread. Additional legal costs and expenses may also form part of claim compensation. The sum insured is decided by the insured based on the above parameters.

Whenever a surveyor finds that a vehicle is either beyond repairs or the repairs are not on an economic proposition, he negotiates with the insured to assess the loss on a total loss basis - for a reasonable sum representing the market value of the vehicle immediately prior to the loss.

In motor insurance, one of the warranties is that vehicle should not be used for speed testing.

Any event that causes a loss and which may be included or excluded in an insurance policy is known as Peril. For example, an insured peril in a fire policy is fire; an excluded peril is war.  

The terms and conditions applicable for coverage under Marine Cargo Insurance are governed by:-

i. Inland Transit Clause (ITC)
ii. Institute Cargo Clause (ICC)
iii. Institute Cargo (Air) Clause

Insurance Regulatory and Development Authority (IRDA) has created a special category of insurance policies called micro-insurance policies to promote insurance coverage among economically vulnerable sections of society. The IRDA Micro-insurance Regulations, 2005 defines and enables micro-insurance.

Barriers to effective communication can arise at various steps of the process. Communication can get distorted because of the impression created about the sender, or because the message has been poorly designed, or because too much or too little has been conveyed, or because the sender has not understood the receiver‟s culture.

The time limit for submission of claim documents is normally fixed at 15 days from the date of discharge. This enables quick and accurate reporting of claims, and also enables the insurer to carry out investigations wherever required.

Employee theft is defined as any stealing, use or misuse of an employer’s assets without permission. Such a theft will not be covered under Burglary insurance.

A Non-Banking Financial Company (NBFC) is a company registered under the Companies Act, 1956. It is engaged in the business of loans and advances, acquisition of shares/stocks/bonds/debentures/securities issued by Government or local authority or other marketable securities of alike nature, leasing, hire-purchase, insurance etc.

For private cars/ scooters/ motorcycles,there are two zones of operation,which are:
1.Zone A : Ahmedabad, Bangalore, Chennai, Hyderabad, Kolkata, Mumbai, New Delhi and Pune
2.Zone B : Rest of India.
For commercial vehicles,there are three zones of operation,which are:

1. Zone A : Chennai, New Delhi, Kolkatta and Mumbai
2. Zone B : All other state capitals
3. Zone C : Rest of India 

With an objective to provide a forum for resolving disputes and complaints from the aggrieved insured, public or their legal heirs against Insurance Companies, the Government of India, in exercise of powers conferred on it u/s 114(1) of Insurance Act, 1938 and framed "Redressal of Public Grievances Rules, 1998", which came into force with effect from 11^th November, 1998.

Contractor Plant and Machinery Policy can be extended to cover:

-third party liability - personal injury and property damage
-damage to owner's surrounding property 

A third-party administrator (TPA) is an organization that processes insurance claims or certain aspects of employee benefit plans for a separate entity. The TPAs are not authorized to sell insurance but they provide administrative services to insurance companies.

Personal risks can be classified into four main types:

(i)         Risk of premature death
(ii)        Risk of old age
(iii)       Risk of sickness
(iv)       Risk of unemployment

Contractors' All Risks insurance (CAR) (also referred to as Contract Works or Construction Insurance) typically provides cover for the cost of physical loss or damage to building works, advanced loss of revenue/income, public liability, installation and constructional plant/machinery including hired-in plant and tools .