Insurance Policies and Claims

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”.

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.

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.

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 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

'Composite insurance agent' means an individual who is appointed as an insurance agent by two or more insurers. He cannot act as insurance agent for more than one life insurer, one general insurer, one health insurer and one of each of the mono-line insurers.