Claim

The claims process is the most critical touchpoint between an insurer and its commercial policyholder. In India, the general insurance claims process is governed by IRDAI's Protection of Policyholders' Interests Regulations, which mandate timelines for claim acknowledgment, survey appointment, and settlement. For commercial lines, the process typically begins with the insured notifying the insurer promptly after the occurrence of a loss event, as delay in notification can prejudice the claim.

Once a claim is lodged, the insurer appoints an IRDAI-licensed surveyor and loss assessor to investigate the cause and quantum of loss. For large commercial claims, specialist surveyors with expertise in the relevant industry are engaged. The surveyor conducts a physical inspection, reviews documentation such as invoices, stock registers, financial statements, and maintenance records, and submits a detailed survey report to the insurer with a recommended settlement amount.

The insurer then evaluates the survey report, applies policy terms including deductibles, average clauses, and depreciation, and arrives at the admissible claim amount. Under IRDAI guidelines, insurers must settle or reject a claim within 30 days of receiving the surveyor's final report. If the claim is rejected, the insurer must provide written reasons.

In Indian commercial insurance, claims disputes frequently arise over the applicability of exclusions, the valuation methodology, the application of the average clause in cases of underinsurance, and the extent of business interruption losses. Policyholders can escalate disputes through the insurer's internal grievance mechanism, the IRDAI Ombudsman, or the consumer courts.

Efficient claims handling is a key differentiator among Indian insurers. Businesses increasingly evaluate insurers not just on premium pricing but on their claims settlement track record, measured by the incurred claims ratio and turnaround times published by IRDAI annually.