Sunday, May 15, 2011

The Basics - What Insurance Is, Why Do You Need Insurance?

According to Wikipedia, insurance is:
"Insurance, in law and economics, is a form of risk management primarily used to hedge against the risk of a contingent loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for a premium, and can be thought of as a guaranteed small loss to prevent a large, possibly devastating loss"
Insurance can be Personal or Business one, but the main goal of insurance is to insure you or your business against a possible loss. Term insurance can be described as:
- A small loss that prevents a large, possibly devastating loss.
Insurance protects you against financial loss in a future if you have an accident. Insurance is a contract between you - a policyholder (person or entity buying the insurance), and the insurance company. Policyholder's payments are called premium.


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There are a lot of types of insurance, but let's stick with the main ones:
Auto Insurance
Auto insurance also known as
- vehicle insurance
- car insurance
- motor insurance
It is purchased for cars, trucks, motorcycles and other vehicles. The primary use of auto insurance is to provide protection against losses incurred as a result traffic accidents.
There were more than 180 million automobiles in USA in 2006. About 175 million were covered by auto insurance companies. It's the largest auto insurance market in the world. There are more than 35 million automobiles in Russia. About 34 million are insured as well. China - 10 million insured automobiles.
Auto insurance provides:
a) Property coverage - it pays for thief or damage of your car
b) Medical coverage - it pays for your responsibility to others for bodily injury or property damage
c) Liability coverage - it pays for the cost of treating injuries, lost wages or even funeral costs.
Insurance premium varies for males and females, teenagers and adults. According to the statistics males drive more miles than females and consequently have a proportionally higher accident involvement at all ages. Teenagers who have no driving record will have higher car insurance premiums as well.
Owners of sport cars, motorcycles would have higher insurance premiums as opposed to compact cars, midsized cars and electric cars.
Your auto insurance policy is a contract, most polices are issued from six months to one year period. In USA, Russia, Brazil, Japan auto insurance company should notify you by mail, phone or any other method to renew your policy.
Home Insurance
As auto insurance, home insurance provides compensation or insure you against damage of a home from disasters. Sometimes it's called hazard insurance or homeowners insurance as well. In the real estate industry it is abbreviated as HOI.
This is the type of insurance that covers private homes. It can include:
- losses occurring to one's home
- loss of home use
- home contents
- loss of other personal possessions of the homeowner
In some geographical areas, it is necessary to buy additional insurance plan for certain types of disasters, for example:
- flood insurance
- earthquakes
- war
They excluded from original policy plan and require additional coverage. Home insurance policy is a lengthy contract. It names what will and what will not be paid in the case of various events. It can be seasonal or long term.
Home insurance company should notify you by mail, phone or any other method to renew your policy.
Health Insurance
Health insurance is the type of insurance that pays for medical expenses. It also known as:
  • health coverage
  • health care coverage
  • health benefits
Policy can be purchased by individual or company on group basis to cover its employees. Health insurance policy is a lengthy contract. Policyholders should pay premiums to help protect themselves from unexpected healthcare expenses. Insurance contract can be renewable annually or monthly.
In 2008 approximately 84% of USA citizens have health insurance:
  • About 9% purchase health insurance directly
  • About 60% obtain it through an employer
  • About 20% of Americans obtain health insurance from various government agencies.
In 2006, there were 16% of Americans (47 million people) who were without health insurance. Average spending is higher in the individual market. Many medical expense plans include coverage for dental expenses. Stand-alone dental insurance is also available.
Health care system is mainly in private hands in USA. Hospitals and doctors generally funded by payments from patients and insurance.
Hospitals provide some outpatient care in their emergency rooms and specialty clinics, but primarily exist to provide inpatient care.
In 2008 a report by the Commonwealth Fund ranked the USA last in the quality of health care among the 19 compared countries. According to the Institute of Medicine of the National Academy of Sciences, the United States is the "only wealthy, industrialized nation that does not ensure that all citizens have coverage".
Life Insurance
Life insurance is also known as life assurance. Insurer (or Life Insurance Company) agrees to pay sum of money upon the occurrence of the policyholder's death, illness, critical illness, terminal illness or other event. Policyholder pays a fee at regular intervals or in lump sums. This fee is called a premium.
Life insurance can be:
  • Temporary.
It's life insurance coverage for a specified term of time for a specified fee (premium). Usually premium buys protection in the event of death and nothing else.
  • Permanent
Type of insurance that remains in force until the policy matures (in other words pays out), unless the policyholder fails to pay the specified fee when due.
As with most insurance policies, life insurance is a contract between the insurer and the policyholder whereby a benefit is paid to the designated beneficiaries if an insured event occurs which is covered by the policy.
Insured events that may be covered include:
  • Protection policies
  • Investment policies
  • Illness
Each contract may include limitations of the insured events. Usually they a written to limit the liability of the policyholder: for example claims relating to war, suicide or fraud. Any misrepresentations by the insured on the application will cause the nullification of the contract.
Upon the insured's death or illness the insurance company requires acceptable proof before it pays the claim. For example list of necessary documents that required upon the policyholder's death:
  • Death certificate
  • Completed, signed and notarized claim form
If insured's death looks suspicious, it can be investigated by insurance company before deciding whether it has an obligation to pay the claim. Proceeds from the policy may be paid as a lump sum or as an annuity.
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Insurance In Tort Laws

INTRODUCTION
This project has been an eye opener for me. It is extremely relevant to the modern times and as the future of India we should understand that it is the common mass that runs the country. Consumer protection rights are an important issue in modern days. The law can be effectively used to stop any abuse of the common people especially illiterate masses who do not understand the rules and regulations which is to be followed while buying particular item. It is law, the controller of the entire society which can stop this abuse from taking place. It can place effective standards guiding a product's genuinity and the proper verification of its price. No extra taxes should be issued according to the seller's wish. I have proceeded by referring to the books written by Avtar Singh, Venkat Rao and others. It has been a wonderful and educational delight in going about this topic and making a project which is of greatest importance in the present day scenario.


DEFINITION OF CONSUMER
The words "consumer", "consumed", "consumption" is all cognate, and when one is defined, the contents of the definition go into all of them wherever they occur in the same act.
Section 2 of the act wherein 'consumer' is defined. According to him, the definition of the consumer will not take a client who engaged the advocate for professional services.
Consumer means any person who-
- Buys any goods for a consideration which has been paid or promised or partly paid and partly promised or under any system or deferred payment and includes any user of such goods other than the person who buys such goods for consideration paid or promised or partly promised or under any system of deferred payment when such use is made with the approval of the person, but does not include a person who obtains such goods for resale or for any commercial purpose
- Hires or avails of any services for a consideration which has been paid or promised or partly paid or partly promised or under any system of deferred payment and includes any beneficiary of such services other than the person who hires or avails of the services for the consideration paid or promised or partly paid or partly promised or under any system of deferred payment when such services are availed of with the approval of the first mentioned person but does not include a person who avails of such services for any commercial support
In Black's Law Dictionary it is to mean:
One who consumes. Individuals who purchase, use, maintain or dispose of products and services. A member of that broad class of people who are influenced by pricing policies, financing practices, quality of goods and services, credit reporting debt collection and other trade practices for which the state and federal consumer laws are enacted.
OBJECTVES OF THE ACT
The act is dedicated, as its preamble shows, to provide for better protection of rights of consumers and for that purpose to make provisions for the establishment of consumer councils and other authorities for settlement of consumer disputes and for other connected matters. In the statement of objects, reasons it is said that and the act seeks to provide speedy and simple redressal to consumer disputes. Quasi judicial body machinery has been set up at the district, state and central levels. These quasi judicial bodies have to observe the principle of natural justice and have been empowered to give relief to a specific nature and to award, wherever appropriate, compensation to consumers. Penalties for non compliance of orders given by quasi judicial bodies have also been provided.
The object and purpose of rendering the act is to render simple, inexpensive and speedy remedy to consumers with complaints against defective goods and deficient services and for that quasi judicial machinery has been sought to be set up at the district, state and national levels. These quasi judicial bodies are required to apply the principle of natural justice and have been empowered to give relief of specific nature and appoint wherever necessary, compensation to consumers.
INSURANCE
An operational definition of insurance is that it is
- the benefit provided by a particular kind of indemnity contract, called an insurance policy;
- that is issued by one of several kinds of legal entities (stock company, mutual company, reciprocal, or Lloyd's syndicate, for example), any of which may be called an insurer;
- in which the insurer promises to pay on behalf of or to indemnify another party, called a policyholder or insured;
- That protects the insured against loss caused by those perils subject to the indemnity in exchange for consideration known as an insurance premium.
The influence of insurance on the law of torts has been significant, both on theoretical level and on practice. Insurance has undermined one of the two main functions of awarding of damages, and it has in cast doubt on the value judgements made by the courts in determining which particular test of liability is appropriate in the given circumstances.
Regardless of whether in the particular circumstances the appropriate principle of liability is intention is malice, fault or strict liability, the purpose of common law damages remains the same. The primary purpose of an award of damages is to compensate the victim for his loss, with view to restoring him as near as possible to the position he would have been in but for the tort of the wrongdoer. But damages have another: by making the wrongdoer responsible for meeting an award of damages, the courts are trying to deter others from committing similar tortuous wrongs.
Insurance vitiates the secondary purpose of damages, at the same time incidentally ensuring that the primary purpose is more often achieved.
It can scarcely be realistically asserted that insured defendants are deterred by the prospect of losing no-claims bonus or by increasing of premium on renewal of their policies. Once it is conceded that insurance renders compensation for the sole purpose of damages but then the tort action itself becomes vulnerable to attack, for there are many ways-some perhaps fairer and administratively cheaper than tort- of compensating a victim for a loss he has suffered.
Prima facie, where a person suffers loss of recognized kind as the result of another's act, then the latter should have to make good that loss. But for valid reasons, the courts have held that, in certain circumstances, the actor will have to compensate his victim only if he is at fault. The victim's right to compensation is, therefore curtailed in an attempt to be fair to both the parties. The courts have made a policy decision that, in the circumstances, it is right to reward a defendant who has been careful by protecting him from liability for the consequences of his actions and that, as a corollary the plaintiff must forego his compensation. The policy decision is made on the supposition that the wrongdoer would himself have to pay for the damages but for this protection; it by no means follows that the same decision would be made if there were no risk of the wrongdoer having to provide the compensation.
It is difficult to judge the victim's right to compensation should be curtailed when that curtailment is not justified by a corresponding benefit to the wrongdoer. The requirement of fault ceases to play its role as the leveler between the victim's legitimate expectations and the wrongdoer's legitimate expectations, and becomes simply a hurdle to the victim's progress to compensation. If it is accepted that no one can insure against liability for harm caused by intentionally to another , then similar arguments can be made by the inappropriateness of the victim's having, in certain circumstances to prove an intention to do him wrong or harm, when it is irrelevant to the wrongdoer whether he had such an intention or not.
Again the victim's right to compensation is being curtailed without any corresponding benefit to the wrongdoer.
However, insurance has influenced the law of tort on a much more practical level as well. While the fact of insurance is not of itself a reason for imposing liability , there can be no doubt that it does add "a little extra tensile strength" to the chain which a wrongdoer to his responsibilities.
As well it has given new horizon to damages ; it is true that traditionally it was considered to inform the court that a defendant was insured , but "those days are long past" and now it is frequently openly recognized that the defendant would be insured.
The policy of insurance constitutes a contract of insurance between Life Insurance Corporation or a subsidiary of General Insurance Company of India, as the case may be, such services such has been undertaken to render under the contract of insurance. However as a rule, occasion to render services arise only when insured surrenders his policy, or the policy matures for payment or the insured dies or any other contingency which gives rise to render service occurs.
Breach of contract of insurance may give rise to a cause of action to file a civil suit, but such breach of contract may itself constitute deficiency in service, so as to give a cause of action to file a complaint under the consumer protection act for one such more relieves awardable hereunder.
Section 13(4) of the act vests in a redressal agency powers of the Civil Court, while trying a suit in respect of such matters as examination of witnesses on oath and production of documents. Declining to exercise jurisdiction in a case before it only because it involves examination and cross examination of facts, witnesses and production and consideration of documents would amount to abdication of its jurisdiction.
Such discretion can be exercised only when the gives rise to several issues and necessities taking of voluminous oral and documentary evidence, or otherwise involve complex questions of fact and law which cannot be decided in time bound proceedings under the consumer protection act.
MOTOR VEHICLE INSURANCE
Where the sale of a vehicle is complete, the title therein passes to the purchaser notwithstanding that his name has not been recorded in the R.C.Book. Such owner is entitled to get his vehicle insured and also to maintain a claim on the basis of such insurance. The earlier owner, who has lost insurable insurance on the sold vehicle, cannot advance a claim on the basis of policy of the said vehicle, earlier taken by him, on the ground that he is still the recorded owner of the said vehicle.
Section 157 of the motor vehicles act is only in respect of third party risks and provides that the certificate of insurance described therein shall be deemed to have been transferred in favour of the person to whom the motor vehicle is being transferred. It does not apply to other risks, if any, covered by the policy. If the transferee wants to avail the benefits of other risks covered by it, he has to enter into an agreement thereof with the investor.
FRAUD BY INSURER
If it is established that the discharge voucher was obtained by fraud, misrepresentation, undue influence or coercive bargaining or compelled by circumstances, the authority of the consumer forum may be justified in granting relief. Mere execution of the discharge voucher would not deprive the consumer of his claim in deficiency of service.
DELAY IN SETTLEMENT OF CLAIM
In Sarveshwar Rao v. National Insurance Company Ltd. , it was held that the delay of two or more years in settling the insurance claim would result in inadequacy in the quality, nature and manner of the service which the insurance company has undertaken to render, and amounts to deficiency in service.
In Delkon India Pvt. Ltd. V. The Oriental Insurance Company Ltd. . The National Commission has held that it was a deficiency of service to have delayed the claim by two years on the ground that the final police report was not coming.
INTERPRETATION OF TERMS
In Skandia Insurance Company v. Kokilaben Chandravadan , the honorable Supreme Court ruled that the exclusion terms of the insurance must be read with so as to serve the main purpose of the policy, which is to indemnify the damages caused to the vehicle.
CONDUCT OF THE INSURER
In Oriental Insurance Co. Ltd. V. Mayur Restaurant and bar , the conduct of the insurer was under question. The commission held that deficiency of the service was established on the part of the opposite party on two counts i)delay in settlement of claims and ii) unreasonable and un maintainable reasons for repudiating the claim of the complainant, and the compensation with the interest and cost was awarded.
SUICIDE BY THE ASSURED
In Life Insurance Corporation v Dharma Vir Anand, the national commission refused to hold the insurance commission liable as the insured committed suicide before the expiry of three years from the date of the policy.
BREACH OF TERMS
In B.V.Nagarjuna v Oriental Insurance Company Ltd., the terms of insurance contract permitted the insured vehicle to carry six passengers at a time but the driver allowed two more persons to get in. It was held that merely adding two more persons without the knowledge of the driver did not amount to indemnification by the insurance company.
NOMINEE'S RIGHTS
In Jagdish Prakash Dagar v. Life Insurance Corporation , it was held that a nominee under a policy of life insurance will be a consumer within the meaning of section 2(1) (d) of the Consumer Protection Act. The commission held that the nominee could legislatively maintain an action against deficiency raised in service by the arbitrary decision of the insurer.
REPUDIATION
Repudiation is defined as the renunciation of a contract (which holds a repudiator liable to be sued for breach of contract, and entitles the repudiatee on accepting the repudiation to treat the contract as at an end
This concept of repudiation is needed in the concept of insurance. The concept of repudiation will be dealt hereto a number of times and to provide beneficiary evidence, the definition has been given.
Unilateral repudiation of its liability, under the contact of by the life insurance corporation or an insurance company does not, by itself oust the jurisdiction of a redressal agency, to go into the sustainability of such repudiation, on facts and in law and to decide and to adjudicate if, in the facts of the case, it amounts to deficiency in service or unfair trade practice, and if so, to award to the aggrieved person, such relief or reliefs under Section 14(1) of the said Act as he or she is entitled to. The fact that before such repudiation it obtained a report from a surveyor or surveyors also does not oust the jurisdiction of a redressal agents to into the merits of such repudiation, for otherwise in each case the corporation or such company, and deprived the aggrieved person of the cheap and expeditious remedy under the consumer protection act.
Where, however the corporation or the company conducts thorough investigations into the facts which have given rise to claim and other associated facts, and repudiates the claims in good faith after exercise with due care and proper application of mind, the redressal agency should decline to go into the merits of such repudiation and leave the aggrieved person to resort to the regular remedy of a suit in a civil court.
The law does not require the life insurance corporation or an insurance company to accept every claim good or bad, true or false, but it does require the corporation or the company to make a thorough investigation into such claim and to take decisions on it, in good faith, after exercise of due care and proper application of mind and where it does so it renders the service required by it and cannot be charged with deficiencies in service, even if, in the ultimate analysis, such decisions is wrong on the facts and in law and the redressal agency would be disinclined to substitute its own judgement in the place of the judgement of the corporation or insurance company.
The question as to whether repudiation of its liability does or does not amount to deficiency in service would depend upon the facts of each case.
Where a cheque sent towards a premium is dishonoured by the drawee bank and consequently the policy is cancelled or it lapses or the injured dies before the proposal is accepted and contract of insurance results, no claim can be founded in such a policy, which was cancelled or has since lapsed, or a contract of insurance, which did not materialize at all. Repudiation of such claim can never amount to deficiency in service.
Insurance agent is not entitled to collect premium on behalf of the corporation. Where an insured issues a bearer cheque towards premium and hands it over the insurance agent who encashes it, but does not deposit the premium with the corporation event till the expiry of the grace period and consequently the policy lapses and meanwhile the insured also dies, his nominee has to blame himself or herself for the indiscretion of the insured and cannot blame or fault the corporation.
BASIC PRINCIPLES OF INSURANCE
There are some basic principles concerning the topic of Consumer Protection Law and Insurance.
- Settlement of insurance claim is service, default or negligence therein is deficiency of that service
In the case of Shri Umedilal Agarwal v. United India Assurance Co. Ltd, the National Commission observed as under:
"We find no merit in the contention put forward by the insurance company that a complaint relating to the failure on the part of the insurer to the settle the claim of the insured within a reasonable time and the prayer for the grant of compensation in respect of such delay will not within the jurisdiction of the redressal forums constituted under the consumer protection act.
The provision of facilities in connection with insurance has been specifically included within the scope of the expression "service" by the definition of the said word contained in section 2(i) (o) of the act. Our attention was invited by Mr. Malhotra, learned counsel for the insurance company to the decision of the Queen's Bench in national transit co. ltd. V. customs and central excise commissioners . The observations contained in the said judgement relating to the scope of the expression insurance occurring in the schedule of the enactment referred to therein are of no assistance to all of us in this case because the context in which that expression is used in the English enactment considered in that case is completely different. Having regard to the philosophy of the consumer protection act and its avowed object of providing cheap and speedy redressal to customers affected by the failure on the part of persons providing service for a consideration, we do not find it possible to hold that the settlement of insurance claims will not be covered by the expression insurance occurring in section 2(1)(d).Whenever there is a fault of negligence that will constitute a deficiency in the service on the part of the insurance company and it will perfectly open to the concerned aggrieved customer to approach the Redressal Forums under the act seeking appropriate relief."
- L.I.C. Agent has no authority in collecting the premium
The supreme court held that under regulation 8(4) of life insurance corporation of India (agents) regulation, 1972 which had acquired the status of life insurance corporation agents rules with effect from January 31, 1981, which were also published in the gazette, LIC agents were specifically prohibited from collecting premium on behalf of LIC and that in view thereof an inference of implied authority cannot also be raised.
- Rejection of claim as false after full investigation
The national commission held as follows:
" from the facts disclosed by the record and particularly averments contained in the consumer affidavit filed by the first respondent it is seen that the insurance company had fully investigated into the claims put forward by the complainant that his claim was rejected. Thus it is not a case where the insurance company did not take a prompt and immediate option for deciding the claims against the insurance company. Having regards to the facts and circumstances of this case and the nature of the controversy between the parties we consider that this is a matter that should be adjudicated before a civil court where the complainant as well as the respondent will have ample opportunities to examine witnesses at length, take out the commission for local inspections etc. and have an elaborate trial of the case."
- Unilateral reduction in the insurance amount.
The national commission held that the insurance company is not entitled to make a unilateral reduction of Rs. 4, 29,771 from Rs. 30, 12,549 at which its own surveyor assessed the loss.
- Mere repudiation does not render the complaint not maintainable.
The national commission overruled the objection of the insurance company that merely because the insurer had totally repudiated its liability in respect of the claim, no proceedings could validly be initiated by the insured under the consumer protection act.
- Mere unilateral repudiation does not oust the jurisdiction.
The national commission held that merely because the insurer has repudiated the insurance claim under the policy unilaterally, it is difficult to hold that the various redressal forums constituted under the consumer protection act, 1986 will have no jurisdiction to deal with the matter that if such a contention of the insurance company can get a report from the surveyors, repudiate the claim and oust the jurisdiction of the redressal forums, that the redressal forums are, therefore, bound to see whether or not the repudiation was made in good faith on valid and justifiable grounds that if the surveyor or surveyors choose to submit the wrong report and the insurance company repudiates the claims without applying its mind then the repudiation cannot be said to be justified that the report of the surveyor will show that the investigations have been proper, fair and thorough and that it has to be remembered that the surveyors bread comes from the employer.
- Mere unilateral repudiation no ground to oust jurisdiction.
The national commission repelled the objection and observed as under:
"Ordinarily a remedy is available to a consumer in Civil Court but mere repudiation of claim arising out of policy of insurance under section 45 of the insurance act, 1938, cannot take away the jurisdiction of the redressal forum constituted under the act. The avowed object of the act is to provide cheap, speedy and efficacious remedy to the consumers and it is with this object that section 3 of the act lies down as follows:
3. Act not in derogation of the provisions of any other law: - the provisions of this act shall be in addition to and not in derogation of the provisions of any other law for the time being in force."
The national commission overruled the objection in the view of repudiation of contract of insurance by the corporation; the redressal agencies under the act cannot entertain the claim of the insured and reiterated the law laid down by it in the Divisional Manager, Life insurance Corporation of India, Andhra Pradesh v. Shri Bhavnam Srinivas Reddy.
- Removal of insured goods on attachment no theft.
It was ruled in the stated case that attachment of certain items of insured Machinery and goods by the bailiff of a civil court, though later found to be illegal and consequent removal did not amount to theft and or house breaking by force so as to entitle the insured to prefer a claim under the policy.
- When repudiation amounts to deficiency and when it does not?
The national has held:
In M/s Rajdeep Leasing and Finance and others v. New India Assurance Company Limited and others -
That rejection of the claim by the insurance company after examining and considering the two separate survey reports from qualified surveyors and three legal opinions from different oriental counsels could not be said to constitute a deficiency in service so as to give a rise in the cause of action for a complaint under the consumer protection act.
In Oriental Insurance Co. Ltd. V Modern Industries Ltd. , the national commission has held that where the cover note inter alia mentions that the risk is subject to the usual terms and conditions of the standard policy, it is equally the responsibility of the complainant to call for these terms and conditions even if they are not sent by the insurance company, as alleged, to understand the extent of risk covered under the policy and associated aspects.
In Life Insurance Corporation of India v. Dr. Sampooran Singh
The complainant had taken out an insurance policy of 40,000 rupees in 1982, for the purpose of payment of estate duty on his only residential house in chandigarh in the event of his death and paid 5 premia, but with the abolition of estate duty on one residential house owner in 1985, the policy became inoperative due to the act of the state and not due to any deficiency on the part of the corporation any dispute between the parties as to the amount payable there under cannot be construed as deficiency in service on part of the corporation.
In LIC of India v M/s Kanchan Murlidhar Akkalwar
The complainant applied to the opposite party for housing loan, and on the advice of the latter, she took two LIC policies, one for Rs. 90000 and the other for Rs. 20000 entered into an agreement for the purchase of the house with the house with the owner on the advice of the opposite party obtained a fire policy for Rs. 2 lakhs. The opposite party advised the complainant to obtain a release deed from the zilla parishad co operative society in respect of the she proposed to purchase with a certificate that the said plot is not mortgaged therein. The complainant got a certificate from the Maharashtra government that the vendor had re paid the housing loan and interest thereon due to Zilla Parishad Krishi Karmachari Sehakari Gribe Narman Sanstha and that there was nothing outstanding from him towards loan amount or interest. Still the opposite party did not release the loan. On these facts the national commission by its majority judgement observed that:
"We have carefully gone through the records and heard the counsel. Clause 1 (c) of the loan offer letter clearly states that the advance of the loan is subject to the property being free from encumbrances to the satisfaction of the insurance company and a good and marketable title. At the same time it appears that the respondent-complainant had to go through a number of steps, although necessary, having financial implications and causing mental and physical stress to her and at the end of all of which she was told that no dues certificate given by the maharashtra government in respect of the prospective seller of the property in question, was not "release of mortgage" certificate that was obtained. The respondent complainant perhaps also had in her mind the case of Mr. Vaishempayam who got the loan under similar circumstances. Thus the evasion petition is disposed of as above."
CONCLUSION
This project topic is increasingly beneficial in the modern times with the consumer protection rights being redressed with due care. It is being advertised in the mass media in our country. The slogan which our consumer is using is: "JAGO GRAHAK JAGO". The time has come to realize the ideal market situation in which the buyers are not persuaded or coerced falsely into buying items which are of no use to them at all. Besides the relationship between buyer and seller should not be damaged at any cost. The relationship between the buyer and seller is said to be a fiduciary relationship and the trust between them should remain intact. A time has come in which the customer should get his proper position in the market conditions. He has to have proper knowledge about what is going on in the market and the concerned prices and the supply and the different other practices referred to.
Insurance is a very sensitive issue in the modern times. People are being hoodwinked into signing up in companies which are turning out to be frauds in the true sense of the term. This project has been an eye opener to me and I have come to realize the importance of the consumer protection act and insurance.

Barnik Ghosh Second Year Gujarat National Law University Contact numbers: 09924509380/03324157023

21+ Useful Insurance Terms You Should Know

INSURED - A person or a corporation who contracts for an insurance policy that indemnifies (protects) him against loss or damage to property or, in the case of a liability policy, defend him against a claim from a third party.


NAMED INSURED - Any person, firm or corporation specifically designated by name as an insured(s) in a policy as distinguished from others who, though unnamed, are protected under some circumstances. For example, a common application of this latter principle is in auto liability policies wherein by a definition of "insured", coverage is extended to other drivers using the car with the permission of the named insured. Other parties can also be afforded protection of an insurance policy by being named an "additional insured" in the policy or endorsement.
ADDITIONAL INSURED - An individual or entity that is not automatically included as an insured under the policy of another, but for whom the named insureds policy provides a certain degree of protection. An endorsement is typically required to effect additional insured status. The named insureds impetus for providing additional insured status to others may be a desire to protect the other party because of a close relationship with that party (e.g., employees or members of an insured club) or to comply with a contractual agreement requiring the named insured to do so (e.g., customers or owners of property leased by the named insured).
CO-INSURANCE - The sharing of one insurance policy or risk between two or more insurance companies. This usually entails each insurer paying directly to the insured their respective share of the loss. Co-insurance can also be the arrangement by which the insured, in consideration of a reduced rate, agrees to carry an amount of insurance equal to a percentage of the total value of the property insured. An example is if you have guaranteed to carry insurance up to 80% or 90% of the value of your building and/or contents, whatever the case may be. If you don't, the company pays claims only in proportion to the amount of coverage you do carry.
The following equation is used to determine what amount may be collected for partial loss:
Amount of Insurance Carried x Loss
Amount of Insurance that = Payment
Should be Carried
Example A Mr. Right has an 80% co-insurance clause and the following situation:
$100,000 building value
$ 80,000 insurance carried
$ 10,000 building loss
By applying the equation for determining payment for partial loss, the following amount may be collected:
$80,000 x $10,000 = $10,000
$80,000
Mr. Right recovers the full amount of his loss because he carried the coverage specified in his co-insurance clause.
Example B Mr. Wrong has an 80% co-insurance clause and the following situation:
$100,000 building value
$ 70,000 insurance carried
$ 10,000 building loss
By applying the equation for determining payment for partial loss, the following amount may be collected:
$70,000 x $10,000 = $8,750
$80,000
Mr. Wrong's loss of $10,000 is greater than the company's limit of liability under his co-insurance clause. Therefore, Mr. Wrong becomes a self-insurer for the balance of the loss-- $1,250.
PREMIUM - The amount of money paid by an insured to an insurer for insurance coverage.
DEDUCTIBLE - The first dollar amount of a loss for which the insured is responsible before benefits are paid by the insurer; similar to a self-insured retention (SIR). The insurer's liability begins when the deductible is exhausted.
SELF INSURED RETENTION - Acts the same way as a deductible but the insured is responsible for all legal fees incurred in relation to the amount of the SIR.
POLICY LIMIT - The maximum monetary amount an insurance company is responsible for to the insured under its policy of insurance.
FIRST PARTY INSURANCE - Insurance that applies to coverage for an insureds own property or a person. Traditionally it covers damage to insureds property from whatever causes are covered in the policy. It is property insurance coverage. An example of first party insurance is BUILDERS RISK INSURANCE which is insurance against loss to the rigs or vessels in the course of their construction. It only involves the insurance company and the owner of the rig and/or the contractor who has a financial interest in the rig.
THIRD PARTY INSURANCE - Liability insurance covering the negligent acts of the insured against claims from a third party (i.e., not the insured or the insurance company - a third party to the insurance policy). An example of this insurance would be SHIP REPAIRER'S LEGAL LIABILITY (SRLL) - provides protection for contractors repairing or altering a customer's vessel at their shipyard, other locations or at sea; also covers the insured while the customer's property is under the "Care, Custody and Control" of the insured. A Commercial General Liability policy is needed for other coverages, such as slip-and-fall situations.
INSURABLE INTEREST - Any interest in something that is the subject of an insurance policy or any legal relationship to that subject that will trigger a certain event causing monetary loss to the insured. Example of insurable interest - ownership of a piece of property or an interest in that piece of property, e.g., a shipyard constructing a rig or vessel. (See BUILDERS RISK above)
LIABILITY INSURANCE - Insurance coverage that protects an insured against claims made by third parties for damage to their property or person. These losses usually come about as a result of negligence of the insured. In marine construction this policy is referred to an MGL, marine general liability policy. In non marine circumstances the policy is referred to as a CGL, commercial general liability policy. Insurance policies can be divided into two broad categories:
  • First party insurance covers the property of the person who purchases the insurance policy. For example, a home owner's policy promising to pay for fire damage to the home owner's home is a first party policy. Liability insurance, sometimes called third party insurance, covers the policy holder's liability to other people. For example, a homeowners' policy might cover liability if someone trips and falls on the home owner's property. Sometimes one policy, such as in these examples, may have both first and third party coverage.
  • Liability insurance provides two separate benefits. First, the policy will cover the damage incurred by the third party. Sometimes this is called providing "indemnity" for the loss. Second, most liability policies provide a duty to defend. The duty to defend requires the insurance company to pay for lawyers, expert witnesses, and court costs to defend the third party's claim. These costs can sometimes be substantial and should not be ignored when facing a liability claim.

UMBRELLA LIABILITY COVERAGE - This type of liability insurance provides excess liability protection. Your business needs this coverage for the following three reasons:
  • It provides excess coverage over the "underlying" liability insurance you carry.
  • It provides coverage for all other liability exposures, excepting a few specifically excluded exposures. This subject to a large deductible of about $10,000 to $25,000.
  • It provides automatic replacement coverage for underlying policies that have been reduced or exhausted by loss.

NEGLIGENCE - The failure to use reasonable care. The doing of something which a reasonably prudent person would not do, or the failure to do something which a reasonably prudent person would do under like circumstances. Negligence is a 'legal cause' of damage if it directly and in natural and continuous sequence produces or contributes substantially to producing such damage, so it can reasonably be said that if not for the negligence, the loss, injury or damage would not have occurred.GROSS NEGLIGENCE - A carelessness and reckless disregard for the safety or lives of others, which is so great it appears to be almost a conscious violation of other people's rights to safety. It is more than simple negligence, but it is just short of being willful misconduct. If gross negligence is found by the trier of fact (judge or jury), it can result in the award of punitive damages on top of general and special damages, in certain jurisdictions.
WILLFUL MISCONDUCT - An intentional action with knowledge of its potential to cause serious injury or with a reckless disregard for the consequences of such act.
PRODUCT LIABILITY - Liability which results when a product is negligently manufactured and sent into the stream of commence. A liability that arises from the failure of a manufacturer to properly manufacture, test or warn about a manufactured object.
MANUFACTURING DEFECTS - When the product departs from its intended design, even if all possible care was exercised.
DESIGN DEFECTS - When the foreseeable risks of harm posed by the product could have been reduced or avoided by the adoption of a reasonable alternative design, and failure to use the alternative design renders the product not reasonably safe.
INADEQUATE INSTRUCTIONS OR WARNINGS DEFECTS - When the foreseeable risks of harm posed by the product could have been reduced or avoided by reasonable instructions or warnings, and their omission renders the product not reasonably safe.
PROFESSIONAL LIABILITY INSURANCE - Liability insurance to indemnify professionals, (doctors, lawyers, architects, engineers, etc.,) for loss or expense which the insured professional shall become legally obliged to pay as damages arising out of any professional negligent act, error or omission in rendering or failing to render professional services by the insured. Same as malpractice insurance.
Professional Liability has expanded over the years to include those occupations in which special knowledge, skills and close client relationships are paramount. More and more occupations are considered professional occupations, as the trend in business continues to grow from a manufacturing-based economy to a service-oriented economy. Coupled with the litigious nature of our society, the companies and staff in the service economy are subject to greater exposure to malpractice claims than ever before.
ERRORS AND OMISSIONS - Same as malpractice or professional liability insurance.
HOLD HARMLESS AGREEMENT - A contractual arrangement whereby one party assumes the liability inherent in the situation, thereby relieving the other party of responsibility. For example, a lease of premises may provide that the lessee must "hold harmless" the lessor for any liability from accidents arising out of the premises.
INDEMNIFY - To restore the victim of a loss, in whole or in part, by payment, repair, or replacement.
INDEMNITY AGREEMENTS - Contract clauses that identify who is to be responsible if liabilities arise and often transfer one party's liability for his or her wrongful acts to the other party.
WARRANTY - An agreement between a buyer and a seller of goods or services detailing the conditions under which the seller will make repairs or fix problems without cost to the buyer.
Warranties can be either expressed or implied. An EXPRESS WARRANTY is a guarantee made by the seller of the goods which expressly states one of the conditions attached to the sale e.g.,"This item is guaranteed against defects in construction for one year".
An IMPLIED WARRANTY is usual in common law jurisdictions and attached to the sale of goods by operation of law made on behalf of the manufacturer. These warranties are not usually in writing. Common implied warranties are a warranty of fitness for use (implied by law that if a seller knows the particular purpose for which the item is purchased certain guarantees are implied) and a warranty of merchantability (a warranty implied by law that the goods are reasonably fit for the general purpose for which they are sold).
DAMAGES OR LOSS - The monetary consequence which results from injury to a thing or a person.
CONSEQUENTIAL DAMAGES - As opposed to direct loss or damage -- is indirect loss or damage resulting from loss or damage caused by a covered peril, such as fire or windstorm. In the case of loss caused where windstorm is a covered peril, if a tree is blown down and cuts electricity used to power a freezer and the food in the freezer spoils, if the insurance policy extends coverage for consequential loss or damage then the food spoilage would be a covered loss. Business Interruption insurance, extends consequential loss or damage coverage for such items as extra expenses, rental value, profits and commissions, etc.
LIQUIDATED DAMAGES - Are a payment agreed to by the parties of a contract to satisfy portions of the agreement which were not performed. In some cases liquidated damages may be the forfeiture of a deposit or a down payment, or liquidated damages may be a percentage of the value of the contract, based on the percentage of work uncompleted. Liquidated damages are often paid in lieu of a lawsuit, although court action may be required in many cases where liquidated damages are sought. Liquidated damages, as opposed to a penalty, are sometimes paid when there is uncertainty as to the actual monetary loss involved. The payment of liquidated damages relieves the party in breech of a contract of the obligation to perform the balance of the contract.
SUBROGATION - "To stand in the place of" Usually found in property policies (first party) when an insurance company pays a loss to an insured or damaged to the insureds property, the insurer stands in the shoes of the insured and may pursue any third party who might be responsible for the loss. For example, if a defective component is sold to a manufacturer to be used in his product and that product is damaged due to the defective component. The insurance company who pays the loss to the manufacturer of the product may sue the manufacturer of the defective component.
Subrogation has a number of sub-principles namely:
  • The insurer cannot be subrogated to the insureds right of action until it has paid the insured and made good the loss.
  • The insurer can be subrogated only to actions which the insured would have brought himself.
  • The insured must not prejudice the insurer's right of subrogation. Thus, the insured may not compromise or renounce any right of action he has against the third party if by doing so he could diminish the insurer's right of recovery.
  • Subrogation against the insurer. Just as the insured cannot profit from his loss the insurer may not make a profit from the subrogation rights. The insurer is only entitled to recover the exact amount they paid as indemnity, and nothing more. If they recover more, the balance should be given to the insured.
  • Subrogation gives the insurer the right of salvage.
In its history of providing insurance services to its clients for over thirty years, Nausch Hogan & Murray has provided coverage for all areas of liability - both on land and at sea.
Over the years Nausch Hogan & Murray has found it helpful to draft a glossary of useful insurance terms that come up time and again in discussions with an insured concerning their coverage needs. We hope these help you as well.

Fire Insurance Under Indian Insurance Law

A contract of Insurance comes into being when a person seeking insurance protection enters into a contract with the insurer to indemnify him against loss of property by or incidental to fire and or lightening, explosion, etc. This is primarily a contract and hence as is governed by the general law of contract. However, it has certain special features as insurance transactions, such as utmost faith, insurable interest, indemnity, subrogation and contribution, etc. these principles are common in all insurance contracts and are governed by special principles of law.


FIRE INSURANCE:
According to S. 2(6A), "fire insurance business" means the business of effecting, otherwise than incidentally to some other class of insurance business, contracts of insurance against loss by or incidental to fire or other occurrence, customarily included among the risks insured against in fire insurance business.
According to Halsbury, it is a contract of insurance by which the insurer agrees for consideration to indemnify the assured up to a certain extent and subject to certain terms and conditions against loss or damage by fire, which may happen to the property of the assured during a specific period.
Thus, fire insurance is a contract whereby the person, seeking insurance protection, enters into a contract with the insurer to indemnify him against loss of property by or incidental to fire or lightning, explosion etc. This policy is designed to insure one's property and other items from loss occurring due to complete or partial damage by fire.
In its strict sense, a fire insurance contract is one:
1. Whose principle object is insurance against loss or damage occasioned by fire.
2. The extent of insurer's liability being limited by the sum assured and not necessarily by the extent of loss or damage sustained by the insured: and
3. The insurer having no interest in the safety or destruction of the insured property apart from the liability undertaken under the contract.
LAW GOVERNING FIRE INSURANCE
There is no statutory enactment governing fire insurance, as in the case of marine insurance which is regulated by the Indian Marine Insurance Act, 1963. the Indian Insurance Act, 1938 mainly dealt with regulation of insurance business as such and not with any general or special principles of the law relating fire of other insurance contracts. So also the General Insurance Business (Nationalization) Act, 1872. in the absence of any legislative enactment on the subject , the courts in India have in dealing with the topic of fire insurance have relied so far on judicial decisions of Courts and opinions of English Jurists.
In determining the value of property damaged or destroyed by fire for the purpose of indemnity under a policy of fire insurance, it was the value of the property to the insured, which was to be measured. Prima facie that value was measured by reference of the market value of the property before and after the loss. However such method of assessment was not applicable in cases where the market value did not represent the real value of the property to the insured, as where the property was used by the insured as a home or, for carrying business. In such cases, the measure of indemnity was the cost of reinstatement. In the case of Lucas v. New Zealand Insurance Co. Ltd.[1] where the insured property was purchased and held as an income-producing investment, and therefore the court held that the proper measure of indemnity for damage to the property by fire was the cost of reinstatement.
INSURABLE INTEREST
A person who is so interested in a property as to have benefit from its existence and prejudice by its destruction is said to have insurable interest in that property. Such a person can insure the property against fire.
The interest in the property must exist both at the inception as well as at the time of loss. If it does not exist at the commencement of the contract it cannot be the subject-matter of the insurance and if it does not exist at the time of the loss, he suffers no loss and needs no indemnity. Thus, where he sells the insured property and it is damaged by fire thereafter, he suffers no loss.
RISKS COVERED UNDER FIRE INSURANCE POLICY
The date of conclusion of a contract of insurance is issuance of the policy is different from the acceptance or assumption of risk. Section 64-VB only lays down broadly that the insurer cannot assume risk prior to the date of receipt of premium. Rule 58 of the Insurance Rules, 1939 speaks about advance payment of premiums in view of sub section (!) of Section 64 VB which enables the insurer to assume the risk from the date onwards. If the proposer did not desire a particular date, it was possible for the proposer to negotiate with insurer about that term. Precisely, therefore the Apex Court has said that final acceptance is that of the assured or the insurer depends simply on the way in which negotiations for insurance have progressed. Though the following are risks which seem to have covered Fire Insurance Policy but are not totally covered under the Policy. Some of contentious areas are as follows:
FIRE: Destruction or damage to the property insured by its own fermentation, natural heating or spontaneous combustion or its undergoing any heating or drying process cannot be treated as damage due to fire. For e.g., paints or chemicals in a factory undergoing heat treatment and consequently damaged by fire is not covered. Further, burning of property insured by order of any Public Authority is excluded from the scope of cover.
LIGHTNING : Lightning may result in fire damage or other types of damage, such as a roof broken by a falling chimney struck by lightning or cracks in a building due to a lightning strike. Both fire and other types of damages caused by lightning are covered by the policy.
AIRCRAFT DAMAGE: The loss or damage to property (by fire or otherwise) directly caused by aircraft and other aerial devices and/ or articles dropped there from is covered. However, destruction or damage resulting from pressure waves caused by aircraft traveling at supersonic speed is excluded from the scope of the policy.
RIOTS, STRIKES, MALICIOUS AND TERRORISM DAMAGES: The act of any person taking part along with others in any disturbance of public peace (other than war, invasion, mutiny, civil commotion etc.) is construed to be a riot, strike or a terrorist activity. Unlawful action would not be covered under the policy.
STORM, CYCLONE, TYPHOON, TEMPEST, HURRICANE, TORNADO, FLOOD and INUNDATION: Storm, Cyclone, Typhoon, Tempest, Tornado and Hurricane are all various types of violent natural disturbances that are accompanied by thunder or strong winds or heavy rainfall. Flood or Inundation occurs when the water rises to an abnormal level. Flood or inundation should not only be understood in the common sense of the terms, i.e., flood in river or lakes, but also accumulation of water due to choked drains would be deemed to be flood.
IMPACT DAMAGE: Impact by any Rail/ Road vehicle or animal by direct contact with the insured property is covered. However, such vehicles or animals should not belong to or owned by the insured or any occupier of the premises or their employees while acting in the course of their employment.
SUBSIDENCE AND LANDSLIDE INCULUDING ROCKSIDE: Destruction or damage caused by Subsidence of part of the site on which the property stands or Landslide/ Rockslide is covered. While Subsidence means sinking of land or building to a lower level, Landslide means sliding down of land usually on a hill.
However, normal cracking, settlement or bedding down of new structures; settlement or movement of made up ground; coastal or river erosion; defective design or workmanship or use of defective materials; and demolition, construction, structural alterations or repair of any property or ground-works or excavations, are not covered.
BURSTING AND/OR OVERFLOWING OF WATER TANKS, APPARATUS AND PIPES: Loss or damage to property by water or otherwise on account of bursting or accidental overflowing of water tanks, apparatus and pipes is covered.
MISSILE TESTING OPERATIONS: Destruction or damage, due to impact or otherwise from trajectory/ projectiles in connection with missile testing operations by the Insured or anyone else, is covered.
LEAKAGE FROM AUTOMATIC SPRINKLER INSTALLATIONS: Damage, caused by water accidentally discharged or leaked out from automatic sprinkler installations in the insured's premises, is covered. However, such destruction or damage caused by repairs or alterations to the buildings or premises; repairs removal or extension of the sprinkler installation; and defects in construction known to the insured, are not covered.
BUSH FIRE: This covers damage caused by burning, whether accidental or otherwise, of bush and jungles and the clearing of lands by fire, but excludes destruction or damage, caused by Forest Fire.
RISKS NOT COVERED BY FIRE INSURANCE POLICY
Claims not maintainable/ covered under this policy are as follows:
o Theft during or after the occurrence of any insured risks
o War or nuclear perils
o Electrical breakdowns
o Ordered burning by a public authority
o Subterranean fire
o Loss or damage to bullion, precious stones, curios (value more than Rs.10000), plans, drawings, money, securities, cheque books, computer records except if they are categorically included.
o Loss or damage to property moved to a different location (except machinery and equipment for cleaning, repairs or renovation for more than 60 days).
CHARACTERICTICS OF FIRE INSURANCE CONTRACT
A fire insurance contract has the following characteristics namely:
(a) Fire insurance is a personal contract
A fire insurance contract does not ensure the safety of the insured property. Its purpose is to see that the insured does not suffer loss by reason of his interest in the insured property. Hence, if his connection with the insured property ceases by being transferred to another person, the contract of insurance also comes to an end. It is not so connected with the subject matter of the insurance as to pass automatically to the new owner to whom the subject is transferred. The contract of fire insurance is thus a mere a personal contract between the insured and the insurer for the payment of money. It can be validly assigned to another only with the consent of the insurer.
(b) It is entire and indivisible contract.
Where the insurance is of a binding and its contents of stock and machinery, the contract is expressly agreed to be divisible. Thus , where the insured is guilty of breach of duty towards the insurer in respect of one subject matters covered by the policy , the insurer can avoid the contract as a whole and not only in respect of that particular subject mater , unless the right is restricted by the terms of the policy.
(c) Cause of fire is immaterial
In insuring against fire, the insured wishes to protect him from any loss or detriment which he may suffer upon the occurrence of a fire, however it may be caused. So long as the loss is due to fire within the meaning of the policy, it is immaterial what the cause of fire is, generally. Thus , whether it was because the fire was lighted improperly or was lighted properly but negligently attended to thereafter or whether the fire was caused on account of the negligence of the insured or his servants or strangers is immaterial and the insurer is liable to indemnify the insured. In the absence of fraud, the proximate cause of the loss only is to be looked to.
The cause of the fire however becomes material to be investigated
(1). Where the fire is occasioned not by the negligence of, but by the willful
(2) Where the fire is due is to cause falling with the exception in the contract.
LIMITATION OF TIME
Indemnity insurance was an agreement by the insurer to confer on the insured a contractual right, which prima facie, came into existence immediately when the loss was suffered by the happening of an event insured against, to be put by the insurer into the same position in which the accused would have had the event not occurred but in no better position. There was a primary liability, i.e. to indemnify, and a secondary liability i.e. to put the insured in his pre-loss position, either by paying him a specifying amount or it might be in some other manner. But the fact that the insurer had an option as to the way in which he would put the insured into pre-loss position did not mean that he was not liable to indemnify him in one way or another, immediately the loss occurred. The primary liability arises on the happening of the event insured against. So, the time ran from the date of the loss and not from the date on which the policy was avoided and any suit filed after that time limit would be barred by limitation.[2]
WHO MAY INSURE AGAINST FIRE?
Only those who have insurable interest in a property can take fire insurance thereon. The following are among the class of persons who have been held to possess insurable interest in, property and can insure such property:
1. Owners of property, whether sole, or joint owner, or partner in the firm owning the property. It is not necessary that they should possession also. Thus a lesser and a lessee can both insure it jointly or severely.
2. The vender and purchaser have both rights to insure. The vendor's interest continues until the conveyance is completed and even thereafter, if he has an unpaid vendor's lien over it.
3. The mortgagor and mortgagee have both distinct interests in the mortgaged property and can insure, per Lord Esher M.R."The mortgagee does not claim his interest through the mortgagor , but by virtue of the mortgage which has given him an interest distinct from that of the mortgagor"[3]
4. Trustees are legal owners and beneficiaries the beneficial owners of trust property and each can insure it.
5. Bailees such as carriers, pawnbrokers or warehouse men are responsible for there safety of the property entrusted to them and so can insure it.
PERSON NOT ENTITLED TO INSURE
One who has no insurable interest in a property cannot insure it. For example:
1. An unsecured creditor cannot insure his debtor's property, because his right is only against the debtor personally. He can, however, insure the debtor's life.
2. A shareholder in a company cannot insure the property of the company as he has no insurable interest in any asset of the company even if he is the sole shareholder. As was the case of Macaura v. Northen Assurance Co.[4] Macaura. Because neither as a simple creditor nor as a shareholder had he any insurable interest in it.
CONCEPT OF UTMOST FAITH
As all contracts of insurance are contracts of utmost good faith, the proposer for fire insurance is also under a positive duty to make a full disclosure of all material facts and not to make any misrepresentations or misdescreptions thereof during the negotiations for obtaining the policy. This duty of utmost good faith applies equally to the insurer and the insured. There must be complete good faith on the part of the assured. This duty to observe utmost good faith is ensured b requiring the proposer to declare that the statements in the proposal form are true, that they shall be the basis of the contract and that any incorrect or false statement therein shall avoid the policy. The insurer can then rely on them to assess the risk and to fix appropriate premium and accept the risk or decline it.
The questions in the proposal form for a fire policy are so framed as to get all information which is material to the insurer to know in order to assess the risk and fix the premium, that is, all material facts. Thus the proposer is required too give information relating to:
o The proposer's name and address and occupation
o The description of the subject matter to be insured sufficient for the purpose of identifying it including,
o A description of the locality where it is situated
o How the property is being used, whether for any manufacturing purpose or hazardous trade.etc
o Whether it has already been insured
o And also ant personal insurance history including the claims if any made buy the proposer, etc.
Apart from questions in the proposal form, the proposer should disclose whether questioned or not-
1. Any information which would indicate the risk of fire to be above normal;
2. Any fact which would indicate that the insurer's liability may be more than normal can be expected such as existence of valuable manuscripts or documents, etc, and
3. Any information bearing upon the more; hazard involved.
The proposer is not obliged to disclose-
1. Information which the insurer may be presumed to know in the ordinary course of his business as an insurer;
2. Facts which tend to show that the risk is lesser than otherwise;
3. Facts as to which information is waived by the insurer; and
4. Facts which need not disclosed in view of a policy condition.
Thus, assured is under a solemn obligation to make full disclosure of material facts which may be relevant for the insurer to take into account while deciding whether the proposal should be accepted or not. While making a disclosure of the relevant facts, the
DOCTRINE OF PROXIMATE CAUSE
Where more perils than one act simultaneously or successively, it will be difficult to assess the relative effect of each peril or pick out one of these as the actual cause of the loss. In such cases, the doctrine of proximate cause helps to determine the actual cause of the loss.
Proximate cause was defined in Pawsey v. Scottish Union and National Ins. Co.,[5]as "the active, effective cause that 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." It is dominant and effective cause even though it is not the nearest in time. It is therefore necessary when a loss occurs to investigate and ascertain what is the proximate cause of the loss in order to determine whether the insurer is liable for the loss.
PROXIMATE CAUSE OF DAMAGE
A fire policy covers risks where damage is caused by way of fire. The fire may be caused by lightening, by explosion or implosion. It may be result of riot, strike or on account of any, malicious act. However these factors must ultimately lead to a fire and the fire must be the proximate cause of damage. Therefore, a loss caused by theft of property by militants would not be covered by the fire policy. The view that the loss was covered under the malicious act clause and therefore .the insurer was liable to meet the claim is untenable, because unless and until fire is the proximate cause f damage, no claim under a fire policy would be maintainable.[6]
PROCEDURE FOR TAKING A FIRE INSURANCE POLICY
The steps involved for taking a fire insurance policy are mentioned below:
1. Selection of the Insurance Company:
There are many companies that offer fire insurance against unforeseen events. The individual or the company must take care in the selection of an insurance company. The judgment should rest on factors like goodwill, and long term standing in the market. The insurance companies can either be approached directly or through agents, some of them who are appointed by the company itself.
2. Submission of the Proposal Form:
The individual or the business owner must submit a completed prescribed proposal form with the necessary details to the insurance company for proper consideration and subsequent approval. The information in the Proposal Form should be given in good faith and must be accompanied by documents that verify the actual worth of the property or goods that are to be insured. Most of the companies have their own personalized Proposal Forms wherein the exact information has to be provided.
3. Survey of the Property/ Consideration:
Once the duly filled Proposal Form is submitted to the insurance company, it makes an "on the spot" survey of the property or the goods that are the subject matter of the insurance. This is usually done by the investigators, or the surveyors, who are appointed by the company and they need to report back to them after a thorough research and survey. This is imperative to assess the risk involved and calculate the rate of premium.
4. Acceptance of the Proposal:
Once the detailed and comprehensive report is submitted to the insurance company by the surveyors and related officers, the former makes a thorough perusal of the Proposal Form and the report. If the company is satisfied that their is no lacuna or foul play or fraud involved, it formally "accepts" the Proposal Form and directs the insured to pay the first premium to the company. It is to be noted that the insurance policy commences after the payment and the acceptance of the premium by the insured and the company, respectively. The Insurance Company issues a Cover Note after the acceptance of the first premium.
PROCEDURE ON RECEIPT OF NOTICE OF LOSS
On receipt of the notice of loss, the insurer requires the insured to furnish details pertaining to the loss in a claim from relating to the following information-
1. Circumstances and cause of the fire;
2. Occupancy and situation of the premises in which the fire occurred;
3. Insured's interest in the insured property; that is capacity in which the insured claims and whether any others are interested in the property;
4. Other insurances on the property;
5. Value of each item of the property at the time of loss together with proofs thereof , and value of the salvage ,if any; and
6. Amount claimed
Furnishing such information relating to the claim is also a condition precedent to the liability of the insurer. The above information will enable the insurer to verify whether-
(1) The policy is in force;
(2) The peril causing the loss is an insured peril;
(3) The property damaged or lost is the insured property.
Rules for calculation of value of property
The value of the insured property is-
1) Its value at the time of loss, and
2) At the place of loss, and
3) Its real or intrinsic value without any regard for its sentimental vale. Loss of prospective profit or other consequential loss is not to be taken into account.
FILING OF CLAIMS
How a claim arises?
After a contract of fire insurance has come into existence, a claim may arise by the operation of one or more insured perils on an unsecured property. There may in addition one or more uninsured perils also operating simultaneously or in succession of the property. In order that the claim should be valid the following conditions must be fulfilled:
1. The occurrence should take place due to the operation of an insured peril or where both insured and other perils operated , the dominant or efficient cause of the loss must have been an insured peril;
2. The operation of the peril must not come within the scope of the policy exceptions;
3. The event must have caused loss or damage of the insured property;
4. The occurrence must be during the currency of the policy;
5. The insured must have fulfilled all the policy conditions and should also comply with requirements to be fulfilled after the claim had arisen.
MATERIAL FACTS IN FIRE INSURANCE: PREVIOUS CONVICTION OF THE ACCUSED
The criminal record of an assured could affect the moral hazard, which insurers had to assess, and the non-disclosure of a serious criminal offence like robbery by the plaintiff would a material non-disclosure.
INSURED'S DUTY ON OUTBREAK OF FIRE, IMPLIED DUTY
On the outbreak of a fire the insured is under an implied duty to observe good faith towards the insurers and the in pursuance of it the insured must do his best to avert or minimize the loss. For this purpose he must (1) take all reasonable measures to put out the fire or prevent its spread, and (2) assist the fire brigade and others in their attempts to do so at any rate not come in their way.
With this object the insured property may be removed to a place of safety. Any loss or damage the insured property may sustain in the course of attempts to combat the fire or during its removal to a place of safety etc., will be deemed to be loss proximately caused by the fire.
If the insured fails in his duty willfully and thereby increases the burden of the insurer, the insured will be deprived of his right to revive any indemnity under the policy.[7]
INSURER'S RIGHTS ON THE OUTBREAK OF FIRE
(A) Implied Rights
Corresponding to the insured's duties the insurers have rights by the law, in view of the liability they have undertaken to indemnify the insured. Thus the insurers have a right to-
o Take reasonable measures to extinguish the fire and to minimize the loss to property, and
o For that purpose, to enter upon and take possession of the property.
The insurers will be liable to make good all the damage the property may sustain during the steps taken to put out the fire and as long as it in their possession, because all that is considered the natural and direct consequence of the fire; it has therefore been held in the case of Ahmedbhoy Habibhoy v. Bombay Fire Marine Ins. Co [8] that the extent of the damage flowing from the insured peril must be assessed when the insurer gives back and not as at the time when the peril ceased.
(B) Loss caused by steps taken to avert the risk
Damage sustained due to action taken to avoid an insured risk was not a consequence of that risk and was not recoverable unless the insured risk had begun to operate. In the case of Liverpool and London and Globe Insurance Co. Ltd v. Canadian General Electric Co. Ltd., [9] the Canadian Supreme Court held that "the loss was caused by the fire fighters' mistaken belief that their action was necessary to avert an explosion , and the loss was not recoverable under the insurance policy, which covered only damage caused by fire explosion., and the loss was not recoverable under the insurance policy, which covered only damage caused by fire or explosion."
(C) Express rights
Condition 5- in order to protect their rights well insurers have prescribed for better rights expressly in this condition according to which on the happening of any destruction or damage the insurer and every person authorized by the insurer may enter, take or keep possession of the building or premises where the damage has happened or require it to be delivered to them and deal with it for all reasonable purposes like examining, arranging, removing or sell or dispose off the same for the account of whom it may concern.
When and how a claim is made?
In the event of a fire loss covered under the fire insurance policy, the Insured shall immediately give notice thereof to the insurance company. Within 15 days of the occurrence of such loss, the Insured should submit a claim in writing, giving the details of damages and their estimated values. Details of other insurances on the same property should also be declared.
The Insured should procure and produce, at his own expense, any document like plans, account books, investigation reports etc. on demand by the insurance company.
HOW INSURANCE MAY CEASE?
Insurance under a fire policy may cease in any of the following circumstances, namely:
(1) Insurer avoiding the policy by reason of the insured making misrepresentation, misdescription or non-disclosure of any material particular;
(2) If there is a fall or displacement of any insured building range or structure or part thereof , then on the expiry of seven days wherefrom, except where the fall or displacement was due to the action of any insured peril; notwithstanding this, the insurance may be revived on revised terms if express notice is given to the company as soon as the occurrence takes place;
(3) The insurance may be terminated at any tie at the request of the insured and at the option of the company on 15 days notice to the insured
CONCLUSION
Tangible property is exposed to numerous risks like fire, floods, explosions, earthquake, riot and war, etc. and insurance protection can be had against most of these risks severally or in combination. The form in which the cover is expressed is numerous and varied. Fire insurance in its strict sense is concerned with giving protection against fire and fire only. So while granting a fire insurance policy all the requisites need be fulfilled. The insured are under a moral and legal obligation to be at utmost good faith and should be telling true facts and not just fake grounds only with the greed to recover money. Further all insurance policies help in the development of a Developing nation. Hence insurance companies have a burden to help the insured when the insured are in trouble.
REFERENCE:
1. (1983) VR 698 (Supreme Court of Vienna)
2. Callaghan v. Dominion Insurance Co. Ltd. (1997) 2 Lloyd's Rep. 541 (QBD)
3. Small v. U.K Marine Insurance Association (1897) 2 QB 311
4. (1925) AC 619
5. (1907) Case.
6. National Insurance Company v. Ashok Kumar Barariio
7. Devlin v. Queen Insurance Co, (1882) 46 UCR 611.
8. (1912) 40 IA 10 PC
9. (1981) 123 DLR (3d) 513 (Supreme Court of Canada)
Books Referred:
1. The Economics of Fire Protection by Ganapathy Ramachandran
2. Modern Insurance Law, by John Birds
3. The Handbook of Insurance Regulatory and Development Authority Act and Regulations with Allied Laws ,by Nagar

Insurance Law - An Indian Perspective

INTRODUCTION
"Insurance should be bought to protect you against a calamity that would otherwise be financially devastating."
In simple terms, insurance allows someone who suffers a loss or accident to be compensated for the effects of their misfortune. It lets you protect yourself against everyday risks to your health, home and financial situation.
Insurance in India started without any regulation in the Nineteenth Century. It was a typical story of a colonial epoch: few British insurance companies dominating the market serving mostly large urban centers. After the independence, it took a theatrical turn. Insurance was nationalized. First, the life insurance companies were nationalized in 1956, and then the general insurance business was nationalized in 1972. It was only in 1999 that the private insurance companies have been allowed back into the business of insurance with a maximum of 26% of foreign holding.


"The insurance industry is enormous and can be quite intimidating. Insurance is being sold for almost anything and everything you can imagine. Determining what's right for you can be a very daunting task."
Concepts of insurance have been extended beyond the coverage of tangible asset. Now the risk of losses due to sudden changes in currency exchange rates, political disturbance, negligence and liability for the damages can also be covered.
But if a person thoughtfully invests in insurance for his property prior to any unexpected contingency then he will be suitably compensated for his loss as soon as the extent of damage is ascertained.
The entry of the State Bank of India with its proposal of bank assurance brings a new dynamics in the game. The collective experience of the other countries in Asia has already deregulated their markets and has allowed foreign companies to participate. If the experience of the other countries is any guide, the dominance of the Life Insurance Corporation and the General Insurance Corporation is not going to disappear any time soon.
The aim of all insurance is to compensate the owner against loss arising from a variety of risks, which he anticipates, to his life, property and business. Insurance is mainly of two types: life insurance and general insurance. General insurance means Fire, Marine and Miscellaneous insurance which includes insurance against burglary or theft, fidelity guarantee, insurance for employer's liability, and insurance of motor vehicles, livestock and crops.
LIFE INSURANCE IN INDIA
"Life insurance is the heartfelt love letter ever written.
It calms down the crying of a hungry baby at night. It relieves the heart of a bereaved widow.
It is the comforting whisper in the dark silent hours of the night."
Life insurance made its debut in India well over 100 years ago. Its salient features are not as widely understood in our country as they ought to be. There is no statutory definition of life insurance, but it has been defined as a contract of insurance whereby the insured agrees to pay certain sums called premiums, at specified time, and in consideration thereof the insurer agreed to pay certain sums of money on certain condition sand in specified way upon happening of a particular event contingent upon the duration of human life.
Life insurance is superior to other forms of savings!
"There is no death. Life Insurance exalts life and defeats death.
It is the premium we pay for the freedom of living after death."
Savings through life insurance guarantee full protection against risk of death of the saver. In life insurance, on death, the full sum assured is payable (with bonuses wherever applicable) whereas in other savings schemes, only the amount saved (with interest) is payable.
The essential features of life insurance are a) it is a contract relating to human life, which b) provides for payment of lump-sum amount, and c) the amount is paid after the expiry of certain period or on the death of the assured. The very purpose and object of the assured in taking policies from life insurance companies is to safeguard the interest of his dependents viz., wife and children as the case may be, in the even of premature death of the assured as a result of the happening in any contingency. A life insurance policy is also generally accepted as security for even a commercial loan.
NON-LIFE INSURANCE
"Every asset has a value and the business of general insurance is related to the protection of economic value of assets."
Non-life insurance means insurance other than life insurance such as fire, marine, accident, medical, motor vehicle and household insurance. Assets would have been created through the efforts of owner, which can be in the form of building, vehicles, machinery and other tangible properties. Since tangible property has a physical shape and consistency, it is subject to many risks ranging from fire, allied perils to theft and robbery.
Few of the General Insurance policies are:
Property Insurance: The home is most valued possession. The policy is designed to cover the various risks under a single policy. It provides protection for property and interest of the insured and family.
Health Insurance: It provides cover, which takes care of medical expenses following hospitalization from sudden illness or accident.
Personal Accident Insurance: This insurance policy provides compensation for loss of life or injury (partial or permanent) caused by an accident. This includes reimbursement of cost of treatment and the use of hospital facilities for the treatment.
Travel Insurance: The policy covers the insured against various eventualities while traveling abroad. It covers the insured against personal accident, medical expenses and repatriation, loss of checked baggage, passport etc.
Liability Insurance: This policy indemnifies the Directors or Officers or other professionals against loss arising from claims made against them by reason of any wrongful Act in their Official capacity.
Motor Insurance: Motor Vehicles Act states that every motor vehicle plying on the road has to be insured, with at least Liability only policy. There are two types of policy one covering the act of liability, while other covers insurers all liability and damage caused to one's vehicles.
JOURNEY FROM AN INFANT TO ADOLESCENCE!
Historical Perspective
The history of life insurance in India dates back to 1818 when it was conceived as a means to provide for English Widows. Interestingly in those days a higher premium was charged for Indian lives than the non-Indian lives as Indian lives were considered more risky for coverage.
The Bombay Mutual Life Insurance Society started its business in 1870. It was the first company to charge same premium for both Indian and non-Indian lives. The Oriental Assurance Company was established in 1880. The General insurance business in India, on the other hand, can trace its roots to the Triton (Tital) Insurance Company Limited, the first general insurance company established in the year 1850 in Calcutta by the British. Till the end of nineteenth century insurance business was almost entirely in the hands of overseas companies.
Insurance regulation formally began in India with the passing of the Life Insurance Companies Act of 1912 and the Provident Fund Act of 1912. Several frauds during 20's and 30's desecrated insurance business in India. By 1938 there were 176 insurance companies. The first comprehensive legislation was introduced with the Insurance Act of 1938 that provided strict State Control over insurance business. The insurance business grew at a faster pace after independence. Indian companies strengthened their hold on this business but despite the growth that was witnessed, insurance remained an urban phenomenon.
The Government of India in 1956, brought together over 240 private life insurers and provident societies under one nationalized monopoly corporation and Life Insurance Corporation (LIC) was born. Nationalization was justified on the grounds that it would create much needed funds for rapid industrialization. This was in conformity with the Government's chosen path of State lead planning and development.
The (non-life) insurance business continued to prosper with the private sector till 1972. Their operations were restricted to organized trade and industry in large cities. The general insurance industry was nationalized in 1972. With this, nearly 107 insurers were amalgamated and grouped into four companies - National Insurance Company, New India Assurance Company, Oriental Insurance Company and United India Insurance Company. These were subsidiaries of the General Insurance Company (GIC).
The life insurance industry was nationalized under the Life Insurance Corporation (LIC) Act of India. In some ways, the LIC has become very flourishing. Regardless of being a monopoly, it has some 60-70 million policyholders. Given that the Indian middle-class is around 250-300 million, the LIC has managed to capture some 30 odd percent of it. Around 48% of the customers of the LIC are from rural and semi-urban areas. This probably would not have happened had the charter of the LIC not specifically set out the goal of serving the rural areas. A high saving rate in India is one of the exogenous factors that have helped the LIC to grow rapidly in recent years. Despite the saving rate being high in India (compared with other countries with a similar level of development), Indians display high degree of risk aversion. Thus, nearly half of the investments are in physical assets (like property and gold). Around twenty three percent are in (low yielding but safe) bank deposits. In addition, some 1.3 percent of the GDP are in life insurance related savings vehicles. This figure has doubled between 1985 and 1995.
A World viewpoint - Life Insurance in India
In many countries, insurance has been a form of savings. In many developed countries, a significant fraction of domestic saving is in the form of donation insurance plans. This is not surprising. The prominence of some developing countries is more surprising. For example, South Africa features at the number two spot. India is nestled between Chile and Italy. This is even more surprising given the levels of economic development in Chile and Italy. Thus, we can conclude that there is an insurance culture in India despite a low per capita income. This promises well for future growth. Specifically, when the income level improves, insurance (especially life) is likely to grow rapidly.
INSURANCE SECTOR REFORM:
Committee Reports: One Known, One Anonymous!
Although Indian markets were privatized and opened up to foreign companies in a number of sectors in 1991, insurance remained out of bounds on both counts. The government wanted to proceed with caution. With pressure from the opposition, the government (at the time, dominated by the Congress Party) decided to set up a committee headed by Mr. R. N. Malhotra (the then Governor of the Reserve Bank of India).
Malhotra Committee
Liberalization of the Indian insurance market was suggested in a report released in 1994 by the Malhotra Committee, indicating that the market should be opened to private-sector competition, and eventually, foreign private-sector competition. It also investigated the level of satisfaction of the customers of the LIC. Inquisitively, the level of customer satisfaction seemed to be high.
In 1993, Malhotra Committee - headed by former Finance Secretary and RBI Governor Mr. R. N. Malhotra - was formed to evaluate the Indian insurance industry and recommend its future course. The Malhotra committee was set up with the aim of complementing the reforms initiated in the financial sector. The reforms were aimed at creating a more efficient and competitive financial system suitable for the needs of the economy keeping in mind the structural changes presently happening and recognizing that insurance is an important part of the overall financial system where it was necessary to address the need for similar reforms. In 1994, the committee submitted the report and some of the key recommendations included:
o Structure
Government bet in the insurance Companies to be brought down to 50%. Government should take over the holdings of GIC and its subsidiaries so that these subsidiaries can act as independent corporations. All the insurance companies should be given greater freedom to operate.
Competition
Private Companies with a minimum paid up capital of Rs.1 billion should be allowed to enter the sector. No Company should deal in both Life and General Insurance through a single entity. Foreign companies may be allowed to enter the industry in collaboration with the domestic companies. Postal Life Insurance should be allowed to operate in the rural market. Only one State Level Life Insurance Company should be allowed to operate in each state.
o Regulatory Body
The Insurance Act should be changed. An Insurance Regulatory body should be set up. Controller of Insurance - a part of the Finance Ministry- should be made Independent.
o Investments
Compulsory Investments of LIC Life Fund in government securities to be reduced from 75% to 50%. GIC and its subsidiaries are not to hold more than 5% in any company (there current holdings to be brought down to this level over a period of time).
o Customer Service
LIC should pay interest on delays in payments beyond 30 days. Insurance companies must be encouraged to set up unit linked pension plans. Computerization of operations and updating of technology to be carried out in the insurance industry. The committee accentuated that in order to improve the customer services and increase the coverage of insurance policies, industry should be opened up to competition. But at the same time, the committee felt the need to exercise caution as any failure on the part of new competitors could ruin the public confidence in the industry. Hence, it was decided to allow competition in a limited way by stipulating the minimum capital requirement of Rs.100 crores.
The committee felt the need to provide greater autonomy to insurance companies in order to improve their performance and enable them to act as independent companies with economic motives. For this purpose, it had proposed setting up an independent regulatory body - The Insurance Regulatory and Development Authority.
Reforms in the Insurance sector were initiated with the passage of the IRDA Bill in Parliament in December 1999. The IRDA since its incorporation as a statutory body in April 2000 has meticulously stuck to its schedule of framing regulations and registering the private sector insurance companies.
Since being set up as an independent statutory body the IRDA has put in a framework of globally compatible regulations. The other decision taken at the same time to provide the supporting systems to the insurance sector and in particular the life insurance companies was the launch of the IRDA online service for issue and renewal of licenses to agents. The approval of institutions for imparting training to agents has also ensured that the insurance companies would have a trained workforce of insurance agents in place to sell their products.
The Government of India liberalized the insurance sector in March 2000 with the passage of the Insurance Regulatory and Development Authority (IRDA) Bill, lifting all entry restrictions for private players and allowing foreign players to enter the market with some limits on direct foreign ownership. Under the current guidelines, there is a 26 percent equity lid for foreign partners in an insurance company. There is a proposal to increase this limit to 49 percent.
The opening up of the sector is likely to lead to greater spread and deepening of insurance in India and this may also include restructuring and revitalizing of the public sector companies. In the private sector 12 life insurance and 8 general insurance companies have been registered. A host of private Insurance companies operating in both life and non-life segments have started selling their insurance policies since 2001
Mukherjee Committee
Immediately after the publication of the Malhotra Committee Report, a new committee, Mukherjee Committee was set up to make concrete plans for the requirements of the newly formed insurance companies. Recommendations of the Mukherjee Committee were never disclosed to the public. But, from the information that filtered out it became clear that the committee recommended the inclusion of certain ratios in insurance company balance sheets to ensure transparency in accounting. But the Finance Minister objected to it and it was argued by him, probably on the advice of some of the potential competitors, that it could affect the prospects of a developing insurance company.
LAW COMMISSION OF INDIA ON REVISION OF THE INSURANCE ACT 1938 - 190th Law Commission Report
The Law Commission on 16th June 2003 released a Consultation Paper on the Revision of the Insurance Act, 1938. The previous exercise to amend the Insurance Act, 1938 was undertaken in 1999 at the time of enactment of the Insurance Regulatory Development Authority Act, 1999 (IRDA Act).
The Commission undertook the present exercise in the context of the changed policy that has permitted private insurance companies both in the life and non-life sectors. A need has been felt to toughen the regulatory mechanism even while streamlining the existing legislation with a view to removing portions that have become superfluous as a consequence of the recent changes.
Among the major areas of changes, the Consultation paper suggested the following:
a. merging of the provisions of the IRDA Act with the Insurance Act to avoid multiplicity of legislations;
b. deletion of redundant and transitory provisions in the Insurance Act, 1938;
c. Amendments reflect the changed policy of permitting private insurance companies and strengthening the regulatory mechanism;
d. Providing for stringent norms regarding maintenance of 'solvency margin' and investments by both public sector and private sector insurance companies;
e. Providing for a full-fledged grievance redressal mechanism that includes:
o The constitution of Grievance Redressal Authorities (GRAs) comprising one judicial and two technical members to deal with complaints/claims of policyholders against insurers (the GRAs are expected to replace the present system of insurer appointed Ombudsman);
o Appointment of adjudicating officers by the IRDA to determine and levy penalties on defaulting insurers, insurance intermediaries and insurance agents;
o Providing for an appeal against the decisions of the IRDA, GRAs and adjudicating officers to an Insurance Appellate Tribunal (IAT) comprising a judge (sitting or retired) of the Supreme Court/Chief Justice of a High Court as presiding officer and two other members having sufficient experience in insurance matters;
o Providing for a statutory appeal to the Supreme Court against the decisions of the IAT.
LIFE & NON-LIFE INSURANCE - Development and Growth!
The year 2006 turned out to be a momentous year for the insurance sector as regulator the Insurance Regulatory Development Authority Act, laid the foundation for free pricing general insurance from 2007, while many companies announced plans to attack into the sector.
Both domestic and foreign players robustly pursued their long-pending demand for increasing the FDI limit from 26 per cent to 49 per cent and toward the fag end of the year, the Government sent the Comprehensive Insurance Bill to Group of Ministers for consideration amid strong reservation from Left parties. The Bill is likely to be taken up in the Budget session of Parliament.
The infiltration rates of health and other non-life insurances in India are well below the international level. These facts indicate immense growth potential of the insurance sector. The hike in FDI limit to 49 per cent was proposed by the Government last year. This has not been operationalized as legislative changes are required for such hike. Since opening up of the insurance sector in 1999, foreign investments of Rs. 8.7 billion have tipped into the Indian market and 21 private companies have been granted licenses.
The involvement of the private insurers in various industry segments has increased on account of both their capturing a part of the business which was earlier underwritten by the public sector insurers and also creating additional business boulevards. To this effect, the public sector insurers have been unable to draw upon their inherent strengths to capture additional premium. Of the growth in premium in 2004-05, 66.27 per cent has been captured by the private insurers despite having 20 per cent market share.
The life insurance industry recorded a premium income of Rs.82854.80 crore during the financial year 2004-05 as against Rs.66653.75 crore in the previous financial year, recording a growth of 24.31 per cent. The contribution of first year premium, single premium and renewal premium to the total premium was Rs.15881.33 crore (19.16 per cent); Rs.10336.30 crore (12.47 per cent); and Rs.56637.16 crore (68.36 per cent), respectively. In the year 2000-01, when the industry was opened up to the private players, the life insurance premium was Rs.34,898.48 crore which constituted of Rs. 6996.95 crore of first year premium, Rs. 25191.07 crore of renewal premium and Rs. 2740.45 crore of single premium. Post opening up, single premium had declined from Rs.9, 194.07 crore in the year 2001-02 to Rs.5674.14 crore in 2002-03 with the withdrawal of the guaranteed return policies. Though it went up marginally in 2003-04 to Rs.5936.50 crore (4.62 per cent growth) 2004-05, however, witnessed a significant shift with the single premium income rising to Rs. 10336.30 crore showing 74.11 per cent growth over 2003-04.
The size of life insurance market increased on the strength of growth in the economy and concomitant increase in per capita income. This resulted in a favourable growth in total premium both for LIC (18.25 per cent) and to the new insurers (147.65 per cent) in 2004-05. The higher growth for the new insurers is to be viewed in the context of a low base in 2003- 04. However, the new insurers have improved their market share from 4.68 in 2003-04 to 9.33 in 2004-05.
The segment wise break up of fire, marine and miscellaneous segments in case of the public sector insurers was Rs.2411.38 crore, Rs.982.99 crore and Rs.10578.59 crore, i.e., a growth of (-)1.43 per cent, 1.81 per cent and 6.58 per cent. The public sector insurers reported growth in Motor and Health segments (9 and 24 per cent). These segments accounted for 45 and 10 per cent of the business underwritten by the public sector insurers. Fire and "Others" accounted for 17.26 and 11 per cent of the premium underwritten. Aviation, Liability, "Others" and Fire recorded negative growth of 29, 21, 3.58 and 1.43 per cent. In no other country that opened at the same time as India have foreign companies been able to grab a 22 per cent market share in the life segment and about 20 per cent in the general insurance segment. The share of foreign insurers in other competing Asian markets is not more than 5 to 10 per cent.
The life insurance sector grew new premium at a rate not seen before while the general insurance sector grew at a faster rate. Two new players entered into life insurance - Shriram Life and Bharti Axa Life - taking the total number of life players to 16. There was one new entrant to the non-life sector in the form of a standalone health insurance company - Star Health and Allied Insurance, taking the non-life players to 14.
A large number of companies, mostly nationalized banks (about 14) such as Bank of India and Punjab National Bank, have announced plans to enter the insurance sector and some of them have also formed joint ventures.
The proposed change in FDI cap is part of the comprehensive amendments to insurance laws - The Insurance Act of 1999, LIC Act, 1956 and IRDA Act, 1999. After the proposed amendments in the insurance laws LIC would be able to maintain reserves while insurance companies would be able to raise resources other than equity.
About 14 banks are in queue to enter insurance sector and the year 2006 saw several joint venture announcements while others scout partners. Bank of India has teamed up with Union Bank and Japanese insurance major Dai-ichi Mutual Life while PNB tied up with Vijaya Bank and Principal for foraying into life insurance. Allahabad Bank, Karnataka Bank, Indian Overseas Bank, Dabur Investment Corporation and Sompo Japan Insurance Inc have tied up for forming a non-life insurance company while Bank of Maharashtra has tied up with Shriram Group and South Africa's Sanlam group for non-life insurance venture.
CONCLUSION
It seems cynical that the LIC and the GIC will wither and die within the next decade or two. The IRDA has taken "at a snail's pace" approach. It has been very cautious in granting licenses. It has set up fairly strict standards for all aspects of the insurance business (with the probable exception of the disclosure requirements). The regulators always walk a fine line. Too many regulations kill the motivation of the newcomers; too relaxed regulations may induce failure and fraud that led to nationalization in the first place. India is not unique among the developing countries where the insurance business has been opened up to foreign competitors.
The insurance business is at a critical stage in India. Over the next couple of decades we are likely to witness high growth in the insurance sector for two reasons namely; financial deregulation always speeds up the development of the insurance sector and growth in per capita GDP also helps the insurance business to grow.