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Industry Profile
General insurance means managing risk against financial loss arising due to fire,
marine or miscellaneous events as a result of contingencies, which may or may not
occur. General Insurance means to “Cover the risk of the financial loss from any
natural calamities viz. Flood, Fire, Earthquake, Burglary, etc.. i.e. the events which are
beyond the control of the owner of the goods for the things having insurable interest
with the utmost good faith by declaring the facts about the circumstances and the
products by paying the stipulated sum , a premium and not having a motive of making
profit from the insurance contract.”
General Insurance Companies provide financial protection to individuals and business
houses. Protection is provided against financial losses caused by unforeseen events.
This protection is available to individuals, businessmen and large companies alike. To
succeed and survive insurance companies must cover their costs, which include
payments to cover the losses of policyholders, as well as sales and administrative
expenses, taxes and dividends. Insurance companies have two sources of income for
covering these costs: Premium and Investment income.
Premiums are collected on a regular basis and invested in Government Bonds, Gift
stocks, mutual funds, real estates and other conservative avenues. However,
investment income depends on market conditions, interest rates, economy etc and
varies from year to year. Because of the uncertainty associated with the investment
income, insurance companies must generate enough income from the premiums to
cover the bulk of their expenses.
Meaning of Risk / Insurance
Insurance is a contract whereby, in return for the payment of premium by the insured,
the insurers pay the financial losses suffered by the insured as a result of the
occurrence of unforeseen events. The term "risk" is used to describe all the accidental
happenings, which produce a monetary loss.
Insurance is a method in which a large number of people exposed to a similar risk
make contributions to a common fund out of which the losses suffered by the
unfortunate few, due to accidental events, are made good. The sharing of risk among
large groups of people is the basis of insurance. The losses of an individual are
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distributed over a group of individuals .
The risk becomes insurable if the following requirements are complied with:
a) The insured must suffer financial loss if the risk operates.
b) The loss must be measurable in money,
c) The object of the insurance contract must be legal.
d) The insurer should have sufficient knowledge about the risks he accepts.
Definition and meaning:
1. INSURANCE:
Insurance is the means of managing risk and protection against financial loss arising
as a result of contingencies, which may or may not occur.
In other words, insurance is the act of providing assurance, against a possible loss, by
entering into a contract, with one who is willing to give assurance. Through this
contract the person willing to give assurance binds himself to make good such loss, if
it occurs.
2. GENERAL INSURANCE:
General insurance means managing risk against financial loss arising due to fire,
marine or miscellaneous events as a result of contingencies, which may or may not
occur.
General Insurance means to “Cover the risk of the financial loss from any natural
calamities viz. Flood, Fire, Earthquake, Burglary, etc.. i.e. the events which are beyond
the control of the owner of the goods for the things having insurable interest with the
utmost good faith by declaring the facts about the circumstances and the products by
paying the stipulated sum , a premium and not having a motive of making profit from
the insurance contract.”
4 I’s of Insurance Service
The 4 I’s refers to the different dimensions/ characteristics of any service. Unlike pure
product, services have its own characteristics and its related problems. So the service
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provider needs to deal with these problems accordingly. The service provider has to
design different strategies according the varying feature of the service. These 4 I’s not
only represent the characteristics of different services but also the problems and
advantages attached to it.
These 4 I’s can be broadly classified as:
• Intangibility
•Inconsistency
• Inseparability
• Inventory
• Intangibility:
Insurance is a guarantee against risk and neither the risk nor the guarantee is tangible.
Hence, insurance rightly come under services, which are intangible. Efforts have been
made by the insurance companies to make insurance tangible to some extent by
including letters and form
• Inconsistency
Service quality is often inconsistent. This is because service personnel have different
capabilities, which vary in performance from day to day. This problem of
inconsistency in service quality can be reduced through standardization, training and
mechanization.
• Inseparability
Services are produced and consumed simultaneously. Consumers cannot and do not
separate the deliverer of the service from the service itself. Interaction between
consumer and the service provider varies based on whether consumer must be
physically present to receive the service.
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• Inventory
No inventory can be maintained for services. Inventory carrying costs are more
subjective and lead to idle production capacity. When the service is available but there
is no demand, cost rises as, cost of paying the people and overhead remains constant
even though the people are not required to provide services due to lack of demand.
In the insurance sector however, commission is paid to the agents on each policy that
they sell. Hence, not much inventory cost is wasted on idle inventory. As the cost of
agents is directly proportionate to the policy sold.
Some of the General Rules:
1. Mis-description :
The insurance policy shall be void and all the premiums paid by insured may be
forfeited by the insurance company in the event of mis-presentation or mis-
declaration and/or non-disclosure of any material facts.
2. Reasonable care :
The insured shall take all reasonable steps to safeguard the property insured against
any loss or damage. Insured shall exercise reasonable care that only competent
employees are employed and shall take all reasonable precautions to prevent all
accidents and shall comply with all statuary or other regulations
3. Fraud :
If any claim under the policy may be in any respect fraudulent or if any fraudulent
means or device are used by the insured or any one acting on the insured’s behalf to
obtain any benefit under the insurance policy, all the benefits under the insurance
policy may be forfeited.
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4. Few basic principles of general insurance are :
Insurable interest
Utmost good faith
Subrogation
Contribution
Indemnity
5 Risks of loss not covered under general insurance are:
The loss or damage or liability or expenses whether direct or indirect occasion by
happening through or arising from any consequences of war, invasion, act of foreign
enemy, hostilities (whether war be declared or not), civil war, rebellion revolution,
civil commotion or loot or pillage in connection therewith and loss or damage caused
by depreciation or wear and tear. However the risk of loss or damage by war can be
insured by payment of additional premium in some cases only.
Today the technology is boosting in each and every field. Insurance is not an
exception. Companies have started providing customers facility of online payment of
premium through their websites. They also provide online assistant to the customer the
policy status and how to calculate the premium. To calculate the premium they just
need the present age, the type of police, sum assured, and accident covered if any. By
filling in this information you can calculate the amount of premium you have to pay.
The customer can pay their premiums by means of credit cards or can also give
standing instruction to the bank in order to pay their monthly premiums.
The insurance companies also provide loan facilities against their policies. At present
loans are granted on unencumbered polices as follows:
• Up to 90% of the Surrender Value for policies, where the premium due is fully paid-
up, and
• Up to 85% of the Surrender Value for policies where the premium due is partly paid-
up.
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The minimum amount for which a loan can be granted under a policy is Rs150. The
rate of interest charged is 10.5% p.a., payable half-yearly. Loans are not granted for a
period shorter than six months, or on the security of lost policies (the assured must
have the duplicate policies) or on policies issued under certain plans. Certain types of
policies are, however, without loan facility.
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COMPANY PROFILE
Reliance General Life Insurance Company is a Reliance Capital Ltd. product. Under
the guidance of Anil Dhirubhai Ambani Group, reliance insurance company has
secured the position of the top insurers in India. Reliance General insurance is one of
the first non-life companies to get the license from the IRDA.
The risks covered under general insurance include property, marine, casualty and
liability. Wide ranges of products are available at Reliance Standard Insurance for
both group and individual customers. Each insurance policy is customized so as the
customers feel as if it was made for their needs. The distribution channels include
branch network, individual and specially trained insurance agents and insurance
brokers and online purchases of the insurance policies.
A completely customer centric company, Reliance Insurance Co Ltd aims at making
insurance affordable and accessible to all. The interests of the policyholders are
protected to the best of their capabilities and complete cooperation is provided in
insurance claims. a pan India presence of Reliance Standard Insurance brings the
insurance policy best suited to your requirements right to a branch near you.
2.a)Background and inception of the company
Reliance Capital Limited (RCL) is a Non-Banking Financial Company (NBFC)
registered with the Reserve Bank of India under section 45-IA of the Reserve Bank of
India Act, 1934. as a public limited company in 1986 and is now listed on the Bombay
Stock Exchange and the National Stock Exchange (India).
RCL has a net worth of over Rs '3,300 crore and over 165,000' shareholders. On
conversion of outstanding equity instruments, the net worth of the company will
increase to about Rs 4,100 crore. It is headed by Anil Ambani and is a part of the
Reliance ADA Group. Reliance Capital ranks among the top 3 private sector financial
services and banking companies, in terms of net worth.
Reliance Capital has interests in : Asset management, Mutual funds. Life and general
insurance. Private equity and proprietary investments. Stock broking. Reliance PMS.
Depository services and financial products. Consumer finance and other activities in
financial services
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2.b) Nature of the business carried
Reliance General Insurance is one of India’s leading private general insurance
companies with over 94 customized insurance products catering to the corporate, SME
and individual customers. The Company has launched innovative products like India’s
first Over-The-Counter health & home insurance policies. Reliance General Insurance
has an extended network of over 200 offices spread across 173 cities in 22 states, a
wide distribution channel network, 24x7 customer service assistance and a full fledged
website. It is also India’s first insurance company to be awarded the ISO 9001:2000
certification across all functions, processes, products and locations pan-India.
2.c)Vision, mission and quality policy
Vision
To be an Insurer of World Standards and the most preferred choice for clientele at the
domestic and global level.
Mission
The Mission is to keep the customer satisfaction as focal point of all our operations,
adopt the best international practices in underwriting, claims and customer service, be
the most innovative in product development, establish presence all over India, ensure
sustained value addition to all stake holders and to uphold Corporate Value &
Corporate Governance.
Objectives
1. Make affordable insurance accessible to all
2. Keep customer as focal point for all operations
3. Protect policy holders interests
4. Adopt best international practices in claims, underwriting and policy servicing
5. Be the most innovative in product development
6. Establish Pan India presence
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Quality Policy
At Reliance General Insurance, one can identify Quality and Customer-focus as the
key strategic initiatives. The Quality roadmap, strictly aligned with the business
priorities, is benchmarked to the best contemporary global practices, and is designed
to support single-minded objectives of maintaining world-class quality standards.
The quality system deployment, defined from the point of the view of the customers,
is to enhance customer experience at all the touch points. As part of this initiative,
every business process in the organization is identified, documented, automated and
deployed. These processes are further monitored continuously through their
compliance scores and dashboard measures and reviewed by the Senior Management
team within the organization.
In fact this passion has taken us one step ahead. The company is pleased to share the
recognition of the Quality Management System by reputed global quality standards
auditing organization – Det Norske Veritas (DNV), which has awarded us the ISO
9001:2000 certification. The certification conforms our adherence to design,
development & sale of General Insurance product offerings to meet customer needs
and in line with 'IRDA regulations'
Advantages of the ISO 9001:2000 certification to the customers
1. Streamlined processes and procedures
Reliance General Insurance has established well-defined and documented process and
to help understand our Customer’s requirements and address them to their satisfaction.
2. Superior Service Standards
Our unwavering commitment to excellence ensures prompt and correct documentation
while also ensuring transparent & speedy claims settlement
2.d)Products / Services Profile
Reliance General Insurance currently offers over 80 customized insurance products for
the retail and corporate sector. All these products are sold through its various offices in
different places.
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Personal accident
I. For Individuals
II. Group Personal Accident
Fire
I. Standard Fir And Special Perils
II. Consequential Loss (Fire)
III. Industrial All Risks
Engineering
I. Erection All Risks/Storage-Cum-Erection
II. Contractor's All Risks
III. Contractor's Plant And Machinery
IV. Machinery Breakdown Insurance
V. Boiler And Pressure Plant Insurance
VI. Electronic Equipment Insurance
Group products
I. Group Term Insurance
II. Group Variable Term Insurance
III. Group Unit Linked Plan
Marine
I. Marine Cargo Insurance
Motor insurance
I. Private Car Comprehensive Insurance
II. Two-Wheeler Insurance
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Liability
I. Directors And Office Liability
II. Public Liability (Act)
III. Public Liability
IV. Product Liability
V. Professional Indemnity
VI. Workmen's Compensation
Other policies
I. Industry Care
II. Commercial Care
III. Office Package
IV. Fidelity Guarantee
V. Burglary and housebreaking
VI. Money insurance
VII. Householder's Package
VIII. Shopkeeper's package
IX. Reinsurance
X. Dental Insurance
XI. Disability Insurance
Besides these specialized products, Reliance General Insurance Company Limited
(RGICL) also provides highly efficient services that have helped establish a loyal
customer base for Reliance Insurance. These services include a dedicated team of
trained agents and brokers that helps in claims and settlements, easy and quick e-
imitation facilities, cashless claims and cashless facilities for tie-ups with leading
TPA's and hospitals and a first-of-its-kind towing facility for the insured vehicles in
the accident cases in the major cities. .
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Health insurance
I. Individual Mediclaim
II. Group Mediclaim
III. Reliance Healthwise Policy
Travel insurance
I. Individual And Family
II. Asia
III. Student
IV. Corporate
Figure 1. RGICL Product Mix
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2.e) Area Of Operation
National and Regional
To achieve business success by improving operational efficiencies, Reliance General
Insurance realizes the need to tighten up and streamline both channel partner relationships
and back office operations. The brokers and channel partners are the interface to end
customers. They play a vital role in helping sustain existing customers as well as attract
new customers through better and diverse services. So it is imperative that the company is
well connected with brokers / channels partners as well as meet their needs. Improvement
in back office operations can happen if policy production and billing are automated;
overall claims expenses are reduced, and claims settlement is made faster.
.
To be successful at doing this, we need to nurture both parts of the solution equation,
that is, creation of solution-oriented strategy and deployment of solution-based
scalable technology that enables meeting of strategic goals laid out as part of the
enterprise strategy. In the current scenario many insurers either rely on manual
methods or custom coded solutions that lack strategic approach to address their
business needs. Manual execution of their crucial operations leads to many errors that
occur in documents passed from insurers to brokers or ceding companies to
reinsurers, which results in lengthy settlement cycles. While custom coded interfaces
are developed to meet a certain set of needs only. They are not scalable so cannot
meet changing needs and require recurring IT investment to keep them in use
.
Reliance General Insurance Co. Ltd is in the process of rolling out a 'Centrally
controlled, Decentralized delivery' operations structure to ensure speedy processing
and service while maintaining predictable and strict quality control. A solution is also
being developed to offer strategic value through systematic design and deployment of
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BPM and integration technologies. The solution will address volatile situations, and
shall be a scalable and reusable solution. It would help meet the challenge of
operational costs saving while enabling the company to exploit business expansion
opportunities .
Global
Reliance Capital Limited intends to be a well-respected global player in the
international financial services sector. It is present in Singapore, Malaysia, United
Kingdom and United Arab Emirates.
Singapore
Reliance Asset Management (Singapore) Pvt. Ltd. (RAMS) is a private limited
company with limited liability and is regulated by the Monetary Authority of
Singapore (MAS). RAMS holds a Capital Markets Services (CMS) license issued by
MAS, for carrying out fund management activities under the Securities and Futures
Act (SFA). It was set up as an offshore fund platform of Reliance Capital Asset
Management Limited in 2006 for managing/advising mandates from global
institutional and accredited investors. The core activity of RAMS is asset
management focusing on India equities, alternative & fixed income instruments.
RAMS has in-house capabilities to structure and manage customized mandates and
new product offerings to meet specific client requirements. RAMS is also a registered
Foreign Institutional Investors (FII) with Securities & Exchange Board of India.
Malaysia
Reliance Asset Management Malaysia Sdn Bhd (RAMMy) has been incorporated to
undertake Islamic Asset Management under the license of The Securities Commission
of Malaysia. RAMMy aims to become the provider of choice within Islamic Asset
Management by launching unique Shariah-compliant investment strategies to
complement investor’s portfolios with the ultimate focus on wealth creation.
United Kingdom and United Arab Emiratess
Reliance Capital Asset Management (UK) Plc is a Financial Services Authority
(FSA) authorized investment advisory business based in United Kingdom
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2.f) Ownership pattern
The ownership pattern of reliance general insurance company limited is shown with a
table below:
TABLE 1. SHARE HOLDING PATTERN
Shareholder As at 30-09-2010 As at 30-09-2009
Number of shares % of
Holding
Number of
shares
% of
Holding
Promoters
• Holding Company - Indian 110,929,269 96.27% 108,786,412 96.20%
• Holding Company – Foreign - -
Others
• Reliance General Insurance
Employees Benefit Trust
4,294,672 3.73% 4,294,672 3.80%
TOTAL 115,223,941 100% 113,081,084
For the period ended 30/09/2010 total number of shares of the company are 115,223,941.
Out of which 96.27% of the shares are held by Indian holding company and no shares are
held by foreign holding company. And shares held by Reliance General Insurance
Employee Benefit Trust 3.73%. Number of shares held by Promoters are increased when
compared to last year.
Reliance Capital Asset Management (UK) plc also established a branch in Dubai
International Financial Centre in 2009. It has commenced operations after receiving a
license from Dubai Financial Service Authority. The DIFC based entity provides a
full range of Wealth and Investment Advisory Services to professional investors and
institutional clients in the region. By establishing this branch RCAM (UK) plc intends
to expand its operations throughout the UK, GCC and Africa.
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2.g) Competitors information
For any industries there are number of competitors who themselves try to emerge with
innovative products and services, to compete with other industries. They provide
products and services in order to satisfy the customers, which are economy to their
purchasing habits. Likewise RGICL is also having its competitors.
The main competitors are
Royal Sundaram: Royal Sundaram Alliance Insurance Company Limited has been at
the forefront of providing innovative insurance solutions for its customers. It became
the first private insurer in the country to be licensed post privatization in 2001. Since
then the company have been innovating constantly for its customers. Its business in
over 150 cities through a combination of own branches and those of our partners. Total
market share is 2.46%
Star Health and Allied Insurance: Another major competitor for Reliance General
Insurance company Ltd is Star health And Allied Insurance. It spreads its business
over 100 cities, through its branches. The Total market share of the company is 2.63%.
Tata AIG: Tata AIG General Insurance Company Limited is a joint venture company
between the Tata Group and American International Group, Inc. (AIG). The Tata
Group holds 74 per cent stake in the insurance venture with AIG holding the balance
26 percent. It commenced its operations on January 22, 2001, by providing insurance
solutions to individuals and corporate. It offers complete range of general insurance
products that includes insurance for automobile, home, personal accident, travel,
energy, marine, property and casualty as well as several specialized financial lines.
Total market share is 2.64%
ICICI Lombard: ICICI Lombard GIC Ltd. is a 74:26 joint venture between ICICI
Bank Limited, India’s second largest bank with consolidated total assets of over USD
100 billion at March 31, 2010 and Fairfax Financial Holdings Limited, a Canada based
USD 30 billion diversified financial services company engaged in general insurance,
reinsurance, insurance claims management and investment management.
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ICICI Lombard GIC Ltd. is the largest private sector general insurance company in
India with a Gross Written Premium (GWP) of 36,948 million for the year ended
March 31, 2010. The company issued over 44 Lakh policies and settled over 62 Lakh
claims and has a claim disposal ratio of 96% (percentage of claims settled against
claims reported) as on March 31, 2010. The company has 4,634 employees and 350
branches as on March 31, 2010. Total market share 9.38%
Bajaj Allianz: Bajaj Allianz General Insurance received the Insurance Regulatory
and Development Authority (IRDA) certificate of Registration on 2nd May, 2001 to
conduct General Insurance business (including Health Insurance business) in India.
The Company has an authorized and paid up capital of Rs 110 crores. Bajaj Finserv
Limited holds 74% and the remaining 26% is held by Allianz, SE.
As on 31st March 2010, Bajaj Allianz General Insurance maintained its premier
position in the industry by achieving growth as well as profitability. Bajaj Allianz has
made a profit before tax of Rs. 180 crores and has become the only private insurer to
cross the Rs.100 crore mark in profit before tax in the last four years. The profit after
tax was Rs. 121 crores, 27% higher than the previous year. Total market share is
6.22%.
Bharthi Axa General: Bharti AXA General Insurance is a joint venture between
Bharti, one of India’s leading business groups with interests in Telecom, Agri
Business and Retail; and AXA, world leader in Financial Protection and Wealth
Management. Bharti Group holds 74% of equity and AXA holds 26% of the equity.
The total market share of the company is 1.13%.
2.h) Infrastructural Facilities
RGICL has good infrastructural facilities. All the employees are provided with the
facilities such as telephone, computer with internet access. All the branches are fully
computerized and all branches are well equipped . Employees in the office are
provided with their own software for calculating the claims and for other operations.
The ambience within the office is what can make the customer feel comfortable. The
cordial and friendly atmosphere at office is like a full time motivation for the
employees.
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2.i) Achievements and Awards
The RGICL has not received any specific awards for the business carried out.
2.j) Work flow model for Claims
Figure 2 work flow model
Customer
Branch Office
Customer Care Center
Surveyor
Customer
Claims Manager
Company
customer
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2.k)Future growth and prospects
We can clearly get the idea about the future growth and prospects of the company by
looking at the following figure. It clears tells that, in the earlier years the company’s
growth was stagnant. And the profit was also low because of its stagnant growth. But
from the year 2006-07 the RGICL is having very high growth every year. The gross
premium and the number of policies of the company are increasing at a very high rate.
As there is high increase in the number of vehicles ,there is a high need of insurance
for it, not only for vehicles but also for other services like marine cargo, employee
liability, travel, personal accident etc there is a lot of need for insurance in order to
protect them from loss. So for Reliance General Insurance there is a opportunity of
better growth in the upcoming years
Figure 3. Business Growth
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Mckensey’s 7S frame work with special reference to RGICL
The 7-S Framework was first mentioned in "The Art Of Japanese Management" by
Richard Pascale and Anthony Athos in 1981. They had been investigating how
Japanese industry had been so successful. At around the same time that Tom Peters
and Robert Waterman were exploring what made a company excellent. The Seven S
model was born at a meeting of these four authors in 1978. It appeared also in "In
Search of Excellence" by Peters and Waterman, and was taken up as a basic tool by
the global management consultancy company McKinsey. Since then it is known as
their 7-S model.
Figure 4. McKensey’s 7S model
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Shared Values (also called Super ordinate Goals).
The interconnecting center of McKinsey's model is: Shared Values. What does the
organization stands for and what it believes in. Central beliefs and attitudes. These are
the core values of the company that are evidenced in the corporate culture and the
general work ethic. Super ordinate goals are the fundamental ideas around which a
business is built. They are of main values. What does the organization stands for and
what it believes in. Central beliefs and attitudes. They are the broad notions of future
direction. According to Mckensey super ordinate goals refers to: a set of values and
aspirations that goes beyond the conventional formal statement of corporate
objectives. All targets and attention of all activities and exercises of the six levers of
any organization should be directed towards accomplishment of the best possible
goals. This is the ultimate and terminal point where the organization will have to
reach.
RGICL believes in total quality at all levels of the organization. It aims at total value
packages for all its needs. The shared values or goals of the RGICL are contained in
the banks mission and vision statement. All the employees are work together to
achieve the objectives of the company. The company try to know the customer needs,
wants and based on that it launches the new product and services. It guides to the
employees in order to provide a better service to customers
Strategy
Plans for the allocation of a firms scarce resources, over time, to reach identified goals.
The plan devised to maintain and build competitive advantage over the competition
.The concept of strategy includes purposes, mission's objectives, goals and major
action plans and policies. The 7s model emphasizes that in practice, the development
of strategies poses less of a problem than their execution. It also includes Plans for the
allocation of firm’s scarce resources, over time, to reach identified goals, environment,
competition, customers.
The company strongly believes that customer satisfaction is indispensable for the
business growth. Customer relation manager and facilitator at the strategic location
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and field units, periodic customer services audit and senior level officer are appointed
as nodal officer monitoring the prompt redressed of customer grievances.
Structure
The way in which the organization's units relate to each other: centralized, functional
divisions (top-down); decentralized; a matrix, a network, a holding, etc. : The way the
organization is structured and who reports to whom .The way the organization's units
relate to each other: centralized, functional divisions (top-down); decentralized (the
trend in larger organizations); matrix, network, holding, etc.
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Figure 5. Organization chart
Central manager
MKT manager
Sin. Fin/operation manager
Jr.fin/operation
manger.
Franchise IIIFranchise II Franchise IV Franchise VFranchise I
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Systems
The procedures, processes and routines that characterize how the work should be done:
financial systems; recruiting, promotion and performance appraisal systems;
information systems. The daily activities and procedures that staff members engage in
to get the job done. Systems include all those procedures and methodologies, which
are framed by the organization and followed by the operating personnel in the
respective functional areas. Example, financial accounting system, materials planning
and inventory control system, quality management computerization, etc all these
functional areas some traditional system may be in existence which needs to be
reviewed and changed, as per requirements, in view of advanced technology and
process developed.
System in relation to RGICL : The system and procedure as well defined and are
available with all the hierarchy as on need to know basis. The well structure process
manuals are available for all the functional areas, be it business or administration
.
Staff
Numbers and types of personnel within the organization. The employees and their
general capabilities. Staffing is the process of acquiring human resources for the
organization and assuring that they have the potential to contribute to the achievement
of organizational goals.
RGICL recruits those persons who are perfect for the job. Since the job profile can
change so that it requires training and updating knowledge. The company provides
required training for the personnel which will results in increased productivity and
efficiency
Style
The Mckensy’s framework considers the style as more than the style of top
management. Aspects of organizational culture also seen to be encompass by the term
style. It includes Cultural style of the organization and how key managers behave in
achieving the organization’s goals. Management Styles.
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Organizational Culture: the dominant values and beliefs, and norms, which develop
over time and become relatively enduring features of organizational life.
The style of the RGICL in business or in administration has a unique niche in the
industry.
i .Top Down: The RGICL has been following Top Down style of leadership. The
employee in the organization has well defined roles duties and responsibilities. The
managers get guidelines from the top management regarding interest rate, products
and services to the customers.
ii Authoritarian: The managers in the organization has their own style of functioning
and collectively works as a team. Most of the managers use Authoritative style of
functioning to control their executives.
Skills
Distinctive capabilities of personnel or of the organization as a whole. The actual skills
and competencies of the employees working for the company. The operating system
can change to desired efficient skillful human being for operation of the new
techniques in the new technology. Skills development has raised the productivity of
the employees of the company. Skill development is needed to training for inadequate
skill persons in the organization.
However, RGICL has never neglected the skills development programmes for
employees. It leads to an organization which helps in establishing goodwill and image
in the business world. It also includes Distinctive capabilities of personnel or of the
organization as a whole and its Core Competences.
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Swot Analysis
Strengths
1. RGIC is the second among private players after ICICI Lombard GI
2. India’s first company to be awarded the ISO 9001:2000 certification
3. Net worth has increased up to Rs. 4.94 billions doubled from last year’s
Rs.2.59 billions
4. Excellent outreach with a large distribution network
5. It has 200 branches across 171 cities and over 20,000 intermediaries. The set
up provides the company is very strong and very effective distribution
network , and consequently strong penetration in the market
6. Reserves and Surplus has increased five times to Rs.4.998 billion from
Rs.1.04 billion previous year 2007
7. Exclusive bancassurance tie-up with annual business of Rs.130-145 crore.
8. RGIC has been able to give highest ROI of 11.27% in last five years.
9. RGIC commands 17% of the Private Sector Share & 7% share of the General
Insurance Industry
10. Company issued 36.57 Lac policies during the year as compared to 14.60 Lac
in the previous year there by registering the growth of 150%
Weakness
1. Earnings per share is Rs. -15.92 (previous year Rs.0.16)
2. Sudden expansion this year by establishing more than 125 branches has
increased operations and administration expenses due to which losses incurred.
3. There is no technical support of the foreign principals as RGIC is not having
any foreign tie-up as other players have.
4. All the inner facts and factors known to the family member cum competitor
company headed by Mukesh Ambani.
5. Overdependence on fellow subsidiaries for various supplies.
27
Opportunities
1. De-tariff
o –IRDA removed controls on pricing in General Insurance
business with effect from 1st January 2008
2. The industry is going to be freed from product wordings and policy wordings
3. Can become market leader as presently it is no. 2 position
4. General insurance industry in India has grown at 15% CAGR in terms of gross
premium collection
Threats
1. New Entrants
– Future General India Life Insurance Company Limited
– IDBI Fortis Life Insurance Company Ltd
– Bharti Axa General Insurance Company Ltd
2. Many foreign bank giants are going to enter Indian market. They have very
large portfolio of various verticals and products with them.
3. New tie-ups by the competitors viz.
o -Online travel portal clear trip ties up with TATA AIG to offer
travel insurance
o -ICICI Prudential inks pact with suvidha Info Serve.
4. New joint ventures (JV’s) by industry giants
o -MAX India forms JVC with Bupa Finance to foray into health
insurance
o -Shriram Group is to enter general insurance market
28
Analysis of Financial Statement
Financial analysis of the company with the help of ratio analysis:
I. Current Ratio:
Current ratio is a measure of liquidity calculated dividing the current assets by the
current Liabilities
Current Ratio = Current Assets ÷ Current liabilities
Table 2. Current Ratio
31/03/2009 31/03/2010
Current assets 6,737,335 8,248,216
Current liabilities 8,086,675 10,129,089
Current ratio 0.833 0.814
The current ratio in the year 2010 is very high this is because of less current
liabilities. Company has repaid the liabilities in the year 2010.
II. Quick Ratio:
Quick ratio is the ratio between quick current assets and current liabilities and is
calculated by dividing current assets minus inventory and prepaid expenses by current
liabilities.
Quick Ratio = Quick Assets ÷ Current Liabilities
29
Table 3. Quick Ratio
31/03/2009 31/03/2010
Quick assets 6,737,335 8,248,216
Current liabilities 8,086,675 10,129,089
Quick ratio 0.833 0.814
The quick ratio and current ratio is same for both the years because there is no
inventory.
III. Proprietary Ratio:
Proprietary ratio indicates the extent to which assets are finance by owner’s funds.
It shows the portions of the total assets are financed by the owner’s capital.
Proprietary ratio = Proprietor’s funds ÷ Total assets
Table 4. Proprietary Ratio
31/03/2009 31/3/2010
Proprietor’s funds 79,70,632 1,00,70,631
Total assets 73,81,070 87,23,283
Proprietary ratio 1.081 1.154
30
Learning experience
As a student of Business Administration the learning experience gained in Reliance
General Insurance Co Ltd was one of the important part of my life before entering
into the corporate world. This work provided strong base to get first hand knowledge
of the corporate world which proved very helpful. It not only provided knowledge of
the corporate world but also taught to tackle each and every tremendous situation with
ease.
RGICL is one of the leading companies in India. The study gave me very fruitful
knowledge experience. It provided the solid foundation to study and learn the tactics
of facing the world.
The study on the industry profile, informed on ever expanding view of business in
India with its fascinating history of Insurance sector and its growth and development
in the recent times. This gave a clear idea of the scope of the general insurance in
future, its vastness and ever expanding coverage which the company will cover in the
coming year. The insurance industry has a tremendous potential in the coming years
worldwide and can boom the economy of any given nation.
The history of this company and its origin gave me knowledge to have a great vision
and move strongly withstanding and difficulty which we face and be strong in our
goals. Practically speaking, RGICL is providing vast variety of services to its
customers, that being a customer it’s rather difficult to have knowledge of all the
services. .
To conclude, the whole study in RGICL was a never ending process to learn more,
experience more and get maximum exposure towards the corporate world. In total the
overall experience was excellent and knowledgeable, experience gained was a never
ending quest for knowledge
31
General Introduction
Claims settlement is the most important aspect of the functioning of an insurance
company. Out of any insurance contract, the customer has the following expectations:
i. Adequate insurance coverage, which does not leave him high and dry in time of
need, with right pricing.
ii. Timely delivery of defect free policy documents with relevant endorsements
/warranties / conditions / guidelines.
iii. Should a claim happen, quick settlement to his satisfaction.
Unlike life insurance, where all policies necessarily result in claims – either maturity
or death – in general insurance not all policies result in claim. Approximately around
15% policies in general insurance result in claim. The claim settlement in general
insurance thus have their own peculiarities and therefore need proper handling. Also
how 15% policy holders are attended is of great importance. The services being
rendered will determine the attitude of the customers.
The insurance companies have hitherto been handling the claim rather than managing
them. Typically this process involves –
I. As soon as a claim is reported, the insurance company checks as to whether the
cover was in force at the time of loss and whether the peril is covered under the
policy.
II. A surveyor is appointed who visits the spot, do the assessment and submits the
report.
III. Insurance company examines the report, calls for relevant supporting
documents.
IV. On receipt of survey report and documents, the same are examined. The claim
file is processed and settlement is offered.
1.a) Statement of the problem:
The claims handling is more process oriented and does not pay adequate attention to
the monitoring and claims cost aspect as also to the service parameters. In the present
liberalized scenario, with cut-throat competition being the order of the day, the
insurance companies have to go much beyond the handling of claims. Incase of
general insurance approximately around 15% of the policies results in claim. Thus
32
claims management in general insurance have their own peculiarities and therefore
need proper handling.
1.b) Objectives of study:
To understand the concept of claims. Its creation and processing.
To know who are the partners in claims.
Comparing claims paid and claims recovered to find out whether they
are positively or negatively correlated.
To find out how the Claims Management System can be helpful to the
company.
Good practices that can be used by the company to manage the claims
effectively.
1.c) Scope of the study:
The study is conducted in order to know, whether the claims are managed properly in
the Reliance General Insurance Company Ltd. The study was conducted on the twelve
months data from 1st January 2010 to 31st December 2010. The data considered for the
study are claims paid, claims recovered, gross incurred claims and net incurred claims
of the year 2010.
1.d) Methodology:
The research carried out a descriptive type of research. The study is mainly based on
the secondary data at appropriate places. Thus the data collected by secondary source
have been tabulated and analyzed making use of appropriate statistical tools and
results, such as correlation. and chi-square tests
33
1.e) Limitations of the study:
No single work is exception to the limitations, every work has got its own limitations,
following are some of the limitations of my study
The study is mainly based on secondary data and no field work is done because
of time constraint.
The study is limited to the data of the previous year 2009- 10 only.
Difficulties are faced while accumulating important data.
It is not an exact science, so we cannot expect 100% result, so only justified
solutions are given.
34
2.a) Creating Claims
When the variance is detected from the project plan, claim can be created using an
Internet application. This means variances can be documented either at work station,
or at any computer that has Internet access. This makes claim entry easy and
convenient. And claims can be entered at a construction site, when traveling, and so
on. The flexible user interface makes things even easier. Details of the claim can be
entered using long texts. In addition to the notification header long text, four other
long text categories are available. That can be used to structure the information on the
claims.
Processing Claims
As claims usually cause additional costs, costs can be entered which expect to arise
either when claim is created, or later, when more precise information is available. The
following options are available:
-Entering the estimated costs manually.
-Creating a unit costing from the claim or link it to an existing unit costing.
Enter the costs demanded and accepted manually. Status management and workflow
are two more high-performance tools you can use to process claims in the R/3 System.
The link between claim management and status management means that processing of
a claim dependent on its status, that a claim cannot. The system documents all changes
to the claim in the action log. Once the claims processed and closed ,it can be
archived. A deletion program deletes the database records for claims successfully
archived.
Evaluating Claims
The work lists for notifications and tasks include an overview of the claims to be
processed and the tasks associated with them. For detailed evaluations of claims,
information system and access the overview reports for the claims are useful. As the
claim is assigned to a project or WBS element either when creating the claim or later,
all the claims created for a project/WBS element in the information system can be
35
displayed. An evaluation program can be used to display the data for claims already
archived.
Table 5. AGIENG OF CLAIMS
Line of business Total amount of claims paid(Rs in lacs)
Fire 1511.41
marine cargo 424.64
Marine hull 1431.06
Engineering 565.22
Motor OD 16490.6
Motor TP 3027.24
Health 6642.62
Overseas travel 191.28
Personal Accident 1324.45
Employee liability 21.18
Crop 0
Misc. 7228.12
Figure 6. Ageing of Claims
36
Ageing of claims means, claims paid after a certain number of days. In the above
graph, X axis represents various products of the company and Y axis represents total
amount of claims paid. Motor OD( Own Damage) is having highest number of claims
paid for ageing i.e. Rs.16,490.6 lacs. Motor TP( Third Party), Health and
Miscellaneous are the other 3 products which have more than Rs.2000 lacs. All other
products have total claims paid less Rs.2000 lacs
Table 6 Net premium and Net incurred claim
Description
NET PREMIUM NET INCURRED CLAIM
Fire 3076.66 772.25
Marine cargo
1088.77
654.77
Marine hull
24.87 -42.8
Motor 93648.79 32043.39
Engineering
1863.94 724.5
Aviation
-185.33 386.34
Liabilities
682.64 254.66
Others
3786.69 1335.12
Health
20364.38 12646.88
Figure 7. Net premium and Net incurred claim
37
Table 7 Details regarding claims
PARTICULARS CLAIMS
PAID
CLAIMS
RECOVERED
CLAIMS
O/S AT THE
QUARTER
END
31/12/2010
CLAIMS
O/S AT THE
BEGINNING
Fire 151,465 113,471 285,389 296,252
Marine 42,592 22,343 116,271 104,793
Motor 2,483,546 747,391 6,980,191 7,723,583
Miscellaneous 4,496,888 1,869,915 7,925,130 8,713,797
Figure 8. Claims Details for Fire Insurance
Incase of Fire related claims, the claims outstanding at the beginning of the quarter,
i.e. on 1st october 2010 is 35%. Total claims paid is 18% and claims recovered is 13%.
Claims outstanding at the quarter end 31st december 2010 is 34%. There is a slight
change in the outstanding claims at the end of the quarter when compared to claims
outstanding at the beginning of the quarter
38
Figure 9 Claims Details for Marine Insurance
Incase of marine related claims, the claims outstanding at the beginning of the period
is 36%, total claims paid is 15%. Here recovered claims are very less in number i.e.
only 8% and claims outstanding at the end of the quarter is 41%. In case of marine
related claims, outstanding claims are increased from 36% to 41%.
Figure 10. Claims Details for Motor Insurance
Incase of motor related claims, 43% of claims are outstanding at the beginning of the
quarter. Total claims paid are 14% and recovered claims are only 4%. Very less
amount of claims are recovered in case of mator policies. And claims outstanding at
the end of the quarter is 39% this shows that nimber of claims outstanding are
decreased at the end of the quarter.
39
Figure 11. Claims Details for Miscellaneous Insurance policies
Incase of miscellaneous claims, total claims outstanding at the beginning of the
quarter is 38%, claims paid is 20% and the claims recovered is 8%. Claims
outstanding is decreased to 34% at the end of the quarter.
2.b) Partners in Claims
Definition
When creating a claim, or each time accessing the claim to change it, it is assigned to a
partner type. Claim Management offers the following partner types:
Vendor
Customer
Internal
Depending on the partner type, the system determines the following in claim
processing:
A suitable partner
If the chosen types are "Customer" or "Vendor", the system does not offer the general
partner overview for partner entry purposes, but:
_ For customers:
Customer Address, where a customer can enter who already exists in the system
40
Contact Person Address, for the contact person at the customer
Notification Address: for example, the customer's lawyer
_ For vendors:
Vendor Address, where a vendor can enter who already exists in the system
Manufacturer Address
Notification Address: for example, sales and distribution at the vendor
Contact person can be entered in the notification address.
If you change the partner the partner type is changed, for example, from customer to
vendor, the system adopts all the partners and displays them in the partner overview.
In the standard claim configuration, the contact person is always the customer contact
person.
Allowed reference documents
For vendors, the purchasing document
For customers, the sales order, delivery, and purchase order number
For "internal", the sales order, delivery, purchase order number, and purchasing
document
2.c) Processing the Partner Information
Prerequisites
In order to process the partner information the company follows the below procedure :
Configuring User Default Values
Use
It is a good idea to define user default values if you enter a lot of claims, but rarely use
particular notification data. The system automatically copies these values to the
appropriate fields while creating a claim. It can be overwritten at any time.
Features
Following default values and settings can be defined:
General data
- Notification type
- WBS element
- Partner type
41
- Whether the system shows a status line/pushbutton when you enter or display
long texts
Appearance of the action box: The system represents the action box as a table
or an overview tree. If the table is chosen, the system displays only the follow-
up activities that can be carried out. If the overview tree is chosen, the system
displays all the available follow-up activities.
2.d) Claim Tasks
Definition
A planned or completed activity that describes the planning and organizational
measure in a claim. A task is defined by a code from the task catalog and if necessary
accompanied by a text.
Use
A task allows to plan the cooperation of various persons during the claim process and
assures that the activities connected to the task are completed within a given
timeframe. The task receives a status depending on its degree of completion.
Data for a task is entered on two different screens with varying degrees of detail.
Overview screen
Detail screen
The following entries are possible for each task:
A table key for the tasks to be executed and a brief instruction describing what
is to be done
The task's planned start and end
The task's status
Responsible partner for carrying out the task
The documentation for processing tasks contains a note explaining how to create a
task for a notification item. This is not possible in claim management because a claim
does not recognize items. In claim management a task refers to the entire claim.
2.e) Evaluating Claims
Features
The project information system includes the following reports for analyzing claims:
42
Claim Overview
The system displays all the data entered for the claim selected, except for tasks and
actions. If this is all the data you need, we recommend you use this report, for
performance reasons.
Claim Hierarchy
The system displays all the data entered for the claim selected, including tasks and
actions.
Archiving Claims.
Procedure
Claim archiving using transaction SARA involves the following steps:
1. Preparation
The preparation program assigns status MARC to the claims selected, thereby flagging
them as ready for archiving and deletion. This also blocks the claims so flagged
against further online changes.
2. Archiving Run
The archiving program writes the database tables for the claim to the archive. If the
process was successful, the program deletes the data from the system immediately
after it has been archived.
3. Delete
A deletion program deletes the database records for claims successfully archived. If
the deletion program is not accessed automatically when the archiving action has been
completed successfully, you must wait until archiving is complete altogether.
4. Evaluation
Evaluation can be used to display the data for claims already archived.
Claims Analysis
The following are the tables regarding claims paid from direct business written,
claims paid on re-insurance accepted, claims recovered on re-insurance accepted,
43
net claims paid, outstanding claims at the quarter end, outstanding claims at the quarter
beginning.net claims incurred. The data is for the period ended 31st December 2010
Table 8 claims analysis (a)
Particulars Claims paid from
direct business
written
Claims paid on re-
insurance accepted
Claims recovered
on re-insurance
accepted
Fire 2,29,133 (2,698) 1,60,449
Marine Cargo 86,059 - 49,291
Marine Hull 144 - 14
Motor OD 31,69,976 - 3,35,344
Motor TP 14,47,604 6,31,783 9,93,288
Employer’s Liability 6,514 - 834
Public Liability - - 54
Engineering 1,40,134 - 89,360
Aviation 8,18,393 - 7,82,436
Personal Accident 1,84,639 - 1,32,995
Health 15,38,084 - 2,29,375
Other Misc 3,13,482 - 2,64,219
Table 9 claims analysis (b)
Particulars Net Claims Paid o/s claims at
the period
ending
31/12/2010
o/s claims at
the period
beginning
Net claims
incurred
Fire 65,986 2,85,339 2,74,149 77,226
Marine Cargo 36,768 1,05,502 76,795 65,475
Marine Hull 130 10,769 15,178 (4,279)
Motor OD 28,34,632 11,37,018 13,22,899 26,48,751
44
Motor TP 10,86,099 58,43,173 63,73,686 5,55,586
Employer’s
Liability
5,680 32,915 17,982 20,613
Public Liability (54) 13,023 8,117 4,852
Engineering 50,774 1,58,057 1,36,831 72,450
Aviation 35,957 30,497 27,820 38,634
Personal
Accidents
51,644 61,461 50,753 62,352
Health 13,08,709 5,36,969 5,80,990 12,64,688
Other Misc 49,263 1,11,567 89,668 71,162
Table 10 COMPUTATION OF CORRELATION BETWEEN CLAIMS PAID
AND CLAIMS RECOVERED
PARTICULARS Claims
paid
Claims
recovered
Fire 151,465 113,471
Marine 42,592 22,343
Motor 2,483,546 747,391
Miscellaneous 4,496,888 1,869,915
Figure 12. Claims paid and Claims Recovered
45
Correlation between Claims Paid and Claims Recovered = 0.985024
Table 11. CHI-SQUARE TEST FOR CLAIMS PAID AND CLAIMS
RECOVERED
PARTICULARS O
(Rs in
lacs)
E
(Rs in
lacs)
(O-E)
(Rs in
lacs)
(O-E)2
(Rs in lacs)
(O-E)2/E
(Rs in lacs)
Fire 1.51 1.13 0.38 0.1444 0.005249
Marine 0.43 0.22 0.21 0.0441 0.001603
Motor 24.84 7.47 17.37 301.7169 10.96754
Miscellaneous 44.97 18.69 26.28 690.6384 25.10499
TOTAL 27.51 36.0794
Degrees of freedom : 4-1=3
@ 5% level of significance 7.815
Table 12. results of correlation and chi-square test
Correlation Table Value X2
0.985024 7.815 36.0794
Therefore, claims paid and claims recovered are positively correlated as the
calculated value is more than 0. And they are highly significant at 5% level of
significance.
46
Table 13
Solvency for the quarter ended 31/12/2010
Required Solvency Margin Based on Net premium and Net incurred
claims
Premium Claims
RSM-1 RSM-2 RSM-
3
Ite
m
No
Descripti
on
Gross
premiu
m
Net
premium
Gross
incurre
d claim
Net
incurre
d claim
1 Fire 11,550.
75
3,076.66 3,831.3
8 772.25
1,155.0
7
1,395.9
1
1,395.9
2 Marine
cargo
2,348.7
6
1,088.77 1,152.3
8 654.77
281.85 570.82 570.82
3 Marine
Hull
141.77 24.87 (80.78)
(42.80)
14.18 58.69 58.69
4 Motor 109,297
.74
93,648.79 59,699.
49
32,043.
39
18,729.
76
20,831.
71
20,831.
71
5 Engineeri
ng
7,889.8
4
1,863.94 2,876.7
7 724.50
788.94 896.14 896.14
6 Aviation 6,949.6
3
(185.33) 21,139.
10 386.34
694.96 3,170.8
7
3,170.8
7
7 Liabilities 1,727.1
1
682.64 276.63
254.66
259.07 83.04 259.07
8 Others 9,185.7
4
3,786.69 3,093.5
7 1,335.1
2
1,286 1,544.7
5
1,544.7
5
9 Health 24,320.
57
20,364.38 14,951.
97
12,646.
88
4,072.8
8
6,636.2
0
6,636.2
47
Table 14
Computation of correlation between gross incurred claim and net
incurred claim
Description Gross incurred claim
(Rs in lacs)
Net incurred claim
(Rs in lacs)
Fire 3.83 0.77
Marine Cargo 1.15 0.65
Marine Hull -0.08 -0.042
Motor 59.70 32.04
Engineering 2.88 0.72
Aviation 21.14 0.386
Liabilities 0.28 0.254
Others 3.09 1.34
Health 14.95 12.65
Correlation between gross incurred claim and net incurred claim is 0.93
Table 15 CHI-SQUARE TEST FOR GROSS INCURRED CLAIM
AND NET INCURRED CLAIM
PARTICULARS
O E (O-E) (O-E)2 (O-E)2/ E
(Rs in
lacs)
(Rs in
lacs)
(Rs in
lacs) (Rs in lacs) (Rs in lacs)
Fire 3.83 0.772 3.06 9.351364 0.1917441
Marine cargo 1.15 0.654 0.5 0.246016 0.0050444
Marine Hull -0.081 -0.043 -0.04 0.001444 2.9608405
Motor 59.69 32.04 27.65 764.5225 15.6760816
Engineering 2.88 0.724 2.16 4.648336 0.0953113
Aviation 21.14 0.386 20.75 430.7285 8.8318334
Liabilities 0.276 0.254 0.02 0.000484 9.9241306
Others 3.09 1.34 1.76 3.090564 0.0633701
Health 14.95 12.65 2.3 5.308416 0.1088459
Total 48.777 37.856
Degrees of freedom 9-1 = 8
@ 5% level of significance 15.507
48
Table 16 Results of correlation and chi-square test
Correlation Table Value X2
0.93 15.507 37.856
The relationship between gross incurred claims and net incurred claims is positively
correlated. And they are highly significant at 5% level of significance.
Table 17.1 Quarterly claims data for the period ended 31/12/2010
Sl no Claims experience Fire Marine
Cargo
Marine
Hull
Motor OD Motor TP
1 Claims o/s at the
beginning of the period
765 598 15 39,497 21,636
2 Claims settled during
the period
381 430 2 60,506 1,116
3 Claims reported during
the period
524 733 1 60,942 4,192
4 Claims repudiated
during the period
70 48 - 2,647 -
5 Claims closed during
the period
99 124 - 5,683 318
6 Claims o/s at the end
of the period
739 729 14 31,603 24,394
7 Less than 3 months 271 376 1 20,406 4,144
8 3 months to 6 months 172 141 - 6,699 3,401
9 6 months to 1 year 138 137 7 3,992 4,487
10 1 year and above 158 75 6 506 12,362
49
Table 17.2 Quarterly claims data
Sl no Claims experience health Overseas
travel
Personal
Accident
liability miscel
laneo
us
1 Claims o/s at the
beginning of the period
9140 862 798 179 813
2 Claims settled during the
period
25,075 624 1,319 81 692
3 Claims reported during
the period
18,580 303 833 20 484
4 Claims repudiated during
the period
2,256 27 124 4 163
5 Claims closed during the
period
2,263 594 36 17 260
6 Claims o/s at the end of
the period
11,116 562 1,124 219 598
7 Less than 3 months 9,247 375 643 72 279
8 3 months to 6 months 873 107 264 52 131
9 6 months to 1 year 686 76 189 37 115
10 1 year and above 310 4 28 58 73
The above tables shows the quarterly claims data, regarding claims outstanding at the
beginning of the period, claims settled during the period, claims reported and claims
repudiated during the period, claims closed during the period and claims outstanding at
the end of the period. And it also gives details of claims paid within different periods
of time, i.e. less than 3 months, 3 months to 6 months, 6 months to 1 year, 1 year and
above. These tables gives complete information of the claims for the different
products offered by the company.
50
Table 18 The following table shows the data regarding Ageing Of
Claims
(Rs in Lacs)
Sl no
no of claims paid
1
month
1-3
month
3-6
month
6
month-
1 year
>1
year
Total
no of
claims
paid
Total
amount
of claims
paid
1 Fire
138
99
80 36 28 381
1,511.41
2 Marine
cargo 255
84
45 32 14 430
424.64
3 Marine hull - 1
-
-
1 2
1431.06
4 Motor OD 33,502 18,711
5,891
2,062
340 60,506
16,490.60
5 Motor TP - 21
76
285
734 1,116
3,027.24
6 Health 12,447 5,064
783
208
78 18,580
6642.62
7 Overseas
travel
48 121
81
38
15 303
191.28
8 Personal
Accident
464 124
114
74
57 833
1324.45
9 Liability 4 1
11
1
3 20
21.18
51
Ageing of claims means claims paid within a specific number of days, as in the above
table, claims are paid within 1 month or between 1 to 3 months, 3 to 6 months, 6
months to 1 year and above 1 year. In most of the policies customers want their claims
to be paid as early as possible. So claims most of the claims are paid within 1 month or
1 to 3 months.
In the below graphs ‘X’ axis represents different periods of time and ‘Y’ axis
represents total amount of claims paid.
1- 1 month
2- 1-3 months
3- 3-6 months
4- 6 months to 1 year
5- > 1 year
Figure 13. showing number of claims paid for different periods for Fire
In the above figure claims paid within 1 month is more than all other periods. Out of
381 claims, 138 claims are paid within a period of 1 months. As the period goes on
52
changing the number of claims paid also goes on decreasing. This means that if the
period for paying claims is less people will be more interested in such policies. As
they can get the claim immedietly.
Figure 14.
Number of claims paid for different periods for Marine Cargo
Out of 430 total claims related to Marine Cargo, 255 claims are paid within 1 month.
Here also most of the people prefer to go for the policies where the claims are paid as
early as possible, i.e. within 1 month. Number of claims paid decreases as the period
changes. At period 5, i.e. when claims are paid after 1 year the total amount of claims
paid is 14 out of 430, which is the least among all.
53
Figure 15.
Number of claims paid for different periods for Motor Own Damage
In the above figure claims paid within 1 month is more than all other periods. Out of
60,506 claims, 33,102 claims are paid within a period of 1 months. More than 50% of
the total claims are paid during period 1. As the period goes on changing the number
of claims paid also goes on decreasing. This means that if the period for paying claims
is less people will be more interested in such policies. As they can get the claim
immedietly.
54
Figure 16
Number of claims paid for different periods for Health
Out of 18,580 claims 12,447 claims are paid within a period of 1 month. i.e morethan
66% of claims are paid in the period 1. In this case also as the period for payment of
claim increases, number of claims paid decreases. People are more interested to get
claims as early as possible. So they prefer the periods in which they will get claims
quicky.
55
Figure 17
Number of claims paid for different periods for Personal Accident
In case of personal accidents people need money as early as possible, to meet their
medical and other expenses. So usually, people will go for the period 1 where they get
the claim within 1 month. Here more than 50% of the total claims are paid within 1
month. Very few people go for the period 5 where the claims are paid after 1 year.
56
Figure 18
Number of claims paid for different periods for Overseas Travel
Incase of oversease travel most of the people go for the 2nd
and 3rd
period where the claims
are paid either between 1 to 3 months or between 3 to 6 months. Nearly 40% of the claims are
paid in period 2. i.e. between 1 to 3 months. And 27% of the claims are paid in period 3. i.e.
between 3 to 6 months. Only 5% of claims are paid in the period 5 where the claims are paid
after 1 year.
Figure 19 showing number of claims paid for different periods for
Employee Liability
57
In case of employee liability more than 50% of the claims are paid in the period 3
where the claims are paid between 3 to 6 months.
Reliance motor( two wheelers and private car ) insurance
Two wheelers are convenient and exuberant. With the many advanced features added
in today’s two wheelers are safe too. However the possibility of damage to your prides
and joy exist by way of theft, natural calamities and accidents
Key highlights
- Cashless facility for a hassle-free claims processing
- Speedy claims settlement
- Easy documentation
Key advantages
-Complete cover
Reliance two wheeler insurance policy give s complete cover on the road and off it.
It covers your car against accidents, burglaries, natural calamities etc.
It will also gives you personal accident insurance cover and third party liability cover.
-Convenience designed
Towing service owned and operated to cut down on inefficiencies. It also provide an
allowance of Rs. 300 towards towing charges if required
A net work of 1700m garages in over 231 cities to provide you with cashless repairs
- Super fast service
Instant policy issuance
It values time and responds immediately. There are 24/7 helpline for emergency
services also.
It also make sure that a survey of the vehicle is arranged within 8 working hours
58
Discounts
If the claim is made in the previous year, one can get a ‘No Claim Bonus’ reward
while renewing the policy.
There is a option of transferring ‘ No Claim Bonus’ to the new vehicle.
additional discounts are given for
-Voluntary excess
-Membership of a recognized automobile association
-Discount if side-car is attached
-Installation of anti-theft device
There are special discounts for physically challenged car owners and vintage vehicles.
The policy coverage is wide and encompasses many aspects, from the vehicle to the
owner to any third party involved in a liability concerning the vehicle that is insured.
Vehicle
The Reliance Two Wheeler Insurance Policy covers loss or damage to vehicle due to:
Accident, fire, lightening, self-ignition, explosion, burglary, house break-in or
theft.
Riot and strike, malicious act, terrorism, earthquake, flood, cyclone and
inundation.
Transit by rail, road, air, elevator and lift.
Personal Accident Cover
This policy will also cover against an accident, while riding the vehicle
59
Third Party Liability
As per the Motor Vehicle Act, third part liability cover is a compulsory cover to be
taken by all vehicles. This cover provides against the liability for third party
injury/death, third party property damage and liability to paid driver.
Add on covers
Electrical/Electronic Accessories
Non electrical accessories
Rally Extension
Racing, speed tests, dexterity trials, Hill Climb extensions
Legal Liability to employees, paid drivers
Exclusions
At Reliance General Insurance, the policies are as transparent as possible. To ensure,
not face any unpleasant surprises when making a claim, some of the major exclusions
under the policy :
Normal wear and tear of the vehicle
Mechanical and electrical breakdown
Vehicles being used other than in accordance with the limitations as to use
Damage to/by a person driving without a valid driving license
Loss or damage under the influence of alcohol or any other intoxicating
substance
Loss or damage due to depreciation
Compulsory deductibles
Consequential loss
Auto insurance policy
As soon as a claim occurs, the person have to intimate immediately to Help line
number, call centre executive will be happy to help with the claim procedure.
60
Following information needs to be furnished while intimating a claim:
Contact Numbers
Policy Number
Name of Insured person,
Date & Time of accident,
Vehicle number
Make and Model,
Location of Loss,
Garage Name with contact details
Brief description on how the accident took place,
Extent of loss
Place & contact details of the Insured Person if the person intimating the claim
is not insured.
Reliance property ( Burglary and House Breaking) insurance policy
The world around us is becoming more and more unsafe and the increase in crime rate
bears witness to this fact. Occurrences like burglary, housebreaking or robbery of
contents at office, warehouse, shop or industry can bring about a huge financial loss.
Reliance General Insurance is pleased to offer a plan that keeps the property protected
at all times against burglary and house breaking.
key benefits
Specially designed plan that covers the business premises against burglary and
housebreaking.
Cover available on a first loss basis by way of judicious management of
probable maximum loss assessment.
Host of extensions such as coverage for riot, strike, malicious damage and
theft.
61
Multiple options for variations in sum insured such as floater policy,
declaration policy, floater declaration policy
Policy coverage
The policy offers coverage against
Property contained in business premises (such as stocks, furniture etc) owned
by the Insured
Stocks held in trust / commission and for which the Insured is responsible, if
specifically covered
Damage to premises resulting from burglary and/or housebreaking or any
attempt at burglary
Cash, valuables and securities kept in a locked safe or cash box in locked steel
cupboard if specifically covered
Policy feature
The following variations with regard to sum insured can be opted for:
Floater policy: Issued for stocks at various locations under one sum insured
Declaration policy: Takes care of frequent fluctuations in stocks / stock values
Floater declaration policy: Comprises of features of both floater and the
declaration policies
Exclusions
The policy does not cover:
Loss of goods held in trust / commission, jewelry, curios, title deeds,
business books unless specifically covered
Burglary without any forcible entry
Shop lifting, acts where Insured or his/her family members or employees are
involved
Losses recoverable under fire / plate glass insurance policy
War perils, acts of god and nuclear perils
62
Riot, strike and malicious damage unless specifically covered
Consequential loss or legal liability of any kind
Premises left uninhabited for seven or more consecutive days unless
specifically agreed upon.
Uninformed material alteration in the premises
Eligibility
The Reliance Burglary & Housebreaking insurance Policy can be bought by any one
who has property and valuables that are exposed to the risk of burglary and
housebreaking.
Reliance Marine Cargo insurance policy
The increase in global trade has boosted our economic prosperity as a nation and has
developed new avenues of business for many organizations. Today, new trade
agreements are expanding the realms of business operations to many new countries
and more goods are being shipped around the world. There are a variety of risks that
are associated with transit of goods and it becomes pertinent to have comprehensive
coverage for loss or damage to the goods. For this purpose, Reliance Marine Cargo
Policy is used. .
Key Benefits
Exhaustive coverage against loss or damage to cargo in connection with its
carriage by land, waterways, air or postal services
Policy extendable to cover War and Strikes perils
Flexible coverage options (Specific Policy, Open Policy and Open Cover)
available for the Insured
Policy coverage
Specific Policy – This policy provides cover against specified perils under
marine cargo sent/received during the Policy period.
63
Open Policy – Typically opted by commercial firms and industrial
establishments with substantial volume of trade and a number of transactions, an
Open Policy is issued for ensuring automatic & continuous insurance protection.
This policy is issued to cover all shipments sent/received during the Policy period.
Open Cover – This is an arrangement similar to Open Policy to cover loss or
damage to cargo where specific stamped certificate is issued for declaration made.
The Marine Cargo Policy covers loss or damage to cargo in relation to and in
connection with its carriage by:
-land (whether by motor vehicle or by railway),
-waterways (that is to say by ship which includes every description of vessel used in
navigation);
-air (that is to say, by aircraft used for the transport of cargo, among others); and
-government or private postal services
The Policy provides cover against loss or damage to cargo during transit from one
place to another by any one or more of the modes of transport.
Coverage provided under Marine Cargo policies range from a restricted form of cover
e.g. Fire and Lightning perils only to the widest available form of cover, namely, All
Risks, at the option of the insured.
Special features
Worldwide Claims Survey and Settlement Assistance.
Network of Surveyors all over the country.
Customized and Innovative covers based on your needs.
Extensions for multi transit, incidental storage, FOB, riot and strikes perils etc
Discounts for Voluntary Higher excess, lesser distance etc.
Exclusions
The Policy does not cover loss or damage to cargo insured due to:
willful misconduct of the Insured;
insufficiency or unsuitability of packing or preparation of the cargo insured;
ordinary leakage, ordinary loss in weight or volume, ordinary wear and tear
and inherent flaws in the cargo insured;
64
delay,
insolvency and financial distress of the carriers;
unseaworthiness of vessel;
Reliance Personal Accident Policy
Safety is always a paramount concern. However accidents do occur. An accident at
home could be simply broken glass or a gas cylinder burst. Reliance Individual
Personal Accident Policy is one of the key security measures to undertake for
providing financial security incase of a injurious accident. It ensures that one's family
does not suffer in event of an accident by providing compensation for accidental death
or disablement.
Key Benefits
Reliance Individual Personal Accident Policy covers against risks of accidents.
It not only provides compensation to the family in case of the accidental death
of the insured but also takes on the onus of providing the insured
with compensation in case of injury, whether temporary or permanent.
The sum insured increases by 5% for each completed claim-free year of
insurance, subject to a maximum of a 50% increase.
This policy can also be expanded to cover actual medical expenses arising out
of the accident
Policy coverage.
Reliance Individual Personal Accident Policy will cover against :
Accidental Death – On the accidental death of the insured person, we will pay
the family the capital sum insured.
Permanent Total Disability – In the event of permanent total disability due to
an accident, we will also pay the capital sum insured.
65
Permanent Partial Disability – In case of a partial disability due to an
accident, a specified percentage of the sum insured will be paid. To know the
specific percentage of the sum assured that will be paid,
Temporary Total Disability – If one is totally disabled by an accident for a
limited period of time, the policy will pay you 1% of the capital sum insured per
week, not exceeding Rs 5,000 per week.
Value Added Benefits
Reliance General Insurance aim at giving the maximum value for money. Hence, this
policy has value-added benefits.
Carriage of Dead Body – In the event of accidental death outside the
residence, a lump sum of 2% of capital sum insured, subject to a maximum of
Rs.2,500, will be paid towards transportation of the insured person's dead body to
place of residence.
Education Grant –Children need protection and nurturing. In the event of
accidental death or permanent total disability for which a claim is payable,
education grant is also provided for the children of the insured. An amount equal to
10% of the capital sum insured, subject to a maximum of Rs 5,000, will be paid in
the case of one dependent child below the age of 25 years. With two dependent
children below the age of 25, an amount equal to 10% of the capital sum insured,
subject to a maximum of Rs 10,000, will be paid.
Exclusions
The policy excludes cover for death or disablement due to:
Pregnancy or related consequence
Any mental disorder
66
Any pre-existing conditions / disabilities
Needless exposure to peril, except in an attempt to save human life
Intentional self-injury, suicide or attempted suicide
Influence of intoxicating liquor or drugs
Insured committing any breach of law with criminal intent
War and nuclear perils
Riots, Crimes, Misdemeanors and Felonies
Eligibility
This policy can be issued to persons in the age group of 5 years to 70 years. It can be
extended to cover persons beyond the age of 70 years and up to 80 years on payment of
suitable additional premiums.
2.f) CLAIMS MANAGEMENT SYSTEM
As Claims Management is one of the most challenging business processes in the
insurance industry. With the number of stakeholders involved, the dependencies and
the logistics, there is a need is to eliminate manual interventions and process silos.
Technology can play a significant role by providing integrated channels for
communication and collaboration. This would help the insurance company to increase
employee productivity by reducing cycle time and defect rate and also increase
employee participation and compliance
Features
a. End-to-end claims cycle management:
The system covers the claims management process right from the moment a case is
registered in the front desk to its closure. Workflow provides corresponding task
allocations to task owners.
b. Role based management:
Profiles that are part of the claims process provided with relevant access to the system.
67
c. Document management:
Case related documents, can be uploaded in the system and managed effectively. This
enables easy access to them by the claims owner.
d. Collaboration through web and mobile solutions:
For stakeholders like surveyors, claims advisors web/mobile solutions speed up their
data collection and uploading tasks.
e. Efficient claims Case and Task tracking:
The manager through operational reports can handle claims tracking and resource
assignments efficiently
.
Solution review.
An application that would help the Insurance Company manage their claims
processing from claims Initiation to closure with automated process flows,
collaboration, document management and reporting features.
a. End-to-end claims cycle management: The system covers the claims
management process right from the moment a case is registered in the front
desk to its closure. Workflow provides corresponding task allocations to task
owners.
b. Role based management: Profiles that are part of the claims process provided
with relevant access to the system.
c. Document management: Case related documents, can be uploaded in the
system and managed effectively. This enables easy access to them by the
claims owner.
d. Collaboration through web and mobile solutions: For stakeholders like
surveyors, claims advisors web/mobile solutions speed up their data collection
and uploading tasks.
e. Efficient claims Case and Task tracking: The manager through operational
reports can handle claims tracking and resource assignments efficiently.
68
Figure 20. claims management system solution review
69
Figure 21. claims management system process review
70
Call Center/ Front
Desk
Claims Manager Claims Advisor Claims Owner
Start
Agent initiates a
case after receiving
details from
customer
Verifies the
case and assigns
a claims advisor
to the case
Validates the
case and assigns
the case to the
claims owner
Runs the final
check and closes
the case
Stop
Collects the
necessary
details about
the case
Submit the case
back to the
claims manager
Handouts
the
claims till
settlement
Submits the case
back to the
claims manager
to take it to
closure
71
FINDINGS
• Claims paid and Claims recovered are compared here using correlation
technique and it shows that they are positively correlated as the computed
value is more than 0
• Claims paid and Claims recovered are highly significant at 5% level of
significance, as the table value is less than the calculated value.
• Net claims incurred and Gross claims incurred are compared and it is found
that they are also positively correlated as the computed value is more than 0.
And are highly significant at 5% level of significance.
• Claims Management System can play a very significant role. This would help
the company in increasing employee productivity by reducing cycle time and
defect rate. It also increases employee participation and compliance.
• The good practices for claims management mentioned here can be effectively
used by the company to settle claims in an efficient way. If the company uses
these practices it would result in ‘timely claim processing’ ‘effective handling
of complaints and disputes’ ‘ fraud detection and prevention’ ‘better claims
procedure’.
RECOMMENDATIONS
1: Claims reporting
The insurance company writes insurance policies in easily understandable language.
Policies spell out what is covered and what is not covered. If necessary, plain language
explanations could be an addendum to the legal language. The insurance company
draws the attention of the policyholder/claimant/beneficiary1 both when he/she signs a
policy (for policyholders only) and when he/she reports a loss on his/her duties related
to claim reporting which include:
Try to minimize losses;
To report claims in a timely fashion;
To co-operate in the investigation by providing the company with all relevant
information and, in particular, copies of official documents regarding the
damage (accident, loss, etc.);
72
To authorize the company to handle necessary inspections and assess the extent
of the damage prior to any repairs or replacement; To ensure that the claims
reporting phase proceeds as smoothly as possible, the insurance company sends
to the policyholder/claimant/beneficiary within a reasonable period of time
(beginning from when the loss is reported):
An appropriate claim form (when the loss reporting is made in writing) for
the type of policy - prepared either by an individual insurance company or at
the national level by companies or the supervisory authorities together with
instructions and useful information on how to comply with the terms of the
policy and the legitimate requirements of the company;
2: Receipt of claims by the company
The company claim department and/or the intermediary (if applicable) are as
accessible as possible for the claimant. If an intermediary is an initial contact for
claimants, claims should be sent to the company claim department within an
appropriate time period.
The insurance company should contact the policyholder/claimant/beneficiary or send
an acknowledgement of receipt as soon as the claim is received. Subsequently, if it
appears that the claim cannot be settled rapidly, the company notifies the
policyholder/claimant/beneficiary and indicates that he/she will be re-contacted within
a reasonable time limit. When it is necessary for the
policyholder/claimant/beneficiary to provide specific documents when filing a claim,
the company should send him/her the list of these documents as soon as possible. In
addition, a specific notification listing the elements to be provided when another
insurance company is involved is sent to the policyholder/claimant/beneficiary.
3: Fraud detection and prevention
In order to curb the growth of fraudulent claims and the rise in premium costs
that results from them, companies take the following steps:
They establish compliance programs for combating fraud and money
laundering appropriate to their exposure and vulnerabilities.
In the claim filing phase, they discourage fraudulent practices by making the
policyholder/claimant/beneficiary aware of the consequences of submitting a
73
false statement (which in particular could be liable to prosecution) and/or an
incomplete statement. To this end, insurance companies place a notification on
their claims forms referring to the appropriate law, statute or insurance
regulation that addresses the filing of fraudulent or incomplete claims.
Where legally possible, companies participate in relevant databases where
claims susceptible to be fraudulent would be reported. Moreover, public
authorities may encourage or take steps to initiate the creation of a public or
private bureau of insurance fraud.
Besides, companies provide their claims department staff with adequate
training on fraud indicators.
4: Claim processing
Company’s claim procedures are gathered together in a manual for internal use. At
least, one staff member should be responsible for ensuring that the manual is kept up
to date and additions/amendments are made when necessary. Companies’ claims
department staff possess proper qualifications. To this end, companies encourage
ongoing internal or external training of their claim staff.
Regular internal audits are carried out for all claims not settled in their entirety.
Internal audits apply to all stages of the claims management process. Peer reviews
(where the claims department staff review each others’ files) could also be carried out.
In case of claim settlement procedures involving several insurance companies,
policyholder indemnification is a priority: the claim should be compensated in an
appropriate time period while potential disputes between insurers are resolved at a
later stage. For the most common insurance claims (related to motor insurance, for
instance), specific agreements are concluded between insurers to accelerate and
simplify claims settlement procedures involving several insured parties.
.
Provision of information to policyholders:
The company keeps policyholders/claimants/beneficiaries informed of the progress
during the claims process. The company provides information on when payments,
repairs or replacements are expected to be made, and, if necessary, explains why
additional time is required.
When the company decides to call on outside parties (i.e. loss adjusters, solicitors,
surveyors, etc.), it informs policyholders/claimants/beneficiaries of this fact, gives the
reasons for this decision and explains the role that these outside parties will play in
74
processing the claim. When a final payment or offer of settlement is made, the
company explains to policyholders/claimants/beneficiaries what the payment or
settlement is for and the basis used for the payment/settlement. The insurance
company documents their claim files in order to be able to address questions that may
arise concerning the handling and payment of the claim.
5: Timely claim processing
In accordance with applicable insurance law, companies should specify in the contract
the most likely period of time for responding to correspondence from
policyholders/claimants/beneficiaries.
− The insurance company endeavors to settle the claim as soon as possible and
advises in writing the policyholder/claimant/beneficiary on the reasons for any delay.
Quick claims settlement as well as high-quality and punctual information provided to
the policyholder/claimant/beneficiary are key competition features for insurance
companies. After an agreement has been reached between the company and the
policyholder/claimant/ beneficiary on the amount of compensation, the payment is
effected within a reasonable amount of time. Insurance companies implement and
update their own statistical database tracing their performance in the timely settlement
of claims as well as in trends in settlements and expenses. A proper procedure for the
coding and statistical processing of losses is developed for this purpose.
6: Supervision of claims-related services
The insurance supervisory authorities may conduct examinations on claims
management services especially where problems are suspected. In these cases, the
following elements are taken into account:
- Possible access to non-confidential claims data for all open and closed files
within a specified time frame (e.g. for the current year and the two preceding
years);
- Maintenance of sufficient and appropriate information on claims files;
- Use of the appropriate type of claim form for the type of insurance;
- Proper qualification of the claims department’s employees based inter alia
on the applicable insurance code;
75
- Valuation of claims payments according to company procedures;
- Appropriate tracking of the nature and number of complaints related to claim
management process;
- Monitoring of the proportion of claims that result in litigation;
- Compliance with procedures for combating fraud and money laundering;
- Regular internal audit practices on claims files;
- Appropriate internal claims procedure manuals;
- Proper procedure for coding and statistical reporting of losses;
- Performance in terms of the speed of claim settlements
7: Market practices
The public authorities promote the implementation of a benchmark exercise regarding
the claims process or a specific part of this process (i.e. handling of complaints). The
terms of remuneration of insurance company employees or other services in charge of
claim management do not give incentives to disadvantageous treatment of
policyholders/claimants/beneficiaries, as regards the handling or the outcome of
claims.
CONCLUSION
After making the study on ‘Claims Management’ with the help of various statistical
tools, I would like to conclude that claims paid and claims recovered are positively
76
correlated and highly significant. The Claims Management System explained above is
very helpful to the company. As the technology plays an important role in the Claims
management System, it will result in less manual errors, time taken to process claims
will be less . claims procedure becomes fully automated. Managing claims becomes
easy for the company it would further results in customer satisfaction. The good
practices on claim management are neither binding nor exhaustive, but meant as a
“checklist” to assist insurance companies in handling claims.
77
ANNEXURE
Reliance General Insurance Company Limited
Balance sheet as at 30th September 2010
PARTICULRS Rs(‘000) Rs(‘000)
Sources of funds
Share capital
Share application money
Reserves and surplus
Faire value change account
borrowings
TOTAL
Applications of funds
Investments
Loans
Fixed assets
Deferred tax asset
Current assets
Cash and bank balances
Advances and other assets
Sub-total(A)
Current liabilities
Provisions
Sub-total(B)
Net current assets(C)=(A-B)
Debit balance in profit and loss account
TOTAL
1,152,239
1,420,000
8,918,392
15,552
----
19,618,135
300,627
376,664
409,735
440,527
3,921,946
4,362,473
10,129,089
6,258,561
16,387,650
(12,025,177)
2,826,199
11,506,183
11,506,183
78
Balance sheet as at 30th September 2009
PARTICULRS Rs(‘000) Rs(‘000)
Sources of funds
Share capital
Share application money
Reserves and surplus
Faire value change account
borrowings
TOTAL
Applications of funds
Investments
Loans
Fixed assets
Deferred tax asset
Current assets
Cash and bank balances
Advances and other assets
Sub-total(A)
Current liabilities
Provisions
Sub-total(B)
Net current assets(C)=(A-B)
Debit balance in profit and loss account
TOTAL
1,130,811
6,839,821
(157,825)
14,592,775
300,627
595,688
8,535
956,365
5,055,035
6,011,401
8,085,675
7,253,307
15,339,982
(9,328,581)
1,643,763
7,812,807
7,812,807
79
BIBLIOGRAPHY
www.reliancegeneral.co.in
www.niapune.com/Research/Claims%20Management.
http://help.sap.com/printdocu/core/print46c/en/data/pdf/PSCLM/PSCLM.
www.oecd.org/dataoecd/43/44/33964905
www.polaris.co.in/practices/technology/.../Claims-Management
http://en.wikipedia.org/wiki/Claims_management_company
www.polaris.co.in/media/media-release/2010-jan-claim-mgmt-solution
80
7,934,162 629,085 3,037,659 5,525,588
81

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  • 1. 1 Industry Profile General insurance means managing risk against financial loss arising due to fire, marine or miscellaneous events as a result of contingencies, which may or may not occur. General Insurance means to “Cover the risk of the financial loss from any natural calamities viz. Flood, Fire, Earthquake, Burglary, etc.. i.e. the events which are beyond the control of the owner of the goods for the things having insurable interest with the utmost good faith by declaring the facts about the circumstances and the products by paying the stipulated sum , a premium and not having a motive of making profit from the insurance contract.” General Insurance Companies provide financial protection to individuals and business houses. Protection is provided against financial losses caused by unforeseen events. This protection is available to individuals, businessmen and large companies alike. To succeed and survive insurance companies must cover their costs, which include payments to cover the losses of policyholders, as well as sales and administrative expenses, taxes and dividends. Insurance companies have two sources of income for covering these costs: Premium and Investment income. Premiums are collected on a regular basis and invested in Government Bonds, Gift stocks, mutual funds, real estates and other conservative avenues. However, investment income depends on market conditions, interest rates, economy etc and varies from year to year. Because of the uncertainty associated with the investment income, insurance companies must generate enough income from the premiums to cover the bulk of their expenses. Meaning of Risk / Insurance Insurance is a contract whereby, in return for the payment of premium by the insured, the insurers pay the financial losses suffered by the insured as a result of the occurrence of unforeseen events. The term "risk" is used to describe all the accidental happenings, which produce a monetary loss. Insurance is a method in which a large number of people exposed to a similar risk make contributions to a common fund out of which the losses suffered by the unfortunate few, due to accidental events, are made good. The sharing of risk among large groups of people is the basis of insurance. The losses of an individual are
  • 2. 2 distributed over a group of individuals . The risk becomes insurable if the following requirements are complied with: a) The insured must suffer financial loss if the risk operates. b) The loss must be measurable in money, c) The object of the insurance contract must be legal. d) The insurer should have sufficient knowledge about the risks he accepts. Definition and meaning: 1. INSURANCE: Insurance is the means of managing risk and protection against financial loss arising as a result of contingencies, which may or may not occur. In other words, insurance is the act of providing assurance, against a possible loss, by entering into a contract, with one who is willing to give assurance. Through this contract the person willing to give assurance binds himself to make good such loss, if it occurs. 2. GENERAL INSURANCE: General insurance means managing risk against financial loss arising due to fire, marine or miscellaneous events as a result of contingencies, which may or may not occur. General Insurance means to “Cover the risk of the financial loss from any natural calamities viz. Flood, Fire, Earthquake, Burglary, etc.. i.e. the events which are beyond the control of the owner of the goods for the things having insurable interest with the utmost good faith by declaring the facts about the circumstances and the products by paying the stipulated sum , a premium and not having a motive of making profit from the insurance contract.” 4 I’s of Insurance Service The 4 I’s refers to the different dimensions/ characteristics of any service. Unlike pure product, services have its own characteristics and its related problems. So the service
  • 3. 3 provider needs to deal with these problems accordingly. The service provider has to design different strategies according the varying feature of the service. These 4 I’s not only represent the characteristics of different services but also the problems and advantages attached to it. These 4 I’s can be broadly classified as: • Intangibility •Inconsistency • Inseparability • Inventory • Intangibility: Insurance is a guarantee against risk and neither the risk nor the guarantee is tangible. Hence, insurance rightly come under services, which are intangible. Efforts have been made by the insurance companies to make insurance tangible to some extent by including letters and form • Inconsistency Service quality is often inconsistent. This is because service personnel have different capabilities, which vary in performance from day to day. This problem of inconsistency in service quality can be reduced through standardization, training and mechanization. • Inseparability Services are produced and consumed simultaneously. Consumers cannot and do not separate the deliverer of the service from the service itself. Interaction between consumer and the service provider varies based on whether consumer must be physically present to receive the service.
  • 4. 4 • Inventory No inventory can be maintained for services. Inventory carrying costs are more subjective and lead to idle production capacity. When the service is available but there is no demand, cost rises as, cost of paying the people and overhead remains constant even though the people are not required to provide services due to lack of demand. In the insurance sector however, commission is paid to the agents on each policy that they sell. Hence, not much inventory cost is wasted on idle inventory. As the cost of agents is directly proportionate to the policy sold. Some of the General Rules: 1. Mis-description : The insurance policy shall be void and all the premiums paid by insured may be forfeited by the insurance company in the event of mis-presentation or mis- declaration and/or non-disclosure of any material facts. 2. Reasonable care : The insured shall take all reasonable steps to safeguard the property insured against any loss or damage. Insured shall exercise reasonable care that only competent employees are employed and shall take all reasonable precautions to prevent all accidents and shall comply with all statuary or other regulations 3. Fraud : If any claim under the policy may be in any respect fraudulent or if any fraudulent means or device are used by the insured or any one acting on the insured’s behalf to obtain any benefit under the insurance policy, all the benefits under the insurance policy may be forfeited.
  • 5. 5 4. Few basic principles of general insurance are : Insurable interest Utmost good faith Subrogation Contribution Indemnity 5 Risks of loss not covered under general insurance are: The loss or damage or liability or expenses whether direct or indirect occasion by happening through or arising from any consequences of war, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion revolution, civil commotion or loot or pillage in connection therewith and loss or damage caused by depreciation or wear and tear. However the risk of loss or damage by war can be insured by payment of additional premium in some cases only. Today the technology is boosting in each and every field. Insurance is not an exception. Companies have started providing customers facility of online payment of premium through their websites. They also provide online assistant to the customer the policy status and how to calculate the premium. To calculate the premium they just need the present age, the type of police, sum assured, and accident covered if any. By filling in this information you can calculate the amount of premium you have to pay. The customer can pay their premiums by means of credit cards or can also give standing instruction to the bank in order to pay their monthly premiums. The insurance companies also provide loan facilities against their policies. At present loans are granted on unencumbered polices as follows: • Up to 90% of the Surrender Value for policies, where the premium due is fully paid- up, and • Up to 85% of the Surrender Value for policies where the premium due is partly paid- up.
  • 6. 6 The minimum amount for which a loan can be granted under a policy is Rs150. The rate of interest charged is 10.5% p.a., payable half-yearly. Loans are not granted for a period shorter than six months, or on the security of lost policies (the assured must have the duplicate policies) or on policies issued under certain plans. Certain types of policies are, however, without loan facility.
  • 7. 7 COMPANY PROFILE Reliance General Life Insurance Company is a Reliance Capital Ltd. product. Under the guidance of Anil Dhirubhai Ambani Group, reliance insurance company has secured the position of the top insurers in India. Reliance General insurance is one of the first non-life companies to get the license from the IRDA. The risks covered under general insurance include property, marine, casualty and liability. Wide ranges of products are available at Reliance Standard Insurance for both group and individual customers. Each insurance policy is customized so as the customers feel as if it was made for their needs. The distribution channels include branch network, individual and specially trained insurance agents and insurance brokers and online purchases of the insurance policies. A completely customer centric company, Reliance Insurance Co Ltd aims at making insurance affordable and accessible to all. The interests of the policyholders are protected to the best of their capabilities and complete cooperation is provided in insurance claims. a pan India presence of Reliance Standard Insurance brings the insurance policy best suited to your requirements right to a branch near you. 2.a)Background and inception of the company Reliance Capital Limited (RCL) is a Non-Banking Financial Company (NBFC) registered with the Reserve Bank of India under section 45-IA of the Reserve Bank of India Act, 1934. as a public limited company in 1986 and is now listed on the Bombay Stock Exchange and the National Stock Exchange (India). RCL has a net worth of over Rs '3,300 crore and over 165,000' shareholders. On conversion of outstanding equity instruments, the net worth of the company will increase to about Rs 4,100 crore. It is headed by Anil Ambani and is a part of the Reliance ADA Group. Reliance Capital ranks among the top 3 private sector financial services and banking companies, in terms of net worth. Reliance Capital has interests in : Asset management, Mutual funds. Life and general insurance. Private equity and proprietary investments. Stock broking. Reliance PMS. Depository services and financial products. Consumer finance and other activities in financial services
  • 8. 8 2.b) Nature of the business carried Reliance General Insurance is one of India’s leading private general insurance companies with over 94 customized insurance products catering to the corporate, SME and individual customers. The Company has launched innovative products like India’s first Over-The-Counter health & home insurance policies. Reliance General Insurance has an extended network of over 200 offices spread across 173 cities in 22 states, a wide distribution channel network, 24x7 customer service assistance and a full fledged website. It is also India’s first insurance company to be awarded the ISO 9001:2000 certification across all functions, processes, products and locations pan-India. 2.c)Vision, mission and quality policy Vision To be an Insurer of World Standards and the most preferred choice for clientele at the domestic and global level. Mission The Mission is to keep the customer satisfaction as focal point of all our operations, adopt the best international practices in underwriting, claims and customer service, be the most innovative in product development, establish presence all over India, ensure sustained value addition to all stake holders and to uphold Corporate Value & Corporate Governance. Objectives 1. Make affordable insurance accessible to all 2. Keep customer as focal point for all operations 3. Protect policy holders interests 4. Adopt best international practices in claims, underwriting and policy servicing 5. Be the most innovative in product development 6. Establish Pan India presence
  • 9. 9 Quality Policy At Reliance General Insurance, one can identify Quality and Customer-focus as the key strategic initiatives. The Quality roadmap, strictly aligned with the business priorities, is benchmarked to the best contemporary global practices, and is designed to support single-minded objectives of maintaining world-class quality standards. The quality system deployment, defined from the point of the view of the customers, is to enhance customer experience at all the touch points. As part of this initiative, every business process in the organization is identified, documented, automated and deployed. These processes are further monitored continuously through their compliance scores and dashboard measures and reviewed by the Senior Management team within the organization. In fact this passion has taken us one step ahead. The company is pleased to share the recognition of the Quality Management System by reputed global quality standards auditing organization – Det Norske Veritas (DNV), which has awarded us the ISO 9001:2000 certification. The certification conforms our adherence to design, development & sale of General Insurance product offerings to meet customer needs and in line with 'IRDA regulations' Advantages of the ISO 9001:2000 certification to the customers 1. Streamlined processes and procedures Reliance General Insurance has established well-defined and documented process and to help understand our Customer’s requirements and address them to their satisfaction. 2. Superior Service Standards Our unwavering commitment to excellence ensures prompt and correct documentation while also ensuring transparent & speedy claims settlement 2.d)Products / Services Profile Reliance General Insurance currently offers over 80 customized insurance products for the retail and corporate sector. All these products are sold through its various offices in different places.
  • 10. 10 Personal accident I. For Individuals II. Group Personal Accident Fire I. Standard Fir And Special Perils II. Consequential Loss (Fire) III. Industrial All Risks Engineering I. Erection All Risks/Storage-Cum-Erection II. Contractor's All Risks III. Contractor's Plant And Machinery IV. Machinery Breakdown Insurance V. Boiler And Pressure Plant Insurance VI. Electronic Equipment Insurance Group products I. Group Term Insurance II. Group Variable Term Insurance III. Group Unit Linked Plan Marine I. Marine Cargo Insurance Motor insurance I. Private Car Comprehensive Insurance II. Two-Wheeler Insurance
  • 11. 11 Liability I. Directors And Office Liability II. Public Liability (Act) III. Public Liability IV. Product Liability V. Professional Indemnity VI. Workmen's Compensation Other policies I. Industry Care II. Commercial Care III. Office Package IV. Fidelity Guarantee V. Burglary and housebreaking VI. Money insurance VII. Householder's Package VIII. Shopkeeper's package IX. Reinsurance X. Dental Insurance XI. Disability Insurance Besides these specialized products, Reliance General Insurance Company Limited (RGICL) also provides highly efficient services that have helped establish a loyal customer base for Reliance Insurance. These services include a dedicated team of trained agents and brokers that helps in claims and settlements, easy and quick e- imitation facilities, cashless claims and cashless facilities for tie-ups with leading TPA's and hospitals and a first-of-its-kind towing facility for the insured vehicles in the accident cases in the major cities. .
  • 12. 12 Health insurance I. Individual Mediclaim II. Group Mediclaim III. Reliance Healthwise Policy Travel insurance I. Individual And Family II. Asia III. Student IV. Corporate Figure 1. RGICL Product Mix
  • 13. 13 2.e) Area Of Operation National and Regional To achieve business success by improving operational efficiencies, Reliance General Insurance realizes the need to tighten up and streamline both channel partner relationships and back office operations. The brokers and channel partners are the interface to end customers. They play a vital role in helping sustain existing customers as well as attract new customers through better and diverse services. So it is imperative that the company is well connected with brokers / channels partners as well as meet their needs. Improvement in back office operations can happen if policy production and billing are automated; overall claims expenses are reduced, and claims settlement is made faster. . To be successful at doing this, we need to nurture both parts of the solution equation, that is, creation of solution-oriented strategy and deployment of solution-based scalable technology that enables meeting of strategic goals laid out as part of the enterprise strategy. In the current scenario many insurers either rely on manual methods or custom coded solutions that lack strategic approach to address their business needs. Manual execution of their crucial operations leads to many errors that occur in documents passed from insurers to brokers or ceding companies to reinsurers, which results in lengthy settlement cycles. While custom coded interfaces are developed to meet a certain set of needs only. They are not scalable so cannot meet changing needs and require recurring IT investment to keep them in use . Reliance General Insurance Co. Ltd is in the process of rolling out a 'Centrally controlled, Decentralized delivery' operations structure to ensure speedy processing and service while maintaining predictable and strict quality control. A solution is also being developed to offer strategic value through systematic design and deployment of
  • 14. 14 BPM and integration technologies. The solution will address volatile situations, and shall be a scalable and reusable solution. It would help meet the challenge of operational costs saving while enabling the company to exploit business expansion opportunities . Global Reliance Capital Limited intends to be a well-respected global player in the international financial services sector. It is present in Singapore, Malaysia, United Kingdom and United Arab Emirates. Singapore Reliance Asset Management (Singapore) Pvt. Ltd. (RAMS) is a private limited company with limited liability and is regulated by the Monetary Authority of Singapore (MAS). RAMS holds a Capital Markets Services (CMS) license issued by MAS, for carrying out fund management activities under the Securities and Futures Act (SFA). It was set up as an offshore fund platform of Reliance Capital Asset Management Limited in 2006 for managing/advising mandates from global institutional and accredited investors. The core activity of RAMS is asset management focusing on India equities, alternative & fixed income instruments. RAMS has in-house capabilities to structure and manage customized mandates and new product offerings to meet specific client requirements. RAMS is also a registered Foreign Institutional Investors (FII) with Securities & Exchange Board of India. Malaysia Reliance Asset Management Malaysia Sdn Bhd (RAMMy) has been incorporated to undertake Islamic Asset Management under the license of The Securities Commission of Malaysia. RAMMy aims to become the provider of choice within Islamic Asset Management by launching unique Shariah-compliant investment strategies to complement investor’s portfolios with the ultimate focus on wealth creation. United Kingdom and United Arab Emiratess Reliance Capital Asset Management (UK) Plc is a Financial Services Authority (FSA) authorized investment advisory business based in United Kingdom
  • 15. 15 2.f) Ownership pattern The ownership pattern of reliance general insurance company limited is shown with a table below: TABLE 1. SHARE HOLDING PATTERN Shareholder As at 30-09-2010 As at 30-09-2009 Number of shares % of Holding Number of shares % of Holding Promoters • Holding Company - Indian 110,929,269 96.27% 108,786,412 96.20% • Holding Company – Foreign - - Others • Reliance General Insurance Employees Benefit Trust 4,294,672 3.73% 4,294,672 3.80% TOTAL 115,223,941 100% 113,081,084 For the period ended 30/09/2010 total number of shares of the company are 115,223,941. Out of which 96.27% of the shares are held by Indian holding company and no shares are held by foreign holding company. And shares held by Reliance General Insurance Employee Benefit Trust 3.73%. Number of shares held by Promoters are increased when compared to last year. Reliance Capital Asset Management (UK) plc also established a branch in Dubai International Financial Centre in 2009. It has commenced operations after receiving a license from Dubai Financial Service Authority. The DIFC based entity provides a full range of Wealth and Investment Advisory Services to professional investors and institutional clients in the region. By establishing this branch RCAM (UK) plc intends to expand its operations throughout the UK, GCC and Africa.
  • 16. 16 2.g) Competitors information For any industries there are number of competitors who themselves try to emerge with innovative products and services, to compete with other industries. They provide products and services in order to satisfy the customers, which are economy to their purchasing habits. Likewise RGICL is also having its competitors. The main competitors are Royal Sundaram: Royal Sundaram Alliance Insurance Company Limited has been at the forefront of providing innovative insurance solutions for its customers. It became the first private insurer in the country to be licensed post privatization in 2001. Since then the company have been innovating constantly for its customers. Its business in over 150 cities through a combination of own branches and those of our partners. Total market share is 2.46% Star Health and Allied Insurance: Another major competitor for Reliance General Insurance company Ltd is Star health And Allied Insurance. It spreads its business over 100 cities, through its branches. The Total market share of the company is 2.63%. Tata AIG: Tata AIG General Insurance Company Limited is a joint venture company between the Tata Group and American International Group, Inc. (AIG). The Tata Group holds 74 per cent stake in the insurance venture with AIG holding the balance 26 percent. It commenced its operations on January 22, 2001, by providing insurance solutions to individuals and corporate. It offers complete range of general insurance products that includes insurance for automobile, home, personal accident, travel, energy, marine, property and casualty as well as several specialized financial lines. Total market share is 2.64% ICICI Lombard: ICICI Lombard GIC Ltd. is a 74:26 joint venture between ICICI Bank Limited, India’s second largest bank with consolidated total assets of over USD 100 billion at March 31, 2010 and Fairfax Financial Holdings Limited, a Canada based USD 30 billion diversified financial services company engaged in general insurance, reinsurance, insurance claims management and investment management.
  • 17. 17 ICICI Lombard GIC Ltd. is the largest private sector general insurance company in India with a Gross Written Premium (GWP) of 36,948 million for the year ended March 31, 2010. The company issued over 44 Lakh policies and settled over 62 Lakh claims and has a claim disposal ratio of 96% (percentage of claims settled against claims reported) as on March 31, 2010. The company has 4,634 employees and 350 branches as on March 31, 2010. Total market share 9.38% Bajaj Allianz: Bajaj Allianz General Insurance received the Insurance Regulatory and Development Authority (IRDA) certificate of Registration on 2nd May, 2001 to conduct General Insurance business (including Health Insurance business) in India. The Company has an authorized and paid up capital of Rs 110 crores. Bajaj Finserv Limited holds 74% and the remaining 26% is held by Allianz, SE. As on 31st March 2010, Bajaj Allianz General Insurance maintained its premier position in the industry by achieving growth as well as profitability. Bajaj Allianz has made a profit before tax of Rs. 180 crores and has become the only private insurer to cross the Rs.100 crore mark in profit before tax in the last four years. The profit after tax was Rs. 121 crores, 27% higher than the previous year. Total market share is 6.22%. Bharthi Axa General: Bharti AXA General Insurance is a joint venture between Bharti, one of India’s leading business groups with interests in Telecom, Agri Business and Retail; and AXA, world leader in Financial Protection and Wealth Management. Bharti Group holds 74% of equity and AXA holds 26% of the equity. The total market share of the company is 1.13%. 2.h) Infrastructural Facilities RGICL has good infrastructural facilities. All the employees are provided with the facilities such as telephone, computer with internet access. All the branches are fully computerized and all branches are well equipped . Employees in the office are provided with their own software for calculating the claims and for other operations. The ambience within the office is what can make the customer feel comfortable. The cordial and friendly atmosphere at office is like a full time motivation for the employees.
  • 18. 18 2.i) Achievements and Awards The RGICL has not received any specific awards for the business carried out. 2.j) Work flow model for Claims Figure 2 work flow model Customer Branch Office Customer Care Center Surveyor Customer Claims Manager Company customer
  • 19. 19 2.k)Future growth and prospects We can clearly get the idea about the future growth and prospects of the company by looking at the following figure. It clears tells that, in the earlier years the company’s growth was stagnant. And the profit was also low because of its stagnant growth. But from the year 2006-07 the RGICL is having very high growth every year. The gross premium and the number of policies of the company are increasing at a very high rate. As there is high increase in the number of vehicles ,there is a high need of insurance for it, not only for vehicles but also for other services like marine cargo, employee liability, travel, personal accident etc there is a lot of need for insurance in order to protect them from loss. So for Reliance General Insurance there is a opportunity of better growth in the upcoming years Figure 3. Business Growth
  • 20. 20 Mckensey’s 7S frame work with special reference to RGICL The 7-S Framework was first mentioned in "The Art Of Japanese Management" by Richard Pascale and Anthony Athos in 1981. They had been investigating how Japanese industry had been so successful. At around the same time that Tom Peters and Robert Waterman were exploring what made a company excellent. The Seven S model was born at a meeting of these four authors in 1978. It appeared also in "In Search of Excellence" by Peters and Waterman, and was taken up as a basic tool by the global management consultancy company McKinsey. Since then it is known as their 7-S model. Figure 4. McKensey’s 7S model
  • 21. 21 Shared Values (also called Super ordinate Goals). The interconnecting center of McKinsey's model is: Shared Values. What does the organization stands for and what it believes in. Central beliefs and attitudes. These are the core values of the company that are evidenced in the corporate culture and the general work ethic. Super ordinate goals are the fundamental ideas around which a business is built. They are of main values. What does the organization stands for and what it believes in. Central beliefs and attitudes. They are the broad notions of future direction. According to Mckensey super ordinate goals refers to: a set of values and aspirations that goes beyond the conventional formal statement of corporate objectives. All targets and attention of all activities and exercises of the six levers of any organization should be directed towards accomplishment of the best possible goals. This is the ultimate and terminal point where the organization will have to reach. RGICL believes in total quality at all levels of the organization. It aims at total value packages for all its needs. The shared values or goals of the RGICL are contained in the banks mission and vision statement. All the employees are work together to achieve the objectives of the company. The company try to know the customer needs, wants and based on that it launches the new product and services. It guides to the employees in order to provide a better service to customers Strategy Plans for the allocation of a firms scarce resources, over time, to reach identified goals. The plan devised to maintain and build competitive advantage over the competition .The concept of strategy includes purposes, mission's objectives, goals and major action plans and policies. The 7s model emphasizes that in practice, the development of strategies poses less of a problem than their execution. It also includes Plans for the allocation of firm’s scarce resources, over time, to reach identified goals, environment, competition, customers. The company strongly believes that customer satisfaction is indispensable for the business growth. Customer relation manager and facilitator at the strategic location
  • 22. 22 and field units, periodic customer services audit and senior level officer are appointed as nodal officer monitoring the prompt redressed of customer grievances. Structure The way in which the organization's units relate to each other: centralized, functional divisions (top-down); decentralized; a matrix, a network, a holding, etc. : The way the organization is structured and who reports to whom .The way the organization's units relate to each other: centralized, functional divisions (top-down); decentralized (the trend in larger organizations); matrix, network, holding, etc.
  • 23. 23 Figure 5. Organization chart Central manager MKT manager Sin. Fin/operation manager Jr.fin/operation manger. Franchise IIIFranchise II Franchise IV Franchise VFranchise I
  • 24. 24 Systems The procedures, processes and routines that characterize how the work should be done: financial systems; recruiting, promotion and performance appraisal systems; information systems. The daily activities and procedures that staff members engage in to get the job done. Systems include all those procedures and methodologies, which are framed by the organization and followed by the operating personnel in the respective functional areas. Example, financial accounting system, materials planning and inventory control system, quality management computerization, etc all these functional areas some traditional system may be in existence which needs to be reviewed and changed, as per requirements, in view of advanced technology and process developed. System in relation to RGICL : The system and procedure as well defined and are available with all the hierarchy as on need to know basis. The well structure process manuals are available for all the functional areas, be it business or administration . Staff Numbers and types of personnel within the organization. The employees and their general capabilities. Staffing is the process of acquiring human resources for the organization and assuring that they have the potential to contribute to the achievement of organizational goals. RGICL recruits those persons who are perfect for the job. Since the job profile can change so that it requires training and updating knowledge. The company provides required training for the personnel which will results in increased productivity and efficiency Style The Mckensy’s framework considers the style as more than the style of top management. Aspects of organizational culture also seen to be encompass by the term style. It includes Cultural style of the organization and how key managers behave in achieving the organization’s goals. Management Styles.
  • 25. 25 Organizational Culture: the dominant values and beliefs, and norms, which develop over time and become relatively enduring features of organizational life. The style of the RGICL in business or in administration has a unique niche in the industry. i .Top Down: The RGICL has been following Top Down style of leadership. The employee in the organization has well defined roles duties and responsibilities. The managers get guidelines from the top management regarding interest rate, products and services to the customers. ii Authoritarian: The managers in the organization has their own style of functioning and collectively works as a team. Most of the managers use Authoritative style of functioning to control their executives. Skills Distinctive capabilities of personnel or of the organization as a whole. The actual skills and competencies of the employees working for the company. The operating system can change to desired efficient skillful human being for operation of the new techniques in the new technology. Skills development has raised the productivity of the employees of the company. Skill development is needed to training for inadequate skill persons in the organization. However, RGICL has never neglected the skills development programmes for employees. It leads to an organization which helps in establishing goodwill and image in the business world. It also includes Distinctive capabilities of personnel or of the organization as a whole and its Core Competences.
  • 26. 26 Swot Analysis Strengths 1. RGIC is the second among private players after ICICI Lombard GI 2. India’s first company to be awarded the ISO 9001:2000 certification 3. Net worth has increased up to Rs. 4.94 billions doubled from last year’s Rs.2.59 billions 4. Excellent outreach with a large distribution network 5. It has 200 branches across 171 cities and over 20,000 intermediaries. The set up provides the company is very strong and very effective distribution network , and consequently strong penetration in the market 6. Reserves and Surplus has increased five times to Rs.4.998 billion from Rs.1.04 billion previous year 2007 7. Exclusive bancassurance tie-up with annual business of Rs.130-145 crore. 8. RGIC has been able to give highest ROI of 11.27% in last five years. 9. RGIC commands 17% of the Private Sector Share & 7% share of the General Insurance Industry 10. Company issued 36.57 Lac policies during the year as compared to 14.60 Lac in the previous year there by registering the growth of 150% Weakness 1. Earnings per share is Rs. -15.92 (previous year Rs.0.16) 2. Sudden expansion this year by establishing more than 125 branches has increased operations and administration expenses due to which losses incurred. 3. There is no technical support of the foreign principals as RGIC is not having any foreign tie-up as other players have. 4. All the inner facts and factors known to the family member cum competitor company headed by Mukesh Ambani. 5. Overdependence on fellow subsidiaries for various supplies.
  • 27. 27 Opportunities 1. De-tariff o –IRDA removed controls on pricing in General Insurance business with effect from 1st January 2008 2. The industry is going to be freed from product wordings and policy wordings 3. Can become market leader as presently it is no. 2 position 4. General insurance industry in India has grown at 15% CAGR in terms of gross premium collection Threats 1. New Entrants – Future General India Life Insurance Company Limited – IDBI Fortis Life Insurance Company Ltd – Bharti Axa General Insurance Company Ltd 2. Many foreign bank giants are going to enter Indian market. They have very large portfolio of various verticals and products with them. 3. New tie-ups by the competitors viz. o -Online travel portal clear trip ties up with TATA AIG to offer travel insurance o -ICICI Prudential inks pact with suvidha Info Serve. 4. New joint ventures (JV’s) by industry giants o -MAX India forms JVC with Bupa Finance to foray into health insurance o -Shriram Group is to enter general insurance market
  • 28. 28 Analysis of Financial Statement Financial analysis of the company with the help of ratio analysis: I. Current Ratio: Current ratio is a measure of liquidity calculated dividing the current assets by the current Liabilities Current Ratio = Current Assets ÷ Current liabilities Table 2. Current Ratio 31/03/2009 31/03/2010 Current assets 6,737,335 8,248,216 Current liabilities 8,086,675 10,129,089 Current ratio 0.833 0.814 The current ratio in the year 2010 is very high this is because of less current liabilities. Company has repaid the liabilities in the year 2010. II. Quick Ratio: Quick ratio is the ratio between quick current assets and current liabilities and is calculated by dividing current assets minus inventory and prepaid expenses by current liabilities. Quick Ratio = Quick Assets ÷ Current Liabilities
  • 29. 29 Table 3. Quick Ratio 31/03/2009 31/03/2010 Quick assets 6,737,335 8,248,216 Current liabilities 8,086,675 10,129,089 Quick ratio 0.833 0.814 The quick ratio and current ratio is same for both the years because there is no inventory. III. Proprietary Ratio: Proprietary ratio indicates the extent to which assets are finance by owner’s funds. It shows the portions of the total assets are financed by the owner’s capital. Proprietary ratio = Proprietor’s funds ÷ Total assets Table 4. Proprietary Ratio 31/03/2009 31/3/2010 Proprietor’s funds 79,70,632 1,00,70,631 Total assets 73,81,070 87,23,283 Proprietary ratio 1.081 1.154
  • 30. 30 Learning experience As a student of Business Administration the learning experience gained in Reliance General Insurance Co Ltd was one of the important part of my life before entering into the corporate world. This work provided strong base to get first hand knowledge of the corporate world which proved very helpful. It not only provided knowledge of the corporate world but also taught to tackle each and every tremendous situation with ease. RGICL is one of the leading companies in India. The study gave me very fruitful knowledge experience. It provided the solid foundation to study and learn the tactics of facing the world. The study on the industry profile, informed on ever expanding view of business in India with its fascinating history of Insurance sector and its growth and development in the recent times. This gave a clear idea of the scope of the general insurance in future, its vastness and ever expanding coverage which the company will cover in the coming year. The insurance industry has a tremendous potential in the coming years worldwide and can boom the economy of any given nation. The history of this company and its origin gave me knowledge to have a great vision and move strongly withstanding and difficulty which we face and be strong in our goals. Practically speaking, RGICL is providing vast variety of services to its customers, that being a customer it’s rather difficult to have knowledge of all the services. . To conclude, the whole study in RGICL was a never ending process to learn more, experience more and get maximum exposure towards the corporate world. In total the overall experience was excellent and knowledgeable, experience gained was a never ending quest for knowledge
  • 31. 31 General Introduction Claims settlement is the most important aspect of the functioning of an insurance company. Out of any insurance contract, the customer has the following expectations: i. Adequate insurance coverage, which does not leave him high and dry in time of need, with right pricing. ii. Timely delivery of defect free policy documents with relevant endorsements /warranties / conditions / guidelines. iii. Should a claim happen, quick settlement to his satisfaction. Unlike life insurance, where all policies necessarily result in claims – either maturity or death – in general insurance not all policies result in claim. Approximately around 15% policies in general insurance result in claim. The claim settlement in general insurance thus have their own peculiarities and therefore need proper handling. Also how 15% policy holders are attended is of great importance. The services being rendered will determine the attitude of the customers. The insurance companies have hitherto been handling the claim rather than managing them. Typically this process involves – I. As soon as a claim is reported, the insurance company checks as to whether the cover was in force at the time of loss and whether the peril is covered under the policy. II. A surveyor is appointed who visits the spot, do the assessment and submits the report. III. Insurance company examines the report, calls for relevant supporting documents. IV. On receipt of survey report and documents, the same are examined. The claim file is processed and settlement is offered. 1.a) Statement of the problem: The claims handling is more process oriented and does not pay adequate attention to the monitoring and claims cost aspect as also to the service parameters. In the present liberalized scenario, with cut-throat competition being the order of the day, the insurance companies have to go much beyond the handling of claims. Incase of general insurance approximately around 15% of the policies results in claim. Thus
  • 32. 32 claims management in general insurance have their own peculiarities and therefore need proper handling. 1.b) Objectives of study: To understand the concept of claims. Its creation and processing. To know who are the partners in claims. Comparing claims paid and claims recovered to find out whether they are positively or negatively correlated. To find out how the Claims Management System can be helpful to the company. Good practices that can be used by the company to manage the claims effectively. 1.c) Scope of the study: The study is conducted in order to know, whether the claims are managed properly in the Reliance General Insurance Company Ltd. The study was conducted on the twelve months data from 1st January 2010 to 31st December 2010. The data considered for the study are claims paid, claims recovered, gross incurred claims and net incurred claims of the year 2010. 1.d) Methodology: The research carried out a descriptive type of research. The study is mainly based on the secondary data at appropriate places. Thus the data collected by secondary source have been tabulated and analyzed making use of appropriate statistical tools and results, such as correlation. and chi-square tests
  • 33. 33 1.e) Limitations of the study: No single work is exception to the limitations, every work has got its own limitations, following are some of the limitations of my study The study is mainly based on secondary data and no field work is done because of time constraint. The study is limited to the data of the previous year 2009- 10 only. Difficulties are faced while accumulating important data. It is not an exact science, so we cannot expect 100% result, so only justified solutions are given.
  • 34. 34 2.a) Creating Claims When the variance is detected from the project plan, claim can be created using an Internet application. This means variances can be documented either at work station, or at any computer that has Internet access. This makes claim entry easy and convenient. And claims can be entered at a construction site, when traveling, and so on. The flexible user interface makes things even easier. Details of the claim can be entered using long texts. In addition to the notification header long text, four other long text categories are available. That can be used to structure the information on the claims. Processing Claims As claims usually cause additional costs, costs can be entered which expect to arise either when claim is created, or later, when more precise information is available. The following options are available: -Entering the estimated costs manually. -Creating a unit costing from the claim or link it to an existing unit costing. Enter the costs demanded and accepted manually. Status management and workflow are two more high-performance tools you can use to process claims in the R/3 System. The link between claim management and status management means that processing of a claim dependent on its status, that a claim cannot. The system documents all changes to the claim in the action log. Once the claims processed and closed ,it can be archived. A deletion program deletes the database records for claims successfully archived. Evaluating Claims The work lists for notifications and tasks include an overview of the claims to be processed and the tasks associated with them. For detailed evaluations of claims, information system and access the overview reports for the claims are useful. As the claim is assigned to a project or WBS element either when creating the claim or later, all the claims created for a project/WBS element in the information system can be
  • 35. 35 displayed. An evaluation program can be used to display the data for claims already archived. Table 5. AGIENG OF CLAIMS Line of business Total amount of claims paid(Rs in lacs) Fire 1511.41 marine cargo 424.64 Marine hull 1431.06 Engineering 565.22 Motor OD 16490.6 Motor TP 3027.24 Health 6642.62 Overseas travel 191.28 Personal Accident 1324.45 Employee liability 21.18 Crop 0 Misc. 7228.12 Figure 6. Ageing of Claims
  • 36. 36 Ageing of claims means, claims paid after a certain number of days. In the above graph, X axis represents various products of the company and Y axis represents total amount of claims paid. Motor OD( Own Damage) is having highest number of claims paid for ageing i.e. Rs.16,490.6 lacs. Motor TP( Third Party), Health and Miscellaneous are the other 3 products which have more than Rs.2000 lacs. All other products have total claims paid less Rs.2000 lacs Table 6 Net premium and Net incurred claim Description NET PREMIUM NET INCURRED CLAIM Fire 3076.66 772.25 Marine cargo 1088.77 654.77 Marine hull 24.87 -42.8 Motor 93648.79 32043.39 Engineering 1863.94 724.5 Aviation -185.33 386.34 Liabilities 682.64 254.66 Others 3786.69 1335.12 Health 20364.38 12646.88 Figure 7. Net premium and Net incurred claim
  • 37. 37 Table 7 Details regarding claims PARTICULARS CLAIMS PAID CLAIMS RECOVERED CLAIMS O/S AT THE QUARTER END 31/12/2010 CLAIMS O/S AT THE BEGINNING Fire 151,465 113,471 285,389 296,252 Marine 42,592 22,343 116,271 104,793 Motor 2,483,546 747,391 6,980,191 7,723,583 Miscellaneous 4,496,888 1,869,915 7,925,130 8,713,797 Figure 8. Claims Details for Fire Insurance Incase of Fire related claims, the claims outstanding at the beginning of the quarter, i.e. on 1st october 2010 is 35%. Total claims paid is 18% and claims recovered is 13%. Claims outstanding at the quarter end 31st december 2010 is 34%. There is a slight change in the outstanding claims at the end of the quarter when compared to claims outstanding at the beginning of the quarter
  • 38. 38 Figure 9 Claims Details for Marine Insurance Incase of marine related claims, the claims outstanding at the beginning of the period is 36%, total claims paid is 15%. Here recovered claims are very less in number i.e. only 8% and claims outstanding at the end of the quarter is 41%. In case of marine related claims, outstanding claims are increased from 36% to 41%. Figure 10. Claims Details for Motor Insurance Incase of motor related claims, 43% of claims are outstanding at the beginning of the quarter. Total claims paid are 14% and recovered claims are only 4%. Very less amount of claims are recovered in case of mator policies. And claims outstanding at the end of the quarter is 39% this shows that nimber of claims outstanding are decreased at the end of the quarter.
  • 39. 39 Figure 11. Claims Details for Miscellaneous Insurance policies Incase of miscellaneous claims, total claims outstanding at the beginning of the quarter is 38%, claims paid is 20% and the claims recovered is 8%. Claims outstanding is decreased to 34% at the end of the quarter. 2.b) Partners in Claims Definition When creating a claim, or each time accessing the claim to change it, it is assigned to a partner type. Claim Management offers the following partner types: Vendor Customer Internal Depending on the partner type, the system determines the following in claim processing: A suitable partner If the chosen types are "Customer" or "Vendor", the system does not offer the general partner overview for partner entry purposes, but: _ For customers: Customer Address, where a customer can enter who already exists in the system
  • 40. 40 Contact Person Address, for the contact person at the customer Notification Address: for example, the customer's lawyer _ For vendors: Vendor Address, where a vendor can enter who already exists in the system Manufacturer Address Notification Address: for example, sales and distribution at the vendor Contact person can be entered in the notification address. If you change the partner the partner type is changed, for example, from customer to vendor, the system adopts all the partners and displays them in the partner overview. In the standard claim configuration, the contact person is always the customer contact person. Allowed reference documents For vendors, the purchasing document For customers, the sales order, delivery, and purchase order number For "internal", the sales order, delivery, purchase order number, and purchasing document 2.c) Processing the Partner Information Prerequisites In order to process the partner information the company follows the below procedure : Configuring User Default Values Use It is a good idea to define user default values if you enter a lot of claims, but rarely use particular notification data. The system automatically copies these values to the appropriate fields while creating a claim. It can be overwritten at any time. Features Following default values and settings can be defined: General data - Notification type - WBS element - Partner type
  • 41. 41 - Whether the system shows a status line/pushbutton when you enter or display long texts Appearance of the action box: The system represents the action box as a table or an overview tree. If the table is chosen, the system displays only the follow- up activities that can be carried out. If the overview tree is chosen, the system displays all the available follow-up activities. 2.d) Claim Tasks Definition A planned or completed activity that describes the planning and organizational measure in a claim. A task is defined by a code from the task catalog and if necessary accompanied by a text. Use A task allows to plan the cooperation of various persons during the claim process and assures that the activities connected to the task are completed within a given timeframe. The task receives a status depending on its degree of completion. Data for a task is entered on two different screens with varying degrees of detail. Overview screen Detail screen The following entries are possible for each task: A table key for the tasks to be executed and a brief instruction describing what is to be done The task's planned start and end The task's status Responsible partner for carrying out the task The documentation for processing tasks contains a note explaining how to create a task for a notification item. This is not possible in claim management because a claim does not recognize items. In claim management a task refers to the entire claim. 2.e) Evaluating Claims Features The project information system includes the following reports for analyzing claims:
  • 42. 42 Claim Overview The system displays all the data entered for the claim selected, except for tasks and actions. If this is all the data you need, we recommend you use this report, for performance reasons. Claim Hierarchy The system displays all the data entered for the claim selected, including tasks and actions. Archiving Claims. Procedure Claim archiving using transaction SARA involves the following steps: 1. Preparation The preparation program assigns status MARC to the claims selected, thereby flagging them as ready for archiving and deletion. This also blocks the claims so flagged against further online changes. 2. Archiving Run The archiving program writes the database tables for the claim to the archive. If the process was successful, the program deletes the data from the system immediately after it has been archived. 3. Delete A deletion program deletes the database records for claims successfully archived. If the deletion program is not accessed automatically when the archiving action has been completed successfully, you must wait until archiving is complete altogether. 4. Evaluation Evaluation can be used to display the data for claims already archived. Claims Analysis The following are the tables regarding claims paid from direct business written, claims paid on re-insurance accepted, claims recovered on re-insurance accepted,
  • 43. 43 net claims paid, outstanding claims at the quarter end, outstanding claims at the quarter beginning.net claims incurred. The data is for the period ended 31st December 2010 Table 8 claims analysis (a) Particulars Claims paid from direct business written Claims paid on re- insurance accepted Claims recovered on re-insurance accepted Fire 2,29,133 (2,698) 1,60,449 Marine Cargo 86,059 - 49,291 Marine Hull 144 - 14 Motor OD 31,69,976 - 3,35,344 Motor TP 14,47,604 6,31,783 9,93,288 Employer’s Liability 6,514 - 834 Public Liability - - 54 Engineering 1,40,134 - 89,360 Aviation 8,18,393 - 7,82,436 Personal Accident 1,84,639 - 1,32,995 Health 15,38,084 - 2,29,375 Other Misc 3,13,482 - 2,64,219 Table 9 claims analysis (b) Particulars Net Claims Paid o/s claims at the period ending 31/12/2010 o/s claims at the period beginning Net claims incurred Fire 65,986 2,85,339 2,74,149 77,226 Marine Cargo 36,768 1,05,502 76,795 65,475 Marine Hull 130 10,769 15,178 (4,279) Motor OD 28,34,632 11,37,018 13,22,899 26,48,751
  • 44. 44 Motor TP 10,86,099 58,43,173 63,73,686 5,55,586 Employer’s Liability 5,680 32,915 17,982 20,613 Public Liability (54) 13,023 8,117 4,852 Engineering 50,774 1,58,057 1,36,831 72,450 Aviation 35,957 30,497 27,820 38,634 Personal Accidents 51,644 61,461 50,753 62,352 Health 13,08,709 5,36,969 5,80,990 12,64,688 Other Misc 49,263 1,11,567 89,668 71,162 Table 10 COMPUTATION OF CORRELATION BETWEEN CLAIMS PAID AND CLAIMS RECOVERED PARTICULARS Claims paid Claims recovered Fire 151,465 113,471 Marine 42,592 22,343 Motor 2,483,546 747,391 Miscellaneous 4,496,888 1,869,915 Figure 12. Claims paid and Claims Recovered
  • 45. 45 Correlation between Claims Paid and Claims Recovered = 0.985024 Table 11. CHI-SQUARE TEST FOR CLAIMS PAID AND CLAIMS RECOVERED PARTICULARS O (Rs in lacs) E (Rs in lacs) (O-E) (Rs in lacs) (O-E)2 (Rs in lacs) (O-E)2/E (Rs in lacs) Fire 1.51 1.13 0.38 0.1444 0.005249 Marine 0.43 0.22 0.21 0.0441 0.001603 Motor 24.84 7.47 17.37 301.7169 10.96754 Miscellaneous 44.97 18.69 26.28 690.6384 25.10499 TOTAL 27.51 36.0794 Degrees of freedom : 4-1=3 @ 5% level of significance 7.815 Table 12. results of correlation and chi-square test Correlation Table Value X2 0.985024 7.815 36.0794 Therefore, claims paid and claims recovered are positively correlated as the calculated value is more than 0. And they are highly significant at 5% level of significance.
  • 46. 46 Table 13 Solvency for the quarter ended 31/12/2010 Required Solvency Margin Based on Net premium and Net incurred claims Premium Claims RSM-1 RSM-2 RSM- 3 Ite m No Descripti on Gross premiu m Net premium Gross incurre d claim Net incurre d claim 1 Fire 11,550. 75 3,076.66 3,831.3 8 772.25 1,155.0 7 1,395.9 1 1,395.9 2 Marine cargo 2,348.7 6 1,088.77 1,152.3 8 654.77 281.85 570.82 570.82 3 Marine Hull 141.77 24.87 (80.78) (42.80) 14.18 58.69 58.69 4 Motor 109,297 .74 93,648.79 59,699. 49 32,043. 39 18,729. 76 20,831. 71 20,831. 71 5 Engineeri ng 7,889.8 4 1,863.94 2,876.7 7 724.50 788.94 896.14 896.14 6 Aviation 6,949.6 3 (185.33) 21,139. 10 386.34 694.96 3,170.8 7 3,170.8 7 7 Liabilities 1,727.1 1 682.64 276.63 254.66 259.07 83.04 259.07 8 Others 9,185.7 4 3,786.69 3,093.5 7 1,335.1 2 1,286 1,544.7 5 1,544.7 5 9 Health 24,320. 57 20,364.38 14,951. 97 12,646. 88 4,072.8 8 6,636.2 0 6,636.2
  • 47. 47 Table 14 Computation of correlation between gross incurred claim and net incurred claim Description Gross incurred claim (Rs in lacs) Net incurred claim (Rs in lacs) Fire 3.83 0.77 Marine Cargo 1.15 0.65 Marine Hull -0.08 -0.042 Motor 59.70 32.04 Engineering 2.88 0.72 Aviation 21.14 0.386 Liabilities 0.28 0.254 Others 3.09 1.34 Health 14.95 12.65 Correlation between gross incurred claim and net incurred claim is 0.93 Table 15 CHI-SQUARE TEST FOR GROSS INCURRED CLAIM AND NET INCURRED CLAIM PARTICULARS O E (O-E) (O-E)2 (O-E)2/ E (Rs in lacs) (Rs in lacs) (Rs in lacs) (Rs in lacs) (Rs in lacs) Fire 3.83 0.772 3.06 9.351364 0.1917441 Marine cargo 1.15 0.654 0.5 0.246016 0.0050444 Marine Hull -0.081 -0.043 -0.04 0.001444 2.9608405 Motor 59.69 32.04 27.65 764.5225 15.6760816 Engineering 2.88 0.724 2.16 4.648336 0.0953113 Aviation 21.14 0.386 20.75 430.7285 8.8318334 Liabilities 0.276 0.254 0.02 0.000484 9.9241306 Others 3.09 1.34 1.76 3.090564 0.0633701 Health 14.95 12.65 2.3 5.308416 0.1088459 Total 48.777 37.856 Degrees of freedom 9-1 = 8 @ 5% level of significance 15.507
  • 48. 48 Table 16 Results of correlation and chi-square test Correlation Table Value X2 0.93 15.507 37.856 The relationship between gross incurred claims and net incurred claims is positively correlated. And they are highly significant at 5% level of significance. Table 17.1 Quarterly claims data for the period ended 31/12/2010 Sl no Claims experience Fire Marine Cargo Marine Hull Motor OD Motor TP 1 Claims o/s at the beginning of the period 765 598 15 39,497 21,636 2 Claims settled during the period 381 430 2 60,506 1,116 3 Claims reported during the period 524 733 1 60,942 4,192 4 Claims repudiated during the period 70 48 - 2,647 - 5 Claims closed during the period 99 124 - 5,683 318 6 Claims o/s at the end of the period 739 729 14 31,603 24,394 7 Less than 3 months 271 376 1 20,406 4,144 8 3 months to 6 months 172 141 - 6,699 3,401 9 6 months to 1 year 138 137 7 3,992 4,487 10 1 year and above 158 75 6 506 12,362
  • 49. 49 Table 17.2 Quarterly claims data Sl no Claims experience health Overseas travel Personal Accident liability miscel laneo us 1 Claims o/s at the beginning of the period 9140 862 798 179 813 2 Claims settled during the period 25,075 624 1,319 81 692 3 Claims reported during the period 18,580 303 833 20 484 4 Claims repudiated during the period 2,256 27 124 4 163 5 Claims closed during the period 2,263 594 36 17 260 6 Claims o/s at the end of the period 11,116 562 1,124 219 598 7 Less than 3 months 9,247 375 643 72 279 8 3 months to 6 months 873 107 264 52 131 9 6 months to 1 year 686 76 189 37 115 10 1 year and above 310 4 28 58 73 The above tables shows the quarterly claims data, regarding claims outstanding at the beginning of the period, claims settled during the period, claims reported and claims repudiated during the period, claims closed during the period and claims outstanding at the end of the period. And it also gives details of claims paid within different periods of time, i.e. less than 3 months, 3 months to 6 months, 6 months to 1 year, 1 year and above. These tables gives complete information of the claims for the different products offered by the company.
  • 50. 50 Table 18 The following table shows the data regarding Ageing Of Claims (Rs in Lacs) Sl no no of claims paid 1 month 1-3 month 3-6 month 6 month- 1 year >1 year Total no of claims paid Total amount of claims paid 1 Fire 138 99 80 36 28 381 1,511.41 2 Marine cargo 255 84 45 32 14 430 424.64 3 Marine hull - 1 - - 1 2 1431.06 4 Motor OD 33,502 18,711 5,891 2,062 340 60,506 16,490.60 5 Motor TP - 21 76 285 734 1,116 3,027.24 6 Health 12,447 5,064 783 208 78 18,580 6642.62 7 Overseas travel 48 121 81 38 15 303 191.28 8 Personal Accident 464 124 114 74 57 833 1324.45 9 Liability 4 1 11 1 3 20 21.18
  • 51. 51 Ageing of claims means claims paid within a specific number of days, as in the above table, claims are paid within 1 month or between 1 to 3 months, 3 to 6 months, 6 months to 1 year and above 1 year. In most of the policies customers want their claims to be paid as early as possible. So claims most of the claims are paid within 1 month or 1 to 3 months. In the below graphs ‘X’ axis represents different periods of time and ‘Y’ axis represents total amount of claims paid. 1- 1 month 2- 1-3 months 3- 3-6 months 4- 6 months to 1 year 5- > 1 year Figure 13. showing number of claims paid for different periods for Fire In the above figure claims paid within 1 month is more than all other periods. Out of 381 claims, 138 claims are paid within a period of 1 months. As the period goes on
  • 52. 52 changing the number of claims paid also goes on decreasing. This means that if the period for paying claims is less people will be more interested in such policies. As they can get the claim immedietly. Figure 14. Number of claims paid for different periods for Marine Cargo Out of 430 total claims related to Marine Cargo, 255 claims are paid within 1 month. Here also most of the people prefer to go for the policies where the claims are paid as early as possible, i.e. within 1 month. Number of claims paid decreases as the period changes. At period 5, i.e. when claims are paid after 1 year the total amount of claims paid is 14 out of 430, which is the least among all.
  • 53. 53 Figure 15. Number of claims paid for different periods for Motor Own Damage In the above figure claims paid within 1 month is more than all other periods. Out of 60,506 claims, 33,102 claims are paid within a period of 1 months. More than 50% of the total claims are paid during period 1. As the period goes on changing the number of claims paid also goes on decreasing. This means that if the period for paying claims is less people will be more interested in such policies. As they can get the claim immedietly.
  • 54. 54 Figure 16 Number of claims paid for different periods for Health Out of 18,580 claims 12,447 claims are paid within a period of 1 month. i.e morethan 66% of claims are paid in the period 1. In this case also as the period for payment of claim increases, number of claims paid decreases. People are more interested to get claims as early as possible. So they prefer the periods in which they will get claims quicky.
  • 55. 55 Figure 17 Number of claims paid for different periods for Personal Accident In case of personal accidents people need money as early as possible, to meet their medical and other expenses. So usually, people will go for the period 1 where they get the claim within 1 month. Here more than 50% of the total claims are paid within 1 month. Very few people go for the period 5 where the claims are paid after 1 year.
  • 56. 56 Figure 18 Number of claims paid for different periods for Overseas Travel Incase of oversease travel most of the people go for the 2nd and 3rd period where the claims are paid either between 1 to 3 months or between 3 to 6 months. Nearly 40% of the claims are paid in period 2. i.e. between 1 to 3 months. And 27% of the claims are paid in period 3. i.e. between 3 to 6 months. Only 5% of claims are paid in the period 5 where the claims are paid after 1 year. Figure 19 showing number of claims paid for different periods for Employee Liability
  • 57. 57 In case of employee liability more than 50% of the claims are paid in the period 3 where the claims are paid between 3 to 6 months. Reliance motor( two wheelers and private car ) insurance Two wheelers are convenient and exuberant. With the many advanced features added in today’s two wheelers are safe too. However the possibility of damage to your prides and joy exist by way of theft, natural calamities and accidents Key highlights - Cashless facility for a hassle-free claims processing - Speedy claims settlement - Easy documentation Key advantages -Complete cover Reliance two wheeler insurance policy give s complete cover on the road and off it. It covers your car against accidents, burglaries, natural calamities etc. It will also gives you personal accident insurance cover and third party liability cover. -Convenience designed Towing service owned and operated to cut down on inefficiencies. It also provide an allowance of Rs. 300 towards towing charges if required A net work of 1700m garages in over 231 cities to provide you with cashless repairs - Super fast service Instant policy issuance It values time and responds immediately. There are 24/7 helpline for emergency services also. It also make sure that a survey of the vehicle is arranged within 8 working hours
  • 58. 58 Discounts If the claim is made in the previous year, one can get a ‘No Claim Bonus’ reward while renewing the policy. There is a option of transferring ‘ No Claim Bonus’ to the new vehicle. additional discounts are given for -Voluntary excess -Membership of a recognized automobile association -Discount if side-car is attached -Installation of anti-theft device There are special discounts for physically challenged car owners and vintage vehicles. The policy coverage is wide and encompasses many aspects, from the vehicle to the owner to any third party involved in a liability concerning the vehicle that is insured. Vehicle The Reliance Two Wheeler Insurance Policy covers loss or damage to vehicle due to: Accident, fire, lightening, self-ignition, explosion, burglary, house break-in or theft. Riot and strike, malicious act, terrorism, earthquake, flood, cyclone and inundation. Transit by rail, road, air, elevator and lift. Personal Accident Cover This policy will also cover against an accident, while riding the vehicle
  • 59. 59 Third Party Liability As per the Motor Vehicle Act, third part liability cover is a compulsory cover to be taken by all vehicles. This cover provides against the liability for third party injury/death, third party property damage and liability to paid driver. Add on covers Electrical/Electronic Accessories Non electrical accessories Rally Extension Racing, speed tests, dexterity trials, Hill Climb extensions Legal Liability to employees, paid drivers Exclusions At Reliance General Insurance, the policies are as transparent as possible. To ensure, not face any unpleasant surprises when making a claim, some of the major exclusions under the policy : Normal wear and tear of the vehicle Mechanical and electrical breakdown Vehicles being used other than in accordance with the limitations as to use Damage to/by a person driving without a valid driving license Loss or damage under the influence of alcohol or any other intoxicating substance Loss or damage due to depreciation Compulsory deductibles Consequential loss Auto insurance policy As soon as a claim occurs, the person have to intimate immediately to Help line number, call centre executive will be happy to help with the claim procedure.
  • 60. 60 Following information needs to be furnished while intimating a claim: Contact Numbers Policy Number Name of Insured person, Date & Time of accident, Vehicle number Make and Model, Location of Loss, Garage Name with contact details Brief description on how the accident took place, Extent of loss Place & contact details of the Insured Person if the person intimating the claim is not insured. Reliance property ( Burglary and House Breaking) insurance policy The world around us is becoming more and more unsafe and the increase in crime rate bears witness to this fact. Occurrences like burglary, housebreaking or robbery of contents at office, warehouse, shop or industry can bring about a huge financial loss. Reliance General Insurance is pleased to offer a plan that keeps the property protected at all times against burglary and house breaking. key benefits Specially designed plan that covers the business premises against burglary and housebreaking. Cover available on a first loss basis by way of judicious management of probable maximum loss assessment. Host of extensions such as coverage for riot, strike, malicious damage and theft.
  • 61. 61 Multiple options for variations in sum insured such as floater policy, declaration policy, floater declaration policy Policy coverage The policy offers coverage against Property contained in business premises (such as stocks, furniture etc) owned by the Insured Stocks held in trust / commission and for which the Insured is responsible, if specifically covered Damage to premises resulting from burglary and/or housebreaking or any attempt at burglary Cash, valuables and securities kept in a locked safe or cash box in locked steel cupboard if specifically covered Policy feature The following variations with regard to sum insured can be opted for: Floater policy: Issued for stocks at various locations under one sum insured Declaration policy: Takes care of frequent fluctuations in stocks / stock values Floater declaration policy: Comprises of features of both floater and the declaration policies Exclusions The policy does not cover: Loss of goods held in trust / commission, jewelry, curios, title deeds, business books unless specifically covered Burglary without any forcible entry Shop lifting, acts where Insured or his/her family members or employees are involved Losses recoverable under fire / plate glass insurance policy War perils, acts of god and nuclear perils
  • 62. 62 Riot, strike and malicious damage unless specifically covered Consequential loss or legal liability of any kind Premises left uninhabited for seven or more consecutive days unless specifically agreed upon. Uninformed material alteration in the premises Eligibility The Reliance Burglary & Housebreaking insurance Policy can be bought by any one who has property and valuables that are exposed to the risk of burglary and housebreaking. Reliance Marine Cargo insurance policy The increase in global trade has boosted our economic prosperity as a nation and has developed new avenues of business for many organizations. Today, new trade agreements are expanding the realms of business operations to many new countries and more goods are being shipped around the world. There are a variety of risks that are associated with transit of goods and it becomes pertinent to have comprehensive coverage for loss or damage to the goods. For this purpose, Reliance Marine Cargo Policy is used. . Key Benefits Exhaustive coverage against loss or damage to cargo in connection with its carriage by land, waterways, air or postal services Policy extendable to cover War and Strikes perils Flexible coverage options (Specific Policy, Open Policy and Open Cover) available for the Insured Policy coverage Specific Policy – This policy provides cover against specified perils under marine cargo sent/received during the Policy period.
  • 63. 63 Open Policy – Typically opted by commercial firms and industrial establishments with substantial volume of trade and a number of transactions, an Open Policy is issued for ensuring automatic & continuous insurance protection. This policy is issued to cover all shipments sent/received during the Policy period. Open Cover – This is an arrangement similar to Open Policy to cover loss or damage to cargo where specific stamped certificate is issued for declaration made. The Marine Cargo Policy covers loss or damage to cargo in relation to and in connection with its carriage by: -land (whether by motor vehicle or by railway), -waterways (that is to say by ship which includes every description of vessel used in navigation); -air (that is to say, by aircraft used for the transport of cargo, among others); and -government or private postal services The Policy provides cover against loss or damage to cargo during transit from one place to another by any one or more of the modes of transport. Coverage provided under Marine Cargo policies range from a restricted form of cover e.g. Fire and Lightning perils only to the widest available form of cover, namely, All Risks, at the option of the insured. Special features Worldwide Claims Survey and Settlement Assistance. Network of Surveyors all over the country. Customized and Innovative covers based on your needs. Extensions for multi transit, incidental storage, FOB, riot and strikes perils etc Discounts for Voluntary Higher excess, lesser distance etc. Exclusions The Policy does not cover loss or damage to cargo insured due to: willful misconduct of the Insured; insufficiency or unsuitability of packing or preparation of the cargo insured; ordinary leakage, ordinary loss in weight or volume, ordinary wear and tear and inherent flaws in the cargo insured;
  • 64. 64 delay, insolvency and financial distress of the carriers; unseaworthiness of vessel; Reliance Personal Accident Policy Safety is always a paramount concern. However accidents do occur. An accident at home could be simply broken glass or a gas cylinder burst. Reliance Individual Personal Accident Policy is one of the key security measures to undertake for providing financial security incase of a injurious accident. It ensures that one's family does not suffer in event of an accident by providing compensation for accidental death or disablement. Key Benefits Reliance Individual Personal Accident Policy covers against risks of accidents. It not only provides compensation to the family in case of the accidental death of the insured but also takes on the onus of providing the insured with compensation in case of injury, whether temporary or permanent. The sum insured increases by 5% for each completed claim-free year of insurance, subject to a maximum of a 50% increase. This policy can also be expanded to cover actual medical expenses arising out of the accident Policy coverage. Reliance Individual Personal Accident Policy will cover against : Accidental Death – On the accidental death of the insured person, we will pay the family the capital sum insured. Permanent Total Disability – In the event of permanent total disability due to an accident, we will also pay the capital sum insured.
  • 65. 65 Permanent Partial Disability – In case of a partial disability due to an accident, a specified percentage of the sum insured will be paid. To know the specific percentage of the sum assured that will be paid, Temporary Total Disability – If one is totally disabled by an accident for a limited period of time, the policy will pay you 1% of the capital sum insured per week, not exceeding Rs 5,000 per week. Value Added Benefits Reliance General Insurance aim at giving the maximum value for money. Hence, this policy has value-added benefits. Carriage of Dead Body – In the event of accidental death outside the residence, a lump sum of 2% of capital sum insured, subject to a maximum of Rs.2,500, will be paid towards transportation of the insured person's dead body to place of residence. Education Grant –Children need protection and nurturing. In the event of accidental death or permanent total disability for which a claim is payable, education grant is also provided for the children of the insured. An amount equal to 10% of the capital sum insured, subject to a maximum of Rs 5,000, will be paid in the case of one dependent child below the age of 25 years. With two dependent children below the age of 25, an amount equal to 10% of the capital sum insured, subject to a maximum of Rs 10,000, will be paid. Exclusions The policy excludes cover for death or disablement due to: Pregnancy or related consequence Any mental disorder
  • 66. 66 Any pre-existing conditions / disabilities Needless exposure to peril, except in an attempt to save human life Intentional self-injury, suicide or attempted suicide Influence of intoxicating liquor or drugs Insured committing any breach of law with criminal intent War and nuclear perils Riots, Crimes, Misdemeanors and Felonies Eligibility This policy can be issued to persons in the age group of 5 years to 70 years. It can be extended to cover persons beyond the age of 70 years and up to 80 years on payment of suitable additional premiums. 2.f) CLAIMS MANAGEMENT SYSTEM As Claims Management is one of the most challenging business processes in the insurance industry. With the number of stakeholders involved, the dependencies and the logistics, there is a need is to eliminate manual interventions and process silos. Technology can play a significant role by providing integrated channels for communication and collaboration. This would help the insurance company to increase employee productivity by reducing cycle time and defect rate and also increase employee participation and compliance Features a. End-to-end claims cycle management: The system covers the claims management process right from the moment a case is registered in the front desk to its closure. Workflow provides corresponding task allocations to task owners. b. Role based management: Profiles that are part of the claims process provided with relevant access to the system.
  • 67. 67 c. Document management: Case related documents, can be uploaded in the system and managed effectively. This enables easy access to them by the claims owner. d. Collaboration through web and mobile solutions: For stakeholders like surveyors, claims advisors web/mobile solutions speed up their data collection and uploading tasks. e. Efficient claims Case and Task tracking: The manager through operational reports can handle claims tracking and resource assignments efficiently . Solution review. An application that would help the Insurance Company manage their claims processing from claims Initiation to closure with automated process flows, collaboration, document management and reporting features. a. End-to-end claims cycle management: The system covers the claims management process right from the moment a case is registered in the front desk to its closure. Workflow provides corresponding task allocations to task owners. b. Role based management: Profiles that are part of the claims process provided with relevant access to the system. c. Document management: Case related documents, can be uploaded in the system and managed effectively. This enables easy access to them by the claims owner. d. Collaboration through web and mobile solutions: For stakeholders like surveyors, claims advisors web/mobile solutions speed up their data collection and uploading tasks. e. Efficient claims Case and Task tracking: The manager through operational reports can handle claims tracking and resource assignments efficiently.
  • 68. 68 Figure 20. claims management system solution review
  • 69. 69 Figure 21. claims management system process review
  • 70. 70 Call Center/ Front Desk Claims Manager Claims Advisor Claims Owner Start Agent initiates a case after receiving details from customer Verifies the case and assigns a claims advisor to the case Validates the case and assigns the case to the claims owner Runs the final check and closes the case Stop Collects the necessary details about the case Submit the case back to the claims manager Handouts the claims till settlement Submits the case back to the claims manager to take it to closure
  • 71. 71 FINDINGS • Claims paid and Claims recovered are compared here using correlation technique and it shows that they are positively correlated as the computed value is more than 0 • Claims paid and Claims recovered are highly significant at 5% level of significance, as the table value is less than the calculated value. • Net claims incurred and Gross claims incurred are compared and it is found that they are also positively correlated as the computed value is more than 0. And are highly significant at 5% level of significance. • Claims Management System can play a very significant role. This would help the company in increasing employee productivity by reducing cycle time and defect rate. It also increases employee participation and compliance. • The good practices for claims management mentioned here can be effectively used by the company to settle claims in an efficient way. If the company uses these practices it would result in ‘timely claim processing’ ‘effective handling of complaints and disputes’ ‘ fraud detection and prevention’ ‘better claims procedure’. RECOMMENDATIONS 1: Claims reporting The insurance company writes insurance policies in easily understandable language. Policies spell out what is covered and what is not covered. If necessary, plain language explanations could be an addendum to the legal language. The insurance company draws the attention of the policyholder/claimant/beneficiary1 both when he/she signs a policy (for policyholders only) and when he/she reports a loss on his/her duties related to claim reporting which include: Try to minimize losses; To report claims in a timely fashion; To co-operate in the investigation by providing the company with all relevant information and, in particular, copies of official documents regarding the damage (accident, loss, etc.);
  • 72. 72 To authorize the company to handle necessary inspections and assess the extent of the damage prior to any repairs or replacement; To ensure that the claims reporting phase proceeds as smoothly as possible, the insurance company sends to the policyholder/claimant/beneficiary within a reasonable period of time (beginning from when the loss is reported): An appropriate claim form (when the loss reporting is made in writing) for the type of policy - prepared either by an individual insurance company or at the national level by companies or the supervisory authorities together with instructions and useful information on how to comply with the terms of the policy and the legitimate requirements of the company; 2: Receipt of claims by the company The company claim department and/or the intermediary (if applicable) are as accessible as possible for the claimant. If an intermediary is an initial contact for claimants, claims should be sent to the company claim department within an appropriate time period. The insurance company should contact the policyholder/claimant/beneficiary or send an acknowledgement of receipt as soon as the claim is received. Subsequently, if it appears that the claim cannot be settled rapidly, the company notifies the policyholder/claimant/beneficiary and indicates that he/she will be re-contacted within a reasonable time limit. When it is necessary for the policyholder/claimant/beneficiary to provide specific documents when filing a claim, the company should send him/her the list of these documents as soon as possible. In addition, a specific notification listing the elements to be provided when another insurance company is involved is sent to the policyholder/claimant/beneficiary. 3: Fraud detection and prevention In order to curb the growth of fraudulent claims and the rise in premium costs that results from them, companies take the following steps: They establish compliance programs for combating fraud and money laundering appropriate to their exposure and vulnerabilities. In the claim filing phase, they discourage fraudulent practices by making the policyholder/claimant/beneficiary aware of the consequences of submitting a
  • 73. 73 false statement (which in particular could be liable to prosecution) and/or an incomplete statement. To this end, insurance companies place a notification on their claims forms referring to the appropriate law, statute or insurance regulation that addresses the filing of fraudulent or incomplete claims. Where legally possible, companies participate in relevant databases where claims susceptible to be fraudulent would be reported. Moreover, public authorities may encourage or take steps to initiate the creation of a public or private bureau of insurance fraud. Besides, companies provide their claims department staff with adequate training on fraud indicators. 4: Claim processing Company’s claim procedures are gathered together in a manual for internal use. At least, one staff member should be responsible for ensuring that the manual is kept up to date and additions/amendments are made when necessary. Companies’ claims department staff possess proper qualifications. To this end, companies encourage ongoing internal or external training of their claim staff. Regular internal audits are carried out for all claims not settled in their entirety. Internal audits apply to all stages of the claims management process. Peer reviews (where the claims department staff review each others’ files) could also be carried out. In case of claim settlement procedures involving several insurance companies, policyholder indemnification is a priority: the claim should be compensated in an appropriate time period while potential disputes between insurers are resolved at a later stage. For the most common insurance claims (related to motor insurance, for instance), specific agreements are concluded between insurers to accelerate and simplify claims settlement procedures involving several insured parties. . Provision of information to policyholders: The company keeps policyholders/claimants/beneficiaries informed of the progress during the claims process. The company provides information on when payments, repairs or replacements are expected to be made, and, if necessary, explains why additional time is required. When the company decides to call on outside parties (i.e. loss adjusters, solicitors, surveyors, etc.), it informs policyholders/claimants/beneficiaries of this fact, gives the reasons for this decision and explains the role that these outside parties will play in
  • 74. 74 processing the claim. When a final payment or offer of settlement is made, the company explains to policyholders/claimants/beneficiaries what the payment or settlement is for and the basis used for the payment/settlement. The insurance company documents their claim files in order to be able to address questions that may arise concerning the handling and payment of the claim. 5: Timely claim processing In accordance with applicable insurance law, companies should specify in the contract the most likely period of time for responding to correspondence from policyholders/claimants/beneficiaries. − The insurance company endeavors to settle the claim as soon as possible and advises in writing the policyholder/claimant/beneficiary on the reasons for any delay. Quick claims settlement as well as high-quality and punctual information provided to the policyholder/claimant/beneficiary are key competition features for insurance companies. After an agreement has been reached between the company and the policyholder/claimant/ beneficiary on the amount of compensation, the payment is effected within a reasonable amount of time. Insurance companies implement and update their own statistical database tracing their performance in the timely settlement of claims as well as in trends in settlements and expenses. A proper procedure for the coding and statistical processing of losses is developed for this purpose. 6: Supervision of claims-related services The insurance supervisory authorities may conduct examinations on claims management services especially where problems are suspected. In these cases, the following elements are taken into account: - Possible access to non-confidential claims data for all open and closed files within a specified time frame (e.g. for the current year and the two preceding years); - Maintenance of sufficient and appropriate information on claims files; - Use of the appropriate type of claim form for the type of insurance; - Proper qualification of the claims department’s employees based inter alia on the applicable insurance code;
  • 75. 75 - Valuation of claims payments according to company procedures; - Appropriate tracking of the nature and number of complaints related to claim management process; - Monitoring of the proportion of claims that result in litigation; - Compliance with procedures for combating fraud and money laundering; - Regular internal audit practices on claims files; - Appropriate internal claims procedure manuals; - Proper procedure for coding and statistical reporting of losses; - Performance in terms of the speed of claim settlements 7: Market practices The public authorities promote the implementation of a benchmark exercise regarding the claims process or a specific part of this process (i.e. handling of complaints). The terms of remuneration of insurance company employees or other services in charge of claim management do not give incentives to disadvantageous treatment of policyholders/claimants/beneficiaries, as regards the handling or the outcome of claims. CONCLUSION After making the study on ‘Claims Management’ with the help of various statistical tools, I would like to conclude that claims paid and claims recovered are positively
  • 76. 76 correlated and highly significant. The Claims Management System explained above is very helpful to the company. As the technology plays an important role in the Claims management System, it will result in less manual errors, time taken to process claims will be less . claims procedure becomes fully automated. Managing claims becomes easy for the company it would further results in customer satisfaction. The good practices on claim management are neither binding nor exhaustive, but meant as a “checklist” to assist insurance companies in handling claims.
  • 77. 77 ANNEXURE Reliance General Insurance Company Limited Balance sheet as at 30th September 2010 PARTICULRS Rs(‘000) Rs(‘000) Sources of funds Share capital Share application money Reserves and surplus Faire value change account borrowings TOTAL Applications of funds Investments Loans Fixed assets Deferred tax asset Current assets Cash and bank balances Advances and other assets Sub-total(A) Current liabilities Provisions Sub-total(B) Net current assets(C)=(A-B) Debit balance in profit and loss account TOTAL 1,152,239 1,420,000 8,918,392 15,552 ---- 19,618,135 300,627 376,664 409,735 440,527 3,921,946 4,362,473 10,129,089 6,258,561 16,387,650 (12,025,177) 2,826,199 11,506,183 11,506,183
  • 78. 78 Balance sheet as at 30th September 2009 PARTICULRS Rs(‘000) Rs(‘000) Sources of funds Share capital Share application money Reserves and surplus Faire value change account borrowings TOTAL Applications of funds Investments Loans Fixed assets Deferred tax asset Current assets Cash and bank balances Advances and other assets Sub-total(A) Current liabilities Provisions Sub-total(B) Net current assets(C)=(A-B) Debit balance in profit and loss account TOTAL 1,130,811 6,839,821 (157,825) 14,592,775 300,627 595,688 8,535 956,365 5,055,035 6,011,401 8,085,675 7,253,307 15,339,982 (9,328,581) 1,643,763 7,812,807 7,812,807
  • 81. 81