Insurance

Surveyors Management Policy (SMP) of Public Sector General Insurance Cos. – Govt of India

Government of India

Department of Financial Services

Insurance Devision

F. No. G-14017/80/2014-Ins.II

Dated : 04/09/2018

Survey and loss assessment is a key and critical component in Claims Management. Although the PSGICs already have guidelines relating to surveyors as part of the Claims Manual and clear-cut guidelines are laid down in the IRDAI (Protection of Policyholders’ interests) Regulations, 2017, yet in view of the criticality of loss assessment function in a regulated business environment with growing customer’s expectations on ease of claims experience, this Policy is being propounded. At present, though the Surveyors and Loss Assessors are regulated by IRDAI (Surveyors and Loss Assessors) Regulations, 2015, wherein the duties and responsibilities of a surveyor are clearly spelt out, it is felt appropriate that the Public Sector General Insurance Companies (PSGICs) shall have a well designed Policy to promote transparency, equity and incorporate the principle of “fit and proper” criteria in the entire value chain of surveyor management starting from empanelment to allotment, finalization of assessment, submission of report and performance appraisal. This policy shall be effective from 01.01.2018, after it is duly approved by the Board of the Company.

A. Surveyors’ empanelment

Any surveyor and loss assessor holding valid license issued by IRDAI as per IRDAI (Surveyors and Loss Assessors) Regulations, 2015 and who is also a member of IISLA can apply for empanelment in the standard application form (as per Annexure I) of the Company. Surveyors License is a pre-condition but not a sufficient condition for surveyor empanelment. Besides this, the number of licensed surveyors is so large that the Company may not need that many in terms of surveyable claims reported in a year. Existing Surveyors on the panel of the Company need not apply again.

1. Applications from surveyors for empanelment shall be invited through notification on the website of the Company in the month of November every year for the requirement of
surveyors on their panel in different portfolio in different Regional Offices/ Service Hubs/ Head Office. A time period of 45 days shall be available for receipt of such duly filled applications.
2. The Company shall provide for submission of on-line applications only and uploading of supporting documents. No physical application shall be entertained.
3. Empanelment Process shall be centralized across four Public Sector General Insurance
Companies by formation of a “Surveyor Empanelment Committee”. After receipt of
applications online, the applications for surveyor empanelment will be scrutinized by the
Head Office on the basis of his/her Bio-data, qualification and experience and incomplete
applications/ applications with mismatched profiles will be rejected. Further to the above,
the applicant(s) shall be called for a personal interview by ‘Surveyor Empanelment
Committee’. The common ‘Surveyor Empanelment Committee’ is to be constituted at central
level for all the four Public Sector General Insurance Companies. Depending upon the
number and requirement, several such Committees can be formed for different categories of
surveyors / portfolios/ area of operations etc.
4. Based on historical data relating to number of claims reported under different portfolios for
the Service Hub/ RO as a whole, the Service Hub/ RO should decide the number of
surveyors, portfolio wise, to be empanelled at any given point in time during the year and
inform the same to HO. The panel of surveyors for any department shall neither be too small
nor be unwieldy but be commensurate with the number of claims estimated to be surveyed in
any geographical spread. Thus, the number of surveyors for each portfolio in the panel shall
be determined by the Regional In charges so as to ensure that the empanelled surveyors get
adequate number of jobs in a year so as to sustain their interest in the Company’s
survey/loss assessment work. Thus, a panel of surveyors shall be 2 % of the average of the  last three years surveyable claims in Motor portfolio and 10% of the average of the last three years surveyable claims in other portfolios. Based on the interview, a decision on empanelment should be taken keeping in view the applicant’s commitment, attitude,
professional approach, service orientation, behavioral skills, knowledge and experience of the portfolio (30% Weightage to qualification , 20% to experience and balance 50% to
remaining parameters of commitment, attitude, professional approach, service orientation,
behavioral skills – 10% each). Based on these parameters, if the Committee is satisfied
about the credentials of the candidate and his/her candidature is assessed as ‘fit and proper’ in the light of the job profile, a decision to empanel be recorded and communicated to the applicant. Where an applicant is rejected, clear reasons must be recorded in writing. Mere eligibility, filing application and attending interview does not confer any right on the part of the applicant (licensed surveyor) to be empanelled.
5. The entire exercise of selection of surveyors for empanelment shall be completed by the Companies within 45 days (i.e. from the cut-off date for receipt of applications from eligible persons). The list of selected surveyors on the panel of Regional Office/Head Office shall be uploaded on the Company’s website.
6. Surveyor who has not been empanelled after due process detailed above, may file an appeal before Appellant Authority, within 15 days from the date of declaration of empanelment list on Company’s website, explaining why he/she considers himself/herself fit for empanelment.
The Appellant Authority is a Committee, constituted at the central level, for all the four Public Sector General Insurance Companies, being at least one level higher than the members of ‘Surveyor Empanelment Committee’. Such Appeal cases shall be disposed off within 30 days of receipt of the Appeal and the decision shall be communicated to the concerned surveyor in writing immediately thereafter.
7. The surveyor, so selected for empanelment, shall be empanelled till the validity of his/her license subject to his satisfactory annual performance appraisal report. Where license is to be renewed, evidence of his application filed with IRDAI for renewal within stipulated timeframe to be submitted.
8. The Company may evolve a grading mechanism within the IISLA framework, within each category. The grading of a surveyor shall be determined by factors like qualification, license
category, experience in handling small/medium/large claims, etc. The grading shall be
reviewed by the Company at the time of performance review of the surveyors and shall be suitably modified, if so warranted.
9. The panel of surveyors shall be communicated to all the Regional Offices and Service Hubs by the HO and additions/deletions shall also be suitably informed.
10. Portfolio-wise separate panel for each Divisional Office (including Branches under it) shall be constructed by RO in turn, apart from an exclusive panel at RO Level (for RO-level surveys).
11. Head Office shall maintain a separate panel of surveyors for each portfolio (which may include surveyors already empanelled with Regional Offices/ Service Hubs).
12. As surveyor empanelment is a centralized process at HO, there shall be no separate
selection process for empanelment by any Regional Office or Service Hub.
13. The panel of surveyors shall be reviewed annually by “Surveyors Empanelment and
Performance Review Committee’ (to be constituted by CMD and in his absence by the two
WTDs) after the ‘Annual Performance Review’ exercise is complete.

B. Allotment of survey jobs to Surveyors

1. Where a surveyor needs to be appointed, it shall be done within 72 hours of receipt of
intimation of the claim. Acceptance or decline of survey job allotted to the surveyor shall be conveyed by him to the Company within 24 hours by mail
2. The appointment of surveyor (who is duly empanelled and holding valid license on the date of allotment of survey) for a claim shall be done by the Competent Authority to settle the said claim (or such delegated officer devolved with such powers by the Authority/ In charge of Office).
3. Spot/ Preliminary Survey is not mandatory, however Claims Authority may order such survey in cases where it is warranted. Spot surveyor shall submit the report to the Company online, and also a signed Report; alongwith dated digital photographs immediately and in any case within 48 hours after visiting the affected site/loss location. The surveyor has to confirm and document (primarily through digital photographs/ videos including GPS coordinates) to the satisfaction of the Company that the risk inspected under the claim is the same as the risk covered under the policy.
4. Final Survey jobs shall be allotted on a reasonable and fair rotation basis. Profile of the
surveyor/ his or her experience shall be kept in view in relation to a claim with special
features like nature of loss, cause and extent of loss, difficulty level of engaging with the
insured, area of operation of surveyor, frequency and severity of claims from the same
insured/geography etc. While the objective is to ensure job rotation, at the same time, it shall
be ensured that the right job is given to the right person. Allotment of jobs to the surveyor,
especially in major property, stock losses, liability claims, high-end vehicles etc. is a
specialized function and warrants careful selection, which skill is professional and
experience-based. However, on a yearly basis, fair rotation of surveyors shall be ensured.
5. Every Office shall maintain ‘surveyor allotment register’ which records details of survey job allotted to each surveyor.
6. The surveyor allotment register shall contain the following details:

1. Date of allotment of survey
2. Name of the surveyor
3. Type of survey (Preliminary/Spot/Final/Reinspection)
4. Date of loss
5. Date of claim intimation
6. Name of the Insured
7. Department
8. Claim No.
9. Estimate of loss
10. Date of submission of Report
7. A standard ‘Appointment letter’ shall be duly signed & sent/ mailed, a copy of which shall be placed in the claim file.

8. In case of corporate surveyor, any licensed Surveyor and Loss Assessor appointed as
director/ partner of such company/ firm, shall undertake survey jobs and issue survey reports only in the capacity of director/ partner of the corporate company/ firm. The company/ firm can undertake survey jobs only in those department and level of membership displayed
against each of the director/ partner in the Corporate Surveyor and Loss Assessor license
issued by the Authority.
9. The Company shall develop facilities to send SMS / Mail alerts to Surveyors about their
appointment containing Date of Accident, Claim Number, Mobile number of contact person and type of claim. Similarly, SMS / Mail alerts should be sent to insured and/or repairer mentioning name & contact number of Surveyor.
10. The Company shall develop SMS / Mail facilities to be sent to repairer / insured on receipt of Survey Report. The System also should send reminders by SMS / Mail to surveyors on fixed time lines for non submission of reports. This data should be captured in the Performance Appraisal format.
11. The Office shall pay the fees to the surveyor within 48 hours of receipt of Final Survey Report without waiting for any clarifications / addendum.
12. The Survey Fees shall be as per the GIPSA Survey Fees Schedule, as revised from time to time, duly approved by the Board of respective Companies.
13. Technology to be leveraged by the Company in better and effective management of
surveyors in terms of allotment of survey jobs, for example, generation of red flag if repeated
jobs (Final Survey) are allotted to surveyors, automated transmission of reminders to
surveyor on delay in survey report, automated allotment register generation on a pre-defined
template, alert on allotment of jobs to surveyors whose license has expired etc. Necessary  dash-boards alerts relating to pending survey-reports with all details shall be developed for the benefit of the claims officers.
14. Separate surveyor panel, wherever required, to specified/authorized motor
dealer/OEM/corporate customers under SLAs/ MOUs, may be drawn from out of the panel of
the surveyors maintained by HO/RO or Service Hub.
15. Joint surveyors may be appointed in complicated claims where multiple domains of
specialization come into play in assessment or where the risk covered is specialized. The
joint surveyors shall also be guided by the Policy in the same manner.
16. Normally, a second surveyor may not be appointed for a claim. However, in difficult and
complex claims, a second surveyor may be deputed with the concurrence of the Insured duly
recording the reasons for such appointment. The Competent Authority in this regard shall be the Claim Approving Authority.
17. In the event of the information being received by the insurer of exit of one director/ partner of a corporate surveyor Firm comprising only two directors/ partners, due to any reason, any survey job allotted to such firm shall be withdrawn and allotted to another suitable surveyor.
18. Any surveyor engaging outside agencies (CA firms, domain consultants etc.) shall take prior approval of the Insurance Company by establishing the credentials of such outside agencies.
Reports of such outside agencies shall form part of the Survey Report and the surveyor shall be responsible for the same.
19. Engagement of other outside agencies like Advocates, Investigator, Valuers, CAs or other such professional agencies shall be through standard terms of engagement specifying their role, responsibility and accountability. Enclosed as Annexure IV.
In this regard, the Company shall take a copy of the professionals’ membership/ license in their Bar Council/ ICAI/ Medical Council/ any other relevant superintending or regulatory body, before engaging them on specific assignments. The letter of engagement shall contain
a proviso whereby the outside agency/professional would be put on notice that they would be
liable for action under law for any fraud committed relating to subject transaction including
submission of fraudulent/ forged documents/ suppression or misrepresentation of facts
gathered either relating to claim transaction or their candidature. Such duly appointed
outside agency/ professional shall be warranted to conduct due diligence on all the
documents procured and submitted to the Insurance Company touching upon admissibility
and/or valuation of claim/ underwriting aspect concerned.
While the above is indicative in nature, the Company may evolve their own specific protocol
for the above verification process.
20. The empanelled surveyor shall at all times cooperate fully with the Company in any legal
dispute.
21. The Regional in Charge & GM (Technical) shall be the final authority on any dispute/
settlement of appointment of surveyors for RO/Service Hub & HO respectively.
22. In case the appointed surveyor for a claim is unable to complete his assignment due to any
extenuating circumstances (with documentary evidence of ill health of self/immediate family
member or absence from station due to unavoidable reasons), his contract for the particular
assignment/claim may be terminated with documented reasons by the Competent Authority
to settle the claim.

C. Surveyors’ Performance Appraisal/Review of Panel:

1. Performance of each surveyor on the panel shall be reviewed by RO/ Service Hub once in a year starting from 01.04.2018 to 31.03.2019 Appraisal Period and such Performance Report shall be submitted to the relevant Technical Department at HO.
2. All the empanelled surveyors to be duly informed of the Annual Appraisal Process and the key matrix governing the same. In addition, the Policy shall be posted on the website of the Company (which includes Annual Appraisal Process). The surveyors are expected to visit the website from time to time for regular updates.

3. Company shall have standard ‘Surveyor Performance Appraisal’ (SPA Form enclosed as Annexure II) which is to be prepared and kept in the claim file concerned and one copy of the
same be maintained in master file (surveyor-wise) for annual performance review.
Alternatively, Company shall ensure that a template in the Claims module comprising
‘Surveyor Performance Appraisal’ is filled up by the claims officer alongside claim settlement
in the system. The system should be enabled to generate Service Hub/RO/HO wise
‘Surveyor’s Performance Appraisal Report’ (enclosed as Annexure III) for each surveyor
through these templates.
4. Company should develop online / SMS formats for rating of surveyors by the customer at the
time of settlement of the claim on the following points on a five-point scale –
outstanding/good/average/below average/poor:
1. Was the surveyor prompt in attending to the claim ?
2. Were you informed about full requirements at the beginning?
3. Was he professional & focused?
4. Was the conclusion of assessment communicated to you?
5. Was he courteous & helpful?
5. The ‘Surveyor Appraisal Form’ shall contain the following standard parameters which shall be
assessed on a scale of 1 to 10 (10 being outstanding and 1 being poor):
1. Prompt and timely submission of survey report
2. Error free and unambiguous survey report – Fair assessment
3. Quick response to queries raised, if any
4. Suggestions for risk improvement
5. Feedback from the customer
6. Annual Performance Review shall be done by the designated ‘Surveyor Performance Review
Committee’ at Head Office/ Regional Office/ Service Hub comprising three members based
on ‘Surveyors’ Performance Appraisal’ (SPA) Forms received from the Claims settling
offices. Such committee shall be nominated by Regional In charge for Regional Office/
Service Hub and by CMD for Head Office. All such reports shall be submitted to the HO.
The Performance Appraisal results shall be shared with the respective surveyors.
7. Based on SPA Forms, Company shall prepare ‘Surveyor Performance Appraisal Report’ for
each Surveyor. The Company shall take necessary action in respect of surveyors who
consistently under-perform on various Performance Evaluation parameters. Such action
would include counseling, reduction in number of jobs allotted and de-empanelment.
8. Any complaint received against the appointed surveyor shall be handled by the Grievance Cell(s)/ Department of the respective Company. The time-lines laid down for redressal of grievances should be strictly adhered to.
9. In respect of fraudulent claims where surveyors are found involved (either actively or
passively), Company may remove such surveyor. Such removal should be only after
recording the same with cogent documented reasons. A reference shall also be made to
IRDAI under the relevant regulatory provisions. Thereafter, the Competent Authority to settle the claim shall appoint a new surveyor. Similar procedure is to be adopted in respect of issues / complaints of corruption against the appointed surveyor. Surveyors shall follow ‘Code of Conduct’ defined in the IRDAI ‘Surveyors and Loss Assessors’ Regulations, 2015 at all times.
10. The suggested actions based on the ‘Surveyor Performance Appraisal Report’ are tabled below:

Assessment Matrix:
Marks scored Suggested Action
61 – 80 Counseling for improving performance
41 – 60 Counseling and reduction in number of survey jobs allotted
40 & below Steps to be taken towards de-empanelment after suitable counseling and
ascertaining the reasons for under/non-performance
11. In case a surveyor is de-empanelled by any Regional Office/ Service Hub/ Head Office, such
communication should be shared with all the Regional Offices/ Head Office of the Company
along with the detailed reasons thereto. Such communication should also be shared across
all PSGICs. This should be in addition to quarterly reporting to IRDAI.

D. Other Important Aspects:

1. Time-line for Survey Report submission:
1. Surveyor shall start the survey immediately but not later than 48 hours of his appointment.
He should submit “Interim Report” along with photographs of the loss immediately but not later than 15 days after visiting the affected site/loss location.
2. He shall immediately but not later than 7 days of the claim intimation, inform the insured / claimant to submit required information and essential documents in support of claim. Where documents are available in public domain or with a public authority, the surveyor shall obtain them.
3. The surveyor shall submit his ‘Final Survey Report’ to the Company within 30 days of his appointment.
4. For commercial and large risks claims, the surveyor shall submit the final report within 90 days of his appointment. Large risks claims may be defined by each Company depending upon their claim profile for each segment.
5. Where special circumstances exists in respect of a claim, either due to its special /
complicated nature or due to difficulties associated with replacement/ reinstatement, the
surveyor shall seek an extension from the Company for submission of his report. In such an event, the surveyor shall give the ‘Status Report’ to the Company fortnightly wherever
warranted.
6. A scheduled follow-up shall be maintained by the Claims Office to ensure submission of survey report by the surveyor within 30 days/ 90 days from the date of allotment of survey
job. The time-line is critical in the overall claims management perspective.
7. In case of delay in submission of report beyond the prescribed timeline, surveyor shall keep
the Insurance Company informed of the reasons thereof, in writing. In any event, where the
insured, fails to provide the required information/data or documents relevant to the loss and
its assessment beyond the time extension provided by the Insurance Company, the surveyor
shall finalise the Survey Report based on available documents and details after giving three written reminders to the Insured/ Claimant.
8. If the Company, on the receipt of a survey report, finds that it is incomplete in any respect, it shall require the surveyor, under intimation to the insured/claimant; to furnish an additional report on certain specific issues within 15 days of the receipt of ‘Final Survey Report’.
9. The surveyor, on receipt of this communication, shall furnish an additional report within three weeks of the date of receipt of communication from the Company.
10. Surveyor shall mark all correspondence with Insured/Claimant to the Insurance Company.
11. A copy of the Survey Report shall be made available to the Insured/Claimant by the
Insurance Company, if the Insured/Claimant so desires.

2. On Account payment:

1. Wherever, admission of liability is clearly established, but exact quantification of loss
cannot be done immediately due to pending repairs/ replacement/ reinstatement,
voluminous records to be sifted, disposal of salvage or any other reason, and
Insured/claimant makes a request for ‘on account payment’, Surveyor may recommend
‘on account’ payment to the claimant so as to provide immediate financial relief to him.
2. Surveyor shall submit his Survey Report within prescribed time-line indicating, in definite
terms, the amount that can be offered to the claimant as ‘on account’ not exceeding 75%
of minimum admissible liability
3. Decision to release ‘on account’ payment shall be at the sole discretion of the Company.
4. Thereafter, the surveyor shall conclude the final loss assessment at the earliest possible.

The empanelled surveyors shall ensure that they are in compliance with the duties and
responsibilities and code of conduct at all times as mandated by the extant Surveyors
Regulations. This Policy needs to be implemented by the Company in conjunction with the IRDAI (Surveyors and Loss Assessors) Regulations, 2015 as amended from time to time. In case any aspect of this Policy is at divergence with IRDAI (Surveyors and Loss Assessors) Regulations as amended from time to time, the Regulation shall prevail over the same. GM (Technical), to be nominated by CMD, shall have residual powers to decide on any dispute arising out of empanelment, appointment or appraisal of surveyor based on facts and circumstances of each case/reference considering the fact that surveyor appointment to a particular claim and managing his/her performance thereto is an experience based and specialized skill. The Chairman cum Managing Director (CMD) of the Company shall have the authority to provide ruling on interpretation issues in implementation of this Policy and review the same and necessary amendments shall be made thereto with the approval of the Board of the Company.


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