Claims & Disputes

How a claim runs

A burglary claim starts with reporting the loss to the police and to the insurer. It then moves through evidence and documentation, the surveyor's assessment and the insurer's decision.

Evidence carries the claim. A timely First Information Report, CCTV footage showing the break-in, a maintained stock register and purchase invoices each support it, and each additional piece strengthens the case. The stock register and invoices show what was there and what it was worth; the FIR and footage show how it was lost.

Survey and time limits

Under IRDAI's surveyor regulations a licensed surveyor and loss assessor must assess losses above ₹1 lakh in general insurance classes other than motor, and above ₹50,000 in motor. Older material quotes ₹20,000, which was the pre-2015 threshold.

For retail general insurance policies, IRDAI's 2024 Master Circulars set the pace. A surveyor must be allocated within 24 hours of the claim being reported, where the earlier rule allowed 72 hours. The survey report is due within 15 days of allocation, and the insurer must decide the claim within 7 days of receiving it; older material quotes 30 days. Commercial and large-risk claims have their own timelines.

The fraud condition and the intermediary's role

A burglary policy carries a fraud condition: if a claim is fraudulent in any respect, all benefit under the policy is forfeited. A claim that mixes genuine items with invented ones is therefore lost in full, not just for the invented part. The insurer has to establish the fraud, and an honest difference over valuation is not fraud.

The decision on a claim rests with the insurer, based on the policy terms and the evidence. A Point of Sales Person or other intermediary may help with documentation and follow-up, but cannot guarantee that a claim will be paid.

If the policyholder disagrees

The first step is a written complaint to the insurer's Grievance Redressal Officer, which the insurer must resolve within 14 days. A complaint can also be registered on IRDAI's Bima Bharosa portal, which tracks it and routes it to the insurer. The Insurance Ombudsman will take a complaint only after the insurer has been approached.

The Ombudsman is free of cost and can award up to ₹50 lakh, raised from ₹30 lakh by an amendment effective 10 November 2023. It hears individuals, sole proprietorships and micro enterprises, so a burglary claim by a larger company falls outside it.

A consumer commission under the Consumer Protection Act, 2019 is the other route. Which commission hears the complaint depends on the consideration paid, which for insurance is the premium, and not on the claim amount: the District Commission up to ₹50 lakh, the State Commission above that and up to ₹2 crore, and the National Commission above ₹2 crore.

Arbitration is no longer the default for a dispute over amount. IRDAI's circular of 27 October 2023 removed the arbitration clause from retail general insurance policies. In commercial policies the parties may still agree to arbitrate, under a separate agreement.

Rules at a glance

Key points

• A burglary claim is reported to both the police and the insurer, and is built on the FIR, stock records, invoices and any CCTV footage.
• A licensed surveyor is mandatory for a non-motor loss above ₹1 lakh.
• For retail policies: surveyor within 24 hours, survey report within 15 days, decision within 7 days of the report.
• A claim fraudulent in any respect forfeits all benefit, but the insurer must establish the fraud.
• Disputes go first to the insurer's Grievance Redressal Officer, then to the Ombudsman (if eligible) or a consumer commission.
• Consumer commission jurisdiction follows the premium paid, not the claim amount.

Common misunderstandings

• A partly fraudulent claim is not paid in part: under the policy's fraud condition a claim fraudulent in any respect forfeits all benefit.
• A disagreement over what stolen stock was worth is not fraud: it is an honest valuation difference, and the insurer has to establish fraud.
• A ₹1 crore claim does not go to the State Commission on that account: jurisdiction turns on the premium paid.
• The 24-hour, 15-day and 7-day limits apply to retail general insurance policies; commercial and large-risk claims have their own timelines.

Questions people ask