Shopkeepers Insurance Claim Process


Scope of Cover and Documents required for Claims

  • The policy comprises of following 11 sections:

Section I - Building & Contents

Covers shop building and/or contents therein against loss or damage caused by Fire & Allied perils i.e.
  • Fire, lightning, explosion of gas in domestic appliances
  • Bursting and overflowing of water tanks, apparatus or pipes
  • Aircraft or articles dropped there from
  • Riot, strike, malicious damage, terrorist act
  • Earthquake-Fire and/or shock, subsidence and landslide (including rockslide)
  • Flood, Inundation, Storm, Tempest, Typhoon, Hurricane, Tornado or Cyclone.
  • Impact damage by rail/road vehicle not belonging to the insured.

Section II - Burglary & Housebreaking

  • Covers contents of insured shop premises (excluding money and valuables) against loss or damage by burglary and/or housebreaking,

Section III - Money Insurance

  • Covers loss of money in transit, loss of money/valuables whilst contained in a locked safe, loss of money contained in cashiers till and/or counter by burglary/housebreaking.

Section IV - Pedal - Cycles

Covers loss/damage to pedal cycles belonging to insured by:
  • Fire, lightning or external explosion.
  • Riot, strike, malicious or terrorist act.
  • Burglary and / or Housebreaking or theft
  • Flood, cyclone, storm, tempest, and other similar convulsions of nature and atmospheric disturbance
  • This section also covers legal liability of insured for death/injury to third parties or damage to their property arising out of use of the insured pedal cycles.

Section V - Neon Sign/Glow Sign

Covers loss of or damage to neon sign/ glow sign by:
  • Accidental external means
  • Fire, lightning or external explosion or theft
  • Riot, strike, malicious or terrorist act
  • Flood, inundation, storm, tempest, typhoon, hurricane, tornado, cyclone

Section VI - Baggage

  • Covers loss or damage to accompanied personal baggage of insured or baggage in connection with his trade, whilst anywhere in India, by accident or misfortune

Section VII - Personal Accident

  • Covers insured and spouse and/or his children, named in the schedule and aged between 5&70 years, against bodily injury caused solely and directly by accident and resulting in death or permanent total or partial disablement or temporary total disablement within 12 calendar months of such injury.

Section VIII - Fidelity Guarantee

  • Covers direct pecuniary loss suffered by the insured due to fraud or dishonesty committed by any of insured`s salaried employees.

Section IX - Public Liability

  • Covers Legal liability in respect of accidental death or bodily injury to a third party or accidental damage to their property during performance of any act in connection with insured`s business,
  • Compensation to insured`s employees under Workmen`s Compensation Act or Common Law.

Section X - Loss of Profit

  • Covers loss of profit due to interruption of business consequent upon loss or damage sustained by property insured under Section I of the policy due to insured perils

Documents Required for Claims:

Sec I Fire Insurance:

  • Fire brigade report in case of fire
  • Seismological report in case of earthquake
  • Meteorological department`s report in case of flood
  • Estimate of the repairs for Fire/Flood/cyclone/earthquake damage/impact damage.
  • In case of Impact Damage, Strike/Riot or Civil Commotion the First Information report from Police is necessary.
  • Rental agreement if situated in a rented place.

Sec II Burglary & Housebreaking:

  • To obtain a First Information report from Police authorities.
  • To notify the Insurance Company and complete the claim form.
  • Take Photographs of the area broken to enter the house if it is forcible entry.
  • List out the articles that have been lost and their approximate value.
  • To maintain and produce a Stock statement on daily basis for stocks maintained and Cash Register to know the amount in cash or till.
  • To Follow up with the Police Authorities and obtain the non traceable certificate

Documents required for Sec III Money Insurance:

Documents required for Amount in transit to Bank:

  • Previous day cash register showing the Cash balance and cheques and drafts.
  • Actual amount of cash taken for deposit in the bank.
  • A declaration from the person carrying Cash and other instruments to the Bank with details of loss with mode of transportation.
  • Intimation to Police and registration of FIR.
  • Statement of witnesses if any who have seen the occurrence of the loss.
  • Obtaining a Non Traceable Certificate from Police Authorities.
  • Submission of Letter of Subrogation to Insurance Company according to their requirement.

Documents required for Amount in transit to Bank:

  • Previous day cash register showing the Cash balance and cheques and drafts.
  • Actual amount of cash taken for deposit in the bank.
  • A declaration from the person carrying Cash and other instruments to the Bank with details of loss with mode of transportation.
  • Intimation to Police and registration of FIR.
  • Statement of witnesses if any who have seen the occurrence of the loss.
  • Obtaining a Non Traceable Certificate from Police Authorities.
  • Submission of Letter of Subrogation to Insurance Company according to their requirement.

Documents required for Amount drawn from the Bank:

  • Counterfoil of Cheque which will show the amount entered in the cheque leaf for withdrawal from the bank.
  • Self Declaration from the person who has drawn the same from the bank regarding the loss.
  • Statement of witnesses who have knowledge about the incidence.
  • Intimation to Police and obtaining of FIR.
  • Obtaining Non Traceable Certificate from Police authorities.
  • Submission of Letter of subrogation to the Insurance Company according to their requirement.

Documents required for Loss from Cash Counters/till:

In case of Burglary/Housebreaking during working hours:/h4>
  • Actual amount of cash collected till the time of Burglary available in the cash register.
  • Denomination of cash kept in the cash counter/till.
  • Statement from the cashier regarding the amount of loss and the loss causing situation.
  • In case the cash counter contains cash withdrawn for disbursements then the value of cash available after deducting for payments made during the time and balance available.
  • Intimation to Police and obtaining of FIR.
  • Obtaining of Non Traceable certificate from Police Authorities.
  • Submission of Letter of Subrogation as required by the Insurance Company.
  • Provision of surveillance equipment at the shop at the time of loss.

In case of Burglary/Housebreaking after working hours:

  • Copy of Cash Register indicating the cash receipts during the day and disbursements if any during the day.
  • Denomination of cash kept in the cash box.
  • Photographs of placement of the cash box and damage thereto.
  • Statement from the cashier and owner regarding holding of the keys to the safe/cash box.
  • Intimation to police and obtaining of FIR.
  • Obtaining of Non Traceable Certificate from the police authorities.
  • Submission of Letter of Subrogation as required by the Insurance Company.
  • Statement of Security personnel who have been in the premises at the time of occurrence of loss.

This policy does not cover damage due to:

  • Fire and related perils
  • War and nuclear perils
  • Overload experiments / tests imposing abnormal conditions/li>
  • Gradually developing defects not requiring stoppage
  • Normal wear and tear, corrosion not leading to explosion / collapse.
  • Willful act / negligence
  • Loss for which the manufacturer is responsible
  • Pre-existing defects & faults
  • Consequential losses

Documents Required for Claims:

  • Immediate intimation to the Insurance Company.
  • Completing the claim form.
  • Photographs to show the extent of damages immediately on the happening of an Event.
  • Copy of Certificate issued by the Inspector of Boilers.
  • Details of last inspection carried out.
  • Copy of Log Book to show the maintenance and checks at regular intervals as recommended by the manufacturers.
  • Details of any tubes/valves replaced and the reasons for such replacement.
  • Details of warranty given by the manufacturer.
  • Details of Maintenance agreement entered into with manufacturers/suppliers.
  • Details of the firing fuel used. Deviations in using any firing material from those recommended by the manufacturer.
  • Details of employees who were on duty at the time of explosion/implosion and their relevant experience in running the same.
  • Details of Boilers which are fully automated.
  • Copy of original invoice showing the cost of the pressure vessel.
  • In case of repairs then the estimated cost of repairs.
  • In case the parts to be replaced have to be imported then the cost of such items including Air/Ship freight.
  • In case of Total loss then the quotation from manufacturers of similar boilers/pressure plants.

Details of any Burglar Alarm kept in the premises

Sec IV Loss of Pedal Cycles-Documents required:

In case of damage whilst plying on the road then:
  • FIR from the police authorities regarding damage if it involves third party. Otherwise a Self Declaration regarding the reason for the damage is sufficient.
  • Repairers estimate for damaged items
  • Here also `deprecation clause` is applied for the spare parts.
  • In case the market value is higher than the Insured value ‘Average Clause” will become applicable.
  • In case of Loss of life or Injury to third party FIR is required.
In case of Burglary Claims:
  • FIR from police authorities is a must. However if it is not possible to obtain an FIR then a General Diary entry from Police authorities is required.
  • Letter of subrogation on Legal paper as directed by the Insurance Company.

Sec IV Neon Sign/Glow Sign-Documents req. for claims:

  • Photographs of the damage to the Neon Sign/Glow Sign boards.
  • Original Invoice of the cost of Neon Sign/Glow Sign.
  • In case of fire only in the board then a statement regarding the same together with the cause of loss.
  • In case the damage is due to the fire in the building then Fire Brigade report.
  • In case of Theft/Burglary/Strike, Riot, Civil Commotion then FIR from Police authorities.
  • In case of loss due to Cyclone, Hurricane, Flood, Inundation then Meteorological report is required.

Sec. VII Baggage- Documents required:

  • Proof of Travel. E.g. Air Ticket/Train Ticket/Bus ticket. In case of loss of baggage by any other means of travel then a self declaration regarding the same. However loss of baggage for travel undertaken within the municipal limits of the Village, town or city wherein Insured is permanently residing is not covered.
  • Registered letter of complaint should be lodged on the carrier if travel by Public Transport.
  • Detailed list of items carried in the Baggage. However the insured should note that money securities, manuscripts, deeds, Bills of exchange, Promissory notes, stock or share certificates, jewellery, precious stones, watches, travel tickets, Cheques, bank drafts etc are not covered.
  • If possible a report of loss from the carriers. Otherwise FIR/General Diary entry from Police is required.
  • The compensation will be according to the value mentioned in the Policy schedule only.

Sec. VIII Personal Accident- Documents Required:

  • Completed claim form
  • FIR from Police authorities regarding the accident.
  • For death claims Postmortem Certificate, Legal Heir certificate and Inquest report.
  • For Disability a certificate from the Government Medical Practitioner mentioning the percentage of disability and medical reports for treatment taken and the disability sustained.
  • In case of death or disability in the course of employment then a certificate from the employer that the Insured person was in their service at the time of death or disability.

Sec. IX Fidelity Guarantee: Documents Required:

  • Statement from the proprietor regarding the finding out of the date of defalcation by the employee.
  • Statement from the proprietor regarding the actual amount of money or stocks defalcated.
  • Statement showing reconciliation of accounts, periodicity of reconciliation, persons who have checked the details and reported the defalcation with amounts/stocks defalcated and the periodicity of such defalcation.
  • Highest amount of cash/stock held by the defalcating employee with reason as to why he was authorized to hold the same.
  • Copy of his appointment letters together with any references duly mentioned by him in his resume.
  • Audited accounts of the firm and date of last audit.
  • Certificate from the Auditor confirming the defalcation.
  • FIR from the Police authorities together with details of Investigation.
  • Non Recoverable Certificate from Police Authorities.
  • Details of security or deposit or property of the employee held with the firm.
  • Action taken against the employee.
  • Letter of Subrogation as required by the Insurance Company.

Sec. X Liability Insurance- Documents required:

  • In case of third party: FIR from Policy authorities is required. Thereon the Insurance Company will make arrangements to defend the Insured since this is Legal Liability. The Insured should cooperate with the Insurance Company and make himself available as and when required by the court. However this is restricted to Rs.25000/- only as compensation and litigation expenses incurred by the Insured.
  • In case of Death or disability of Employees: The said employee should be named in the policy schedule. The compensation will be paid according to the Workmen`s Compensation Act and the proceedings should move from the disabled employee or from the legal heirs of the deceased employee. The documents to be submitted to Insurance Company are FIR from Police, Postmortem certificate and Inquest report (for death Claims). Thereupon the Insurance Company will deal with the case.
  • For Workmen’s Compensation Claims the insured has to submit Form A of the Workmen’s Compensation Act and also statement of witnesses if any.

Sec. XI Loss of Profit- Documents Required:

  • Previous 3 years audited accounts or if shorter period then the years during which the firm is involved in the business.
  • Statement of Actual Business done during the previous year corresponding to the period of loss.
  • Fixed expenses statement certified by the Auditor.
  • Sales Tax returns or any other returns submitted to the Government authorities corresponding to the period of loss in the previous year.
  • Details of saving in Standing Charges.
  • Details of Increased cost of working.
  • Details of trends in business.
  • Statement of business done up to the date of loss duly certified by the auditor.
  • Statement showing the Loss of Profit for the period under loss duly certified by the Auditor.

In the event of Claims being repudiated by the Insurance Company the following options are available as a recourse:

  • Make a representation to the Insurance Company/TPA.
  • If no reply is received within 15 days on making such representation make a representation to the Grievance Cell of the Insurance Company.
  • If No Reply is received or if the reply is not satisfactory then make a representation to the Insurance Ombudsman who has Quasi Judicial powers to hear the case and make adjudication.
  • If still not satisfied the next option is to go to court.