Definition & Meaning:
Insurance is the means of managing risk and protection against
financial loss arising as a result of contingencies, which may or may
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.
Insurance is defined as the equitable transfer of the risk of a loss, from
one entity to another, in exchange for a premium, and can be thought of
as a guaranteed small loss to prevent a large, possibly devastating loss.
An insurer is a company selling the insurance; an insured is the person
or entity buying the insurance. The insurance rate is a factor used to
determine the amount to be charged for a certain amount of insurance
coverage, called the premium. Risk management, the practice of
appraising and controlling risk, has evolved as a discrete field of study
One of the- main features of the pre-nationalized insurance sector was
the utilization of the insurance sector as a backup or extension by the
well-known industrial houses of India. There are mainly two forms, of
insurance in India viz. Life and non-life. Life insurance provides
protection to a household against the risk of premature death of its
income-earning, member. Non-life insurance can be grouped under
three heads viz., fire, marine and miscellaneous insurance. Life
insurance Corporation of India carries on life insurance business and,
the General Insurance Corporation and its four subsidiaries deal with
After liberalization of the insurance sector in 1999 private players have
entered both life and non-life business in India. The Insurance
Regulatory and Development Authority (IRDA) was constituted in
April 2000 as an autonomous body to regulate and develop the business
of insurance and re-insurance in the country in terms of the insurance
regulatory and Development Authority Act, 1999.
As the insurance market in India is liberalized, the pattern of
distribution is likely to undergo vast changes with new channels being
introduced, A quantum jump in Insurance business in terms of
premium, policies, lives covered, etc., would necessitate; corresponding
increase in the capacity of the distribution channels.
THE NEED FOR NEW CHANNELS:
The need for new channels can also be appreciated if distribution is
approached from the point of view of the customer.
Customer choice of the distribution channel is dictated
Socio-demographic factors (education, employment income)
Ease of access
Complexity of product/service; need for advice.
On the other hand the insurers' choice of distribution channels is
Costs associated relative to the premium charged
Access to customer base
Complexity of the products
Globally, as a result, many different channels such as agents, brokers,
banks and direct have emerged. There have also emerged several
variations between these like brokers liaising with banks, advisors
employed by insurers working out of a Bank branch, and bank as a
whole acting as a broker or agent.
HISTORY OF INSURANCE
In India, insurance has a deep-rooted history. It finds mention in the
writings of Manu (Manusmrithi), Yagnavalkya (Dharmasastra) and
Kautilya (Arthasastra). The writings talk in terms of pooling of
resources that could be re-distributed in times of calamities such as fire,
floods, epidemics and famine. This was probably a pre-cursor to
modern day insurance. Ancient Indian history has preserved the earliest
traces of insurance in the form of marine trade loans and carriers’
contracts. Insurance in India has evolved over time heavily drawing
from other countries, England in particular.
1818 saw the advent of life insurance business in India with the
establishment of the Oriental Life Insurance Company in Calcutta. This
Company however failed in 1834. In 1829, the Madras Equitable had
begun transacting life insurance business in the Madras Presidency.
1870 saw the enactment of the British Insurance Act and in the last
three decades of the nineteenth century, the Bombay Mutual (1871),
Oriental (1874) and Empire of India (1897) were started in the Bombay
Residency. This era, however, was dominated by foreign insurance
offices which did good business in India, namely Albert Life
Assurance, Royal Insurance, Liverpool and London Globe Insurance
and the Indian offices were up for hard competition from the foreign
In 1914, the Government of India started publishing returns of
Insurance Companies in India. The Indian Life Assurance Companies
Act, 1912 was the first statutory measure to regulate life business. In
1928, the Indian Insurance Companies Act was enacted to enable the
Government to collect statistical information about both life and non-
life business transacted in India by Indian and foreign insurers
including provident insurance societies. In 1938, with a view to
protecting the interest of the Insurance public, the earlier legislation
was consolidated and amended by the Insurance Act, 1938 with
comprehensive provisions for effective control over the activities of
The Insurance Amendment Act of 1950 abolished Principal
Agencies. However, there were a large number of insurance companies
and the level of competition was high. There were also allegations of
unfair trade practices. The Government of India, therefore, decided to
nationalize insurance business.
An Ordinance was issued on 19th January, 1956 nationalizing the
Life Insurance sector and Life Insurance Corporation came into
existence in the same year. The LIC absorbed 154 Indian, 16 non-
Indian insurers as also 75 provident societies—245 Indian and foreign
insurers in all. The LIC had monopoly till the late 90s when the
Insurance sector was reopened to the private sector.
The history of general insurance dates back to the Industrial
Revolution in the west and the consequent growth of sea-faring trade
and commerce in the 17th century. It came to India as a legacy of
British occupation. General Insurance in India has its roots in the
establishment of Triton Insurance Company Ltd., in the year 1850 in
Calcutta by the British. In 1907, the Indian Mercantile Insurance Ltd,
was set up. This was the first company to transact all classes of general
insurance business 1957 saw the formation of the General Insurance
Council, a wing of the Insurance Association of India. The General
Insurance Council framed a code of conduct for ensuring fair conduct
and sound business practices.
In 1968, the Insurance Act was amended to regulate investments and
set minimum solvency margins. The Tariff Advisory Committee was
also set up then.
In 1972 with the passing of the General Insurance Business
(Nationalisation) Act, general insurance business was nationalized with
effect from 1st January, 1973. 107 insurers were amalgamated and
grouped into four companies, namely National Insurance Company
Ltd., the New India Assurance Company Ltd., the Oriental Insurance
Company Ltd and the United India Insurance Company Ltd. The
General Insurance Corporation of India was incorporated as a company
in 1971 and it commence business on January 1sst 1973.
This millennium has seen insurance come a full circle in a journey
extending to nearly 200 years. The process of re-opening of the sector
had begun in the early 1990s and the last decade and more has seen it
been opened up substantially. In 1993, the Government set up a
committee under the chairmanship of RN Malhotra, former Governor
of RBI, to propose recommendations for reforms in the insurance
sector. The objective was to complement the reforms initiated in the
financial sector. The committee submitted its report in 1994 wherein,
among other things, it recommended that the private sector be
permitted to enter the insurance industry. They stated that foreign
companies be allowed to enter by floating Indian companies, preferably
a joint venture with Indian partners.
Following the recommendations of the Malhotra Committee report,
in 1999, the Insurance Regulatory and Development Authority (IRDA)
was constituted as an autonomous body to regulate and develop the
insurance industry. The IRDA was incorporated as a statutory body in
April, 2000. The key objectives of the IRDA include promotion of
competition so as to enhance customer satisfaction through increased
consumer choice and lower premiums, while ensuring the financial
security of the insurance market.
The IRDA opened up the market in August 2000 with the invitation
for application for registrations. Foreign companies were allowed
ownership of up to 26%. The Authority has the power to frame
regulations under Section 114A of the Insurance Act, 1938 and has
from 2000 onwards framed various regulations ranging from
registration of companies for carrying on insurance business to
protection of policyholders’ interests.
In December, 2000, the subsidiaries of the General Insurance
Corporation of India were restructured as independent companies and
at the same time GIC was converted into a national re-insurer.
Parliament passed a bill de-linking the four subsidiaries from GIC in
Today there are 14 general insurance companies including the
ECGC and Agriculture Insurance Corporation of India and 14 life
insurance companies operating in the country.
Insurance mediators or intermediaries are autonomous populace or
firms who carry the insurer and the insured together and act as a
mediator. Some groups’ 0f intermediaries also act as a distribution
channel for bringing the product of the insurance to the customer as in
the case of brokers. An insurance intermediary acts either on behalf of
the client or the insurance company. In India, the insurance
intermediaries except surveyor were not in existence till 1999 but with
liberalization, privatization and globalization (LPG) of insurance sector
the distribution channel have also been widened and the IRDA Act,
1999 included the term "Insurance Intermediaries" in the Insurance
Act, 1938. Up to 1999, the insurance product was sold either through
an Agent or the company directly through Development Officers and
branch mangers. Prior to 1950, the chief agent, special agent, and
principle agent were also in existence but the practice was discounted
In India the insurance intermediaries have been defined in the IRDA
Act, 1999 and section 2(1) (f) of the act states:
"Intermediaries or insurance intermediary includes insurance
brokers, insurance, consultants, surveyors and loss assessors."
Through the insurance sector has been privatized the insurers can deal
with intermediaries only if they are holding valid license issued by the
authority and the authority has laid down the norms for licensing of
The insurance broker is such individual who contribute maximum share
insurance business. A high standard of professional skills and conduct
expected of the broker.
WHO CAN BECOME AN INSURANCE BROKER?
Any person may be an individual, a partnership firm or a company
formed and registered under the companies Act, 1956 can apply for
grant of license to be a Broker. (In case of a company the aggregate
holding of equity shares by foreign Company either by itself or through
Its Subsidiaries or nominees or persons should be within the prescribed
limits laid down by the Reserve Bank Of India).
HOW TO APPLY:
The application is to be sent to the insurance regulatory and
development authority in prescribed form and it can be made for
anyone of the following categories:
CATEGORY - 1
(A) Direct general insurance broker, or
(B) Direct life insurance broker.
This means a person who is registered in respect of either general
insurance business for life insurance business but not for reinsurance
business. Such individuals contribute maximum share of business in
CATEGORY - 2
Re insurance broker, which is different from category one and is also
called indirect broker.
CATEGORY – 3
Composite broker whose functions will consist of that of Direct
Insurance Broker and Reinsurance Broker.
CATEGORY – 4
Others insurance consultants, risk management consultants or any other
classification as may be approved by the authority. Such intermediaries
create awareness among the people about the importance of insurance
and also provide consultancy as to how to invest in the insurance.
FUNCTIONS OF BROKERS:
The functions of brokers are as follows:
1. Obtaining a detailed knowledge of the clients business and
2. Maintaining clear records of the clients business so that this can
be explained to an insurer and other parties,
3. Provision to the client of technical advice and advice on
developments in the insurance market and the law,
4. Maintaining a detailed knowledge of available markets,
5. Selection and recommendation of an insurer or group of insurers,
6. Negotiating with insurer on the client behalf,
7. Acting promptly on instructions from a client and providing
written acknowledgements and progress reports,
8. Collecting and remitting premiums and claims,
9. Where appropriate and dependent oh the size of both the client
and broker, providing additional services such as insurance
consultancy services, risk management services and uninsured
10. Maintaining precise records of past claims; and
11. Providing services such as insurance consultancy risk
management services and uninsured loss recoveries.
PROCESSING OF APPLICATION FOR BROKERSHIP:
While processing the application for grant of licenses the authority
itself towards the following aspects:
Availability of infrastructure, i.e. adequate office space, equipment
Applicant should have minimum 2 persons in his employment who
have the experience to conduct the business of insurance broker.
Applicant should have no direct or indirect connection with a person
whose application has been rejected earlier.
Applicant should have a net worth of Rs. 25 lakhs in case of
category 1, Rs. 100 lakhs for category 2, Rs. 125 lakhs for category
3, and Rs. 10 lakhs for category-4.
IF FEE IS NOT PAID BY BROKER:
If the broker fails to pay the fee within the stipulated period Authority
may suspend his license and the insurance broker shall cease. To
function as an insurance broker for the duration of the suspension
period any person who acts as a insurance broker without holding a
license shall be punishable with the Authority with a fine, which, may
extend to Rs.l lakh.
REMUNERATION TO BROKERS:
Brokers belonging to Category 1 will be paid brokerage not exceeding
17.5% of the premium payable on the policy. In other categories the
market forces will determine the remuneration.
CODE OF CONDUCT FOR BROKERS:
The code of conduct is required to establish a recognized standards of
Professional conduct of which all insurance brokers should, in the
interest of the Public and in the performance of their duties, conform
and in doing so they should bear in mind this objective and the
underlying spirit of this code in the matter of regulation of their
professional standard. The code of conduct will cover the following:
1) Brokers Relationship With Clients:
Insurance Brokers must:
Deal with their clients with utmost good faith and
truthfulness at an times;
Act with care and meticulousness;
Make sure that the client understands his relationship with the
broker and on whose behalf the broker is acting;
Treat all information supplied by the prospective clients a
completely confidential to themselves and to the Insurers to
which the business is being offered;
Take appropriate steps to maintain the security of confidential
documents in the possession;
Understand the type of clients that they are dealing with and the
extent of the client awareness of risk and insurance. This
knowledge should be taken into account in their dealings with
their c1ient, and
Avoid conflicts of interest.
2.) Sales Practices of Brokers:
Insurance brokers must:
Authentic that they are members of the insurance brokers
association of India (IBAI), as approved by the Authority;
Make out who they are and explain as soon as possible the
degree of choice in the products that they are able to offer;
Ensure that the policy proposed is suitable to the needs of the
Offer advice only on those matters in which they are
knowledgeable and seek or recommend other specialist advice
Not make inaccurate or unfair criticisms of any insurer or IBAI
Enlighten why a policy or policies are proposed and provide
comparisons in terms of price, cover and / or service where they
are able to offer more than one choice of product cover and / or
service where they are able to offer more than offer more than
Explain the period for which the quotation remains valid if cover
is not affected immediately;
Clarity the procedures to follow in the event of a complaint.
3) Duty to Disclose Information
Insurance broker must:
Make certain that the consequences of non-disclosure and
inaccuracies are pointed out to the prospective client;
Stay away from influencing the prospective client and make it
clear that all the answers or statements given are the latter’s own
Appeal their client to make true, air and complete disclosure
where they believe that the client has not done so. If further
disclosure is not forthcoming they should consider declining to
Explain to their clients the importance of disclosing all
subsequent changes that might affect the Insurance throughout
the duration of the policy; and
Disclose on behalf of their client all material facts within and
give a fair presentation of the risk.
4.) Explanation of the contract
Insurance Brokers must:
Categorize the insurer or insurers. Any changes once the contract
has commenced must be advised immediately;
Draw attention to any major or unusual restrictions and
exclusions in the policy, explain how the contract, may be
Notify changes to the terms and conditions of any Insurance
contract and give reasonable notice before any changes take
Advise their clients of any Insurance proposed on their behalf
which will be effected with an insurer outside India and, if
appropriate of the possible risks involved; and
Advise their, client that any non-insurance product will not be
subject to IBAl and, if appropriate, the implications in terms of
consumer redress and solvency.
5) Renewal Procedures:
Insurance Brokers must:
Promise that their clients are aware of the expiry date of the
insurance even if they choose not to offer further cover to the
Make certain that renewal notice contains a warning about the
duty of disclosure including the necessity to advice changes
affecting the policy which have occurred since the policy
inception or the last renewal date;
Ensure that renewal notices contain a warning that the proposer
keep a record (including copies of letters) of all information
supplied to the insurer for the purpose of renewal of the
Assurance that their client always receives the insurers renewal
6) Claims Management by Brokers
Insurance brokers must:
Put in plain words to their clients their obligations to notify
claims promptly and to disclose all material facts and advice
subsequent developments as soon as possible;
Request their clients to make true, fair and compete disclosure
where they believe that the client has not done so. If further
disclosure is not forthcoming they should consider declining to
act further for the client;
Give prompt advice to the client of any requirements concerning
Forward any information received from the client regarding a
claim or an incident that may rise to a claim without delay, and
in any event within three working days; and
Inform the client without the delay of the insurer's decision or
otherwise of a claim; and on request give all responsible
assistance to a client in pursuing his claim pursuing his claim.
Insurance Brokers must:
Ascertain that letter of instructions; policies and renewal
documents contain details of complaints handling procedures;
Accept complaints either by phone or in writing;
Acknowledge a complaint not later than 14 days from the
receipt of correspondence; advise the member of staff who will
be dealing with the complaint and the timetable for dealing with
Ensure that they have a procedure so that the complaints are
dealt wit at a suitably senior level; and
Have in place a system for recording and monitoring
Insurance Brokers must:
Make sure that any documents, issued by them comply with all
statutory or regulatory requirements from time to time in force;
Send policy documents without avoidable delay;
Make available, with policy documentation, advice that the
documentation should be read carefully and retained by the client;
Not withhold documentation from their clients without their consent,
unless adequate and justifiable reasons are disclosed in writing and
without delay to the client.
9) Handling Client /Insurer Money:
Insurance broker must:
Make certain that the money belonging to clients or insurers are not
mixed with their/his own;
Separate accounts are properly maintained in regard to those amounts
proper information is periodically made to the client/insurer;
Ensure that these moneys are banked in a proper manner;
Ensure that moneys belonging to others are kept with them for a
reasonable period only; and
Ensure strict compliance of the provisions of regulation 17 (i.e.
Segregation of Insurance moneys.)
Insurance Brokers must:
Reveal all fees or charges (not commission) they propose to charge the
client, which will be in addition to the insurance premium. Score back
of commission will be considered as a charge for this purpose;
Recommend the client in writing of the insurance premium and any
fees charges separately and the purposes of any related services;
If requested by a client, disclose the amount of their commission or
other remuneration they receive as a result of effecting insurance for
that client. This will include any payment received as a result of
securing on behalf of the client any service additional to the
arrangement of the contract of insurance; and
Advice their client prior to affecting the insurance of their intention to
make any deductions from the amount of claim collected for a client
where there are reorganized practices for the type of insurance
11) Competence and Training:
Insurance Brokers must:
Make certain that their staff are aware of and adhere to the standards
expected of them by this code;
Make sure that are competent, suitable and have been given the
necessary training as required by the authority;
Ensure that there is a system in place to monitor the quality of advice
given by their staff; and
Ensure that members of staff are aware of legal requirements including
the law of agency affecting their activities; and only handle.
Insurance companies do the business of insuring people against perils, whose
main business is to club people sharing the same risk; collect the share of
contribution from all of them, and then payout the compensation to the
sufferers. The business of insurance companies both life and non-life is
procured through an individual who is appointed as an agent.
An Agent is a person licensed by the IRDA to do insurance business. Agents
are not the regular employees of the insurer; they work on commission basis
in a freelance manner. There are some qualifications and procedural
formalities, which have to be fulfilled for grant of a license of agent.
An agent, in order to obtain a license, has to go through a training
programmed and appear for an examination. The purpose of licensing course
is designed to prepare an individual to work as an insurance agent. It provides
a foundation, terminology, and concepts upon which an individual can build
successful career as an agent.
COMMON LICENSING PROVISIONS:
Evidence of all of the following has to be made available to the authority
before registration as an agent.
Section 42 (4) of the amended Insurance Act, 1938 states an agent to be one
who is not:
a) A minor;
b) Found to be of unsound mind by a court of competent jurisdiction;
c) Found guilty of criminal misappropriation or criminal breach of trust
or cheating or forgery or an abetment of or attempt to commit such
offence by a court of competent jurisdiction; and
d) Found guilty of having knowingly participated in or convinced at any
fraud, dishonesty or misrepresentation against an insurer or an
e) Possesses a pass in 12th standard (reduced to 10th standard for rural
f) Has been trained for a minimum period of four weeks; and
g) Has a pass in an examination prescribed by the Authority.
The expectations from an agent are:
Agent should offer consumers good service by responding to
customer’s needs in terms of grant cover, advice, conduct, etc
Agent should be willing to promote products in personal lines market
making the best use of their professional ability.
Needs for Agent's Training:
Agents are provided training to:
a) Instruct him (her) complete knowledge of products;
b) Imbibe in him (her) the importance of Pre-and-post sale service to
c) Equip him (her) as a trusted professional capable of advising persons
d) Make him (her) as an efficient salesperson;
e) Enable him (her) to master various techniques in the area of sale of
Training Schedule and Structure:
Training Modus Operandi
The classroom training may be by means of lectures, discussions,
Speeches/seminars, question-answer sessions, case, studies, role-playing,
exchange of experiences, team training, replication of real life situation in the
classroom; open house, self-study, etc
"'The use of various audiovisual devices while taking the lectures like slides,
overhead projectors computers, markers, etc may be encouraged.
The training institute will arrange 'to supply every agent -an agents manual,
service manual, list of all products available in .the market, a handbook
containing specimen copies of proposal form, claim form, etc. from the
insurance company who has nominated the agent for the training course.
Examination For Agents
a) All agents on completion of their training will have to appear in a
b) The exam will consist of objective type questions only.
c) The exam will be of maximum 100 marks.
d) The time for examination will be 2 hours.
e) 10% of Question will be numerical.
f) This will be followed by an interview of 25 marks, conducted by the
g) Every agent will have to score at least 50% marks in the written exam
and 60% in the interview for qualifying in the agents examination and
for award of a certificate.
a) Every person aspiring to take up agency as a career will have to undergo on
the job practical training with the designated company where he will work
under the supervision of a sales functionary.
b) The sales functionary will teach the trainee the nuances of creating the need
in the mind of the customer, understanding the wants of the clients, proposing
2 or 3 solutions for satisfying the want and finally helping him decide the best
option and closing the deal.
c) In addition, administrative matters, documentation, etc. will also be taught
to the trainee.
SURVEYOR AND LOSS ASSESSORS:
This category of intermediaries is related to only non-life business. Their
main functions are to survey and assess any mis-happening or disaster and
evaluate the financial loss to the insurance companies. The insurance
companies make financial assistance on the basis of the evaluation made
surveyor. More specifically, the functions of any Surveyor and Loss Assessor
will be as follows:
Conduct inspection, re-inspection, pre-inspection of the property in
question suffering a loss;
Examine, inquire, investigate, verify and check upon the causes and the
circumstances of the loss in question including their nature and extent
of loss and related factors/documents;
Estimate measure determine: the quantum-description-valuation of the
subject under loss;
Initiate immediate measures to protect damage property and to prevent
aggravation of losses;
Advise the insurer and the insured about the loss minimization;
Loss control, security, and safety measures, where appropriate to avoid
Check the admissibility of the loss whether it falls within the scope of
the policy contract, to point out about the adequacy or inadequacy of
the sum insured, and whether the amount claimed are: fair reasonable
Survey and assess the loss on behalf of insurer a or insuring public;
Recommend the net liability in terms of insurance contract;
Advice on repair and replacement techniques;
Checking the ownership-insurable interest-indemnity related proofs;
Declare whether the surveyor/loss assessor has an interest in the subject
matter in question or whether it pertains to any blood relation, business
partners or through shareholding & if so refrain from carrying out the
survey and loss assessment in that respect;
Report on the financial loss of the damage suffered by the insured to
the insurer. The reporting must be intelligently communicated, so
that, adequate information and the supporting documents and
statements satisfy beyond doubt that the recommendations are sub
stained and the he has thoroughly discharged his duties expected of
Report about unfair claim handling practices, observed during
discharge of duties;
Comment any happening in the process of discharge of duties if it is
against the law of the land;
State there is no professional negligence in discharge of the service;
Report about the damages to the third parties and properties which are
not parties to the contact of insurance;
Adjust the loss after it is assessed, taking into account; the policy
conditions, exclusions and other factors, e.g. custom duty, usage of
items expenses for which others may be responsible and salvage
Eligibility for becoming Surveyor
Any person who holds any of the following qualifications can become a
Surveyor and Loss Assessor:
Degree of a recognized university in any branch of engineering;
Fellow or Associate member of institute of Chartered Accountants of
India or Institute of cost works Accountants of India;
Actuarial qualifications or holds a degree or diploma of any recognized
university or institute in relation to insurance; and
Holds a Diploma in insurance granted or recognized by the
Modus Operandi for License
Any person possessing the above-mentioned conditions can apply Insurance
Authority in a prescribed format provided he following grounds:
That a person is minor;
That he is found to be unsound mind by a court of competent
That he has been found guilty of criminal misappropriation or criminal
breach of trust or cheating or forgery or an abetment of or attempt to
commit any such offence by a Court of competent jurisdiction; and
That he does not poses the requisite qualifications and practical
training for a period not exceeding twelve months.
Code of conduct for Surveyor and Loss Assessors
Like the brokers and agents, every surveyor and loss assessor including the
Company/ Firm of Surveyor and Loss Assessors shall abide by the code of
conduct specified by-the Authority from time to time. In particular and
without prejudice to the generality of the foregoing the code of conduct shall
include the following:
To exhibit the identity card and/or the license issued by the Authority
while carrying out the job of survey and loss assessment and be physically
fit to undertake the rigorous of the job.
'To conduct the survey job in a manner and behavior, which is transparent,
honest, sincere, fair, objective and free from personal interest and ensure
that the professional, technical standards of competence are upheld.
To endeavor to keep abreast with profession attending professional
courses, trainings, seminars and workshops upgrading the required skills.
To uphold not only ethical behavior but professional reputation and
credibility while refraining from making remarks, comments or
grievances in the public or to the press without exhausting internal
professional and legal avenue.
Any conduct of surveyor and loss assessor which is not:
professional, proper, right, efficient, good behavior, efficient or contains
deliberate disobedience, unlawful behavior, neglect of duty, conduct
amiss, malfeasance, will include among other matters to be misconduct
and volatize of the code of conduct. The Authority, before imposing any
penalty, fine or suspension or cancellation of a license because of
misconduct shall cause an enquiry and provide reasonable opportunity to
the license-holder of being heard.
THIRD PARTY ADMINISTRATORS (TPAs) - HEALTH
Third Party Administrators (TPAs) are the intermediaries who bring all
the components of health care delivery - hospitals, physicians, and clinics;
long-term care facilities and pharmacies - into a single entity. They extend
quality health care and services at reasonable costs. It is important to take an
overview of the health insurance scenario in India before taking a detailed
look at the functioning of TPAs. The IRDA has defined TPA as "an insurance
intermediary licensed by the Authority who, either directly or indirectly,
solicits or effects coverage of underwrites, collects, charges premiums from
an insured, or adjusts or settle claims in connection with health insurance,
except as an agent or broker or an insurer.
Functioning of TPAs
TPAs sort out health care providers by setting up networks with hospitals,
general practitioners, diagnostic centres, pharmacies, dental clinics etc. They
sign a memorandum of understanding with insurance companies under which
they let policyholders know about the various health care delivery facilities
and methods for settling claims.
Policyholders get themselves registered with TPAs to benefits from these
services and at the time of hospitalization, health facilities are expected to
pass on this information to the TPAs. The medical representative of the TPA
examines acceptability of the case and accordingly informs the health care
providers to go ahead with the treatment.
The agreement between TPAs and health care facilities includes the collection
of documents and bills concerning the treatment. Documents are assessed and
sent to the insurance company for reimbursement. TPAs also procure
reimbursements from the insurance company and pay the health care
provider. TPAs usually have in-house specialists comprising medical doctors,
insurance consultants, legal experts and IT professionals. The mainstay of TP
As is an information management system.
The client groups of TP As fall into two categories: corporate and individuals.
The major sources of revenue are the fees charged for providing various
services. Insurance companies pay the fee in proportion to the volume and
scope of services provided by TPAs and usually it is a fixed percentage of the
premium collected from the enrollees.
CODE OF CONDUCT FOR TPA'S:
The IRDA has made it compulsory for TPAs to get a license to operate in
So far IRDA has granted this license 23 TPAs. The TPAs have formed an -
association called Indian Association of TPAs to protect their interests.
IRDA along with the Insurance Advisory Committee has formulated the
Insurance Regulatory and Development Authority (Third Party
Administration - Health Services) Regulations, 2001 to regulate TPAs.
Some of the regulations include:
Only an organization registered under the Companies Act 1956 with a
share capital of at least Rs. 10 million in equity shares can set up TPA
The primary object of the company should be to carry on business in
India as a TPA in health services. It should not be involved in any other
At least one of the directors shall be a qualified medical doctor
registered with the Medical Council of India. The CEO or CAO of TPA
should have successfully undergone a course in hospital management
from an institution recognized by IRDA and have passed the licentiate
examination conducted by the Insurance Institute of India, Mumbai.
Apart from this he should have undergone practical training of at least
three months in the field of health management.
Foreign equity in TP As is limited to 26 per cent.
TPAs shall not charge any kind of fee from the clients.
IRDA guidelines do not permit marketing of health insurance policies
by the TPA.
TPAs have to maintain and report to IRDA on transaction carried out
on behalf of the insurer.
TPAs are expected to furnish to the insurance company and the
authority an annual report and other return as may require by the
IRDA has drawn up a code of the TPAs refraining them from trading
information, submitting wrong information to insurers and advertising
without prior approval of the insurer among other things.
Bancassurance symbolizes the convergence of banking and insurance.
The term involves distribution of insurance products through a bank’s branch
network. In concrete terms, bancassurance, which is also known as Allfinanz
– describes a package of financial services that can fulfill both banking and
insurance needs at the same time. While Bancassurance has become a success
story In Europe, it is relatively a new premium in Asia. For instance,
bancassurance represents over 65% of the premium income in life insurance
in Spain, 60% in France, 50% in Belgium and Italy. Bancassurance
penetration is expected to substantially increase in Asia over the next five
years, potentially accounting for 13% of life insurance premiums. A key
factor driving the development of bancassurance in Asia its relaxation of
stringent regulating Japan, South Korea and the Philipp ines are taking a more
accommodating stance towards bank distribution of insurance products.
Bancassurance as a means of distribution of insurance products is already in
force in India in some form or the other. Banks are selling personal accident
and baggage insurance directly to their customers as a value addition to their
products. Banks are also participating in the distribution of mortgage linked
insurance products like fire, motor or cattle insurance to their customers. Even
IRDA Bill in India has stimulated the growth of bancassurance by allowing
the use of multiple distribution channels by banks and insurance companies.
(A) BENEFITS OF BANCASSURANCE:
Insurance companies see bancassurance as a too for increasing their
market penetration and premium turnover. The customer sees bancassurance
as a bonanza in terms of reduced price, high quality product and delivery at
doorsteps. Banks and Insurance companies have complementary strengths. In
their natural and traditional roles and with their current skills, neither banks
nor insurance companies could effectively mount a bancassurance start-up
alone. Collaboration is the key to making this new channel work. For banks,
bancassurance is a means of product diversification and a source of additional
free income. Insurance companies see it as a tool for increasing their market
penetration and premium turnover. Expenses ratio in insurance activities
through bancassurance is very low. Banks and the insurance companies
benefit from the same distribution channels and people. Above all a back-of-
the-envelope calculation taking into account only the existing customer base
shows that banks could collectively be looking at a fee-based income of
anywhere between Rs. 13,500 crore and Rs.22, 000 crore over the next five
years. The total fee-based income of the Indian banking Industry in 2001-02
was Rs. 9,213 crore Banks are thus looking at tie-up with insurance
companies to boost their non-interest income. In turn, insurance companies
are keenly eyeing the spread of bank branches and the potential to tap 18
crore customer accounts. SBI Life Insurance Company, a predominant player
in bancassurance, is positive about the channel bringing about a
transformation in the way insurance has been sold so far. The company is
banking heavily on bancassurance and plans to explore the potential of State
Bank of India’s 9,000 plus branches spread across the country and also its
4,000 plus associate banks. OM Kotak Mahindra Life insurance has tied up
with Dena bank besides its own Kotak Bank for bancassurance. The company
is targeting around 10% of the business during its startup phase.
Bancassurance makes use of various distribution channels like salaried
agents, bank employees, brokerage firms, and direct response, Internet etc.
Insurance companies have complementary strengths. In their natural and
traditional roles Bancassurance if of great benefit to the customers. It leads to
the creation of one-shop where a customer can apply for mortgages, pensions,
savings, and insurance products. The customer gains from both the sides as
cost gets reduced. Bancassurance for the customer is a bonanza in terms of
reduced premium charges, a high quality product and delivery at the doorstep.
The development of bancassurance in Ind ia has been slowed down by certain
regulatory barriers, which have only recently been cleared with the passage of
the Insurance (Amendment) Act, 2002. Prior to this, all the directors of a
company wishing to take up corporate agency (such as a bank) were
technically required to undertake 100 hours of agency training and pass an
examination. This was clearly an impractical requirement and had held up the
implementation of bancassurance in the country. As the current legislation
places the training and examination requirements upon a designated person
(.the corporate insurance executive.) within the corporate agency, this barrier
has effectively been removed.
Other regulatory changes of note in this area are the recently published
Insurance Regulatory and Development Authority (IRDA) regulations
relating to the licensing of corporate agents.
This specifies the institutions that can become corporate agents and sets out
the training and examination requirements for the individuals who will be
selling on behalf of the corporate agent, the so-called specified persons.
Specified persons have to satisfy the same training and examination
requirements as insurance agents. A noticeable exception is that for those
possessing the Certified Associateship of Indian Institute of Bankers (CAIIB)
only 50 hours of training (rather than 100 hours) will be required. This also
applies to certified accountants and actuaries. It is hoped that this aspect of
the regulations will lead to well educated, professional bank officers carrying
out the financial advisory process.
Although expected, a restrictive feature of the bancassurance regulations is
that they appear to constrain the corporate agent to receiving only
commission; profit-sharing arrangements would seem to be ruled out. We feel
that this, if applied in practice, is unfortunate as profit sharing agreements,
which are increasingly common internationally, serve to align the interests of
the bank and the insurance company. Also, as products sold through bank
channels can be highly profitable, such agreements may be financially
advantageous for banks. In the longer term a profit-sharing agreement can
help a bank move from being a distributor to a manufacturer of insurance
products thus leading to greater integration in the financial services
Given the open-mindedness and responsiveness of the IRDA to regulations in
general, we hope that it will not be too long before profit-sharing agreements
are permitted between insurers and corporate agents.
WHY IS BANCASSURANCE MORE SUITED TO LIFE
Traditionally, much fewer non-life insurance products are distributed through
bancassurance than life insurance products. There are several reasons for this:
✔ The main reason may be the complementary nature of life insurance and
banking products: bank employees are already familiar with financial
products and quickly adapt to selling insurance-based savings or pension
✔ On the other hand, the non-life market requires special management and
selling skills, which are not necessarily prevalent in bancassurance. In
addition, such competencies require significant investment in training and
motivation, and therefore additional costs;
✔ Life insurance products are generally long-term products, which require
customers to have complete confidence in the institution that invests their
money. And we now know that, in many countries, banks have a better image
and are more trusted than insurance companies;
✔ Bank advisers can use their knowledge of their customers’ finances to
target their advice towards specific needs. This is a major advantage in life
insurance and less important in personal injury insurance;
Some professionals also refer to the claims management aspect of personal
injury insurance, which could have a negative impact on brand image. This
would seem to explain why for a long time bancassurance operators hesitated
to offer these types of product.
INSURANCE INTERMEDIARIES IN INDIA - AN
In terms of sheer numbers, the strength of LIC’s distribution channel
comprising over 5.90 lakh active Agents and over 18,800 development
officers appears to be phenomenal. This is indeed a diverse in nature and
spread, for which a strong marketing network is imperative. The network duly
supported by 2048 servicing branches no doubt gives us the confidence in
terms of numbers. Let us examine the Indian intermediaries’ channel.
Since the reorganization in 80’s LIC has been laying a lot of emphasis on
professionalizing its field force. Prior to these attempts, most of the – training
needs were left to the Agent’s instructors and this arrangement had many
shortcomings, which included:
a) Lack of professional approach, technical and material know how on the
part of the instructor himself.
b) Fewer number of instructors in comparison to the training requirements
c) Lack of proper infrastructure and training facilities; and lukewarm
approach on the part of the development officers in promoting
professionalism amongst their agents.
Even today, some of the agents do not have adequate product knowledge and
their sales skills have not been developed beyond a certain level. One of the
inhibiting factors possibly is ensuring that the agency force remains
dependent on sales supervision or in other words, fear of independence of the
agency force is predominant. As such, the phenomenon of dependency was
and is being encouraged to maintain a firm grip/hold over the agency force.
One of the best indicators of this phenomenon is the fact that when the
umbrella of sales supervision is somehow not available, a majority of agents
get terminated due to lack of guidance, which they had got used to. This has
also given rise to a situation where a majority of agents never visit the office,
as the need to do so is never emphasized upon them by their sales supervisor.
However, with training becoming a major focus of the reorganization
especially for the field force with the creation of a network of ZTCs and STCs
to provide both knowledge and professional inputs to the agents as well as
the. Development officers, the situation has been slowly changing for the
better. However, a lot still needs to be done in terms of qualitative
improvement of our agents, which cannot be achieved just through training
but also requires qualitative improvement in selection/recruitment itself.
Life insurance requires need-based selling. For need-based selling, we need to
emphasize on the customer’s need distinct from the salesman’s need. The
picture of life insurance selling has to be in conformity with the customer
aspirations. Some of the agents have a tendency to sell products that they
want to sell rather than the products is attributable to the commission
structure somehow has been designed to give the agents. The incentive to
promote certain products, which would guarantee a bulkier commission
initially, rather than those products wherein the commissions are spread out
over a period of time. To overcome this lacuna, it is essential that the basis
rate of commission itself be restructured. So that the agents do not derive any
benefit in so far as promoting a product for there own short-term financial
gain. This will lead to a situation where the customer is more assured of being
sold a product of his choice rather than being misled into buying a product
that he does not need.
SUMMARY AND FINDINGS:
The concept of broker is very well entrenched in the developed
countries and more than 40% of the insurance business is conducted
through brokers as compared to India.
The broker will not only act for one insurance company but he can
represent more than three companies at a time.
Agents present eligibility conditions to be certainly being made more
stringent and the minimum qualification level for rural and urban
agents needs to be raised. This is necessary because insurance is not a
simple product but a complex service that will require a certain degree
of understanding to ensure correct sale.
In general insurance, the claims are settled on the basis of the report
submitted by the independent agency which is known as surveyor or
loss assessors and they are qualified persons, having expertise in this
field. If an insurance company employs its own experts then they may
be biased toward the claim, as they are an employee of insurance
company. Therefore, to avoid any conflicts of interest independent
surveyors are necessary.
Third party administrators in health services also play an important role
in insurance sector but health insurance is not very popular in India
because it is a costly proposal. Further more there is lack of awareness
among the people about the benefits they can derive from health
insurance. At present, health insurance purchased by those who are
affluent and can afford to pay the medical bills whereas it is actually
required by those who cannot afford the costly medical treatment.
Syllabus for agent training- life insurance
Introduction to insurance:
a) Purpose and need of insurance.
b) Insurance as a social security tool.
c) Role of insurance in the development of economy.
d) Pooling of risk and resources.
Fundamentals of agency law:
a) Agency law including the definition of who is an agent, what are his
functions, who can become an agent, the kind of business he can
b) Agents regulations
c) Contract act.
d) Various intermediaries in the insurance market-agents, brokers,
surveyors, consultants, etc.
e) Difference between an agent, a broker, and other intermediaries.
Legislative and regulatory matters:
a) Insurance act 1938.
b) LIC Act, 1956.
c) Insurance regulatory and development authority Act, 1999.
d) Consumer protection Act, 1986.
e) Ombudsman scheme.
f) Various other Acts such as income TAX Act, etc. connected with
conduct of life insurance business.
g) Code of conduct in advertisement and publicity areas.
Procedure for becoming and agent:
a) Pre requisite for obtaining a license.
b) Insurance company sponsorship.
c) Obtaining a license minimum age, educational qualification,
d) Maintenance and duration of license.
e) Termination of license: revocation or suspension/termination of
f) Unfair practices: rebate; prohibited inducements and discrimination;
twisting a poaching, misrepresentations and incomplete comparison;
false statement regarding insurance companies financial condition.
Functions of agent:
a) Proposal form and other forms for grant of cover.
b) All material and relevant information.
c) Financial and medical underwriting.
d) Family history, medical examination, special medical reports, etc.
e) Admission of age.
f) Special reports, moral hazard report, etc
g) Ensuring delivery of policy to the insured.
i) Nomination and assignment
j) Procedure regarding settlement of benefits.
a) Organizational setup of the company.
b) Corporate mission.
c) Strengths of the company.
d) Market share.
e) Product details.
f) Promation strategy.
g) The acturial professions-role in life insurance companies.
h) Product pricing-acturial aspects
i) Distribution channels which the insurer has-other distribution
channels-their relative merits and demerits.
j) Hierarchical structure for agents- Ttranee AGENT, junior/senior
Fundamentals/principles of life insurance:
a) Utmost good faith
b) Insurable interest.
c) Pooling of similar risks.
Financial planning and taxation:
a) Trends in financial services market.
b) Other savings instruments like shares, units, capital markets, mutual
c) Tax benefits under insurance policies.
d) Life cycles-Needs.
e) Solutions matching of the customers’ needs and requirements to that
of the products available.
f) Comparisons between different products offered vis-à-vis premium
chargeable, coverage, etc.
Insurance Salesmanship: selling techniques
a) Salesmanship- an introduction
b) Selling process.
h) Consumer education.
Computation of premiums/bonuses:
a) Use of premiums table in calculating premiums.
b) Premium rebates mode rebates, large sum assured policies rebate.
c) Computation of premium, extra premium rider premiums.
d) Computation of benefits-surrender value, paid up value, etc.
a) Proposal forms and other relevant forms.
b) First premium receipt/renewal premium receipt.
c) Policy contract.
e) Renewal notice/bonus notices.
f) Other Insurance Documents related to insurance
Life insurance products:
a) Traditional/ unit –Linked Policies.
b) Individual and Group policies.
c) Different types of insurance products –whole life products, interest
sensitive products, term, Annuities, Endowment, combination plans
d) Policies For Females, Children, Physically Handicapped.
Options, guarantees and Riders:
a) Policy riders
b) Individual and Group policies.
c) Different types of insurance products- whole life products, Interest
sensitive products, Term, Annuities, Endowment, combination plans
d) Policies for Females, children, Physically Handicapped.
Group Insurance and Superannuating Schemes Pension plans:
a) Special legal other Features of group insurance superannuation
b) Group insurance schemes Employees deposit Linked Scheme
(EDLI) and Non EDLI Schemes.
c) Gratuity schemes.
d) Superannuation schemes-money purchase and Defined benefit
e) Savings linked insurance policies
f) Group annuity schemes.
g) Voluntary retirement schemes.
a) Critical Illness Dreaded Disease Plans.
b) Health Insurance Riders.
c) Permanent Health Insurance.
d) Notification of Claim Doctor’s Report, Claim Form, Payment
Government Schemes Programmes On Insurance:
a) Details Of Different Government Insurance Schemes.
b) Subsidy Provided by Government for Underwriting the
Schemes- SSGS, RGLIS, IRDP scheme.
a) Definition Of Rural Area
b) Rural Insurance Schemes SSGS, RGLIS, IRDP Schemes.
c) Targets In Terms Of Total Premium, which Should Be
Completed By the Agent
d) Penalties for Not Meeting Rural Insurance Schemes.
e) Details Of Schemes Specially Designed For The Rural
a) Intimation Procedure
b) Claims Documents- Forms
c) Settlement Procedures.
Agency Commission Structure:
a) Personal Business Goals- Understanding The Competition And
Enhancing Time Management Skills, Future Prospects Within The
b) Marketing And Sales Opportunities- Identifies Target Markets And
Builds Relationship Skills In The Total Planning Sale.
c) Target Marketing-Develops The Customers Profits And Focus On
New Profitable Target Markets.
d) Review The Expanding Market Of Aging Adults.
c) Communication Skills.
d) Persuasive Skills
e) Analytical Ability
f) Behavior with Other Agents/ Employees of Insurer.
Feedback To companies On Customer’s Requirements With Regard To
Their Insurance Needs and Miscellaneous Matters:
a) New Requirement of the Customers.
b) Modification On The Coverage, Rates Etc. Of The Customers.
c) Code Of Conduct Laid Down By IRDA
e) Dispute Resolution Forum Set-Up By IRDA For Adjudication Of
Disputes Between The Agent And Customer/Insurer.
f) Feedback To IRDA On The Nature Of Disputes And Methods Of
Syllabus for Agent Training – Non Life Insurance:
Introduction to insurance:
a) Purpose and Need of insurance
b) Insurance as a social security tool
c) Role of insurance in the development of economy
d) Pooling of resources, spread of risks
Fundamental of Agency Law:
a) Agency Law including definition of who is an agent, what are his
functions, who can become an Agent, the kind of business he can
b) Agents Regulations.
c) Contract Act.
d) Various intermediaries in insurance market agents, brokers, surveyors,
e) Difference between an agent and other intermediaries.
f) Methods of remunerating the agent.
Legislative and Regulatory Matters:
a) Insurance Act, 1936.
b) Marine Insurances Act, 1963.
c) General Insurance Business Nationalization Act, 1972.
d) Carriers Act, 1899.
e) Indian Stamp Act,1899
f) Public liability Insurance Act Consumer Protection Act, 1986 1991.
g) Motor Vehicles Act,1899
h) Consumer Protection Act, 1986 and Ombudsman Scheme.
i) Workmen’s compensation act, 1923.
j) Sale of goods act, 1930
Procedure for becoming an agent:
a) Pre-requisite for obtaining a license.
b) Insurances company sponsorship.
c) Obtaining a license minimum age, educational, qualification, practical
d) Maintenances and duration of license.
e) Termination of license; revocation or suspension/termination of
f) Unfair practices: rebates, prohibited inducement and discrimination,
misrepresentation and incomplete comparison; false statements
regarding insurance companies’ financial condition.
Functions of agent:
a) Proposal form and other forms of grant of cover.
b) Gathering all material and relevant information to the risk including
signature of the customer on the proposal form.
c) Explaining the terms, conditions, coverages, and exclusions under the
d) Ensuring delivery of policy to the insured.
e) Helping the customer in lodging the claim and completing all
a) Organizational set-up of the company.
b) Corporate mission.
c) Strengths share.
d) Market share.
e) Product details.
f) Promotion strategy
g) Product pricing.
Fundamentals/Principles of General Insurance:
a) Utmost Good Faith.
c) Insurable Interest.
f) Proximate cause.
Financial Planning and Taxation:
a) Premium rates charged in policies.
b) Tax benefits under selected insurance policies.
c) Comparison between different products offered by various insurers vis -
à-vis premium chargeable, coverage, etc.
Insurance Salesmanship: selling Techniques:
a) Salesmanship- An introduction.
b) Selling process.
h) Consumer Education
Proper Use of General Insurance products:
a) Products available in the general insurance market.
b) Scope of coverage some of the important policies.
c) Matching of the customer’s needs and requirements to that of the
d) Code of Advertisement and publicity.
b) Basis of Rate Making.
c) Market Agreements.
d) Importance of Data base
e) Role of TAC.
a) Insurance forms
b) Proposal Forms
c) Cover Notes
d) Certificate of Insurance
e) Policy forms
g) Renewal Notice
h) Other Insurance Documents related to insurance.
a) Fire policies: scope: Coverage; Exclusions: Conditions; Premium.
b) Marine Policies: Scope: Coverage; Exclusions; Premium.
c) Miscellaneous Policies: Scope; Coverage; Exclusions; Conditions;
d) Motor Policies: Scope; Coverage; Exclusions; Conditions; Premium.
e) Basis of fixing the sum insured under different policies
f) Discount, Loadings, etc.
Management of Risks:
a) Long Term/Short-Term Policies.
b) Annual Policies.
c) Unit-Linked Policies.
d) Post-Retirement (Bhavishya Arogya) Type plans.
e) Unit-Linked Policies.
f) Basic Hospital, Medical and Surgical Policies.
g) Coverages, exclusions, Premium, Cumulative Bonus.
h) Time limit on certain defences, reinstatement, Grace period for renewal
i) Pre-existing disease clause, maternity Benefit
j) Notification of claim, Doctor’s report, claim form, payment of claims
Government Schemes/Programmes Insurance:
a) Details of different Government insurance schemes like Crop
insurance, PASS, Landless Agriculture Scheme, and Solatium Fund.
b) Subsidy provided by the Government for underwriting the schemes.
a) Definition of rural areas.
b) Rural Insurance Schemes.
c) Targets in terms of total premium, which should be completed by the
d) Penalties for not meeting the laid down stipulations.
e) Special Skills to market rural insurance schemes.
f) Details of Schemes specially designed for the rural areas.
a) Preliminary Procedure.
b) Investigation and assessment.
c) Surveyors and Loss Assessors.
d) Claim Documents.
h) Loss Minimization and Salvage.
Provisions and differences in policy Contracts:
1) Important differences to be highlighted.
2) Difference between branch of Warranty and Condition.
4) Drafting of a Cover Note.
1) Important business Goals-Understanding the time management skills.
2) Marketing and sales opportunities-identify target market planning sale.
3) Target Marketing –Develop the customer’s profile and focus on the
profitable target markets.
4) Review the expanding market of aging adults.
5) Business continuity-emphasis on retaining the client by providing him
up to date information on the changes taking place, the benefits that he
may enjoy because of changes in Rules/regulations/change in company
policy, sending out renewal notices.
3) Communication skills
4) Analytical ability
Feedback to companies and customer’s requirements with regard to their
insurance needs and miscellaneous matters:
1) New requirements of the customers.
2) Modification on the coverages, rates, etc. of the customers
3) Code of conduct laid down by IRDA
5) Dispute resolution forum set-up by IRDA for adjudication of disputes
between the Agent and customer/insurer.
Mathew M.J. Insurance Principles And Practices