Claim Admissibility: S-01 Chapter 12
Before anyone measures a loss, someone has to say whether it is covered. Seven checks, in order.
Before a surveyor works out how much a loss is worth, a more basic question has to be answered: is this claim payable at all? That is admissibility, the subject of S-01 chapter 12, Factors Affecting the Admissibility of the Claim.
The regulations put it in plain words. A surveyor must comment on the admissibility of the claim and assess the liability of the insurer as per the policy terms and conditions, and give reasons where a claim is not covered. The insurer decides. Your comment is what it decides on.
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The Admissibility Checks, in Order
If a claim fails an early check, the later ones do not save it.
- 1
Was the policy in force?
The loss date must fall inside the policy period, and the premium must have been received before cover started. A loss one day after expiry, or before the premium was paid, fails here.
- 2
Is it the insured property, at the insured place?
Match the item, the description and the address with the schedule. Stock moved to an undeclared godown is a different risk from the one insured.
- 3
Does the claimant have insurable interest?
Check ownership, or other financial interest, at the time of the loss. The regulations name ownership and insurable interest as points the surveyor must verify.
- 4
Was the cause an insured peril?
Find the proximate cause: the dominant, effective cause in the chain of events. If it is an insured peril, the loss is covered. If it is an excluded peril, it is not, whatever came after.
- 5
Does any exclusion apply?
Read the exclusions against the facts. A covered peril can still be excluded in a particular situation, such as a loss caused by an excluded event.
- 6
Were warranties and conditions kept?
Check conditions on storage, protection, notice of loss and care of the property. Note whether the breach is relevant to the loss.
- 7
Was there full disclosure and no fraud?
Compare the proposal with what you find on site. Material facts hidden at the proposal stage, or exaggeration in the claim, go into the report with evidence.
One Fire, Four Outcomes
An illustration: a fire damages stock in a textile godown insured under a fire policy.
| What the surveyor finds | Admissibility comment |
|---|---|
| Fire from a short circuit, policy in force, stock at the insured address | Admissible. Move on to assessing the amount |
| Same fire, but the loss date is two days after the policy expired and renewal premium was paid later | Not admissible: no cover on the date of loss |
| Same fire, but the damaged stock was in a second, undeclared godown | Not admissible for that stock: it was not the insured location |
| Same fire, but books show stock bought only on paper, with no matching suppliers | Report the facts and the gaps. Whether this is fraud is for the insurer to decide on the evidence |
Admissible Is Not the Same as Paid in Full
An admissible claim still has to be measured. Under-insurance, depreciation, salvage, excess and the sum insured all cut the figure down. Admissibility answers "is anything payable?". Assessment answers "how much?". S-01 keeps them in separate chapters for this reason.
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Writing the Comment
A good admissibility comment names the policy term it rests on. "Claim not admissible" alone is weak. "Claim not admissible: the loss occurred at an address not in the policy schedule (schedule item 2, address X; loss at address Y)" is a comment an insurer can act on and a policyholder can understand.
Where the wording itself is unclear, say so. The regulations expect the surveyor to point out any discrepancy in the policy wording, not to quietly resolve it one way.
How S-01 Tests This
Questions are usually short scenarios: a loss, a fact, and options like "admissible", "not admissible" or "admissible subject to average". Read for the first failing check. The common trap is to jump to the amount when the claim fails on time, place or cause.
The other trap is the surveyor's authority. The surveyor comments and recommends. The insurer accepts or repudiates.
FAQs
What does admissibility of a claim mean?expand_more
Whether the loss is covered at all under the policy: the policy was in force, the property and place match, the claimant has insurable interest, the cause is an insured peril, no exclusion applies, and the conditions were kept.
Does the surveyor decide whether a claim is admissible?expand_more
No. The surveyor comments on admissibility and assesses the insurer's liability under the policy terms. The insurer makes the decision.
Is a claim inadmissible if a policy condition was breached?expand_more
It depends on the policy wording and on whether the breach is relevant to the loss. The surveyor records the breach and its link to the loss; the insurer applies the terms.
Which S-01 chapter covers admissibility?expand_more
Chapter 12, Factors Affecting the Admissibility of the Claim.
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