Insurance Claim & Portfolio Review Support

PNPC does not adjudicate, approve, or settle claims — that authority sits with the insurer and, for larger claims, the IRDAI-licensed surveyor appointed by the insurer. What we do is support the policyholder: filing the First Notification of Loss correctly and on time, assembling complete documentation, preparing an independent financial quantification of the loss using your books of account, coordinating with the surveyor, tracking the insurer's response against regulatory timelines, and escalating through the insurer's grievance process, the Insurance Ombudsman, or IRDAI's Bima Bharosa portal if the claim is unreasonably delayed or repudiated.

A portfolio review is a structured audit of every insurance policy a business or individual currently holds — checking for coverage gaps, overlapping or duplicate cover, under-insurance relative to current asset values, lapsed add-ons, and premium efficiency. We recommend a full review at least annually, ideally timed a few weeks before your main renewal cycle, and an ad hoc review any time there is a material change — a new location, new machinery, a significant increase in stock or turnover, new employees, or entry into a new line of business.

Under-insurance occurs when the sum insured in a policy is lower than the actual value of the insured asset (stock, machinery, building) at the time of loss. Most property and fire policies contain an 'average clause': if the sum insured is less than the actual value, the claim payout is reduced proportionately — even for a partial loss. For example, if a stock is insured for 60% of its actual value, the insurer may pay only 60% of an otherwise valid claim, regardless of the size of the actual loss.

Notification timelines are set by the specific policy wording, not by a single uniform law — commonly a short window (often within 24 to 72 hours, though this varies significantly by policy and insurer) from when the loss becomes known to the insured. Missing this window is one of the most common grounds insurers cite when disputing or delaying a claim, even where the loss itself is genuine and covered.

For claims above a prescribed threshold, IRDAI regulations require the insurer to appoint a licensed surveyor and loss assessor under Section 64UM of the Insurance Act 1938 to independently assess the loss. The surveyor's report is a key input to the insurer's settlement decision, though the insurer is not always bound to accept it in full. A policyholder can, at their own cost, also engage an independent surveyor or valuer to support their own claim quantification — this is common in larger or disputed commercial claims, and PNPC frequently prepares the underlying financial workings that support such an independent assessment.

A business interruption (also called consequential loss or loss of profits) claim compensates for the loss of gross profit a business suffers because operations were disrupted by an insured event — for example, a fire that halts production for several weeks. It is calculated using a formula based on historical turnover and gross profit trends, the 'indemnity period' specified in the policy (the maximum time the cover applies), and the actual reduction in turnover during the disrupted period, adjusted for any savings in costs that did not have to be incurred. This requires solid historical financial data — exactly the kind PNPC already prepares as part of accounting and audit engagements.

First, obtain the insurer's repudiation letter in writing, stating the specific policy clause relied upon. Review it against the actual policy wording — repudiations are sometimes based on a misapplication of an exclusion or a documentation gap that can be cured. If the rejection appears unjustified, the next step is typically a written complaint to the insurer's Grievance Redressal Officer, followed — if unresolved — by a complaint to the Insurance Ombudsman (for claims within the Ombudsman's monetary jurisdiction) or a grievance filed on IRDAI's Bima Bharosa portal. Both the Ombudsman and IRDAI grievance routes are free of cost to the policyholder.

The Insurance Ombudsman is a statutory grievance redressal mechanism under the Insurance Ombudsman Rules, providing a free, relatively fast alternative to litigation for policyholder complaints against insurers — covering delay in claim settlement, partial or total repudiation, and disputes over premium or policy terms, subject to a prescribed monetary limit on claim value and the requirement that the complaint first be raised with the insurer's own grievance cell. Complaints can generally be filed if the insurer has not responded within a prescribed period, or has rejected the complaint, or the policyholder is dissatisfied with the insurer's response.

Premiums paid by a company on a keyman insurance policy (insuring the life of a key employee, director, or partner critical to the business) are generally allowable as a business expense under the Income-tax Act, since the policy is taken to protect the business against the financial loss of losing that person. On claim, the proceeds received by the company are generally taxable as business income, since the premium was claimed as a deduction. If the policy is subsequently assigned to the keyman individual (a common practice near retirement), the tax treatment shifts and requires careful handling to avoid an unintended tax outcome for both the company and the individual.

We support both. On the personal side, this most commonly involves group medical or health insurance claims (including cashless claim disputes with the Third Party Administrator), life and term insurance claims, and personal property claims. On the business side, it covers property, fire, marine, liability, keyman, D&O, professional indemnity, and cyber risk claims. The underlying skill — organising documentation, quantifying loss, and navigating insurer and regulatory processes — applies across both.

Our core role in this service is claim support and portfolio review — identifying gaps, quantifying claims, and navigating the settlement and escalation process. We are not a licensed insurance broker and do not place policies or earn commission on premium. Where a portfolio review identifies that a specific type of cover, insurer, or broker relationship should be revisited, we advise on what to look for and can work alongside your existing broker or help you identify a suitably licensed one — but policy placement itself is typically handled by a licensed broker or directly with the insurer.

At minimum: copies of all current policy schedules and wordings across every insurer you use, premium payment records for the last two to three years, your latest audited financial statements, a fixed asset register, and recent stock statements if you carry inventory. For group medical or keyman cover, we also need employee headcount and salary data. Most of this overlaps with records PNPC already holds if we handle your accounting or audit — which is one reason the review tends to move quickly for existing clients.

For a small to mid-sized business with a handful of policies, a full review — intake, exposure mapping, gap analysis, and a written report — typically takes two to three weeks. Larger businesses with multiple locations, several insurers, and complex liability exposure take longer, since exposure mapping across each site and asset class requires more detailed data collection.

We recommend correcting a confirmed under-insurance gap as soon as practically possible, since the exposure exists for every day the gap remains — a loss event tomorrow would still trigger the average clause reduction on today's inadequate sum insured. Most insurers allow a mid-term endorsement to increase the sum insured for an additional pro-rata premium, without waiting for the renewal date. Where the gap is significant, we prioritise this over waiting for the annual renewal cycle.

Yes. Cyber risk insurance is one of the fastest-growing and most commonly under-assessed categories in the portfolios we review — many businesses either have no cyber cover at all, or hold a policy purchased quickly with sub-limits or exclusions that would materially reduce a payout in an actual breach or ransomware event. We assess whether the cover matches your actual data exposure, third-party liability risk, and any sector-specific regulatory notification obligations.

A D&O claim typically arises from a legal or regulatory action against a director or officer personally — a shareholder claim, a regulatory investigation, or third-party litigation alleging a wrongful act in their capacity as director. PNPC supports the financial documentation of the exposure and coordinates with the company's legal counsel, who leads the legal defence itself; our role is quantifying the financial exposure, assembling supporting records, and managing insurer correspondence and documentation timelines alongside the legal process — not providing the legal defence.

A claims-made policy covers claims that are made against the insured during the policy period (or a specified extended reporting period), regardless of when the underlying act occurred — as opposed to an 'occurrence' policy, which covers events that happened during the policy period regardless of when the claim is eventually made. Professional indemnity and D&O policies are almost always claims-made. This means a lapse in continuous renewal, or a change of insurer without proper retroactive cover, can leave a genuine claim uncovered even if the original act occurred while a policy was in force.

Yes. Cashless claim rejection at the hospital by the Third Party Administrator (TPA) is common and is often based on incomplete pre-authorisation information rather than an actual policy exclusion. We help assemble the full medical documentation and pursue the claim on a reimbursement basis where cashless approval is denied, and support escalation to the insurer or Ombudsman where the rejection appears inconsistent with the policy terms.

Market value (or indemnity value) cover pays the depreciated value of the asset at the time of loss — factoring in age and wear. Reinstatement value (or 'new for old') cover pays the cost of replacing the asset with a new one of similar kind and capacity, without deduction for depreciation, subject to the policy's terms. For machinery and buildings that have depreciated significantly on the books but would cost much more to replace new, the difference between these two bases can be substantial.

Buyer payment default and country risk on export receivables are not covered by standard property, fire, or marine cargo insurance — those covers respond to physical loss or damage to goods, not to a buyer's failure to pay. That exposure is addressed separately through ECGC (Export Credit Guarantee Corporation) export credit insurance, including schemes like NIRVIK/ECIS, which PNPC also advises on as a distinct service. If your loss relates to buyer non-payment rather than physical damage to goods in transit, it needs to be assessed against your ECGC cover, not your marine policy.

PNPC charges a professional advisory fee agreed in writing before the engagement begins — either a fixed fee for a portfolio review or a fee structure appropriate to the complexity and expected duration of a claim support engagement. We do not charge a percentage of the claim amount or the premium placed, which is the typical model for insurance intermediaries and creates a direct conflict of interest with impartial portfolio advice.

You do not need to switch brokers. PNPC's role is advisory — reviewing your portfolio, supporting claims, and quantifying losses — and we routinely work alongside an existing broker or agent relationship. If a portfolio review identifies that your broker relationship itself is a gap (poor renewal service, no proactive gap review, slow claim support), we will say so directly, but the choice of broker remains yours.

Bima Bharosa is IRDAI's centralised online grievance registration and tracking system for insurance policyholders, allowing complaints against insurers to be logged, tracked, and escalated if not resolved satisfactorily at the insurer level within the prescribed timeframe. It is a free channel and functions alongside — not as a replacement for — the Insurance Ombudsman mechanism.

Yes. PNPC operates from Chennai, Bangalore, Hyderabad, and Dubai. For clients with UAE operations or UAE-placed insurance, our Dubai office coordinates directly on claim documentation and portfolio review under UAE insurance regulation (overseen by the UAE Central Bank's Insurance Sector Regulation), while our India team handles the India-side entity. For businesses with both an Indian and a UAE entity, we coordinate the review as one engagement rather than splitting it across two disconnected advisors.

Treating the policy as a compliance checkbox purchased once and auto-renewed every year without re-checking whether the sum insured, the covered perils, and the exclusions still match the business as it actually operates today. The second most common mistake is discovering an exclusion or sub-limit for the first time when a claim is being assessed, rather than when the policy was purchased or renewed.

Both. A structured review commonly finds duplicate or overlapping cover across policies bought at different times from different agents, unnecessary riders that add cost without meaningful benefit, and sub-limits that could be consolidated more efficiently. Correcting genuine under-insurance does increase premium for that specific cover, but the overall portfolio often becomes more cost-efficient once redundancy is removed — the net premium change varies by business and is not predictable in advance.

This is one of the practical advantages of using the same firm for both functions. A major claim event — significant stock loss, machinery write-off, business interruption — has direct implications for the year's financial statements and the statutory audit. When PNPC handles both, the claim quantification, the accounting treatment of the loss and the eventual insurance recovery, and the audit disclosure are handled with full context, rather than the auditor learning about a major claim secondhand after the fact.

It can. Input tax credit (ITC) originally claimed on goods that are subsequently lost, stolen, or destroyed is required to be reversed under Section 17(5)(h) of the CGST Act, regardless of whether an insurance claim is later received for that stock. The insurance claim itself is generally not a supply for GST purposes, but the ITC reversal on the underlying lost stock is a distinct and commonly overlooked compliance step that should be handled alongside the claim.

We conduct a structured post-claim review: which specific policy clause, exclusion, or sub-limit was tested by the claim; whether the sum insured proved adequate or under-insured; and whether the loss revealed an entirely new exposure (for example, a business interruption loss that showed the indemnity period specified in the policy was too short for actual recovery time). These findings are built directly into the recommendations for the next renewal.

No formal minimum. We work with sole proprietors and individuals on personal insurance portfolios (health, life, term, property) through to large multi-location businesses with complex commercial coverage. The scope and fee are tailored to the size and complexity of the portfolio or claim, agreed in writing before the engagement begins.

The insurer's surveyor works for the insurer, and a broker's incentive is generally tied to placing and renewing policies, not to the financial mechanics of a specific claim. PNPC's role is independent of both — we are not paid a commission by any insurer, and our quantification of a loss is grounded in the same accounting and audit standards we apply to statutory financial reporting. That independence, combined with direct access to your books of account and financial history, is difficult for either the insurer's own process or a commission-based broker to replicate.