Merged
Merged
Merged
___________
Marks
Q.1 Explain the following: (2 marks each) 14
(a) Loss Frequency
(b) Underwriting
(c) Fire Insurance
(d) Insurance
(e) Life Insurance
(f) Non-Life Insurance
(g) Term Policy
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Q.5 Read the following case and answer: “Mr. X took a policy in February 2008.
He died within two years, in August 2009. The insurer investigated the claim
and found that he had consulted a doctor, and had taken medicine on various
occasions in 2006, 2007 and 2008. In the proposal for the question: Have you
within the past five years consulted any medical man for any ailment not
necessarily confining to your house? The response gien was ‘NO’. The insurer
repudiated the claim alleging that the inssured had deliberately suppressed
facts about his illness which was a material fact. When the issue was taken to
court, the insurer could prove that the insured had been taking medicines and
injections but not that he was suffering from any particular disease. The doctor
who gave evidence about the medicines taken also stated ‘the diseased was
usually of neurasthenic type, that his condition was almost normal.
Occasionally took medicines from him and used to make much fuss about even
small ailments, and he would be quite upset over such small ailments.’ The
judgment was in favour of the claiment.” Hyperchondria: an abnormal
condition characterized by a depressed emotional state and imaginary ill
health, referable to the physical condition of the body or one of its parts.
(b) Discuss the claim settlement procedure along with required documents 07
in Life Insurance.
a. Maturity of Policy
b. Death of insured person
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Seat No.: ________ Enrolment No.___________
OR
Q.3 (a) What is Life Insurance? Explain various types of Life Insurance plans. 07
(b) What is Fire insurance? Discuss various Features of Fire insurance contract 07
OR
Q.3 (a) Define Marine Insurance. Explain various types of Marine insurance Policies 07
(b) Discuss different types of claims and the procedure to settle those claims. 07
(b) “Underwriting is the heart of insurance Operations” Explain the statement in detail 07
OR
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Q.5 Case Study – Answer the Following Question
Reliance General Insurance to focus on Fire, Engineering and Marine
Reliance General Insurance is focusing more on fire, engineering and marine insurance
segments as part of its plan to diversify product basket and achieve profitable growth, a top
company official said. “We are focusing on commercial lines, fire, engineering and marine
insurance, which are still untapped and more profitable than traditional segments. We are
trying to grow these portfolios this fiscal,” Reliance General Insurance Chief Executive Rakesh
Jain said. As per the company, while fire insurance accounts for 8 per cent of its total business,
engineering segment contributes around 4 per cent, marine 2 per cent and others including
commercial lines account for 6 per cent. Jain also said the company is reducing its dependence
on motor insurance segment and plans to bring it down to below 60 per cent by the end of this
financial year. “Our aim is to expand our presence in fire and engineering segments and
increase their business contributions in the next couple of years,” he said, adding the company
plans to increase health insurance contribution to 20 per cent from present 16 per cent. The
general insurer also aims to come up with sector specific insurance products. “We are planning
to devise sector-wise insurance schemes. We are in touch with people in cement, IT and power
sectors and are working to create a more risk-based approach for different sectors,” Jain said.
Reliance General, which is part of Reliance Capital, has posted 25 per cent increase in gross
written premium to Rs. 706 crore in the June quarter.
Q.5 (a) Does Reliance General Insurance’s Current Business Strategy suitable to current 07
market situation?
(b) Does Expansion strategy of the Company works in real life? Explain your answer 07
OR
Q.5 (a) Company’s reduction in the motor insurance segment will be suitable for the future 07
(b) “Sector specific insurance products” Strategy is good or bad? Justify your answer 07
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Seat No.: ________ Enrolment No.___________
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Q.7 CASE STUDY:
The insurance company was rejecting her claim saying that the
illness for which she was treated was not covered under the policy.
The insurance company paid her Rs 1,500 only, for being admitted
in the hospital for three days, at Rs 500 per day, as was defined in
the policy. The company denied paying other expenses saying her
illness was not a 'critical illness'.
The company confessed that it had rejected her claim because the
illness for which she was treated was not covered under the said
policy. The illness necessitating a permanent pace maker was also
not specified in the policy taken by the woman.
The critical illness cover promised the woman 'a lump sum
payment of up to Rs 5 lakh' in case she was diagnosed with a
critical illness.
The policy further said that it will ensure that woman has access to
the most technologically advanced treatment, and can pay for
medicine related costs and other recuperation costs.
(a) Why TATA AIG has been penalized for Rs. 2.5 lacs? Do you 5.5
think it is valid? Why?
(b) What is the core concept of the case? Discuss it along with 5.5
various types of claim.
OR
Q.7 (a) Why did the Policy holder file the complain? Do you think 5.5
that it is right way? Why?
(b) What are the reasons for disputes in claim? Discuss various 5.5
reasons for rejection of claim
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Seat No.: ________ Enrolment No.___________
Q.1 Explanation: 06
(a) (a) Peril
(b) Dynamic Risk
(c) Insurable Risk
Q.4 (a) Define: TPA’s. At time of claim evaluation and settlement judgment 06
given by TPA’s is consider as final. Do you agree with this statement?
Justify it.
(b) To secure and procure health one must have health insurance policy. 06
Support your answer with Jeevan Aastha and Jeevan deep policy.
Q.5 (a) To evaluate insurance company financial performance, being an 06
evaluator which financial ratios will consider by you. Support your
answer with hypothetical figures relating to ratios.
(b) Write detail note on IRDA as a controlling mechanism for insurance 06
company.
Q.6 (a) What is reinsurance? Analysis role of Re-insurers any two techniques 06
of reinsurance in detail.
(b) “In GLOCAL time insurance industry faces many issues and challenges 06
for development.” Do you agree with this statement?
1
Q.7 Mr. Kabir takes out a fire policy on his house valued at Rs. 24 lakhs
with two insurance companies. He insures it for Rs.12 lakhs with each
company. When the house is partially damaged in a fire, the loss is
estimated at Rs. 6 lakhs. He claims Rs. 6 lakhs each from the two
insurers.
Kindly justify following.
(a) Shown your calculation for each company’s claim amount to the Mr. 5.5
Kabir.
(b) In above case is TPA’s needed? Justify your answer with TPA’s 5.5
agreement with insurance company.
OR
Mr. Rajveer, while riding a horse, fell on the ground and had his leg
broken, he was lying on the wet ground for a long time before he was
taken to hospital. Because of lying on the wet ground, he had fever that
developed into pneumonia, finally dying of this cause.
Q.7 (a) Which principle of insurance is applicable in above case? Justify your 5.5
answer with logical reasoning.
(b) Which claim will receive by the family member on behalf of Mr. 5.5
Rajveer?