Regulatory & Compliance Glossary

A state-issued license in the US that authorizes an individual to investigate, evaluate, and negotiate insurance claims, with requirements varying by state.

Laws and regulatory requirements designed to prevent, detect, and punish insurance fraud, including mandatory reporting, special investigation units, and penalty provisions.

A qualified actuary appointed by an insurance company as required by IRDAI regulations to certify the financial soundness of the insurer, including adequacy of premiums, reserves, and solvency margins.

An insurer's unreasonable denial or delay of a valid claim, failure to investigate properly, or other conduct that breaches the duty of good faith owed to the policyholder.

Mandatory ongoing professional education required for licensed adjusters and surveyors to maintain their licenses, ensuring they stay current with industry developments and regulatory changes.

The set of professional and ethical standards that licensed surveyors, adjusters, and other insurance professionals must follow in their practice, often mandated by regulatory authorities.

A quasi-judicial body in India where policyholders can file complaints against insurers for deficiency in service, unfair practices, or claim disputes, at district, state, and national levels.

The regulatory requirements governing how insurers, adjusters, and surveyors collect, store, process, and share personal data of policyholders and claimants.

The process by which insurance companies approve and register surveyors or adjusters on their panel of authorized professionals who can be appointed to handle claims.

The legal duty of an insurer to handle claims fairly, promptly, and honestly, including thorough investigation, reasonable evaluation, and timely communication with the policyholder.

The formal mechanism established by insurers and regulators for policyholders to raise and resolve complaints about claim handling, policy servicing, or insurer conduct.

The statutory body established under the IRDAI Act, 1999, responsible for regulating and promoting the insurance industry in India, including licensing of surveyors and setting compliance standards.

The classification system under IRDAI regulations that categorizes surveyors into different tiers based on qualifications and experience, each with specific claim value limits they can handle.

The prescribed deadlines under IRDAI regulations for submitting preliminary and final survey reports, with specific timeframes that surveyors must comply with to avoid penalties.

An independent authority that resolves insurance complaints and disputes between policyholders and insurers through mediation, providing a quicker alternative to courts.

The identity verification process that insurance companies must conduct on policyholders and claimants to comply with anti-money laundering regulations and prevent insurance fraud.

The US standard-setting and regulatory support organization governed by insurance commissioners from all 50 states, providing model laws and guidelines for state-level insurance regulation.

US state laws that mandate specific timeframes within which insurance companies must acknowledge, investigate, and pay valid claims, with penalties for non-compliance.

The government agency in each US state responsible for regulating insurance within that state, including licensing insurers and adjusters, approving rates, and handling consumer complaints.

The official authorization issued by IRDAI that allows an individual to practice as an insurance surveyor and loss assessor in India, requiring specific qualifications and examinations.

The minimum amount of capital that an insurance company must maintain above its liabilities, as prescribed by regulatory authorities, to ensure it can meet future claims obligations.

A body that was established under the Insurance Act in India to regulate insurance premium rates. While detariffication has given insurers more pricing freedom, TAC guidelines still influence standard policy wordings.

Prohibited insurer behaviors defined by US state laws, including unreasonable delays, lowball offers, failure to communicate, and other practices that disadvantage policyholders during claims.