Calculation of Actual Amount of Claim - Explained! (2024)

ADVERTIsem*nTS:

Formula for Calculating the Actual Amount of Claim!

In case of under-insurance, the Insurance Company applies the Average Clause. Under-insurance means insuring for lesser value of stock. This is because businessmen think that in case of fire out­break the complete stock will not be burnt. So, they take insurance policy for partial stock, of course at a lesser premium.

In order to discourage under-insurance, generally the Average Clause is inserted by the Insurance Company. If the insured value of the stock is less than the total of stock, then the Average Clause may apply, that is, the loss will be limited to that proportion of the loss as the insured value bears to the total cost.

Formula for Calculating the Actual Amount of Claim:

ADVERTIsem*nTS:

The actual amount of claim is determined by the formula:

Claim = Loss Suffered x Insured Value/Total Cost. The object of such an Average Clause is to limit the liability of the Insurance Company. Both the insurer and the insured then bear the loss in proportion to the covered and uncovered sum. For in­stance, if Rs 1,00,000 policy is taken for Rs 1,50,000 stocks, then the under-insurance will be by Rs 50,000.

Here, the insurer and insured will be the co-insurers for Rs 1, 00,000 and Rs 50,000 respec­tively. When, in such a case, Rs 30,000 stock is lost, then the Insurance Company indemnifies only Rs 20,000 i.e. 30,000 x 1,00,000/1,50,000 and the balance Rs 10,000 i.e. Rs 30,000 x 50,000/1,50,000 is met by the insured himself.

Thus, the under-insurance relieves the insurer and penalizes the insured for under-insurance. Irrespective of the insertion of such Clause, the entire policy amount insured, and then Insurance Company pays only the amount insured. When the loss is more than the sum insured, the insured can recover the whole amount in spite of Average Clause.

Illustration 1:

Malcom owns a retail stationery shop which was partly destroyed by fire on 27th June 2005. The stock was insured for Rs 13,000.

The Balance Sheet drawn on 31st December 2004 included, inter alia, the following items:

Calculation of Actual Amount of Claim - Explained! (1)

A physical check of stock after the fire showed that items undamaged were Rs 7,000. The normal rate of gross profit is 25% on purchases but the stock on 31st December 2004 included items of discontinued lines totaling Rs 3,800 which were all sold during next two months at cost.

ADVERTIsem*nTS:

You are required to compute the amount of claim to be made to the insurer. There was an average clause in the policy.

Solution:

A purchase from 1.1.2005 to 27.6.2005 has not been given in this problem.

It is to be found out by preparing Sundry Creditors Account, as shown below:

Calculation of Actual Amount of Claim - Explained! (2)

Calculation of Actual Amount of Claim - Explained! (3)

Illustration 2:

From the following particulars in respect of Ram Prasad, ascertain the insurance claim with regard to the loss of stock due to a fire accident on 11th May 2005:

1. The Company had the practice of valuing stock at cost less 5%.

2. The value of fire insurance taken was for Rs 2, 15,000.

ADVERTIsem*nTS:

3. The policy was subject to average clause.

4. Stock as on 1.1.2004. Rs 2, 85,000.

5. Stock as on 31.12.2004, Rs 3, 80,000.

6. Purchases made during the year. Rs 5, 20,000.

ADVERTIsem*nTS:

7. Sales for the year 2004 Rs 6, 00,000.

8. Purchases from 1.1.2005 to the date of fire Rs 2, 19,000.

9. Sales from 1.1.2005 to the date of fire Rs 2, 70,000.

10. Value of stock salvaged Rs 30,000.

Calculation of Actual Amount of Claim - Explained! (4)

Calculation of Actual Amount of Claim - Explained! (5)

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Calculation of Actual Amount of Claim - Explained! (2024)

FAQs

What is the actual amount of claim? ›

The “Actual Claim Value” is a fundamental concept in the insurance industry, especially in the context of settling claims. It refers to the real monetary amount that an insurance company agrees to pay to a policyholder or beneficiary when a covered event occurs and a valid claim is filed.

What is the formula for the actual claim? ›

The actual amount of claim is determined by the formula:

Claim = Loss Suffered x Insured Value/Total Cost. The object of such an Average Clause is to limit the liability of the Insurance Company. Both the insurer and the insured then bear the loss in proportion to the covered and uncovered sum.

How do you explain actual cash value? ›

What Is Actual Cash Value? Actual cash value (ACV) is the amount equal to the replacement cost minus depreciation of a damaged or stolen property at the time of the loss. The actual value for which the property could be sold, which is always less than what it would cost to replace it.

What does total amount of claim mean? ›

Total Claim Amount means all amounts expended by Licensor and/or Licensee in connection with any third party claim of infringement or misappropriation in a Defense Action, including, but not limited to, attorney fees and legal costs, and/or a royalty or other amount that must be paid to a third party as a result of a ...

How does a claims adjuster calculate the actual cash value? ›

What are the methods to determine ACV? To determine an item's ACV, an insurance adjuster will start from the cost of replacing your damaged or stolen property and lower the value based on depreciation factors, such as age and wear and tear.

How is the claim calculated in insurance? ›

The ICR is computed by dividing the total number of claims paid out by the premiums collected within a specific financial year.

How do you calculate the amount of claim by applying the average clause? ›

The Average Clause applies only to underinsurance, not to partial insurance. How is the claim amount calculated under the Average Clause in Fire Insurance? The claim amount is calculated using the formula: Claim Amount = (Sum Insured/Property's Actual Value) × Loss Amount.

What is the formula for claim settlement ratio? ›

(Total number of claims settled in a year/ Total number of claims in a year) X 100 = Claim Settlement Ratio (CSR). For example, out of the 10,000 claims filed in 2019-2020, Company A settled 9,600 of them. As a result, its CSR will be 96% (9,600/10,000*100) for that year.

What is the formula for actual cost example? ›

Actual material cost = (Number of units of materials) x (Price per unit) Actual labor cost = (Total labor hours used) x (Salary of direct workers per hour) Actual overhead cost = Sum of all overhead expenses = Utility fees + Rent + Insurance.

How do you calculate actual cash? ›

Actual cash value (ACV) is a way to determine the value of your business property that's getting repaired or replaced after covered damage. Insurance companies calculate ACV by subtracting the depreciation from an item's replacement cost value.

What is the formula for calculating the actual cash value of a property? ›

The ACV of a property is typically determined by subtracting depreciation from the property's or item's replacement cost. Depreciation accounts for wear and tear or loss in value over time. To calculate ACV, insurers consider factors such as the property's age, condition and market value.

What is the cash value of a $25,000 life insurance policy? ›

Examples of Cash Value Life Insurance

An example is a cash value life insurance policy with a $25,000 death benefit. Assuming you don't take out a loan or withdraw, the cash value accumulates to $5,000. After the policyholder's death, the insurance company would pay out the full death benefit, which would be $25,000.

What is the formula for the amount of claim? ›

Solution: Amount of Claim = Policy Amount/ Stock on the date of Fire × Loss of stock by fire = 3,42,000 /4,56,000 × 4,00, = 3,00, ` Illustration 2 (Calculation of Claim in case of under insurance using average clause): Find out the actual claim in the following case: Particulars Value of stock on the date of fire 25, ...

What is the meaning of claim amount? ›

What is a Claim Amount? The claim amount in insurance refers to the money that an insurance company pays to the policyholder or beneficiary when a valid claim is made. This amount is determined based on the terms and conditions of the insurance policy.

What does total amount of claim if incurred mean? ›

Total Amount of Claim If Incurred This is the total amount of money the insurance company will pay out to cover these damages. This is equal to the RCV minus whatever deductible your particular plan has.

What is the total amount claimed? ›

What is Claim Amount. Definition: Claim amount can be defined as the sum payable at the maturity of an insurance policy or upon death of the person insured to the beneficiary or the nominee or the legal heir of the insured.

What is the maximum claim amount? ›

A maximum claim amount (MCA) is the highest amount that the FHA will insure on a reverse mortgage. That means that, if your home is valued greater than this, then the amount above that limit will not be eligible for the HECM program.

References

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