Shop Accident Insurance refers to the coverage of financial liability for fixed premises (including houses, buildings and their equipment, fixtures, etc.) due to the existence of structural defects or mismanagement, or the insured's negligence in carrying out production and business activities in the insured premises, resulting in bodily injury or death of another person or damage to property. Its reimbursement criteria will generally take into account these factors:
1. Liability review. In the insurance liability determination ten should confirm the following points:
(1) the accident causing damage to the third party occurs within the validity period of the policy, and the insured person reports the accident in a timely manner; the formal claim filing does not exceed two years from the time of the accident, but if the litigation activity occurs within the valid claim period, and the time to close the case is more than the valid claim period, unless the case is closed, notwithstanding the above limitation.
(2) the accident must occur within the scope of the location listed in the policy, generally can be extended to be responsible for the listed address of the front three areas, but is limited to within lOO meters - 150 meters from the building's exterior walls, fences or foundations.
(3) The occurrence of the accident is related to the activities of the insured's business, and the loss caused by the accident should be liable to it according to the law; and the claim should not be a matter stipulated in the exclusion of the terms, or belong to the items extended by the approval order or special agreement.
(4) Analyze whether the insurance accident is a liability assumed under the main insurance or under the additional insurance, and confirm whether the additional insurance has lapsed.
(5) Claims that are not covered by insurance shall be carefully analyzed and treated with caution, and the insured shall be given justifiable explanations. If part of the claim does not meet the conditions of (3) and (4) above, the relevant claim items which do not meet the conditions shall be excluded; and if all the claims do not belong to the insurance responsibility, the claim shall be rejected.
(6) In cases where a third party is responsible or partially responsible, the insured's claim can be compensated first; however, the insured should be allowed to fill in the Assignment of Rights and Interests, and hand it over to the insurer together with the documents and information related to the forced compensation.
2. Approved loss. The purpose of the approved loss is to accurately determine the amount of compensation belonging to the insurance coverage.
Premises liability insurance compensation generally includes compensation for property damage, personal injury and death, litigation costs and other expenses. In the approved loss, if the claim involves two or more items, the claim should be categorized by item.
(1) Liability for property damage. Determined in accordance with the court judgment, arbitration award amount; or according to the insured in the accident should bear the responsibility of the size, with reference to the relevant provisions of the claims to be determined.
(2) Liability for personal injury or death. The amount shall be determined in accordance with the court judgment or arbitration award; or it shall be determined in accordance with the responsibility to be borne by the insured in the accident, and the certificate of injury or death issued by the relevant departments, medical fee receipts, disability appraisal certificates and other proofs of relevant expenses, and shall be approved in accordance with the national laws and the policies of the relevant governmental departments on personal injury compensation and the relevant agreements in the insurance terms and conditions.
(3) Litigation (arbitration) costs and other costs. Litigation (arbitration) costs are determined in accordance with the amount of the court judgment; for other costs, the insurer is generally only pre-approved expenditures, reasonable costs.
(4) The necessary and reasonable expenses paid by the insured after the occurrence of the insured accident in order to minimize or reduce the liability to the third party. Such expenses shall be reimbursed up to the limit of indemnity in addition to the amount of indemnity for accidental damage.
(5) Compensation calculation. After the loss is approved, the claims adjuster shall, on the basis of the liability audit, specifically calculate the amount of compensation according to the various limits and conditions stipulated in the insurance policy. If there is duplicate insurance, the compensation shall be calculated in proportion to the limit of indemnity for each accident of the policy.
3. Payment of claims. After the approval of the claim, the claims adjuster shall promptly notify the insured; the insured shall compensate the third party first, and the insured must provide the insurer with the receipt of the claim issued by the third party before closing the case and receiving the payment.
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