Optima Insurance Brokers Pvt. Ltd.

It is not uncommon to find an ongoing construction project being interrupted. The reasons for the interruptions could be manifold and many a times are beyond the control of the Principal or the owner of the project. It is critical for every stakeholder to understand the risk exposures which might continue to haunt them, irrespective of
whether the project is running or not.

SOME OF THE CAUSES OF INTERRUPTIONS ARE

• Dynamic risks like the changing economic environment which might make the project unviable or might require some changes in the nature of the project
• Temporary liquidity problems
• Disputes between the principal and the contractor over contract conditions / payment to contractors etc
• Investors not able to fulfil their obligations
• Delay on account of late delivery or shortage of construction materials/ project machinery resulting in interruptions.

THE EFFECTS ARE

• The Principal abandons the project
• The Contractor goes away without completing the project and the Principal has to look for another vendor to complete the unfinished job.
• Both the Principal and contractor mutually decide that the project needs a temporary suspension.
• The Investor decides to stop financing the project

Each of the above would leave an unfinished / partially constructed structure / works, which could be a building(s) of hospital, school, office, factory, residence or roads /bridges / flyovers / any other civil works or power plants / manufacturing risks.

HOW WILL THE UNDERWRITERS VIEW THE SITUATION ?

Contractor’s All Risk as well as the Erection All Risk policy under the General Exclusion excludes any liability, loss or damage arising out of or aggravated by (directly orindirectly) cessation of work total or partial. This means that the policy ceases to cover any loss which might have arisen due to the cessation of work / work stoppage.

In addition to this a condition of the policies also stipulates that any material change in the risk needs to be intimated to the insurers by the insured. No material alteration shall be made or admitted by the insured whereby the risk is increased unless the continuance of the insurance is confirmed in writing by the Insurer.

Stoppage of work / standstill period can be seen as a material alteration which increases the risk. Thus as per the terms and conditions of the project insurance policies, the coverage gets restricted if there is a cessation of work and the continuation of the policy also depends on the underwriters. Any Advance Loss of Profit cover ( ALOP ) if taken as an extension to the project policies also ceases to exist, if there is partial or total stoppage of work.

Principal / Owner of the partially constructed assets is certainly exposed to many risks during the standstill period for which his existing insurance policy may not assist. The risks require mitigation and possibly after the suitable loss prevention steps are in place the insurers may view the risk favorably and provide cover.

INSURANCE COVERAGE

There is a provision of “Work Stoppage” extension under the guidelines for project insurance called “Cessation of works”. However the same is entirely at the discretion of the underwriters and for a maximum period of 3 months. The underwriters after satisfying themselves on the minimum safety provisions available on site can agree to
at . This would be possible after a proper risk survey. The mitigating steps as mentioned above, if implemented can lead to favourable response from the insurers.

Alternatively, the underwriters might also agree to restrict the cover to NAMED PERILS as against the all risk coverage available under CAR and EAR policies after incorporating suitable deductibles and pricing the risk appropriately. Certain factors which the underwriters might consider before accepting and pricing the risk would be as under:

• Status of completion of the basements and number of basements
• Percentage of completion, whether interior work is in progress, quantum of combustible substances at site etc.
• Whether the start of the standstill period is close to onset of monsoon In case of completed basements, whether any storage is being done therein Fire fighting installations and availability of water for fire fighting
• Availability of round the clock security, drainage facility, level of the premises as against adjoining road, availability of pumping facilities at site.
• Surroundings and exposure to third party damages
• Wind storm exposure and precautions taken
• Estimated value of the completed portions

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The IRDAI has modified guidelines on proportionate deductions under health insurance policies that will take effect from October with the goal to reduce out-of-pocket expenses for policyholders.

According to the IRDAI, as a part of product design, insurers are to propose proportionate deductions of the associated medical expenses when a policyholder chooses a higher hospital room category than the category that is eligible as per terms and conditions of the policy.

The following expenses will not be part of the ‘associate medical expenses’:

• Cost of pharmaceuticals
• Cost of implants and medical devices
• Cost of diagnostics

The insurers will have to ensure that proportionate deductions are not applied in respect of the hospitals which do not follow differential billing by room category nor for those expenses in respect of which
differential billing is not adopted based on room category.

In addition, insurers are not permitted to apply proportionate deductions to ‘ICU charges’ because there
are no different categories of ICU.

The insurance regulator has also asked the insurer to standardise exclusions — listing diseases or medical
conditions that are not covered under a policy.

The new conditions have to be incorporated in the new policies filed by insurers on or after 1 October and
for existing products which are due for renewal from 1 April 2021.

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From October health insurance policies in India will change in accordance with the guidelines and specifications issued by IRDAI. The changes will be applicable on all existing and new health insurance policies. Here is the list of expected changes:

COVER FOR NEW AILMENTS

Now the health insurance policies will cover:

• Illnesses contracted due to hazardous activity.
• Treatment of mental illness, behaviour and neurodevelopment disorders
• Age-related degeneration and internal congenital diseases
• Artificial life maintenance
• Puberty and menopause-related disorder.

NO REJECTION OF CLAIM AFTER 8 YEARS

If a health insurance policy has completed eight years, i.e., the policyholder has renewed the policy for eight years continuously, a claim cannot be rejected except for proven fraud and permanent exclusions.

NEW DEFINITION OF PRE EXISTING DISEASE (PED)

1. Any disease/s or ailment/s that has been diagnosed by a physician 48 months before issuance of the
   health cover will be classified under PED.
2. Any disease/s or ailment/s for which any type of medical advice or treatment was recommended by a
   qualified doctor 48 months before issuance of the policy will be qualified under PED.
3. Any condition whose symptoms or signs have resulted within three months of the issuance of the policy
   will also be classified under
4. Pre-existing Diseases.

All health conditions and illnesses suffered after the issuance of policy will be covered under health insurance. Some of the major diseases include Alzheimer, Parkinson, AIDS/HIV and morbid obesity.

PAYING HEALTH INSURANCE PREMIUMS IN EMIS

The regulator has allowed the payment of health insurance premiums in instalments.
The premium mode (frequency) can bemonthly, quarterly or half-yearly.

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