Key Points to the Insurance Audits

The Insurance auditors shall examine policy and liability procedures, risk valuation, tax documents, and various other financial records of insurance. It is to ensure that proper insurance rates and premiums are implemented and regulators laws are being followed by insurance companies. Claims and commissions are also the core areas to verify during the course of insurance audits. In addition to these responsibilities, insurance auditors might be expected to maintain quality control between insurance companies and policyholders.

An Indian insurance company is formed and registered under the Companies Act, 2013 and the aggregate holdings of equity shares by a foreign company, either by itself or through its subsidiary companies or its nominees, do not exceed twenty-six per cent of the paid-up equity capital of such Indian insurance company. The sole objects of the Indian Insurance Company shall be to carry on life insurance business or general insurance business or re-insurance business. The said definition is according to section 2 of Insurance Act 1938.

The Insurance Audit & Role of Insurance Auditors

As per Section 12 of the Insurance Act, 1938, the financial statements of every insurer are required to be audited annually by an auditor. According to IRDA Act, 1999, every insurer, in respect of insurance business transacted by him and in respect of his shareholders ‘funds, should prepare, a Balance Sheet, a Profit and Loss Account, a separate Account of Receipts and Payments and a Revenue Account in accordance with the regulations made by the IRDA at the end of each financial year.

The central and branch auditors of an insurance company are appointed at the annual general meeting of the company and the approval of the C & AG required before the appointment is made. With the latest amendment to the Insurance Act, 1938 and the Companies Act, 2013, Authority (IRDAI) has issued the revised guidelines that Insurers shall comply with the provisions relating to appointment of Auditors as contained in the Companies Act, 2013. Additionally, insurers shall also comply with the provisions contained in such guidelines. Further the recommendation of the Audit Committee, the Board shall appoint the statutory auditors, subject to the shareholders’ approval at the general meeting of an Indian insurance company. The branch auditors is appointed to conduct the audit of the divisions have the same rights and obligations under the statute as those of the, statutory auditors to whom they are expected to submit their report. However the branch auditors at division level certified the Trial balance of the division duly incorporated the financial statements of the branches under divisions.

An insurer cannot remove its statutory auditor without the prior approval of the Authority. An audit firm cannot accept the audits of more than three insurers (Life/Nonlife/Health /Reinsurer) at a time. The appointment can be cancelled if found that the appointment of auditors by insurers is not in line with the guidelines.

Four Important Audit Points in Insurance Company Profit & Loss Account

1. VERIFICATION OF PREMIUM

The premium collections are credited to a separate bank account and no withdrawals are normally permitted from that account for meeting the general expenditure. As per the policy of the insurance company, the collections are transferred to the Regional Office or Head Office. No Risk shall be assumed by the insurer without receipt of premium according to section 64VB of the Insurance Act, 1938. Verification of premium is of utmost importance to an auditor because Insurance premium is collected upon issuing policies. It is the consideration for bearing the risk by the insurance company. The auditor should apply the following procedures: – • Before commencing verification of premium income, the auditor should look into the internal controls and compliance which are laid down for collection and recording of the premiums. • Cover notes should be serially numbered • The auditor should check whether Premium Registers have been maintained chronologically, giving full particulars including GST charged as per acceptance advice on a day -to-day basis. • The auditor should verify whether the figures of premium mentioned in the register tally with those in General Ledger. • The auditor should verify whether instalments falling due on or before the balance sheet date, whether received or not, have been accounted for as premium income as for the year under audit.

2. VERIFICATION OF CLAIMS

The auditor should obtain from the divisions/branches, the information for each class of business. The auditor should determine the total number of documents to be checked giving due importance to claim provisions of higher value. The claims under policies comprise the claims paid for losses incurred, and those estimated or anticipated claims pending settlements under the policies. Settlement cost of claims includes surveyor fee, legal expenses, etc. The Claim Account is debited with all the payments including repair charges, fire fighting expenses, police report fees, survey fees, amount decreed by the Courts, travel expenses, photograph charges, etc. The auditor should-

• Check whether provision has been made for all unsettled claims.

• Check whether provision has been made for only such claims for which the company is legally liable.

• Check whether provision made is normally not in excess of the amount insured.

• check in case of co-insurance arrangements, the company has made provisions only in respect of its own share of anticipated liability.

• Check claimed paid should be duly sanctioned by the authority concerned

3. VERIFICATION OF COMMISSION

The remuneration of an agent is paid by way of commission which is calculated by applying a percentage to the premium collected by him. Commission is payable to the agents for the business procured and is debited to Commission on Direct Business Account. An insurance business is solicited by insurance agents. The auditor should verify-

• Voucher disbursement entries with reference to the disbursement vouchers with copies of commission bills and commission statements.

• Check whether the vouchers are authorized by the officers- in –charge as per rules and income tax is deducted at source, as applicable.

• Test check correctness of amounts of commission allowed.

• To check whether commission outgo for the period under audit been duly accounted or not.

4. VERIFICATION OF OPERATING EXPENSES  

All the administrative expenses in an insurance company are broadly classified under 13 heads as mentioned in Schedule IV. The auditor should check-

• Expenses in excess of Rs.5 Lakhs or 1% of net premium, whichever is higher, should be shown separately; and

• Expenses not directly relating to insurance business should be shown separately for example, expenses relating to investment department, bank charges etc.

Three Important Audit Points in Insurance Company Balance Sheet

1. INVESTMENTS

The auditor should keep in mind the following provisions related to Investments  of the Insurance Act, 1938 while examining the investments-of an insurance company-

a. An insurance company can only invest in approved securities. However, it can invest otherwise than in approved securities if the following conditions are satisfied.

• Such investments should not exceed 25% of the total investments; and

• Such investments are made with the consent of board of directors.

b. An insurer should not invest in shares or debentures of insurance or Investment Company in excess of least of the following:

• 10% of its own total assets;

• 2% of the investee’s subscribed share capital or debentures.

c. An insurer company should not invest in shares or debentures of a company other than insurance or investment company in excess of least of the following

• 10% of its own total assets;

• 10% of investee’s subscribed share capital or debentures.

d. An insurance company cannot invest in shares and debentures of a private company.

e. The insurance companies cannot invest the funds of its policy holders outside India.

2. CASH AND BANK BALANCES

• Bank reconciliation statements shall be prepared.

• The auditor should obtain confirmation of Bank Balances for all operative and inoperative accounts.

• The auditor should physically verify Term Deposit Receipts issued by bankers. Generally all cash at year end deposited as term deposit with the bank

• The auditor should verify the deposits and withdrawals transactions at random and check whether the Account is operated by authorized persons only.

• In case of funds, in -transit, he should verify that the same are properly reflected in a reconciliation statement.

3. OUTSTANDING PREMIUM AND AGENTS’ BALANCE

The audit procedures, which may be followed with regards to agent’s balance, are as follows: a. Verify whether agent’s balances and outstanding balances in outstanding premium account have been listed, analyzed and reconciled for the purposes of audit. b. Verify whether recoveries of large outstanding have been made in post audit period. c. Verify whether there is any old outstanding debit or credit balances as at the yearend which require adjustment. A written explanation may be obtained from the management is to their nature. d. Verify that agent’s balances do not include employees’ balances and balances of other insurance companies. e. Verify that no credit of commission is given to agents for businesses directly procured by it. 

Legislations / Guidelines of Regulators

There are a number of Legislations relating to life Insurance and general insurance companies. The important statutory provisions relevant to the audit of life insurance companies are prescribed in the following acts and rules. Such as The Insurance Act 1938, The Insurance Rules 1939, The Income Tax Act 1961, The Companies Act 2013 and The Life Insurance Corporation Act 1956. In case of General insurance, in addition to the above mention there shall be applicability of Employees State Insurance Act 1948.

In addition to the acts and ruler there are guidelines for Corporate Governance for insurers in India. The regulator IRDAI issued Guidelines on Corporate Governance for insurance companies on 5th August, 2009. As per guidelines Insurance companies are required to form the following mandatory committees. Such as . Audit Committee Investment Committee, Risk Management Committee, Policyholders Protection Committee, Nomination and Remuneration Committee , Corporate Social Responsibility Committee and Profits Committee.

Audit Committee Is Mandatory

Every Insurer shall constitute an Audit Committee as per Section 177 of the Companies Act, 2013. The committee should oversee the financial statements, financial reporting, statement of cash flow and disclosure processes both on an annual and quarterly basis. The Chairperson of the Audit Committee should be an Independent Director of the Board with an accounting /finance /audit experience and may be a Chartered Accountant or a person with a strong financial analysis background. The association of the CEO in the Audit Committee should be limited to occasions where the Audit Committee requires eliciting any specific information concerning audit findings. As required under Section 177 of the Companies Act, 2013, the Audit Committee shall comprise of a minimum of three directors, majority of whom shall be Independent Directors. The Audit Committee will oversee the efficient functioning of the internal audit department and review its reports. The Committee will additionally monitor the progress made in rectification of irregularities and changes in processes wherever deficiencies have come to notice. The Audit Committee shall have the oversight on the procedures and processes established to look after the issues relating to maintenance of books of account, administration procedures, transactions and other matters having a bearing on the financial position of the insurer, whether raised by the auditors or by any other person. The Audit Committee shall discuss with the statutory auditors before the audit commences, about the nature and scope of audit as well as have post-audit discussions to address areas of concern.

Books, Registers & Reports

Books and Registers to be maintained by an insurer are :- Register of Policies, Cashbook , Register of Claims, Ledger , Subsidiary Records & Control Register. Reports and Returns are regulated U/s 18 of the Insurance Act 1938 where every insurer is required to furnish to the authority a certified copy of every report on the affairs of the concern. Financial Statements and Auditor’s Report of Insurance Companies have been prescribed by the authority in Regulation 3 under Schedule C of IRDA.

Independent Auditors’ Report to the Regional Office Auditors/ Central Statutory Auditors

Of

XYZ INSURANCE COMPANY LIMITED

1. We have audited the attached Trial Balance, Annexures I & IA (Statement of Revenue account balances transferred to Head Office account), & Annexure II (Trial Balance after transferring Revenue items to Head Office) of (Office code) Divisional Office (DO Name) of XYZ Insurance Company Ltd. having its registered office xxxxxxxxxxxxx as at 31st March, 2018 and statements annexed thereto for the year ended on that date in which are incorporated the Returns of ___ number of operating offices under its jurisdiction.

2. Management’s Responsibility for the Trial Balance, Annexures I, IA & II and the statements annexed thereto

The Management is responsible for the matters stated in sub section (5) of Section 134 of the Companies Act, 2013 (“the Act”) with respect to the preparation of the Trial Balance, Annexures I, IA & II that gives a true and fair view of the financial position and financial performance of the Divisional Office in accordance with the Guidelines issued by Head Office, Insurance Act, 1938, Insurance Regulatory and Development Authority (IRDA) (Preparation of Financial Statements and Auditor’s Report of Insurance Companies) Regulation 2002, and in accordance with the accounting principles generally accepted in India, including the Accounting Standards specified under Section 133 of the Act, read with Rule 7 of the Companies (Accounts) Rules, 2014, to the extent applicable and in the manner so required. This responsibility also includes maintenance of adequate accounting records for safeguarding of the assets of the Divisional Office and for preventing and detecting frauds and other irregularities; selection and application of appropriate accounting policies; making judgments and estimates that are reasonable and prudent; and design, implementation and maintenance of adequate internal financial controls, that were operating effectively for ensuring the accuracy and completeness of the accounting records, relevant to the preparation and presentation of the financial statements that give a true and fair view and are free from material misstatement, whether due to fraud or error.

3. Auditor’s Responsibility

Our responsibility is to express an opinion on these Trial Balance, Annexures I, IA & II and the statements annexed, based on our audit. We have taken into account the provisions of the Act, Insurance Regulatory and Development Authority (IRDA) (Preparation of Financial Statements and Auditor’s Report of Insurance Companies) Regulation 2002, the accounting and auditing standards and matters which are required to be included in the audit report under the provisions of the above said Acts and rules made thereunder.

We conducted our audit in accordance with the Standards on Auditing specified under Section 143(10) of the Act. Those Standards require that we comply with ethical requirements and plan and perform the audit to obtain reasonable assurance about whether the financial statements are free from material misstatement.

An audit involves performing procedures to obtain audit evidence about the amounts and the disclosures in the Trial Balance, Annexures I, IA & II and the statements annexed. The procedures selected depend on the auditor’s judgment, including the assessment of the risks of material misstatement of the Trial Balance, Annexures I, IA & II and the statements annexed, whether due to fraud or error. In making those risk assessments, the auditor considers internal financial controls relevant to the Divisional Office preparation of the Trial Balance, Annexures I, IA & II and the statements annexed that give a true and fair view in order to design audit procedures that are appropriate in the circumstances. An audit also includes evaluating the appropriateness of Guidelines issued by Head Office, the accounting policies used and the reasonableness of the accounting estimates made by the Divisional Office, as well as evaluating the overall presentation.

We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinion on the Trial Balance, Annexures I, IA & II and the statements annexed.

4. Opinion

In our opinion and to the best of our information and according to the explanations given to us, the Trial Balance, Annexures I, IA & II and the statements annexed thereto except for the possible effects of the matter described in our notes attached to this report give the information required by the Insurance Act, 1938, Insurance Regulatory and Development Authority (IRDA) (Preparation of Financial Statements and Auditor’s Report of Insurance Companies) Regulation 2002, read with Section 133 of the Act, read with Rule 7 of the Companies (Accounts) Rules, 2014, to the extent applicable in the manner so required and give a true and fair view in conformity with the accounting principles generally accepted in India: –

a. In the case of the Trial Balance and Annexure II, of the state of affairs of the Divisional Office of the Company as at 31st March 2018; and

b. In the case of Annexure I & IA, of the surplus/deficit for the year ended on that date.

5. Report on Other Legal and Regulatory Requirements

I. As required by Section 143 (3) of the Act, and Insurance Regulatory and Development Authority (IRDA) (Preparation of Financial Statements and Auditor’s Report of Insurance Companies) Regulation 2002 we report that:

a. We have sought and obtained all the information and explanations which to the best of our knowledge and belief were necessary for the purposes of our audit and found them satisfactory.

b. In our opinion, proper books of account as required by law have been kept by the Divisional Office so far as appears from our examination of those books and proper returns adequate for the purposes of our audit have been received from the operating offices not visited by us.

c. Trial Balance, Annexures I, IA & II and the statements annexed dealt with by this Report are in agreement with the books of account and with the returns received from the operating offices not visited by us.

d. In our opinion, the aforesaid Trial Balance, Annexures I, IA & II and the statements annexed comply with the Accounting Standards specified under Section 133 of the Act, read with Rule 7 of the Companies (Accounts) Rules, 2014 and Guidelines issued by Head Office.

e. With respect to the adequacy of the internal financial controls over financial reporting of the Divisional Office and the operating effectiveness of such controls, refer to our separate Report in “Annexure A”.

f. With respect to the other matters to be included in the Auditor’s Report in accordance with Rule 11 of the Companies (Audit and Auditors) Rules, 2014, in our opinion and to the best of our information and according to the explanations given to us

i. The Divisional Office has disclosed the impact of pending litigations on its financial position, other than those related to claims in its financial statements under Schedule R-23 for Contingent Liability.

ii. Divisional Office does not have any long-term contracts including derivative contracts for which there were any material foreseeable losses.

iii. No amounts were required to be transferred to the Investor Education and Protection Fund by the Divisional Office.

II. As Required by Comptroller and Auditor General of India in terms of sub section (5) of section 143 of the Act, we give in the Annexure “B” statement on sub directions issued.

6. Reporting under the Management’s requirement

a. Proper provisions have been made for all liabilities (including Claims Outstanding, unidentified motor TP Claims and Expenses Outstanding) as at the closing date.

b. We have verified the Cash and other imprest balances.

c. We have verified the Bank Balances with bank statements/ certificates or confirmation of balance.

7. Other Matters

a. No adjustments/provisions have been made in the accounts of the Divisional Office in respect of matters usually dealt with at Head Office, including in respect of:

i. Permissible terminal benefits to eligible employees on their retirement (including additional retirement benefits), Gratuity, Pension, liability for leave encashment benefits and other benefits covered in terms of ‘Accounting Standard 15 –Employee Benefits’;

ii. Arrears of salary/wages/allowances, if any, payable to staff;

iii. Staff welfare contractual obligations;

iv. Provision for unexpired risk, Claims Incurred But not reported (IBNR) and claims incurred but not enough reported (IBNER)

v. Taxation (Current Tax and Deferred Tax).

b. Motor Own Damage (OD) or/and Motor Third Party (TP) Claims paid during the year and outstanding at the end of the year recorded in the books of the Divisional Office to the extent serviced by other Divisional Offices/ the Service Hub attached to the Regional Offices have not been audited by us, as the same is audited by respective Statutory Auditors.

c. Motor OD claims and TP Claims paid and outstanding at the end of the year, pertaining to other Offices, which are processed by this Divisional Office, have been audited by us.

d. Claims paid and claims outstanding at the end of the year in respect of LOBs other than Motor OD and Motor TP, where there is co-sharing within the company:

i. where this Divisional office is the leader Office, have been audited by us.

ii. where this Divisional office is follower Office, have not been audited by us.

e. Reconciliation of the balances appearing under the account head Inter Office Transaction (other than DO/BO and DO/RO) is handled at Head office level.

f. Goods and Service Tax (GST):

Discharge of statutory compliance like payment of liability including GST on Reverse Charge mechanism, availing of Input Credit and filing of GST returns are handled by Head Office.

	For ______ (Name of the Firm)
	Chartered Accountants
	FRN No:
	Signature
	(Name of the Member signing the Audit Report)
Place:	(Designation)
Date:	Membership No:

Annexure “A” to the Independent Auditors’ Report

TO THE RO AUDITORS/ CENTRAL STATUTORY AUDITORS OF

XYZ INSURANCE COMPANY LIMITED

Report on the Internal Financial Controls under Clause (i) of Sub-section 3 of Section 143 of the Companies Act, 2013

1. We have audited the internal financial controls over financial reporting of (Office code) Divisional Office (DO Name) as at 31 March 2018 in conjunction with our audit of the Trial Balance, Annexures I & IA(Statement of Revenue account balances transferred to Head Office account), & Annexure II (Trial Balance after transferring Revenue items to Head Office) and the statements annexed of the Divisional Office for the year ended on that date.

Management’s Responsibility for Internal Financial Controls

2. The Head Office is responsible for establishing and Divisional Office is responsible for maintaining internal financial controls based on the essential components of internal control stated in the Guidance Note on Audit of Internal Financial Controls Over Financial Reporting (‘the Guidance Note’) issued by the Institute of Chartered Accountants of India (‘the ICAI’)”. These responsibilities include the design, implementation and maintenance of adequate internal financial controls that were operating effectively for ensuring the orderly and efficient conduct of its business, including adherence to Divisional Office’s policies, the safeguarding of its assets, the prevention and detection of frauds and errors, the accuracy and completeness of the accounting records, and the timely preparation of reliable financial information, as required by the Guidelines issued by Head Office, Insurance Act, 1938, Insurance Regulatory and Development Authority (IRDA) (Preparation of Financial Statements and Auditor’s Report of Insurance Companies) Regulation 2002 and the Companies Act, 2013 (‘the Act’).

Auditor’s Responsibility

3. Our responsibility is to express an opinion on the Divisional Office’s internal financial controls over financial reporting based on our audit. We conducted our audit in accordance with the Guidance Note and the Standards on Auditing (‘the Standards’), issued by the ICAI and deemed to be prescribed under section 143(10) of the Act, to the extent applicable to an audit of internal financial controls, both issued by the ICAI. Those Standards and the Guidance Note require that we comply with ethical requirements and plan and perform the audit to obtain reasonable assurance about whether adequate internal financial controls over financial reporting was established and maintained and if such controls operated effectively in all material respects.

4. Our audit involves performing procedures to obtain audit evidence about the adequacy of the internal financial controls system over financial reporting and their operating effectiveness. Our audit of internal financial controls over financial reporting included obtaining an understanding of internal financial controls over financial reporting, assessing the risk that a material weakness exists, and testing and evaluating the design and operating effectiveness of internal control based on the assessed risk. The procedures selected depend on the auditor’s judgment, including the assessment of the risks of material misstatement of the financial statements, whether due to fraud or error.

5. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinion on the Divisional Office’s internal financial controls system over financial reporting.

Meaning of Internal Financial Controls Over Financial Reporting

6. A Divisional Office’s internal financial control over financial reporting is a process designed to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles. A Divisional Office’s internal financial control over financial reporting includes those policies and procedures that (1) pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect the transactions and dispositions of the assets of the branch; (2) provide reasonable assurance that transactions are recorded as necessary to permit preparation of financial statements in accordance with generally accepted accounting principles, and that receipts and expenditures of the branch are being made only in accordance with authorizations of management and directors of the company; and (3) provide reasonable assurance regarding prevention or timely detection of unauthorized acquisition, use, or disposition of the Divisional Office’s assets that could have a material effect on the financial statements.

Inherent Limitations of Internal Financial Controls Over Financial Reporting .

7. Because of the inherent limitations of internal financial controls over financial reporting, including the possibility of collusion or improper management override of controls, material misstatements due to error or fraud may occur and not be detected. Also, projections of any evaluation of the internal financial controls over financial reporting to future periods are subject to the risk that the internal financial control over financial reporting may become inadequate because of changes in conditions, or that the degree of compliance with the policies or procedures may deteriorate.

Opinion

8. In our opinion, the Divisional Office has, in all material respects, an adequate internal financial controls system over financial reporting and such internal financial controls over financial reporting were operating effectively as at 31 March 2018, based on the internal control over financial reporting criteria established by the Head Office considering the essential components of internal control stated in the Guidance Note.

	For ______ (Name of the Firm)
	Chartered Accountants
	FRN No:
	Signature
	(Name of the Member signing the Audit Report)
Place:	(Designation)
Date:	Membership No:

Annexure “B” to the Independent Auditors’ Report

XYZ INSURANCE COMPANY LIMITED

DIRECTIONS UNDER SECTION 143(5) OF THE COMPANIES ACT, 2013

S.No.	Directions
1	Whether the company has clear title/lease deeds for freehold and leasehold land respectively? If not please state the area of freehold and leasehold land for which title/ lease deeds are not available
2	Whether there are any cases of waiver/ write off debts/loans/interest etc., if yes, the reasons there for and the amount involved
3	Whether proper records are maintained for inventories lying with third parties & assets received as gift/grants(s) from Govt. or other authorities.

Sub-directions to Statutory Auditors of UIIC (HO/RO/DO)-  for audit of accounts (2017-18) under section 143(5) of the Companies Act, 2013

S.No.	Particular
1	Number of titles of ownership in respect of CGS/SGS/Bonds/Debentures etc. available in physical/demat form and out of these, number of cases which are not in agreement with the respective amounts shown in the Company’s books of accounts may be verified and discrepancy found may be suitably reported.
2	Whether stop loss limits have been prescribed in respect of the investments. If yes, whether or not the limit was adhered to. If no, details may be given.
3	Whether Company has carried out reconciliation exercise for inter-company balances reflected in their financial statements with other PSU insurers and whether confirmation has been obtained from other PSU insurers for balances due from them?
4a)	Whether the method of accountal of premium and reported claims are as per conditions of agreement/scheme relating to Pradhan Mantri Fasal Bima Yojana
4(b)	Whether the method of accountal of premium and reported claims are as per conditions of agreement/scheme relating to Rashtriya Swasthya Bima Yojana
5	Migration of outstanding scroll account balances from legacy GENISYS system to CORE and controls existing to prevent misuse of outstanding scroll balances may be commented upon. Age-wise outstanding report may be prepared.

(About the Author– Author was Member of ICAI- Capacity Building Committee 2010-11 and ICAI- Committee For Direct Taxes 2011-12 and can be reached at email amresh_vashisht@yahoo.com or on phone Phone: 0 1 2 1-2 6 6 1 9 4 6. Cell: 9 8 3 7 5 1 5 4 3 2 having office at 1 1 5, Chappel Street, Meerut Cantt, UP, INDIA)