Escolar Documentos
Profissional Documentos
Cultura Documentos
A legal concept in which an indivudal must COMPENSATE an individual for the harm
that he or she caused
liability
a legal concept in which an individual is responsible for the harm that occurred
because the individual was performing an extremely hazardous activity, which
caused harm even though the individual took all of the necessary precautions
absolute liability
a legal concept in which an individual is responsible for the harm that occurred due
to the actions of another individual because the individual is responsible for the
SUPERVISION OR CARE of the individual who caused the harm
vicarious liability
The declarations section of an insurance policy that identifies the specific resources
and/or perils that the policy covers
insuring agreement
the declarations section of an insurance policy that identifies the specific
resources/perils that the policy does not cover
exclusions
The declarations section of an insurance policy that identifies what key items who
is covered\nname of insurer\namount of coverage\nphone # & address\ncost of
premium\nspecific property covered
an individual who is covered by an insurance policy that he or she does now own
but is listed on the policy additional insured
an individual or organization that is covered by the policy because the individual or
organization owns the policy
named insured
individual or organization that is covered by the policy because the individual or
organization is considered to be the PRIMARY owner first named insured
covered by the policy because the individual or organization owns the policy but the
individual or organization is not considered to be the primary owner
an additional
named insured
a provision that allows an insurer to acquire the rights to a piece of damaged
property in exchange for a payment equal to the amount necessary to replace the
property
salvage provision
a provision that prohibits the policyholder from transferring the policy to another
individual or organization during his lifetime unless the insurer has agreed to the
transfer in writing assignment provision
provision that allows an insured individual or organization to collect the benefits of
the policy even if the individual or or organization decides to abandon the property
abandonment provision
a provision allows an insurer to seek the amount that it paid for a claim from the
individual who caused the harm if the insurer is required to pay a claim related to an
incident for which the insured individual(s) are not responsible subrogation
provision
The Dwelling policy Broad form (DP1) will only cover damage to a dwelling that
occurs as a result of
a fire, internal explosion, and/or lightning
The Dwelling policy Broad form (DP2) will only cover damage to a dwelling that
occurs as a result of (COVERS THE MOST!!) accidental dischararge or overflow of
liquids\nan aircraft; burglary; civil commotion; an explision; falling objects; a fire;
freezing pipes; hail; lightning; smoke; sudden and accidental damage from electrical
current; cracking; a sprinkler system; vandalism
Dwelling policy Broad form with extended coverage will cover
commotion, an explosion, hail, smoke, vehicles, and/or wind
an aircraft, civil
The Dwelling policy Broad form (DP3) will only cover damage to a dwelling that
occurs as a result of
any even that is not specifically excluded in the policy
A type of dwelling coverage in which an insurer agrees to pay an amount equal to
the income that a landlord would lose if the landlord's rental property is damaged
and a tenant is no longer able to occupy the property
Fair Rental Value
A type of dwelling coverage in which an insurer agrees to pay an amount equal to
the value of an individual's personal property if the individual's property is stolen
Broad Theft Coverage
A type of dwelling coverage in which an insurer agrees to pay an amount equal to
the amount that an individual would need to pay to LIVE in another location if the
individual's property is damaged
Coverage E Additional Living Expense
A type of dwelling coverage in which an insurer agrees to pay some of the MEDICAL
expenses for an individual other than the insured if an individual is injured on the
insured individual's property
Coverage M Medical Payments to others
an exclusion that states that an insurer will not pay any claim in which an
individual's property is damaged as a result of A LAW OR ORDINANCE THAT
Building Law
an exclusion that states that an insurer will not pay any claim in which an
individual's property is damaged or seized by the government
Governmental
Action exclusion
an exclusion that states that an insurer will not pay any claim in which an
individual's property is damaged as a result of an earthquake, mudslide. landslide,
sinkhole
An Earth Movement exclusion
an exclusion that states that an insurer will not pay any claim in which an
individual's property is damaged as a result of the fact that the individual did not
maintain the property
A Neglect exclusion
Which Home Owners form covers damage to a condo owner's PROPERTY that occurs
as the result of any event that is not specifically excluded in the policy HO6 Unit
Owner's form
Which Home Owner's form covers damage to a tenant's PROPERTY that occurs as
the result of an aircraft, civil commotion, an explosion, fire, hail, lightning, smoke,
theft, vandalism, vehicles, and/or wind HO4 Contents Broad form
Which Home Owner's form covers damage to the DWELLING that occurs as the
result of any event that is not specifically excluded in the policy and damage to the
PROPERTY inside the dwelling that occurs as the result of an aircraft, civil
commotion, an explosion, fire, hail, lightning, smoke, theft, vandalism, vehicles,
and/or wind HO3 Special form
Which Home Owners form covers damage to the DWELLING and PROPERTY inside
the dwelling that occurs as the result of any event that is not specifically excluded
in the policy HO5 Comprehensive form
What means conducting business in accordance with current rules and laws set by
government regulatory agencies and the courts
compliance
standards of conduct and moral judgement
ethics
agency
what is the term to describe how an insurer appoints an individual to act on its
behalf agency contract
an individdual whose position and responsibilities involve a high degree of trust and
confidence (trustees, guardians & executors) fiduciary
the name for the fact that a producer must sell the kind of policies that best fit the
prospect's needs and in amounts that the prospect can afford
needs selling
what is given when the applicant pays the initial premium at the time the
application for a policy is signed conditional receipt
what is the term for informing the prospect or client of all facts involving a specific
policy or plan so that an informed decision can be made full disclosure
what is the name for the watchdog group whose member companies agree to
adhere to and enforce ethical principles
Insurance marketplace Standards
Association (IMSA)
what act deals with the inappropriate use of advertising
any written or oral statement that does not accurately describe a policy's features,
benefits, or coverage
misrepresentation
any false, maliciously critical, or derogatory communication that injures another's
reputation, fame or character
defamation
what is the term if the buyer of an insurance policy receives any part of the
producer's commission or anything else of significant value as an inducement to
purchase a policy rebating
the unethical act of persuading a policyowner to drop a policy solely for the purpose
of selling another policy without regard to possible disadvantages to the policy
owner twisting
a resident producer license must meet what two requirements
in PA or have their principal place of business in this state
states that there must be an adequate spread of risk for insurance to be effective
law of large numbers more examples used, more reliable the statistic
(predict the number of losses; predict the charge for premium)
installing an automatic sprinkler system is an example of what
avoid risk but can reduce risk)
deciding not to produce a product due to serious potential side effects avoidance
(avoid the risk of being sued)
person in good health cancels health insurance policy what risk management
method
retention (retaining risk)
under what regulation in PA does it state that insurers must maintain specified
minimum levels of capital stock and surplus Regulation of insurer solvency
Who regulates insurance rates to avoid excessive, inadequate, or unfairly
discriminatory rates
Casualty and Surety Rate Regulatory Act
who must an insurer notify when they terminate a producer's appointment
Commissioner and the producer
the
which of the following is not a power and duty of the Insurance Commissioner
issuing cease and desist orders\nprosecuting producers who violate state
insurance laws\nconducting complaint hearings\nappointing examiners
what unfiar practices is when a producer offers, promises, allows, gives, sets off or
pays a rebate on the contract of insurance
rebating
what unfair insurance practice is the purchase of insurance from a financial
institution or from a designated insurer or producer as a condition of any loan or
deposit transaction Tiein sales
what unfair insurance practive occurs when a producer makes, issues, circulates, or
uses any written or oral statement misrepresenting the terms of a policy or contract
of insurance misrepresentation
what unair insurance policy occurs when a producer misrepresents or provides an
icomplete comparison of policies to induce the policyholder to lapse, forfeit or
surrender his insurance to take out a similar policy in another company twisting
nonpublic personal financial information about individuals Privacy of Consumer
Financial Information
what is the term for an instruction by the consumer to the licensee not to disclose
nonpublic personal financial informationabout that consumer to a nonaffiliated third
party Opt out
When can a producer share a commission with an unlicensed person
if licensee
was held at time of sale\nreferring person can receive a one time nominal set fee
when a personal fire insurance policy is cancelled because the insured's acts
increase the hazard insured against, how many days' notice must be provided to the
insured
30 days
When an automobile policy is cancelled for a reason other than non payment of
premium, how many days' notice must be provided to the insured
60
If an insured's driver's license has been suspended, the insurer may cancel the
automobile insurance policy by giving how many days' notice? 15
what are the minimum limits of liability any individual must provide for bodily injury
and property damage?
15/30/5\n$15000 per person bodily injury\n$30000 per
accident for body injury\n$5000 per accident property damage
purchased in the normal or standard market Pennsylvania Fair Plan Act
After an accident, what is the waiting period before the insured can apply for
income loss benefits
5 work days
what must occur in order for funeral expenses to be paid death within 24 hours of
accident
When an automobile policy is cancelled for a reason other than non payment of
premium, how many days' notice must be provided to the insured
60
If an insured's driver's license has been suspended, the insurer may cancel the
automobile insurance policy by giving how many days' notice? 15
what are the minimum limits of liability any individual must provide for bodily injury
and property damage?
15/30/5\n$15000 per person bodily injury\n$30000 per
accident for body injury\n$500 per accident property damage
What act is intended to provide property owners with fire, extended coverages,
vandalism and malicious mischief coverage when insurance is unable to be
purchased in the normal or standard market Pennsylvania Fair Trade Ace
After an accident, what is the waiting period before the insured can apply for
income loss benefits
5 work days
an insurer must notify an insured at least how many days before increasing the
premium on a commercial casualty insurance policy?
30
Which agency provides motor vehicle insurance to those applicants who would
otherwise by uninsurable?
Pennsylvania Auto Assigned Risk Plan
When an employer must provide workers' compensation insurance but is unable to
do so through normal channels, which organization can provide the required
coverage? State Workers Insurance fund
What term describes a producer who converts premiums for his own use
Breach of fiduciary duty
What insurance option lets the insured seek recovery for all medical and other out
ofpocket damages, pain and suffering, and other nonmonetary damages as a result
of injuries caused by other drivers
Full Tort option
With Crop insurance, at what percent can crops be insured of their expected value?
75%
Peril: Peril: A cause of loss [md] for example, fire, collision, or flood.
Hazard:
Hazard: Something that increases the chance of loss [md] for example,
overloaded electrical outlets, worn brakes on a car, or building on a flood plain.
Law of large numbers:
Law of large numbers: Principle that helps insurers predict
the number of losses that will occur and allows them to provide large amounts of
insurance for relatively little money. It states that the more examples used to
develop any statistic, the more reliable the statistic will be.
Insurable risk:
Insurable risk: A risk must meet certain criteria to be a suitable
subject for insurance. These criteria are: pure risk, definite as to time and place, not
expected, large enough to create financial hardship for insured, affordable to
insured, can be assigned a financial value, will not occur to large number of
insureds at the same time, and large number of persons with similar potential loss.
Indemnity: Indemnity: Insurance policies are contracts of indemnity because they
restore the insured to approximately the same financial condition he or she was in
before a loss. A person whose twoyearold car is totaled in an accident will be paid
the value of that car, not the amount required to purchase a new car.
Aleatory contract: Aleatory contract: Contract that is contingent on an uncertain
event. An insurance policy is an aleatory contract because an insured does not
receive claim payments unless a covered loss occurs.
Contract of adhesion:
Contract of adhesion: A contract in which only one party
draws up the terms and the other party simply consents to them; ambiguities in the
terms are interpreted by courts in favor of the party who did not write the terms.
Insurance is a contract of adhesion.
Unilateral contract: Unilateral contract: A contract in which only one party is legally
bound to perform its part of the agreement. An insurance policy is a unilateral
contract because the insurer is legally required to pay for covered losses under the
policy. An insured is not legally required to pay premiums or comply with the policy
terms.
First named insured:
First named insured: Person whose name appears first in
the declarations as an insured. Might be responsible for paying premiums, receiving
cancellation notices, and agreeing to changes in the policy.
Offer and acceptance:
Offer and acceptance: One party to a contract must make
an offer, and the other party must accept it. With an insurance contract, the insured
makes the offer by completing an application and the insurance company accepts
the offer by issuing a policy.
Consideration:
Consideration: Both parties to a contract must provide
consideration, which is a thing of value exchanged for the performance promised in
the contract. The consideration the insured provides is the premium; the
consideration the insurance company provides is the promise to pay if certain losses
occur.
Binder:
Binder: Oral or written statement used to provide immediate insurance
protection for a specified time period. Can be issued by the agent or the insurance
company. Guarantees temporary coverage, but is not a guarantee that a policy will
be issued.
Material fact:
Material fact: A fact that would cause an insurer to decline a risk,
charge a different premium, or change the provisions of a policy that was issued.
The fact that an individual has caused three auto accidents in the past five years
would be a material fact for a company issuing auto liability insurance
Misrepresentation: Misrepresentation: Written or verbal misstatement of a material
fact involved in the contract on which the insurer relies. Can be grounds for the
insurer to void the policy. Might be intentional or unintentional.
Fraud: Fraud: A deliberate misrepresentation that causes harm. Unlike
misrepresentation, which might be either intentional or unintentional, fraud is
always intentional and involves an allout effort by one party to deceive and cheat
the other.
Representations versus warranties:
Representations versus warranties: A
representation is a statement in an application that the insured believes is true. A
warranty is a specific agreement between the insured and insurer that certain
conditions will be met. The key difference between the two is that a representation
is not a part of the contract, but a warranty is. A policy cannot be voided on the
basis of a representation, but it can be voided for breach of warranty.
Waiver:
Waiver: Intentional relinquishment of a known right, such as not
applying a policy condition that could be grounds to deny payment of a claim.
Estoppel:
Estoppel: Legal principle that prevents someone from asserting that
something is not true after creating the impression that it is true. Under this
principle, if a producer misinterprets a policy and tells an insured that a loss will be
covered, the insurer cannot deny payment of the claim.
Short rate versus pro rata cancellation:
Short rate versus pro rata
cancellation: When an insurance policy is cancelled before its expiration date, any
premium paid for insurance that will not be provided (unearned premium) must be
returned to the insured. If the insured cancels the policy, the insurer is also allowed
to keep a certain amount for expenses involved in issuing the policy (short rate
cancellation). This is not permitted when the insurer cancels the policy (pro rata
cancellation).
Direct loss versus indirect loss: Direct loss versus indirect loss: A direct loss is a
financial loss resulting directly from a loss to property, such as tornado damage to a
home. An indirect loss is a consequence of a direct loss, such as the expenses
required to stay at a motel while tornado damage to a home is repaired.
Actual cash value: Actual cash value: Method of determining reimbursement for an
insured loss; usually calculated by determining the property's replacement cost and
subtracting an amount for depreciation. Depreciation is deducted because the
insured has already had use of the property. Paying the full replacement cost would
violate the principle of indemnity.
Replacement cost: Replacement cost: Losses may be reimbursed on a replacement
cost basis, without deduction for depreciation, if the insured agrees to maintain
insurance equal to a specified percentage of the property's value.
Blanket insurance: Blanket insurance: Insurance that is written to cover more than
one item of property at a single location or one or more items of property at
multiple locations. Personal property coverage in Dwelling and homeowners policies
is an example of blanket insurance.
Valued policy:
Valued policy: Certain hardtovalue items, such as art work,
may be insured under a valued policy to avoid the difficulty involved in determining
the property's value after it is damaged. The property is written for a specified
amount that is used to value losses. Also called an agreed amount policy.
Coinsurance:Coinsurance: Policy condition that benefits insureds who insure
property for its full value. If the insured maintains insurance equal to a specified
percentage of the property's value, the insurer will fully reimburse losses (up to the
policy limits). If the coinsurance requirement is not met, the amount paid for the
loss will be reduced.
Surplus lines:
Surplus lines: Term used to describe highly specialized insurance
coverages that are not available or cannot be procured from authorized insurers
within a state.
insurance binder oral or written statement made by the agent that the insured
has immediate protection that is valid for a specified time lets you know you have
coerage before the actual policy has been issued. Does not guarantee that a policy
will be issued only guarantees temporary coverage. If a policy is issued then the
binder ceases as of the effective date of the policy
federal Fair Credit Reporting Act protects comsumers by requiring that the
consumer e notified in certain situations and establishing provisions for the removal
of outdated and incorrect information from their consumer credit reports
investigative consumer report gathers data through personal interviews with
friends, neighbors, and associates of the consumer
who can get a copy of your consumer credit report someone who intends to use
the information for insurance underwriting purposes or in conncection with
employment, credit transactions, or other types of personal business transactions
what is prevent from being in a consumer credit report
1. bankruptcies over 10
years old\n2. suits and judgements over seven years old or in which the statute of
limitations has expired whichever period is longer\n3. paid tax liens or accounts
placed for collection or charged to profit that are over seven years old\n4. arrests,
indictments, or conviction of crime reports\n5. any other adverse information that
took place seven years before the report\n*these restrictions are not applicable
when the credit report is used in connection with a credit transaction of $150,000 or
more, or when concerns or employment of an individual earning $75,000 or more
When must a consumer be notified about the release of their credit report?
If an
investigative report is ordered or if an insurance is rejected ,reduced, or written at a
higher premium. The consumer myst be notified an provided with the name and
address of the reporting agency\n the comusmer then has the right to obtain the
substance of the information in the report and be informed of who received the
report in the last 6 months
adverse selection the tendency for people with greater than average exposure to
loss to purchase insurance. The underwriter should protect the insurer from this
Construction classification for property insurance underwriting Class 1 frame
Class 1: Frame outside support walls, roof and floors constructed of wood or
other combustible materials
Construction classification for property insurance underwriting Class 2 joisted
masonry
Class 2: Joisted Masonryoutside support walls made of non
combustible masonry materials (such as concrete, brick, stone or tile) and a roof
and floor made of combustible materials like wood
Construction classification for property insurance underwriting Class 3 non
combustible class 3 exterior walls, floors, and roof are constructed of and
supported by non combustible material such as metal, asbestos, or gypsum
Construction classification for property insurance underwriting Class 4 Masonry
non combustible
class 4 exterior walls constructed of masonry material and a
roof and floor made of metal or other noncombustible materials
Construction classification for property insurance underwriting Class 5 modified
fire resistive class 5 exterior walls, floors and roof constructed of masonry or fire
resistive material with a fire resistance rating of 2 hours or less
Construction classification for property insurance underwriting Class 6 fire
resistive
class 6 constructed of masonry or fire resistive material with fire
resistance rating of 2 hours or more
3 ways of computing a premium 1. Judgment rating\n2. Manual Rating\n3. Merit
Rating
Judgement Rating for computing a premium premium is determined by considering
the individual risk. No books or tables are used, just thorough judgement
Manual or Class Rating for computing a premium
the most common method of
determining an insurance premium rates for a particular state are obtained by
consulting a manual. Rates are arranged by various categories or classes.
(underwriter classifies the risk using defined criteria and then looks up the rate)
Rate is then multiplied by the number of units of insurance purchased ( Rate per
unit x number of units = premium) Ex: insured purchases $60,000 of insurance at a
rate of $2 per $1000 of coverage 2 x 60= $120 premium
Merit Rating for computing a premiumstarts with manual/class rating and then is
modified to relfect unique characteristics of the risk that are not reflected by the
manual rate... experience rating is form of this which takes into account the
insured's loss experience (dollar paid out for claims vs premium paid over a period
of usually 3 years)
retrospective rating
form of merit rating which bases the insured's premoum
on losses that occurred during the policy period
schedule rating
form of merit rating which applies a system of debits and credits
to reflect the characteristics of the particular insured
certificate of insurance (COI)
proof that a policy has been written contains
general summary of the policy's coverage and is frequently required in loan
transactions and other legal matters
Under what conditions may an insurance company cancel insurance during a policy
period?
1. Misrepresentation\n2. Concealment\n3. Fraud
Misrepresentation written or verbal misstatement of a material fact (fact that
would cause an insurer to deline a risk, charge a differnt premium or change the
provisions of the policy that was issued) involved in the contract on which the
insurer relies.\n may be intentional or unintentional
concealmentwithholding material facts
fraud deliberate misrepresentation that CAUSES HARM always intentional
What 4 elements are needed in an act of fraud
1. someone deliberately lies\n2.
the intent of the lie is for someone else to rely on that lie\n3. another person relies
on that lie\n4. another person suffers harm as a result of relying on that lie
Representations in an insurance application statements that the applicant believes
to be true. A policy may not be voided on the basis or representation.
Warranties specific agreements made between the insured and the insurer that
certain conditions will be met (ex: while a business is closed, a security guard will
be on duty). \n\nIf these agreements are breached the policy can be voided
whether or not the breach was intentional
Waiver
intentional relinquishment of a known right knowingly overlooking a
condition or exclusion that would normally have been grounds for denying
coverage, increasing the premium, or reducing the benefits provided. The
requirement of an insurable interest and facts cannot be waived
Estoppel
If an insurance company representative intentionally or unintentionally
creates the impression that certain facts exist when they do no and an innocent
party relies on that impression and is damaged as a result, the insurance company
will be estopped (prevented) from denying this fact (ex: if an agent states or
indicates by his actions that a particular loss is covered, the insurance company will
be estopped/prevented from denying that coverage)
What happens when an insured wants to cancel insurance during a policy period?
the insured needs to write a letter to the insurance company or surrender the
policy itself to them then the insurance company must give back any unearned
premium (premium not yet used up at that point in the policy period)
short rate basis
if an insured cancels before the expiration date the insurance
company no only keep the premium for the insurance already provided but also
keeps an allowance for expenses, such as issuing the policy
What happens when an insurance company wants to cancel insurance before the
expiration date of the policy?
this is governed by state regulations usually can
only be cancelled for nonpayment. Usually the insurer is required to notify the
insured in writing a certain number of days before the impending cancellation.
pro rata basis
when the insurance company cancels a policy, unearned
premium is returned to the insured on a pro rata basis company retains only the
earned premium and is not allowed to keep an extra amount for expenses (as in the
short rate basis)
flat cancellation
cancellation of insurance by either insured or insurer on the
effective date of the policy
nonrenewal not providing coverage for the next term once a policy expires.
Insureds can nonrenew for any reason, but insurers are limited in the reasons for
nonrenewal and have to notify the insured of the decision to nonrenew
What are the three (3) components of Insurance? Risk: the uncertainty of an
outcome; positive or negative\nTransfer: shifting financial responsibility\n\nPooling:
sharing losses as a whole
What are the two (2) major sectors of Insurance?
Health
What are the two (2) goals of Claims?1) Maintain the Insurer's Promise\n
claimants to preloss state, financially\n2) Support Profit Goals
Return
First Party \n\n\nvs.\n\n\nThird Party Claims 1) 1st Party Claim: a demand from the
insured seeking to recover for loss/damage that is covered by insurance\n\n\n2) 3rd
Party Claim: a demand against the insured/insurer seeking to recover from
damages; mostly liability
Define Subrogation Subrogation: the possibility of an insurer, after a loss has been
recovered, being able to receive money from the party who is legally responsible for
the loss
Define Loss Reserves
Loss Reserves: an estimate of the amount of money an
insurer should expect to pay on future losses that have not occurred, not been
settled or not reported.
Why is Insurance Regulated?
1) Protect Consumers\n2) Maintain Solvency\n3)
Prevent Destructive Competition
How do Regulations on Insurance Protect Consumers?
1) Regulations ensure
that forms/applications/languages are easier to comprehend, and ultimately benefit
the consumer\n\n\n2) Ensure that insurance is available when needed; without
unethical business behavior
How do Regulations on Insurance Maintain Solvency?
1) Solvency: the ability
for an insurer to meet its financial obligations\n\n\n2) Gov't safeguards funds for
policyholders\n\n\n3) Premiums are paid in advance, coverage extends to the future
Domestic vs. Foreign vs. Alien Insurers1) Domestic: licensed in the state domiciled
in\n\n\n2) Foreign: insurers that write insurance in states outside their home
state\n\n\n3) Alien: insurers licensed outside the US
Admitted Insurer\n\n\nvs.\n\n\nNonadmitted Insurer
1) Admitted: an insurer
with a license by the state to perform business\n\n\n2) Nonadmitted: insurers not
authorized to do business
Define Surplus Lines of InsuranceSurplus Lines: a form of "specialty" coverage that
is not typically provided by an admitted insurer\n\n\nusually offered by non
admitted insurers
What are the three (3) types of Insurance Company Ownership? 1) Stock
Insurer\n2) Mutual Insurer\n3) Reciprocal Insurance
What is a Stock Insurer Ownership?The insurer's goal is the maximize profits for the
shareholders\n\n\nOwned by stockholder; operated by BoD
What is a Mutual Insurer Ownership?The insurer's focus is to provide insurance; no
stocks\n\n\nOwned by policyholders; operated by BoD
Binder:
Oral or written statement used to provide immediate insurance
protection for a specified time period. Can be issued by the agent or the insurance
company. Guarantees temporary coverage, but is not a guarantee that a policy will
be issued.
Material fact:
A fact that would cause an insurer to decline a risk, charge a
different premium, or change the provisions of a policy that was issued. The fact
that an individual has caused three auto accidents in the past five years would be a
material fact for a company issuing auto liability insurance
Misrepresentation: Written or verbal misstatement of a material fact involved in the
contract on which the insurer relies. Can be grounds for the insurer to void the
policy. Might be intentional or unintentional.
Fraud: A deliberate misrepresentation that causes harm. Unlike misrepresentation,
which might be either intentional or unintentional, fraud is always intentional and
involves an allout effort by one party to deceive and cheat the other.
Representations versus warranties:A representation is a statement in an application
that the insured believes is true. A warranty is a specific agreement between the
insured and insurer that certain conditions will be met. The key difference between
the two is that a representation is not a part of the contract, but a warranty is. A
policy cannot be voided on the basis of a representation, but it can be voided for
breach of warranty.
Waiver:
Intentional relinquishment of a known right, such as not applying a
policy condition that could be grounds to deny payment of a claim.
Estoppel:
Legal principle that prevents someone from asserting that something is
not true after creating the impression that it is true. Under this principle, if a
producer misinterprets a policy and tells an insured that a loss will be covered, the
insurer cannot deny payment of the claim.
Short rate versus pro rata cancellation:When an insurance policy is cancelled before
its expiration date, any premium paid for insurance that will not be provided
(unearned premium) must be returned to the insured. If the insured cancels the
policy, the insurer is also allowed to keep a certain amount for expenses involved in
issuing the policy (short rate cancellation). This is not permitted when the insurer
cancels the policy (pro rata cancellation).
Direct loss versus indirect loss: A direct loss is a financial loss resulting directly
from a loss to property, such as tornado damage to a home. An indirect loss is a
consequence of a direct loss, such as the expenses required to stay at a motel while
tornado damage to a home is repaired.
Actual cash value: Method of determining reimbursement for an insured loss;
usually calculated by determining the property's replacement cost and subtracting
Intervening cause: A separate action that breaks the chain of causation between a
person's negligent actions and resulting damage to a third party. The intervening
cause then becomes the proximate cause of loss.
Personal injury:
In the insurance industry, this term does not have the same
meaning as bodily injury. It refers to losses arising out of such things as slander,
libel, and invasion of privacy.
Absolute liability: Type of law imposed on those involved in activities considered
especially hazardous, such as activities involving dangerous materials, hazardous
operations, and dangerous animals. A person involved in these activities can be
held liable for damages arising out of them, even though the individual was not
negligent.
Supplementary payments:
Expenses included in a liability insurance policy
that are paid in addition to the policy's regular limit of liability. Typically includes
defense costs, claim investigation expenses, bond premiums, first aid expenses,
expenses incurred by the insured at the insurer's request, loss of earnings,
prejudgment interest, and postjudgment interest.
Covered perils: (Dwelling and Homeowner Coverages)
Dwelling forms can
provide basic, broad, or special coverage. Homeowner forms can provide broad or
special coverage for owneroccupied dwellings and broad form coverage for tenants
or condominium unit owners.
Removal coverage: (Dwelling and Homeowner Coverages) both cover property
against loss from any peril while being removed from a premises endangered by a
covered peril, and for a specified number of days while it is away from the premises.
Debris removal: (Dwelling and Homeowner Coverages)
both contain debris
removal coverage, which pays for the expense of removing debris resulting from a
covered loss.
Temporary substitute auto:
An auto the insured rents or borrows while the
insured's damaged auto is out of service because of its breakdown, repair,
servicing, loss, or destruction. In both personal and commercial auto policies,
temporary substitute autos are considered covered autos for liability coverage.
Collision:
One of two physical damage coverage options in personal and
commercial auto policies. Covers damage caused by the impact of the auto with
another object or vehicle or by the upset of the vehicle.
Nonowned auto:
In the personal auto policy, it is any private passenger auto,
pickup truck, trailer, or van not owned by or available for the regular use of the
named insured or a family member. Under the policy's physical damage coverage
(but not liability coverage), a temporary substitute auto is considered a nonowned
auto instead of a covered auto.
Businessowners property
Agreed value:
Optional commercial property coverage that suspends the
coinsurance requirement and stipulates a certain value for designated property. If
the policy limit equals or exceeds this amount, the insured will not be assessed a
coinsurance penalty.
Business Income From Dependent Properties Form: Commercial Property form
designed for insureds whose business income is dependent on the ongoing
operations of other businesses they do not own. This includes businesses that:
deliver materials or services to the insured (contributing locations), are the primary
purchasers of the insured's products or services (recipient locations), manufacture
products for delivery to the insured's customers (manufacturing locations), or
attract customers to the insured's business (leader locations).
Additional coverages: \n(Commercial Property Insurance) The Commercial Property
Building and Personal Property coverage form includes the following additional
coverages: debris removal, preservation of property, fire department service
charge, pollutant cleanup and removal, increased cost of construction, and
electronic data.
Coverage extensions:\n(Commercial Property Insurance) The commercial property
building and personal property coverage form includes the following coverage
extensions, which apply only if the insured has agreed to meet an 80% or higher
coinsurance requirement or has purchased a reporting form: newly acquired or
constructed property, personal effects and property of others, valuable papers and
records [md] other than electronic data, property off premises, outdoor property,
and nonowned detached trailers.
Optional coverages:\n(Commercial Property Insurance)
The commercial property
building and personal property coverage form includes the following optional
coverages, which apply only if designated in the declarations and require an
additional premium: agreed value coverage, inflation guard coverage, and
replacement cost coverage.
Personal and advertising injury:\n(Commercial General Liability Insurance)
In the
Commercial General Liability (CGL) forms, this is injury that results from false arrest
or imprisonment, malicious prosecution, wrongful eviction or entry, slander, libel,
violation of personal privacy, use of another's advertising idea, or copyright
infringement.
Occurrence versus claims made forms: \n(Commercial General Liability Insurance)
CGL coverage can be written on an occurrence or claimsmade basis. The
major difference between occurrence and claimsmade forms is how coverage
under the form is activated, or triggered. An occurrence form covers bodily injury
(BI) or property damage (PD) that occurs during the policy period, regardless of
when the claim is made. A claimsmade form pays for BI or PD losses for which a
claim was first made against the insured during the policy period.
Errors and omissions insurance: Type of professional liability insurance written for
nonmedical professionals, such as insurance agents, accountants, architects,
stockbrokers, and attorneys.
Difference in conditions insurance:Type of Commercial Property policy that covers
most insurable perils but excludes basic fire and extended coverage perils. It is
usually written on large risks with a high deductible.
Surplus lines:
Term used to describe highly specialized insurance coverages
that are not available or cannot be procured from authorized insurers within a state.
Risk
Insurance
a contract or device for transferring risk from a person, business, or
organization to an insurance company that agrees in exchange for a premium to
pay for losses through an accumulation of premiums.
Speculative Risk
Pure Risk
risks in which there exist both the possibility of gain and of loss.
Physical Hazard
itself.
Morale Hazard
through carelessness or by irresponsible actions can increase
the possibility for a loss.
Moral Hazrad
When a loss or situation is created on purpose to collect from
the insurance company.
Contract
legal agreement between two competent parties that promises certain
performance in exchange for certain consideration.
Contract Characteristics
Acceptance(agreement)
Contract of Utmost Good Faith Company relies on the truthfulness and integrity of
the applicant. In return the insured relies on the companies promise and ability to
provide coverage and pay claims.
Conditional The Insured must notify the insurer about the loss. While the insurer
must use the valuation method specified in the contract to settle the loss.
Decleration Usually on the first page, contains information like the names of the
insured their address, the amount of the coverage, descriptions of the property or
item being insured, and the cost of the policy.
Insurance Agreement
States in general what is to be covered, the losses for
which the insured will be indemnified, the type of property covered and the perils
against which it is insured.
Conditions
insured.
Describe the responsibilities and obligations of both the insurer and the
Exclusion
Definitions
Endorsements
Stock Companies
Mutual Companies The insured's are also members of the company. They can vote
to elect the management and receive the profits in in forms of dividends or
reductions in future premiums.
Advance Premium Companies Charge non assessable premiums and are required
to set money aside in case their claims experience is higher then expected.
Assessment Companies
each policy period.
Reciprocal Companies
Members share the insurance responsibilities with all the
other members. Managed by an Attorney in Fact who handles the business of the
reciprocal.
Lloyd's Assosiation A voluntary association of individuals, or groups of individuals
who agree to share in insurance contracts. Each individual or syndicate is
individually responsible for the amount of insurance they write.
Fraternal Benefit Society an incorporated society without capital stock, operated on
the lodge system and conducted solely for the benefit of is members.
Risk Retention Groups
Group self insurance program formed by product
manufactures to insure against product liability.
Purchasing Groups Used to purchase liability insurance on a group bassis.
Liability Risk Retention Act
Self Insuarnace
Amended in 1986
Casualty Insurance Liability, Aviation, Auto, Workers Comp, and Surety Bonds.
Life Insurance
Designed to handle the risk of premature death or the risk that
an individual may outlive their financial resources.
Health and Disability Insurance Handles the risk of medical bills and loss of income
resulting from injury or sickness.
Agent Represents the insurance company, is the link between the company and the
insured. Sells insurance, issues and counter signs policies, collects premiums.
Countersign The agent signs each new policy prepared by the company before
delivering it to the insured.
Field Uderwriting Using pre established criteria to seek out the type of business
that is likely to be acceptable to the company.
Application The insured's offer.
Suspense (Diary System) A way to keep track of when a policy will need to be
renewed.
Service Needs
Name changes, change in method of payment, and accurate
record of such changes must be documented.
Agency Relationship
When one party (the agent) is authorized to act on behalf
of another (the principal).
Express Authority The authority specifically given to an agent, either orally or
written by the principal.
Implied Authority Authority given by the insurance company to the agent that is
not formally expressed.
Apparent Authority A doctrine that holds that an agent may have whatever
authority a reasonable person would assume that they have.
Solicitor
policies.
Can sell insurance collect premiums but cannot issue or counter sign
Earned Premium
The premium the company actually earned by providing
insurance protection for the designated period.
Incurred Loss
Include amount paid on claims for covered losses and various
expenses related to handling claims.
Underwriting Expenses
Written Premium
Combined Ratio
Companies, Agents,
Insolvent
When an insure does not have the funds to meet all of the financial
obligations it is contracted to meet.
Insurance guarantee AssociationProvides funds for payment of unpaid claims when
an insurer becomes insolvent.
Fiduciary
person.
Twisting
A form of misrepresentation in which the agent convinces the client to
cancel already existing insurance and buy another policy from the agent.
Rebating
Giving or offering benefits other then those specified in the policy, such
as cash, gifts or securities to induce a customer to buy insurance.
Unfair Discrimination
Giving a lower or higher rate then another insured in
identical circumstances.
Ratification the approval by state insurance department of the policy forms,
endorsements, and rates used by companies in their state.
Prior Approval
and rates.
File and Use Companies may use forms and rates as soon as they are filed. But
after states review they can still be rejected.
Open Competition Companies compete openly with forms and rates as long as they
meet adequacy and nondiscrimination requirements.
Rates The basic charges an insurance company sets for various types of insurance.
Adverse Selection The tendency for people with a greater then average exposure
to loss to purchase insurance.
Class 1 Frame
Class 2 Frame
Joisted Masonry
Class 3 Frame
Non Combustible
Class 4 Frame
Class 5 Frame
Class 6 Frame
Fire Resistive
Judgment Rating
Manuel Rating
Merit Rating Starts with manual rating and are then modified to reflect unique
characteristics of the risk that are not reflected in the manual rate.
Experience Rating Modifies the manual premium on the basis of the insureds loss
experience.
Retrospective Rating
the policy period.
Schedule Rating
Applies a system of debits or credits to reflect characteristics of
a particular insured.
Certificate of Insurance
Concealment
Representations
Flat Cancellation
Vacant
No People No Property
Reporting
Pays a deposit premium, submits reports, premiums are calculated
based on the factors in the reports.
Liability
When a person is determined to have been responsible for loss to
another person or to another persons property and is required to make financial
restitutions.
Surety Bonds
emphasize that certain things will happen.\nsomeone will
faithfully perform whatever he agrees to do.\nsomeone will make a payment as
agreed upon by that person and another party.
Contract Bonds
Bid Bonds
Guarantee that if a contractors bid is accepted, the contractor will
enter into a contract and provide the required Performance bond.
Performance BondsGuarantee that jobs will be completed by the contractor
according to contract specifications.
Payment Bonds
Guarantees that bills for labor and materials will be paid by the
contractor as they are due.
Supply Bonds
Guarantee that a supplier will furnish supplies products or
equipment at an agreed upon price and time.
Completion Bond Guarantee that when contractors borrow money to fund
construction projects, the project will be carried out and the work will be delivered
free and clear of liens and encumbrances.
Judicial Bonds
forth by law.
Fiduciary Bonds
Commonly used to bond guardians, administrators, trustees, and
executors, all of whom are fiduciaries, or persons appointed by a court of law to
manage the property of others.
Court Bonds Are used to settle legal arguments that do not involve monetary
damages. Their primary purpose is to protect obliges against loss in case principals
are not able to prove that they are legally entitled to the legal remedy they sought
against the oblige.