PNC Insurance - Training Slides

PROPERTY & CASUALTY INSURANCE
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IHL Consulting
Agenda
P&C Insurance Definition and Practice 07
Slides 03 -
Overview of various Personal P&C Insurance 33
Slides 08
Overview of various Commercial P&C Insurance 34 66 IT solutions available to meet P&C Insurance 73
Slides
Slides 67
Clients at Infosys dealing in P&C Insurance Slides 74 79

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P&C Insurance - Overview
Property & Casualty insurance deals with insurance on property (homes, cars, cargo, valuables and businesses) and casualty (legal liability for losses caused by injury to other people or damage to the property of others). It could broadly be classified as Personal and Commercial, depending upon the insured. All guiding principles of Insurance viz. Uberrimae fidei, Indemnity, Subrogation, Causa proxima, Exclusions, Deductibles etc. all apply to it in addition to LoB specific rules and regulations. General mechanism for P&C insurance involves
2nd Edition
New Business Application >> Underwriting >> Policy Administration >> Claims ManagementINS 22 Study Material, 1st Edition & INS 23 Study Material, >> Policy Renewal Source :
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New Business Application & Underwriting
The customer contacts an insurance agent or insurance company directly to inquire about

Types of coverage available Costs related to coverage for a specific need (such as a new house)
Customer chooses the policy type and package and fills out an application, which is then sent to an insurance company underwriter. Underwriting Factors
Source : INS 22 Study Material, 1st Edition & INS 23 Study Material, 2nd Edition
Policy Administration
Based on the underwriting factors, the insurer will either

accept the application, or reject the application, or accept the application with modifications Declarations Page Insuring Agreement Endorsements Modifications
The policy sent to the insured includes the following

It is the policyholders responsibility to read the policy and make sure the coverage provided is what was requested. The policyholder is required to submit the premium payment finally.
Source : INS 22 Study Material, 1st Edition & INS 23 Study Material, 2nd Edition
Claims Management
Generally, when a claim is registered, the claim representative / adjuster has the responsibility to offer a fair settlement to the injured party subject to the maximum limits of the policy. Once the claimant and company agree on the amount of loss, the company pays that amount. If there is disagreement over the claim, the matter may go to arbitration, mediation, or court for resolution. Property Claim
In the event of loss, the policyholder calls their agent or company claims department to report the loss/file a claim. The claims representative will investigate the loss. They will determine whether a policy is in force, and prepare a repair estimate.
Liability Claim
If a third party makes a claim alleging that the policyholder is responsible for damage to/losses by the claimant, the insurance company claims representative would assess the claim, verify insurance coverage, and interview the policyholder, claimant, and the claimants medical doctor to determine theINS 22 Studyof injuries and INS 23 Study Material, Source : extent Material, 1st Edition & negligence.
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2nd Edition
Policy Renewal
Most policies (especially personal lines) run for either six months or 12 months and are renewed at the end of that period. However, policies also can be cancelled or nonrenewed by either the policyholder or the insurer. The policyholder can choose to cancel the policy during the policy period or move to another insurer at the end of the policy period. The insurer can decide to non-renew a policy if the insured has had an unacceptable number of claims, and can cancel a policy during the policy period for non-payment of premium or other specific reasons. Advance notice to the policyholder is required for cancelling the policy and for non-renewing it. 22 Study Material, 1st Edition & INS 23 Study Material, Source : INS
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2nd Edition
Personal P&C Insurance
Overview of Personal P&C Insurance
Personal P&C Insurance covers the financial consequences of loss to Individuals and families caused by damage to property, illness, injury, disability and unemployment. Types of Personal Insurance
Automobile Insurance Homeowners Insurance Other Residential Insurance Health and Disability Insurance
Source : INS 22 Study Material, 1st Edition
Personal Automobile Insurance
Personal Automobile Insurance is insurance purchased for personal vehicles. Its primary use is to provide protection against losses incurred due to damage caused to the vehicle and against liability that could be incurred in an accident. Automobile insurance can cover some or all of the following items:
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Essentials of an Auto Policy
Insurance Company: Indicates Insurance Co. providing the

coverage
Named Insured: Refers to the policyholder(s) Policy Period: The period of coverage (6 Months/ 1 Year) Description of Insured Autos: Vehicles Covered Schedule of Coverages: Indicates Coverages provided along
with the limits and deductibles
Applicable Endorsements: Endorsements that are attached

to the policy
Lienholder: Legal ownership of the vehicle Garaged Location: Where auto is primarily garaged Rating Information: Rating class of the vehicle Signature: Authorized legal representative of the insurer
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6 parts to the Summary of Coverages

Part Part Part Part Part Part
A- Liability Coverage B- Medical Payments Coverage C- Uninsured Motorists Coverage D- Coverage for Damage to Your Auto E- Duties After an Accident or Loss F- General Provisions
Types of Endorsements
Endorsements covering motorcycles, recreational vehicles, and customizing equipment Other endorsements affecting multiple coverages Underinsured motorists coverage endorsement Endorsements affecting physical damage coverage
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Homeowners Insurance
Homeowners insurance is a type of property insurance that covers private homes. It is an insurance policy that combines various personal insurance protections which can include losses occurring to one's home, its contents, loss of its use, as well as liability insurance for accidents that may happen at the home or at the hands of the homeowner within the policy territory. Types of Homeowners Insurance Policies

Basic Form Homeowner Policy Broad Form Homeowner Policy Special Form Homeowner Policy Renter's Insurance Premier Homeowner Policy Condominium Policy Older Houses
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Homeowners Insurance Policy Structure
Section I Property Coverages
Coverage A : Dwelling itself .
Covers the value of the dwelling
Coverage B : Other Structures - Covers other structure around the property which are not used for business, except as a private garage. Coverage C : Personal Property - Covers personal property, with limits for the theft and loss of particular classes of items . Coverage D : Loss of Use/Additional Living Expenses Covers expenses associated with additional living expenses and fair rental value. Additional Coverages - Covers a variety of :expenses such Edition Source INS 22 Study Material, 1st as debris removal, reasonable repairs, damage to trees and shrubs 14 for certain named perils , fire department changes, removal of
Homeowners Insurance Policy Structure
Section II Liability Coverages
Coverage E Personal Liability Covers the cost of a claim or a suit filed against the insured because of bodily damage or property damage. Coverage F Medical Payments to others Covers the necessary medical expenses incurred by others (not an insured) within three years of an injury. Additional Coverages Covers a variety of expenses such as claim expenses, Premium on bonds, reasonable expenses and post judgement Interest .
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Homeowners Insurance Endorsements
Endorsements that modify Section I
Scheduled Personal Property Endorsement Scheduled Personal Property Endorsement (With Agreed Value Loss Settlement)
Endorsements That Increase Limits Other Structures- Increased Limits Increased Limit on Personal Property in Other Residences Increased Special Limits of Liability Increased Limit on Business Property Inflation Guard Water Back-Up and Sump Discharge or Overflow
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Homeowners Insurance Endorsements
Endorsements that modify Section II

Personal Injury Business pursuits Additional Residence Rented to Others Incidental Low- power Recreation Motor Vehicles Owned Snowmobile Watercraft
Endorsements that modify Section I and II

Additional Insured Residence held in Trust Home Daycare Coverage Structures Rented to others
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Other Residential Insurance - Overview
Insurance that covers residential property apart from those covered under standard Homeowners, Renters or Condominium policies. Types of Residential Insurance Policies
Dwelling Insurance Policies Mobile Home Coverage Personal insurance for Farms and Ranches Flood Insurance Insurance for Hard-to-Insure Residences
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Dwelling Insurance
Traditionally, Dwelling insurance is a type of insurance policy used to insure only a dwelling. It doesn't cover any surrounding property or any personal items contained inside the dwelling. However, ISO* Dwelling Policies cover the dwelling and its contents with exception to any theft coverage, personal property and liability coverage. It is * ISO Insurance policy. significantly cheaper than a traditional Homeowners Services Office Structures Eligible for Dwelling Policies
Mobile homes at a permanent location Houseboats in some states Certain incidental business occupancies, if they are operated by the owner- insured or by a tenant of the insured location
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Mobile Home Coverage
Mobile Home coverage relates to the cover provided to homes that are not built on permanent foundations. Mobile Home coverage may cover the following losses:
Damage to or destruction of mobile home Damage to or destruction of other structures on the residence premises
Damage to or destruction of personal property in the mobile home or in other structures
Loss of use of the mobile home Liability loss because of bodily injury to others or damage to the property of others
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Personal Insurance for Farms and Ranches
Personal insurance for farms and ranches covers farmers and ranchers and their land, where they work and usually reside, from loss exposures. PIFR policies consist of Property and Farm Personal Liability Coverages. Property Coverages include

The Farm dwelling Related private structures Household personal property Additional living expenses and loss of rent Personal Injury Expanded custom farming Additional business activities Fruit or vegetable picking by the public Farm chemicals liability
Farm personal Liability Coverages include

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Flood Insurance
Flood Insurance covers the insureds dwelling, as well as its contents from losses that may occur due to catastrophic floods. Flood Insurance may be written only in communities that the Federal Emergency Management Agency (FEMA) has designated as participating communities in the National Flood Insurance Program. Flood Insurance is available on:

Protect Homes Condominiums Apartments Non-Residential buildings
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Insurance for Hard-to-Insure Residences
Insurance for Hard-to-Insure Residences cover homes, which insurers are reluctant to insure under standard homeowners or dwelling policies due to their exposure to greater-than-average losses. FAIR Plans : Fair Access to Insurance Requirements or FAIR plans are state run programs that provide basic property insurance coverage on buildings, dwellings, and their contents for property owners who are unable to obtain coverage in the standard insurance market. To be eligible for FAIR plan coverage, the property to be insured must meet the FAIR plans inspection criteria. Under most FAIR plans, the following types of exposures are considered uninsurable:

Vacant Property Property poorly maintained Property subject to unacceptable physical hazards Property in violation of law or public policy Property not built in accordance with building and safety codes
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Other Personal Property and Liability Insurance
Other Personal and Liability Insurance consists of insurance which cover individuals and families who have special needs. It consists of:

Personal Inland Marine Insurance Personal Watercraft Insurance Personal Umbrella Insurance
Personal Inland Marine Insurance covers miscellaneous types of property, such as movable property, goods in domestic transit, and property used in transportation and communication. Inland marine policy that provides coverage for property that floats or moves (such as jewelry, furs, or cameras) rather than providing coverage at a fixed location are called personal inland Source : INS 22 Study Material, 1st Edition marine floaters.
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Personal Inland Marine Insurance
General Conditions: With certain exceptions, such as fine arts, the amount paid for a covered loss is the least of the four following amounts
The actual cash value of the insured property at the time of loss or damage. The amount for which the insured could reasonably be expected to have the property repaired to its condition immediately before loss The amount for which the insured could reasonably be expected to replace the property with property substantially identical to the article lost or damaged. The amount of insurance stated in the policy
Types of Personal Inland Marine Floaters

Personal articles floater (PAF) Personal property floater (PPF) Personal effects floater (PEF)
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Personal Watercraft Insurance
Personal watercraft insurance covers personal vessels which include small rowboats, canoes, outboard and inboard motorboats, sailboats, houseboats, and power yachts. Personal Watercraft Insurance covers the following losses:
Damage to the boats hull as a result of a collision with another boat Theft of the boats motor or equipment Damage to the boats propeller from hitting an underwater object Lightening damage to electrical and navigational equipment aboard the boat Wind damage to the sail Fire damage to the boat trailer
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Personal Umbrella Insurance
Personal Umbrella Insurance covers catastrophic claims or judgments arising from personal liability exposures associated with homes, automobiles, boats, recreational vehicles, sports, and other personal activities. A catastrophic claim is one that is so large that if uninsured, or underinsured, can impair the insureds standard of living. The personal umbrella policy provides additional liability limits over any underlying insurance, such as homeowners coverage, personal auto liability, and personal watercraft liability policies. The personal umbrella policy typically provides broader coverage than that provided by underlying policies. This broad coverage is called drop down coverage.
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Personal Health and Disability Insurance
Personal Health and disability insurance provides protection against the loss exposures of poor health and injury. Basic Medical Expenses Coverage Hospital Expense Insurance: HEI covers medical expenses
while the patient is in the hospital, such as daily room-and-board and miscellaneous expenses incurred during the hospital stay.
Surgical Expense Insurance: SEI covers part or all of a

physicians fee for a surgical operation.
Physicians Visits Insurance: PVI covers no-surgical care

provided by an attending physician other than a surgeon.
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Major Medical Insurance
Major Medical Insurance covers medical expenses resulting from illness or injury that are not covered by a basic medical expense plan. Types of Major Medical Plans
Supplemental plans cover medical expenses that exceed the limits of the underlying basic medical expense policy. Comprehensive plans are a combination of the basic medical expense coverage and major medical insurance.
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Personal Dental Insurance
Personal Dental Insurance covers normal dental care and damage to teeth in an accident. Types of Dental Plans
Scheduled Plan covers dental services which are listed in a schedule and a specific dollar amount is paid for each service. Most scheduled plans do not have deductibles or coinsurance. Non-scheduled Plan covers most dental services and dentists are reimbursed on the basis of their usual, reasonable, and customary charges subject to any limitations on benefits stated in the plan.
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Other Types of Personal Health Plans
Long-Term Care Insurance pays for extended medical care or custodial care received in a nursing home, hospital or home. Managed Care Plans provide coverage for cost-effective medical services to plan members. Health Maintenance Organization is a managed care plan that provides a range of comprehensive health-care services to its members for a fixed, prepaid fee; members choice of healthcare providers is usually restricted to those in the HMO network. Preferred Provider Organization is a managed care plan that contracts with healthcare providers for medical services provided to plan members at discounted fees; members choice of healthcare providers is not restricted, but members have a financial incentive to choose contracted providers.
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Other Types of Personal Health Plans contd
Exclusive Provider Organization is a managed care plan that pays only for medical care received within the network of preferred providers. Point-of-Service Plans is a managed care plan that combines the characteristics of a HMO and a PPO; has a network of preferred providers who, if used by the member, charge little or nothing for services; healthcare received out of the network is covered, but members must pay substantially higher coinsurance charges and a deductible. Disability Income Insurance pays periodic income payments to an insured who is unable to work because of sickness or injury.
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Govt. Heath Insurance & Healthcare Programs
These are Healthcare programs run by the Government and they consist of
Medicare: Social insurance program that covers the medical expenses of most individuals age sixty-five and older. Medicaid: Federal-state welfare program that covers the medical expenses of low income persons, including those who are aged, blind, or disabled; members of families with dependent children; and pregnant women as well as certain children. Workers Compensation: Social Insurance program that provides valuable health and disability insurance protection to employed workers.
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Commercial P&C Insurance
Commercial Insurance
It is a property & liability insurance for businesses and other organizations. Lines of Commercial Insurance
Commercial Auto Insurance Commercial Property Insurance Inland & Ocean Marine Insurance Crime Insurance
Commercial General Liability Ins. Farm Insurance Equipment Breakdown Insurance Excess & Umbrella Liability Ins. Business Income Insurance
Professional Liability Insurance
It could be Monoline Policy (only one LoB) and Package Policy (combination of 2 or more LoB) Business owners Insurance Environmental Insurance
Source : INS 23 Study Material, 2nd Edition
Workers Compensation & EL Ins. Aircraft Insurance
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Commercial Package Policy

Commercial Commerci Property al Property Dec. Page Dec. Page Commercial Commerci Property al Property Coverage Dec. Page Form(s) Commercial Commerci Property al Property Causes of Dec. Page Loss Form(s) Commercial Commerci Property al Property Conditions Dec. Page Form
CGL Dec. Page
CGL Coverage Form
Commercia l Package Policy (CPP)
Commercial Policy Conditions
Common Declarations
Crime Dec. Page
Crime Coverage Form
Equipment Breakdown Protection Dec. Page
Equipment Breakdown Protection Coverage Form
Inland Marine Dec. Page
Inland Marine Coverage Form(s) Auto Coverage Form
Inland Marine Conditions Form
Auto Dec. Page
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Commercial Auto Insurance - Overview
Commercial Auto Insurance is meant for organization that owns one or more autos. Commercial property and general liability insurance exclude commercial auto exposures. Commercial Auto Exposures
Physical damage to an auto can reduce its value or reduce business income. Organization may have to defend itself against suits alleging negligent ownership, maintenance, or use of autos thereby creating auto liability.
ISO enlist 03 different Coverage Forms Business Auto
Coverage, Garage Coverage and Motor Carrier Coverage forms.
Business Auto Coverage covers liability arising out of the ownership, maintenance, or use ofSource : INS 23 and autos Study Material, 2nd Edition physical damage to autos owned, leased or hired by the 37
Commercial Auto Insurance Coverage Forms
Structure of Business Auto Coverage Form (filed by ISO)

Section I Section II Section III Section IV Insurance Section V
: : : :
Details Details Details Details
about about about about
the covered automobiles the liability coverage the physical damage coverage the conditions of Comm. Auto
: Enlists various pertinent definitions
Garage Coverage covers the commercial auto and general liability exposures of auto and trailer dealers. Motor Carrier Coverage covers businesses using autos to transport their own or others property.
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Rating of Commercial Auto Insurance
Commercial Auto Insurance rating shall conform to ISO Commercial Lines Manuals automobile rules and statutes. Private passenger vehicles are rated per the private passenger premium tables. Trucks, Tractors, and Trailers are rated per

Size Class (Light / Medium / Heavy / Extra-Heavy) Business Use (Service / Retail / Commercial) Radius (Within 50 miles, 51 200 miles, Beyond 200 miles)
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Commercial Property Insurance - Overview
Types of Property

Real Property (Immovable Property) Land, Building etc. Personal Property (Movable Property) Furniture, Fixture, H/W etc. Tangible Property Properties which physically exist. Intangible Property Trademark, Copyrights, S/W, IP etc.
Structure of Comm. Property Coverage part
Commercial Property Declarations Commercial Property Coverage Forms (one or more) Causes of Loss Forms (one or more) Commercial Property Conditions Endorsements (if any)
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Building & Personal Property Coverage Form
09 sections of BPP Coverage Form

1.
Covered Property Property Not Covered Additional Coverage Coverage Extensions Limits of Insurance
6.
Deductibles Loss Conditions Additional Conditions Optional Coverage
2.
7.
3.
8.
4.
9.
5.
Insuring fluctuating values Due to wide fluctuations in property
values (e.g. stocks, inventory etc.), it is difficult to underwrite and evaluate accurately. Value Reporting Form and Peak Season Limit of Insurance endorsements provide possible solution to this problem.
Specific Insurance (Covers each building and its property for a specific limit) vs Blanket Insurance (Covers either one type of
property in one or more separately rated buildings or two or more types of property in one or more separately rated buildings). Source : INS 23 Study Material, 2nd Edition
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Causes of Loss Form
Types
Basic Form : Fire, lightning, explosion, windstorm, hail, smoke, riot etc.
Broad Form : Basic Form perils+ falling objects, snow/ice, water perils
Special Form : Covers risks of direct physical loss
Sections
Section A : Covered causes of loss Fire, Explosion, Windstorm etc.
Section B : Exclusions Earth Movement, Nuclear Hazard, War etc.

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Commercial Property Conditions
Coverage is doomed void in case of concealment or misrepresentation of material facts, or in case of fraud.
Coverage under policy will not be affected by acts or omissions of persons other than the insured. Violation of a policy condition at one location shall not the coverage at any other location.
Duplication of insurance under two or more coverage is not allowed. Legal Action against Insurers can only be entertained if the insured has complied to all policy conditions and has brought the legal action to notice within 02 years of the occurrence of the event (loss).
No benefit of insurance shall be extended to Bailee in case of any damage.
Insurer has the Rights of Recovery (Subrogation) against other parties.

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Commercial Property Endorsements
Ordinance or Law Coverage Covers 3 types of losses resulting

from the enforcement of building ordinance or laws

The value of undamaged portion of building that must be demolished The cost to demolish the buildings undamaged part & remove debris The increased cost to rebuild the property.
Spoilage Coverage Covers damage to perishable goods due Manufacturers consequential loss assumption Brands and Labels It permits the insured to stamp the word Flood Coverage Earthquake and Volcanic eruption coverage
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power outage or contamination of insureds refrigerating, cooling and humidity control equipment.
salvage on the merchandise or to remove its brands/labels before it is sold by the insurer as salvage.
Rating Commercial Property Coverage
Premiums may be affected by

Limit of Insurance Covered causes of loss Coinsurance percentage Deductible Amount Optional Coverage COPEL (Construction, Occupancy, Protection, Exposure & Location)
Specific Rating vs Class Rating
Specific Rating bases a buildings property insurance rate on inspecting and evaluating that particular building. Class Rating uses rates reflecting the average probability of loss for business within large groups of similar risks. This is predominantly used for rating commercial properties.
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Commercial General Liability Ins. - Overview
CGL Insurance covers many of the common liability loss exposures faced by an organization, including its premises, operations, and products. If Mr. Gupta visits Big Bazar and while shopping he slips on the uneven and breaks his arm. If Mr. Gupta sues the store to recover the medical expenses and lost wages, Big Bazar will sustain a liability loss (which may be covered under CGL Insurance). But, if Big Bazar incurs cost to make the floor even to avoid any such occurrence in future, it wont be reimbursed. Also, indirect costs, time consumed while defending the claim, adverse publicity etc. would not be covered.
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Loss Exposures covered by CGL
Premises Liability A customer slips on a spill in the insureds store and breaks his ankle. Operations Liability While soldering pipes, an employee of the insured plumbing contractor accidentally sets a customers house on fire. Products Liability A defective gas range manufactured by the insured causes an explosion that damages the buyers home. Completed Operations Liability A completed building constructed by the insured collapses, injuring tenants and pedestrians.
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CGL Coverage Forms
3 different ISO Coverage Forms

A : Bodily Injury and Property Damage Liability B : Personal and Advertising Injury Liability C : Medical Payments To pay damages on behalf of the insured To defend the insured against claims or suits seeking damages covered under the policy. Expected or Intended injury Contractual Liability Liquor Liability (manufacturers, distributors or sellers) Workers Compensation & Employers Liability Pollution, War, Fire Legal liability etc.
Insurer, in Coverage A, promises

Insurer, in Coverage A, excludes

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A - Bodily Injury and Property Damage Liability
Insurers duty to pay damages only when
Insured is legally obligated to pay damages, and Damages result from bodily injury or property damage defined in the policy, and
Policy must apply to bodily injury or property damage, and It must be caused by an occurrence, and The occurrence must take place in coverage territory, and It must occur during the policy period, and It must not be known to the insured or certain other persons before the policy period.
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B - Personal and Advertising Injury Liability
CGL Coverage B covers liabilities resulting from numerous offenses like
False arrest, detention, or imprisonment; Malicious prosecution; Wrongful eviction from/entry into a room/dwelling by owner/lessor;
Oral or written publication of any material that slanders or libels a person or organization;
Oral or written publication of any material that violates a persons right of privacy;
Use of anothers advertising idea; and Copyright infringement.

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Coverage Form C - Medical Payments
Coverage C of the CGL form obligates the insurer to pay for medical expenses of persons injured on the insureds premises or as a result of insureds operations. It excludes
Bodily injury to any insured (other than a volunteer worker) Anyone who is hired to do work for an insured or for his tenant Anyone who is entitled to workers compensation benefits to the injury
If a person is injured while taking part in athletics Bodily injuries which are excluded under Coverage A
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Equipment Breakdown Insurance - Overview
Covers loss due to accidental breakdown of equipment that operates under pressure or that controls, transmits, or uses power (electrical or mechanical). Example cases
A heating boiler in a telephone company switching office exploded and tore through the roof like a missile. A factory boiler that over-heated as a result of low-water conditions sustained damage to its furnace tubes & a portion of rear tube sheet. A short circuit in the aluminum bus in an apartment building caused extensive damage to buildings cables and wiring. Not restricted to perils mentioned in BPP Electrical or Mechanical breakdown & Steam Boiler explosion excluded in BPP To cover business income loss, extra expenses and other losses.
Why EBI if I already have taken BPPI?

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Equipment Breakdown Insurance
10 insuring agreements of ISO EB Form

Property Damage

Newly acquired Premises Ordinance or Law Errors & Omissions Brands & Labels
Expediting Expenses BI Loss & Extra Expenses Spoilage Damage Utility Interruption
Contingent BI Loss & Extra Expenses
Limits of EBI
Overall Limit Maximum quantum of cover (including all forms of liabilities on the insurer) against a covered peril/incident. Individual Sub-limits for Ammonia Contamination, Hazardous Substance, Water damage etc. (generally 25000 USD each).
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Business Income Insurance
BII covers the reduction in the insureds net income due to interruption in operations caused by a covered peril. Business Income Loss = Foregone Profit + Continuing Expenses + Extra Expenses Types

Business Income (and Extra Expense) Coverage Form Business Income (Without Extra Expense) Coverage Form
Additional Coverage Expenses to reduce loss, Civil Authority, Alterations & New Buildings etc. Exclusions Off-premises services interruption, Finished Stock, Delay /Suspension /Lapse /Cancellation of agreements etc.
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Workers Compensation & Employers Liability Insurance
It started with industrialized nations. Presently, it covers all states of the US and provinces of Canada. Workers Compensation Statute : It obligates employers, regardless of fault, to pay specified medical, disability, rehabilitation and death benefits for their employees jobrelated injuries and diseases. WC & EL Insurance covers
Employee injury claims arising out of industrial accidents or occupational disease.
Liability claims arising out of workers compensation laws.
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Important Aspects of WC&EL Insurance
Benefit Administration

Administered by Workers Comp. Board / Industrial Commission. Employee notifies the employer >> Employer submits injury report to Insurer >> Insurer transmits to Administrator >> Claim settled. Covers virtually all industrial workers. Applicable for regular/temporary/leased employee and those under an independent contractor except Casual Employee. Farm labour, Domestic work, Maritime workers etc. are exempt. If Mr. X, an employee of ABC Insurance, MI is injured while on work in LA, he shall be subject to WC regulations of MI. The same applies for expats provided they have not been out of the US for more than a stipulated period (generally, 30 days 06 months).
Persons/Employments Covered

Extraterritorial Provisions
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WC & EL Policy Structure

Per NCCI*, WC&EL Policy consists of Information Page Details about insured, coverage period,
summary of coverage provided, State WC regulations etc.
*NCCI National Council on Compensation Insurance, US
Policy Form 1. Workers Compensation Insurance 2. Employers Liability Insurance 3. Other States Insurance 4. Your Duties (if injury occurs) 5. Premium 6. Conditions Endorsements (if any) Provisions to add/remove/modify
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certain coverage, conditions etc. can be mentionedStudy this 2nd Edition Source : INS 23 in Material, section.
Six parts of the Policy Form
Part 1 deals with WC statutes of listed state. Includes coverage details and rights of the insurer and insured. Part 2 deals with EL statutes (e.g. occupational injuries, 3rd party claims etc.) of listed state. Includes EL exclusions & limits of liability. If the insured wishes to expand in other states (not listed on Info page), Part 3 provides provisions/details on this. Part 4 details the duties and rights of the insured in case any claim occurs. It also details the procedure for intimating the claim. Part 5 details about the premium factors affecting Source : INS 23 premium, segregation of premium and premium Study Material, 2nd Edition determination procedure. 58
Marine Insurance - Overview
Insurance on the risks of transportation of goods is one of the oldest (with origins in the Greek & Roman maritime loan) and most vital forms of insurance. Marine Insurance Act, 1906 of UK is the basis of marine insurance across the globe with country-state-specific changes. All basic principles of insurance like uberrimae fidei , insurable interest, indemnity, subrogation, causa proxima etc. apply to it in addition to specific clauses like Franchise, Average etc. Broadly 02 categories Inland Marine Insurance (inland) and Ocean Marine Insurance (international transit, generally sea). Source : INS 23 Study Material, 2nd Edition
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Inland Marine Insurance
Insurance cover against perils of inland transit which may cause damage to property or which may create liabilities out of such an incident. Goods in domestic transit Common Carrier vs Contract Carrier vs Private Carrier Bailment Contracts a) For benefit of bailor (owner), b) For benefit
of bailee (temporary possession) and, c) For mutual benefit of bailor and bailee.
Filed Inland Marine Coverage

Commercial Articles Camera & Musical Instruments Physicians & Surgeons Equipment Signs, Film, Theatrical Property, Jewelry etc.
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Inland Marine Insurance
Non-filed Inland Marine Coverage

Contractors Equipment Builders Risk Transit (Trip transit policy vs Annual transit policy) Motor Truck Cargo Liability Difference in Conditions policy
Rating of Inland Marine Coverage
ISO Commercial Lines Manual (CLM) for filed class inland marine insurance. For non-filed class, common practice includes Loss Experience rating, Judgment rating, case-to-case transit evaluation along with market forces.
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Ocean Marine Insurance
Insurance cover against perils of sea which may cause damage to property or which may create liabilities out of such an incident. Major 3 types Cargo Insurance, Hull Insurance and Protection & Indemnity Insurance. Cargo Insurance covers the shipper or receiver of the goods if the goods are damaged or lost while in transhipment from one place to another. It could be covered either under Voyage Policy (single trip) or Open Cargo Policy (for a policy term until either insured or insurer cancels it). Loss could be quantified by bill of lading or invoice or an agreed value. But in general practice, it is valuedStudy Material, 2nd Edition as = Source : INS 23 Amount of Invoice + Freight + x % (for additional expenses).
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Warehouse to warehouse clause ensures complete cover from point of origin to point of final destination. All risk coverage except loss due to delay, war, strikes, riots or civil commotion. Hull Insurance covers physical damage to vessels including their machinery and fuel against the perils of sea, fire, lightning, earthquake, barratry and all other like perils. It could be covered either under Voyage Policy (at-and-fromvia) or Time Policy (for a specified period, round the globe with some restrictions). A vessel is insured for an agreed value and in case of total loss, the same is payable. For partial loss, cost of repairs is insurers liability. Source : INS 23 Study Material, 2nd Edition
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Protection & Indemnity insurance covers ship owners against various liability claims due to operating the insured vessel. P&I Liabilities may arise out of - Damage to public property, injury to passengers and crew, injury to persons on other ships (collision) etc. A significant portion of P&I insurance is underwritten by P&I Clubs. Cargo underwriters may consider past loss experience, type of packing, trade route, time of the year, volume of shipments, port conditions, ocean and inland carriers etc. while deciding upon premium. Hull and P&I underwriters may consider factors like size, type and age of the vessel, area of navigation, trade in 2nd Edition Source : INS 23 Study Material, which it is employed, past record etc. while deciding upon 64 premium.
Miscellaneous Commercial Insurance Types
Crime Insurance
Coverage for loss of money & securities caused by employee theft. Also covers robbery, burglary & theft.
Key-man Insurance
Coverage to compensate for financial losses that would arise from the death or extended incapacity of the key member (highly skilled professional) of the business specified on the policy.
Professional Liability Insurance
Protects professional practitioners such as Chartered Architectural Technologists, Architects, Quantity surveyors, Home inspectors, Lawyers, Physicians, and Accountants against potential negligence claims made by their patients/clients.
Aircraft Insurance
Covers liability due to insureds ownership, maintenance, or use of aircraft; physical damage to aircraft owned or used by the insured; and other aircraft loss exposures.
Surety Bonds
In a surety bond, the surety (usually an insurer) guarantees to the obligee that principal will fulfill an obligation or perform as Source : INS 23 Study Material, 2nd Edition promised. If principal fails to honour the contract, surety will fulfill the obligation. 65
Few important things to remember
Though there are several different kinds of personal and commercial P&C Insurance, generally they are taken as a package policy and not in silos. There may be instances where property damages and liabilities out of an accident could call for multiple insurers. Principle of Contribution comes to respite to handle such situations. The basic principles of insurance indemnity, insurable interest and risk pooling shall apply to all forms. An insured shall not make profit out of insurance.
66
IT Solutions for P&C INS.
IT Solutions for P&C Insurance
3i Infotechs PREMIA Policy Admin & Analytics
PREMIA is a web-based application that provides a broad range of components for small and mid-sized insurers and is gaining some momentum in the North American marketplace. PREMIA provides a 360 degree view of a carriers information, allowing a user to search on all lines of business, policies, claims, billing info, customers, etc. The Cram Business Application Suite is a comprehensive solution that includes both core SEM and program-specific components required to support a social enterprise. It is designed to help agencies manage their clients in a holistic and integrated manner. TCS BNCS flagship insurance offering provides an end-to-end solution for insurers in both the property/casualty and life sectors. TCS BNCS insurance solution offers new business and underwriting, policy service, claims administration, and several other components. TCS BNCS insurance solution is also in use in 14 countries outside of North America.
Source : Policy Administration Systems for Commercial Lines P/C Insurers US 2009, May 2009
IBMs Curam Workmens Compensation
TCSs BNCS (Insurance Suite)
68
3i Infotechs PREMIA
PREMIA offers 6 of the 7 advanced policy administration functions.
Source : Policy Administration Systems for Commercial Lines P/C Insurers US 2009, May 2009
69
IBMs Cram Business Application Suite

Workforce Services Solution
Source : Cram Business Application Suite on IBM System z Application Manual
70
Cram Solutions provide
Accurate eligibility determination and entitlement assessment.
Support for the management and processing of temporary payments.
Support for multiple access channels within a single system. Tools for capturing and reporting worker data. Client registration and referral to supportive service requirements.
Full claim life cycle management. Service planning tools.

Source : Cram Tools for monitoring financial data.Business Application Suite on IBM System z Application Manual
71 Automated support for change-in circumstance processing,
TCS BNCS (Insurance Suite)
TCS BNCS solutions include line-of-business products for property and casualty, workers compensation, extended warranty, individual life, group life and reinsurance. It is a flexible platform that helps insurers to become bigger, leaner and smarter. Product Workbench, the product management component of TCS BNCS Insurance, supports the development of innovative and complex insurance products across all business lines. Agent Workbench, a component on BNCS Insurance, is a stand-alone, connected, on-demand, browser-based application, which enables sales personnel to conduct presale and post-sale activities offline efficiently. Its functions include - Illustration, Plan combination and comparison; Source : http://www.tcs.com/offerings/bancs/solutions/insurance System management and administration; Insurance 72 calculation; Manage Customer information and a lot of
Insurance solutions at Infosys
Infosys partners with leaders across all segments of the insurance industry - Life, P & C, LTC, Reinsurance, Specialty lines. Our IT services footprint covers application development and maintenance, infrastructure services, BPO and business consulting. Our New Business Excellence (NBX) solution for P & C enables commercial lines carriers to revamp new business processes and leverage technology. NBX helps carriers improve their operational efficiency and makes underwriting more effective by making it data driven, thus creating a robust platform for sustained profitable growth. Our Claims Excellence - Life and Health solution uses a combination of workflow automation, electronic content management, system integration and information channel management to transform claims processing.
Source : http://www.infosys.com/offerings/industries/insurance/industryOur insurance outsourcing services reduce operating costs while offerings/pages/index.aspx increasing efficiency, responsiveness, consistency and quality.
73
P&C Clients at infosys
P&C Insurance Clients at Infosys
AON Corporation Allstate Corporation AMB Generali Axis Capital Holding Chubb Genworth Financial Nationwide
Northwestern Mutual Life PMI

75
AON Corporation
Aon Ltd. is worlds second largest Risk Management Company with revenues of $7.60 billion (2009). 59,000+ Employees worldwide, headquarters based in Chicago, IL. It operates through 600 Offices in over 125 Countries and Sovereignties. Best Employee Benefit Consulting Firm and Best Retail Agent/Broker in 2007 by Business Insurance. Aon provides products and services in Risk services, Specialty risk services, Outsourcing services, Human capital consulting, Management consulting. Aon Corporation has been associated with Infosys Technologies since 1998. Projects
76
Allstate Corporation
Allstate is the second-largest personal lines insurer in the United States with revenues of $32 billion (2009). The Allstate Corporation encompasses more than 70,000 professionals. Headquarters based in Northbrook, IL. Allstate sells 13 major lines of insurance, including auto insurance, home insurance, life insurance, and commercial insurance. Allstate Corporation has been associated with Infosys Technologies since 2006. Projects DMEA (Distribution & Marketing), Alliance (Legacy to Web Apps migration), Transcend (Annuity), Interlink etc.
77
Swiss Reinsurance Company
Swiss Re is one of the oldest insurance companies in the world with revenues of CHF 33 billion (2009). Swiss Re is the worlds second-largest reinsurer, not only in the United States but internationally. 10500+ Employees worldwide. Swiss Re has its headquarters at Zurich, with 90 offices in 25 countries. As one of the worlds leading and most diversified reinsurers, Swiss Re provides reinsurance products and financial services that enable risk taking essential to enterprise and progress. Swiss Re has been associated with Infosys Technologies since ????. Projects
78
Nationwide Insurance
Nationwide Insurance, a Fortune 100 company based in Columbus, Ohio is one of the largest insurance and financial services companies in the world. Nationwide provides a full range of insurance and financial services, including auto, homeowners and commercial insurance, life insurance, annuities, retirement plans, mutual funds and employerrelated administrative services. Nationwide currently has about 36,000 employees with revenues of $ 22 billion (2009) operating in all 50 states of the US. Nationwide has been associated with Infosys Technologies since 2005. Projects
79
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The contents of this document are proprietary and confidential to Infosys Technologies Ltd. and may not be disclosed in whole or in part at any time, to any third party without the prior written consent of Infosys Technologies Ltd. 2008 Infosys Technologies Ltd. All rights reserved. Copyright in the whole and any part of this document belongs to Infosys Technologies Ltd. This work may not be used, sold, transferred, adapted, abridged, copied or reproduced in whole or in part, in any manner or form, or in any media, without the prior written consent of Infosys Technologies Ltd.

PNC Insurance - Training Slides

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PROPERTY & CASUALTY INSURANCE

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P&C Insurance Definition and Practice 07

Overview of various Personal P&C Insurance 33

Clients at Infosys dealing in P&C Insurance Slides 74 79

P&C Insurance - Overview

New Business Application & Underwriting

Based on the underwriting factors, the insurer will either

The policy sent to the insured includes the following

Personal P&C Insurance

Overview of Personal P&C Insurance

Source : INS 22 Study Material, 1st Edition

Personal Automobile Insurance

Source : INS 22 Study Material, 1st Edition

Personal Automobile Insurance

Essentials of an Auto Policy

Insurance Company: Indicates Insurance Co. providing the

Applicable Endorsements: Endorsements that are attached

Personal Automobile Insurance

6 parts to the Summary of Coverages

Part Part Part Part Part Part

Source : INS 22 Study Material, 1st Edition

Homeowners Insurance Policy Structure

Section I Property Coverages

Coverage A : Dwelling itself .

Covers the value of the dwelling

Homeowners Insurance Policy Structure

Section II Liability Coverages

Source : INS 22 Study Material, 1st Edition

Homeowners Insurance Endorsements

Endorsements that modify Section I

Homeowners Insurance Endorsements

Endorsements that modify Section II

Endorsements that modify Section I and II

Source : INS 22 Study Material, 1st Edition

Other Residential Insurance - Overview

Source : INS 22 Study Material, 1st Edition

Mobile Home Coverage

Damage to or destruction of personal property in the mobile home or in other structures

Personal Insurance for Farms and Ranches

Farm personal Liability Coverages include

Protect Homes Condominiums Apartments Non-Residential buildings

Source : INS 22 Study Material, 1st Edition

Insurance for Hard-to-Insure Residences

Other Personal Property and Liability Insurance

Personal Inland Marine Insurance

Types of Personal Inland Marine Floaters

Personal Watercraft Insurance

Source : INS 22 Study Material, 1st Edition

Personal Umbrella Insurance

Personal Health and Disability Insurance

Surgical Expense Insurance: SEI covers part or all of a

Physicians Visits Insurance: PVI covers no-surgical care

Source : INS 22 Study Material, 1st Edition

Major Medical Insurance

Source : INS 22 Study Material, 1st Edition

Personal Dental Insurance

Source : INS 22 Study Material, 1st Edition

Other Types of Personal Health Plans

Other Types of Personal Health Plans contd

Source : INS 22 Study Material, 1st Edition

Govt. Heath Insurance & Healthcare Programs