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182 Cards in this Set

  • Front
  • Back
Insurance is these four things
1. Risk management technique
2. Transfer system
3. Business
4 Contract
Law of large numbers
A mathematical principal stating that as the number of similar but independent exposure units increase, the relative accuracy of predictions about future outcomes (losses) based on these exposure unites also increase
Three major types of losses
1. Property loss
2. Liability loss
3. Personal and personnel loss
Personal loss exposure
Any condition or situation that presents the possibility of financial loss to an individual or family by such causes as death, sickness, injury or unemployment
Personnel loss exposure
Any conditions or situation that presents the position of a financial loss to a business because of death, disability, retirement or resignation of key employees
Six ideally insurable loss exposures
1. Pure, not speculative risk
2. Accidental loss
3. Definite in time and measurable
4. Large number of similiar but independent exposures
5. Not subject to simultaneously affect many other similar exposures
6. Economically feasible to insure
Three types of private insurers
1. Stock insurers
2. Mutual insurers (owned by policyholders)
3. Reciprocal insurance exchanges
Nine benefits of insurance
1. Indemnifying for the cost of covered losses
2. Reducing the insured's financial uncertainty
3. Promoting insurers' loss control activities
4. Using resources efficiently
5. Providing support for credit
6. Satisfying legal requirements
7. Satisfying business requirements
8. Providing a source of investment funds
9. Reducing social burden
Five costs of insurance
1. Premiums paid by insureds
2. Operating costs of insurers
3. Opportunity costs
4. Increased losses
5. Increased lawsuits
Six types of property insurance
1. Fire and allied lines
2. Business income
3. Crime
4. Ocean marine
5. Inland marine
6. Auto physical damage
Fire and allied lines insurance
Covers direct damage to or loss of insured property
Four types of liability insurance
1. Auto liability
2. Commercial general liability
3. Personal liability
4. Professional liability
Three types of life insurance
1. Whole life
2. Term
3. Universal life
Whole life insurance
Life insurance that provides lifetime protection, accures cash value, and has premiums that remain unchanged during the insured's lifetime
Term insurance
Life insurance that provides coverage for a specific period, such as ten or twenty years, with no cash value
Universal life insurance
Insurance that provides life insurance protection and a savings component
Stock insurance
Insurer that is owned by its stockholders and formed as a corporation for the purpose of earning a profit
Four ways private insurers differ
1. Purpose for which they were formed
2. Legal form of organization
3. Ownership
4. Method of operation
Mutual insurer
Insurer that is owned by its policyholders and formed as a corporation for the purpose of providing insurance to them
Demutualization
The process by which a mutual insurer owned by its policyholders becomes a stock company which is then owned by its stockholders.
Reciprocal insurance or interinsurance exchange
An insurer owned by its policyholders, formed as an unincorporated association for the purpose of providing insurance to its members
Subscribers
Policyholders of a reciprocal insurance exchange
Four thing Social Security provides
1. Retirement benefits for the elderly
2. Surivorship benefits for the dependents of deceased workers
3. Disability payments for disabled workers
4. Medical benefits for elderly
Five common types of state goverment insurance programs
1. Workers' comp
2. Unemployment
3. Automobile insurance plans
4. Fair Access to Insurance Requirements
5. Beachfront and windstorm pools
Guaranty fund
A state fund that provides a system to pay the claims of insolvent insurers, generally funded by assessments collected from all insurers licensed in the state
Three primary objectives of insurance regulation
1. Rate regulation
2. Solvency surveillance
3. Consumer protection
National Association of Insurance Commissioners
Association of commissioners from each state who coordinate regulation activities among various state insurance departments
Model law
Document drafted by NAIC that reflects the NAIC's propsed solution to a given problem and provides common basis to states for drafting laws that affect the insurance industry
Actuarial equity
A ratemaking concept though which actuaries base rates on calculated loss experience to place insureds with similar characteristics in the same rate class
Social equity
A rating concept that holds that rate structures discriminate unfairly if they impose a higher rate on a insured for factors beyond the insured's control
Six types of insurance rating laws
1. Prior-approval
2. Flex rating (approval only if rate is above/below certain amount)
3. File-and-use
4. Use-and-file
5. Open competition / no-file
6. State-mandated
Insurance Regulatory Information System
An information and early-warning system established and operated by the NAIC to monitor the financial soundness of insurers
Five ways regulators protect consumers
1. Licensing insurers
2. Licensing insurer repesentatives
3. Approving policy forms
4. Examining market conduct
5. Investigating consumer complaints
Foreign insurer
Licensed to operated in a state but incorporated in another state
Alien insurer
Licensed in a U.S. state but incorporated in another country
Excess and surplus lines insurance
Insurance coverages unavailable in the standard market that are written by nonadmitted insurers
Five classes of business often insured in E&S market
1. Unusual or unique loss exposures
2. Nonstandard business
3. Insureds needing high limits
4. Insureds needing unusually broad coverage
5. Loss exposures that require new forms
Earned premium
Portion of the written premium that apply to the part of the policy period that has already occured
Incurred losses
Paid losses + Changes in loss reserves
Loss reserves
Amounts designated by insurers to pay claims for losses that have already occurred but are not yet settled
Three underwriting expenses (not losses or LAE)
1. Acquisition expenses
2. General expenses
3. Premium taxes, licenses and fees
Net investment income
Investment income - Investment expenses
Net underwriting gain or loss
Earned premium - losses and underwriting expenses
Overall gain or loss from operations
Net investment gain or loss + Net underwriting gain or loss
Admitted assets
Types of property, such as cash and stocks, that regulators allow insurers to show as assets on their financial statements
Nonadmitted assets
Types of property, such as office furniture and equipment, that regulators do not allow insurers to show as assets on financial statements because thee assets cannot readily be converted to cash
Unearned premium reserve
Total of an insurer's unearned premium on all policies at a particular time
Policyholders' surplus
An insurer's total admitted assets minus its total liabilities
Loss ratio
Incurred losses (including LAE) / Earned premiums
Expense ratio
Incurred underwriting expenses / Written premium
Dividend ratio
Policyholder dividends / Earned premium
Combined ratio
Loss ratio + Expense ratio
Investment income ratio
Net investment income / Earned premiums
Overall operating ratio
Combined ratio - Investment income ratio
Capacity ratio
Written premiums / Policyholders' surplus
Five duties on insurance agents
1. Loyalty
2. Obedience
3. Reasonable care
4. Accounting
5. Relaying information
Principal
In the agency relationship, the party that authorizes the agent to act on its behalf.
Three types of authority for an agent
1. Express
2. Implied
3. Apparent
Express authority
The authority that the principal specifically grants to the agent
Implied authority
The authority implicitly conferred on an agent by custom, usage or a principal's conduct indicating intention to confer such authority
Apparent authority
A third party's reasonable belief that an agent has authority to act on the principal's behalf.
Four insurance marketing systems
1. Independent agency
2. Exclusive agency
3. Direct writing
4. Alternative distribution channels
Independent agency
A business, operated for the benefits of its owners that sells insurance, usually as a representative of several unrelated insurers
Insurance broker
An independent business owner or firm that sells insurance by representing customers rather than insurers
Direct writing system
A system of insurance marketing that uses sales representatives who are employees of the insurer
Five alternative distribution channels
1. Direct response
2. Internet
3. Call centers
4. Group marketing
5. Financial institutions
Direct response
A system of insurance marketing that relies primarily on mail, phone and/or Internet sales without the services of an agent
Contingent commission
A commission that an insurer pays, usually annually, to an independent agency that is based on the premium volume and profitability level of the agency's business with that insurer.
Marketing representative
An insurer employee who visits agents representing the insurer, develops and maintains sound working relationships with those agents , and motivates the agents
Production underwriter
Insurer employee who works in the insurer's office in an underwriting position but also travels to visit and maintain rapport ith agents and sometimes clients.
Unfair trade practices law
State law that specifies certain prohibited business practices
Four unfair trade practices
1. Misrepresentation and false advertising
2. Tie-in sales
3. Rebating
4. Other deceptive practices
Rebating
A practice, prohibited in most states, of offering a cash payment or something of value to an applicant as an inducement to buy or maintain insurance
Adverse selection
A situation that occurs because people with the greatest probability of loss are the ones most likely to purchase insurance
Capacity
The amount of business an insurer is able to write, usually based on a comparison of the insurer's written premiums to its policyholders' surplus
Three ways insurers protect their acailble capacity
1. Maintaining a spread of risk
2. Optimizing use of available resources
3. Securing reinsurance
Merit rating plan
A rating plan that modifies class rates to reflect loss characteristics of a particular insured
Judgement rate
A type of individual rate that is used to develop a premium for a unique exposure for which there is no established rate
Treaty reinsurance
An arrangement whereby a reinsurer agrees to automatically reinsure a portion of all eligible insurance of the primary insurer
Five underwriting management responsibilities
1. Participating in the insurer's overall management
2. Arranging reinsurance
3. Delegating underwriting authority
4. Developing and enforcing underwriting guidelines
5. Monitoring underwriting results
Facultative reinsurance
An arrangemtn whereby the primary insurer choose which policies to submit to the reinsurers and the reinsurer can accept or reject any policies submitted
Four steps of the underwriting process
1. Gathering underwriting information
2. Making the underwriting decision
3. Implementing the underwriting decision
4. Monitoring the underwriting decision
Four types of hazards
1. Moral hazard
2. Attitudinal (morale) hazard
3. Physical hazard
4. Legal hazard
Moral hazard
A condition that may lead a person to intentionally cause or exaggerate a loss
Attitudinal (morale) hazard
A hazard that involved carelessness about, or indifference to, potential loss on the part of an insured or application
Physical hazard
A tangible characteristic of property, persons or operations that tends to increase the frequency or severity of loss
Legal hazard
A characteristic of the legal or regulatory environment that hampers an insurer's ability to collect a premium commensurate with the exposure to loss
Two examples of underwriting activity regulation
1. Prohibition of unfair discrimination
2. Restrictions on cancellation and nonrenewal
Public adjuster
A person hired by an insured to represent the insured in handling the claim
Third-party administrator
An organization that contracts to provide administrative services, including claims handling to other businesses
Four steps to claims handling process
1. Verifying coverage
2. Determining cause of loss
3. Determining the amount of damage or extent of loss
4. Negotiating and settling (or denying) the claim
Reservation of rights letter
A notice sent by the insurer advising the insured that the insurer is proceeding with a claim investigation but that the insurer retains rights to deny coverage later
Four questions claims rep must answer for a property insurance claim
1. Does the insured have an insurable interest in the property?
2. Is the damaged property covered by the policy?
3. Is the cause of loss covered by the policy?
4. Do any additional coverages, endorsements or coverage limitations apply?
Actual Cash Value
The cost to replace property minus an allowance for the property's depreciation
Replacement cost
The cost to repair or replace property using new materials of like kind and quality with no deduction for depreciation
Three ways replacement cost of real property is determined
1. Square footage of the property
2. Type and quality of construction
3. Construction cost per square foot
Salvage rights
The insurer's rights to recover and sell or otherwise dispose of insured property on which the insurer has paid a total loss or a constructive total loss
Constructive total loss
A loss such that property cannot be repaired for less than its actual cash value minus the anticipated salvage value
Damages
Money claimed by, or a monetary award to, a party who has suffered bodily injury or property damage for which another party is legally responsible
Two types of damages
1. Compensatory damages
2. Punitive damages
Compensatory damages
Damages intended to compensate a victim for actual harm suffered; these damages include special damages and general damages
Special damages
Compensatory damages for specific, out-of-pocket expenses, such as doctor and hospital expenses
General damages
Compensatory damages awarded for losses that do not have a specific economic value, such as pain and suffering.
Punitive damages
Damages awarded by a court to punish wrongdoers who cause bodily injury or property damage to others and to defer others from committing similar wrongs
Case reserve
A loss reserve assigned to an individual claim.
Unfair claim practice laws
A state law that specifies illegal claim practices
Four prohibited claim practices
1. Misrepresentation of material facts or insurance policy provisions relating to coverage at issue in a claim
2. Failure to acknowledge and promptly respond to communications about claims arising under insurance policies
3. Actions that compel an insured to sue to recover amounts due under insurance policies by offering amounts that are substantially lower than the amounts ultimately recovered in legal actions brought by such insureds
4. Refusal to pay claims without first conducting a reasonable investigation based on all available information.
Four elements of a contract
1. Agreement (offer and acceptance)
2. Competent parties
3. Legal purpose
4. Consideration
Consideration
Something of value given by each party to a contract
Six characteristics of an insurance contract
1. A conditional contract
2. A contract involving fortuitous events and the exchange of unequal amounts
3. A contract of adhesion
4. A contract of indemnity
5. A nontransferable contract
Conditional contract
A contract in which one or more parties must perform only under certain conditions
Utmost good faith
An obligation to act in complete honesty and to disclose all relevant facts
Contract of adhesion
A contract to which one party (the insured) must adhere as written by the other party (the insurer)
Valued policy
A policy in which the insurer pays a stated amount in the event of a speified loss (usually a total loss), regardless of the actual value of the loss.
Eight reasons for exclusions
1. To eliminate duplicate coverage
2. To assist in managing moral hazards
3. To avoid insuring other losses that are deliberate
4. To assist in managing attitudinal (morale) hazards
5. To avoid covering losses that are not economically feasible
6. To eliminate coverage that most insureds do not need
7. To eliminate coverage for exposures that require special handling by the insurer
8. To keep premiums reasonable
Policy condition
Any provision that qualifies an otherwise enforceable promise of the insurer
Manuscript policy
A insurance policy that is specifically drafted according to terms negotiated between a specific insured (or group of insureds) and an insurer
Self-contained policy
A single document that contains all the agreements between the insurer and the insured; forms a complete policy by itself.
Modular policy
A policy consisting of several different documents, none of which by itself forms a complete contract.
Short rate refund
A refund of premium that is less than what the pro rata refund would be; sometimes used when the insured cancels a policy midterm.
Liberalization clause
A policy condition that if a policy form is broadened at no additional premium, the broadened coverage automatically applies to all existing policies of the same type.
Three aspects of property loss exposure
1. Types of property
2. Cause of loss
3. Financial consequences
Seven types of property
1. Buildings
2. Personal property (contents) contained in buildings
3. Money and securities
4. Motor vehicles and trailers
5. Property in transit
6. Ships and their cargoes
7. Boilers and machinery
How is a peril different from a hazard?
A peril is actual means by which property is damaged or destroyed. Hazard is anything that increases the frequency or severity of a loss.
Two important differences between named perils and special form coverage when it comes to burden of proof
1. With a named perils policy, for coverage to apply, the insured must prove that the loss was caused by a covered cause of loss.
2. With a special form policy, if a loss to covered property occurs, it is initially assumed that coverage applied. However, coverage may be denied if the insurer can prove that the loss was caused by an excluded cause of loss.
Four parties affected by a property loss
1. Property owners
2. Secured lenders of moeny to the property owner
3. Property users
4. Property holders
Bailee
A person or busines in possession of property entrusted to them by others
Floater
A policy designed to cover property that floats, or moves, from location to location
Three levels of property insurance policies
1. Basic form coverage
2. Broad form coverage
3. Special form (open perils) coverage
Proximate cause
The event that sets in motion an uninterrupted chain of events contributing to a loss
Vandalism
Willful and malicious damage to or destruction of property
Sinkhold collapse
A cause of loss involving the sudden sinking or collapse of land into underground empty spaces created by the action of water on limestone or similar rock formation
Mine subsidence
A cause of loss involving the sinking of ground surface when underground open spaces, reulting from the extraction of coal or other minerals, are gradually filled in by rock and earth from above.
Three additional causes of loss covered in broad form coverage
1. Falling objects
2. Weight of snow, ice, or sleet
3. Sudden and accidental water damage
Burglary
The taking of property from inside a building by someone who unlawfully enters or exits the building
Robbery
The taking of property from a person by someone who has caused or threatened to cause the person harm
Five maintenance perils
1. Wear and tear
2. Marring and scratching
3. Rust
4. Gradual seepage of water
5. Damage by insects, birds, rodents, or other animals
First named insured
The person or organization whose name appears first as the named insured on a commercial insurance policy; this person or organization is usually responsible for paying premiums and has the right to receive any return premiums, to cancel the policy, and to receive the notice of cancellation or nonrenewal
Mortgage clause
A clause in a property insurance policy that protects the insurable interest of the mortgagee by giving it certain rights, such as the right to be named on claim drafts for losses to insured property and the right to be notified of policy cancellation.
Six insurable interests of the mortgagee under the mortgage clause
1. The insurer promises to pay covered claims to both the named insured and the mortgage as their interest may appear
2. The insurer promises to notify the mortgagee before any policy cancellation or nonrenewal
3. If the insurer cancels the policy and neglects to inform the mortgagee, the mortgagee's interest is still protected, even if the named insured no longer has coverage.
4. The mortgagee has the right to pay the premium to the insurer if the insured fails to pay the premium so the policy remains in effect.
5. In case of loss, the mortgagee may file a claim if the insured does not.
6. If a claim is denied because the insured did not comply with the terms of the policy, the mortgagee may still collect under the policy
Loss payee
A lender named on an insurance policy, who is loaned money o personal property
Three options insurer has to settle a loss
1. Paying the value of the lost or damaged property
2. Paying the cost to repair or replace the property
3. Repairing, rebuilding, or replacing the property with other property of like kind and quality
Insurance-to-value provision
A provision in property insurance policies that encourages insured to purchase an amount of insurance that is equal to, or close to, the value of the covered property.
Six provision relating to the payment of a loss
1. Policy limits
2. Valuation provisions
3. Settlement options
4. Deductibles
5. Insurance-to-value provisions
6. "Other insurance" provisions
Coinsurance
An insurance-to-value provision in many property insurance policies providing that if the property is underinsured, the amount that an insurer will pay for a covered loss is reduced.
Three things the United States law derives essentially from
1. The Constitution, source of constitutional law
2. Legistlative bodies, soure of statutory law
3. Court decisions, source of common law
Statutory law
The formal laws enacted by federal, state or local legislative bodies
Common law, or case law
A body of principals and rules established over time by courts on a case-by-case basis
Criminal law
The category of law that applies to wrongful acts that society deems so harmful to the public welfare that government takes the resposibility for prosecuting and punishing wrongdoers
Civil law
The category of law that deals with the rights and responsibilities of citizens with respect to one another
Two elements of liability loss exposure
1. The legal basis of a claim by one party against another for damages
2. The potential financial consequences of liability loss exposure
Tort
A wrongful act, other than a crime or breach of contract, committed by one party against another.
Negligence
A person or an organization's failure to exercise the level of care that a reasonably prudent person would have exercised under similar circumstances
Four elements of proof required based on negligence
1. Duty owed to another
2. Breach of that duty
3. Injury or damage
4. Unbroken chain of events between the breach of duty and the injury or damage
Vicarious liability
Legal responsibility that occurs when one party is held liable for the actions of another party.`
Defamation
An intentional false communication, either written or spoken, that damages another's reputation or good name
Strict liability
Legal liability that arises from inherently dangerous activities or dangerously defective products that result in injury or harm to another, regardless of how much care was used in the activity.
Hold-harmless agreement
A contractual provision that obligates one party to assume the financial consequences of legal liability for another party.
Statutory liability
Legal liability imposed by a specific statue or law
Nine liability exposures
1. Automobiles
2. Premises
3. Business operations
4. Completed operations
5. Products
6. Advertising
7. Pollution
8. Liquor
9. Professional activities
Personal injury
Injury, other than bodily injury, arising from intentional torts such as libel, slander, or invasion of privacy.
Four types of advertising injury
1. Libel and slander
2. Publication of material that consitutes an invasion of privacy
3. Misappropriation of advertising ideas or business style
4. Infringement of copyright, trade dress or slogan.
Six exclusions on a liability insurance policy
1. To avoid covering uninsurable losses
2. To avoid insuring losses that could be prevented
3. To eliminate duplicate coverage
4. To eliminiate coverage that most insureds do not need
5. to eliminate coverage for exposures that require special handling by the insurer
6. To keep premiums reasonable
Two covered costs in liability policies
1. The damages that the insured is legally liable to pay
2. The cost of defending the insured against the claim
Supplementary payments
Various expenses the insurer agrees to pay under a liability insurance policy (in addition to the liability limits) for items such as premiums on bail bonds and appeal bonds, loss of the insured's earning because of the attendance at trials, and other reasonable expenses incurred by the insured at the insurer's request
Prejudgement interest
Interest that may accrue on damanges before a judgment has been rendered
Postjudgement interest
Interests that may accur on damages after a judgment has been entered in a court and before the money is paid.
Medical payments coverage
Coverage that pays necessary medical expenses incurred within a specified period by a claimant (and in certain policies, by an insured) for a covered injury, regardless of whether the insured was at fault
Occurrence basis coverage
Coverage for liability claims that occur during the policy period, regardless of when the claim is submitted.
Claims-made coverage
Coverage for liability claims that are first made against the insured during the policy period for covered events that occur on or after the retroactive date and before the end of the policy period.
Retroactive date
The date in claims-made policy on or after which injury or damage must occur in order to be covered.
Split limits
Separate limits for bodily injury and property damage liability coverage
Single limit
The maximum amount an insurer will pay for the inured's liability for both bodily injury and property damage that arise from a single occurence
Six steps to the risk management process
1. Identifying loss exposures
2. Analyzing loss exposures
3. Examining the feasibility of risk management techniques
4. Selecting the appropriate risk management techniques
5. Implementing the selected risk management techniques
6. Monitoring results and revising the risk management program
Loss severity
Monetary amount of damage that results from a loss.
Five risk control techniques
1. Avoidance
2. Loss prevention
3. Loss reduction
4. Separation
5. Duplication
Loss prevention
A risk control technique that seeks to lower the frequency of loss from a particular loss exposure
Loss reduction
A risk control technique that seeks to lower the severity (decrease the dollar amount) of losses.
Risk financing
A risk management technique that includes steps to pay for or transfer the cost of losses.
Noninsurance transfer
A risk financing technique in which on party transfers the potential financial consequences of a particular loss exposure to another party that is not an insurer.
Four informal guidelines to risk management
1. Don't retain more than you can afford to lose.
2. Don't retain large exposures to save a little premium.
3. Do not spend a lot of money for a little protection
4. Do not consider insurance a substitute for loss control
Four decisions risk managers make
1. What should be done
2. Who should be responsible
3. How to communicate the risk management information
4. How to allocate the cost of the risk management program