Term
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Definition
| social device for spreading the chance of financial loss among a large number of people. |
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Term
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Definition
| Comb through large number of homogeneous units, and then able to make predictions of possible loss. Use this information to establish the rates for premiums that will cover their losses and their operating expenses. |
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Term
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Definition
| Process of selecting certain types of risks that have been historically produced a profit and rejecting those risks that do not fit the underwriting criteria of the insurer. Usually produces a favorable loss ratio. |
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Term
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Definition
| selection against the insurance company . Tendency of insureds with a greater-than-average chance of loss to purchase insurance. |
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Term
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Definition
| section of the policy includes the ID and address of the named insured, policy term or period, the amount of insurance or limits of liability, the policy premium and any applicable deductables. Also includes either a property description or a schedule of coverage parts, and a list of endorsements. |
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Term
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Definition
| describes the covered perils, or risks assumed or the nature of the coverage, or makes some reference to the contractual agreement between the insurer and insured. In package policies wach different coverage includes its own. |
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Term
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Definition
| set provisions, rule of conduct, duties, and obligations for the parties. Commonly describe such things as the policy period, and territory, the insured's obligation to provide proof of loss, how settlements are handled when other insurance is involved and the right of each party to cancel the policy. May be found in its own section or scattered throughout the policy forms. |
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Term
| Exclusions and limitations |
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Definition
| may describe property, perils, hazards or losses arising from specific causes that are not covered by the policy. May be found in its own section or may be scattered throughout the policy. In some cases they are built into wording of insuring agreements and the defitions of perils. |
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Term
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Definition
| some policies include some that are less sweeping than true exclusions. They may eliminate or reduce coverage, but only under certain circumstances or when specified conditions apply. |
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Term
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Definition
| after a building has been vacant for 60 days, some types of commercial property losses will not be covered at all, while the amount payable for other types of losses will be reduced by 15% |
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Term
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Definition
| define important terms used in the policy language. Some policies list them in a distinct section having that title. Some policies include them in the "conditions" section, while others spread them throughout policy sections. |
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Term
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Definition
| some policies included them to add, delete or change any of the policy parts. They may alter the content of the declarations. They are considered to be a written modifications of the policy. |
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Term
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Definition
| refer to forms that have been filed by ISO to the individual insuance departments for approval. Many companies use the approved ISO forms rather than filing their own forms in each individual state. |
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Term
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Definition
| a potential cause of loss. Accident, fire, and theft are commons ones |
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Term
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Definition
| anything that increases the seriousness of a loss or increases the likelihood that a loss will occur |
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Term
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Definition
| a loss that is a direct consequence od a particular peril. Fire damage to an apartment is an example. |
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Term
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Definition
| if the insurer pays a loss on behalf of the insured, the insurer is entitled to the _______ to reduce the claim. |
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Term
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Definition
| the insured cannot simply abandon the property to the insurance company in exchange for the full-insured value. |
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Term
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Definition
| A loss settlement condition that appears in many property insurance contracts including inland marine. It stated that if part of a pair or set is lost or damaged, the loss will be valued as fair proportion of the total value of the set, giving consideration to the importance of the damaged atricle to the set. The insurer is not required to pay for the value of the whole set. |
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Term
| Example of pair or set clause |
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Definition
| A pair of earrings is worth and insured for $5,000. One is lost or detroyed. The company will not pay $5,000 for the set. They will pay a fair proportion of the pair's full value |
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Term
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Definition
| the self0insured part of an insured loss. Ususally applies to first party claims such as property claims or auto physical damage claims. The insured must bear this loss. |
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Term
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Definition
| the building is void of contents and people. May not being used. Perils such as freezing,vandalism and malicious mischief are limited when a building is in this state. |
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Term
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Definition
| the premises are void of people. In most cases this will mot affect the coverage provided by the policy |
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Term
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Definition
| an insurance policy cannot be assigned to another party without the consent of the insurance company. |
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Term
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Definition
| A clause in property/casualty insurance contract which states that if the policy or endorsement forms are broadened and no additional premium is required, then all existing similar policies or endorsements will be construed to include the broadened coverage. If a renewal policy has been issued but not yet taken effect, _______ of the policy terms made within 45 days of the renewal date will automatically be included in the renewal policy without having to be reprinted. |
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Term
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Definition
| Serve as temp evidence that covg is in effect until the policy is issued. They usually are either oral or written. Some states require that they must be in writing. Other states require that an oral binder is legal but must be transferred to a written binder can be in force. For example:30, 60 or 90 days. |
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Term
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Definition
| in cases where more than one policy is in force, the primary policy pays first. |
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Term
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Definition
| an insurance policy that pays benefits only when coverage under other applicable insurance policies have become exhausted. |
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Term
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Definition
| a sudden and unforeseen event resulting in a financial loss. |
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Term
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Definition
| a sudden and unforseen event resulting in financial loss. May also be a continuous or repeated exposure to an event that results in a financial loss. |
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Term
| Appraisal and arbitration |
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Definition
| policies may contain one or both of these clauses to facilitate an agreement when the insured and the insurer cannoth agree on the value of a claim |
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Term
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Definition
| when the dispute involves a property claim, both partied select an appraiser to determine the value of the loss. The appraisers choose an umpire. If they cannot agree on an umpire, either may request that selection be mafe by a court of law having jurisdiction. The appraisers will state separately the value of the property and amount of loss. If they fail to agree, they will submit their differences to the upmire. A decision agreed to by any two will be binding. Each party will pay its chosen appraiser and bear the other expenses of the appraisal and umpire equally. |
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Term
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Definition
| usually appears in automobile policies to resolve liability disputes for BI and/or PD. It may also be used to settle disputes between insurance companies involving third party liability claims. |
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Term
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Definition
| used when the insurer has paid a covered claim on behalf of the insured that is caused by another party. The insurance company is entitled to the insured's right of recovery from the negligent party. This clause is sometimes called, "transfer of right to recovery against others to us". |
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Term
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Definition
| if the insured has other sources of recovery for a covered claim, this clause is activated. Also called "other sources of recovery on insuance under two or more policies". Some policies are primary and some are excess depending on the wording in the insuranc contract. The clause specifies the obligations of the insurance carrier when other covg is in force. Some clms are paid based on limit bears to the total amt of covg i nforce. Example: if an insurer is covering 20% of a propertyrisk it will only pay 20% of a loss. |
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Term
| Certificated of insurance |
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Definition
| not uncommon for an insured to be required to provide a certificate of insurance as evidence that covg in effect. Many states require evidence of automobile insurance be carried at all times. The auto ID card is an example of this. |
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Term
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Definition
def of this term varies depending on individual state. Most states it means that any person who has contact with an insured involving insurance matters should be licensed.
Example of who would be: Personnel that quote, sell, service, offer advice, explain coverage or adjust claims
Who would not: Attorneys, appraisers, clerical personnel. |
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Term
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Definition
| principle that assumes that the slmt should only be restored to the approx financial condition that existed prior to the loss, no better or no worse. If a clmt makes a profit from a loss, the principle of indemnity is violated. This principle applies to both first party property losses and thrd party liability claims. |
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Term
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Definition
| an unbroken chain of events that causes a loss. An event that, in natural and continuous sequence, produces a loss. If a fire should occur, followed by smoke and water damage, the entire loss is considered to have been caused by the peril of fire. |
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Term
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Definition
| a form completed by the clmt listing the property that has either lost or dmged due to a covered loss. Most state laws require this from to be completed and returned by the insured or clmt within 60 days of being requested by the insurer. |
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Term
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Definition
| language that is vague and creates doubt. If found in the policy provisions will usually be resolved by the courts in favor of the insured. |
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Term
| Contribution by equal shares |
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Definition
| the of "other insurance" condition found in liablity policies. It calls for all insurers to contribute equally up to the limist of the policy having the smallest limist, whereupon that company stops paying. The other companies share in the remainder of the loss until the loss is paid in full or until all polucy limits are exhausted. |
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Term
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Definition
| situation that exists when the same property is covered by more than one policy, but the policies are not identical as to the extent of covg provided. |
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Term
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Definition
| state the perils that are to be insured against |
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Term
| named peril vs open peril |
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Definition
| the former lists the specific perils to be covere in the policy. The latter does not list the perils but provides a broader covg. That means that all perils are covered except the perils listed in the exclusions section of the policy. |
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Term
| Basic types of construction |
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Definition
| refers to frame, masonry, metal, brick veneer, fire resistive, etc. The better the construction the lover the fire rate. |
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Term
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Definition
1. Actual cash value
2. replacement cost
3. functional replacement cost
4. market value
5. agreed value
6. stated amount
7. valued policy |
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Term
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Definition
| the cost of replacement minus depreciation |
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Term
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Definition
| the current cost to purchase new, the item that was lost, w/o depreciation. |
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Term
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Definition
| usually antiques claims are adjusted on the basis or market value- the price that the market will support. |
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Term
| Functional replacement cost |
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Definition
| as reasonably close to the replacement of the lost or dmged item as possible |
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Term
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Definition
| the value to be insrued is agreed to by the insured and the insurer. This is method is used when the true value cannot accurately be determined. |
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Term
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Definition
| and agreed amount of insurace which is shown on the policy and that will be paid in the even of a total loss regardless of the actual value of the property. |
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Term
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Definition
| a policy that states that in the event of a total loss, a specific amount will be paid, and that is set as the limit of the policy. It is generally used to insure fine arts, jewelry and furs. This term also applies in some states that have valued policy law. In case of total loss the co. cannot dispute the amount to be paid under most circum. execpt for the normal exceptions such as fraud, etc. |
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Term
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Definition
1. Those that have an insurable interest inthe property who would suffer a finan loss if the property were dmged by an insd peril
2. in personal insurance this can include family members w/o listing their names on the declarations page of the policy.
c. Additional insds such as the lien holder |
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Term
| basis of insuring property |
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Definition
1. Specific basis
2. blanket basis
3. reporting form |
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Term
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Definition
| a separate limit per insured item applues. Example: a separate limit on the bldg. and/or one for the contents. |
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Term
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Definition
| one limit that applies to both bldg and contents. With blanket insurance, usually more than one location is insured under a single limit. Blanket insurance is more often written on contents covg. w/ one blanket limit applying to more than one blg or location. This assists the insured in avoiding underinsurance at the particular location in case of loss. |
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Term
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Definition
| this allows the insured to report values to the co. (usually on a monthly basis) of the insd contents. This allows the insd to pay for covg on what is actually reported to the co. This form requires a 100% coinsurance clause. |
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Term
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Definition
| in commercial property insurance this clause is a method of requiring the insd to insure at least 80% of the value of the prop in exchange for a premium discount. This clause is used wheter the insd insures the prp on actual cash value or on a replacement basis. If the insd's policy contains this clause and the insd carries less that this amount, a penalty will occur in case of partial losses. The isd can always insure for more than 80% of the value prop. |
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Term
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Definition
| a person isures prop with an actual cash value of $100 on a policy with 80% coincurace requirement. The insurance req. is $80. If the insd elects to carry a limit of only $60 then he or she becomes a partner w/ the insurance co on partial losses. When such loss occurs, the adjuster will take the amount the insd did carry ($60) and devide that amount by the amount the isd should have carried ($80), then mult the result by the amnt of the partial loss. Since the insd is carrying on 75$ of the amnt he should have carried, the insurer will only pay 75% of the loss. Therefore, if an insured has a loss of $40 and carries only $60 then the insured would be entitled to recieve $30 (75%of $40). he or she would be co0insured to the extent of $10. |
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Term
| Loss of settlement clause |
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Definition
| found in personal lines prop ins. It is similar to coinsurance. |
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Term
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Definition
1. standard mortgage clause
2. loss payable clause
3. no benefit to bailee |
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Term
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Definition
| protect interest of the financial institution against loss to real prop caused by perils insd against. Also grants covg even if the insd intentionally cause the loss. The institution can al provide proof of loss or pay premiums in the case the insd cant or refuses to do so. They must also be advisd if the contract has been cancelled or non-renewed by the insurer. |
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Term
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Definition
| same as mortgagee cluase but applues to chattel prop. |
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Term
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Definition
| an insd's prop insurance policy protects the insd and not a bailee of the insd's prop. If the insd's prop were destoyed by fire while at the dry cleaners, the insurance co. would only protect the insd. If the dry cleaners are negligent the insurance co could pay the insd and subro against the dry cleaners. |
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Term
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Definition
| occurs when a person or entity is determined to have been responsibly, or legally liable, for injury or loss to another person or liable for dmg to another's prop and the law requires them to make financial restitution. Called third part losses. |
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Term
| Liab losses are paid by casualty ins including the follwoing policies: |
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Definition
- personal auto
- commercial auto
-general liab
- professional liab
- umbrella
-personal liab (including boats and yachts) |
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Term
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Definition
| occurs when the dmg to repair exceed the value of the veh after repairs have been made. Applies to other types of losses as well. |
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Term
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Definition
the lack of reasonable care that is required to protect others a/o their prop from the unreasonale chance of harm. could be failure to act or not to act as a resonable person under the same set of circumstances.
for liab policy to respond the insd must be guilty of this and covg must be granted by the policy. Intentional acts are never covered by liab policies. |
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Term
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Definition
| the willful or wanton negligence or misconduct w/o the slightest degree of care. |
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Term
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Definition
| a civil wrong that violates the rights of others. A person becomes legally liable by committing this. Generally a court of law must determine negligence. |
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Term
| four factors involved to establish negligence |
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Definition
1. Legal duty is owed
2. breach of legal duty owed
3. proximate cause
4. dmgs |
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Term
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Definition
Dmgs covered by casulty policies that cover BI and PD caused by the isnd as a result of their negligence. Two categories.
special dmgs
general dmgs |
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Term
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Definition
| type of compensatory dmgs the injured party receives for direct and specific expenses involved in the loss, such as med expenses and loss of wages. These dmgs pay for so called "economic losses" |
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Term
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Definition
| type of compensatory dmgs that reimburse the injured party for such things as pain and suffering and disfigurement and life altering issues such as loss of mobility and loss of consortium not readily defined by actual incurred expenses. These dmgs pay for so called "non- economic losses" |
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Term
| Defenses against negligence |
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Definition
1. contibutory neg
2. comparative neg
3. assumption risk
4. intervening cause
5. statute of limatations |
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Term
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Definition
| common law def against neg that states that is an individual contributes to his or her own loss in any way, then another cant be held liab for the loss. |
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Term
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Definition
| law that allows an injured party to collect from another party for a loss, even when the injured party contributed to his or her own loss. Dmgs are reduced to the extent of the injured party's neg. Thi is the def used in most cases. |
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Term
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Definition
| A doctrine that applies in some states. Applies when a person knowingly exposes themself to danger or injury. When a person assumes this risk, they may be prevented from recovering from a neg party. This doctrine is frequently associated w/ injuries incurred by spectators at sporting events. |
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Term
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Definition
| an independent action that breaks the chain of causation and sets in motion a new chain of events. when this occurs, the intervening cause becomes the proximate cause of loss. This can serve as a common law defense. |
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Term
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Definition
| states have enacted laws as to when certain types of lawsuits must be filed. |
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Term
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Definition
| often awarded by the court and indtended to punish the defendant. |
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Term
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Definition
| imposed by law on those particpating in certain activities that are considered especially hazardous. Individuals involved in such operations may be held liable for dmgs of another, even though the individual was not neg. Aka strict liab |
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Term
| vicarious liab or imputed liab |
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Definition
when a person is held responsible for the neg act os another person.
example: employer and employee. The employer can be imputed (charged) of neg because the employer has control over the employee. |
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Term
|
Definition
1. single limits
2. split limits
3. aggregate limits |
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Term
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Definition
| pays up to one amount as the max limit of liab of the insurer w/ respect to any one accident/ occurance involving either or both BI and PD |
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Term
|
Definition
| expressed by 2 figures. There may be a limit representing the max payable for each person injured per occurance for BI and other limit applicable to the clms of all persons injured in the accident or occurence |
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Term
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Definition
| the limit stated in the policy that represents the total amount for all claims paid during the policy period. Found in genreal liab and garag liab policies. Once the agregate has been met the person is w/o covg. |
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Term
| Parts of a liability contract |
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Definition
1. insuring agreement
2. Exclusion
3. Definitions
4. conditions
5. policy period
6. coverage territory
7. cancellation and nonrenewal |
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Term
| Liab contract insuring agreement |
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Definition
| outlines the promises made by the insurance co. to the insured. Vary by type of liab plicy. Contain a duty to defend the insured. |
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Term
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Definition
| exposures for which the insurer is unwilling to provide covg. |
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Term
| Liab contract definitions |
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Definition
| claify def to clarify the terms used throughout the policy |
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Term
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Definition
| outline duties of each party in case of a loss as well as other items that require claification |
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Term
| Liab contract policy period section |
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Definition
| applies only to accidents and losses which occur during the policy period as shown in the declarations |
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Term
| Liab contract covg territory section |
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Definition
| used to clearly identify where covg applies. |
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Term
| Liab contract cacellation section |
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Definition
| occurs before a policy has expired. If canceled by the insurer, an unearned policy premium will be returned to the insured on a pro-rated basis. Small penalty when policy cancelled by the insured. Insured can cancel at any time whereas the insurer is bound by the legal cancellation provisions in any given state and by the policy provisions. |
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Term
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Definition
| notice sent prior to the expiration date of the policy advising the insured that the policy will not be renewed. |
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Term
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Definition
1. actual cause of loss
vs.
2. any condition that increases the possibilty of a loss. |
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Term
|
Definition
1. physical hazard
2. moral hazard
3. morale hazard |
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Term
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Definition
| any hazard arising from the material, structural, or operational features of the risk itseld apart from the persons owning or managing it. |
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Term
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Definition
a condition of morals or hanits that increase the probability of a loss from a peril.
Example: someone who would intentionally dmg their own property in order to collect on insurance. |
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Term
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Definition
| hazard arising out of an insd's indifference to loss because of the existence of insurance. |
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Term
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Definition
1. pure risk
2. speculative risk
3. static risk
4. dynamic risk
5. fundamental risk
6. particular risk |
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Term
|
Definition
a situation where there is only the possibility of loss. Insurable risk.
Example: catastophic medical expenses, liability loss suit, dmg by fire, lightning, etc... |
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Term
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Definition
a situation where either profit or loss is possible. Usually not insurable
Example: betting on horse race, investing in real estate... |
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Term
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Definition
| these are connected with losses caused by the irregular action of nature, by the mistake and misdeeds of human beings. Similar to pure risk. Insurable |
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Term
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Definition
| risk that affects the entire economy or large number of persons or froups within the economy. Not insurable. Example: change in taste of the consumers, tech changes. |
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Term
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Definition
risk that affects the entire economy or large number of persons or groups with in the economy.
Not insurable
example: double digit inflation, foreign competition |
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Term
|
Definition
risk that affects only the individual and not the entire community or country.
Insurable
Example: theft of a stereo set |
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Term
| Methods for managing or handling risk |
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Definition
1. Avoidance
2. Sharing risk
3. Transfer risk
4. assumption of Risk
5. Risk reduction |
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Term
|
Definition
avoinding the hazard.
Example: if you don't want to risk of owning a car a home, you avoid awning a car or a home |
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Term
|
Definition
| method of risk management by members of insurance pools |
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Term
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Definition
| most common method of handling risk. Involves transferring the risk to an insurance co. in return for premium charge. |
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Term
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Definition
| an individual decides to do what created a risk (buys a car or home) and retain the uncertainty of loss. If the car is wrecked or house burns, the individual will replace the car, rebuild the home or do whatever he deems appropriate at his own expense |
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Term
| Risk reduction or Risk control |
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Definition
| Risk may be reduced via loss prevention methods. Example: installing a sprinkler system in a bldg, a person stops smoking or a planned weight loss program . |
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Term
|
Definition
| Before a person can be insured must have this... deemed when the individual has a lawful, sunstantial, economic interest in the preservation of that property. Includes individual, company, insurer, association, organization, reciprocal etc... |
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Term
| Characteristics of an insurable risk |
|
Definition
- the loss must be definite and definable
- the loss must be accidental
- the insurance co. should be able to calculate the chance of loss
- the law of large numbers should apply
- the loss must be great enough to create economic hardship
- The insurance must be offered at the reasonable cost
- the loss must not be catastrophic in nature. |
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Term
| parties to an insurance contract |
|
Definition
1. first party - the insured
2. second party- insurance company
3. thrid party - party has been dmged by the 1st party |
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Term
|
Definition
1. capacity to contract
2. legal purposes/ object
3. offer and acceptance
4. consideration |
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Term
|
Definition
all partied must have the necessary capacity to enter into the contract. Cases where capacity has been deemed insufficient include: minor, mental incompetents and those who sign a contract while under the inlufence of drugs or alchohol.
Exception: status of minor and contracts exists in life insurance. |
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Term
|
Definition
| must not be written to conver an illegal activity or immoral purose |
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Term
|
Definition
| applicant completes the application for covg. and the ins co. accepts and returns a policy or binder. |
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Term
|
Definition
| something that has value in the eyes of the law in which a promisee receives something in return for promise. The insured (promisee) gives the application and premium to the agent a/o company in return for their promis to pay in the future |
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Term
| Characteristics of an insurance contact |
|
Definition
1. aleatory
2. contract of adhesion
3. executory
4. conditional
5. utmost good faith
6. principle of indemnity
7. personal aspect
8. valued contract
9. unilateral |
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Term
|
Definition
| maning it is contingent on an uncertain event (loss) |
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Term
|
Definition
Meaning that one party (insurance co) has greater power over the other party in drafting the contract.
insurance co is the author of the contract and the insured must accept it "as is". Any ambiguous language will bring court decision in favor of the insd. |
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Term
|
Definition
| both sides must perform certain acts to make the contract legally enforceable |
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Term
|
Definition
| promises action in the event og future occurrence. Insured's obligations are based on conditions specified in the contract. |
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Term
|
Definition
| both partied bargain in good faith |
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Term
|
Definition
| the insurance contract is bound to the insurable interest of the insured person. For instance, with the sale of a house, the policy doesnt automatically pass to the new purchaser |
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Term
|
Definition
| the contract myst restore the insured to the financial position previously held before the loss. |
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Term
|
Definition
| pays stated amount in the event of a claim |
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Term
|
Definition
| pays only the amount of the loss. |
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Term
|
Definition
| insured has agreed to pay the premium in exchange for the insurers promise to act in the future. An insurance policy is one-sided because only the insurance company is legally bound to perform its part of the agreement. However the insured are not legally bound to pay premiums. |
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Term
| legal interpretations affecting the insurance contract |
|
Definition
1. representations
2. misrepresentation
3. concealment
4. Fraud
5. Warrenty
6. breach of warranty
7 reasonale expectations |
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Term
|
Definition
| stmts made on an application for insurance that the applicant believes to be true to the best of his or her knowledge. Plicy cant be void based on them |
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Term
|
Definition
| untrue stmts made by the insd. usually at time of application. |
|
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Term
|
Definition
| an intentional act designed to decieve and induce another party to part with something of value. May occur before or after a policy has been issued. |
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Term
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Definition
| something that becomes part of the contract and is a stmt that is considered to be a guarantee 100% of the time |
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Term
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Definition
| states that a policy includes covg that an avg person would reasonably expect it to include regardless of that the policy actualy provides. |
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Term
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Definition
| voluntary or intential relinquishment of a known right. Example: an insd who fails to report a clm in a timely manner. |
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Term
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Definition
if someone intentionally or unintentionally creats the impression that a certain fact exists, and an innocent party relies on that impression and is dmged as a result, the guilty paty may be legally prohibited from asserting that the fact does not exist.
Example: an agent has advised an insd that certain peril is covered under their homeowner policy when it is actually excluded. The insured suffers a loss from the exclued peril. In most cases the loss must be paid because the insured relied on the stmts of the agent. |
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