Chapter 1 Flashcards

1
Q

What is demutualization?

A

Mutual companies can convert to stock companies through a process called demutualization.

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2
Q

What is Reinsurers?

A

Reinsurance is an arrangement by which an insurance company transfers a portion of an assumed risk to another insurer. Usually, reinsurance occurs to limit the loss any one insurer would face should a very large claim become payable. Another reason for reinsurance is to enable a company to meet specific objectives, such as favorable underwriting or mortality results.

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3
Q

What is a ceding company?

A

The company transferring the risk is called the ceding company.

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4
Q

What is reinsurer?

A

The company assuming the risk is the reinsurer.

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5
Q

What is treaty reinsurance?

A

A typical reinsurance contract between two insurance companies is called treaty reinsurance, which involves an automatic sharing of the risks assumed.

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6
Q

What is a primary insurer?

A

In a reinsurance agreement, the insurance company that transfers its loss exposure to another insurer is called the primary insurer.

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7
Q

What is Fraternal Benefit Societies?

A

Insurance is also issued by fraternal benefit societies, which have existed in the United States for more than a century. Fraternal societies, noted primarily for their social, charitable, and benevolent activities, have memberships based on religious, national, or ethnic lines.

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8
Q

What is Lloyd’s of London

A

Contrary to popular belief, Lloyd’s of London is not an insurer but rather a syndicate of individuals and companies that individually underwrite insurance. Lloyd’s can be compared to the New York Stock Exchange, which provides the arena and facilities for buying and selling public stock. Lloyd’s function is to gather and disseminate underwriting information, help its associates settle claims and disputes, and, through its member underwriters, provide coverages that might otherwise be unavailable in certain areas.

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9
Q

What is Self-Insurers

A

Though self-insurance is not a method of transferring risk, it is an important concept to understand. Rather than transfer risk to an insurance company, a self-insurer establishes a self-funded plan to cover potential losses. Large companies often use Self-insurance to fund pension plans and some health insurance plans. A self-insurer will often look to an insurance company to provide insurance above a specified maximum loss level. The self-insurer will bear the loss below that maximum amount.

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10
Q

What is a Captive Insurer?

A

An insurer established and owned by a parent firm to insure the parent firm’s loss exposure is known as a captive insurer.

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11
Q

What is Surplus Lines Insurance?

A

Surplus lines insurance is available to those who need protection, but it is not available through private or commercial carriers. Surplus lines insurance refers to the nontraditional insurance market. A person will seek coverage through a surplus lines broker to secure coverage for high, substandard, or unusual risks (i.e., hole-in-one insurance or nonappearance coverage). To qualify for surplus line coverage, an individual must attempt to secure coverage in the authorized market. An individual may not attempt to secure coverage just because it may be less expensive.

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12
Q

Industrial Insurer

A

Insurance is also sold through a specialized branch of the industry known as home service or debit insurers. These companies specialize in a particular type of insurance called industrial insurance. Industrial insurance is characterized by relatively small face amounts (usually $1,000 to $2,000) and weekly premiums.

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13
Q

What is the PRINCIPLE OF INDEMNITY

A

The “Principle of Indemnification” is designed to “restore” the insured to the same financial position that he or she was in prior to the loss occurrence. The principle of indemnity also stands for the fact that an insured shall not profit or gain by their loss.

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14
Q

what is the LAW OF LARGE NUMBERS (SPREAD OF RISK)

A

The law of large numbers states that larger groups provide an increased degree of accuracy in loss predictions, based on past experience.

For example, if an insurance company insures one million homes (instead of only 100 homes) for total loss and collects $1,000 in premium from each homeowner, this should provide enough money so the insurer can pay all losses to policyholders during the year while meeting all overhead obligation and still make a profit. If an insurer only insured 100 homes and five of them were total losses in the same year, it would likely bankrupt the carrier. There is safety in larger numbers.

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15
Q

What is ADVERSE SELECTION

A

Insurers must minimize adverse selection, which is defined as the tendency for higher-than-average risks to seek out insurance.

Adverse selection is represented by a company taking on more significant risks or not being accurately compensated for actual risk. The adverse selection of risk must be avoided in order for the company to be profitable and to stay in business. The company must avoid risks that put them in a position to experience a catastrophic loss. If an insurer cannot compensate for higher risks with better than average risks, then its loss experience will increase, and its ability to pay claims may be compromised. Therefore, sound and competent underwriting may reduce the chance of adverse selection.

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16
Q

What is PERIL

A

A peril is an immediate, specific event that causes a loss. Perils can also be referred to as the accident itself.

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17
Q

what is Loss exposure

A

Loss exposure is the risk of a possible loss. Basically, any situation that presents the possibility of a loss.

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18
Q

what is Homogeneous exposure units

A

Homogeneous exposure units are similar objects of insurance that are exposed to the same group of perils. The larger the number of homogeneous units (similar risks), the easier it becomes to predict loss.

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19
Q

what is Moral hazards

A

Moral hazards make the loss more likely to occur due to the dishonest character of the insured, who may be more disposed to either engage in criminal activity or cause a loss because of their negative habits. The chance of loss is higher because of who the insured is. It is due to the individual character of the insured.

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20
Q

what is Morale hazard

A

The insured unintentionally creates a loss situation on an unconscious level. They just do not care about loss prevention since the property is insured.

For example, Alex leaves his car running unattended, with the doors unlocked to heat it up on a cold winter morning. This act makes it more likely that his car will be easily stolen by a passing car thief on the lookout for such vehicles. On some unintentional mental level, the insured simply does not care that this kind of loss might happen, probably because the vehicle is insured.

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21
Q

what is Risk Retention

A

Self-insurance is typically used when losses are highly predictable, and the worst possible loss is not severe.

For example, a person retains the risk of needing to replace a toaster by not purchasing the 2-year extended warranty on a new toaster that only cost $50.

22
Q

What is a monoline insurer

A

A company that only sells one line of insurance is known as a monoline insurer.

23
Q

What is a multi-line insurer

A

A company that sells more than one line of insurance is known as a Multi-line insurer.

24
Q

What is a domestic insurer?

A

An insurance company that has a principal office in a state where it is authorized

25
Q

What is a foreign insurer?

A

An insurance company that is authorized in one state, but its principal office is in another state

26
Q

What is an alien insurer?

A

Insurance company which is authorized in any state within the United States but its principal office is located outside the country

27
Q

What are mutual insurance companies?

A

Mutual companies allow the policyholder to participate in electing the board of directors and receive dividends from the surplus profit. Such companies are referred as participating companies.

28
Q

What are stock insurance companies?

A

A stock company is referred to as a non-participating company. It does not allow policyholders to participate in the selection of the board of directors or receive dividends from the surplus profit. It aims to increase profit for the stockholders.

29
Q

What is a mixed-plan insurance company?

A

A company issuing both participating and nonparticipating policies is referred to as using a mixed plan.

30
Q

What is mutualization?

A

A stock company may be converted into a mutual company through a process called mutualization.

31
Q

What is the underwriting department?

A

Insurance underwriting involves evaluating risk to determine insurability and pricing.

32
Q

What is an actuarial department?

A

Insurance companies employ actuaries to work in reinsurance and broking operations and assist with their financial management. Actuaries analyze statistics about claims severity and frequency to help insurance companies invest wisely and ensure they maximize income and payout potential claims.

33
Q

Water career agencies?

A

A career agency is a branch of major stock and mutual insurance companies that are contracted to represent an insurer in a specific area. Carrier agencies recruit, supervise, train, and manage agents.

34
Q

What is personal producing general agencies (PPGA)

A

PPGA does not recruit, train, or supervise agents. They primarily sell insurance. The agents hired by BPG A are considered employees of PPGA and not employees of the insurance company. They are Supervised by regional directors.

35
Q

What are independent agents?

A

Independent agents represent several insurance companies through contractual agreements. They are compensated on a commission or fee basis.

36
Q

What is aleatory

A

Aleatory: An aleatory contract presents the potential for an unequal exchange of value or consideration between both parties. Aleatory contracts are conditioned upon the occurrence of an event.

A fire insurance company promises A that, considering A’s premium payment, it will pay A $20,000 if A’s house burns down in a lightning-caused fire. In this aleatory contract, the fire insurance company will not be liable if A’s house burns down in a fire caused by an overheated fireplace.
Accidental death policy can be another such example of an aleatory contract.

37
Q

What is contract of adhesion

A

Adhesion: A contract of adhesion describes a contract that has been prepared by one party (the insurance company) with no negotiation between the applicant and insurer. The applicant adheres to the terms of the contract on a “take it or leave it” basis when accepted.

38
Q

What is apparent authority

A

Apparent Authority: Apparent Authority is the appearance of the insurer providing the agent authority to perform unspecified tasks based on the agent-insurer relationship.

39
Q

What is consideration?

A

Consideration: Consideration is the part of an insurance contract setting forth the amount of initial and renewal premiums and frequency of future payments.

40
Q

at what point does an information agreement become a binding contract?

A

An informal contract becomes a legally binding contract when both parties agree to the terms of the contract and there is consideration, which is something of value exchanged between the parties.

Consideration: Something of value is exchanged between the parties, such as money, goods, services, or a promise to do something.

41
Q

What is estoppel

A

Estoppel is the legal impediment to one party denying the consequences of its own actions or deeds if such actions or deeds result in another party acting in a specific manner or if certain conclusions are drawn.

42
Q

What is utmost good faith

A

Utmost Good Faith: Utmost good faith involves the belief that both the policyowner and the insurer must know all material facts and relevant information, and as such, they will provide each other with all material facts and relevant information.

43
Q

what is investor-originated Life Insurance (IOLI)

A

Investor-originated life Insurance (IOLI), also known as Stranger-Owned Life Insurance (STOLI), is a practice where an investor initiates a life insurance policy for the benefit of a third party who has no insurable interest in the insured. The primary purpose of the policy is to provide the investor with a financial benefit when the insured dies. Here are some examples of IOLI:
Senior citizen
A senior citizen with exaggerated financial numbers buys a large life insurance policy, and a third-party investor pays the premiums. The senior citizen then sells the policy to the investor for cash.
Healthy senior
An investor approaches a healthy senior citizen in her 70s and offers her a percentage of her life insurance benefits in exchange for giving up the benefits. The investor also pays for the premiums.
Loan
An investor or broker offers a loan to a potential insured person, usually a senior or someone with a limited life expectancy. The insured person applies for a policy, pays the premiums, and holds the policy for a set period of time. Then, they transfer the policy to the investor or broker, who may pay an additional sum and start paying the premiums.

44
Q

what is a Representation?

A

A representation is a statement made by the applicant that they consider to be true and accurate to the best of the applicant’s belief. It is used by the insurer to evaluate whether or not to issue a policy.

45
Q

if material to the risk false representations will void a policy?

A

A false statement that is material to the risk and would have changed the insurer’s decision to issue the policy.
A material misrepresentation can occur when an applicant: Falsely describes the property, Omits to communicate a material circumstance, Intentionally conceals a material fact, and Engages in fraudulent conduct

46
Q

what is a Concealment?

A

The issue of concealment is also crucial to insurance contracts. Concealment is defined as the failure or neglect by the applicant to disclose a known material fact when applying for insurance. If the purpose of concealing information is to defraud the insurer (that is, to obtain a policy that might not otherwise be issued if the information were revealed), the insurer may have grounds for voiding the policy.

47
Q

Void versus Voidable Contracts

A

The terms void and voidable are often incorrectly used interchangeably. A void contract is simply an agreement without legal effect. In essence, it is not a contract at all, for it lacks one of the elements specified by law for a valid contract. A void contract cannot be enforced by either party.

For example, a contract having an illegal purpose is void, and neither party to the contract can enforce it.

An insurer may also void an insurance policy if a misrepresentation on the application is proven to be material.

For example, a policyholder is failing to comply with a condition of the contract when they stop paying their insurance premium. As such, the contract is now voidable, and the insurance company has the right to cancel the contract and revoke the coverage.

48
Q

What is Parol Evidence Rule?

A

For example, once an insurance producer delivers the insurance policy to the insured, the written contract (policy) supersedes anything discussed verbally during the application or sales process. Furthermore, only that which is written in the contract is enforceable.

49
Q

what is Estoppel?

A

For example, a producer makes a false representation to an applicant who relies on the statement. Later, harm is caused to the policyowner when a claim is denied because of this reliance. The insurer will then be “estopped” or prevented from denying the claim.

50
Q

What is fiduciary responsibility?

A

Fiduciary responsibility in insurance refers to legal obligations that require one party to act in the best interests of another. In insurance, these duties often focus on the relationship between the insurer and the insured, such as the agent-policyholder relationship. For example, an insurance agent may have fiduciary duties to their policyholders

51
Q

Valued vs. Indemnity

A

Life insurance contracts are valued contracts, which means it will pay a
stated amount. Health insurance contracts are indemnity contracts and will only reimburse the actual cost of the loss (pay medical bills, etc.) You cannot profit from an indemnity contract.

52
Q
A