Insurance Flashcards
Risk
Condition with a possibility of loss or a situation with exposure to loss
Peril
The cause of a loss
Hazard
Condition that increases the chance and severity of loss
Insurable Risks
- Predictable
- Definite and Measurable
- Fortuitous or Accidental
- Not catastrophic to the insurance company
Basic Planning rules for Risk Management
- Coverage for potential catastrophes should be purchased first (life, DI, health, HO and car insurance)
- Severity is more important than probability
- High probability means high premiums or declination of coverage by the insurance company
Guidelines for Risk Management
High Severity/Low Frequency - Transfer
High Severity/High Frequency - Avoidance
Low Severity/High Frequency - Retention and/or Reduction
Low Severity/Low Frequency - Retention
Indemnity
Principle under which the insurance company seeks to reimburse the insured for actual loss or costs incurred. No more, no less
1. Insurable Interest
2. Actual Cash Value
3. Other Insurance
4. Subrogation
Aleatory Contract
Unequal consideration between members of the contract. In life insurance, the premium paid is much smaller than the potential death benefit. It’s for this reason life insurance paying out upon death is considered a “step up” in basis.
Subrogation
The insurance company pays the claim and then takes over the legal rights from that point. The insured is out of the picture.
Collateral Source Rule
In tort liability, the negligent party is still held responsible and damages are not mitigated by payments received from other 3rd parties.
Parts of the Insurance Contract (DICE)
Declarations - Identify specific parties to the contract and what is covered
Definitions - Key policy terms
Insuring Agreements - Basic promises of the insurance company
Conditions - Detailed duties and rights of both parties
Exclusions - Circumstances under which the insurance company will not pay
Capital utilization method of insurance needs analysis
Method by which annuitization is factored in to account for future needs, but leaves no money left over
Capital retention or preservation method of insurance needs analysis
Only interest is utilized for future needs. Capital remains at the end of the income period
Participating Policies
Policies offered by mutual (owned by policy holders) or stock (owned by stockholders) insurance companies. Overcharge premiums, rebate unused premiums to policyholders via tax-free (usually) dividend. Dividends are based on higher than expected returns or lower than expected mortality costs.
Non-participating Policy
Company retains profits for shareholders
Insurance Rating Agencies
A.M. Best - A++ to F
Standard and Poor’s - AAA to CCC
Moody’s - Aaa to C
Weiss - A+ to F
Note: only A.M. Best provides detailed historical information on carriers
Loss Adjustment Process
- Notice of loss
- Investigation
- Proof of loss (signed document)
- Payment or Denial
Homeowners’ Insurance Coverages
Section I Coverages
A. Dwelling
B. Other Structures
C. Personal Property
D. Loss of Use
Section II Coverages
E. Personal Liability
F. Medical Payments
Deductible Section I
Mortgagee:
Premium:
Coverage A: Dwelling Coverage
Covers the dwelling as well as all structures attached to the dwelling (such as garage, deck, or fence). It also covers supplies located on or next to the premises for construction, repair or alteration of the dwelling or other structures. Land is specifically excluded.
Coverage B: Other Structures Coverage
Covers structures on the premises adjacent to the dwelling in a clear space. Swimming pool, detached garage, fences, patio, or detached living space.
Coverage C: Personal Property Coverage
Personal property coverage operates anywhere in the world. There are usually sub-limits for things like watercraft, jewelry, silverware or money.
Specific exclusions from Coverage C:
1. Animals, birds, and fish
2. Motor vehicles/aircraft (separate policy)
3. Property of roomers or boarders
4. Property in an apartment rented by others
Homeowners policies generally require an endorsement for exposures related to being a landlord.
Coverage D: Loss of Use
Loss of use covers additional living expenses arising from damage to the insured property. Only pays necessary increase in living expense incurred to continue as nearly as possible to the normal standard of living.
Coverage E: Personal Liability
Provides protection for damages that the insured is legally liable for and arise out of bodily injury or property damage. Insurance company also agrees to defend the insured and settle any suit. Exclusions:
1. Liability from business activities or professional services
2. Liability from usage of motorized land vehicles (except RV or golf cars on premises)
3. Liability from usage of watercraft 26’ or longer or 50HP or more
4. Liability from usage of aircraft
5. Liability for bodily injury that results in worker’s compensation
Coverage F: Medical Payments
Provides very limited amounts of coverage for necessary medical treatment of persons other than the insured who are injured while on the covered premises. Does not provide and liability coverage.
Basic Form Perils (covered)
WHARVES/FLT or HARVEST/WFL
Windstorm, Hail, Aircraft, Riot, Vandalism, Vehicles, Explosion, Smoke, Fire, Lightning and Theft
There are 10 basic form covered perils in total
Broad Form Perils (covered)
Royal Air Force
Includes all basic form perils, as well as RAF
Rupture of a system, Artificially generated electricity, Falling objects, Freezing of plumbing
Open Perils
Most comprehensive coverage. Insurer pays for damage by ANY peril except those specifically excluded. (generally a correct answer on the exam)
HO-1 Policy (Dwelling)
HO-1 provides Basic Peril coverage for A, B, C and D
HO-2 Policy (Home)
HO-2 provides Broad Peril coverage for A, B, C and D
HO-3 Policy (Home)
HO-3 provides Open and Broad Peril coverage as follows:
A: Open Perils
B: Open Perils 10% of Coverage A
C: Broad Perils 50% of Coverage A
D: Open Perils 30% of Coverage A
HO-5 (home) (HO-3-15)
HO-5/HO-3-15 provides fully Open Peril coverage and is the most comprehensive HO policy.
A: Open Perils
B: Open Perils 10% of Coverage A
C: Open Perils 50% of Coverage A
D: Open Perils 30% of Coverage A
HO 3-15 has an an endorsement that changes C coverage on an HO-3 policy from Broad Perils to Open Perils (essentially making it an HO-5)
HO-8
HO-8 provides Basic Perils coverage for older homes.
HO-4
HO-4 is also known as renter’s insurance. Provides Broad Perils coverage for C and D only:
A and B: No coverage
C: Broad
D: Broad 50% of C
HO-6
HO-6 covers Condominiums. Provides Open and Broad Perils coverage for C and D only:
A and B: Named Perils Only for installed items
C: Open
D: Broad 50% of C
Can also provide loss assessment coverage which protects against assessments made by condo association due to community losses
Exclusions
There are 8 general exclusions that apply to ALL forms of homeowners insurance:
OPEN WIF
Ordinance of law
Power failure
Earth movement (earthquake)
Neglect
Nuclear Hazard
War
Intentional Loss
Flood
*Sinkhole is covered if it affects the stability of the house
Replacement Cost vs. Actual Cash Value (ACV)
Replacement cost does not factor in depreciation. Typically used for dwelling coverage on the exam.
ACV is replacement cost less depreciation. Typically used for personal property.
Neither Replacement Cost nor ACV use original purchase price in the calculation.
Property Loss Calculation
Greater of:
Actual Cash Value or
Replacement Cost X the Coinsurance Percentage = insurance required
Insurance Carried / Insurance Required minus the deductible
Note, if insurance carried is greater than 80% of the replacement cost, ACV is not used
Personal Auto Policy Coverages
A. Liability
B. Medical Payments
C. Uninsured Motorist Liability
D. Damage to your Auto
1. Collision
2. Other than Collision
Other Than Collision
Open Perils type property coverage that designates several exclusions:
1. Breakage of glass
2. Loss caused by missiles
3. Falling objects
4. Fire, theft, larceny
5. Flood
6. Earthquake
7. Windstorm, hail
8. Vandalism, riot
9. Contact with bird or animal
10. Explosion
Umbrella Liability Insurance
Provides coverage for catastrophic liability claims. Must have certain underlying liability coverage in place for homeowners and auto insurance.
If it is an answer on the exam, it is correct.
Umbrella Exclusions
- Intentional acts to harm (bodily injury or property damage)
- Damage to owned property
- Business pursuits
- Malpractice
- Directors and Officers activities
- Worker’s compensations obligations
Business Owner’s policy
Coverage for small to medium sized business. Covers real property, contents and liability. Professional liability is excluded. Premium is deductible to the business.
Commercial Umbrella policy
Excludes error, omission, malpractice or mistake of a professional. Premium is deductible to the business.