Main Focus Flashcards
Coverage A: dwelling
Include garage, attached patio cover, etc. can also include building materials used in the construction and/or repair of the covered structures and building it outdoor equipment used to service the premises
ISO
Insurance services office, the advisory organization that develops forms for the standard market
Coverage B: other structures
Limits insured buildings on the same proper as the dwelling but not attached to it: Detached garage, fencing, gazebo, or work shed
Coverage C: personal property
Insured contents and personal possessions kept at the primary resident. Coverage may be extended to cover personal property of guests and servants. Standard limit of coverage is 50% of coverage A
Coverage D: fair rental value
Cover the loss if fair rental value minus expenses that are not required due to the uninhabitable nature of the premises. Up to 10% of the insurance in the dwelling is available
Coverage E: additional living expense
If the insureds home is uninhabitable due to covered loss, this will cover the additional living expenses related to maintaining the insureds normal standard of living at an alternate resident until the property is repaired or the coverage limit is reached, whichever occurs first. Motel, dining, laundry, and transportation expenses.!
Eligible property for a dwelling policy
Personal residents except farm with no more than four family units and/or five timers or boarders. Manufactured mobile homes in permanent foundations, only covered by the basic form. Private out buildings used with mobile homes: household and personal property in eligible properties. Vacant buildings
DP-1: the basic dwelling policy
Automatically covers buildings and personal property for fire,lightening and internal explosion. Furnace, stove or hot water heater. Stems explosions are excluded if the equipment is owned, leases or operated by the insured party.
Extended coverage (EC)
May be added to extend the perils covered to also include: windstorm, hail, aircraft, riot and civil misconduct, vehicle, explosions, smoke.
DP-2: the broad dwelling policy
Covers building and personal property from the basic perils of perils of fire, lightning and internal explosion. Automatically provides the extended coverage perils and VMM. Falling objects, burglary, weight if Ice sleet or snow, discharge/overflow, tearing apart, freezing or plumbing, artificially generated electric current, smoke damage, vehicle damage. Minimum insurance requirement is 12,000 for the dwelling or 4,000 if the policy is written for personal property only.
VMM
Vandalism and malicious mischief
DP-3: the special dwelling policy
Written on an all-risk basis for real property and broad form for personal property. It covers the dwelling and other structures for all risk of direct physical loss. Pays replacement cost on buildings if they are insured to 80% of value and ACV on personal property. Minimum insurance requirement is 15,000 for dwelling or 4,000 if the policy is written for personal property only.
Homeowners insurance
Considered package or multi-line policies, meaning they provide both property and liability coverage. It’s divided into two sections, section 1 provides property insurance and section 2 provides liability and medical payments insurance
Coverage A: dwelling
Insures the dwelling and attached structures including garage or attached patio cover. Paint for the interior of the house is personal property that would be under coverage A
Coverage B: other structures
Insures buildings on the same property as the dwelling but not attached to it. Detached garage, fencing, gazebos or work she’s. Limit is 10% of coverage A
Coverage C: personal property
Insured contents and personal possessions kept at the primary residence for ACV. Limit is 50% of coverage A. Also insured personal property in the insureds possession anywhere in the world up to the full limit of 100% of the personal property limit/
Coverage D: loss of use
If a covered property loss leaves the insureds primary residence premises uninhabitable, the insured will have coverage for additional living expenses related to maintaining the insureds normal standard if living until resident is repaired
HO-8
BASIC
Privies basic form coverage on an ACV basis for the dwelling and personal property. HO-8 is an option for insurers when the replacement cost if the home exceeds the value. A home that is too old to qualify for replacement coverage or has historic value can be covered under HO-8
HO-2
BROAD
The standard broad form homeowner policy covering both real property and personal property for names perils. Adds some perils not covered by the DP-1 basic form and broadens the. Coverage for others. See page 16 chapter 2 for coverage
HO-4: the renters form
Used to provide coverage for tenants. Only their own personal property. Provides coverage for personal property and liability coverage at home and away.
HO-6: the condominium unit form
Provide coverage for a condominium unit owner. Designed to provide named peril or broad form coverage for personal property. Has a flat $1,000 coverage under coverage A for dwelling coverage.
HO-3: special form
Provides all risk or open peril coverage for real property and broad form or named peril basis for personal property. Exclusions are: earthquake, flood, sewer back up, building ordinance, war and nuclear hazard, wear and tear, rust, dry rot, wet rot, smoke, corrosion, deterioration, birds, rodents, animals as pets
Insurance
A contract whereby one undertakes to indemnify another person against loss, damage, or liability arising from a contingent or unknown event
Insurable events
Are past, present, and future events that may be insured. With no potential of gain or profit. There must be an insurance interest to qualify to purchase insurance policy
Parts of insurance contracts
Declaration page, insuring clause, conditions, exclusions, endorsements, and definitions. (DICEED)
Element for an insistence contract to be valid- contract law
Competent parties, consideration, agreement, legal valid purpose. (CCAL)
All insurance policies must provide the following information.
Parties to the contract. what is being insured-such as home, car, life, business. financial interest- amount of coverage. perils insured- fire, death. Premium. Policy period.
Insurance policy
Is a written instrument in which the insurance contact is set forth
Fraud
Is intentional fraudulent omission in part of an insured, and entitles the insurer to rescind contract.
Concealment
Is failure, it neglect to communicate material facts to a person who knows, that the other party does not know. Hiding, or deciding not to communicate, material facts. Entitles the injured party to rescind contract
Required disclosure
The requirement that each party shall communicate to each other, in good faith, all facts sitting their knowledge, they believe to be material to the contract.
Information not required to be communicated
Information known by the other party, information that is waived by the other party, or information which is immaterial to the contract being insured.
Determination if materiality
Based on the influence of facts provided by each party, and being aware of the disadvantages of the proposed contract
Right of rescission
Termination if a contract as if it never existed. Contract is voided, and entire premium paid to company is refunded
An insurer has right of rescission.
Anytime before the insured files a claim, or upon discovery of misrepresentation, concealment, fraud, increase risk exposure or non payment if premium
A representation
May qualify to be considered the best if belief and knowledge of the party providing information.
Is false when facts do not agree with it’s assertions or stipulations.
Can be altered it withdrawn before the policy is issues but not after issuance
Misrepresentation
No insurer, officer, or agent shall in any shape it form, misrepresent the terms, benefits, privileges, or payment of future policy dividends.
Pure risk
Loss exposure that is subject to loss only, therefore may be Insurable
Speculative risk
Loss exposure that provides possibility of gain/profit therefore is uninsurable
Peril
A cause it trigger of a loss also known as event or situation, that leads up to a loss
Hazard
Anything that increases chances if loss
Physical hazard
For example, driving on worn tires, walking in wet floor, living next to an explosive factory
Moral hazard
Intentionally creating a situation to file a claim on a loss
Morale hazard
Unintentionally creating a situation to file a claim on a loss, such as bad habits, irresponsibility, or carelessness
Law of large numbers
Is a theory used to predict losses an determine premiums
Types of exposures
Are property, liability, and human loss exposures
Types of loss exposures
Are real property and personal property loss exposure
Types of liability exposures
Are personal liability, personal automobile, professional liability, business general liability, commercial automobile liability, workers compensation, and ocean marine loss
Human loss exposure
Personal loss exposure (buying life insurance for personal needs) and personnel loss exposure (purchasing life insurance on life of valuable employee to protect business needs)
Requirements for a risk to be Insurable
Law if large numbers, measurable, uncertainty, cases economic hardship, and excludes catastrophic perils
Insurable interest
Defined as financial interest, economic interest, and emotional interest
Insurable interest in property and casualty
Required interest to exist when insurance takes effect and when loss occurs
Principle of indemnity
Means to restore insured to the same financial position, as prior to the loss (supports Insurable interest)
Private insurers
Stock insurers, mutual insurers, and reciprocals. But not fraternal a or Lloyd’s
Stock insurer
Owned by stock/shareholders/owners. Issued non participating policies
Mutual insurer
Owned by policyholders who are issued a participating policy. Any person holding a participating policy may be entitled to receive policy dividends
Policy dividends
Are not taxable or guaranteed. Any licensed person who uses policy dividends to mislead insured into purchasing insurance shall be guilty of misdemeanor
Underwriting
Is selection, classification, and rating of an application. Before accepting or rejecting a risk
Adverse selection
Risk exposure higher than the average may be rejected it have a higher premium
Self-funded
Retains risk exposure by setting an account with the runes to cover losses/claims. Allows benefits to be tailored
Deductibles
Are “first dollars” of expenses that insured agreed to pay before insurer pays for May losses. Higher deductible, loser premium. Lower deductible, higher premium.
Reinsurance
When ceding (original) insurer goes to a third party to insure themselves.
Reinsurance (section 620 of CIC)
Is used to allow ceding insurer to go over retention limit.
Retention limit
Is the maximum amount if risk an insurer can assume in any one policy
Total classes of insurance
Twenty
Insurance regulation
Is provided by federal regulation, state regulation, and self regulation
Competent parties
Must be legal age, not intoxicated, mentally capable, and the insurer is agent licensed
Legal valid purpose
Is not contrary to public policy. All parties will benefit from contract
Agreement
Includes offer and acceptance
Considerations
Includes anything if value, such as money, promise, premium, policy, giving up or exchange of an act.
Adhesion
Relates to the insurer creating contract. If there is a dispute it unclear terms in the contract, court will rule either against, or in favor of the insured. Take it or leave it
Conditional contract
Means both the insurer and insured just fulfill conditions in the contract to enforce rights
Aleatory
Is the nature of an insurance contract because both parties, insurer and insured, have an element of uncertainty of what each will receive
Unilateral
Is the exchange of unequal values (exchange if an act for a promise) and only the insurer must love up to it’s side if the contract
Utmost good faith
Means both parties enter into contract in good faith
Th major operating divisions if insurers
Are marketing and sales, underwriting, claims, and actuarial
Personal contract
Does not allow policy owners to transfer their right in policy to another person, without consent if insurer
Waiver
Relinquishment of a known righ
Estoppel
The doctrine that stops the party from taking back what they gave up
A standard market insurer
An insurer who offers rates for insurance coverage to those who have an average, or better than average, loss exposure
Market conduct regulations
State laws that regulate insurer practices regarding underwriting, sales, rate making, and claims/handling. May be conducted once every 3 years
Insurance rates
Shall not be approved or remain in effect, if excessive, inadequate, or unfairly discriminatory. Insurance commissioner shall not give consideration to competition between insurers
Rating laws
Some states allow insurers to first use the rate, then file- known as use and file. Other states require rate to first be filed then use rate- known as file and use. California uses prior approval if rates, meaning Rates must be filed before an insurer can use any rates
Surplus lines
Excess and surplus lines insurance derives it’s name from the fact that it is insurance business, legally conducted, with unauthorized or non admitted insurers. Any person may negotiate with a non admitted insurer to produce insurance to protect hire interest in their own property, provided they may require premium taxes
Excess and surplus lines (E&S) lines
May only be transacted through a licensed surplus lines broker or special one surplus lines broker
Tort law
Does not cover crime (criminal acts) or breach if contract (contRact law)
Torts
Can be either intentional or unintentional. Liability insurance provides coverage for unintentional torts.
Tort law- civil action
Used to establish financial responsibility against party at fault; individuals who are found responsible for losses if, or injuries to, another person can be held liable under tort
Intentional torts
Are not covered. The exception is when the tort is performed by an individual that is under the responsibility of another person, such as an employer has vicarious liability. Example- libel, slander, false arrest, assault, battery and intentional infliction of emotional distress
Negligence
Is failure to do what an ordinary person would have done under the same set of circumstances. 4 elements
Gross negligence
A person has acted so far below the ordinary standard of care, their acts are labeled as being “gross”
Comparative negligence
Occurs when weighing of the seriousness of negligence on the part if each party is measured in a contributory negligence case
Contributory negligence
Occurs hen one party’s care for him/herself falls below a required standard and together with the other party’s negligence, contributed to his/her harm. Is like adding woke to the fire; therefore the insurance company will not provide payment on the loss
Strict liability
Liability imposed to products even though the individual may not have caused damage intentionally
Absolute liability
Imposed by law on those participating in activities that are viewed as hazardous, within regard to fault or negligence.
Absolute and strict liability
Refers to situations where a party is liable for injuries no matter what precautions were taken. Recognize situation in which they would apply
Vicarious liability
Employers are vicariously liable for negligent acts or in omissions in the course if employment by tiger employees
Compensatory damages
Includes special and general damages. General damages cover intangibles (pains and suffering) special/specific damages pay for the tangible or measurable (loss if earrings or medical exp)
General damages
Compensate a claimant for the non monetary aspects of the specific harm suffered, usually pain, suffering and loss if amenity. Ex; physical it emotional pain and suffering, loss if companionship, loss of consortium, disfigurement, loss of reputation, loss or impairment of mental or physical capacity, and/or loss if enjoyment of life
Special damages
Compensate for the quantifiable or measurable/monetary losses suffered by the injured party; extra costs, repair or replacement of damages property, loss of earrings, loss of irreplaceable items, additional domestic costs, medical expenses, etc,
Punitive damages
Are exemplary damages intended to reform it deter the defendant, and others, from engaging in conduct similar to that which formed the basis if the lawsuit. The purpose is bit to compensate the plaintiff; however, the plaintiff may receive all or part of the punitive damage award
Assumption if the risk doctrine
A defense in the law if torts. Disallows injured party to seek recovery against a negligent party if defendant can demonstrate that the plaintiff voluntarily or knowingly, assumed the risks at issue inherent to dangerous activity in which he/she was participating at the time if the injury. Does not absolve a defendant of liability for reckless behavior
California workers compensation inspection rating bureau
Provides reliable statistics an rating information regrading workers compensation and employers liability insurance. Provided statistics for purpose of developing pyre premium rates to be submitted to the commissioner for issuance or approval
Identify the terms expenses, losses and combined ratios
Expenses + losses combined/ divided by premiums collected= provide the basis, to determine if there is a profit or loss. If percentage is at 100% company is breaking even: over 100% means losses have resulted. Lower than 100% means profits have resulted
Short rate/ short change means
Insurance company cancels policy and returns all unearned premium minus admin or policy fees. Pro-rate means insurer cancels policy and returns or credits all unearned premium- unused premium. Flat rate insurer returns entire premium usually as result if right to rescind contract is contract was violated
Notice if cancellation
Requires the insured to be notified in Writing during the policy period. Only if insurer discovers increase risk exposure, material misrepresentation, concealment, fraud or non payment of premium
Lapses
Are a result on non payment of premium. No insurance protection is in force
Non-renewal
An insurance policy requires 30 day written advance notice before coverage expires, unless otherwise agreed in original terms
Unearned premium
Is unused premium. Earned premium is the amount of money insurer gas earned since the insured was protected under the terms of the policy. E.g. Annual premium of $1200 policy is cancelled after 3 months, $300 earned premium, $900 unearned premium
Manual rating
Underwriter uses that rate published in the manual rating book. Risk may be classified as standard
Merit rating
Underwriter uses the manual rating and makes adjustments to rate based on variables if insured and risk
Judgment rating
Allows underwriter to use his/ her own experience and judgement. No manual is used
A third party
Files claim against the responsible party at fault / insurance company
Meaning of claims- first party claims
Insured files a loss against those own insurance/personal proper losses or third party claims: liability claims files against the insureds insurance company. The insured is being held responsible for the losses of third party
Subtogation
Defines as the transfer if injureds party’s rights against party at fault, to their own insurance company, that has paid then for their losses instead of having to wait for party at fault to pay for losses: assigns the rights of the insureds party
Arbitration rights
Are granted when a loss gas been sustained and the injured party does hit agree with the losses covered or amount if payment agreed to be paid by insurance company. Insurer and insured do not after on amount to settle a claim
Loss reserve
An estimate if the total amount that an insurers will pay for future claims and current losses, pending proof of loss
Assignment
A provision that states policy rights or interest may be transferred, only if approval by the officer if the insurance company
Difference between property and property liability insurance
Property insurance can cover real or personal property, whether personal or business. Liability insurance is written to protect the insured/business against the claims if third parties when insured is found at fault or responsible (on a personal, professional it business level)
Concurrent policies
When the insured has two or more picked covering the same insured, terms, conditions, coverages and property. When a loss occurs the insurer will pay a proportionate share. Versus non concurrent policies- one policy becomes primary and the other will pay on excess basis
Concurrent causation
When two perils occur, and one peril is covered and the other peril is excluded. Under concurrent causation all losses will be covered. Versus non concurrent causation that has an exclusion that stated, there will be no coverage for the perils specifically excluded, even if two or more perils occur in any sequence. Perils excludes will not be covered
Liberalization
Means In the scent that insurer creates a contract revision during policy period, the broadest form of coverage will be provided without additional premium.
Supplementary payments
Are defined as a form of additional insurance to defend insured against legal costs as a result of third party claims (liability)
Severability provision
Allows terms inside contract to be separate from each other so that the insurance protection is valid. It Also states that each party insured under the contract shall be provided separate coverage, up to policy limits for each insured
Warranty
Is a statement if fact. It may be either expresses it implied, but must be truth
Express warranty
Is a statement in the policy if a matter relating to the person being insured, or thing being insured, or risk wing insured
Implied warranty
Includes in the contract, even though bit specifically stated. It may qualify as a representation or as an implied warranty
Misrepresentation when found guilty
May be charges with misdemeanor, punishable by a fine of up to $25,000 or if victim suffered loss of over $10,000, agent may be required to pay up to 3 times the amount of loss and up to one year in jail. Commissioner may revoke license after a hearing
Distribution systems
Are a means insurance companies use to sell their insurance products, insurance producers, independent/ exclusive, direct writing/ direct mail and internet
Admitted insurer
Means any person entitled to transact insurance business in this state, after satisfying the laws/ conditions in the state of CA without regard to origin, and holds a certificate of authority
Foreign insurers
Are organized outside the laws of CA.
Alien insurer
Organized outside the United States, whether admitted or not
Domestic insurers
Organized under the laws of their home state, whether admitted or not
No -admitted
Means any person not entitled to transact insurance business in this state, whether by reason of failure I comply with the conditions or inability to comply
Unlawfully acting, aiding, assisting, or advertising for an insurer without a certificate of authority
Is a misdemeanor or subject to $500 plus $100 for each month in which the violation continues
Person under the insurance code
Is any natural Person, corporation. Association, organization, partnership, business trust, it limited liability corp (LLC)
Marketing methods
Insurance companies May marker their insurance products by mass marketing, direct response or insurance producers
Insurance producers
Have a legal relationship as agents to insurer and insured. Agents have a fiduciary responsibility to both parties that have trusted them
Underwriting applications
Requires the gathering if additional information in order to evaluate risk for selection, classification, and rating if the policy to be issues
Insurance agent
A person authorized by, and on behalf if, an insurer to transact all classes of insurance other than life
Insurance biker- section 1623 CIC
A licenses person who has a written agreement from the insured, and is transacting insurance in behalf if the insured
Insurance solicitor- section 1624 CIC
A licenses natural person, that must be appointed by an agent or broker, and hold permanent broker-agent license
Authorities if MGA
Are granted specified geographic territories, have the ability to appoint and terminate agents under their agency, are able to act as underwriters, and can collect premiums from their producing agents
MGA- section 769.81 (C)
Negotiated and binds ceding reinsurance in behalf if the insurer. Acts as an agent, and produces and underwrites gross direct written premiums, equal to or more than 5 percent, of the policyholder surplus, as reported in the insurers last annual statement
Property broker-agent it casualty broker-agent licensee
A person that is authorized to act as an insurance broker, insurance agent, or insurance solicitor, and has the authority to transact 24 hour coverage and any coverage that a personal lines licensee is authorized to transact
Personal lines licenses, section 1625.5 CIC
A eosin authorized to transact personal automobile, homeowners, watercraft, inland marine, excess, and umbrella insurance
Insurance adjusted
A person, other than a private investigator, who, for compensation, acts in behalf if or aids in any manner, an insurer in the negotiating for it effecting the settlement of a claim or claims
Public insurance adjusted
A person who, for compensation, acts on behalf of or aids in any manner an insured in the negotiating for, or effecting of, the settlement if a claim or claims for loss or damage under an insurance policy
Surplus line and special surplus line broker, section 1761 CIC
Authorized to transact insurance with non admitted insurers, in the event the risk has been rejected by at least three admitted insurers
Errors and omission (E&O) coverage available
They are: professional liability, directors and officers, and malpractice
Definition if transact
any person who transacts insurance on behalf if an admitted insurer, must hold a valid insurance license to receive insurance commissions. If not licensed, may be guilty if a misdemeanor, punishable by a fine up to $50,000 and/or jail up to 1 year
Solicitation- section 35 (a) CIC
The initial contact with the possible purchaser, and includes: calling to set up appointment, passing out flyers or brochures, and hanging out business cards
Life broker or health broker
Under the CA insurance code, life or health brokers do not exist
WhT constitutes transaction of insurance - section 35 CIC
The solicitation of insurance, negotiations preliminary to execution if insurance contract, and transaction if matter subsequent to and arising out of a contract of insurance
Negotiation -section 35 (b) CIC
Gathering information to discover beds/risk and reviewing premiums, coverages, deductibles, types and amounts if insurance, and terms if coverage. Anne’s if insureds to be protected, which leads to execution
Execution of a contract of insurance -section 35 (c) CIC
Is when agent issues a binder/covering note. Or when the insured signs application, the agent collects check/premium, and then the policy is issues
Transaction of matters subsequent to, and arising out of, a contract of insurance m, include:
Policy delivery, annual reviews, changes to policy, filing claims, updates to policy coverage, and renewing policy
Insurance broker
Someone paid, by written agreement, for transacting insurance in behalf of the insured
Know life settlement brokers
They are licensed to assist the insured to find the best buyer for their existing life insurance policy
Code prohibits certain actions by unlicensed peesons
It’s prohibits any person to solicit, negotiate or execute and type of insurance contract, or act in any capacity for which a license is required/ shall be guilty if a misdemeanor, punishable by a fine bit to exceed $50,000 or up to one hear in jail or both
Life settlement broker
It is prohibited to place before the public, directly or indirectly, any means if communication for the purpose if inducing public to purchase, well, assign, devise, or bequest an insurance policy
Life settlement brokers, when an insured is terminally I’ll -section 10113.3 CIC
Must obtain a written statement from an attending physician that the owner of the policy is of sound mind and under no constraints or influence to enter into contract
Life agent
May submit proposal for a life policy in behalf of the insurer, to which the agent is not appointed with, provided the insurer submits notice of appointment within 14 days after agent has submitted the insurance application
Effect if the code regarding termination if producers license
States, upon death if insurance producer, license shall terminate it cease to exist
Change if address -section 1729 CIC
Must be notified in writing immediately
Differentiate between an insurance agent, an insurance broker and an insurance solicitor
An agent is appointed by an insurer. A broker is required to have on file. $10,000 bond, on the favor if people of CA. An insurance solicitor is a natural person appointed by an agent or broker to work on their behalf
Insurance agents errors and omissions insurance
Is professional liability insurance, an is the responsibility of the agent to purchase in case they are used by the insured for an unintentional error or omission
Rules regarding fictitious names
Must first be filed for approval with the insurance commissioner
Identify the prohibitions if free insurance
No insurer or agent shall participate in any plan to offer or effect any kind insurance or annuities as an inducement to purchase or rent any real or personal property or services, without a separate agreement and charges for insurance
All agency names, or use of name by any person transacting in this state
Shall file all names used when transacting insurance. All names may be disapproved by insurance commissioner, except the bona dude natural name
Agency barn, use of name
Broker agents or life agent who have a contract with corporations or associations m, licensed under the code, must clearly identify in advertisement or printed material, name of corporation or association, and their relationship
Rules regarding internet advertising
The licensed agent who advertises on the internet shall identify name as it appears on their license, any fictitious name approves by insurance commissioner, principal place of business and the insurance license number: phone number is not required
Licensee’s duty for disclosure of the effective date of coverage
A life agent, or fire and casualty broker-agent, shall provide to all insureds/applicants at time if application, or upon receipt if premium, the effective date if coverage, if known, or circumstances or conditions before coverage is effective
Be able to identify the code specifications regarding producer application denial after a hearing -section 1668 CIC
If applicant is not properly qualified to perform the duties if a person holding the license, ten granting license would not be in the best interest of the public. Applicant is lacking integrity, bit trust worthy, or has enhances in dishonest matters.
Applications filings and suspension or revocation of license without a hearing
Applicant with a conviction of felony, applicant who was convicted if a misdemeanor denounce by insurance laws; or application denied for cause within the past 5 years for a vocational or occupational license, or had a license suspended or revoked for cause wishing past 5 years
