Module 1 Flashcards
Principles of Insurance
What does risk represent?
The possibility of a loss—or a negative deviation from a desired outcome.
What is a peril?
The cause of loss.
What is a hazard?
A hazard increases the potential for loss.
One type of risk is a possible loss to your house. Here, the perils might include hurricane, tornado, flood, or fire. Assume a loss occurs due to the peril of fire in which your home is significantly damaged. A related ? might be the oily shop rags piled in the corner of the garage next to the space heater. This hazard increases the potential of a fire occurring.
hazard.
What are static risks?
Risks that are relatively constant over time and do not change based on external factors or actions. These risks are typically predictable, often related to the nature of the activity, environment, or system involved. Static risks are generally considered part of the inherent nature of certain activities or conditions.
**typically result from factors other than changes in the economy and can be insured.
What are dynamic risks?
Risks that arise from changes in circumstances, environments, or activities. These risks are variable and influenced by evolving conditions such as economic, social, technological, or organizational changes. Unlike static risks, dynamic risks are often unpredictable and require continuous monitoring and adaptation to manage effectively.
**Insurance does not typically cover dynamic risks.
What are fundamental risks?
Risks that affect large groups of people or entire communities, societies, or economies. These risks are typically beyond the control of any one individual or organization and arise from widespread social, economic, natural, or political conditions. Because they are broad in scope and impact, they often require collective or governmental intervention for mitigation and management.
What are particular risks?
Risks that affect specific individuals, organizations, or localized areas rather than entire communities or societies. These risks are often the result of specific circumstances or actions and are more controllable at the individual or organizational level.
What are pure risks?
Involves only the chance of loss or no loss; in other words, there is no chance of gain. The possibility that a person’s home will burn represents a pure risk because there is no chance of gain but only the chance of loss or no loss. Pure risks are insurable.
What are speculative risks?
Involves both the chance of loss and the chance of gain. Gambling is a classic example of speculative risk because it presents both the chance of loss and the chance of gain. Speculative risks are not insurable.
How many steps are in the risk management process?
7
What two methods of handling risk are grouped under Risk Control?
Avoidance & Reduction
What two methods of handling risk are grouped under Risk Financing?
Retention & Transfer
What is risk control?
A risk management technique that seeks to minimize the risk of loss.
What is risk financing?
A risk management technique that pays the costs of losses incurred.
Avoiding owning an aggressive dog, installing security systems, fencing off pools with locks, maintaining clear walkways, and hiring a driver at night for seniors are all risk ?/? techniques.
avoidance/reduction.
What are the advantages of risk avoidance and reduction?
Savings in premiums and potential liability claims.
Reasonable ? could include not insuring antiques, gun collections, jewelry, and damage to an older vehicle.
risk retention
What is self-insurance?
A method of risk retention.
Large businesses use risk retention and financial planners typically rely upon a specialist to make sure that the business risks are covered for their clients who are business owners.
Self-insurance is a method of risk retention that has several requirements:
The organization should have enough homogeneous exposure units to make losses somewhat predictable.
Adequate funds must be accumulated to cover plan losses.
The self-insurer must be able to administer the insurance functions, such as analysis of potential claims, disbursement of payments to providers, and objective determination of claim validity, as efficiently as an insurance company would.
The self-insurer must be able to competently manage investment of the self-insurance fund.
In order to transfer risk, there must be ?
a party willing to accept the risk in return for a payment.
When an insurance company considers providing coverage for a given type of risk exposure, it gathers as much information on the risk exposure as it can so it is able to:
determine if the exposure meets the requirements of an insurable risk,
decide whether it is practical for the insurer to provide insurance against this particular risk, and
establish how the insurance should be priced.
What is an insurable risk?
A situation or condition that meets certain criteria, making it possible for an insurance company to provide coverage. These criteria ensure that the risk can be evaluated, priced, and managed effectively.
Risk analysis and pricing are done by actuaries who use several factors to determine what the company must charge for coverage (i.e., the premium amount). Anticipated losses are one of the most important pricing factors. Two critical assumptions are used in evaluating these loss statistics:
The elements of an insurable risk have been met and adverse selection can be controlled.
Clearly identifying the elements of an insurable risk and determining whether they are present is a crucial part of the underwriting process, which is considered from the perspective of the insurance company. That is, the insurer is trying to determine which risks it will or will not insure. The elements of an insurable risk include the following:
There must be a sufficiently large number of homogeneous exposure units to make losses reasonably predictable (i.e., the law of large numbers).
The loss resulting from the risk must be definite and measurable.
The loss must be fortuitous or accidental.
The loss must not be catastrophic to the company.
What is the law of large numbers?
A fundamental principle in probability and statistics that states:
As the size of a sample increases, the average of the results obtained from the sample is more likely to converge to the true average (expected value) of the entire population.
In simpler terms, the larger the group or dataset being analyzed, the closer the observed outcomes will align with the expected outcomes over time.
What is the reason for dollar limits on policies?
If the potential loss cannot be measured, the insurance company cannot know how much is needed to pay claims. That is the reason for dollar limits on policies. For a risk to be insurable, losses must be fortuitous (i.e., accidental), with the exception of life insurance. A planned loss generally involves a criminal act (e.g., arson).
The requirement that a loss not be catastrophic tends to cause some confusion. For clarity, remember that insurable risk requirements are stated from the perspective of the ?
insurance company.
What are the seven factors that insurance companies use to limit an insurer’s liability covering losses?
- Insurable interest.
- Actual cash value of the loss.
- Policy limits or face value.
- Other insurance.
- Coinsurance.
- Deductibles.
- Subrogation.
What is an insurable interest?
Simply stated, insurable interest exists when the interested party will suffer a financial loss if the insured loss occurs. In other words, the policyholder must demonstrate that some sort of reasonable relationship exists with the insured and that they will experience financial or emotional suffering if the insured dies.
What is “actual cash value of the loss”?
Actual cash value (ACV), which is used with property losses, is the replacement cost minus depreciation.
What are/is the “policy limits or face value”?
The policy limit or face value of a policy is the maximum amount that will be paid when the insured loss occurs. With most forms of insurance, the policy will pay for losses up to the amount of coverage. With life insurance, it is the amount that is paid when the death occurs.
What is “other insurance”?
This provision states that when a loss occurs, and there is more than one insurance policy covering the same loss, the insured will not profit from the loss. Either one policy is considered primary with the other paying for any uncovered loss, or the policies pay prorated shares of the loss.
What is coinsurance?
Coinsurance may be a splitting of costs, or it may refer to a minimum percentage of insurance that is required to avoid being penalized for inadequate property insurance when there are partial losses.
What is a deductible?
A deductible is a retained risk. It is the portion of insured losses that the insured is expected to pay before the insurance company pays anything.
What is subrogation?
Subrogation is the right of an insurance company that has paid for a loss to recover its payments if it is determined that a different insurance company or person is responsible for the loss and is required to pay for it. This prevents the insured from collecting twice for the same loss.
A client’s risk management plan is composed of ?, ?, and ?.
Social insurance, public insurance, and private insurance.
What is social insurance?
Mandatory insurance administered by the government, with benefits mandated by law. The purpose of social insurance is to protect people from large fundamental risks. Examples include Social Security, Medicare, Medicaid, and workers’ compensation.
What is public insurance?
Designed to enhance public trust in financial institutions. Similar to social insurance, public insurance is usually mandatory and administered by the government or by quasigovernmental institutions. The Federal Deposit Insurance Corporation (FDIC), Pension Benefit Guaranty Corporation (PBGC), and Securities Investor Protection Corporation (SIPC) all administer types of public insurance.
What is private insurance?
Insurance marketed by private insurance companies. Examples of private insurance include disability, health, long-term care insurance, property insurance, liability insurance, and life insurance. Some of these types of coverage may be mandatory as a result of state laws or lender requirements. For example, states may require automobile liability insurance coverage if you choose to register a motor vehicle.
Insurance companies use various distribution channels to provide their products and services. These individuals are generally referred to as producers. The major types of producers are:
independent agents,
captive agents,
career agents,
producing general agents,
brokers,
surplus-line or excess-line brokers or agents, and
solicitors.
What is an insurance producer?
A licensed individual or business entity authorized to sell, solicit, or negotiate insurance policies on behalf of an insurance company. Insurance producers act as intermediaries between insurance companies and consumers, helping individuals and businesses find coverage that meets their needs.
What is an independent agent?
Generally represent several insurance companies doing business under the American or independent agency insurance system. These independent agents decide where they will place their business, dividing the policies they sell among those various companies they represent while, ideally, basing that on the needs of the client and the suitability of the companies.
What is a captive agent?
An insurance agent who works exclusively for one insurance company. These agents are bound by contract to sell and promote the insurance products of that specific company and generally cannot represent or sell policies from other insurers.
What are career agents?
Insurance agents who are employed by a specific insurance company, typically on a long-term or full-time basis, to sell its products. They are similar to captive agents in that they exclusively represent one company, but the term “career agent” often implies a deeper, more structured relationship with the insurer, including benefits like career development opportunities, training programs, and incentives.
What are producing general agents (PGAs)?
Individuals or entities that act as intermediaries between insurance companies and independent agents or brokers. PGAs typically manage a network of agents and are responsible for overseeing their sales activities while also selling insurance products directly to clients. They often have a more substantial role in terms of business operations and management compared to regular agents.
What kind of agent do the following correspond with?
generally produce the majority of their income by selling insurance personally,
do not have specified territories, and
have authority to hire agents to work for them if they wish.
producing general agents (PGAs)
? are individuals who are licensed with and represent many insurers. A broker is the agent of an insurance buyer.
Brokers.
A broker represents a prospective insured and generally cannot bind the prospective insured to an insurance contract. The knowledge, actions, and assertions of the broker are between the broker and the client. The insurer is neither bound by them nor deemed to have any notice of them. Therefore, while the broker can bind herself, the broker cannot bind the insurer. Because of this, the insurer would not have legal liability arising from actions between the broker and the prospective insured.
What are surplus & excess lines brokers?
Handle any type of insurance that cannot be purchased using normal distribution channels within a given state. An individual may not be able to obtain coverage from an admitted (in-state) insurer. A surplus-line agent has the authority to go outside the state and place the business with a surplus-line (nonadmitted) insurer if the necessary coverage cannot be obtained from an insurer admitted in the state. These are found almost exclusively in the property and casualty field.
The insurer is legally liable for the acts of its agents performing their duties, even if:
agents make fraudulent statements unknown to or unauthorized by the insurer.
In the law of agency, there is no presumption that one person can legally act as an agent for another unless a basis for such an assumption is clearly established. An agent’s authority to legally bind a principal (the insurer, in this case) stems from three sources:
Express authority
Implied authority
Apparent authority
What is express authority?
Express authority refers to the specific powers and permissions explicitly granted to an individual or entity by a principal, often through a written or oral agreement. In the context of insurance, express authority is the authority given by an insurance company (the principal) to an agent or representative to act on its behalf in specific ways.
What is implied authority?
Implied authority refers to the power of an agent to perform actions that are not explicitly stated in their contract but are reasonably necessary to fulfill their express authority and carry out their duties effectively. It is a form of authority that is assumed as part of the agent’s role, even though it is not formally documented.
What is apparent authority?
Apparent authority refers to the authority an agent appears to have based on the actions, statements, or representations of the principal (e.g., an insurance company). It is the power an agent seems to possess in the eyes of a third party, even if that authority was not explicitly granted by the principal.
Which authority is the following situation an example of?
An agent who is terminated from employment with the insurer but still is allowed to possess policy illustration software, business cards, and application forms can be presumed to be acting on behalf of the insurer. Therefore, any acts by the agent would bind the insurer unless the insurer notifies the clients that the agent’s employment has been terminated.
Apparent Authority
NOTE: The example encompasses both implied and apparent authority. From the perspective of the client, he presumed the agent had the authority, which is apparent authority. The failure of the insurer to take action against the agent creates implied authority.
What is ratification?
Ratification is the act of approving or affirming an action that was taken on behalf of a principal by another party (e.g., an agent), even though the agent did not have proper authority to perform the action at the time it occurred. By ratifying the act, the principal retroactively grants authority and accepts responsibility for the action.
For example, an insurer may stipulate that its agents must not write insurance on a certain class of applicant (thus putting such an action outside the scope of the agents’ authority). If an agent then writes coverage on an applicant in the prohibited class and the insurer, with full knowledge of the prohibited action, accepts the premium, then the insurer has ratified the agent’s act, and modified the agent’s powers. From then on, the insurer is bound by that act of the agent. Thus, the agent’s act and the insurer’s ratification of that act have modified the agency agreement.
What are the three main “global” purposes for regulation?
to maintain competition, to prevent abuse of consumers, and to minimize market failures.
State regulation of insurance companies involves all three areas of government:
legislative, executive/administrative, and judicial.
A state legislature passes laws that govern conduct of the insurance business in the state. These laws cover the requirements involved in:
organizing an insurance company, standards of solvency, regulation of rates and investments, and licensing of agents.
The ?, headed by the state insurance Commissioner, sets regulations implementing legislation and administers compliance.
state insurance department (executive/administrative)
? interpret and apply the laws and regulations applicable to insurers and interpret policy provisions. They also provide insurers with recourse for a review of the actions of regulators and the constitutionality of laws passed by the legislature.
State courts (judiciary)
The role each branch of government plays with regard to insurance is no different than for any other lawmaking process. The legislative branch ?, the executive branch ?, and the judicial branch ?.
makes laws; enforces the law; interprets the law when disputes arise
What is Public Law 15?
Public Law 15, also known as the McCarran-Ferguson Act of 1945, is a key piece of U.S. legislation that establishes the regulation of insurance as primarily the responsibility of individual states rather than the federal government. This law was enacted to clarify the role of state and federal regulation following a Supreme Court decision in United States v. South-Eastern Underwriters Association (1944), which ruled that insurance transactions could be subject to federal antitrust laws.
While federal agencies, regulations, and legislation certainly influence the regulation of insurance, the ? are tasked with direct regulation of the insurance industry within their respective borders.
states
What is the National Association of Insurance Commissioners (NAIC)?
The U.S. standard-setting and regulatory support organization created and governed by the chief insurance regulators from the 50 states, the District of Columbia, and five U.S. territories.
The purpose of the ? in establishing the accreditation program is to increase the reliability of the oversight of insurance companies by various states.
NAIC
What is an aleatory contract?
An aleatory contract is a legal agreement between two parties where one party’s performance is dependent on an uncertain event, such as an accident, natural disaster, or death. The term “aleatory” comes from the Latin word aleatorius, which means “pertaining to a gambler”.
Aleatory contracts are commonly used in insurance policies, where the insurer is not required to pay the insured until a triggering event occurs. For example, an insurance policy may not pay out if a vehicle is not damaged or stolen.
What is a contract of adhesion?
A “contract of adhesion” in insurance refers to a standard form insurance policy where the terms and conditions are drafted entirely by the insurance company, leaving the insured with little to no ability to negotiate or modify the contract; essentially, the insured must “adhere” to the terms presented on a “take it or leave it” basis, due to the unequal bargaining power between the parties involved.
Insurance contracts are ? in that the insurance company pays on the condition that a covered loss occurs.
conditional
Under the principle of ?, insureds are restored to the financial position they were in before they suffered their losses.
indemnity
What is the collateral source rule?
The “collateral source rule” is a legal principle in tort law that prevents a defendant from reducing a plaintiff’s damages award by the amount of compensation they received from sources other than the defendant, such as health insurance, meaning the plaintiff can still seek full recovery even if they have already been partially compensated by a third party; essentially, it ensures the wrongdoer bears full responsibility for the harm caused, regardless of other sources of payment for the plaintiff’s injuries.
Insurance contracts are ? because the nature of the risk is related to the individual who owns the contract.
personal contracts