Principles of Insurance Flashcards

1
Q

definition of insurance

A
  • involves the transfer of loss and the sharing of losses with others
  • used as a protection against financial loss
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2
Q

what type of risk is insurance used to protect someone against?

A

pure risk

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3
Q

pure risk - definition

A

with pure risk, there is a chance of loss or no loss

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4
Q

pure risk - examples

A

death, auto accident, house fire

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5
Q

speculative risk

A

there is a chance of profit, loss, or no loss

generally undertaken by entrepreneurs, is voluntary, and is not insurable

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6
Q

subjective risk

A

differs upon an individual’s perception of risk

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7
Q

objective risk

A

does not depend on an individual’s perception, but is measurable and quantifiable

measures the variation of an actual loss from expected loss

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8
Q

probability of loss

A

the “chance” of a loss occurring

measure of the long-run frequency with which an event occurs

the higher probability of loss may result in a decline of coverage

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9
Q

severity of loss

A

the actual dollar amount of the loss

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10
Q

what is more important: probability of loss or severity of loss?

A

severity of loss

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11
Q

law of large numbers

A

specifies that when more units are exposed to a similar loss, the predictability of such a loss to the entire pool increases

the more exposures, the more likely that the results will equal true and thus will be predictive of future results

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12
Q

perils - definition

A

the actual cause of a loss

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13
Q

perils - examples

A

fire, wind, tornado, earthquake, burglary, collision

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14
Q

hazard - definition

A

a condition that increases the likelihood of a loss occurring

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15
Q

3 types of hazard

A
  1. moral hazard
  2. morale hazard
  3. physical hazard
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16
Q

moral hazard

A

a character flaw

a character flaw would lead to a filing of a false claim

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17
Q

morale hazard

A

the indifference created because a person is insured

laziness

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18
Q

physical hazard

A

a tangible condition that increases the probability of a peril occurring

ex: icy or wet roads, poor lighting

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19
Q

adverse selection

A

the tendency of persons with higher-than-average risks to purchase or renew insurance policies

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20
Q

how is adverse selection managed?

A

underwriting

denying insurance on the front end, and raising premiums on the back end

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21
Q

requisites for an insurable risk

A
  • large number of similar exposure units
  • losses must be accidental
  • losses must be measurable and determinable
  • losses must not pose a catastrophic risk for the insurer
  • premiums must be affordable
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22
Q

elements of a valid contract

A
  • one party must make an offer and the other party must accept that offer
  • there must be legal competency of all parties involved in a contract
  • there must be legal consideration
  • a contract must pertain to a lawful purpose
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23
Q

what does it mean that there must be legal competency of all parties involved in a contract?

A

all parties must be 18 years or older, otherwise the contract is voidable by the minor

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24
Q

what does it mean that there must be legal consideration with a contract?

A

a promise to pay (insurer) and actual payment of a premium (insured)

consideration is whatever is being exchanged (could be money, services, or property)

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25
Q

what does it mean that a contract must pertain to a lawful purpose?

A

the contract cannot promote illegal actions

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26
Q

the principle of indemnity

A

an insured is only entitled to compensation to the extent of the insured’s financial loss

insured can’t make a profit from a contract

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27
Q

subrogation clause

A

the insured cannot receive compensation from both the insurer and a third party for the same claim

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28
Q

the principle of insurable interest

A

an insured must have an emotional or financial hardship resulting from damage, loss, or destruction

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29
Q

when must an insured have insurable interest for a property and liability insurance contract?

A

at the time of inception and at the time of loss

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30
Q

when must an insured have insurable interest for a life insurance contract?

A

at the time of inception

31
Q

void vs voidable

A

void = contract was never valid and thus never came into existence

voidable = a valid contract that allows cancelation by one of the parties while the other party is bound by the agreement

32
Q

warranty

A

a promise made by the insured to the insurer

33
Q

representation

A

statements made by the insured to the insurer during the application process

34
Q

when will a misrepresentation of information void an insurance contract?

A

when it is a material misrepresentation

35
Q

is a misrepresentation of age for a life insurance contract considered a material misrepresentation?

A

no

36
Q

concealment

A

when the insured is silent about a fact that is material to the risk

37
Q

adhesion

A

an insurance policy is “take it or leave it”

there are no negotiations

38
Q

when there are ambiguities in an insurance contract, who is favored in the final decision of whether a claim should be paid? the insured or the insurer?

A

the insured is found in favor due to adhesion

39
Q

aleatory

A

the money exchanged in an insurance contract may be unequal

small premium paid by insured vs large benefit paid out by insurer

40
Q

unilateral

A

only one promise is made by the insurer which is to pay in the event of a loss

insured is not obligated to pay the premiums

41
Q

conditional

A

the insured must abide by the terms and conditions of the insurance contract

42
Q

what are the 4 distinguishing characteristics of an insurance contract?

A
  1. adhesion
  2. aleatory
  3. unilateral
  4. conditional
43
Q

agent

A

a legal representation of the insurer

44
Q

3 types of agents

A
  1. general agent
  2. independent agent
  3. broker
45
Q

general agent

A

represents one insurer (ex: State Farm agent, Allstate agent)

46
Q

independent agent

A

represents multiple, unrelated insurers

47
Q

broker

A

represents the policy owner, not the insurance company

48
Q

express authority

A

given through an agency or written agreement

insurer is responsible for acts of an agent based on express authority

49
Q

implied authority

A

authority that the public perceives, and a valid agency agreement exists

insurer is still responsible even if a client is misled

50
Q

apparent authority

A

when the insured believes that agent has the authority to act on behalf of the insurer when in fact, no authority actually exists

insurer is still responsible

51
Q

features of insurance contracts

A
  • conditions
  • declarations
  • exclusions
  • riders/endorsements
52
Q

conditions

A

details the duties and rights of the insured and insurer

53
Q

declarations

A

includes name of the insured, description of the property, amount of coverage, amount of premium term of the policy, inception/termination dates

54
Q

exclusions

A

this section outlines specifically what will NOT be covered

55
Q

riders and endorsements

A

written additions to an insurance contract, making it possible to customize an insurance contract that may be limited in coverage under the normal terms and conditions

56
Q

how is the insurance industry regulated?

A

at the STATE level

57
Q

what role does the legislative branch play in the insurance industry?

A

provides for licensing of agents, enacts laws and requirements for doing business in a particular state

58
Q

what role does the judicial branch pay in the insurance industry?

A

rules on constitutionality of laws passed by the legislative branch

render decisions and interpretations regarding policy terms

59
Q

what role does the executive branch play in the insurance industry?

A

administers, interprets, and enforces insurance laws

60
Q

replacement cost

A

the current cost of replacing property with new materials of like kind

61
Q

actual cash value (ACV)

A

replacement cost less depreciation

62
Q

agreed-upon value

A

a value that is determined jointly by insured and insurer

63
Q

when is agreed-upon value typically used in an insurance policy?

A

for art and antiques

64
Q

deductible

A

a stated amount the insured must pay before the insurer will make payments

65
Q

copayments

A

insured pays a portion of the losses incurred

common is an 80/20 copayment clause with health insurance, where the insured pays 20% of expenses above the deductible

66
Q

coinsurnace

A

a homeowners policy requires the insured to cover at least a stated percentage of the property value

67
Q

coinsurance formula for how much the insurer pays

A

(face value / coinsurance) x loss - deductible

68
Q

what are the 3 main insurance rating agencies?

A
  1. A.M. Best’s
  2. Moody’s
  3. Standard and Poor’s
69
Q

what does NAIC stand for?

A

National Association of Insurance Commissioners

70
Q

what does the NAIC do?

A

provides a watch list of insurance companies based upon financial ratio analysis

issues “model legislation” that state legislatures may or may not adopt

has NO regulatory power

71
Q

when to use avoidance as a risk management strategy?

A

for the most serious types of risks

72
Q

when to use risk transfer as a risk management strategy?

A

when the financial risk is severe but the frequency is low

use insurance for this

73
Q

when to use risk retention as a risk management strategy?

A

when the financial risk is low and the frequency is high