Unit 1: General Insurance Flashcards

1
Q

What are the 2 types of risk?

A

•speculative
•pure

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2
Q

What are speculative risks?

A

•have a possibility of a loss and also the possibility of making a gain
•insurance companies will not insure these since you can win or lose money

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3
Q

What are some examples of speculative risks?

A

•gambling losses
•investments

—> because you could win or lose money

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4
Q

What are pure risks?

A

ONLY involve the possibility of experiencing a loss & CAN be covered by insurance

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5
Q

What is an example of a pure risk?

A

The chance of being in a car accident

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6
Q

How do you determine the total amount of loss?

A

[value before loss] - [value after loss]

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7
Q

What is exposure?

A

•the risk assumed by an insurer and the amount that the insurer is responsible to pay out at any given time
i.e., risks for which the insurance company would be liable

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8
Q

How is exposure expressed?

A

•in units

Ex. The unit for life insurance exposure is $1,000 of death benefit and premium rates apply per unit of exposure

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9
Q

What is the calculation for insurance premium?

A

[rate] x [# of exposure units]

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10
Q

What is an example of a calculation for insurance premiums?

A

•if the life insurance rate is $32 per $1,000 of death benefit,

—> the premium for a $100,000 policy would be: $32 x $100 = $3,200

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11
Q

What is a peril?

A

A cause of loss

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12
Q

For life insurance, what is the peril?

A

Death

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13
Q

For health insurance, what are the perils?

A

•accidents
•illness

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14
Q

What are some examples of perils?

A

•if a house burns down, the peril (cause of loss) is the fire

•if electronics in a home are destroyed because of lightning, the peril is the lightning

•if you drive your car through a hailstorm and the car’s body is damaged, the peril is the hail

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15
Q

For property & casualty insurance, what are the perils?

A

Fire, lighting, etc.

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16
Q

What is a hazard?

A

•anything that increases the chance that a loss will occur
•do NOT cause the loss
*”get down before you get hurt”

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17
Q

What are the 3 types of hazards?

A

•physical
•moral
•morale

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18
Q

What are physical hazards?

A

•physically identifiable factors that increase the chance of loss
•can be seen or determined

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19
Q

What are some examples of physical hazards?

A

•a wet floor
•for life & health insurance, a heart condition-because it is physically identifiable using lab equipment that produces tangible evidence of its existence

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20
Q

What are moral hazards?

A

•arise from an individual’s character
•intentionally causing a loss

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21
Q

What is an example of a moral hazard?

A

Dishonesty—>because it increases the chance that an individual might lie on an insurance application or fake a loss

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22
Q

What are morale hazards?

A

•a state of mind or careless attitude
•an unconscious change in a person’s actions or behaviors

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23
Q

What is an example of a morale hazard?

A

Carelessly leaving the doors & windows unlocked when not at home

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24
Q

What are the methods for handling risk?

A

STARR:

•Sharing
•Transfer
•Avoidance
•Reduction
•Retention

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25
Q

What is Sharing of risk?

A

•2 or more individuals agree to pay a portion of any loss incurred by any member in the group

Ex. Stockholders in a corporation share the risk of profit or loss

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26
Q

What is Transfer of risk?

A

•what happens with insurance
•the insurer agrees to pay if any individual or business has a loss
•the individual or business has a cost in the form of a premium payment
•while the loss is large & uncertain, the premium is a much smaller certainty
•this is used by insurance companies to spread a risk of loss among thousands/millions of insureds
•not everyone will experience an accident while they own an insurance policy
—>the large # of insureds who do not have an accident will be paying for the losses of the few who do have an accident
—>this is the only way that insurance can work & make the premiums affordable

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27
Q

What is Avoidance of risk?

A

•eliminating a particular risk by not engaging in a certain activity

Ex. An individual who does not drive avoids the risk of injuring someone in a collision & being held liable for those damages

Ex. Working from home if the roads are icy

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28
Q

What is Reduction of risk?

A

•lessening the chance that a loss will occur
•lessening the extent of a loss that does occur

Ex. Wearing seatbelts reduces the severity of a car accident

Ex. Installing a smoke detector will not prevent a fire, but it may keep individuals from serious harm

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29
Q

What is Retention of risk?

A

•the individual will pay for the loss if it occurs
•without health insurance a person will have to pay the bill if they need hospitalization
—>this is an example of intentionally retaining a risk

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30
Q

What is the law of large numbers?

A

•the principle that makes insurance possible
•the larger the group—>the more accurately the losses can be predicted
•it is impossible to guess specifically who will suffer a loss in the future, but can be fairly certain how many losses will occur in the group as a whole
—>so insurance companies can predict fairly accurately how many dollars in claims they will have to pay out each year based on the actual losses they experienced in the past
—>this prediction allows them to charge each insured a premium that, pooled together, will cover all claims & operating costs

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31
Q

What are the elements of risks that can be insured?

A

CANHAM:

•Calculable
•Affordable
•Non-catastrophic
•Homogeneous
•Accidental
•Measurable

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32
Q

In CANHAM, what is Calculable?

A

Premiums must be calculable based upon prior loss statistics for that particular risk in order to predict future losses

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33
Q

In CANHAM, what is Affordable?

A

The premium for transferring the risk should be affordable for the average consumer

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34
Q

In CANHAM, what is Non-catastrophic?

A

•insurance cannot insure events that cause widespread losses to large numbers of insurers at the same time
—>this is why the peril of war is excluded from most policies, because the risk is much too large for the insurance company to pay

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35
Q

In CANHAM, what is homogeneous?

A

The individual risks that the insurer covers must all be similar (homogeneous) in regard to the factors that affect the chance of loss

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36
Q

In CANHAM, what is Accidental?

A

•insurance is a method of handling risk
—>if a loss is certain to occur, there is no risk

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37
Q

In CANHAM, what is Measurable?

A

•must be possible to estimate the loss as a dollar amount
•insurance covers the financial loss of unexpected death or medical bills from sickness

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38
Q

What is adverse selection?

A

•the tendency for higher-risk individuals to get & keep insurance more than individuals who represent an average level of risk
•risks that have a greater than average change of loss
•the statistics insurers use to predict their losses are based on average risks
—>adverse selection could cause the insurance company to experience more losses than predicted
—>it increases the chance that they have not collected enough premiums to pay for their losses

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39
Q

What can be done to avoid adverse selection?

A

An insurer can do an underwriting

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40
Q

What is an underwriting?

A

To avoid adverse selection, insurers make an extensive evaluation of information related to a particular risk

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41
Q

What can an insurer do if an underwriter determines that a risk is higher than average?

A

•charge a higher rate to insure the risk
•limit the amount of coverage it will issue on the risk
•refuse the application for insurance altogether

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42
Q

What is reinsurance?

A

•like insurance for insurers
•an insurance company paying another insurance company to take some of the company’s risk of catastrophic loss
•transfers risk from one insurer to another
•to reduce the total amount of loss it is liable for, one insurer may pay the other insurer a premium to assume a portion of its risk

•ceding insurer=the company reducing its risk
•reinsurer=the company assuming the risk

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43
Q

What is one example of reinsurance?

A

•insuring risks in certain geographical areas may expose the insurer to the potential of having to pay for a large number of losses at one time-may happen due to things such as earthquakes or hurricanes
•to protect the company from these catastrophic losses, the insurer pays a premium to another insurer to transfer some or all of its risks in these areas
•the company accepting the risk is called the reinsurer

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44
Q

What are the 2 types of reinsurance?

A

•facultative reinsurance
•treaty reinsurance

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45
Q

What is facultative reinsurance?

A

The reinsurer considered each risk before allowing the transfer to be made from the ceding company

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46
Q

What is treaty reinsurance?

A

•the reinsurer accepts all risks of a certain type from the ceding company
•accepts the transfer according to an agreement called a “treaty”

47
Q

What is a stock insurer?

A

•a business formed as a public or private corporation owned by its stockholders/shareholders

•BOD that oversees the operation of the company is chosen by the stockholders/shareholders

•if the company makes money, a taxable dividend from the profits may be paid to the stockholders/shareholders

•issues “non-participating/non-par policies” to distinguish them from the participating policies used by mutual insurers

48
Q

What is a mutual insurer?

A

•owned by policyholders (customers)
•policyholders choose BOD—>BOD appoints officers who operate the company
•if the company makes a profit, excess premiums can be returned to its policyholders as nontaxable dividends
•issue “participating” or “par” policies

49
Q

Why are mutual policies referred to as “participating” or “par” policies?

A

Because the policyowners participate in the operating results of the company

50
Q

What are fraternal benefit societies?

A

•provides insurance & other benefits
•must be a member of the society to get the benefits

•exist for the benefit of its members & offer life insurance as one of the benefits of membership

•also provide social activities & usually engage in charitable & benevolent causes

•organized under a lodge system, operate as nonprofit societies, & receive some income tax advantages

•operate their insurance programs under a special section of the state insurance code

•fraternal policies are called “certificates”
—>members who own life insurance are called “certificate holders”

•certificate holders may be assessed additional charges if premiums are not sufficient to pay claims during a given period
—>policies with this feature are called “open contracts”

**by comparison, mutual & stock insurers are not assessable & are sometimes referred to as “legal reserve” companies

51
Q

What are fraternal policies called?

A

Certificates

52
Q

What is a distinctive feature of fraternal life insurance?

A

•certificate holders may be assessed additional charges if premiums are not sufficient to pay claims during a given period
—>policies with this feature are called “open contracts”

53
Q

What is a reciprocal insurer?

A

•unincorporated
•members are assessed the amount they have to pay if a loss to any member of the group occurs
•run by an attorney-in-fact

•unincorporated groups of people that agree to insure each other’s losses under a contract
•members of the reciprocal groups are called “subscribers”
•each subscriber has an account through which premiums are paid & earned interest is tracked
•if any subscriber suffers a loss covered by the reciprocal insurance agreement, each subscriber account is assessed an equal amount to pay the claim
•administration, underwriting, sales promotion, & claims handling are handled by an “attorney-in-fact”
—>the attorney-in-fact is often controlled & overseen by an advisory committee

54
Q

What is a Risk Retention Group (RRG)?

A

•liability insurance company created for policyholders from the same industry
Ex. Car dealers RRG-only car dealers can be policyholders

•an insurer formed for the sole purpose of providing liability insurance to its policyholders
•owned by the insureds or members
•policyholders must all be members of the same type of business
•regulated by the state where they are headquartered
—>HOWEVER, they can operate in other states as well

55
Q

What are Lloyd’s Associations?

A

•insurance provided by individual underwriters, NOT insurance companies

•NOT insurance companies
•provide a hub for the exchange of information among member underwriters who actually transact the business of insurance
•members are individually liable & responsible for the contracts of insurance into which they enter
•have insured unusual risks such as hole-in-one contests, the hair of athletes, & body parts of celebrities
•most Lloyd Association insurance needs to be sold by surplus lines intermediaries because they are only licensed in a few states

56
Q

What is self-insurance?

A

•a business that pays its own claims

•a means of retaining risk, rather than transferring
•businesses may develop a formal program for self-insuring all or a portion of certain risks
—>they set aside savings to cover losses in advance & may even have a claim system like an insurance company
—>they often contract with an insurance company to manage the day-to-day operation of the business

57
Q

What is residual market?

A

Insurance from the state or federal government

58
Q

What are some insurance benefits provided by the federal government?

A

•social security benefits
•military life insurance benefits
•federal employee compensation benefits
•various retirement benefit programs

•also provides, supports, or subsidizes a number of insurance programs designed to cover catastrophic risks, including insurance for war risks, flood, & crop losses

*local governments also participate in providing medical, disability, & retirement benefits

59
Q

What are some insurance benefits offered by state governments?

A

•unemployment insurance
•workers’ compensation insurance
•disability insurance
•medical insurance for the needy

*local governments also participate in providing medical, disability, & retirement benefits

60
Q

What is a domestic insurer?

A

•Writes business in the state in which the insurer was formed (chartered or incorporated)

•an insurer’s home state is also called it’s “state of domicile”

61
Q

What is a foreign insurer?

A

Writes business in states other than where it is domiciled

62
Q

What is an alien insurer?

A

Insurer formed under the laws of any country other than the U.S. & its territories

63
Q

When a company is licensed to sell insurance in a state, what is the license called?

A

A certificate of authority

64
Q

When a company is licensed to sell insurance in a state, what is it called?

A

“Admitted” or “authorized”

65
Q

What is a company that is nonadmitted/unauthorized/non approved?

A

A company that is allowed to sell insurance to certain types of risks (called surplus) without having to have a license (certificate of authority) from the state

66
Q

What is surplus lines insurance?

A

•insurance sold by unauthorized/nonadmitted insurers-if on the state’s approved list of surplus insurers
•can only be sold to certain high risk insureds
•CANNOT be sold just for a cheaper rate than licensed/admitted insurers

67
Q

A stock company is a __________ company.

A

Participating

68
Q

Who do agents legally represent?

A

The insurer, NOT the insured

69
Q

What are the 4 types of agents?

A
  1. Independent insurance agents
  2. Exclusive or captive agents
  3. General agents (GAs) or managing general agents (MGAs)
  4. Direct-writing companies
70
Q

What are independent insurance agents?

A

•individuals that sell the insurance products of several companies
•independent contractors, NOT employees of the insurers
•own the renewals of the policies they sell

71
Q

What are exclusive or captive agents?

A

•represent only one company
•sometimes referred to as “career agents”
•independent contractors, NOT employees of the insurer
•insurance company owns the renewals of the policies sold on their behalf

72
Q

What are general agents (GAs) or managing general agents (MGAs)?

A

•hire, train, & supervise other agents within a specific geographical area
•receive overriding commissions (overrides) on the business produced by the agents they manage

73
Q

What are direct-writing companies?

A

•usually pay salaries to employees whose job function is to sell the company’s insurance products from a company office
•not usually paid a commission & the insurer owns all of the business produced

74
Q

What is direct response marketing?

A

•no producer/agent
•policies are sold directly to the public by the insurer
•conducted through the mail, by advertisements in newspapers & magazines, on television & radio, or through the internet

75
Q

What is an agency?

A

A relationship in which one person is authorized to represent & act for another person or for a corporation

76
Q

What is an agent?

A

The person authorized to act on behalf of the other (in an agency)

77
Q

What is a principal?

A

The person on whose behalf the agent acts (in an agency)

78
Q

In insurance, who is the principal (in an agency)?

A

The insurer

79
Q

In insurance, who is the agent (in an agency)?

A

The sales representative or producer

80
Q

What is the law of agency?

A

•contracts made by the agent are considered to be contracts of the principal

•when the employer/principal provides specific directions & exerts more control over an individual/agent’s job duties, then an agency relationship may exist

•payments made to an agent, within the scope of the agent’s authority, are considered to be received by the principal

•the knowledge of the agent is assumed to be the knowledge of the principal

—>therefore, the principal is liable for the statements & actions of their agents

81
Q

Under the law of agency, what are the 3 types of authority?

A
  1. Express
  2. Implied
  3. Apparent
82
Q

What is express authority?

A

•what the agent’s written contract with the company states

83
Q

What is implied authority?

A

•not written, but are actions agents normally do to sell insurance

•not written in the agency contract
•assumed to be granted to an agent in accordance with general business practices
•the power that the agent believes they have because it is necessary for the agent to conduct the business of the insurer

Ex. An agent’s contract may not say in writing that the agent has the right to print business cards with the insurers logo on them, but this authority is implied by allowing the agent to act on the insurer’s behalf

84
Q

What is apparent authority?

A

•actions the agent does that a reasonable person would assume as authority, based on the agents’ actions & statements

•authority that others believe the agent has

Ex. If the insurer’s name is on the sign at the agent’s place of business & the agent takes applications for the insurer’s policies, then the agent apparently has the insurer’s authority to conduct its business as far as the public is concerned

85
Q

What are the fiduciary responsibilities of agents?

A

•promptly send premiums to insurer
•knowledge of products
•comply with laws & regulations
•no commingling

86
Q

What are the 5 elements that must be present to form a valid contract?

A

CLOAC:

  1. Consideration
  2. Legal purpose
  3. Offer
  4. Acceptance
  5. Competent parties
87
Q

What is legal purpose?

A

•to be valid; a contract must be for a legal purpose & not contrary to public policy
Ex. An agreement to address purchase stolen goods would not be a valid contract because it lacks legal purpose

88
Q

Acceptance of an offer must be _________ and _________.

A

Unconditional, unqualified

89
Q

If acceptance of an offer is qualified or conditional, what is it?

A

•no agreement has been reached
•it is actually a rejection of the offer
•called a “counter offer”

90
Q

What is consideration?

A

think MONEY
•refers to an exchange of value
•each party to the contract must give something valuable to the other
•in an insurance contract, the applicant provides consideration in the form of the information (representations) in the application & the premium payment
•the insurer provides consideration in the form of a promise to pay if certain loss occurs

91
Q

What is competent parties?

A

•for a contract to be binding, both parties must have the legal capacity to make a contract
•the insured or applicant must be of legal age (usually 18) & be mentally competent to make an insurance contract
•applications of minors usually must be signed by an adult parent or guardian

92
Q

What is adhesion?

A

•policy written by the insurance company
•if ambiguous (not clear), court will take the side of the insured (parties that have no input into the wording of a contract & no power to change it cannot be held responsible for any unclear contract language)

•insurance policies are contracts of adhesion
•their provisions are written by only one party to the contract & the other party is required to adhere (stick) to them
•it is the insurer who writes the contract’s terms & the insured that must adhere

93
Q

What is aleatory?

A

•not equal value-small premium for a large amount of coverage

•insurance policies are aleatory contracts
—>the value received from the contract by each party may be unequal
•the receipt of unequal value arises because the insurer’s performance under the contract depends upon an uncertain event—i.e., the occurrence of a loss which may or may not occur
•the insured may pay premiums for many years & receive no monetary value in return if the loss does not occur
•on the other hand, the insured may pay only one relatively small premium & receive thousands of dollars in return if a covered loss occurs shortly after the policy goes into affect

94
Q

What is a contract of utmost good faith (& reasonable expectation)?

A

The insured & insurance company have a right to expect honesty from each other

95
Q

What is unilateral?

A

•insurance policies are one-sided
•only one promise is made
•insurance company promises to pay for a covered loss
•insured does NOT promise to pay the premium (can stop paying premiums at any time)

96
Q

What insurance policies are personal?

A

Property-casualty (such as auto & homeowners)

97
Q

What insurance policies are NOT personal?

A

Life & health

98
Q

What is a personal contract?

A

Cannot be transferred/assigned to someone else

99
Q

What is a contract that is NOT personal?

A

•the insurer has a contract NOT with a particular person, but with whatever party is the policyowner
•can be transferred/assigned to someone else

100
Q

What is conditional?

A

•insured must pay the premium for coverage & file a claim if a loss occurs

•insurance policies are conditional contracts
•they require certain conditions to be fulfilled in order for performance under the contract to be enforced

Ex. -contract may require certain documents to be submitted to prove that a loss has occurred
-in the case of life insurance, a death certificate must be filed

101
Q

What is indemnification?

A

The principle of restoring an insured to their pre-loss financial state

102
Q

What is indemnity?

A

•insurance policies are contracts of indemnity
•restore to the insurer’s original pre-loss financial condition-no better, no worse
•applies to health insurance, but not life insurance because with life insurance, payment occurs upon death

103
Q

What is a representation?

A

•statement that is believed to be true

104
Q

What is a misrepresentation?

A

•information given is not true
•however, the correct information would not affect the insurance company’s decision
•does not necessarily void insurance contracts

Ex. Insured mistakenly gives one number of their address wrong-doesn’t void coverage

105
Q

What is a material misrepresentation?

A

•false information must have been a determining (or material) factor in the insurer’s acceptance of the risk
•can void an insurance contract

Ex. Insured has a conviction for DUI-this could void coverage

106
Q

What is a warranty?

A

•guaranteed to be true
•always made by the insurance company-if promise to pay is broken-company could be sued by the insured
•may be made by the insured-if promise is broken-insured may have no coverage
•if a warranty is not kept, their is a breach of warranty that voids the contract

•applicants for property-casualty insurance sometimes makes warranties to an insurer
Ex. A business may guarantee that it will hire a security guard—>if it does not, it’s property insurance will be void

•however, for life & health insurance, most state laws say that statements or responses to questions on an application are representations & NOT warranties
—>an untrue statement on a life & health insurance application is NOT a breach of warranty
•to be grounds for voiding the contract, it must be material to the insurer’s acceptance of the risk

107
Q

What is a breach of warranty?

A

•happens when a warranty is not kept
•voids the contract
•must be material to the insurer’s acceptance of the risk to be grounds for voiding the contract

108
Q

What is concealment?

A

•the intentional failure to disclose known facts
•if intentional & the information is material, coverage could be voided
•if not intentional, coverage cannot be voided

Ex. A previous heart attack

109
Q

What is fraud?

A

•intentional act to cheat another
•voids the policy

110
Q

What are the potential penalties of fraud & false statements?

A

•fine and/or imprisonment (10-15 years)
•embezzlement included

111
Q

What is a waiver?

A

Intentionally & voluntarily giving up a known right

112
Q

What is an estoppel?

A

•actions reasonably relied on by one party can’t be denied by the party that accepted the same previously

•a legal doctrine that prevents a party from denying an action if it had been accepted previously

113
Q

What is an example of a waiver & an estoppel?

A

•by repeatedly accepting late premium payments, an insurance company may have waived its right to cancel a policy for nonpayment or late payment of premium
•in the future, the insurer may be legally estopped from making any prompt cancellation for nonpayment because the policyholder has begun to rely on the prior acceptance of late payments

114
Q

What is insurance?

A

The transfer of risk