E. Chapter Recap
This chapter was all about giving you the basics of insurance. Let's recap some of the major points:
| GENERAL CONCEPTS |
| Insurance |
- Transfers the risk of loss from an individual to an insurer
- Based on the principle of indemnity
- Based on the spreading of risk (risk pooling) and the law of large numbers
|
| Hazards | Hazards give rise to a peril. There are 3 kinds of hazards:
- Physical - physical condition;
- Moral - a tendency toward increased risk;
- Morale - an indifference to loss
|
| Risk |
- Uncertainty regarding financial loss
- 2 types of risks:
- Pure - insurable because it involves a chance of loss only;
- Speculative - not insurable because it involves a chance of gain
- Methods of handling risk:
- Avoidance
- Retention
- Sharing
- Reduction
- Transfer
|
| Elements of Insurance Risk |
All of the following elements apply to an insurable risk:
- Due to chance: chance of loss beyond insured's control
- Definite and measurable: loss must have definite time, place and amount
- Predictable: number of losses must be statistically predictable
- Not catastrophic: there must be limits that the loss can't exceed
- Large exposure: insurer must be able to predict losses based on the law of large numbers
- Randomly selected exposure: insurer must have a fair proportion of both good and poor risks
|
| INSURERS |
| Stock |
- Owned by stockholders
- Issue nonparticipating policies (nonpar)
|
| Mutual |
- Owned by policyowners (policyholders)
- Issue participating policies (par)
- Pay dividends to policyholders which are a refund of excess premiums
|
| Fraternal Benefit Society |
- Not for profit organization
- Benevolent and charitable brotherhood
- Membership based on religious, national or ethnic lines
- Must be a member to receive benefits
|
| AGENT'S AUTHORITY |
| Express |
Powers specifically stated in the contract
|
| Implied | Not specifically stated in the contract, but is assumed necessary to conduct insurance business |
| Apparent | The appearance of a relationship between the agent and principal based on words or actions |
| COMPANY DOMICILE AND AUTHORIZATION |
| Domicile |
- Domestic - incorporated in this state
- Foreign - incorporated in another state of territory
- Alien - incorporated in another country
|
Authorized/
Admitted |
- Approved by the Department of Insurance
- Has a Certificate of Authority
|
Unauthorized/
Nonadmitted |
- No Certificate of Authority
- Cannot transact business in this state
|
| INSURANCE CONTRACTS |
| Elements of a Legal Contract |
All of the following requirements apply:
- Agreement: offer and acceptance
- Consideration: premiums and representations on the part of the insured; payment of claims on the part of the insurer
- Competent parties: of legal age, sound mental capacity, and not under the influence of drugs or alcohol
- Legal purpose: not against public policy
|
| Contract Characteristics |
- Adhesion - one party prepares the contract; the other party must accept it as is
- Aleatory - exchange of unequal amounts
- Conditional - certain conditions must be met
- Personal - between the policyowner and the insurance company
- Unilateral - only one of the parties to the contract is legally bound to do anything
|
| Legal Interpretations |
- Ambiguities in the contract are always resolved in favor of the insured
- The insured can reasonably expect coverage based on the agent's words and actions
- Utmost good faith - parties rely on each other for information
- Material misrepresentations(if intentional), breach of warranties, concealment, fraud - all can void the contract
- Waiver - voluntary act of relinquishing a legal right; estoppel - consequence of a waiver
|
E.章节回顾
本章的主要内容是为您提供保险的基础知识。让我们回顾一些主要观点：
一般概念
保险
将个人损失的风险转移给保险公司
基于赔偿原则
基于风险（风险共担）和大数法则的传播
危害
危害会带来危险。有三种危害：
身体 - 身体状况;
道德 - 风险增加的趋势;
士气 - 对失落漠不关心
风险
财务损失的不确定性
2种风险：
纯粹 - 可保险，因为它只涉及损失的机会;
投机 - 不可保险，因为它涉及获利的机会
处理风险的方法：
躲避
保留
分享
减少
传递
保险风险的要素
以下所有要素均适用于可保风险：
由于机会：失去的可能性超出了被保险人的控制范围
确定和可衡量：损失必须有确定的时间，地点和数量
可预测：损失数量必须在统计上可预测
不是灾难性的：必须有限制，损失不能超过
大量风险：保险公司必须能够根据大数定律预测损失
随机选择的风险：保险公司必须有相当比例的好风险和差风险
保险人
股票
由股东拥有
发布非参与政策（nonpar）
相互
由投保人（保单持有人）拥有
签发参与政策（标准杆）
向保单持有人支付股息，这是超额保费的退款
兄弟福利社会
不以营利为目的的组织
仁慈慈善的兄弟情谊
基于宗教，民族或种族的成员资格
必须是获得福利的会员
代理人的权力
表达
合同中明确规定的权力
默示
合同中没有明确规定，但假定有必要开展保险业务
明显的
基于单词或动作的代理和委托人之间关系的出现
公司的DOMICILE和授权
住所
国内 - 在此州注册成立
外国 - 并入另一个领土
外国人 - 在另一个国家注册成立
授权/
承认
经保险部批准
有权威证书
未经授权/
Nonadmitted
没有权威证书
无法在此状态下进行交易
保险合同
法律合同的要素
以下所有要求均适用：
协议：提供和接受
代价：被保险人的保费和陈述;支付保险公司的索赔
主管方：法定年龄，良好的心理能力，不受毒品或酒精的影响
法律目的：不违反公共政策
合同特征
附着力 - 一方准备合同;另一方必须按原样接受
Aleatory - 交换不等数额
有条件的 - 必须满足某些条件
个人 - 在保单持有人和保险公司之间
单方面 - 合同双方中只有一方在法律上有义务做任何事情
法律解释
合同中的含糊不清总是有利于被保险人
被保险人可以根据代理人的言论和行为合理地预期承保范围
最大的诚意 - 各方互相依赖信息
重大失实陈述（如果是故意的），违反保证，隐瞒，欺诈 - 都可能使合同无效
放弃 - 放弃合法权利的自愿行为;不容反悔 - 弃权的后果