Conditional Contract
As the name implies, a conditional contractrequires that certain conditions must be met by the policyowner and the company in order for the contract to be executed, and before each party fulfills its obligations. For example, the insured must pay the premium and provide proof of loss in order for the insurer to cover a claim.
3. Legal Concepts and Interpretations Affecting Contracts
Ambiguities in a Contract of Adhesion
Because only the insurance company has the right to draw up a contract, and the insured has to adhere to the contract as issued, the courts have held that any ambiguity in the contract should be interpreted in favor of the insured.
Indemnity
Indemnity (sometimes referred to as reimbursement) is a provision in an insurance policy that states that in the event of loss, an insured or a beneficiary is permitted to collect only to the extent of the financial loss, and is not allowed to gain financially because of the existence of an insurance contract. The purpose of insurance is to restore, but not let an insured or a beneficiary profit from the loss.
Life and Health Example:
Brenda has a health insurance policy for $20,000. After she was hospitalized, her medical expenses added up to $15,000. The insurance policy will reimburse Brenda only for $15,000 (the amount of the loss), and not for $20,000 (the total amount of insurance).
Property and Casualty Example:
Brenda has a homeowners insurance policy for $200,000. After her home was destroyed, her expense to rebuild the home added up to $150,000. The insurance policy will reimburse Brenda only for $150,000 (the amount of the loss), and not for $200,000 (the total amount of insurance).
Utmost Good Faith
The principle of utmost good faith implies that there will be no fraud, misrepresentation or concealment between the parties. As it pertains to insurance policies, both the insurer and insured must be able to rely on the other for relevant information. The insured is expected to provide accurate information on the application for insurance, and the insurer must clearly and truthfully describe policy features and benefits, and must not conceal or mislead the insured.
Representations and Misrepresentations
Representations are statements believed to be true to the best of one's knowledge, but they are not guaranteed to be true. For insurance purposes, representations are the answers the insured gives to the questions on the insurance application.
Untrue statements on the application are considered misrepresentations and could void the contract. A material misrepresentation is a statement that, if discovered, would alter the underwriting decision of the insurance company. Furthermore, if material misrepresentations are intentional, they are considered fraud.
Warranties
A warranty is an absolutely true statement upon which the validity of the insurance policy depends. Breach of warranties can be considered grounds for voiding the policy or a return of premium. Because of such a strict definition, statements made by applicants for life and health insurance policies, for example, are usually not considered warranties, except in cases of fraud.
有条件的合同顾名思义，有条件合同要求保单持有人和公司必须满足某些条件才能执行合同，并且在各方履行其义务之前。例如，被保险人必须支付保险费并提供损失证明，以便保险公司承保索赔。
3.影响合同的法律概念和解释
粘附合同中的含糊不清
由于只有保险公司有权起草合同，并且被保险人必须遵守已签发的合同，法院认为合同中的任何含糊不清都应被解释为有利于被保险人。
赔款
赔偿（有时称为报销）是保险单中的一项规定，规定如果发生损失，被保险人或受益人只能在经济损失的范围内收取，并且不得从经济上获得，保险合同的存在。保险的目的是恢复，但不能让被保险人或受益人从损失中获利。
生命与健康示例：
布伦达有一项20,000美元的健康保险。她住院后，她的医疗费用增加到15,000美元。保险单将仅以15,000美元（损失金额）偿还Brenda，而不是20,000美元（保险总额）。
财产和伤亡案例：
布兰达有房主保险单20万美元。在她的房屋被毁之后，她重建房屋的费用增加了15万美元。保险单将仅以150,000美元（损失金额）偿还Brenda，而不是200,000美元（保险总额）。
最大诚信
最大诚信原则意味着双方之间不会有欺诈，失实陈述或隐瞒。由于涉及保险单，保险公司和被保险人必须能够依赖另一方获取相关信息。被保险人应提供有关保险申请的准确信息，保险人必须清楚，真实地描述保险申请的政策特征和利益，不得隐瞒或误导被保险人。
陈述和虚假陈述
陈述是被认为对一个人的知识最好的陈述，但并不保证是真实的。出于保险目的，陈述是被保险人对保险申请中的问题给出的答案。
关于申请的不实陈述被视为虚假陈述，可能使合同无效。重大失实陈述是一种声明，如果被发现，将改变保险公司的承保决定。此外，如果重大失实陈述是有意的，则将其视为欺诈行为。
保修
保修是绝对真实的声明，保险单的有效性取决于该声明。违反保证可被视为取消保单或退还保费的理由。由于这种严格的定义，例如，生命和健康保险政策的申请人所作的陈述通常不被视为保证，除非是欺诈。