Chapter recap
Basic Insurance Concepts and Principles
What insurance is, and who's who in a policy
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§22: insurance is a contract to indemnify against loss, damage or liability from a contingent or unknown event.
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§23: insurer = the one who indemnifies; insured = the one indemnified.
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A bill already received is not contingent, so it cannot be insured.
Pure risk vs. speculative risk
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Only pure risk is insurable.
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Speculative risk = chance of gain or loss (stocks, a new business).
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Insurance shifts the financial loss; it does not remove the risk.
Hazard → peril → risk → loss
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Peril = direct cause of loss; hazard = condition that raises the chance or severity of loss.
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Moral hazard = dishonesty; morale hazard = carelessness or indifference; physical hazard = a physical condition.
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A&H perils: accident and sickness. §533: a wilful act excuses the insurer; negligence does not.
Loss exposures, risk situations, and STARR
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Loss exposure = a situation where loss is possible; it exists even if no loss ever occurs.
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Medical bills → medical expense; lost income → disability income; daily-living help → long-term care.
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STARR = Sharing, Transfer, Avoidance, Retention, Reduction. Insurance = transfer; self-funding = retention.
Requisites of an insurable risk, and insurable events
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Chance, measurable, predictable, not catastrophic, large similar group, insurer may select.
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Planned losses and small routine costs are not ideally insurable.
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§250: contingent or unknown events, past or future, may be insured; §251: never a lottery.
Insurable interest in health and disability insurance
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§10110: yourself, those you depend on for support or education, those who owe you money.
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§10110.1(a): financial expectation, or love and affection between close relatives; friendship alone is not enough.
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Employer: insurable interest + written consent (§10110.1(c)); interest needed at issue, not at loss (§10110.1(f)).
Indemnity and utmost good faith
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Indemnity = make whole; no profit from a loss (coordination of benefits).
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§10111: in disability insurance, liability = the sum the policy says it pays.
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§331: intentional OR unintentional concealment allows rescission; §334: materiality = influence on the other party.
Underwriting, adverse selection, and the law of large numbers
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Underwriting order: gather information → evaluate and classify → decide.
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§10384: no postclaims underwriting for hospital, medical or surgical coverage.
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Adverse selection = high risks seek coverage more; the law of large numbers predicts group losses, not individual ones.