Chapter recap
Casualty Basics
The support crew: ISO, ACORD, WCIRB and NCCI
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ISO = standard forms + advisory loss costs; never final rates (§1855.5).
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ACORD = standard forms and data standards; it is not an insurer.
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WCIRB = California workers' comp rating bureau (§11750.3); NCCI = out-of-state example. Test audits: within 1 year after expiration.
What an insurer rating tells you
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A rating = an opinion of financial strength, not a guarantee that a claim is paid.
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Each agency has its own scale: A++ is AM Best's top, AAA is S&P's top.
Finding loss exposures: six methods and their blind spots
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Financial statements give dollar values but miss off-the-books exposures.
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Flowchart = bottlenecks and dependencies; inspection = slow, costly, misses the unseen.
Direct vs. indirect losses, and property vs. liability coverage
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Direct = the peril damages the property; indirect = loss that follows from that damage.
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Lost income, continuing expenses, extra expense and lost rent are indirect.
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Property pays the insured's own loss; liability pays others.
Keeping score: loss, expense and combined ratios, and reserves
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Loss ratio = incurred losses ÷ EARNED premium.
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Combined = loss + expense; over 100% = underwriting loss.
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§923.5: reserves for all losses and claims plus adjusting expense; required by law = statutory.
How coverage ends: cancellation, nonrenewal, lapse, and refund methods
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Lapse = ended for unpaid premium; nonrenewal = insurer won't continue; cancellation = ended early.
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Short rate keeps a penalty; must be disclosed in writing (§481(c)(1)).
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Commercial nonrenewal: 60-120 days' notice; late notice = 60 more days (§678.1).
Earned vs. unearned premium: the math
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Earned = time passed; unearned = time left (returned on pro rata cancellation).
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§481(b): auto liability and homeowners premium is fully earned only at expiration.
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§481.5(e): net unearned = gross unearned − unearned commission.
Manual, merit and judgment rating
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Manual = class rate; merit = class rate adjusted for the insured's record; judgment = underwriter's experience.
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Experience mod below 1.00 lowers premium: $40,000 × 0.85 = $34,000.
First and third party claimants, subrogation and arbitration
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First party = claims under own policy (includes UM claims); third party = claims against an insured.
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Subrogation = the payer pursues the party at fault.
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UM disputes: one neutral arbitrator (§11580.2(f)).
Assigning a policy, and what happens when property changes hands
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Assignment of a policy generally needs the insurer's written consent.
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§305: selling the property suspends the insurance; §303 death and §304 co-owner transfers are exceptions.
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§520: a pre-loss ban on assigning a post-loss claim is void.
Insurable interest in property, and interests that are not insurable
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§280: no insurable interest = void contract; §281: ownership not required (liability counts).
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§282: expectancy coupled with an existing interest is insurable; §283: a mere hope is not.
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§285: a carrier or depositary's interest = value of the thing held.
CA
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