Definition: An agent holds a position of trust and must ethically handle the interests of clients (the insured) and the insurer.
Fiduciary Duty:
Agents must treat all applicants and clients ethically.
Handle funds with integrity, promptly submitting premiums to avoid embezzlement.
Handling Premiums:
Agents must forward premiums to the insurer within specified time frames (commonly 15 days).
Failure can result in legal consequences or breach of fiduciary duty.
Representation:
Agents represent the insurer but prioritize the insured's (client’s) best interests.
Agents should not be pressured into selling unsuitable policies.
Agents can report unethical pressure from insurers to the state insurance commissioner for protection.
Fair Credit Reporting Act vs. Gramm-Leach-Bliley Act
Fair Credit Reporting Act (FCRA):
Protects consumers against inaccurate or outdated financial information dissemination.
Ensures individuals are not unfairly treated based on incorrect past information.
Gramm-Leach-Bliley Act (GLBA):
Governs sharing of nonpublic personal information with third parties.
Requires financial institutions to inform customers about information-sharing practices at the start of the relationship and annually.
Customers must have the option to opt-out of information sharing.
Insurance Producer Responsibilities
Production and Duty:
Insurance producers have a fiduciary duty to handle premium funds responsibly, ensuring timely submission to insurers.
Producers must assess policy appropriateness for clients and provide all information for underwriting.
Key Considerations:
Producers exceeding contractual authority can be held personally liable.
Producers must always disclose material facts that may affect underwriting decisions.
Terrorism Risk Insurance Act (TRIA)
Overview:
TRIA is a federal program established post-9/11 to share the risk of loss from future terrorist attacks with insurers.
An act of terrorism requires certification from governmental authorities, including the Secretary of the Treasury.
Importance of TRIA:
Helps mitigate potential enormous losses that insurance companies could face due to terrorist activities.
Types of Insurance Companies
Stock Companies vs. Mutual Companies:
Stock Companies: Owned by stockholders who invest capital and share profits; examples include Wells Fargo and Bank of America.
Mutual Companies: Owned by policyholders rather than stockholders; profits are typically reinvested for the benefit of policyholders rather than distributed to investors.
Key Distinction: Understanding who owns the companies can impact how decisions are made regarding policy offerings and customer service.
Importance of Legal Contracts
Understanding the elements of a legal contract is crucial in the insurance field for ensuring policies are valid and enforceable.
Elements of a Legal Contract (CLAC):
Consideration:
Each party must provide something of value.
Example: Insured pays premiums, and the insurance company pays claims.
Legal Purpose:
The contract cannot be illegal or against public policy.
Example: No contracts involving illegal activities will be upheld.
Agreement:
Consists of an offer, acceptance (policy issued), and agreement reached.
All parties must be of legal age (usually 18), mentally competent, and sober.
Engaging with someone under the influence can lead to legal issues for the insurer.
Understanding Key Terms
Indemnity:
The insurer will reimburse for the actual loss, not provide an extra amount.
Example: If a vehicle's damage is assessed at $1,000, that is the maximum amount the insurer will reimburse.
Concept: Bring the insured back to their original state.
Subrogation:
The insurer's right to seek damages from a third party after paying the insured for a loss.
Prevents the insured from collecting from both the insurer and the responsible third party.
Insurable Interest:
Must exist at the time of loss; it indicates financial loss or economic hardship risk.
Cannot file a claim for an incident that occurred before securing insurance.
Contract Characteristics
Adhesion:
Contracts are take-it-or-leave-it with standard terms and no negotiation.
Unilateral:
Only one party (the insurer) is legally bound to fulfill the agreement.
Conditional:
Both parties must meet obligations for a contract to be enforceable.
Aleatory:
Unequal exchange; premiums are smaller than potential payouts.
Personal:
Policies are not transferable; exceptions apply upon death (e.g., beneficiaries).
Only the named insured is protected under the policy.
Representations and Misrepresentations
Representations:
Statements made on an application believed to be true.
Misrepresentations:
Untrue statements made accidentally.
Material Misrepresentation:
An untrue statement that can affect the issuance or validity of the policy; typically intentional.
Warranties and Concealment
Warranties:
Absolute true statements, crucial for the validity of the policy.
Concealment:
Intentional hiding of information.
Fraud:
False statements to deceive and gain from the insurer.
Utmost Good Faith
There must be honesty in all representations, ensuring no fraud or misrepresentation.
Waiver and Estoppel
Waiver:
Giving up a right or privilege.
Estoppel:
Prevents someone from reclaiming a right after waiving it.
Policy Structure (DEAD ICE)
Declarations: Identify who, what, when, where, how much.
Endorsements: Changes/modifications to the original policy.
Additional Coverage: Out-of-pocket costs for repairs or maintenance on property.
Definitions: List of terms for clarity in policy.
Insuring Agreement: Details the parties involved and what is covered.
Conditions: Specifies obligations of both the insured and insurer.
Exclusions: What is not covered by the policy, clearly defined.
Duties after Loss
Notify the insurer promptly, protect property, cooperate with investigations, and submit proof of loss.
Types of Insurance Claims
Notice of Loss: Informing the insurer of an incident.
Proof of Loss: Official documentation verifying damage or loss.
Cancellation and Nonrenewal
Cancellation: Ending a policy before its expiration date.
Nonrenewal: Not renewing a policy upon its expiration
Pro-Rata Cancellation: Full refund proportional to the unused coverage period.
Short Rate Cancellation: Refund after deducting expenses incurred.
Flat Rate Cancellation: Cancellation on the effective date without refund.
Common Provisions
Limits of Liability: Caps the payout amount for losses.
Policy Period and Territory: Defines the timeframe and jurisdiction for coverage.
Liberalization: Expanding coverage terms or benefits without extra premium costs.
Other Insurance: When multiple insurance policies cover the same risk, they share the loss in proportion to the policy limits.
Resolution Processes
Appraisal: Disputes over property damage payouts.
Arbitration: Disputes over casualty claims.
Cumulative Knowledge
Review frequently to reinforce concepts for exams.
Overview
This session focuses on fundamental insurance concepts through interactive learning and reading activities.
Key Definitions
Insured: The person or entity covered by the insurance policy, regardless of whether they are explicitly listed.
Insurer: The insurance company that provides coverage to the insured (e.g. USAA, GEICO, Progressive).
Analogies
To remember key roles:
Ed: Policyholder (insured).
ER: Insurer (the hospital for damages).
Essential Insurance Concepts
Insurance: Transfer of risk from the insured to the insurer.
Example: Ed transfers the financial burden of a 20,000 kitchen repair due to fire to the insurer (ER).
Risk Analysis Terminology
Exposure: Risk of loss due to existence.
All property owners are exposed to risk by merely owning items (e.g., car, house).
Loss: Reduction or disappearance of value due to damage or harm.
Examples: Car accident, theft, natural disaster.
Types of Risks
Pure Risk: Only chance of loss (e.g., natural disasters, accidents) - insurable.
Speculated Risk: Chance of loss or gain (e.g., gambling) - not insurable.
Perils and Hazards
Peril: A cause of loss (e.g., fire, lightning).
Hazard: Conditions that increase the likelihood of a loss.
Types of Hazards:
Physical: Wet floors, unguarded machinery.
Moral: Lying on insurance applications.
Morale: Carelessness (e.g., leaving flammable items near heat sources).
Risk Management Strategies
Risk Sharing: Pooling resources in a group to minimize the impact of loss.
Risk Transfer: Insurance moves risk from the insured to insurer.
Risk Avoidance: Stepping away from risky activities or assets.
Risk Reduction
Measures taken to decrease severity or likelihood of loss (e.g., installing smoke detectors).
Risk Retention
Bearing full financial responsibility for a loss (e.g., self-insurance).
Elements of Insurable Risk
Large number of similar risks (such as homes in a tornado-prone area).
Definite and measurable loss (specific time and place).
Statistically predictable losses.
Non-catastrophic impact on financial stability.
Law of Large Numbers
Predictability of losses increases with a larger pool of similar risks.
More people exposed to a risk leads to a higher likelihood of predictable outcomes.
Adverse Selection
Higher-risk individuals are more likely to seek insurance.
Insurers may charge more for coverage of high-risk policies or refuse coverage.
Reinsurance Concept
A method for insurers to spread their risk beyond their capacity.
Example: USAA may pass on some risk to larger insurance groups to manage extensive losses in events like natural disasters.
Company Structure: Stock vs. Mutual Companies
Stock Companies: Owned by shareholders, profits go to investors.
Mutual Companies: Owned by policyholders, profits may reduce premiums or increase benefits for policyholders.
Domicile Types
Domestic Domicile: Insurer incorporated in the same state.
Foreign Domicile: Insurer incorporated in a different state.
Alien Domicile: Insurer incorporated outside of the country.
Certificate of Authority
Requirement for insurers to operate in a state.
Insurers with approval are considered admitted; without approval, non-admitted.
Property Insurance Basics
Property insurance (sometimes called fire insurance) provides financial protection for damage to or loss of:
Real property (buildings)
Fixed property
Personal property
A property policy is a two-party contract between:
First party: insured
Second party: insurer
Property insurance is often regarded as first-party insurance because it covers loss to the insured's own property from covered perils.
When a claim is submitted, the insured acts as a first-party claimant.
Learning Objectives
Define basic property insurance terms.
Recognize the types of property losses.
Define the scope of coverage.
Identify types of loss valuation.
Recognize the methods of determining appropriate property insurance limits.
Apply important property insurance provisions and conditions.
Property Insurance Terminology
Fire Protection
Fire is an essential covered peril.
Policies cover damage from a hostile fire:
A fire that burns outside its intended boundaries.
A fire that becomes uncontrollable.
Property insurance does not cover damage from a friendly fire:
A fire that was intentionally set.
A fire that stays within its intended boundaries.
Example:
Friendly fire: fire in a fireplace.
Hostile fire: a spark from a fireplace ignites furniture, wildfire.
Theft
Property policies may exclude or provide coverage for theft, depending on the type of theft.
Theft: any act of stealing, including burglary and robbery.
Burglary: taking property from inside a premises by forcibly entering or exiting the property.
Robbery: taking property from the care and custody of a person who has been threatened with bodily harm.
Mysterious disappearance: when property goes missing and the cause of loss is unknown and may be excluded by property policies.
Crime Definitions
Burglary: Taking property by forcibly entering/exiting the property.
Signs of force must be visible (e.g., broken lock, window).
Robbery: Taking property from someone's care/custody by harming/threatening them.
Force is threatened or used against a person.
Theft: Any act of stealing (broad term including burglary and robbery).
Mysterious Disappearance: Cause of loss is unknown.
No physical evidence of burglary, robbery, or theft.
Examples of Crimes
Robbery: Armed thief threatens bank tellers and demands money.
Burglary: Thief breaks into a locked vault in a bank, causing property damage.
Theft: Customer takes another's wallet (seen on security camera).
Mysterious Disappearance: Ring goes missing after a party, no proof of theft.
Occupancy and Vacancy
Occupancy: A property contains personal property but has no occupants.
Vacancy: A property contains no personal property and has no occupants.
Vacancy provision: Specifies how coverage is affected after an extended period of vacancy (typically >60 days).
Bailor and Bailee
Bailee: A person/organization that has taken the property of another into their care, custody, or control for servicing, repair, or storage.
Bailor: The person who retains ownership of the property in the bailee's care.
No Benefit to Bailee Condition: Property insurance policies exclude coverage that would benefit a bailee; bailees are legally responsible for property in their care.
Direct Loss: Immediate result of a peril; policies typically require a direct physical loss to covered property.
Indirect Loss (Consequential Loss): A consequence of a direct physical loss.
Financial losses such as loss of income or additional expenses during repairs.
Example:
Direct Loss: Hailstorm damages a hotel.
Indirect Loss: Loss of use and income due to shutdown for repairs.
Causes of Loss
Proximate Cause
Primary cause of loss.
If only one peril: the first event in an unbroken chain of events that resulted in loss.
If multiple perils: the one with the most significant impact in generating the loss.
The proximate cause must be a covered peril for coverage to apply.
Example:
A house fire causes fire, smoke, and water damage. The fire is the proximate cause, and a fire insurance policy would cover all resulting damage.
Concurrent Causation
When two perils simultaneously cause a loss, the insurer must pay even if one peril is excluded.
Example:
A homeowner's policy covers fire but excludes earth movement. An earthquake causes a wire to short, starting a fire. Under concurrent causation, the fire damage would be covered.
Inherent Vice
A quality within property that causes it to damage or destroy itself (e.g., spoiled food, rusting, wear and tear).
Inherent vice is not covered by property policies.
Scope of Coverage
Named Perils Coverage
Provides insurance only for causes of loss listed in the policy.
If the peril is not named, there is no coverage unless added by endorsement.
The insured has the burden of proof to demonstrate that the loss was caused by an insured peril.
Open Perils Coverage (All Risk Coverage)
Provides insurance for all causes of loss that are not specifically excluded.
The insurer has the burden of proof to demonstrate that a loss was caused by an excluded peril.
Common Forms of Coverage
Basic and Broad Forms: Named perils coverage (broad form covers more perils).
Special Forms: Open perils coverage.
Methods of Valuing Losses and Writing Limits
Loss Valuation
A property policy pays for losses based on the valuation method in the policy.
Actual Cash Value (ACV)
Pays to repair or replace damaged property at the time of loss, minus depreciation.
Replacement Cost
Pays the full cost to repair or replace damaged property with like kind and quality at current pricing, without deducting depreciation.
Many policies require the property to be insured to a certain percentage of its replacement value (e.g., 80%).
Available via endorsement for policies that automatically pay ACV.
Example:
A TV purchased 5 years ago for 1,500 is destroyed by fire. It has a useful life of 10 years. A comparable TV costs 2,000. With replacement cost coverage, the insurer pays 2,000. With ACV coverage, the insurer pays 2,000 - (0.5 \times 2,000) = 1,000.
Functional Replacement Cost
Used for properties with obsolete materials/techniques (e.g., older dwellings).
Pays to replace the property with its functional equivalent.
Agreed Value
The policy limit is paid in the event of a total loss, regardless of the actual cash value.
Useful for articles difficult to replace or value (e.g., vineyards, paintings, classic cars).
Policies written on an agreed value basis are sometimes called valued policies.
Stated Value
The insurer bases the premium on the insured's statement of the property's value.
The insurer pays the lesser of the stated amount and the actual cash value at the time of loss.
More affordable, but the property may not be fully insured.
Market Value
The price a willing buyer would pay a willing seller under fair market conditions.
Used for goods/commodities whose value fluctuates (e.g., agricultural products).
Salvage Value
The amount property can be sold for at the end of its useful life (scrap value of damaged property).
Loss Settlement Condition
Loss settlement condition specifies how the insurer will settle claims based on a particular loss valuation method.
Methods offer various ways for insurers to determine the monetary value of property at the time of the loss and how much the policyholder is owed for the covered claim.
Agreed Value
If an insurance policy covers property that is difficult to value or replace, the policy may settle losses on an agreed value basis, insurer and policyholder agree on a specific limit of insurance.
Stated Value
However, stated valuation gives the insurer an option when it comes time to pay a claim: The insurer may pay the stated value or the actual cash value of the damaged property at the time of loss, whichever is less.
Property Insurance Limits
Specific Limit
Ensures a single item of property for a single limit of insurance.
Blanket Limit
Ensures multiple items of property for a single amount of insurance.
Properties could be at different locations and/or different types of property.
Deductible
The insured pays a specified amount of each loss.
Common in property insurance, less common in casualty/liability.
Underwriting tool used to reduce small claims.
Larger deductible = reduced premium.
Types of Deductibles
Straight Deductible: Flat amount retained by the insured, regardless of the amount of loss.
Franchise Deductible: Loss must equal or exceed a specified amount; after which, the loss is paid in full.
Percentage Deductible: The amount retained is calculated as a percentage of the property value or the policy limit (often used with windstorm/hurricane losses).
Examples:
Policy A: 250 straight deductible. A 1,000 loss results in a 750 payment.
Policy B: 250 franchise deductible. A 2,000 loss results in a 2,000 payment.
Policy C: 5% percentage deductible for windstorm losses. Policy limit is 100,000. A 10,000 windstorm loss results in a 5,000 payment 10,000 - (0.05 \times 100,000) = 5,000.
Common Property Policy Conditions
Insurance to Value
The amount of insurance sufficient to cover a total loss.
Lack of full insurance to value increases the risk of financial loss.
Coinsurance Provision
Requires the insured to carry a percentage of the property's total valuation (usually 80%) for losses to be paid in full.
If the insured carries less, the policy pays an amount proportionate to the insurance carried.
Coinsurance Formula:
Amount of Insurance Required = Coinsurance Percentage * Current Replacement Cost
The policy pays 5,000, because the building was underinsured. If the building was insured for 80,000 or more, the policy would have paid the full loss.
Insurer Provisions
Loss Settlement
Specifies which loss valuation method applies.
Payment is based on valuation method, but the insurer is not liable beyond the actual amount to repair, rebuild, or replace the damaged property.
Also subject to the appropriate policy limit.
Loss Payment
Specifies how the insurer will make payment and time frames for submitting claim documents.
Named Insured Provisions
Abandonment of Property
The insured surrenders damaged property to the insurer for repair/disposal, which is prohibited.
Arranging for repair/disposal is the insured's responsibility.
Third-Party Provisions
Mortgage Clause
Protects a mortgagee's financial interest in property policies.
Payment can be made to mortgagees up to their insurable interest, in order of precedence.
A mortgagee's interest is separate from the insurance; mortgagees may receive payments even if the insured's actions result in coverage denial.
Mortgagee Requirements to collect under the policy, despite denial of the insured's claim:
Pay any premium due under the policy on demand if the insured fails to do so.
Notify the insurer of any change in ownership or occupancy or any substantial change in risk of which the mortgagee is aware.
Submit a proof of loss to the insurer if the insurer fails to do so, typically within sixty days after receiving notice that the insured failed to do so.
The insurer must give the mortgagee advance written notice (typically 10 days) before canceling/nonrenewing due to the insured's failure to pay the premium.
Example:
An insured buys a home for 300,000 with a 50,000 down payment 250,000 mortgage and insures it for 300,000. A total loss by fire occurs.
The insurer would pay 250,000 to the mortgagee and 50,000 to the insured (if the insured complies with policy terms).
Even if the insured violated policy terms, the mortgagee can still be protected and receive up to 250,000 by paying the premium.
Bankruptcy of Insured
Mortgagee's interests continue to be protected in most cases.
The insured must report the claim to bankruptcy court, which will provide instructions on how bankruptcy law affects property claim payments.
Third-Party Provisions in Property Insurance
These provisions apply to parties other than the insurer and the named insured.
Mortgage Clause
Applies to homeowners policies where mortgage lenders have a financial interest in the property.
Protects the mortgagee's interest.
Specifies conditions under which the insurer delivers claim payments to the mortgagee.
Claim denial to the insured doesn't automatically apply to the mortgagee.
Mortgagee Requirements to Submit a Claim:
Pay any premium the insured failed to pay.
Notify the insurer of changes in ownership or occupancy, or substantial increases in risk.
Submit a signed, sworn proof of loss if the insured fails to do so.
Mortgagee's Right to Payment:
Receives payment for a valid covered claim, even if the insured's claim is denied (e.g., due to arson).
Payment is up to the mortgagee’s interest in the property.
Policy Termination:
Advance notice must be provided to the Mortgagee in case the insurance company chooses to terminate the policy. This notice is in addition to the notice provided to the insured.
Loss Payable Clause
Similar to the mortgage clause.
Allows creditors, lenders, lienholders, or similar parties with insurable interest to be included as insureds to receive claim payments.
The loss payee is the first party paid for a covered loss.
Rights:
Do not have all the rights of mortgagees.
Must receive advance notice of policy cancellation or nonrenewal.
No Benefit to Bailee Condition
Bars certain third parties (bailees) from benefiting from a policy.
Definition of Bailee:
A person or organization that has care, custody, or control of someone else's property for servicing, repair, or storage.
Example: A dry cleaner is a bailee when taking in a customer's clothes.
Bailee's Responsibility:
Legally responsible for protecting the property from loss while in their care, custody, or control.
Purpose of the Condition:
Excludes paying claims that would benefit the bailee under the customer's insurance policy.
The bailee needs their own insurance policy to protect customers' property.
Pair or Set Clause
Applies when there is a loss to part of the property that comes as a pair or set (e.g., earrings, dinnerware).
Recognizes that the value of the pair or set is more than the sum of individual parts.
Insurer Options in Case of Loss:
Repair or replace any part to restore the pair or set to its original value.
Pay the difference between the actual cash value (ACV) of the property before and after the loss.
Insurance in Action: Sofia's Earrings
Sofia owns a pair of diamond earrings.
Individual value: 800 each.
Combined individual value: 1,600.
Pair value: 2,000.
Value increase as a pair: 400.
Scenario: One earring is stolen.
Loss Calculation:
Loss of individual earring value: 800.
Loss of value as a pair: 400.
Total loss: 1,200.
Appraisal
Addresses disputes about the amount of a property loss.
Initiation: May be requested by either the insurer or the insured.
Process:
Each party selects its own appraiser.
The appraisers select an umpire.
Agreement by any two parties settles the loss.
Cost:
Each party pays the cost of its own appraiser.
The parties share the cost of the umpire and the appraisal process.
Important Note:
Appraisal is not used to determine whether the policy provides coverage for a loss; it only addresses the amount of the loss.
Recovered Property
Scenario: Lost or stolen property is recovered after the insurer has made payment.
Notification Requirement: The party that recovers the property (insured or insurer) must notify the other party.
Insured's Options:
Keep the claim payment and give up rights to the recovered property.
Retain the recovered property and return the claim payment.
Insurer's Option:
If the insurer chooses to retain the recovered property, the insurer will pay for recovery and repair expenses.
Standard Fire Policy (SFP)
The Standard Fire Policy (SFP) of New York is the basis for modern property insurance policies.
Structure: Written based on 165 standardized lines that describe coverages.
State Regulations: States using the SFP require that insurers cannot write a property policy that is more restrictive than the 165 lines.
Coverage:
Provides coverage for direct loss resulting from fire, lightning, and the removal of property endangered by fire or lightning.
Note:
In property policies, fire and lightning coverage is often combined.
Coverage for the removal of property endangered by covered perils is an additional coverage.
Insurer's Payment in the Event of Loss
The insurer will pay the lesser of:
Actual cash value (ACV) of the property at the time of loss.
The amount actually necessary to repair or replace property with material of like kind and quality within a reasonable time after the loss (excluding increased costs due to ordinance or law regulating construction).
An amount equal to the interest of the insured.
Uninsurable Property
Some items are considered uninsurable and are not covered, including:
Accounts, bills, currency, deeds, evidences of debt, money, and securities.
Bullion and manuscripts (unless specifically named in the policy).
Other Insurance Condition
If other insurance applies to the same property, the insurer will use a pro rata liability basis to cover only its proportion of the loss compared to the total insurance covering the property.
Neuroplasticity
Neuroplasticity depends on:
Symptoms
Diagnosing
Treatment
Medication Management
Brain re-wiring depends on:
disassociation from doing psychoactive substances
doing breathing, mindfulness, CBT, ACT, things like that
Coping vs Conquering
Nobody should be coping with anything, but should be trying to conquer it.
Coping means there's still an earworm or itch that's unscratchable
Key Insurance Concepts Definitions
Theft: Taking something.
Burglary: Forced entry is required; something must be broken to gain entry.
Robbery: Involves theft and violence or the threat of violence, placing life in danger.
Home Invasion
Forced entry suggests a home invasion scenario.
The presence of a weapon is highly likely during a home invasion.
Mysterious Disappearance
Defined as something missing with no known cause.
Often not covered by insurance policies due to the unknown nature of the loss.
Example: Leaving a tablet on the porch, and it goes missing. It can be many things.
Occupancy vs. Vacancy
Unoccupancy: People are not present, but their belongings are still at the property.
Example: A vacation home that is owned and furnished but not continuously inhabited.
Vacancy: Both people and contents are absent; the house is completely empty.
Vacancy can void insurance coverage if lasting more than