The document discusses several key challenges in analyzing insurance coverage litigation, including determining whether a policy covers claimed damages and whether damage occurred during the policy period. It explains concepts like notice provisions, definitions of terms, exclusions, and the differences between an insurer's duty to defend and duty to indemnify. The document provides examples of policy language addressing topics like uninsured motorist coverage, pollution exclusions, and types of covered claims.
This document provides an overview of common mistakes that lenders make regarding insurance. It discusses the importance of understanding insurance contracts and coverage details. Key points include: defining covered losses and determining how insurance proceeds will be used; ensuring sufficient coverage amounts and resolving valuation issues; avoiding assumptions that insurance proceeds substitute for lost collateral; and properly structuring additional insured endorsements and bonds. The document emphasizes the need for lenders to thoroughly read policies and endorsements to fully understand risk allocation and obligations.
The document discusses various types of insurance contracts in India including life, fire, and marine insurance. It outlines key elements such as insurable interest, indemnity, disclosure requirements, and types of policies for each. For life insurance, it describes who can have an insurable interest and different types of life policies. For fire insurance, it discusses the average clause, insurable interest, and types of fire policies. For marine insurance, it discusses insurable interest, maritime perils, and types of marine policies.
This document discusses the concepts of risk and risk management. It defines risk as the chance of harm, loss, or negative consequences. Risks can be physical, financial, or related to reputation. Risk management involves identifying risks, measuring their probability and severity, controlling risks through prevention or mitigation, and financing risks through insurance or other means. The document provides examples of different types of risks like political risk and discusses challenges in practical risk management like organizational competence and conflicting objectives.
Chapter 1[definition and nature of insurance]aaykhan
The document defines insurance as a cooperative method for spreading risk over a group of individuals exposed to the same risks. It discusses key terms like risk, chance of loss, peril, hazard, loss, and the roles of the insurer and insured. The definition section examines insurance as both a functional and contractual concept that allows individuals to receive payment in the event of a specified loss or contingency in exchange for regular premium payments.
This document outlines the seven principles of insurance: [1] utmost good faith, [2] insurable interest, [3] indemnity, [4] contribution, [5] subrogation, [6] loss minimization, and [7] proximate cause. It provides details on each principle, explaining that they aim to ensure trust between insured and insurer, compensate only for actual losses, prevent misuse of insurance policies, and place the insured in the same position prior to a loss. The principles are designed to protect both parties in insurance contracts.
Non-life or general insurance provides coverage for risks other than human life. It includes various types of insurance like health, property, liability, marine, fire, motor, and credit insurance. Health insurance covers medical expenses while property insurance protects insured property from risks like fire, theft, and natural disasters. Liability insurance protects against claims by third parties for damages. Marine insurance covers risks for ships, cargo and freight. [END SUMMARY]
Classification of insurance property insurance (marine) wahidsajol
This document outlines the classification and types of insurance. It discusses two ways of classifying insurance: branch wise and subject matter wise. Branch wise includes marine, fire, life, accident, and others. Subject matter wise includes insurance of person, property, liability, and interest. It then focuses on marine insurance, outlining the key subjects of hull, cargo, and freight. It describes five types of marine policies: time policy, voyage policy, mixed policy, floating policy, and building risk policy.
Fire insurance provides compensation for losses caused by fire or other perils related to fire. It shifts the burden of fire losses from victims to the broader society through a system where many share the losses of a few. The document discusses the meaning, definition, and nature of fire insurance as well as the scope, functions, and causes of losses covered. It also examines the role of fire insurance in loss prevention and the public and private activities used to reduce fire risks and losses.
This document provides an overview of common mistakes that lenders make regarding insurance. It discusses the importance of understanding insurance contracts and coverage details. Key points include: defining covered losses and determining how insurance proceeds will be used; ensuring sufficient coverage amounts and resolving valuation issues; avoiding assumptions that insurance proceeds substitute for lost collateral; and properly structuring additional insured endorsements and bonds. The document emphasizes the need for lenders to thoroughly read policies and endorsements to fully understand risk allocation and obligations.
The document discusses various types of insurance contracts in India including life, fire, and marine insurance. It outlines key elements such as insurable interest, indemnity, disclosure requirements, and types of policies for each. For life insurance, it describes who can have an insurable interest and different types of life policies. For fire insurance, it discusses the average clause, insurable interest, and types of fire policies. For marine insurance, it discusses insurable interest, maritime perils, and types of marine policies.
This document discusses the concepts of risk and risk management. It defines risk as the chance of harm, loss, or negative consequences. Risks can be physical, financial, or related to reputation. Risk management involves identifying risks, measuring their probability and severity, controlling risks through prevention or mitigation, and financing risks through insurance or other means. The document provides examples of different types of risks like political risk and discusses challenges in practical risk management like organizational competence and conflicting objectives.
Chapter 1[definition and nature of insurance]aaykhan
The document defines insurance as a cooperative method for spreading risk over a group of individuals exposed to the same risks. It discusses key terms like risk, chance of loss, peril, hazard, loss, and the roles of the insurer and insured. The definition section examines insurance as both a functional and contractual concept that allows individuals to receive payment in the event of a specified loss or contingency in exchange for regular premium payments.
This document outlines the seven principles of insurance: [1] utmost good faith, [2] insurable interest, [3] indemnity, [4] contribution, [5] subrogation, [6] loss minimization, and [7] proximate cause. It provides details on each principle, explaining that they aim to ensure trust between insured and insurer, compensate only for actual losses, prevent misuse of insurance policies, and place the insured in the same position prior to a loss. The principles are designed to protect both parties in insurance contracts.
Non-life or general insurance provides coverage for risks other than human life. It includes various types of insurance like health, property, liability, marine, fire, motor, and credit insurance. Health insurance covers medical expenses while property insurance protects insured property from risks like fire, theft, and natural disasters. Liability insurance protects against claims by third parties for damages. Marine insurance covers risks for ships, cargo and freight. [END SUMMARY]
Classification of insurance property insurance (marine) wahidsajol
This document outlines the classification and types of insurance. It discusses two ways of classifying insurance: branch wise and subject matter wise. Branch wise includes marine, fire, life, accident, and others. Subject matter wise includes insurance of person, property, liability, and interest. It then focuses on marine insurance, outlining the key subjects of hull, cargo, and freight. It describes five types of marine policies: time policy, voyage policy, mixed policy, floating policy, and building risk policy.
Fire insurance provides compensation for losses caused by fire or other perils related to fire. It shifts the burden of fire losses from victims to the broader society through a system where many share the losses of a few. The document discusses the meaning, definition, and nature of fire insurance as well as the scope, functions, and causes of losses covered. It also examines the role of fire insurance in loss prevention and the public and private activities used to reduce fire risks and losses.
Home insurance is important for homeowners to protect their largest investment - their home - from events like fire or natural disasters by covering rebuilding costs. It also provides liability coverage if someone is injured on the property. While it doesn't cover floods or earthquakes, homeowners can purchase additional insurance for those. Mortgage companies often require home insurance, so getting quotes from different providers ensures homeowners get the lowest rates.
Insurance involves the equitable transfer of risk, where an insurer agrees to compensate an insured for a potential loss in exchange for a premium payment. The key parties are the insurer (the company), the insured (the policyholder), and the premium (the amount charged). Insurance is governed by acts and involves a contract between the insurer and insured regarding a specific insurable risk, with defined terms and conditions. For a risk to be insurable, it must be measurable, accidental in nature, and not catastrophic. Common types of insurance include life, property, liability, and guarantee policies.
This document provides an introduction to general insurance concepts. It discusses that risk is the possibility of an adverse financial outcome from an uncertain event. Insurance handles risks by accepting, avoiding, reducing, or transferring them. For a risk to be insurable, any potential loss must be accidental, have an insurable interest, not be excessive, and not against public interest. Reinsurance allows insurers to transfer some risks to reinsurers to increase their capacity. Insurance functions in society include bearing risk, stimulating business, freeing up capital, and promoting loss prevention. The regulatory framework for insurance includes regulators, laws, consumer protection acts, and complaints procedures.
This document provides an overview of insurance and risk. It defines insurance as the pooling of fortuitous losses among a group to spread risk. Key points covered include the characteristics of an insurable risk, how insurance differs from gambling and hedging, the types of private and government insurance, and the social benefits and costs of insurance.
1. There are multiple parties that could potentially be liable for injuries arising from entertainment events including the venue, performers, security, concessionaires, and promoters.
2. These parties often have overlapping insurance coverage like general liability policies, and disputes can arise around whether a party is an additional insured for a particular loss.
3. The allocation of liability between insurers is complex and depends on factors like whether the same risk, interest, and insured are covered by the different policies. The policies may also contain "other insurance" clauses addressing overlapping coverage.
This document discusses risk and its treatment. It begins with definitions of risk and discusses the various types of risk individuals and businesses face, such as personal risks, property risks, and liability risks. It also outlines techniques for managing risk, such as avoidance, loss control, retention, non-insurance transfers, and insurance. The document provides learning objectives, outlines the key topics, and includes short answer questions, multiple choice questions, true/false questions, and case applications related to risk management.
Lecture slide chapter 2 insurance and risk managementDashing Shithil
The document provides an overview of key concepts in insurance contracts and principles. It discusses:
1. The nature of insurance as an aleatory contract between an insurer and insured based on principles of utmost good faith and indemnity.
2. Key principles of insurance contracts including insurable interest, utmost good faith, indemnity, subrogation, warranties, proximate cause, return of premium, and assignment.
3. Elements of a valid contract including offer/acceptance, consideration, competency, and lawful object.
4. Distinct characteristics of insurance contracts and methods of providing indemnity for losses.
Insurance is a social device for spreading the chance of financial loss among
a large number of people. Insurance protects against pure risk.
Risk is the possibility of losing economic security.
Risk can be of two kinds: speculative or pure And only pure risks are insurable
Pure risk involves only two possible outcomes:
loss or no loss, with no possibility of gain or profit
Speculative Risk
involves three possible outcomes: loss, no loss or profit
The Law of Large Numbers:
The average of the results obtained from a large number of trials should
be close to the expected value.
Underwriting:
The process of selecting certain types of risks that have historically
produced a profit.
Peril:
A potential cause of loss. Accident, fire, and theft are common perils.
Hazard:
Anything that increases the seriousness of a loss or increases
the likelihood that a loss will occur.
Adverse Selection:
Is the tendency of person with a higher than average chance
of loss to seek insurance at the average state, which if not
Controlled by underwriting, result in higher than expected
Loss levels.
Insurance is not same as gambling. Gambling is creat a new
speculative risk and socially is unproductive but insurance
Deals with pure risk and socially is productive.
Insurance is not same as hedging. Insurance involves the
Transfer of pure risk and reduce objective risk but hedging
Involves just the transfer of speculative risk not risk
Reduduction.
Types of Insurance:
Private insurance, consist of health insurance, property and
liabilty insurance.
Government Insurance, cnosist of social insurance and other
Government insurance programs.
How does insurance work?
You pay a fee called a premium, and in exchange,
the insurance company agrees to pay you a certain
amount of money
-Basic Characteristics Of Insurance
Pooling of losses
Payment of fortuitous losses
Risk transfer
Indemnification
-Pooling of losses
Spreading of losses incurred by the few over the entire group.
• Key mechanism is “law of large number”.
• Future losses are predicted based on law of large number.
Note
• Pooling of loss is the spreading of losses incurred by the few over the
entire group so that in the process average loss is substituted for actual loss.
• The primary purpose of pooling is to reduce the variation in possible
Outcomes , which reduces risk.
-Payment of fortuitous losses
A fortuitous loss is one that is unforeseen and
unexpected and occurs as a result of chance.
Insurance policies do not cover intentional losses
-Risk Transfer
Risk transfer means that a pure risk is transferred from
the insured to the insurer,who typically is in a stronger
Financial position to pay the loss than the insured.
-Indemnification
Means that the insured is restored to his or her approximate
financial position prior to the occurrence of the loss.
- Insurable Risk
Insurer normally insure only pure risk.
The document provides information on property insurance and the various parties involved. It discusses the types of property insurance like home insurance, flood insurance, and landlord insurance. It then describes the roles of claims adjusters, public adjusters, and loss consultants in investigating and assessing insurance claims. Claims adjusters work on behalf of the insurance company, public adjusters work for the policyholder, and loss consultants provide reports to determine property values and restoration costs.
Principles & practices of insurance com 334Haresh R
- The document discusses principles and practices of insurance. It begins with quotes related to risk and uncertainty.
- It then provides an introduction to insurance, defining it as the socialization of risks where insurance companies indemnify insured parties for losses. It discusses the different types of risks businesses face.
- The document goes on to define key insurance terms like risk, insurable interest, indemnity and different categories of risk. It also outlines the principles of insurance like utmost good faith, subrogation and contribution.
- Finally, it discusses the history and development of insurance in India and the establishment of the Insurance Regulatory and Development Authority.
Powerpoint, adapted from a powerpoint available on the web by the Texas Department of Insurance. Review of the basic types of insurance and their reasons.
The document provides an overview of insurance companies and the insurance industry in India. It discusses the history and evolution of insurance, including the nationalization of life and general insurance. It describes the functions of insurance companies in providing protection and risk management. It also outlines the different types of insurance like life insurance, general insurance, and reinsurance. Key entities discussed are LIC, GIC and their subsidiaries, objectives, and the various insurance plans and policies offered.
1-The Basics Parts of an Insurance Contract
Declarations
Definitions
Insuring Agreement
Exclusions
Conditions
Deductibles
Miscellaneous Provisions
Insured
Rider And Endorsement
2-COINSURANCE
A coinsurance formula is used to determine the
amount paid for a covered loss. The coinsurance for-
mula is as follows:
(Amount of insurance carried/Amount of insurance required) * Loss = Amount of recovery
This document outlines seven key principles of insurance: utmost good faith, insurable interest, indemnity, contribution, subrogation, loss minimization, and nearest cause. It provides examples and explanations of each principle, including how insurable interest requires a financial stake in the insured object or loss, utmost good faith requires full disclosure, indemnity provides compensation for loss rather than profit, and contribution and subrogation determine payment among multiple insurers. The principles of loss minimization and nearest cause also guide determining responsibility and liability.
Types of insurance By SHAMSIKADALUR MBAshamsikadalur
This document provides an overview of the many different types of insurance that exist. It discusses categories such as life insurance, health insurance, property insurance, auto insurance, and home insurance. Within these categories, it further outlines specific types of insurance like term life, whole life, dental, disability, fire, flood, earthquake, and more. It also explains what types of risks or losses each insurance is intended to cover.
This document provides an introduction to various types of insurance including auto, homeowner's/renter's, umbrella, health, and life insurance. It defines key insurance terms and outlines recommended coverage amounts. Auto insurance covers liability, collision, comprehensive coverage, medical payments, and uninsured motorist risks. Homeowner's insurance protects dwellings, other structures, personal property, and provides liability coverage. The document advises considering the pros and cons before filing an insurance claim and provides questions to consider.
The document discusses homeowner insurance policies. It defines homeowner insurance and explains that policies provide property coverage, liability coverage, and other coverages. It outlines the main types of home insurance policies including basic, broad, special, renter's, and premier forms. It details the typical coverage areas in home policies and underwriting guidelines insurance companies use.
The document provides information on different types of insurance policies including fire, marine, motor and personal accident insurance. It summarizes the key details of each type of insurance such as what risks are covered, claim procedures, documentation required and exclusions. It also discusses the importance of insurance and provides definitions and explanations of core insurance concepts like risk, peril and indemnity.
The document discusses the meaning and characteristics of insurance. It outlines some key points:
1. Insurance involves pooling losses from many individuals so average losses can be substituted for actual losses of a few. It provides payment for unexpected, accidental losses.
2. Risk is transferred from the insured to the insurer, who is in a stronger position to pay losses. Indemnification means restoring the insured to their pre-loss position.
3. For a risk to be insurable, losses must be measurable, large numbers must be exposed, losses cannot be catastrophic, and the chance of loss must be calculable so premiums can be affordable.
The document provides an overview of insurance, including:
1. It defines insurance and explains why we need it to reduce exposure to risks.
2. It discusses insurance lines and products such as life, property-liability, disability, and health insurance.
3. It describes the roles of insurers and intermediaries in functions like product design, pricing, distribution, underwriting, and loss settlement.
This document provides an overview of common mistakes that lenders make regarding insurance. It discusses the importance of understanding insurance contracts and coverage details. Key points include: defining covered losses and determining how insurance proceeds will be used; ensuring sufficient coverage amounts and resolving valuation issues; avoiding assumptions that insurance proceeds replace lost collateral; and properly naming additional insureds and beneficiaries on bonds. Reading the full policy and understanding exclusions, limitations, and obligations is emphasized.
Home insurance is important for homeowners to protect their largest investment - their home - from events like fire or natural disasters by covering rebuilding costs. It also provides liability coverage if someone is injured on the property. While it doesn't cover floods or earthquakes, homeowners can purchase additional insurance for those. Mortgage companies often require home insurance, so getting quotes from different providers ensures homeowners get the lowest rates.
Insurance involves the equitable transfer of risk, where an insurer agrees to compensate an insured for a potential loss in exchange for a premium payment. The key parties are the insurer (the company), the insured (the policyholder), and the premium (the amount charged). Insurance is governed by acts and involves a contract between the insurer and insured regarding a specific insurable risk, with defined terms and conditions. For a risk to be insurable, it must be measurable, accidental in nature, and not catastrophic. Common types of insurance include life, property, liability, and guarantee policies.
This document provides an introduction to general insurance concepts. It discusses that risk is the possibility of an adverse financial outcome from an uncertain event. Insurance handles risks by accepting, avoiding, reducing, or transferring them. For a risk to be insurable, any potential loss must be accidental, have an insurable interest, not be excessive, and not against public interest. Reinsurance allows insurers to transfer some risks to reinsurers to increase their capacity. Insurance functions in society include bearing risk, stimulating business, freeing up capital, and promoting loss prevention. The regulatory framework for insurance includes regulators, laws, consumer protection acts, and complaints procedures.
This document provides an overview of insurance and risk. It defines insurance as the pooling of fortuitous losses among a group to spread risk. Key points covered include the characteristics of an insurable risk, how insurance differs from gambling and hedging, the types of private and government insurance, and the social benefits and costs of insurance.
1. There are multiple parties that could potentially be liable for injuries arising from entertainment events including the venue, performers, security, concessionaires, and promoters.
2. These parties often have overlapping insurance coverage like general liability policies, and disputes can arise around whether a party is an additional insured for a particular loss.
3. The allocation of liability between insurers is complex and depends on factors like whether the same risk, interest, and insured are covered by the different policies. The policies may also contain "other insurance" clauses addressing overlapping coverage.
This document discusses risk and its treatment. It begins with definitions of risk and discusses the various types of risk individuals and businesses face, such as personal risks, property risks, and liability risks. It also outlines techniques for managing risk, such as avoidance, loss control, retention, non-insurance transfers, and insurance. The document provides learning objectives, outlines the key topics, and includes short answer questions, multiple choice questions, true/false questions, and case applications related to risk management.
Lecture slide chapter 2 insurance and risk managementDashing Shithil
The document provides an overview of key concepts in insurance contracts and principles. It discusses:
1. The nature of insurance as an aleatory contract between an insurer and insured based on principles of utmost good faith and indemnity.
2. Key principles of insurance contracts including insurable interest, utmost good faith, indemnity, subrogation, warranties, proximate cause, return of premium, and assignment.
3. Elements of a valid contract including offer/acceptance, consideration, competency, and lawful object.
4. Distinct characteristics of insurance contracts and methods of providing indemnity for losses.
Insurance is a social device for spreading the chance of financial loss among
a large number of people. Insurance protects against pure risk.
Risk is the possibility of losing economic security.
Risk can be of two kinds: speculative or pure And only pure risks are insurable
Pure risk involves only two possible outcomes:
loss or no loss, with no possibility of gain or profit
Speculative Risk
involves three possible outcomes: loss, no loss or profit
The Law of Large Numbers:
The average of the results obtained from a large number of trials should
be close to the expected value.
Underwriting:
The process of selecting certain types of risks that have historically
produced a profit.
Peril:
A potential cause of loss. Accident, fire, and theft are common perils.
Hazard:
Anything that increases the seriousness of a loss or increases
the likelihood that a loss will occur.
Adverse Selection:
Is the tendency of person with a higher than average chance
of loss to seek insurance at the average state, which if not
Controlled by underwriting, result in higher than expected
Loss levels.
Insurance is not same as gambling. Gambling is creat a new
speculative risk and socially is unproductive but insurance
Deals with pure risk and socially is productive.
Insurance is not same as hedging. Insurance involves the
Transfer of pure risk and reduce objective risk but hedging
Involves just the transfer of speculative risk not risk
Reduduction.
Types of Insurance:
Private insurance, consist of health insurance, property and
liabilty insurance.
Government Insurance, cnosist of social insurance and other
Government insurance programs.
How does insurance work?
You pay a fee called a premium, and in exchange,
the insurance company agrees to pay you a certain
amount of money
-Basic Characteristics Of Insurance
Pooling of losses
Payment of fortuitous losses
Risk transfer
Indemnification
-Pooling of losses
Spreading of losses incurred by the few over the entire group.
• Key mechanism is “law of large number”.
• Future losses are predicted based on law of large number.
Note
• Pooling of loss is the spreading of losses incurred by the few over the
entire group so that in the process average loss is substituted for actual loss.
• The primary purpose of pooling is to reduce the variation in possible
Outcomes , which reduces risk.
-Payment of fortuitous losses
A fortuitous loss is one that is unforeseen and
unexpected and occurs as a result of chance.
Insurance policies do not cover intentional losses
-Risk Transfer
Risk transfer means that a pure risk is transferred from
the insured to the insurer,who typically is in a stronger
Financial position to pay the loss than the insured.
-Indemnification
Means that the insured is restored to his or her approximate
financial position prior to the occurrence of the loss.
- Insurable Risk
Insurer normally insure only pure risk.
The document provides information on property insurance and the various parties involved. It discusses the types of property insurance like home insurance, flood insurance, and landlord insurance. It then describes the roles of claims adjusters, public adjusters, and loss consultants in investigating and assessing insurance claims. Claims adjusters work on behalf of the insurance company, public adjusters work for the policyholder, and loss consultants provide reports to determine property values and restoration costs.
Principles & practices of insurance com 334Haresh R
- The document discusses principles and practices of insurance. It begins with quotes related to risk and uncertainty.
- It then provides an introduction to insurance, defining it as the socialization of risks where insurance companies indemnify insured parties for losses. It discusses the different types of risks businesses face.
- The document goes on to define key insurance terms like risk, insurable interest, indemnity and different categories of risk. It also outlines the principles of insurance like utmost good faith, subrogation and contribution.
- Finally, it discusses the history and development of insurance in India and the establishment of the Insurance Regulatory and Development Authority.
Powerpoint, adapted from a powerpoint available on the web by the Texas Department of Insurance. Review of the basic types of insurance and their reasons.
The document provides an overview of insurance companies and the insurance industry in India. It discusses the history and evolution of insurance, including the nationalization of life and general insurance. It describes the functions of insurance companies in providing protection and risk management. It also outlines the different types of insurance like life insurance, general insurance, and reinsurance. Key entities discussed are LIC, GIC and their subsidiaries, objectives, and the various insurance plans and policies offered.
1-The Basics Parts of an Insurance Contract
Declarations
Definitions
Insuring Agreement
Exclusions
Conditions
Deductibles
Miscellaneous Provisions
Insured
Rider And Endorsement
2-COINSURANCE
A coinsurance formula is used to determine the
amount paid for a covered loss. The coinsurance for-
mula is as follows:
(Amount of insurance carried/Amount of insurance required) * Loss = Amount of recovery
This document outlines seven key principles of insurance: utmost good faith, insurable interest, indemnity, contribution, subrogation, loss minimization, and nearest cause. It provides examples and explanations of each principle, including how insurable interest requires a financial stake in the insured object or loss, utmost good faith requires full disclosure, indemnity provides compensation for loss rather than profit, and contribution and subrogation determine payment among multiple insurers. The principles of loss minimization and nearest cause also guide determining responsibility and liability.
Types of insurance By SHAMSIKADALUR MBAshamsikadalur
This document provides an overview of the many different types of insurance that exist. It discusses categories such as life insurance, health insurance, property insurance, auto insurance, and home insurance. Within these categories, it further outlines specific types of insurance like term life, whole life, dental, disability, fire, flood, earthquake, and more. It also explains what types of risks or losses each insurance is intended to cover.
This document provides an introduction to various types of insurance including auto, homeowner's/renter's, umbrella, health, and life insurance. It defines key insurance terms and outlines recommended coverage amounts. Auto insurance covers liability, collision, comprehensive coverage, medical payments, and uninsured motorist risks. Homeowner's insurance protects dwellings, other structures, personal property, and provides liability coverage. The document advises considering the pros and cons before filing an insurance claim and provides questions to consider.
The document discusses homeowner insurance policies. It defines homeowner insurance and explains that policies provide property coverage, liability coverage, and other coverages. It outlines the main types of home insurance policies including basic, broad, special, renter's, and premier forms. It details the typical coverage areas in home policies and underwriting guidelines insurance companies use.
The document provides information on different types of insurance policies including fire, marine, motor and personal accident insurance. It summarizes the key details of each type of insurance such as what risks are covered, claim procedures, documentation required and exclusions. It also discusses the importance of insurance and provides definitions and explanations of core insurance concepts like risk, peril and indemnity.
The document discusses the meaning and characteristics of insurance. It outlines some key points:
1. Insurance involves pooling losses from many individuals so average losses can be substituted for actual losses of a few. It provides payment for unexpected, accidental losses.
2. Risk is transferred from the insured to the insurer, who is in a stronger position to pay losses. Indemnification means restoring the insured to their pre-loss position.
3. For a risk to be insurable, losses must be measurable, large numbers must be exposed, losses cannot be catastrophic, and the chance of loss must be calculable so premiums can be affordable.
The document provides an overview of insurance, including:
1. It defines insurance and explains why we need it to reduce exposure to risks.
2. It discusses insurance lines and products such as life, property-liability, disability, and health insurance.
3. It describes the roles of insurers and intermediaries in functions like product design, pricing, distribution, underwriting, and loss settlement.
This document provides an overview of common mistakes that lenders make regarding insurance. It discusses the importance of understanding insurance contracts and coverage details. Key points include: defining covered losses and determining how insurance proceeds will be used; ensuring sufficient coverage amounts and resolving valuation issues; avoiding assumptions that insurance proceeds replace lost collateral; and properly naming additional insureds and beneficiaries on bonds. Reading the full policy and understanding exclusions, limitations, and obligations is emphasized.
I was tasked by my professor to present to the class about my experience and insight of the insurance industry. I engaged with my peers about the industry so they can have an a glance of what it is like. Since I had some background, I was given the opportunity to be the guest speaker.
This document provides an overview of insurance, including how it works, the roles of actuaries and risk pooling. It discusses that people seek security against economic risks like losses from accidents or natural disasters. Insurance provides a way to pool risks among many policyholders so that the costs of unlikely but expensive losses can be paid out of regular premiums. Actuaries use statistical analysis to set fair premiums and ensure the insurance company has sufficient assets to cover expected claims. The document also outlines several common types of insurance products and provides a brief history of the development of the insurance industry in India.
This document discusses managing business risks through understanding risks, managing risk, and obtaining appropriate insurance coverage. It identifies common business risks like hackers, theft, and fraud. It also discusses reducing risk through prevention programs, avoiding risks when possible, self-insuring or buying various types of insurance like general liability, property, health, disability, workers' compensation, and life insurance. The document emphasizes the importance of understanding different types of insurance policies and coverage for risks facing various businesses, including home-based businesses.
This document discusses the claims administration and claims process for insurance companies. It outlines the key steps as notification, processing, and settlement of claims. It emphasizes the importance of proper claims handling for customer satisfaction and retention. The claims department works with various stakeholders and has policies governing responsibilities, guidelines, approvals, and dispute resolution.
This document discusses marine insurance. Marine insurance covers risks associated with transporting cargo, freight, ships, and other interests by sea. The key types of marine insurance discussed are cargo insurance, hull insurance, freight insurance, and liability insurance. Cargo insurance covers goods being transported by ship against risks like war, fire, theft, and confiscation. Hull insurance insures the ship itself against risks during voyage. Freight insurance covers the financial interest a shipping company has in freight charges. Liability insurance pays damages to third parties in the event of compensation liability. The document also outlines principles of marine insurance like insurable interest, implied warranties of seaworthiness, non-deviation of route, and legality of venture.
This document discusses key documents related to marine insurance. It outlines various intermediaries involved in domestic and international trade such as agents, brokers, warehouse keepers, and shipping agents. It then describes two important marine insurance documents: open covers which provide blanket coverage for frequent shipments, and marine policies which specify risks covered, excluded, duration and claims processes. The document also notes several other policy documents like the schedule, surveyor's note, and certificate of insurance that provide important details of an insured shipment and claims handling.
This session discusses risk management and insurance. It defines risk and different types of risks. It covers the basic characteristics of insurance including risk pooling and the law of large numbers. It discusses the requirements for an insurable risk and different methods of handling risks including avoiding, controlling, accepting, and transferring risk through insurance. Key principles of insurance contracts are explained including indemnity, insurable interest, subrogation, and utmost good faith. The objectives of risk management before and after a loss are also summarized.
An insurance contract is an agreement where an insurance company agrees to compensate the insured for financial losses from specified risks in exchange for premium payments. Key characteristics include indemnifying the exact financial loss, contracts of adhesion drafted by the insurer, and consideration in the form of premiums paid by the insured. Insurance promotes savings, investment, financial security, and protection from risks for individuals and businesses. For a contract to be valid, there must be agreement between competent parties, lawful consideration, a legal purpose, and fulfillment of legal formalities. The principles of utmost good faith, insurable interest, proximate cause, and indemnity also apply to insurance contracts.
This document discusses the benefits financial advisors can provide by bridging gaps in their clients' property and casualty insurance coverage. It notes that major life events often reveal needs for insurance reviews. The document outlines signs that indicate a client may need a property and casualty review, such as owning high-risk properties or assets. It also discusses types of insurance like employee practices liability insurance, differences between homeowner's policies, and factors to consider when determining appropriate umbrella policy limits.
banking and insurance hgjhgjhgjhgjhghjgjhg.pptxsgtuniversity
This document discusses types of risks and risk management, as well as definitions and principles of insurance. It covers topics like pure and speculative risks, risk management objectives, methods of handling risks, functional and legal definitions of insurance, principles of insurance, classification of insurance, differences between insurance and assurance, functions and characteristics of insurance, life insurance definitions and features, and types of life insurance policies like term plans, endowment plans, and whole life policies.
Insurance is a contract where an individual pays a premium in exchange for an insurer providing compensation for financial losses from unexpected events. There are many types of personal and business insurance that cover risks like health issues, property damage, accidents, disability, and death. Key components of insurance policies are the premium, policy limit, and deductible which determine costs and coverage. Common personal insurances include health, home, auto, life, travel, and disability while businesses require policies tailored to their specific risks.
A protection against the loss of income that would result if the insured passed away. The named beneficiary receives the proceeds and is thereby safeguarded from the financial impact of the death of the insured.
The document provides an overview of insurance concepts including the definition of insurance, features of insurance contracts, need for insurance, objectives of insurance contracts, insurable risks, legal aspects of insurance contracts, types of insurance policies, and reinsurance. It defines insurance as a contract where an individual or organization receives financial protection and reimbursement of damages from an insurer in exchange for payment of a premium. Key features of insurance include risk sharing among a large number of insured persons, payment on a contingency or insurable event, and payment of a premium. [END SUMMARY]
United India Insurance Company Ltd (UIIC) is a leading public sector general insurance company in India. It was formed through the nationalization of insurance companies in India in 1972. UIIC offers various insurance products including auto, health, accident and life insurance. Some key factors that determine insurance premiums are the insured declared value of vehicles, cubic capacity of vehicles, geographical zones, age of vehicles, home characteristics, and policyholder choices and risk factors. The types of homeowners insurance policies available include dwelling fire form, modified coverage form, special form, tenants form, and condominium unit owners form.
This presentation is all about insurance. It will cover some topics.
1-What is Insurance ?
2-Why Insurance ?
3- Type of Insurance
4-What is Risk?
5- Peril and Hazard
6- Transfer of Risk ?
7- Mitigation
8-WHAT IS GENERAL INSURANCE ?
9- Type Of General Insurance
10- Insurance Company Operations
11- Underwriting, Claims Settlement
12- Reinsurance
The document provides an overview of the insurance sector in India. It discusses the definition of insurance and provides a brief history of insurance in India. It then covers the major policies and laws governing the insurance sector, how insurance business works, and how premiums are determined. It also discusses the two major types of insurance - life insurance and general insurance - and provides details on key products within each type.
- Insurance is a means of protection from financial loss by hedging against the risk of uncertain losses. An insurance company or insurer provides insurance policies to individuals or entities known as insureds. If an insured experiences a loss covered by their policy, they can file a claim with the insurer.
- Theft insurance policies in India cover losses due to theft of personal or business property. They provide compensation for stolen items and damage to premises during theft. Coverage, premiums, and claim processes vary between policies and insurers. Theft insurance protects against financial losses from theft but excludes some high-value items or losses caused by certain people or events.
This document summarizes a presentation about general/non-life insurance. It defines insurance and outlines key principles like utmost good faith, insurable interest, indemnity, contribution, subrogation, and loss minimization. It defines general insurance and describes major types like fire, motor, health, and marine insurance. For fire insurance, it explains scope and perils covered. For marine insurance, it outlines scope, who can take policies, selecting sum insured, and claims. It provides an overview of New India Assurance Co., including its history, position in the market, vision, mission, strengths, international presence, and awards.
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2. Analyzing Insurance
Contract Provisions
• Pre Litigation Opinions on Underwriting
and Coverage Issues
– Does the Policy Cover the Damage Claimed?
– Did the Damage Occur within the policy
period?
3. What is Insurance?
• Insurance is a special kind of contract
• Insurance is heavily regulated
• Three elements:
– Risk Distribution
– Among a substantial number of members
– Through an insurer engaged primarily in the
business of insurance
4. Risk Distribution
• Risk: According to Black’s
• The chance of injury, damage, or loss
• The chance or degree of probability of loss to
the subject matter of an insurance policy
• The amount that an insurer stands to lose
• A person or thing that an insuraer considers a
hazard
• The type of loss covered by a policy
5. Who will suffer the risk?
• Without insurance, the unlucky person
who suffers the misfortune
• A person who intentionally or negligently
proximately causes the misfortune to
occur to others
• Under certain statutory schemes, the party
the legislature decides should bear the
loss (Workers’ Compensation, e.g)
6. What risk can be transferred
• Obviously, the actual misfortune cannot be
transferred. If someone runs over me in
the parking lot and breaks my leg, I can’t
transfer the broken leg to him
• Economic loss, and economic
compensation for other losses is all we can
transfer.
7. Insurance transfers risk
• Insurer work on the basis of statistics
• Actuaries calculate the risk of certain
eventualities over the population of the
insured
• Insurers fix premium rates to cover losses,
administrative costs, and other costs
– Bonuses for insurance executives, for example
8. Factors in calculating risk/cost
• To figure out a premium the actuary has
to consider
– What is the risk to be covered?
– How frequently will the risk occur?
– How much will it cost to cover the risk?
– What will it cost to administer the program?
9. The Insurer
• Primarily in the business of insurance
• Compare warranties on merchandise
– An insurer is in the business of insuring
against risk of loss
– A manufacturer can guarantee that its widgets
will work. There is always a risk that the
widgets won’t work. If that risk occurs, the
insurer will replace the widgets. But the
manufacturer isn’t really an insurer
10. Insurers act as underwriters
• Underwriting in this context is just the act
of assuming a risk by insuring it
• The insurer assumes liability to pay the
proceeds on loss
• Historically, there were mutual assessment
associations. Sometimes it was hard to
collect when members were assessed.
That’s where the underwriter came in.
11. Underwriting
• Lloyd’s Coffee House in
London, 1600’s, shippers
would pass around a slip of
paper with relevant facts.
Interested person would
write on the slip the amount
of insurance, the rate, and
his initials. Hence:
Underwriting.
12. So what must the insurer do?
• Gather data to fix premiums
• Determine what losses it will cover
• Drafting insurance contracts consistent
with the law
• Investigate and pay (or not pay) claims
– It’s the “or not pay” that is why we’re here
today
13. Types of Insurance
• In theory just about anything legal could
be insured
• In practice most insurance actually written
can be categorized as:
– Life Insurance
– Fire and Casualty Insurance
– Marine and Inland Marine Insurance
14. Life Insurance
• Pay on death—easy enough
• Who is involved:
– Insurer
– “Owner” of the policy—who can change
beneficiary
– “Owner” often is, but is not always the
subject of the policy, the cestui que vie
– “Beneficiary” Who is paid in the event of loss
15. Fire and Casualty
• Fire
– Pretty simple concept
– Except that by now this
insurance also can
cover other losses such
as weather (lightning,
water, etc). There is
also earthquake, riot,
etc. insurance available.
16. Casualty
• Liability
• Theft/burglary
• Accident
• Health
• Property damage
• Workers Compensation
• Fidelity and surety bonds
• Car insurance
• Boat / airplane insurance
17. Marine Insurance
• “Perils of the sea”
• Fairly comprehensive, covering all losses
except those excluded.
• Similar, Inland Marine Insurance, covers
gaps between seas and docks.
18. Yacht Insurance Policy
• PERILS
• Upon the Hull, Spars, Sails, Tackle, Apparel, Machinery, Boats, and
other Furniture of and in the Yacht hereby insured.
• Touching the adventures and perils which we, the Assurers, are
contented to bear, and do take upon us, they are of the
• seas, men-of-war, fire, enemies, pirates, rovers, assailing thieves,
jettisons, letters of mart and countermart, reprisals,
• takings at sea, arrests, restraints and detainments of all kings,
princes and people, of what nation, condition or quality
• soever, barratry of the Master and Mariners, and of all other like
perils, losses and misfortunes, that have or shall
• come to the hurt, detriment or damage of said Yacht or any part
thereof.
19. Floater policies
• All risk insurance on personal property not
situated at a fixed location. Another kind
of inland marine insurance.
21. Policy language: Liability Insurance
• The company will pay on behalf of the
insured all sums which the insured shall
become legally obligated to pay as
damages because of ... the property
damage to which this insurance applies,
caused by an occurrence.
22. Occurrence
• An accident, including continuous
repeated exposure to conditions, which
results in bodily injury or property
damage, neither expected nor intended
from the standpoint of insured.
23. Language of Insurance Policies
• Legal Language is a dialect of English
– Special meaning of words--jargon
– Special constructions
• Subjunctive more common
• Struggle for more precision in language
• Use of “magic words”
24. Talking about legal writing
• What is it that makes the language of
contracts, including insurance contracts,
so difficult for not only the lay person, but
the lawyer as well?
• In the most carefully crafted language,
insurance policy forms, educated lawyers
and judges can disagree greatly about the
meaning of words, phrases, clauses, and
paragraphs.
25. Characteristics of Legal Writing
• Clarity
– Word choice
– Organization
– Avoid Legalese where possible
• In functional writing, legalese is often preferable
• In persuasive writing you can get by with it when
you have to
• In “informative” writing it will seldom do much
good
26. Characteristics of Legal Writing
• Conciseness
– Strunk’s advice, “Make each word tell.”
– Sometimes you have to balance the need for
completeness and the need for concise writing
– Avoid repetition
27. Characteristics of Legal Writing
• Accuracy/Precision
– The goal is to be precise and understandable.
– Ambiguity works against the insurer.
29. Informative
• Letters to client
– Not necessarily “simple” but not “legalese”
– Explain terms
• Interoffice memoranda
• Opinion letter
– understandable.
– disclaimers
30. Persuasive
• Briefs
– Vary in complexity
– Probably the most time consuming of all
documents
– Different concerns with
• Trial Courts
• Appellate Courts
• Administrative Agencies
• Settlement Brochures
31. Functional
• This kind of document is one which is supposed
to create a result
– Will
– Deed
– Complaint
– Trust
– Power of Attorney
– Contract
– Real Estate Documents and, for our purposes
– INSURANCE POLICY
32. Pre Litigation Opinions
• Locate and read all relevant policies
– Sometimes more than one policy may apply
• Especially in business cases
– Coordination of benefits
• Who’s primary?
• Excess coverage?
• Umbrella coverage?
33. Read the Policy
• , "Read the Statute
and Read the Policy."
State Farm Mut. Auto.
Ins. Co. v. Beavers,
321 Ark. 292, 295,
901 S.W.2d 13 (1995)
34. Notice Provisions
• Insurance policies typically have notice
provisions.
– Notice of “occurrence”
– Notice of “claim”
– Notice of “suit.”
35. Notice of loss
• The insurance policy provides:
1. What To Do In Case Of Loss. If a covered loss occurs, the insured
must:
(a) give us immediate written notice. In case of theft, also notify the
police.
....
(d) send to us, within 60 days after loss, a proof of loss signed and
sworn to by the insured, including:
....
10. Suit Against Us. We may not be sued unless there is full
compliance with all the terms of this policy. Suit must be brought
within one year (in Kansas 5 years) after the loss or damage occurs.
Ripley v. Shelter Mut. Ins. Co. 1991 WL 89652, *1
(Ark.App.) (Ark.App.,1991)
36. Another example
• Duties After Loss. In case of an accident or occurrence, the insured shall
perform the following duties that apply. You shall cooperate with us in
seeing that these duties are performed:
• a. Give written notice to us or our agent as soon as practicable, which sets
forth:
• the identity of this policy and insured;
• reasonably available information on the time, place and circumstances of
the accident or occurrence; and
• names and addresses of any claimants and available witnesses;
• b. Immediately forward to us every notice, demand, summons or other
process relating to the accident or occurrence.
• "Immediately" means within a reasonable time under the circumstances.
With most losses, the circumstances are that damage has been done, and
evidence of how the damage was done, and how much damage was done,
is quickly disappearing.
37. Definition of Damage
• Property damage in the policy is defined as:
• (1) Physical injury to or destruction of tangible
property which occurs during the policy period,
including the loss of use thereof at any time
resulting therefrom, or
• (2) Loss of use of tangible property which has
not been physically injured or destroyed
provided such loss of use is caused by an
occurrence during the policy period.
38. Pre-Litigation Negotiations
• Open a dialog with the insurer/insured if
you can.
• Sometimes it’s a waste of time, but if both
parties are willing to resolve the dispute,
it’s in both parties’ best interest to do it
sooner rather than later.
39. Whether a Policy Covers the
Damages Claimed—Example
• Hit-and-run automobile means an
automobile which causes bodily injury to
an insured arising out of physical contact
of such automobile with the insured or
with an automobile which the insured is
occupying at the time of the accident,
provided: (1) there cannot be ascertained
the identity of either the operator or
owner of such "hit-and-run automobile. . .
40. Broad “Personal Injury” coverage
under Commercial and General
Liability coverage
• “Personal injury" means injury, other than "bodily injury," arising
out of certain enumerated "offenses." These include:
• a. False arrest, detention or imprisonment;
• b. Malicious prosecution;
• c. The wrongful eviction from, wrongful entry into, or invasion of
the right of private occupancy of a room, dwelling or premises that
a person occupies by or on behalf of its owner, landlord or lessor;
• d. Oral or written publication of material that slanders or libels a
person or organization or disparages a person's or organization's
goods, products or services; or
• e. Oral or written publication of material that violates a person's
right of privacy
41. Pollution Exclusions
• This insurance does not apply to:
• (1) "Bodily injury" or "property damage" arising out of the
actual, alleged or threatened discharge, dispersal, release or escape
of pollutants at or from premises owned, rented or occupied by the
named insured.
• (2) Any loss, cost or expense arising out of any governmental
direction or request that the named insured test for, monitor, clean
up, remove, contain, treat, detoxify or neutralize pollutants.
• Pollutants means solid, liquid, gaseous or thermal irritant or
contaminant, including smoke, vapor, soot, fumes, acids, alkalis,
chemicals and waste. Waste includes materials to be recycled,
reconditioned or reclaimed.
42. Another Pollution Exclusion
• In consideration of the premium charged, it is
hereby agreed and declared that this policy shall
not apply to bodily injury of property damage
arising out of the discharge, dispersal, release or
escape of smoke, vapors, soot, fumes, acids,
alkalis, toxic chemicals, liquids or gases, waste
materials or other irritants, contaminants or
pollutants into or upon land, the atmosphere, or
any water course or body of water.
43. Another version
• 2. a "hit and run" land motor vehicle
whose owner or driver remains unknown
and which strikes:
• a. the insured; or
• b. the vehicle the insured is occupying and
is the proximate cause of bodily injury to
the insured.
44. Uninsured Motorist—Contact Rule
• Still good law, probably
• State Farm Mutual Ins. Co. v. Henderson,
___ Ark. ___ , ___ S.W.3d ___, 2004
WL 396355 (Mar. 4, 2004).
45. There may be a way out
• Additionally, Henderson urges us to consider a recent act of the
legislature, Act 1043 of 2003, which amended Ark.Code Ann. §
27-19-503 (Repl.2004) to provide a presumption that both a
motorist and the vehicle itself are uninsured if the motorist fails to
file a certificate of insurance within ninety days of an accident. Prior
to that change, section 27-19-503 only provided such a presumption
to the motorist, but not to the vehicle. Henderson asserts that this
change relieves him of the burden to prove that the other vehicle
was uninsured, as required in Ward, 259 Ark. 696, 535 S.W.2d 830.
[FN1] We do not address this argument, as the amendment to
section 27-19-503 was not made until some three years after the
issuance of Henderson's policy and the date of his accident. This
court has previously recognized that an insurance policy is governed
by statutes in effect at the time of its issuance.
46. Whether the damage occurred
during the policy period
An occurrence policy provides coverage if
the event insured against takes place
within the policy period, regardless of
when the claim is presented. The "claims
made" policy provides coverage only if a
claim is made during the policy period.
47. Duty to Defend
• Can be broader than duty to indemnify
• "As a general matter, the duty to defend is
determined by comparing the allegations in the
underlying complaint to the scope of the
coverage provided by the insurance policy. If
injury or damage within the policy coverage
could result from the underlying suit, the duty to
defend arises." Union Insurance Company v. The
Knife Company, 897 F.Supp. 1213 (W.D.Ark.
1995).
48. Duty to Defend
• ... the company shall have the right
and duty to defend any suit against the
insured seeking damages on account of
such bodily injury or property damage,
even if any of the allegations of the suit
are groundless, false, or fraudulent ...
49. Comprehensive General Liability
• In examining the duty to defend, this court has
recognized the general rule that the allegations
in the pleadings *176 against the insured
determine the insurer's duty to defend.
Murphy Oil USA, Inc. v. Unigard Security Ins.
Co. 347 Ark. 167, 175-176, 61 S.W.3d 807,
812 (Ark.,2001)
50. Duty to defend broader
• Additionally, this court has recognized that the duty to
defend is broader than the duty to indemnify. See
Commercial Union Ins. Co. of America v. Henshall, supra.
However, the duty to defend arises when there is a
possibility that the injury or damage may fall within the
policy coverage. See Home Indemnity Co. v. City of
Marianna, 291 Ark. 610, 727 S.W.2d 375 (1987).
Conversely, where there is no possibility that the damage
alleged in the complaint may fall within the policy
coverage, there would be no duty to defend.
Murphy Oil USA, Inc. v. Unigard Security Ins. Co. 347
Ark. 167, 176, 61 S.W.3d 807,812 - 13 (2001)
51. If the possibility of damages exists,
the duty to defend arises
• Home's secondary argument is that genuine issues of
material fact remain. We are not persuaded that that is
so. One fact assertedly undecided deals with the issue of
whether damages will result in the federal suit. But the
duty to defend is broader than the duty to pay damages
and as we have seen, it is enough if the possibility of
damages exists. If injury or damage within the policy
coverage could result, the duty to defend arises.
Commercial Union Ins. Co. v. Henshall, 262 Ark. 117,
553 S.W.2d 274 (1977).
52. Claim for reimbursement of
Defense and Settlement Costs
• An insured who is forced to defend and
settle a case may have a cause of action
against an insurer which wrongfully denied
coverage
• An insurer which defended an action
under reservation of rights may have a
claim for reimbursement against the
insured.
53. Reimbursement
• Brady & Handleman, INSURER'S RIGHT TO
REIMBURSEMENT: NEGLECTED BUT VALUABLE
REMEDY, 59 Def.Cou.J. 547 (Oct 1992)
• Dennis Wall, 68 INSURED'S REIMBURSEMENT OF
INSURERS'S DEFENSE EXPENSES: SOME PRACTICAL
• STEPS, 65 Def.Cou.J. 68 (1998)
• Melinda Kirk, THE INSURER'S RIGHT TO SEEK
REIMBURSEMENT: WILL THE BUSS STOP IN
• OKLAHOMA?, 38 Tulsa L.J. 599 (2000)
– Interesting because it’s from another state that has not
developed much law on the subject.
– Buss refers to a seminal California case
54. Reimbursement
• There are some practical difficulties
– Insured probably won’t have the money
– Insurer’s duty to defend is broader than duty
to cover the losses.
55. Insurer’s right to withdraw defense
• Arguably, if circumstances change in the
course of litigation and it becomes clear
that there is no conceivable liability
covered by the policy, an insurer might
withdraw
• If so, it does so at its own risk.
56. Actions that Trigger Coverage
• Occurrence
– Means an accident, including continuous or
repeated exposure to substantially the same
general harmful conditions
57. Claim Analysis/Denial
• Read the statute and read the policy
• Who is the insured
• What is covered
• What is excluded
• How much is payable?
59. Named Insured
• Since plain language came into effect, it’s
usually something like, “Throughout this
policy the words “you” and “your” refer to
the Named Insured in the Declarations.
The words “we,” “us,” and “our” refer to
the Company providing this insurance.
60. Homeowner, example
• --”and a spouse if a resident of the same
household”
• “Insured means you and the following
persons if permanent residents of your
household:
– Your relatives
– Anyone under the age of 21
61. Commercial General Liability,
example
• "your employees, other than your
executive directors, but only for acts
within the course and scope of their
employment by you." Tri-State Ins. Co. v.
Sing, 41 Ark. App. 142, 850 S.W.2d 6
(1993).
62. Omnibus Clause
• Any person using your covered auto
• Permission issues
– Hell or High Water rule
63. Drafting a Reservation of Rights
Letter
• There are a lot of cases nationwide that
hold that an insurer must state all possible
grounds for claims denial in the
reservation of rights letter.
– Colorado Lawyer article, 26-AUG Colo. Law.
93 (Robinson and Powers)
64. Robinson and Powers
• If the issue of coverage is anything but certain,
it is advisable that the insurer provide a
defense for its insured under a reservation of
rights and, if appropriate, institute a declaratory
judgment action to determine the insurer's
obligations. A reservation of rights letter
should be sent as soon as a coverage question is
recognized, and it must inform the insured in
detail of all the potential defenses to coverage
the insurer has discovered from its
investigation and analysis of the claim or suit.
65. Robinson and Powers, continued
• Defenses known to the insurer, or those that
the insurer reasonably should have known, that
are omitted from the reservation of rights
letter may be waived by the insurer. However,
if additional grounds come to the knowledge of
the insurer during its continued investigation of
the claim or during discovery in the underlying
lawsuit, the insurer can supplement its
reservation of rights letter to add the newly
discovered coverage defenses.
66. Robinson and Powers, Continued
• The reservation of rights letter should make specific
reference to the insurance policy and should quote from
the actual policy provisions that are the basis for the
insurer's decision to reserve the right to assert that
there is no coverage for the claim under the policy. The
reservation of rights letter should be sent to each
person or entity that may assert a right to be considered
a named insured or additional insured under the policy.
Additionally, because an insured is entitled to know the
excess insurer's position regarding coverage, the excess
insurer should issue a reservation of rights letter to
preserve the right to deny coverage.
67. Robinson and Powers, continued
• Finally, the insurer should include in the reservation of rights
letter a statement that it is reserving any and all rights that it might
have under the pertinent insurance policy. This phrase was recently
scrutinized in Employers' Fire Ins. v. Western Guaranty Fund, [in which
the court held that while Employers' participated in the defense of its
insured, it expressly reserved "any and all rights" which it might have
under the policy to later contest the existence of any duty it may have
to provide a defense. While the court refused to determine whether
such language was sufficient to allow Employers' to seek
reimbursement from the insured for defense costs, it found that the
reservation of rights letter made it clear that the insurer's
participation in the defense of its insured could not be construed as a
waiver of its right to contest its duty to defend under the policy.