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General Insurance Principles

15 questions

1. Under California law, insurance is best defined as a contract whereby one party undertakes to:

a.Guarantee a financial profit to another party when an event occurs
b.Indemnify another against loss, damage, or liability arising from a contingent or unknown event
c.Pay a fixed annuity for the life of the insured regardless of any loss
d.Pool savings of many persons and return the savings on demand

California Insurance Code §22 defines insurance as a contract whereby one undertakes to indemnify another against loss, damage, or liability arising from a contingent or unknown event. Insurance is about indemnification for a contingent loss, not guaranteeing profit, paying annuities, or pooling savings.

Cal. Ins. Code §22

2. A small business owner asks her broker to insure her chance of profit on a new restaurant venture. The broker should explain that this exposure is not insurable because it is:

a.A pure risk that fails the DICE test
b.A morale hazard rather than a peril
c.A speculative risk that includes the chance of gain
d.A legal hazard inherent in the restaurant industry

Insurers will only write pure risk — situations involving the chance of loss or no loss. The chance of profit on a business venture is speculative risk because it also includes the chance of gain, and speculative risk is uninsurable as a matter of underwriting and public policy.

Insurance theory — pure vs. speculative risk

3. A homeowner buys a comprehensive policy and immediately stops locking his front door because he reasons that any theft will be covered. This change in behavior is BEST described as:

a.A physical hazard
b.A moral hazard
c.A legal hazard
d.A morale (attitudinal) hazard

A morale or attitudinal hazard is the careless behavior that grows because the insured knows coverage is in place. It differs from a moral hazard, which involves dishonesty or intent to file a fraudulent claim, and from a physical hazard, which is a tangible condition like a broken lock.

Insurance theory — hazards

4. The principle that allows actuaries to predict losses with reasonable accuracy as the number of similar exposure units grows is:

a.The law of large numbers
b.The doctrine of indemnity
c.The principle of utmost good faith
d.The rule of adhesion

The law of large numbers is the statistical foundation of insurance: as the number of similar exposure units observed grows, actual losses approach the predicted average. Indemnity, utmost good faith, and adhesion describe legal features of the contract, not a statistical prediction tool.

Insurance theory — DICE / law of large numbers

5. An auto insurer notices that drivers with three recent at-fault losses are far more likely to apply for a new policy than drivers with clean records. This pattern is BEST described as:

a.Moral hazard
b.Adverse selection
c.Speculative risk
d.Reinsurance

Adverse selection is the tendency of higher-than-average risks to seek insurance more aggressively than the general public. Underwriting standards, including the right to decline or surcharge, exist precisely to control adverse selection so the pool stays balanced.

Insurance theory — adverse selection

6. Which of the following is NOT one of the four essential elements of an insurance contract?

a.Offer and acceptance
b.Consideration
c.A written application notarized by a public notary
d.Legally competent parties

The four contract elements are offer and acceptance, consideration, legally competent parties, and a legal purpose. Notarization is not required; insurance contracts may be formed by oral binders and accepted applications without a notary.

Cal. Civ. Code §1550; Cal. Ins. Code §22

7. An insured pays a $900 annual premium and suffers a $300,000 fire loss in the first month of the policy. The fact that the value exchanged is unequal and depends on chance makes the insurance contract:

a.Bilateral
b.Conditional
c.Unilateral
d.Aleatory

An aleatory contract is one in which the values exchanged are unequal and depend on a chance event. The insured may pay a small premium and collect a very large sum, or pay premium for years and collect nothing. Unilateral, conditional, and bilateral describe different features of the contract.

Insurance contract characteristics — aleatory / unilateral / adhesion

8. An ambiguous exclusion appears in a homeowners policy. Under California law, the ambiguity will most likely be construed:

a.Against the insurer that drafted the contract
b.Against the insured because the insured signed it
c.In favor of whichever party has the higher financial interest
d.Stricken from the policy entirely by operation of law

Insurance policies are contracts of adhesion drafted by the insurer and offered take-it-or-leave-it. Under long-standing California case law, any ambiguity in the contract is construed against the drafter, which means against the insurer and in favor of coverage for the insured.

California case law — adhesion contracts

9. A homeowner sells her house on April 1 but forgets to cancel her fire policy. The house burns on May 15. Under California property insurance law, the seller can recover:

a.The full policy limit because she still held the policy
b.Nothing, because she had no insurable interest at the time of the loss
c.Only the unearned premium that would have been refunded
d.Half of the loss, with the other half paid to the buyer

California Insurance Code §286 requires that an insurable interest in property exist at the time of the loss. Because the seller transferred ownership before the fire, she had no insurable interest when the loss occurred and may not recover anything under the policy. This is a key contrast with life insurance, where insurable interest need only exist at policy inception.

Cal. Ins. Code §286

10. A commercial applicant fails to disclose that he was non-renewed by two prior carriers for arson suspicions. Under California law, the failure to disclose this material fact is:

a.A breach of warranty that requires court approval to enforce
b.A representation that becomes binding only if repeated under oath
c.A concealment that entitles the insurer to rescind, even if unintentional
d.Not actionable unless the insurer can prove it was intentional fraud

Under California Insurance Code §§330–334, concealment is the failure to communicate a material fact one knows and ought to communicate. The injured party (typically the insurer) is entitled to rescind the policy, whether or not the concealment was intentional. The insurer does not have to prove fraud to rescind based on concealment.

Cal. Ins. Code §§330–334 (concealment)

11. An insurer pays its insured $40,000 for collision damage caused entirely by a negligent third-party driver. The insurer then sues the at-fault driver to recover the $40,000. This action is BEST described as:

a.A coinsurance claim
b.A reinsurance recovery
c.An apportionment under an excess clause
d.Subrogation against the responsible third party

Subrogation is the right of the insurer, after paying its insured, to step into the insured's shoes and pursue any third party legally responsible for the loss. Subrogation enforces the indemnity principle by preventing the insured from collecting twice and shifting the loss back to the at-fault party. Coinsurance and reinsurance address different problems.

Indemnity / subrogation principles

12. A California homeowner suffers a fire loss to a 15-year-old roof. The policy provides Actual Cash Value coverage. Under §2051 the insurer will pay:

a.Replacement cost at the time of loss minus depreciation for age and wear
b.Original purchase price of the roof, without any deduction
c.Replacement cost in full, with depreciation paid only after rebuild
d.A pre-agreed stated amount regardless of actual repair cost

Cal. Ins. Code §2051 defines Actual Cash Value (ACV) for most California property losses as the replacement cost at the time of loss minus depreciation. A 15-year-old roof is paid at its depreciated value, not at the new-roof cost. Replacement Cost with a depreciation holdback is a separate, optional coverage (§2051.5).

Cal. Ins. Code §2051 (ACV)

13. A commercial building has a replacement cost of $500,000 and a policy with an 80% coinsurance clause. The insured carries only $300,000 of insurance. After a $100,000 partial loss (ignore deductible), how much will the insurer pay?

a.$60,000
b.$75,000
c.$80,000
d.$100,000

Required insurance = 80% × $500,000 = $400,000. The insured carries $300,000. Payment = (Carried ÷ Required) × Loss = ($300,000 ÷ $400,000) × $100,000 = 0.75 × $100,000 = $75,000. The coinsurance penalty applies because the insured failed to insure to value, even though the loss is less than the policy limit.

Standard ISO property form — coinsurance

14. Two policies cover the same warehouse: Policy A with a $400,000 limit and Policy B with a $600,000 limit, each containing a pro-rata other-insurance clause. A covered $200,000 loss occurs. Policy A will pay:

a.$200,000 because the full loss is within its limit
b.$100,000 because the carriers must split the loss equally
c.$80,000 because Policy A is 40% of the total insurance in force
d.Nothing because Policy B has the higher limit and is therefore primary

Under a pro-rata other-insurance clause, each insurer pays the proportion that its limit bears to the total insurance in force. Total = $400,000 + $600,000 = $1,000,000. Policy A's share = $400,000 ÷ $1,000,000 = 40% × $200,000 = $80,000. Policy B pays the remaining 60% = $120,000.

Standard ISO clauses — other insurance

15. A California earthquake endorsement carries a 15% deductible on a $400,000 dwelling limit. After a covered earthquake causes $90,000 in damage, the deductible the insured must absorb is:

a.$60,000
b.$15,000
c.$13,500
d.$0 because percentage deductibles do not apply below the dwelling limit

A percentage deductible is a percent of the dwelling (Coverage A) limit, not a percent of the loss. 15% × $400,000 = $60,000 deductible. The insurer would then pay the remaining $30,000 of the $90,000 loss. Percentage deductibles are common on California earthquake and on hurricane policies elsewhere because they significantly reduce insurer exposure to catastrophic events.

Insurance theory — deductible types