Duyệt tất cả câu hỏi

Rủi ro thuần túy chỉ tạo ra tổn thất hoặc không có tổn thất, không bao giờ có lợi nhuận, và là loại duy nhất mà bảo hiểm xử lý. Cháy bếp phù hợp với định nghĩa đó. Mua cổ phiếu, cờ bạc và mở doanh nghiệp đều có khả năng đem lại LỢI NHUẬN, khiến chúng là rủi ro đầu cơ và không thể bảo hiểm được.

Bài kiểm tra DICE yêu cầu rủi ro phải Xác định, Độc lập (không thảm họa diện rộng), Tính toán được, và Kinh tế. Rủi ro đầu cơ bị LOẠI TRỪ khỏi khả năng bảo hiểm vì liên quan đến khả năng có lợi nhuận, điều sẽ tạo nên một hợp đồng đánh bạc.

Một mẫu hình các yêu cầu bồi thường đáng ngờ lặp lại trước đây cho thấy khuynh hướng không trung thực ở người đề nghị bảo hiểm, đó chính là định nghĩa sách giáo khoa của hiểm họa đạo đức. Hiểm họa vật chất là một điều kiện hữu hình; hiểm họa tâm lý chỉ là sự bất cẩn vì có bảo hiểm; "hiểm nguy nền tảng" không phải là một phân loại hiểm họa.

Sự bất cẩn hoặc thờ ơ phát sinh CHÍNH VÌ đã có bảo hiểm là hiểm họa tâm lý, đôi khi gọi là hiểm họa thái độ. Hiểm họa đạo đức đòi hỏi tính không trung thực, chẳng hạn khai khống hoặc dàn dựng yêu cầu bồi thường. Hiểm họa vật chất là một điều kiện hữu hình của tài sản, như dây điện hỏng. Hiểm họa pháp lý mô tả môi trường tòa án và quản lý của một khu vực tài phán, không phải hành vi của người được bảo hiểm.

Một bên (unilateral) nghĩa là chỉ MỘT bên (doanh nghiệp bảo hiểm) bị ràng buộc về mặt pháp lý. Người được bảo hiểm chỉ cần ngừng đóng phí mà không bị kiện vì vi phạm. Hợp đồng hai bên ràng buộc cả hai phía; hợp đồng đã thực hiện là hợp đồng đã hoàn tất thực hiện.

Hợp đồng bảo hiểm là một hợp đồng MẪU (adhesion) do doanh nghiệp bảo hiểm soạn thảo. Theo án lệ lâu đời của California, mọi điểm mơ hồ thực sự được giải thích bất lợi cho bên soạn thảo - doanh nghiệp bảo hiểm - nhằm bảo vệ người được bảo hiểm không có cơ hội đàm phán điều khoản.

Điều §331 là một trong những quy định nghiêm khắc nhất đối với người đề nghị bảo hiểm: bất kỳ hành vi che giấu TRỌNG YẾU nào đều cho phép doanh nghiệp bảo hiểm hủy hợp đồng, không xét ý định. California không có thời gian "không thể tranh chấp" cho hợp đồng bảo hiểm tài sản và tai nạn; quy tắc hai năm không thể tranh chấp là khái niệm của bảo hiểm NHÂN THỌ.

Điều 382.5 định nghĩa giấy bảo hiểm tạm thời là một VĂN BẢN nêu tên và địa chỉ người được bảo hiểm, mô tả tài sản cùng tính chất và số tiền bảo hiểm, xác định công ty bảo hiểm và đại lý cấp giấy, và ghi ngày hiệu lực; điều luật giới hạn thời hạn không quá 90 ngày kể từ ngày lập. Điều luật quy định tiếp rằng giấy bảo hiểm tạm thời cấp đúng quy định 'được coi là một đơn bảo hiểm nhằm chứng minh người được bảo hiểm có phạm vi bảo hiểm ghi trong giấy đó'. (a) sai vì giấy hợp lệ là phạm vi bảo hiểm thật sự và có hiệu lực thi hành, không phải lời bày tỏ quan tâm; (b) nêu sai giới hạn, vốn là 90 ngày chứ không phải 30; và (d) bịa ra điều kiện ký và gửi lại mà luật không hề có.

Thế quyền là quyền của doanh nghiệp bảo hiểm, sau khi chi trả cho người được bảo hiểm, được "thay vào vị trí của người được bảo hiểm" và truy đòi bất kỳ bên thứ ba chịu trách nhiệm nào. Nó thực thi nguyên tắc bồi thường bằng cách ngăn người được bảo hiểm nhận bồi thường hai lần - một lần từ hợp đồng và một lần từ bên gây thiệt hại.

Phân chia theo tỷ lệ: mỗi hợp đồng trả phần tổn thất bằng giới hạn của mình chia cho tổng các giới hạn áp dụng. Hợp đồng A trả 300.000 / 400.000 = 75% của 80.000 USD = 60.000 USD. Hợp đồng B trả 25% còn lại = 20.000 USD. Nguyên tắc bồi thường vẫn giới hạn tổng mức bồi thường ở tổn thất thực tế 80.000 USD.

Doanh nghiệp bảo hiểm được cấp phép (admitted, được ủy quyền) có Giấy chứng nhận Thẩm quyền do CDI cấp, chịu quản lý biểu phí, và đóng góp vào California Insurance Guarantee Association (CIGA), tổ chức trả các yêu cầu bồi thường được bảo hiểm trong phạm vi giới hạn nếu doanh nghiệp bảo hiểm mất khả năng thanh toán. Doanh nghiệp bảo hiểm không được cấp phép (surplus lines) chỉ có thể đặt bảo hiểm cho những rủi ro mà thị trường được cấp phép không nhận, và người được bảo hiểm KHÔNG được CIGA bảo vệ.

Doanh nghiệp bảo hiểm tương hỗ thuộc sở hữu của những người được bảo hiểm; mọi khoản hoàn trả thặng dư cho họ là cổ tức cho người được bảo hiểm, vốn KHÔNG BAO GIỜ được bảo đảm. Doanh nghiệp bảo hiểm cổ phần thuộc sở hữu của cổ đông và trả cổ tức cho cổ đông. Cả doanh nghiệp bảo hiểm cổ phần và tương hỗ đều có thể được cấp phép tại California.

Bồi thường nghĩa là người được bảo hiểm được khôi phục về CÙNG MỘT trạng thái tài chính như trước khi xảy ra tổn thất - không giàu lên, không nghèo đi. Đó là lý do các khoản chi trả bị giới hạn ở tổn thất thực tế, lý do thế quyền ngăn chặn bồi thường kép, và lý do đồng bảo hiểm khuyến khích bảo hiểm đầy đủ theo giá trị.

Bộ luật Bảo hiểm California §334 định nghĩa một sự kiện TRỌNG YẾU là sự kiện có thể ảnh hưởng đến doanh nghiệp bảo hiểm thận trọng trong việc chấp nhận rủi ro hay định mức phí. Một mái nhà 28 năm tuổi hư hỏng rõ ràng đáp ứng tiêu chí đó. Theo §331, doanh nghiệp bảo hiểm có thể hủy hợp đồng dù sự bỏ sót là cố ý hay chỉ do bất cẩn.

Insurance is the transfer of risk from an individual to an insurer in exchange for a premium; the insurer agrees to pay for covered losses. Avoidance and retention are other ways to handle risk, but they are not insurance. Insurance cannot eliminate the chance a loss will happen; it shifts the financial consequences of that loss from the insured to the insurer through pooling.

In property insurance, insurable interest, the financial stake a person has in the property, must exist at the time of the loss. A homeowner who has already sold the house before a fire has no insurable interest and cannot collect. This differs from life insurance, where insurable interest is required only at the policy's inception, not at the time of the claim.

Indemnity restores the insured to approximately the financial position held just before the loss, making them whole without allowing a profit. Personal lines property coverages are built on this principle, which is why tools like actual cash value, deductibles, and other-insurance clauses exist. Paying the full limit for every loss, regardless of the actual amount, would violate indemnity by permitting gain.

A physical hazard is a tangible condition that increases the likelihood or severity of a loss, such as faulty wiring or a worn cord. A peril is the actual cause of loss, such as the fire itself. A moral hazard involves dishonesty (setting a fire to collect), and a morale hazard is carelessness because insurance exists. Distinguishing hazards from perils is a foundational concept.

An insurance policy is a contract of adhesion, drafted entirely by the insurer with no negotiation by the applicant. Because the insured had no hand in the wording, courts resolve genuine ambiguities in favor of the insured. This rule encourages insurers to write clear policy language and protects consumers who must accept the contract as written.

Pure risk presents only two outcomes, loss or no loss, and that is the only kind of risk private insurers will write. The choice describing a possible profit describes speculative risk, such as buying stock or opening a restaurant, which insurance does not cover. No insurer can predict the outcome for one household; the law of large numbers predicts results for the group.

The law of large numbers says that the larger the group of similar exposure units, the more closely actual loss experience will match the expected experience, which is what makes rating possible. It does not change the odds facing any individual insured, so the choice saying more policies lower the chance of loss reverses the idea. Reinsurance is still bought to handle severity and catastrophe accumulation.

Adverse selection is the pull of worse-than-average risks toward coverage, and toward keeping it, in larger proportion than the average risks the rate assumed. Underwriting screens and classifies applicants so the price matches the exposure. The choice about competing for good accounts describes market cycles, not selection against the insurer.

A peril is the cause of loss itself, such as wind, fire or theft. A hazard is a condition that increases the likelihood or the severity of that cause operating, which is what sloppy repair work does. The choice that calls the wind a hazard reverses the two terms, and the loss is the resulting reduction in value, not a cause.

Morale hazard is indifference to loss because insurance is in place; the insured is not dishonest, just careless. Moral hazard involves dishonesty, such as staging a theft or inflating a claim, and nothing here shows the insured wanted the car taken. A physical hazard would be a tangible condition, like a broken door lock, rather than a state of mind.

Loss-control measures such as sprinklers are risk reduction, because they cut the frequency or severity of loss. Accepting a larger deductible is retention, since the insured now funds that first slice of every loss. Reversing the pair mislabels both. Avoidance would mean not operating the restaurant at all, and transfer is what buying the policy accomplishes.

An insurable risk must produce losses that are accidental from the insured's standpoint and definite enough to measure, drawn from a large pool of similar exposures, with a calculable chance of loss and an affordable premium. An intentional loss is not fortuitous and is excluded. A single event capable of wrecking the whole book is catastrophic exposure, which is exactly what insurers try to avoid or reinsure.

The insurer drafts the contract and the applicant adheres to it on a take-it-or-leave-it basis, which is why courts read genuine ambiguity in favor of the insured. The clause-by-clause answer describes a bargained contract, such as a construction agreement, not a policy. A policy also follows the person insured rather than attaching to the property.

An aleatory contract is one in which the dollars each side gives up may be wildly unequal and depend on an uncertain event. The unilateral and conditional answers are true statements about a policy, but they describe who is legally bound and what must be done first, not the lopsided exchange in the question. A policy is executory, not executed, because the insurer's duty lies in the future.

Once the premium is paid the insurer alone has made an enforceable promise, the promise to pay covered losses. The insured cannot be sued for refusing to pay the next premium; coverage simply ends, which is why the answer saying only the insured is bound is backwards. Unilateral describes whose promise can be enforced, not how many signatures the paperwork carries.

A conditional contract makes each side's obligation depend on conditions being met, and the duties after loss, giving notice, protecting property, submitting a proof of loss and cooperating with the investigation, are those conditions. The unilateral answer overstates a real feature: the insured has no enforceable promise to pay premium, but the policy still imposes conditions that must be satisfied before payment is owed.

Property insurance covers a person against financial loss, not the building itself, so the insurer underwrote this particular owner. Assignment therefore requires the insurer's consent, since it would otherwise be forced to accept a stranger it never evaluated. The answers that let the coverage ride along with the deed or the closing confuse the policy with the property.

Because the insurer prices a risk it cannot see, the applicant is expected to disclose material facts honestly and the insurer is expected to deal fairly in its wording and its claim handling. Investigating a claim is a right, not a breach of good faith, so the answer forbidding investigation is wrong. Fixing an answer only after the loss arrives is the opposite of good faith at the time of contracting.

A warranty is guaranteed and written into the contract, so an untrue warranty is a breach of the contract itself. A representation only has to be substantially true to the best of the applicant's knowledge, and the insurer must show the untrue statement was material before it can rescind. The answer about renewal at the same rate confuses a warranty with a rate guarantee.

Concealment is the deliberate withholding of a material fact the insurer needed to evaluate or price the risk, and a concealed fact of this size can let the insurer void the policy. The innocent-misstatement answer fails on the facts, because the applicant knew about the flooding and was directly asked. Recurring flooding is a physical condition of the property, not an attitude of indifference.

Fraud requires deliberate deception aimed at an unfair gain, and it can void the policy and expose the person to criminal charges. An innocent misrepresentation of a material fact may still let the insurer rescind the contract, but there is no fraud because the applicant believed the answer was right. Whether the answer was written or spoken, and how big the loss turned out to be, do not create the intent.

Insurable interest means suffering a genuine financial loss if the property is damaged, so the owner holds it in the equity and the mortgagee holds it up to the unpaid loan balance. In property insurance that interest must exist at the time of loss. Simply living in a house creates no financial stake, and being named on a policy does not manufacture an interest that was never there.

Indemnity restores the insured to the same financial position as before the loss, not a better one. Actual cash value here is $700, and subtracting the $250 deductible leaves $450. Paying the full $1,200 replacement cost would hand the insured a new machine in place of a five-year-old one, which is the profit that the actual cash value basis exists to prevent.

Subrogation lets the insurer step into the insured's shoes and recover from the party at fault, and the policy requires the insured to do nothing that impairs that right. Signing a release destroys the recovery, so the insurer can reduce or deny payment to that extent. Collecting from both the insurer and the wrongdoer would also breach indemnity by leaving the insured better off than before the fire.

Waiver is the voluntary giving up of a known right, and estoppel then stops a party from asserting the right after the other side reasonably relied on its words or conduct to its detriment. Here the adjuster's written assurance is the conduct relied on. Subrogation concerns recovery from a third party at fault, and abandonment is the insured's attempt to dump damaged property on the insurer.

Apparent authority arises from the principal's own conduct: leaving signage, forms and supplies in place lets a reasonable customer believe the agent still speaks for the insurer. Express authority is what the agency contract states in writing, and implied authority covers the incidental acts needed to exercise it, such as maintaining an office. Neither describes authority the insurer allowed to appear after ending the appointment.

A broker is the buyer's representative and shops the market on the client's behalf, so the broker ordinarily cannot commit an insurer to a risk. An appointed agent is the insurer's representative and, within the authority granted, can bind coverage, which is why the answer giving the broker that power is wrong. A producer never acts as a neutral referee between the two sides.

Premium in a producer's hands belongs to the insurer, and any return premium belongs to the client, so the producer holds the money as a fiduciary and must keep it apart from personal funds. Commingling is the breach, and forwarding the money later does not cure it. Coinsurance is a property-rating clause about insuring to value and has nothing to do with handling money.

A binder is a temporary contract of insurance that runs until the policy is issued or the insurer gives notice that it will not write the risk, so the coverage in that gap is real. Waiting for a policy number confuses paperwork with the contract. A binder is not limited to one peril; it reflects the coverage applied for while underwriting is completed.

In a mutual, the policyholders are the owners, they elect the board, and any dividend declared is a return of unused premium rather than a payment on invested capital. The shareholder answer describes a stock insurer, whose dividends go to investors. Mutuals write property and casualty lines widely and do retain earnings as surplus to support their writings.

A reciprocal is an unincorporated group of subscribers who exchange insurance contracts with one another and share the losses, and the whole arrangement is managed by an attorney-in-fact. The lodge answer describes a fraternal benefit society, a nonprofit membership organization writing chiefly life and health benefits for its members. A residual-market pool is a different mechanism again, created for applicants the voluntary market turned down.

Lloyd's does not assume risk itself. It provides the market, the framework and the financial safeguards, while individual and corporate members grouped into syndicates accept the risks, which is why the answer calling it one large insurer is wrong. Lloyd's associations write both direct insurance and reinsurance, and they license nobody.

Admitted, or authorized, means the insurer has been licensed there and holds a certificate of authority; a non-admitted insurer lacks that license and can be used only through a surplus lines placement. Where an insurer was formed decides whether it is domestic, foreign or alien, which is a separate question from admission. How it distributes its product has no bearing on either.

Surplus lines handles hard-to-place or unusual exposures that licensed insurers will not write, and the placement is made through a specially licensed surplus lines producer after a search of the admitted market. It is not a discount channel, and surplus lines pricing is often higher. A guaranty association pays certain claims of insolvent licensed insurers; it does not write coverage.

Treaty reinsurance is automatic: the agreement is struck in advance, the ceding company must cede and the reinsurer must accept everything in the described class, with no case-by-case review. Facultative reinsurance is the opposite, offered and accepted risk by risk, which the insurer typically uses for an unusual or very large exposure that the treaty will not take.

Congress declared that continued regulation by the states is in the public interest and that federal antitrust law applies to insurance only to the extent the business is not regulated by state law. There is no federal agency licensing insurers under the act, so that answer describes something that does not exist. Trade associations may draft model wording, but they do not regulate anyone.

A direct writer employs its producers, and the accounts and their expirations belong to the insurer. An independent agency represents several insurers and owns its expirations, so it can move a client's business to another carrier at renewal. An exclusive or captive agency sits between the two: it represents one insurer but its producers are not employees.

A rate is the price of one unit of exposure: expected losses, plus a loading for expenses such as commissions, taxes and overhead, plus profit and contingencies. Premium is then the rate times the number of exposure units. Adequacy guards solvency, the excessive test guards buyers, and unfair discrimination means charging different prices to insureds with the same expected loss. Deductibles and limits shape one policy, not the rate structure.

Rebating is offering any share of the commission, or any other thing of value not written into the contract, to persuade someone to buy. Twisting is a different unfair trade practice: using misrepresentation or incomplete comparison to talk a client into lapsing or replacing a policy already in force. Nothing here involves threats, and no client money has been mishandled yet.

The loss ratio is incurred losses divided by earned premium: $7,500,000 divided by $10,000,000 gives 75%. Turning the fraction upside down produces 133%, which would describe an insurer paying out far more than it collected. The loss ratio ignores underwriting expenses, so it is the expense ratio added to it that produces the combined ratio.

Errors and omissions cover is professional liability for a producer who makes a negligent mistake in advising on or placing coverage, and failing to order a requested endorsement is the classic claim. A fidelity bond answers dishonest acts such as theft by an employee, not carelessness. The client's own liability coverage protects the client against claims by others, not the producer's mistake.

The statute bars anyone convicted of a felony involving dishonesty or a breach of trust from engaging in the business of insurance affecting interstate commerce unless written consent is first obtained from an insurance regulatory official. The prohibition is not lifted by the passage of time, and posting a bond is no substitute for that consent. When the offense happened relative to the person's career is irrelevant.

Adverse action taken wholly or partly on a consumer report triggers a notice to the consumer that identifies the reporting agency, and the consumer may then obtain a copy of the report and dispute anything inaccurate. Withholding the source is exactly what the act forbids, since the consumer could not otherwise correct the file. The act does not require a second report or force the insurer to leave the application pending.

The privacy notice explains what nonpublic personal information the company collects and discloses, to whom, and how the customer may opt out of sharing with nonaffiliated third parties. It is a disclosure about handling information, not a claims history. Nothing in the act bans the use of consumer reports; that use is governed by the Fair Credit Reporting Act instead.