Duyệt tất cả câu hỏi

Cal. Ins. Code §22 định nghĩa bảo hiểm là hợp đồng trong đó một bên cam kết bồi thường cho bên kia về tổn thất, thiệt hại hoặc trách nhiệm phát sinh từ một sự kiện ngẫu nhiên hoặc chưa biết. Bảo hiểm là về bồi thường cho tổn thất ngẫu nhiên, không phải bảo đảm lợi nhuận, trả niên kim hay gom tiền tiết kiệm.

Công ty bảo hiểm chỉ nhận bảo hiểm cho rủi ro thuần túy — tình huống chỉ có khả năng tổn thất hoặc không tổn thất. Khả năng có lợi nhuận từ một dự án kinh doanh là rủi ro đầu cơ vì bao gồm cả khả năng sinh lợi, và rủi ro đầu cơ không thể bảo hiểm được xét trên khía cạnh thẩm định cũng như chính sách công.

Hiểm họa thái độ (morale) là hành vi cẩu thả gia tăng do người được bảo hiểm biết mình đã có bảo hiểm. Nó khác với hiểm họa đạo đức (liên quan đến sự không trung thực hoặc ý định gian lận yêu cầu bồi thường) và khác với hiểm họa vật chất (điều kiện hữu hình như ổ khóa bị hỏng).

Quy luật số lớn là nền tảng thống kê của bảo hiểm: khi số đơn vị rủi ro tương tự được quan sát tăng lên, tổn thất thực tế tiến gần đến mức trung bình dự đoán. Bồi thường, thiện chí tối đa và hợp đồng gia nhập mô tả các đặc tính pháp lý của hợp đồng, không phải công cụ dự đoán thống kê.

Lựa chọn bất lợi là xu hướng những rủi ro cao hơn mức trung bình tìm kiếm bảo hiểm tích cực hơn công chúng nói chung. Các tiêu chuẩn thẩm định, bao gồm quyền từ chối hoặc tính phụ phí, tồn tại chính là để kiểm soát lựa chọn bất lợi nhằm giữ cân bằng nhóm rủi ro.

Bốn yếu tố của hợp đồng là đề nghị và chấp nhận, đối ứng, các bên có năng lực pháp lý và mục đích hợp pháp. Không yêu cầu công chứng; hợp đồng bảo hiểm có thể được hình thành qua xác nhận miệng (oral binder) và đơn đăng ký được chấp nhận mà không cần công chứng viên.

Hợp đồng may rủi (aleatory) là hợp đồng trong đó các giá trị trao đổi không cân bằng và phụ thuộc vào một sự kiện ngẫu nhiên. Người được bảo hiểm có thể đóng phí nhỏ nhưng nhận khoản bồi thường rất lớn, hoặc đóng phí nhiều năm mà không nhận được gì. Đơn vụ, có điều kiện và song vụ mô tả các đặc tính khác của hợp đồng.

Hợp đồng bảo hiểm là hợp đồng gia nhập do công ty bảo hiểm soạn thảo và đưa ra theo dạng "chấp nhận hoặc từ chối". Theo án lệ lâu đời của California, mọi sự mơ hồ trong hợp đồng được giải thích bất lợi cho bên soạn thảo, nghĩa là bất lợi cho công ty bảo hiểm và có lợi cho người được bảo hiểm.

Cal. Ins. Code §286 yêu cầu lợi ích bảo hiểm trong tài sản phải tồn tại tại thời điểm tổn thất. Vì người bán đã chuyển quyền sở hữu trước khi cháy, cô không có lợi ích bảo hiểm khi tổn thất xảy ra và không thể nhận được bất cứ khoản nào theo hợp đồng. Đây là điểm khác biệt then chốt với bảo hiểm nhân thọ, trong đó lợi ích bảo hiểm chỉ cần tồn tại tại thời điểm cấp hợp đồng.

Theo Cal. Ins. Code §§330–334, che giấu là việc không thông báo một sự thật trọng yếu mà mình biết và đáng lẽ phải thông báo. Bên bị thiệt hại (thường là công ty bảo hiểm) có quyền hủy hợp đồng, bất kể việc che giấu có cố ý hay không. Công ty bảo hiểm không cần phải chứng minh gian lận để hủy hợp đồng dựa trên cơ sở che giấu.

Thế quyền là quyền của công ty bảo hiểm, sau khi trả tiền cho người được bảo hiểm, được thay vào vị trí của người được bảo hiểm và truy đòi bất kỳ bên thứ ba nào chịu trách nhiệm pháp lý về tổn thất. Thế quyền thực thi nguyên tắc bồi thường bằng cách ngăn người được bảo hiểm nhận tiền hai lần và chuyển tổn thất trở lại bên có lỗi. Đồng bảo hiểm và tái bảo hiểm giải quyết các vấn đề khác.

Cal. Ins. Code §2051 định nghĩa Giá trị Tiền mặt Thực tế (ACV) đối với hầu hết tổn thất tài sản tại California là chi phí thay thế tại thời điểm tổn thất trừ đi khấu hao. Mái nhà 15 năm tuổi được thanh toán theo giá trị đã khấu hao, không phải giá mái nhà mới. Bảo hiểm Chi phí Thay thế (RC) với khoản giữ lại khấu hao là một bảo hiểm tùy chọn riêng biệt (§2051.5).

Bảo hiểm yêu cầu = 80% × $500,000 = $400,000. Người được bảo hiểm mang $300,000. Khoản trả = (Số đã mua ÷ Số yêu cầu) × Tổn thất = ($300,000 ÷ $400,000) × $100,000 = 0,75 × $100,000 = $75,000. Phạt đồng bảo hiểm áp dụng vì người được bảo hiểm không bảo hiểm đủ giá trị, ngay cả khi tổn thất nhỏ hơn hạn mức hợp đồng.

Theo điều khoản bảo hiểm khác theo tỷ lệ, mỗi công ty bảo hiểm trả phần tương ứng với tỷ lệ hạn mức của mình so với tổng bảo hiểm đang có hiệu lực. Tổng = $400,000 + $600,000 = $1,000,000. Phần của Hợp đồng A = $400,000 ÷ $1,000,000 = 40% × $200,000 = $80,000. Hợp đồng B trả 60% còn lại = $120,000.

Khấu trừ theo phần trăm là phần trăm của hạn mức nhà ở (Coverage A), không phải phần trăm của tổn thất. 15% × $400,000 = $60,000 khấu trừ. Công ty bảo hiểm sau đó sẽ trả $30,000 còn lại của tổn thất $90,000. Khấu trừ theo phần trăm phổ biến với bảo hiểm động đất California và bảo hiểm bão ở các nơi khác vì chúng làm giảm đáng kể mức tiếp xúc của công ty bảo hiểm với các sự kiện thảm họa.

Insurers cover pure risk, which is a situation with only two possible outcomes: a loss or no loss, with no possibility of gain. Speculative risk (such as gambling or investing) includes a chance of gain and is not insurable, because insurance is meant to restore a loss, not create profit. Market and dynamic risks generally involve speculative elements and broad economic change that are not suited to insurance pooling.

A morale hazard is an attitude of carelessness or indifference to loss because the person knows insurance will pay (for example, leaving a car unlocked). A physical hazard is a tangible condition that increases the chance of loss, such as an oily rag pile. A moral hazard involves dishonesty, such as intentionally causing a loss to collect. Distinguishing morale from moral hazard is a common exam point: morale is carelessness, moral is dishonesty.

Indemnity means restoring the insured to the approximate financial condition they were in just before the loss, so they are made whole but do not profit. Paying the full limit regardless of the actual loss would violate indemnity by allowing gain. Property insurance is built on indemnity, which is why concepts like actual cash value, deductibles, and other-insurance clauses exist to prevent overpayment.

In property and casualty insurance, insurable interest must exist at the time of the loss, because the purpose is to indemnify an actual financial loss. This differs from life insurance, where insurable interest must exist only when the policy begins. A person who has sold the covered property before a loss no longer has an insurable interest and cannot collect.

A contract of adhesion is prepared by one party (the insurer) and offered to the applicant on a take-it-or-leave-it basis, with no negotiation of terms. Because the insured did not write the wording, any ambiguity is generally interpreted in favor of the insured. This is separate from the contract being unilateral (only the insurer makes a legally enforceable promise) and aleatory (an unequal exchange of value dependent on chance).

Insurers underwrite pure risk, where the only outcomes are a loss or no loss. The second location is a speculative risk because it can also produce a gain, and paying for that would turn insurance into an investment. Calling the earnings exposure a physical hazard confuses a tangible condition that raises the chance of loss with a business decision taken for profit.

The law of large numbers says that as the number of similar, independent exposure units grows, actual results move closer to the predicted results, which is what lets an insurer price a class. Adverse selection describes who buys coverage, not how accurately losses can be forecast. Indemnity limits recovery to the amount of loss and has nothing to do with forecasting accuracy.

Adverse selection is the tendency of applicants with a higher-than-average chance of loss to seek insurance most eagerly, so a single average price attracts the worst risks and repels the best. Underwriting and classification exist to counter it. Moral hazard is a different problem: dishonesty by an insured who wants a loss to happen, not a pricing distortion in who applies.

A peril is the cause of loss itself, such as fire; a hazard is a condition that makes the loss more likely or more severe. Brittle wiring and a blocked exit are tangible conditions, so they are physical hazards. Morale hazard is carelessness that grows out of having insurance, and moral hazard is outright dishonesty such as arson, neither of which is a physical condition of the building.

Retention means funding losses internally, and it fits exposures that are frequent but small, because such losses are predictable and cheap to absorb while insuring them would cost more in expense loading than the losses themselves. Transfer through insurance is reserved for the opposite profile, low frequency and high severity. Avoidance would mean giving up the hauling operation altogether.

An insurable risk should not be catastrophic to the insurer, because a peril that hits a huge share of the book at the same moment destroys the pooling on which pricing depends; that is why such exposures move to reinsurance, pools or federal programs. The other three are requirements an insurable exposure should meet: losses must be definite and measurable, accidental, and significant enough to be worth insuring.

Aleatory describes an exchange of unequal value that turns on an uncertain event: a small premium may buy a very large claim payment, or produce no payment at all. The description of only one enforceable promise is what makes the contract unilateral, the duties-before-payment description is what makes it conditional, and the take-it-as-written description is adhesion. All four labels fit an insurance policy, but each names a different feature.

Only the insurer gives a legally enforceable promise, namely to pay covered losses; the insured merely pays premium and can stop at any time, which is why an insured cannot be sued for declining to renew. The equal-value description contradicts the aleatory nature of the contract. Note that the promise is still conditional, since the insurer owes nothing until the policy conditions are met.

Concealment is the silent withholding of a material fact that the applicant knows and the insurer would want, and because insurance is a contract of utmost good faith it can give the insurer grounds to void the policy even though no question was asked. Treating the insurer's silence as a waiver misstates waiver, which is the intentional giving up of a known right by the insurer, not the applicant's own choice to stay quiet.

A warranty is a statement guaranteed to be true that is written into the contract, so even a small untruth can give the insurer grounds to void coverage. A representation is only offered as true to the best of the applicant's knowledge, and it must be both false and material before the insurer can act on it. The belief-based description therefore defines a representation, not a warranty.

Property insurance indemnifies a financial stake, so the insured must stand to lose something when the loss happens; the seller who no longer owns the warehouse suffers no loss and collects nothing. Requiring the interest only at issue would let a policy pay someone who has since walked away, which is exactly the wagering that the rule prevents. Life insurance takes the opposite approach, testing the interest at inception.

Indemnity aims to restore the insured to the same financial position as before the loss and no better, and an actual cash value settlement does exactly that by subtracting depreciation. Replacement cost pays for new property without that deduction, so the insured can end up better off, making it a recognized exception. Subrogation and coinsurance support indemnity rather than defeat it, one by preventing a double recovery and the other by policing the amount carried.

Subrogation lets the insurer step into the insured's place and pursue the party at fault, and policy conditions require the insured to do nothing after a loss that impairs that right. A release given to the responsible contractor destroys the right, so the insurer can reduce or deny the claim to that extent. Suing the contractor anyway is not open to the insurer, because it can have no better claim than the insured it stands in for.

Waiver is the voluntary giving up of a known right, and estoppel prevents a party from taking back a position that the other side reasonably relied on to its detriment; by handling the claim as though the late proof were acceptable, the insurer gave up that defense. Adhesion is described backwards here, because ambiguous wording drafted by the insurer is construed against the insurer and in favor of the insured.

Apparent authority arises when the insurer's conduct leads a reasonable applicant to believe the producer holds powers the written contract never granted, and the insurer is bound by acts within that appearance. Express authority is what the agency agreement states in words, and implied authority is what is incidental to carrying out the express grant, such as ordering supplies or paying office staff.

A broker is legally the representative of the client and shops the market for that client, while an agent represents the insurer under an agency contract and can commonly bind coverage for it. Saying a broker is appointed by the insurer describes an agent instead. Both are licensed producers who owe duties to the people they serve, so the idea that a broker owes the buyer nothing is wrong.

Premiums collected by a producer belong to the insurer or the client, not to the agency, so they are trust funds and the producer holds them as a fiduciary; spending them on agency overhead is commingling and conversion. Rebating is a different offense, the giving of value not stated in the policy to induce a sale, and it says nothing about how collected money is banked.

A binder is temporary evidence of real coverage that bridges the gap before the policy is delivered, and it ends when the policy is issued or when the insurer declines the risk. Coverage under a binder does not wait for the premium to be paid, and a binder may be oral where the producer holds binding authority, although prudent practice is to confirm it in writing. The insurer can still decline and issue nothing.

A mutual insurer is owned by the policyholders it insures, and any divisible surplus is returned to them as policyholder dividends rather than paid out to investors. A stock insurer is owned by shareholders who elect the board and receive stock dividends, which is the description offered in two of the wrong answers. Assessable policies exist in some mutuals but are not a feature of every mutual line.

A reciprocal is an unincorporated group of subscribers who insure one another, run by an attorney-in-fact who handles underwriting and claims for the group. A captive is formed by a parent organization to insure that parent's own exposures, and a risk retention group is a member-owned insurer restricted to liability coverage for members in a similar business, so neither uses an attorney-in-fact structure.

Lloyd's is not an insurance company but an organized marketplace in which syndicates, backed by their members, underwrite risks brought to them by brokers; the liability sits with the members of each syndicate rather than with Lloyd's itself. It is often used for unusual or hard-to-place exposures. A rating bureau does something different, gathering loss data and filing loss costs that insurers may use.

A non-admitted insurer holds no certificate of authority in the state, so its policies fall outside the state guaranty fund and the insured bears the insolvency risk; in exchange it has far more freedom in rates and forms, which is what allows it to write hard-to-place exposures. Surplus lines placements are generally allowed only after a diligent search shows the admitted market has declined the risk.

Residual markets are the market of last resort for applicants who cannot buy coverage in the voluntary market, and the burden is generally spread among the insurers writing that line, not funded by a federal appropriation. Coverage is real insurance that is paid for, usually at a higher price and sometimes with narrower terms. Reinsuring the industry against catastrophe years is a wholly separate function.

Under a treaty the reinsurer agrees in advance to accept all business falling inside the defined class, so no risk is offered or judged individually. Facultative reinsurance is the opposite, with each risk submitted and the reinsurer free to decline it. Primary insurers buy either form to add capacity for large accounts, to smooth results, to guard against a catastrophe and to relieve pressure on surplus.

McCarran-Ferguson declares that regulating and taxing insurance is in the public interest as a matter for the states, and it holds most federal law back to the extent that a state actually regulates the subject. That is why licensing, rate filings and market conduct are state functions across all lines. It is not a blanket exemption from federal law, and there is no single federal insurance commissioner.

A rate is built from the expected loss cost plus expenses plus an allowance for profit and contingencies, so adequacy asks whether the price will fund the losses and costs of the class and keep the insurer solvent. Not excessive means the price is not unreasonably high for the coverage given, and not unfairly discriminatory means insureds with similar loss potential are charged similarly, which is not the same as charging everyone the same amount.

Workers compensation is rated on payroll within each governing class code, priced per $100 of remuneration, because payroll tracks both the number of workers exposed and the time they spend at the work. Sales receipts and area are common exposure bases for general liability instead, and a simple headcount ignores wages, hours and the differing hazard of each job classification.

The combined ratio adds the loss ratio to the expense ratio, so 68% plus 29% gives 97%. A figure under 100% means the insurer collected more premium than it paid out in losses and expenses, which is an underwriting profit before investment income is counted; a figure above 100% would be the underwriting loss. Subtracting the two ratios has no meaning, and expenses are very much part of the calculation.

Failing to place or amend coverage that a client asked for is professional negligence, and errors and omissions insurance is the policy written for exactly that exposure. A general liability policy answers for bodily injury and property damage liability, not for the purely financial loss a professional mistake causes, so it would not respond. A fidelity bond covers dishonest acts such as theft by an employee, not an honest mistake in servicing an account.

The federal statute bars anyone convicted of a felony involving dishonesty or breach of trust from engaging in the business of insurance affecting interstate commerce unless written consent is granted by the appropriate insurance regulatory official, and it also penalizes any insurer that knowingly employs such a person. Simply waiting out a period of years, disclosing the conviction or moving the person to a back-office role does not satisfy it.

When a consumer report contributes to an adverse decision such as a declination or a higher rate, the insurer must give the consumer an adverse-action notice identifying the reporting agency and explaining the right to obtain a copy and to dispute what it says. The agency, not the insurer, supplies the report to the consumer. Underwriting is a permissible purpose, so a separate written permission is not what the act demands here.

The act's make-available requirement means the insurer must offer coverage for certified acts of terrorism on terms that do not differ materially from the rest of the policy, and it must disclose the premium for it; the buyer is then free to accept or reject the offer. Coverage is neither automatic and free nor forbidden, and the federal backstop shares losses after a certified event rather than taking the whole exposure by cession.

Rebating is the offer of any inducement not specified in the policy, such as paying part of the premium or sharing a commission, to persuade someone to buy. Twisting is a different unfair practice, using misrepresentation to talk a policyholder into dropping one policy for another, and unfair discrimination is charging insureds of like risk different prices. All are unfair trade practices, but only one describes paying the client's premium.