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INSURANCE Terminology Insurer Premium Beneficiary Insured Wagering contract Insurance contract Life Insurance Contracts Whole Life Insurance Ordinary or straight life Cash surrender value Term Life Insurance Guaranteed renewability Guaranteed convertibility

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Presentation Transcript

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Terminology

  • Insurer

  • Premium

  • Beneficiary

  • Insured

  • Wagering contract

  • Insurance contract


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Life Insurance Contracts

  • Whole Life Insurance

    • Ordinary or straight life

    • Cash surrender value

  • Term Life Insurance

    • Guaranteed renewability

    • Guaranteed convertibility


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Property Insurance Contracts

  • Types of Losses Covered

    • Covered Perils

    • Excluded Perils

    • Additional Coverage

  • Personal Property Insurance

    • Homeowners’ policies


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Property Insurance Contracts

  • Types of Policies

    • Valued Policies

    • Open Policies

  • Special Terms

    • Coinsurance Clause

    • Pro Rata Clause


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Liability Insurance Contracts

  • Liability Coverage

    • Personal Liability Policies

    • Business Liability Policies

      • Malpractice insurance


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Insurer’s Obligations

  • Duty to Defend

    • Each liability insurance provider has a duty to defend the insured when a third party files a legal claim against the insured that falls within the coverage terms of the policy

  • Duty to Pay

    • Each liability insurance provider has a duty to defend the insured when a third party files a legal claim against the insured that falls within the coverage terms of the policy


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Health Insurance Contracts

  • Coverage

  • Group Policies

    • Portable health insurance

    • COBRA

  • Payment Obligations

    • Deductible


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Insurance Policies as Contracts

  • Offer and Acceptance

    • Binder

  • Misrepresentation

    • Misstatement of Age Clause

    • Incontestability Clause

  • Warranties

  • Capacity

  • Form and Content

  • Interpreting Insurance Contracts

  • Third Parties and Insurance Contracts


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Insurable Interest

  • Insurable Interest in Life Insurance

    • In life insurance contracts, the requested insurable interest must exist at the time the policy was issued

  • Insurable Interest in Property Insurance

    • Those who have an insurable interest in property must have that interest at the time the loss occurs

    • Video 60:


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Notice and Proof of Loss

  • Time Limits

    • In most insurance policies, notice and proof of loss must be given within a specified period of time

  • Rights of Subrogation

    • Insurer obtains all of the insured’s rights to pursue legal remedies against anyone who may have negligently or intentionally damaged property


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Cancellation and Lapse

  • Cancellation

    • Generally, the insurer cannot cancel a life insurance contract

    • The insured can cancel a life insurance policy by surrendering the policy to the insurer

  • Lapse

    • Insurance policies that are written for a stated period of time lapse at the expiration of the policy term


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Workers’ Compensation

  • State law

  • Benefits for work-related injuries and illnesses.

  • Benefits might be paid by

    • Insurance company

    • Employer

    • State


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Work-related injury or illness

  • Must occur within the scope of employment

  • Must not be intentional self-inflicted

  • Employee must not be drugged or intoxicated


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Workers’ Compensation statutes began being passed in the early 1900s

  • Before that employers had a number of defenses if an employee was injured

    • Contributory negligence

    • Assumption of risk

    • Fellow-servant rule


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What does Workers’ Compensation typically cover?

  • Medical bills

  • Lost income (2/3 of salary. Not subject to income tax.)

  • Recovery for loss of use of body parts.

  • Rehabilitation

  • Death benefits for dependents


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Who is covered?

  • In some states, employers do not have to provide coverage if they have fewer employees than a certain number. (In GA, it is 3.)

  • Some workers are covered under similar federal laws

    • Federal Employer’s Liability Act

    • Longshore & Harbor Workers’ Compensation Act

    • Merchant Marines Act (Jones Act)


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Advantages to Workers’ Compensation

  • Employer is strictly liable

    • Do not care who is at fault

    • Less for employee to have to prove. Should be paid faster


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Disadvantages to Workers’ Compensation

  • Employees collect less than in a lawsuit

  • Workers’ Compensation is “the exclusive remedy against the employer.” The employer can not be sued in negligence.

  • What additional damages could an employee collect if s/he could sue in negligence?

    • 100% lost income (unlimited)

    • Pain and suffering

    • Punitive damages


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What defenses can an employer raise? about a third party?

  • Worker is not an employee. S/he is an independent contractor.

  • Not work related. Not within the scope of employment.

  • Employee is actually able to work.


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  • Georgia State Board of Workers’ Compensation


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