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INSURANCE PowerPoint PPT Presentation

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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INSURANCE

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INSURANCE


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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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  • Employee cannot sue the employer in negligence, but what about a third party?

  • Employer/insurance carrier usually have a right of SUBROGATION.


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What defenses can an employer raise?

  • 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

  • Georgia State Board of Workers’ Compensation


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