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INSURANCE - PowerPoint PPT Presentation


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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
terminology
Terminology
  • Insurer
  • Premium
  • Beneficiary
  • Insured
  • Wagering contract
  • Insurance contract
life insurance contracts
Life Insurance Contracts
  • Whole Life Insurance
    • Ordinary or straight life
    • Cash surrender value
  • Term Life Insurance
    • Guaranteed renewability
    • Guaranteed convertibility
property insurance contracts
Property Insurance Contracts
  • Types of Losses Covered
    • Covered Perils
    • Excluded Perils
    • Additional Coverage
  • Personal Property Insurance
    • Homeowners’ policies
property insurance contracts5
Property Insurance Contracts
  • Types of Policies
    • Valued Policies
    • Open Policies
  • Special Terms
    • Coinsurance Clause
    • Pro Rata Clause
liability insurance contracts
Liability Insurance Contracts
  • Liability Coverage
    • Personal Liability Policies
    • Business Liability Policies
      • Malpractice insurance
insurer s obligations
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
health insurance contracts
Health Insurance Contracts
  • Coverage
  • Group Policies
    • Portable health insurance
    • COBRA
  • Payment Obligations
    • Deductible
insurance policies as contracts
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
insurable interest
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:
notice and proof of loss
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
cancellation and lapse
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
workers compensation
Workers’ Compensation
  • State law
  • Benefits for work-related injuries and illnesses.
  • Benefits might be paid by
    • Insurance company
    • Employer
    • State
work related injury or illness
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
workers compensation statutes began being passed in the early 1900s
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
what does workers compensation typically cover
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
who is covered
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)
advantages to workers compensation
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
disadvantages to workers compensation
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
slide20
Employee cannot sue the employer in negligence, but what about a third party?
  • Employer/insurance carrier usually have a right of SUBROGATION.
what defenses can an employer raise
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.
slide22
Georgia State Board of Workers’ Compensation
  • Georgia State Board of Workers’ Compensation