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03/10/17 Insure to Ensure Safety 1

Welcome to Insurance Basics

Why Insurance
Every person, family and business needs insurance to
Protect assets against unforeseen events causing

financial hazards.
Protect Mortgage Companies Investment on our

assets.
To Indemnify from the loss suffered.

Purpose
To provide a brief insight into the basis

of Insurance, its coverage along with its three
major working phases namely,
Transfer System
Business
Contract

Insurance as Transfer System
Insurance as a system enables us to transfer the costs of
losses from the insured to the insurance company
Insured's exchange the possibility of a large loss

by paying a much smaller periodic payments called
Premium.
Insured who incur covered losses are paid from

insurers funds .Thus total cost of losses is
thereby shared among all insured.
Transfer is done through an Insurance Policy,

which is a contract that states the rights and duties
of both Insurer and Insured regarding transfer

Insurance as a Contract
An insurance policy is a contract between the

insured and the insurance company which holds
the promises of insurance company to pay for the
covered losses of the insured.
Insured in turn reduces the uncertainty that may

occur by paying premium to the insurer.

Loss Exposure
Loss exposure or simply an exposure, is any condition or situation that
presents the possibility of loss.
The major types of loss exposures are
Property Loss exposure - Possibility that a property loss

will happen
Liability Loss exposure - Possibility of legal
responsibilities of a person or
business for injury or damage
suffered by another party.
Human Loss exposure - Possibility of financial loss to
an individuals.
Personnel Loss exposure - Possibility of financial loss to
a Business

Insurable Loss Exposures
Mutual benefit
Sole idea of insurance is to benefit both the

insurer and insured through the contract
-insurance policy.
By,
Insured transferring the loss of cost to insurer.

Insured charging a premium in turn.
Assuring Ideal characteristics of a property which
makes it ideally insurable form insurers
standpoint.

Ideally Insurable Loss Exposures
Large number of Similar exposure units
IILE must be common that insurer can pool

the homogeneous exposure units in large
number.
It enables the insurer to predict future losses
accurately and to detect the premium.
Losses that are accidental
If losses are not accidental then the insured might have an

incentive to cause a loss and cannot calculate the accurate
premium.

Losses that are definite and measurable
If the time and location of loss is not definite

then one cannot say the actual loss of amount.
For example, sudden bursting of a water pipe

can be insured because its of definite time and
location, where as one cannot claim for the
decay caused by gradual leakage over a
period of time.
In short wear n tear cannot be insured.

Losses that are not Catastrophic :
Loss suffered by one insured should not affect

any other insured or group of insured.
An insurer company usually avoids possible

Financial disaster by managing its pool of
insureds in such a way that it does not have
a large portion of insured exposed to a single
event.

Losses that are Economically Feasible to Insure
Loss exposures involving small losses as well as

those of high probability are considered
uninsurable.
For small losses the expense of providing
insurance exceeds the amount of potential losses.
eg: Insurance for disappearance of office
supplies.
For large losses the premium would be high
enough that the claim for the potential losses.
eg: Situations were losses are certain to occur

Types of Insurance
Four types of basic insurances is broadly classified into

two categories namely,
Property Insurance / Liability Insurance
Life Insurance / Health Insurance

Property Insurance
Definition:
Property Insurance covers the costs of accidental
losses to an insureds property like house, inventory,
equipments.
Types of property insurance are
Fire and Allied Lines Insurance

Business Income Insurance
Crime Insurance
Ocean marine Insurance
Auto physical Damage

Fire and Allied Line Insurance (FAL)
What FAL covers ?
FAL covers direct damage to or loss of property
such as buildings at fixed location or locations described in the
policy.
Allied Term refers to insurance against cause of loss

written with fire insurance, such as windstorm, hail, smoke,
explosion etc
Policies covering FAL are

A commercial Property policy.
A dwelling policy.

Business Income Insurance (BII)
What BII Covers ?
Business Income/Interruption Insurance, pays a business for

its loss of net income or additional expenses as a result of
covered loss such as fire.
BII pays the expenses that the insured

incurs because of the loss during the time
needed to restore the business.

Crime Insurance
What Crime Insurance Covers ?
Money, Securities, merchandise, and other property due to
burglary, robbery, theft and employee dishonesty.
Separate coverage is provided for specific types of property

against specific crime losses.
eg: Policies covering Crime Insurance is

usually Home Owners Policy.

Ocean Marine Insurance (OMI)
What OMI Covers ?

Being one of the old type of insurance OMI
covers ships and their cargo against fire, lightening
and other perils of sea including high winds ,rough
waters etc
In addition Inland marine Insurance (IMI) covers

miscellaneous type of property, goods in domestic transit, and
those property used in transport and communication.

Auto Physical Damage Insurance
Auto Physical Damage Insurance usually provides auto

liability coverage, such as a personal auto policy or a business
auto policy.
It is generally meant for damage or loss to specific type

of vehicles from collision, fire etc

Liability Insurance
Liability Insurance is other wise called Third Party
Insurance as it includes three parties namely Insured, Insurer
and Claimant.
The insurance company pays the claimant on behalf of the

insured if the insured is legally responsible for damage.
Liability insurance includes
Auto Liability,
Commercial General Liability,
Personal Liability,
Professional Liability

Life Insurance
Insuring ones life can greatly reduce

the adverse financial consequences when
premature death of Primary wage earner
happens in a family.
Basic type of Life insurance
Whole Life Insurance

Term Insurance
Universal life Insurance

Whole Life Insurance
Whole Life Insurance provides lifetime

protection for insureds whole life( to age 100) and is
considered as permanent insurance.
Whole life policies accrue a cash value that the

policy holder can borrow after a policy period.
Generally, whole life policy finds its effect when a

consumer wants lifetime protection with a level premium and
cash value.

Term Insurance
Term insurance provides coverage for a specified period,

such as five or ten years, and is therefore not permanent
insurance.
A term insurance policy has no cash value accumulation.
It is used when the consumer wants the maximum amount of

life insurance protection available at low cost.

Universal Life Insurance
Universal life Insurance policy is a flexible-premium policy that
separates the protection, savings, and expense components and is sold
as an investment vehicle that combines life insurance protection with
savings.
The policy holder has a cash value account that is credited with the
premium paid.
On surrendering the policy, the cash value account may be reduced

by a surrender charge to determine the surrender value paid to the policy
owner.

Health Insurance
Health Insurance protects individuals and families from

financial losses caused by sickness. Like Life insurance , it can
be provided for individual or a group basis.
Various types of Health insurance are
Medical insurance coverage

Disability insurance coverage

Medical and Disability Insurance
Medical Insurance covers the cost of medical care, including

doctors bills, hospital charges, laboratory charges, and related
expenses.
Disability Income Insurance provides periodic benefits to an

insured who is unable to
work as a result of accident or illness until
he/she returns back to work or till the
maximum period elapses.

Insurance as Business
Insurance is a business were the insurance

company provides coverage in exchange of a
premium amount from the insured
Insurance as business highlights the following
Types of Insurer
Financial Operations
Financial Performance of insurer
State insurance regulation
Benefits and costs of insurance

Types of Insurer
Many different type of insurers provides different types

of services. In some cases, government insurance plans supply
coverage that is not available from private insurers
Major types of insurers are
Private (Non- Government) insurers

Federal Government Insurance programs
State Government Insurance programs.

Types of Private Insurers
The major purpose of insurance agent is to indemnify
insureds if a covered loss is occurred.
Major types of the Private insurers are
Stock Insurance Companies

Mutual Insurance Companies
Reciprocal Insurance Exchange
Lloyds Association
Captive Insurance companies
Reinsurance Companies

Private Insurers
Stock insurance company is an insurer that is owned by its

stock holders and formed as a corporation for the purpose of
earning a profit for these stock holders.
Mutual Insurance company is an insurer that is owned by its

policy holders and formed as a corporation for the purpose of
providing insurance to its policyholder owners.
Demutualization is the process by which a mutual insurer

becomes a stock company, which is then owned by its
stockholders.

Private Insurers
A reciprocal insurance exchange is an unincorporated

association formed to provide insurance coverage to its members
(Subscribers).
Lloyds of London is an unincorporated association formed to

earn profit for its individual investors and its corporate investors.
A captive insurance company is an insurer that is formed as a

subsidiary of its parent company, organization or group, for the
purpose of writing all or part of the insurance on the parent
company or companies.

Private Insurers
Reinsurance Companies is a type of insurance in which
one insurer transfers some or all of the loss exposures from
policies written for its insureds to another insurer
In reinsurance, the primary insurer is the insurance

company that transfer its loss exposure to another insurer in the
contractual agreement called reinsurer.

Federal Government Insurance
Federal government provides coverage which are

behind the scope of private concerns like
Coverage requiring huge financial resources.

eg: Social Security
Coverage required for only certain segment of
population need.
eg: National Flood Insurance program
Insures depositors against loss resulting from
failure of insolvency of banks.
eg: Federal Deposit Insurance Corporation

State Government Insurance
All states ensures their employers be able to meet the
financial obligations based on workers compensation laws.
Unemployment insurance plan ensures at

least a minimum level of protection for eligible
workers who are unemployed.
Fair Access to Insurance Requirement (FAIR) plan

which provides basic property insurance to property owners which is
other wise cannot obtain coverage.

Insurance Regulation
To regulate the performance of the insurance companies

The National Association of Insurance Commissioners
(NAIC) was established to encourage co ordination and co
operation among state insurance departments.
A model law is a document drafted by NAIC that reflects

the proposed solution to a given problem and provides a common
basis to the states for drafting laws that affect insurance industry.

Objective of Insurance Regulation
The NAIC enables state regulators to pool their

resources while preserving state regulation of insurance.
Despite the differences among the states the primary

objective of insurance regulations are,
Rate Regulation
Solvency Surveillance
Consumer Protection

Rate Regulation
State give rights to the state insurance commissioner the

power to enforce regulation of insurance rates, since rate affects
most people.
Insurer must collect sufficient premium to pay for the

incurred losses that occur, cover the costs of operating the insurance
company.
Rate making is the process by which insurer calculate the

rates that determine the premium to charge for insurance coverage.
Premium = Rate * Number of exposure units

Objective of Rate Regulation
Rate regulation serves three general objective
To ensure that rates are adequate

To ensure that rates are not excessive
To Ensure that rates are not unfairly
discriminatory .
An actuary using mathematical methods and technology

analysis the loss data and other Statistics to develop systems for
determining insurance rates.

Insurance Rating Laws
To balance conflicting objectives, state have developed

various insurance rating laws namely,
Prior-approval laws
Flex rating laws
File and Use laws
Use and File laws
Open competition
State mandated rates.

Solvency Surveillance
Solvency is the ability of the insurance company to meet its
financial obligations as they become due , even those resulting
from insured losses that might be claimed several years in the
future.
Two major aspects of Solvency surveillance are
Insurance Company Examinations

An exam where thorough analysis of an insurance
companys operations and financial condition.
Insurance Regulatory Information System (IRIS).
To help regulators identify insurance companies with
potential financial problems.
Consumer Protection
The activities that regulators undertake to protect

insurance consumers include
Licensing Insurers
Licensing Insurance Company representatives
Approving policy Forms
Examining Market Conduct
Investigating Consumer Complaints.

Excess and Surplus Line Insurance
The Standard market refers collectively to insurers who
voluntarily offer insurance coverages at rates designed for
customers with average or better- than average loss exposure.
Excess and Surplus line Insurance consists of insurance

coverage, usually unavailable in the standard market, that are written
by unlicensed insurers.
The following classes of business are often insured in the

excess and surplus market.
Unusual or unique exposure

Non Standard business
Insured's needing high limits
Insured's needing unusually broad coverage
Exposure that require new forms.

Welcome to Financial Consequences

Purpose
The major purpose is to provide a brief insight into the

financial performance of the insurer which assist in sound
management of an insurance company.
Typically includes
Insurers Profitability
Insurers Solvency

Insurer Profitability
To survive in the long term, insurance company should
manage the overall gain from its operation by managing the
income and the expenses, thereby insuring the profitability
Two major sources of income to the insurance company is

from namely,
Premium Income from sale of insurance

Investment Income from investment of funds.
Some insurers receive from other income from the sales of

specialized services or other incidental activities.

Premium Income
Premium income is the money an insurer receives from its
policy holders in return for the insurance coverage it provides.
Premium includes
Written Premium premiums on policies written

during a given period.
Earned Premium portion of written premium that
is recognized as time passes.
Unearned Premium portion of written premium that
applies to the policy period
that has not yet occurred.

Premium Income Calculation
Sample Condition:
Consider an Annual Policy with $600 premium is effective

from July 1.
At the end of first calendar year 1:
Written premium - $600

Earned premium - $300
Unearned premium - $300

Investment Income
Insurance company has funds available for investment for

two reasons namely
Policyholder Surplus which is maintained

that the insurer can meet its obligation after
catastrophic loss.
Premium funds as the amount is collected

before the claims are paid.

Expenses
Major expenses incurred by an insurance company are

claim payments for insureds who have suffered loss and cost
associated with handling those claims.
Other major expenses are
Losses and Underwriting Expenses

Investment Expenses.

Losses and Underwriting Expenses
Expenses associated with insurers underwriting activity

include payment for losses, loss expenses and other underwriting
expenses.
Claim payment includes the following losses
Paid losses Claim payments that an insurer

has made.
Incurred losses Sum of paid losses and
change in loss reserve.

Loss Reserves
Loss reserves are amounts designated by insurance

companies to pay claims for losses that have already occurred but
not yet settled.
Loss reserve for a particular claim is the insurers best estimate

of the total amount that it will pay in the future for a loss that has
already occurred.
Incurred losses = Paid losses + Change in loss reserve

Loss Expenses
Loss expenses includes
Expenses necessitated by the process of investigation

insurance claims and settling them according to the terms in the
insurance policy.
For property insurance claims the claim representative must

identify the cause of the loss and decide whether this loss is covered in
the policy.
For liability insurance claims the claim representative must

identify whether the insured is legally responsible for the bodily injury
or property damage to/by the IIIrd party

Other Underwriting Expense
The major categories of insurer underwriting expenses, other than

losses and loss expenses are
Acquisition expenses The expenses associated with

acquiring new business like
advertisement, agent commissions.
General expenses Includes the infrastructure
management and other support
functions within the organization.
Taxes and fees Includes expenses of tax paying and
participation in state insurance
programs.

Investment Expenses
Investment expenses include the salaries and all other expenses

related to the activities of the insurance department.
Net Investment Income is calculated by subtracting the investment

expenses from income .
(i.e) Net Investment Income = Investment Income

Investment Expenses
Overall gain (loss) of operation = Net investment gain (loss) +

Net underwriting gain (loss).

Insurer Solvency
The financial position of an insurance company at any

particular time is measured by its assets, liabilities, and
policyholders surplus.
Assets - Tangible and Intangible property owned

by an entity, in this case.
Admitted assets - The Assets that are easily convertible
to cash at or near the value of the
propertys market value.
Non Admitted assets - Properties like office furniture that are
not easily convertible to market value
easily.

Insurer Solvency
Liabilities are financial obligations are debts, owed by a
company to another entity, usually the policy holder in case of
insurance company.
Major liabilities are
Loss reserve
Unearned Premium reserve
Policyholders surplus of an insurance company is equal to its

total admitted assets minus its total liabilities.
Policy Holders surplus = Admitted Assets - Liabilities

Monitoring Financial Performance
Financial statements gives clear view on the financial performance
of the company, which in turn helps the regulators, investors to monitor
the companies financial performance.
Two major financial statements that provide most information are
Balance Sheet Shows companies financial

position at a particular point of time.
Income Statement Shows companies financial
position for a particular period of
time.

Financial Statement Analysis
Analyzing by comparing two items produces a ratio that

highlights a particular aspect of financial performance.
Several such profitability ratios widely used in the industry

are,
Loss Ratio
Expense Ratio
Combined Ratio
Investment Income Ratio
Overall operating Ratio.

Loss Ratio
Loss ratio provides the percent of earned premium used to
fund losses and their settlement. One can compare the actual loss
experience with the expected loss experience.
The loss ratio is calculated by dividing an insurers incurred

losses (including loss expenses) for a given period by its earned
premiums for the same period.
Loss Ratio = Incurred losses( including loss expenses)

---------------------------------------------------------
Earned Premium

Expense Ratio
Expense ratio indicates what proportion of insurers

written premiums is being used to pay acquisition costs, general
expenses and taxes.
Expense ratio compares the underwriting expenses that an

insurer has incurred to its written premiums in a specific time
period.
Expense ratio = Incurred underwriting expenses

--------------------------------------------
Written premium

Combined and Investment Ratio
Combined ratio compares the inflow and outflows from
insurance operations. It is the sum of the loss ratio and the
expense ratio.
Combined Ratio = Loss Ratio + Expense Ratio.
Investment Income ratio compares the amount of net

investment income with earned premiums over a specific period.
It is defined as
Investment Income ratio = Net Investment Income
-------------------------------
Earned premiums

Overall Operating Ratio
Overall Operating Ratio is used to provide the overall

measure of the financial performance of the insurance company.
The overall operating ratio is calculated by subtracting the

investment income ratio from the combined ratio.
Overall Operating Ratio = Combined ratio

Investment Income Ratio

Capacity Ratio
The capacity Ratio compares the insurance companys
written premiums to its policyholders surplus.
Capacity Ratio = Written Premiums

-------------------------
Policyholders surplus
The written premium should not become too large relative to

policyholders surplus, because,
If the losses and expenses exceed written
premium then insurer must use its surplus to
meet its obligations.

Welcome to Marketing

Marketing
Marketing is the process of identifying
customers and their needs and then creating, pricing,
promoting, selling, and distributing products or
services to those needs.
A producer is any person who sells products for an

insurance company or companies.
Agency is a legal relationship that is formed when one

party, the principal, authorizes another party, the agent, to act as
a legal representative of the principal.
An Agency Contract is a written agreement between an

insurance company and an agent that specifies the scope of the
agents authority to conduct business for the insurer.

Responsibilities
The agency relationship, which is based on mutual trust and

confidence, empowers the agent to act on behalf of the principal and
imposes significant responsibilities on both parties.
It includes
Responsibilities of the agent to the principal

Responsibilities of the principal to the agent
Responsibilities of the agent and principal to
Third parties.

Authority of Agents
The principal is legally bound by any acts of the agents that

are within the agents authority.
Insurance agents have three types of authority to transact

business on behalf of insurers that they represent.
Express Authority
Implied Authority
Apparent Authority

Authorities Defined
Express Authority is authority that the principal specifically

grants to the agent.
Binding Authority which is usually granted in the agency

contract, is the authority of an insurance agent to effect
coverage on behalf of a particular insurer.
Implied Authority is authority that arises from actions of

the agent that are in accord with accepted custom and that are
considered to be within the scope of the authority granted by the
principal though such authority is not expressed in the agency
contract.

Insurance marketing System
Insurance companies have many marketing or

distributing systems, designed to meet their particular marketing
objectives.
Traditional marketing systems like
Independent Agency System

Exclusive Agency System
Direct Writing System
Direct Response System

An independent agency is an independent firm that sells

insurance, usually as a representative of several unrelated insurance
companies.
The agency can be organized as
A sole proprietorship owned by individuals

A partnership owned by two or more individuals
A corporation owned by Stockholders.

People working with independent agency system are
An Independent Agent A producer who works for an

independent agency.
An insurance broker An independent business owner or

firm that sells insurance by
representing customers rather
than insurers.
A Managing General Agency (MGA) - An independent

business organization that appoints and supervises
independent agents for insurance companies that use the
independent agency system.
Other Agency System
An Exclusive Agent is an agent that has a contract to sell

insurance exclusively for one insurance company ( or a group of
related companies).
The direct writing system of insurance marketing uses

sales representatives who are employees of an insurance
company.
The direct response System includes any insurance

marketing system that does not depend primarily on individual
producers to locate customers and sell insurance but relies mainly
on mail, phone or internet sales.

Compensation of Products
While some producers receive a salary, commissions provide the
primary form of compensation for producers.
Two types of commissions that producers typically earn are
Sales Commissions
Percentage of the premium that the insurer
pays to the agency or producer for new policies sold or
existing policies renewed.
Contingent Commissions
commission that an insurer pays, usually
annually, to an independent agency and that is based on
the premium volume and profitability level of the agencys
business with that insurer.

Advertising
In advertising, an independent agency
attempts to attract customers for the agency, and local
advertising agents rather than the various insurers it
represents.
An exclusive agency system, advertising programs

emphasize the name of both insurance company and
agent.
Direct writers tends to emphasize the company itself
rather than individual producers or office location.
Direct response system has no producers, use other
means of advertising and others, working with stable base
relied on free word -of mouth advertising.
Marketing Management
Insurance companies need some means of managing the

activities of the producers like,
To supervise producers,
To motivate them, and
To provide them with insurance products for sales.
So as to ensure that both the companys and agencys sales

and profit objective are met,.

Product Supervision
Marketing representatives are insurance company employees

whose roles are
To visit agents representing the insurer to develop and

maintain sound working relationship.
To motivate the agents to produce a satisfactory volume of
profitable business for the insurer.
In some companies Product Underwriters who in addition to

underwriting work, also travel to visit and rapport with agents and
sometimes clients.

Unfair Trade Practices Law
Unfair Trade Practices Laws are state laws that specify
certain prohibited business practices like,
Misrepresentation and False Advertising - due to

misrepresenting the benefits, terms and condition of
the policy.
Tie in Sales - when one producer ties the purchase of

insurance to some other sale or financial arrangement.
Rebating is offering anything of value than the

insurance itself, to an applicant as an inducement to
buy or maintain insurance.
Other Deceptive practices includes insurer and

agents from making a false statement about the
financial condition of another insurer.
Welcome to Underwriting

Underwriting
Underwriting is the process in which decides who are

the potential customers to insure and what coverage to offer
them.
It Includes
Selecting insured
Pricing coverage
Determining insurance policy terms and conditions
Monitoring the underwriting decisions made,
Usually done by an underwriter who is an insurance

companys employee.

Selecting Insured
Proper selection of Insured's prevents the risk of some

insured purchasing insurance that do not adequately reflect their
loss exposures.
An insurance company limits its applicants based on the

following reason.
Adverse selection consideration

Capacity factor consideration.

Adverse Selection Consideration
An Adverse Selection, a situation where people with

greatest probability of loss are the ones mostly like to purchase
insurance.
Adverse selection normally occurs if the premium is low

relative to the loss exposure.
Poor underwriting may result in adverse selection, so try to

underwriters avoid such situations by screening applications to
identify apt ones, and decline coverage to those present high loss
potentials.

Capacity Consideration
Capacity refers to the amount of business an insurer is

able to write, usually based on the comparison of the insurers
written premiums to the size of its policyholders surplus.
Insurance companies attempt to protect their available

capacity in three primary ways :
Maintaining a spread of risk

Optimizing use of available resources
Arranging reinsurance

Maintaining a Spread of Risk
Risk in the world of insurance mean the financial loss.
By spreading their risks among various types of

insurance and different geographic areas, insurance companies
reduce the chances of large number of losses in one type of
insurance or territory.
eg: Toronto might require an insurer to pay extensive

property claims in one community , but these claims would be
balanced against premium from other community that do not
experience in the same year.

Optimizing Use of available
Resources
Underwriting and servicing some kinds of insurance require
special skills or experience , and many insurers offer only certain
types of insurance and not others.
eg : An insurer might chose not to accept the applications for

insurance on farms if that insurer does not have personnel
experience in handling farm business.
On the other hand an insurer possession resource capable

of handling farm business will tend to increase its capacity to
write for farmers.

Arranging Reinsurance
In Reinsurance, the reinsurer receives a portion of the
premium from the primary insurers policies and assumes some
of the losses on the policies.
The primary insurer usually retains a portion of the premiums

and pays the insured losses on the reinsured policies and then it
is reimbursed by the reinsurer for losses for which the reinsurer is
contractually responsible.
If reinsurer is available then the insurance company can

increase the number of new policies.

Pricing Coverage
Each insureds premium should be set at a level that is

adequate to pay the loss expenses of the group and in turn earns
reasonable profit to the insurer.
Pricing insurance involves
Classify the applicant according to the loss

exposure.
Determining premium by applying appropriate
rate to the applicants exposure units.

Premium Determination
Premium is determined by multiplying the rate by the number of
exposure units.
where ,
Rate - The price of insurance charged

per exposure unit
Exposure unit - A measure of loss potential used
in rating insurance.
The premium for property insurance with a limit of $ 250,000 at

a rate of$.40 per $100 of insurance is $1000.
Premium = $250000
---------------- * $.40 per unit = $ 1,000.
$100

Determining Policy Terms and
Conditions
The insurer must decide exactly what types of coverage it
will provide to each applicant and then charge a premium
appropriate to that coverage.
In addition to developing loss costs, insurance advisory

organizations develop policy forms using standard insurance
wording and are called as Standard Forms.
When advisory organizations develop insurance policies,

they also develop rules specifying what kinds of insured will be
eligible for certain policies and its up to Insurers to modify or stick
to these rules.

Monitoring Underwriting Decisions
Underwriters periodically monitor the hazards, loss

experience and other conditions of specific insured to determine
whether any significant changes have occurred. So as to alter
coverage and premium necessary.
Monitoring also applies to underwriting decisions on a entire

Book of Business ( or portfolio).
A book of business is a group of policies with a

common characteristics, such as territory or type of
coverage.
It also refers to all policies written by a particular insurer
or agency.

Underwriting management
The role of an insurance companys underwriting
management involves various responsibilities.
Participating in the overall management of the insurance

company
Arranging reinsurance
Delegating underwriting authority
Making and enforcing underwriting authority
Monitoring the results of underwriting guidelines.
Underwriting management is the conduit for implementing

these changes.

Ratemaking
Rate Making is the process by which the

insurers
determine the rates to charge the thousands
(or millions) of similar but independent insureds.
Insurer needs appropriate rates to have enough

money to pay for losses, cover operating expenses, and earn a
reasonable profit.
Ultimately in the long run the insurance company,

exceed the amount it pays for claims and administrative expenses
to remain financially liable in the market.

Types of Rates
To determine the appropriate premium to charge for coverage,

insurers use either rates or individual rates.
Class rates (manual rates):

Those rates apply to all insureds in the same
rating category, or rating class.
Merit rates :
Rating plans that modify class rates to reflect
loss characteristics of a particular insured.
eg: In home owners insurance, insurers typically

provide premium discounts for insureds with fire alarm or
burglar alarms.

Types of Rates
Individual Rates (Specific Rates) :

Used to assign a specific insurance rate that
reflects the unique characteristics of an insured
or the insureds property.
A judgment rate :
Type of individual rate used to develop a premium
for a unique exposure for which there is no
established rate and the underwriter relies heavily
on his or her experience .
eg: Judgment rating is often used in rating ocean marine

insurance covering many types of cargo being transported to
ports worldwide.

Underwriting process
To make decisions underwriters use
Expert Systems ( Knowledge- Based Systems) :
These computerized system are programmed

to emulate the under writing decision making process as it
would be performed by expert underwriters.
Steps in underwriting process are
Gathering the necessary information

Making the underwriting decision
Implementing the decision
Monitoring the decision
Making the Underwriting Decisions
Once the underwriter has gathered the necessary

information, he or she must analyze the information to determine
what hazards, the applicant presents.
Hazards are conditions that increase the chance of a loss

occurring and an underwriter must evaluate the following
hazards,
Physical Hazard are tangible characteristics of

property , persons or operations that tend to increase
the probable frequency or severity of loss.

Analyzing Hazards
Moral hazards are dishonest tendencies in the character

of the insured that increases the probability of a loss
occurring.
Morale hazards or attitudinal Hazards involve

carelessness about, or indifference to, potential loss on the
part of an insured or applicant.
Legal Hazards are the characteristics of the legal or

regulatory environment that affect an insurers ability to collect
a premium commensurate with the exposure to loss .

Welcome to Claim Handling

Claims
Claim is a demand by a person or business seeking to

recover from an insurance company for a loss that might be
covered by an insurance policy.
A claim representative or adjuster is a person

responsible for investigating, evaluating, and settling claims.
A claimant is anyone who submits a claim to an insurance

company. In liability claims the claimant is the third party that has
suffered a loss and seeks to collect the loss from then insured

Claim Handling
Claim handling enables insurance companies to determine

whether a covered loss has occurred and decides the amount to be
paid for the loss.
The role of the claim representative is to satisfy the insurers

obligations under an insurance policy
by
Promptly responding to claims,

Gathering information to respond to claims,
Finally reaching a fair settlement.

Responsibilities of the Claim
Representative
The claim representative must verify whether the claim is
covered under the policy, then he may send a Reservation of
rights letter to the insureds policy.
Reservation of rights letter serves for two purposes namely
To inform the insured that a coverage problem might

exist
To protect the insurer so that it can deny coverage
later, if necessary.
And, finally the claim representative should determine the

dollar amount payable under the policy.

Types of Claim Representative
Several type of claim representatives who perform the

complex claim handling activities depending on the circumstances:
They are
Staff claim representatives
Independent adjusters
Agent
Public adjusters.
In addition, an organization that has established a self

insurance plan must make provisions to settle its own claims by
using either an internal claim department or an outside
administrator.

Staff Claim Representatives
Most insurance companies have at least two kinds of staff
claim representatives
Inside Claim Representative
Those who work exclusively inside the office to

handle the claims, usually through telephone or letter.
Outside Claim Representative
Those who travel to the site of loss to perform claim

investigations and evaluations, interviewing witnesses,
investigating damage and is a part of the insurers
staff located in a branch office.
Independent Adjusters
Independent claim representatives offer claim handling

services to insurance companies for a fee.
They can be either be either self-employed or

work for an independent adjusting firm.
Expert independent adjusting firms can meet the

special claim handling needs of the insurance
companies.
In case of natural disasters, independent adjusters

can handle huge claims along with their claim
handling staffs to meet the obligations.

Agents and Public Adjusters
In exclusive agency, the agency usually contains one

person , several people, or a department responsible for handling
claims.
If the agents has draft authority i.e. authority given by the

insurer to settle the claim by writing a claim draft up to specific
limit.
On the other hand , a public adjuster is a person hired by a

insured to represent the insured in handling a claim and he acts
as an advocate for the insured in the negotiation.

Internal Claim Administration
A self insurance plan is an arrangement in which an
organization pays for its losses with its own resources rather than
purchasing insurance.
However, the organization might choose to purchase

insurance for losses that exceed a certain limit.
Organizations with self-insurance plans has two provisions for

handling claims, namely
Internal Claim Departments

organizations personnel to handle claims.
Third party Administrators
Business firm that contract to provide
administrative services to other business.

The Claim Handling Process
Claims vary for different cases, but despite of unique
challenges the same three steps is involved in the process of
most claims.
They are
Investigation
Valuation
Negotiation
But the manner these claims handled are different from

property insurance claims and for liability insurance claims.

Investigation
Investigation begins when the claim representative
receives the initial report of a claim, he or she must investigate to
gather further information relevant to the loss.
It involves,
Determining the causes the loss and assessing

damage.
Verifying Coverage by confirming whether the insured
have an insurable interest in the property, damaged
property and the cause covered under the policy.

Valuation
Valuation of the property includes
Actual cash value Replacement cost minus depreciation

Replacement Cost The cost to repair or replace
Agreed value The value agreed for the property
at the time of policy.
If the property loss occurs , the insurer will pay the agreed
value, without regard to the exact value of the property at the time of
the loss.

Replacement Costs
The replacement costs for the Real property is usually estimated

by using the following factors
Square footage of the property

If the property is damaged then its area can be
calculated from the blue print.
Quality of construction
Deals with quality ,for Eg: an house with furnished
high quality working will have a greater
replacement cost than a normal house.
Construction cost per square foot
Here the replacement can be found by multiplying
the square footage and cost per square foot.

Negotiation and Settlement
After investigation and valuation of the claim handling
process, the claim representative and the insured
negotiates on the loss and settlement of claim.
Once the claim representative and the insured agree on

the amount of the settlement , the following affects the
insurers cost of property claims,
Subrogation Insurer's right to recover payment from a

negligent third party.
Salvage rights The rights of the insurer to recover and
sell or otherwise dispose of the insured
property on which the insurer has paid a
total loss.

Liability damages
Legal liability cases might involve the following types of damages
Compensatory Damages includes both special and

general damages that are intended to compensate a victim for
harm suffered.
Special damages Specific, out-of-pocket expenses, such
as doctor and hospital bills.
General damages losses such as pain and suffering, which
do not have a specific economic value.
Punitive Damages awarded by court to punish wrong doers
who, through malicious or outrageous actions, cause injury or
damage to others.

Unfair Claim Practices laws
Unfair claim practices law are state laws that specify claim
practices that are illegal.
The prohibited claim practices includes
Misrepresentations of pertinent facts or insurance

policy provisions
Failure to promptly responding to the Claims
Actions that compel an insured to sue to recover
amounts that are substantially lower than those
covered.
Refusal to pay the amount without first conducting a
reasonable investigation based on all available
information.

Welcome to Insurance Contract

Insurance Contracts
Insurance contract is the insurance

companys promise that, it will pay claims in the future
for losses that are covered under the policy.
An insurance contract, called a policy, is a complete

written contract of insurance .The validity of a contract depends
on four essential elements:
Agreement (offer and acceptance)

Competent parties
Legal Purpose
Consideration

Characteristics of Insurance
Contracts
The Wording of insurance policy reflects certain fundamental
principles of insurance. An insurance policy generally contains distinct
characteristics
A personal Contract
Insurers right to select Insureds.
A Conditional Contract
Action performed under Specified
condition.
A contract of Utmost Good Faith Concealment and
Misrepresentation.
A contract of adhesion Rules insureds should stick to.
A contract of Indemnity To recover an insured from covered
loss.
A contract Involving the exchange of unequal amounts

Insurance Policy Provisions
The best way to determine the coverage provided by a

particular policy is to examine its provisions in the policy.
They are
Declarations
Definitions
Insuring Agreements
Exclusions
Conditions
Miscellaneous provisions.

Self Contained Policy
Insurance Companies use two approaches to structuring an
insurance policy manuscript or standardized.
A policy can be either Self contained or modular.
A Self contained policy is a single document that contains

all the agreements between the insurer and the insured and that
forms a complete policy by itself.
eg: Personal auto policy is a self contained policy
An endorsement is a document that amends /apology an
insurance policy in some way. It may delete or add coverage,
include state specific changes, show a change in the insureds
exposure or otherwise modify the policy.

Modular Policy
A modular policy consists of several different documents,
none of which by itself forms a complete contract. It combine
coverage forms and other documents to tailor a policy to the
insureds needs.
eg: Commercial package policies (CCPs).
All CCPs must contain,
Common Policy Considerations It contains information

that applies to entire policy , such as the name and address
of the insured.
Common Policy Conditions It contains standard condition
that applies to all CCPs regardless of the coverage included

Conditions Found in Property and
Liability Policies
The conditions provide the rules for the
relationship between the insurance company and the
insured, using which the operation becomes efficient.
Conditions common to most property and liability

insurance policies , both personal and commercial,
includes
Cancellation
Changes
Duties of the insured after a loss
Assignment
Subrogation

Cancellation
Cancellation refers to the termination of a policy by either

the insurer or the insured , during the policy period.
Cancellation may be because of
Cancellation by the insured

Cancellation by the Insurance company
Prior written notice is must in both the process to avoid

dispute over a cancellation request.

Cancellation
When a policy is canceled, the insured might be entitled to a

refund.
If the insurance company cancels the policy , the

return premium is calculated on pro rata refund, which is the
unused premium returned to the insured when a policy is
canceled.
If the insured cancel the policy , the return premium is

calculated on Short rate fund and it would be obvious less than
the Pro Rata refund.

Changes
Many policies contain a policy change provision stating
that the written insurance policy contains all the agreement
between the insurer and the insured and the term of the policy
can be changed only by a written endorsement issued by the
insurer.
A liberalization clause is a policy condition that

provides that if a policy form is broadened at no additional
premium, the broadened coverage automatically applies to all
existing policies of the same type.

Duties of the Insured After a Loss
Insureds part is high in settling a loss,
If a covered loss is to be paid ,promptly, the insurer must be

informed that the loss occurred .
Insured should prepare an inventory of damaged and
undamaged property and protect the property from further
damage.
Liability Insurance policies usually require that the insured
promptly forward all papers regarding a claim or suit to the
insurer.

Assignment and Subrogation
Assignment is the transfer of the rights or interest

in a policy to another party by the insured. Most
policies cannot be assigned without written permission
of the insurer.
It is also called Transfer of your Rights and Duties

Under This Policy , which makes clear that assignment is not
permitted without the written consent of the insurer.
Subrogation is the insurers right to recover payment from a

negligent third party for losses the insurer has paid to an insured.

Welcome to Property Loss Exposure

Property Loss Exposure and Policy
Provisions
A Property loss exposure is any condition or situation that

presents the possibility that a property loss will happen.
The three main aspects of property loss exposure are
Types of Property
Causes of loss
Financial Consequences

Types of Property
Property is any item with value. Property can decline in

value or even become worthless if it is lost, damaged or
destroyed.
Two types of property are,
Real property - Land and any property attached to it.

eg : A house, a storage shed, flagpole.
Personal property - All tangible and intangible property

that is not real.
eg : Money, automobiles, patents and
copy rights.

Property By Insurance
Insurance practitioners use categories that relate to the
insurance treatment of property such as
Buildings
Personal Property
Money and Security
Motor Vehicles and Trailers
Property in Transit
Ships and their Cargo
Boilers and Machinery

Buildings
Buildings includes all Properties that are permanently attached
to the structure, such as
Wall to wall carpeting
Built-in appliances
Paneling
Personal property includes the contents contained inside
the building. The contents of a commercial building might include
Furniture and fixtures

Machinery and equipment
Stock
So, when the contents of a commercial building are
involved, policies generally use the term business personal
property.

Money and Securities
Money means currency, coins, and bank notes.
Travelers checks, credit card slips, and money
orders
held for sale to the public are also considered money
in some cases.
Securities are written instruments representing either

money or other property. Stocks and bonds for example, are
securities.
Money and securities are also light in weight, easily

concealed, and easy to transport.

Motor Vehicles and Trailers
To identify property loss exposures, motor vehicles are
categorized into three types namely
Autos and other highway vehicles

It includes vehicles like car ,trucks such
those designed for use on public roads.
Mobile equipment
It includes Off road vehicles like tractors,
bulldozers, road graders.
Recreation vehicles
It includes vehicles like dune buggies,
all - terrain vehicles, dirt bikes and most
snow mobiles.

Boilers and Machinery
Boilers and machinery share two characteristics
Those susceptible to explosion or breakdown that can result

in serious financial losses.
Those less likely to have explosion or breakdown if they are
periodically inspected and properly maintained.
So as others include ships and cargo which are exposed to

special perils that are not encountered in the other means of
perils.
eg: If the ship is not able to reach the intended designation
and the cargo must be sold in a different port which may result in
fluctuation of the expected price.

Cause of loss to Property
A cause of loss (or peril) is the actual means by which

property is damaged or destroyed like fire, lighting, windstorm,
hail and theft.
Named perils are listed and described in the policy , only

these named perils are covered.
Special form coverage ( open perils) provides coverage to

risks of direct loss i.e. coverage is provided for any direct loss to
property unless the loss is caused by a peril specifically excluded
by the policy.

Financial Consequences of
Financial Losses
The loss of or damage to property can have undesirable
financial consequences .
The adverse financial effects of a property loss might occur

in any of the following ways
Reduction in the value of the property

Loss Income
Increased Expenses

Reduction in value of Property
When a property loss occurs, the property is reduced in
value.
The reduction in value can be measured in different ways.
If the property can be repaired or restored , the

reduction in value can be measured by the cost of the
repair or restoration.
Replacement cost is the cost to repair or replace
property using new materials of like kind and quality with
no deduction for depreciation.

Loss Income and Increased
Expenses
When property is damaged, income might be lost as the
income producing capacity of the property is reduced or
terminated until the property is repaired, restored or replaced.
The additional expenses may be due to acquiring a

temporary substitute or in temporarily maintaining the property in
usable condition.
eg : A family whose house is damaged might have to live in a

hotel temporarily at considerably greater expense than living at
home

Parties Affected by Property Loss
Parties that might be affected by a property loss include the
following:
Property owner - owns the property.

Secured Lenders
Secured even when the borrower fails
to make loan payments.
Users of Property
Events results in losses to users of the
damaged property.
Other Holders of Property
A Bailee is a person or business that holds
the property of others for some specific
purpose.

Property Insurance policy Provisions
Property insurance policy must clearly specify exactly
Which property loss exposures are covered

- the types and locations of property, cause of loss,
and the financial consequences that are covered.
What parties are covered
How the value of insured property will be determined.
Property other than the insureds buildings and contents include
Autos
Non owned property
Movable property

Covered Cause of Loss
Property and commercial property insurance policies on
buildings and personal property are available with three different
degree of coverage's namely,
Basic form Coverage The lowest cost version that

provides coverage for
approximately dozen named perils.
Broad form Coverage A highest cost version of coverage
that adds several perils to those
covered by basic coverage
Special form (open perils) Includes all cause of losses that
are not specifically excluded.

Basic Form coverage
The following are the causes of loss , generally included in
both commercial and personal policies , that provides basic form
coverage
Fire and lighting

Windstorm
Hail
Aircraft
Vehicle Damage
Riot and civil Commotion
Explosion
Smoke
Vandalism

Board Form coverage
Broad form coverage includes those not included in the

basic form coverage
Breakage of glass
Falling objects
Weight of snow, ice or sleet.
Sudden and accidental water damage
Collapse
Crime perils
Some policies the perils of theft and others covers only a

specific type of theft like burglary and robbery.

Auto Physical Damage
Insurance policies that provide auto physical damage
coverage offer the following types of coverage
Collision Covers the damage to an insured

motor vehicle.
Comprehension Covers losses due to fire, theft,
( other than collision) vandalism etc
Specified causes of loss Less expensive alternate to

comprehensive coverage in
commercial auto policies.

Cause of Loss Often Excluded
Certain insurance policies contain exclusions for
several reasons like,
To avoid covering uninsurable losses

To avoid insuring losses that could be prevented,
duplicate coverage and to keep insurance premium
reasonable.
It includes
Catastrophe perils - war and nuclear risks
Coverage on ocean going vessels and cargo.
Maintenance perils - Wear and tear, Marring and
scratching, rust, Gradual,
damage by insects, etc

Amounts of Recovery
Amounts of recovery says how much will an insurer pay to a

covered party with a insurable interest.
It depends on the following provisions namely,
Policy Limit
Valuation Provision
Settlement Options
Deductibles
Insurance to value provisions
Other insurance provisions.

Policy Limit and Valuation
Provision
A policy limit
Tells the insured the maximum amount of money that can

be recovered from the insurance company after a loss.
Tells the insurer the maximum amount it may have to pay
for a covered loss.
For most property insurance coverage , the premium
charged is directly related to the policy limit.
Two most common valuation approaches in property insurance

policies are
Replacement cost
Actual cash Value

Settlement Options
Property insurance policies usually give the insurer the

choice of different ways to settle a loss.
The Insurer generally has the following options
Paying the value

Paying the cost to repair or replace the property
Repairing, rebuilding, or replacing the property with
other property of like and quality.
These options for settling property loses can often reduce

the insurers costs of settling claims without diminishing the
insureds actual indemnification.

Deductibles and Insurance to Value
Provisions
A deductible is a portion of a covered loss that is not paid by
the insurer. The deductible is subtracted from the amount the
insurer would otherwise be obligated to pay the insured.
Insurance to value provisions are provisions in property

insurance policies that encourage insureds to purchase an
amount of insurance that is equal to , or close to, the value of the
covered property.
Coinsurance is an insurance to value provision in many

property insurance policies. If the property is underinsured, the
coinsurance provision reduces the amount that an insurer will
pay for a covered loss.

Welcome to Liability Loss Exposure

Liability Loss Exposure And Policy
Provision
Definition:
A liability loss exposure is any condition or situation that

presents the possibility that a liability loss will happen.
Basic understanding of legal liability is essential for anyone

dealing with liability loss exposures.

Why Laws?
Law exists in civilized society to enforce certain

standards of conduct and accomplishes its objective
by
holding people responsible for their actions.
The legal System is derived from
The Constitution - Source of Constitutional Law

Legislative Bodies - Source of Statutory Law
Court Decisions - Source of Common Law

Constitutional Law
Constitutional Law consists of the Constitution itself and all the
decisions of the Supreme Court that involves the constitution.
It specifies
The structure of the federal government
Outlines the respective powers of the legislative,
executive, and judicial branches of the government.
It guarantees certain fundamental rights such as
Freedom of speech
Freedom of religion
Freedom from unreasonable searches, right to trail by
jury.
Statutory Law
Statutory Law consists of the formal laws, or statues,
enacted by federal state, or local legislative bodies.
It Includes
A bill receiving a majority of vote in both Senate and the

House, becomes a Law on presidents sign.
The laws made by the local government are often called
ordinances
Agencies like Federal trade Commission, the Environmental
protection agency have regulatory powers granted by the
legislative bodies to cover a particular public concern.

Criminal Law
Criminal law that applies to wrongful acts that society

deems so harmful to the public welfare that government takes the
responsibility for prosecuting and punishing wrongdoers.
Criminal Law prohibits murder, rape, robbery,

arson, theft, and driving while intoxicated.
Crimes are punishable by fines, imprisonment, or,

in some states even death.

Civil Law
Civil law is the category of law that deals with the rights and
responsibilities of citizens with respect to one another and applies to
legal matters that not governed by criminal law.
Civil law protects personal and property rights and thus

contributes to the welfare and safety of the society.
If someone invades the privacy or property of other , the

injured may seek amends in court.
Contract law is the branch of civil law that deals with

contracts and settles contract disputes.

Elements of Liability Loss Exposure
A liability loss exposure involves the possibility of

one party becoming legally responsible for injury or harm to
another party.
The elements of such exposure are
The legal basis of a claim by one party against

another for damage.
The financial consequences that might occur
from a liability loss.

Legal Basis of Liability Claim
For injured party to have the recover from liable party,

some principle of law must create a link between two parties.
The different aspects of civil law that can give an injured

party the legal basis for recovering damages from another party
are
Torts
Contracts
Statutes

Torts
A tort is any wrongful act other crime or breach of

contract, committed by one party against the other.
Tort law determine the responsibility for injury or

damage, Under which an individual or organization can
face a claim for legal liability on the any one of the following
basics namely,
Negligence
Intentional Torts
Absolute Liability
Tort law is based on common law.

Negligence
Negligence is failure to act in a manner that is reasonably

prudent and usually occurs when a person or organization fails to
exercise the appropriate amount of care under given
circumstances.
A liability judgment based on negligence depends on the

following,
A duty owed to another

A breach of that duty
Injury or damage
Unbroken chain of events between the
breach of the duty and the injury or damage.

Intentional Torts
A deliberate act other than breach of contract that cause harm
to another person , regardless of whether the harm is intended.
Intentional torts include,
Assault -
Intentional threat of bodily harm
Battery -
Unlawful physical contact
Libel -
Written untrue statement
Slander -
Oral untrue statement
False Arrest -
Unlawful physical restrain of
anothers freedom
Invasion of privacy - Violation on another persons right
to be left alone.

Absolute Liability
Absolute liability is legal liability that arises from

inherently dangerous activities or dangerously defective products
that results in injury or harm to another, regardless of how much
care was taken.
Its also called as Strict liability.
eg: The owner of wild animal, such as snake or circus lion,

is liable for any injury caused by the animals regardless of how
much care was taken.

Contracts
Contract law enable an injured party to seek recovery

because another party has breached a duty voluntarily accepted
in a contract.
Two areas of contract important to insurance are
Liability assumed under contract.

Breach of Warranty
Hold Harmless agreement is a contractual provision that

obligates one party to assume the legal liability of another.

Statutes
Statutory liabilities is the legal liability imposed by a specific

statute or law.
Common law may cover a particular situation , statutory laws

may extend ,restrict, or clarify the rights of the injured parties in that
situation or similar ones.
Prominent examples are
No Fault Auto Laws - to minimize legal proceedings

Work Compensation Laws - to benefit the employee.

Potential Financial Consequences
of Liability Loss
A person must sustain some definite harm for
a liability loss to result in valid claim.
It includes
Damages
For those who can show that
actual harm or loss occurred
due to negligence.
Defense Costs Those who required to defend
themselves in court.

Activities leading to Liability Loss
Liability loss exists whenever some activity or relationship can
create liability to others.
Possible liability exposures are,
Automobiles and other conveyances

Premises
Business operations
Completed operations
Products & Advertising
Pollution & Liquor
Professional activities

Difference b/w Property & Liability
Loss exposures
Property insurance claim usually involves two parties
namely insured, insurer where as Liability includes an additional
person called claimant who bring legal complaints against the
insured for injury or damage.
In Property insurance insurer pays for the covered loss to

the insured, where as in Liability insurance insurer pays to a third
party on behalf of insured.
Property Insurance should clarify which property cause of

loss the policy covers, where as liability indicates the activities and
types of injury or damage that covered.

Terms in Liability Policy
Named Insured is the policy holder whose name (s) appears

on the declaration page of an insurance policy.
Bodily injury is any physical injury to a person, including

sickness, disease and death.
Property damage is physical injury to, destruction of , or loss

of use of tangible property .
Personal injury used to mean injury, other than bodily injury

arising out of intentional torts , libel, slander or invasion of privacy.

Advertising injury includes Libel and slander, publication

of material that constitutes an invasion of privacy,
misappropriation of advertising ideas and infringement of
copyright, title, or slogan.
Litigation expenses are the expenses incurred for legal

defense, such as attorneys fees, expert witness fees and the
cost of legal research.
Supplementary payments are amounts the insurer agrees

to pay( in addition to liability limits) for items such as premium on
bail bonds, loss of insureds earnings because of attendance at
trails.

Pre judgment interest is interest that might accrue on

damages before a judgment has been rendered.
Post judgment interest is interest that might accrue on

damages after a judgment has been entered in a court and before the
money is paid.
Occurrence basis coverage covers liability claims that occur

during the policy period, regardless of when the claim is submitted to
the insurer.

Claims made coverage covers liability claims that are

made during the policy period for covered events that occur on or
after the retroactive date and between the end of the policy.
A retroactive date in a claims made policy is the date on or

after which injury or damage must occur in order to be covered.
An each person limit is the maximum amount an insurer will

pay for injury to anyone person for a covered loss

.
An each occurrence limit is the maximum amount an insurer
will pay for all covered losses from a single occurrence.
An aggregate limit is the maximum limit an insurer will pay

for all covered losses during the covered policy
period.
A Split limit are separate limits that an insurer will pay for
bodily injury and for property damage.
A single limit of liability is the maximum amount an insurer will

pay for the insured's liability and property damage that arise from a
single occurrence.

Welcome to Risk Management

Purpose
To provide a brief insight into loss exposures

management.
Typically includes
Risk management objectives

Steps involved In Risk management
Benefits of Risk Management.

Risk Management & Steps Involved
Risk Management is the process of making and

implementing decisions to deal with loss exposures.
It demands careful attention in all well managed

household or organization regardless of its nature involving the
following steps.
Identifying and analyzing loss exposures

Examining Risk Management Techniques
Selecting more appropriate Technique
Implementation of selected Techniques
Monitoring and Modifying the Techniques

Identifying Loss Exposures
Identifying involves developing a complete list of loss exposures
and the possible accidental losses which may affect the household or
organization.
It involves the following steps

Physical inspection - Physically inspecting all the
locations ,operations, maintenance routines,
safety and other activities.
A loss exposure survey - A checklist or questionnaire
listing the potential losses.
Flowchart - Diagram that depicts the flow of a particular
operation or set of related operations
within
the organization.
Analyzing Loss Exposures
Analyzing involves how often losses may occur and to

determine how these losses might interfere with the activities and
objectives of the household or organization.
It involves determining the financial effect of a potential

loss by measuring
Loss Frequency
Loss Severity of the losses.
Analyzing enables the risk manager to

priorities the significant exposures.

Analyzing Methods
Loss Frequency indicates how often losses occur or

expected to occur, thus used to predict the likelihood of similar
losses in the future.
eg: Losses like minor auto accident , spoilage of super

market products occur much frequently than earthquake and
hurricanes
.
Loss Severity refers to the dollar amount of damage that
results or might result from loss exposures, thus used to predict
how costly future losses are likely to be.

Risk Management Techniques
After identifying and analyzing the loss exposure, all

possible techniques should be examined for treating the
exposure, which includes
Avoidance
Loss Control
Retention
Non Insurance Transfer
Insurance

Avoidance
Avoidance eliminates the chance of a particular type of

loss by either disposing of an existing loss exposure or by not
assuming a new exposure.
eg: A manufacture of sports equipments might

decide not to manufacture football helmets to its line
of product to avoid the possibility of large lawsuits
from head injuries.

Loss Control
Loss control involves procedure to lower the frequency or
severity of losses.
This technique is rarely used by itself and is often most
effective when used in conjunction with other risk management
techniques.
It includes
Loss prevention - to control the number of losses.
Loss reduction - to decrease the dollar amount of losses.

Retention
Retention involves retaining all or part of a

particular loss exposure. Thus the organization or
household must pay for losses resulting from the
exposure with its own funds or from its own assets.
Retention May be either Intentional or unintentional,

but mostly they are unintentional due to the lack of exposure
identification or analysis.
eg: A restaurant might not identify its liability exposure

serving too many alcohol to a customer.

Non Insurance Transfer
Non Insurance Transfer involves, one party transferring

the potential financial consequences of a particular loss exposure to
another party that is not an insurance company.
eg: The landlord of a commercial building might wish to

transfer the liability exposure arising out of activities of a tenant.
Here, transfer is accomplished by having the tenant signed

Hold harmless agreement, which is a contractual provision in
which one party assumes the legal liability of another party.

Insurance
Insurance is the most effective method of risk

management where one can transfer financial consequences of
specified losses from one party to the insurance company in
exchange for a specified fee called premium.
eg: A family purchasing home owners

and personal auto policies from an
insurance company.

Selecting Appropriate Technique
Selecting appropriate risk management technique

involves basically two factors namely,
Decisions based on Financial Criteria

Done by business organizations that are accustomed to
reaching decisions based on expected profits and other financial
standards.
Decisions based on Informal Guidelines

Done by business organizations that are less financially
oriented.

Informal Guidelines
Most households and small organizations follow less
formal guidelines in selecting risk management techniques
namely,
Do not retain more than you can afford to loss.

Do not retain large exposures to save a little
premium.
Do not spend a lot of money for a little protection.
Do not consider Insurance a Substitute for loss
control.
Do not consider Insurance a substitute for loss
control

Implementing the Chosen Technique
The following decisions should be considered by the risk

manager of an organization before implementing the chosen
technique,
Deciding what should be done

Deciding who should be responsible
Communicating Risk Management Information
Allocating costs of the Risk Management
Program.

Monitoring and modification
Monitoring the risk management program is an ongoing

activity which includes handling routine matters like updating
fleets of vehicles.
To monitor and modify the risk management program , the

risk manager should periodically identify and analyze new and
existing loss exposures, Reexamine, select, and implement
appropriate risk management techniques

Benefits of Risk management
Insurance is an essential part of most sound risk management

programs. Risk management has many advantage over merely buying
insurance.
They are
Benefits to Business
Benefits to Individuals
Benefits to Families
Benefits to society
Benefits to Insurers.

Costs of Insurance
Benefits of insurance are not cost free, still it

outweighs the costs and provides tremendous economic
and social benefits.
Major Costs of insurance are
Premium paid by insureds

Operating costs of insureds
Opportunity costs
Increased losses
Increased lawsuits

Benefits of Insurance
On the whole the benefits of insurance are as follows,
Payments for the costs of covered loss,

Reduction of the insureds financial uncertainty,
Loss control activities of insurance company,
Efficient use of resources,
Support for credit,
Satisfaction of legal requirement,
Satisfaction of business requirement,
Source of investment funds and
Reduction of social burdens

Reference
Books:
Property and Liability Insurance Principles ( INS 21) by

Constance M. Luthardt . Third Edition(1999).
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03/10/17 Insure to Ensure Safety 1

03/10/17 Insure to Ensure Safety 2

Every person, family and business needs insurance to

Protect assets against unforeseen events causing

Protect Mortgage Companies Investment on our

To Indemnify from the loss suffered.

03/10/17 Insure to Ensure Safety 3

To provide a brief insight into the basis

03/10/17 Insure to Ensure Safety 4

Insured's exchange the possibility of a large loss

Insured who incur covered losses are paid from

Transfer is done through an Insurance Policy,

03/10/17 Insure to Ensure Safety 5

An insurance policy is a contract between the

Insured in turn reduces the uncertainty that may

03/10/17 Insure to Ensure Safety 6

The major types of loss exposures are

Property Loss exposure - Possibility that a property loss

03/10/17 Insure to Ensure Safety 7

Sole idea of insurance is to benefit both the

Insured transferring the loss of cost to insurer.

03/10/17 Insure to Ensure Safety 8

Large number of Similar exposure units

IILE must be common that insurer can pool

Losses that are accidental

If losses are not accidental then the insured might have an

03/10/17 Insure to Ensure Safety 9

If the time and location of loss is not definite

For example, sudden bursting of a water pipe

In short wear n tear cannot be insured.

03/10/17 Insure to Ensure Safety 10

Losses that are not Catastrophic :

Loss suffered by one insured should not affect

An insurer company usually avoids possible

03/10/17 Insure to Ensure Safety 11

Losses that are Economically Feasible to Insure

Loss exposures involving small losses as well as

03/10/17 Insure to Ensure Safety 12

Four types of basic insurances is broadly classified into

Property Insurance / Liability Insurance

Life Insurance / Health Insurance

03/10/17 Insure to Ensure Safety 13

Types of property insurance are

Fire and Allied Lines Insurance

03/10/17 Insure to Ensure Safety 14

Allied Term refers to insurance against cause of loss

Policies covering FAL are

03/10/17 Insure to Ensure Safety 15

What BII Covers ?

Business Income/Interruption Insurance, pays a business for

BII pays the expenses that the insured

03/10/17 Insure to Ensure Safety 16

Separate coverage is provided for specific types of property

eg: Policies covering Crime Insurance is

03/10/17 Insure to Ensure Safety 17

What OMI Covers ?

In addition Inland marine Insurance (IMI) covers

03/10/17 Insure to Ensure Safety 18

Auto Physical Damage Insurance usually provides auto

It is generally meant for damage or loss to specific type

03/10/17 Insure to Ensure Safety 19

The insurance company pays the claimant on behalf of the