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Chapter 2 Recap

Complete Summary: Policy Provisions and Contract Law

Part 1 Elements of a Legal Contract

Agreement

Offer and acceptance between parties

Consideration

Premiums and representations from insured; payment of claims from insurer

Competent Parties

Of legal age, sound mental capacity, not under the influence of drugs or alcohol

Legal Purpose

Must be for a lawful reason, not against public policy

Memory Trick: OACL

Offer + Acceptance | Assessment (Consideration) | Competent | Legal

Legal Terms

Representations

Statements believed to be true to the best of one's knowledge, but NOT guaranteed to be true

Misrepresentations

Untrue statements that could void the contract

Material Misrepresentation

A statement that, if discovered, would alter the underwriting decision

Warranty

An absolutely true statement that the policy depends on to be valid

Concealment

Intentional withholding of a material fact that is crucial in making a decision - may void a policy

Binders

  • • Temporary agreement issued by an agent or insurer providing temporary coverage
  • • Expire when policy is issued

Part 2 Policy Components

1

Declarations

Basic underwriting info: name, address, coverage amounts, premiums, insured locations

2

Definitions

Clarifies the terms used in the policy

3

Insuring Agreement

Establishes insurer's obligation to provide coverage

4

Additional Coverage

Extra coverage for specific expenses, at no additional premium

5

Conditions

General rules/procedures both parties agree to follow

6

Endorsements

Printed addendums to change terms, conditions, or coverages

7

Exclusions and Policy Limits

Perils NOT insured against + maximum amounts insured may collect

Part 3 Insured and Insurance Company

Insured

Anyone covered under the policy, whether named or not

Named Insured

Individual(s) whose name appears on the declaration page

First Named Insured

Individual whose name appears first on the declaration

Additional Insureds

Not named on declaration, but protected by the policy

Duties of Named Insured After a Loss (PICPS)

P

Protect property

I

Inventory damaged property

C

Cooperate with insurer

P

Police (theft)

S

Submit proof of loss

Part 4 Common Policy Provisions

Appraisal

Used when there's disagreement on the value of property loss

Arbitration

Used when parties don't agree on how to settle a claim

Cancellation

Termination of in-force policy before expiration date

Nonrenewal

Termination at expiration by not offering continuation

Loss Settlement

Under professional liability, insurer must get insured's consent before settling

Mortgagee Clause

Protects the interest of the lender in mortgaged property

Notice of Claim

Form informing insurer that events leading to possible claim have occurred

Proof of Loss

Sworn statement that must be furnished before loss can be paid

Other Insurance / Pro Rata

Defines how policy responds if other valid insurance exists on same risk; Pro rata provides for sharing of loss

Part 5 Sources of Insurability Information

1

Application Form

2

Motor Vehicle Records

3

Interviews

4

Property Inspection

5

Insurance History

Part 6 Federal Acts

Fair Credit Reporting Act (FCRA)

  • • Administered by the Federal Trade Commission
  • • Protects consumers from any distributing false or obsolete personal financial information
  • • Gives consumers the right to know what's in their credit file
  • • Allows consumers to dispute and correct inaccurate information

Key Terms Quick Reference

Appraisal

Disagreement on VALUE

Arbitration

Disagreement on HOW to settle

Earned Premium

Portion insurer has "earned" for elapsed time

Liberalization

Improved coverage is automatic & free

Negligence

Failure to use reasonable care

Third Party

Anyone other than insured or insurer

Exam Trap Alerts

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Appraisal vs Arbitration: Appraisal = VALUE dispute. Arbitration = HOW to settle dispute.

!

Notice of Claim vs Proof of Loss: Notice = "something happened." Proof = sworn statement with details.

!

Cancellation vs Nonrenewal: Cancel = BEFORE expiration. Nonrenewal = AT expiration.

!

Warranty vs Representation: Warranty must be ABSOLUTELY true. Representation = believed to be true.

!

Consumer vs Investigative Report: Consumer = credit/claims data. Investigative = interviews with people.

Chapter 2 Complete!

You've mastered Policy Provisions and Contract Law. Ready to continue?

Continue to Chapter 3 →