Personal Lines-California Insurance
Insurance - answerInsurer, entity, principal, underwriter, carrier or company. Uses "we,
us, and our". Insurer is the 2nd party to contract
Person receiving benefits - answerInsured, policyholder, owner. Named insured uses
"you and your". Insured is first parry on contract.
Claimant - answerPerson seeking recovery. In property=insured. In liability=3rd party
Falsification provision - answerWarning found on claim forms that those filing a false or
fraudulent claim are subject to fines and imprionment
CIC - answerCalifornia Insurance Code- state insurance laws proposed, written,
enacted and changed only by state Legislatures. Commissioner just enforces
CCR - answerCalifornia Code of Regulations- rules and procedures written by the
commissioner to carry out the intent of the code. Commissioner writes and changes the
regulations.
Pooling - answerSharing or spreading the risk
Department of Insurance/California Department of Insurance - answerDOI and CDI
Rescind - answerVoiding or revoking a contract back to its inception date (beginning) as
though it never existed (flat cancellation). Can ONLY be done for material
misrepresentation, material concealment, breach of warranty or fraud
CIC definition of Insurance - answerInsurance is a contract (written) in which one
undertakes to indemnify (restore/whole) another against loss, damage or liability arising
from a contingent or unknown event (may or may not happen)
Layman definition of Insurance - answerSubstitution/exchange of a small certain loss
(premium) for a large uncertain loss (claim)
Conceptual definition of Insurance - answerSocial device transferring risk from
individuals to a group
Insurance Contract - answerPolicy, written instrument, indemnity agreement and legal
document
, Benefits of insurance - answerDevice that allows individuals and society to recover from
unexpected loss; secure credit; satisfy legal requirements; source of investment income;
reduce social burdens; promotes loss control; reduces anxiety, uncertainty. Cost
benefits increases moral and morale hazards (dishonesty/lack of care)
Loss - answerAny reduction in quantity, quality or value of something. Can mean death,
bodily injury, property damage, incurred expenses, reduction in quality of life or an
obligation to pay for any such loss
Property insurance loss - answerDirect to tangible property or indirect
Liability insurance loss - answerObligation to pay for bodily injury, property damage,
personal injury, advertising injury. Harm caused by the insured to others
Loss exposure - answerPossibility of loss. There are 3 dimensions of loss exposure.
Type of value exposed to loss, the peril causing loss, the extent of the potential financial
consequences. Normally written as Property, Liability or Human/Personnel
Property Loss Exposure - answerDamage to the insureds property
Liability Loss Exposure - answerHarm caused to others/another
Personal Loss Exposure - answerDeath, retirement, unemployment, disability
Human Loss Exposure - answerConsidered personal unless they give work scenario
(personnel)
Financial Loss - answerIS NOT a loss exposure, it is a consequence of all of the
exposures
Personnel Loss Exposure - answerDeath, resignation, termination, disability
Peril - answerCause of loss or reason for loss
Named Peril - answerFire, lightening, etc. the perils are named/listed/stated in the
contract. Not listed claim is not paid. The burden is on the insured to prove the damage
was caused by listed peril. (Basic form: dp1, ho8 Broad Form: dp2, ho2, ho4, ho6)
Open Peril/All Risk - answerLists exclusions and does not name/state/list the perils but
states it covers all or any peril except those specifically excluded. This type of policy
shifts the burden of proof to the insurer (company). The insurer must pay unless they
can show the cause of loss was an exclusion under the policy/contract. (Special: dp3,
ho3 Comprehensive: ho5 Inland/Ocean Marine)
Hazard - answer(Key phrases: increases or leads to) Chance/likelihood/severity of loss.
Types of Hazards: Moral, Morale, Physical, and Court