Chapter 01 concepts and principles of insurance
- 1. CONCEPTS AND PRINCIPLES OF INSURANCE
- 2. DEFINITION In financial sense It is a social device in which a group of individuals (insured) transfer risk to another party (insurer) in order to combine loss experienced, which permits statistical prediction of losses and provides for payment of losses from funds contributed (premium) by all members who transferred risk
- 3. Definition (Contd.) In legal sense It is a contract by which one party (Insurer) in consideration of price paid to him proportionate to risk provides security to the other party (Insured) that he shall not suffer loss, damage or prejudice by the happening of certain specified events. Insurance is meant to protect insured against uncertain events which may cause disadvantage to him
- 4. ELEMENTS IN INSURANCE Insurance - combination of three elements Insurance as a Transfer System - transferring of risks from Insured to IC which is financially sound and has capacity and willingness to take risks. A Loss exposure can give rise to three types of losses, namely: Property loss (including net income loss), Liability loss, and Human and personnel loss.
- 5. Elements in Insurance (Contd.) Insurance as a Business - insurance primarily attempts to meet its costs and expenses from premium that it earns and also make a reasonable margin of profit for its own sustainability . Other benefits to society as a whole such as: Payments for the costs of covered losses Reduction of the insured’s financial uncertain Efficient use of resources Support for credit Satisfaction of legal requirements Satisfaction of business requirements Source of investment funds for infrastructure development Reduction of social burden
- 6. Elements in Insurance (Contd.) Insurance as a Contract - an insurance policy is a legally enforceable contract. The contract is between IC and the Insured. An insurance contract must meet these four requirements: Offer and acceptance Consideration Capacity Legal purpose
- 7. FUNDAMENTAL ADVANTAGES Transfer of risk from one person (Insured) to another (Insurer) Sharing (Pooling) of losses on some equitable basis such that fortuitous (random) losses will be indemnified (paid) Reduction in tension and fear Credit multiplication Avenue for investment
- 8. FUNDAMENTAL PRINCIPLES OF INSURANCE Principle of Uberrimae Fides ( Utmost Good Faith) – A positive duty voluntarily to disclose, accurately and fully, all facts material to the risk being proposed, whether requested or not. Non-disclosure of any fact may be unintentional on the part of the insured. Even so such a contract is rendered voidable at the insurer’s option and it can refuse any compensation. Any concealment of material facts is considered intentional.
- 9. Fundamental Principles Of Insurance (Contd.) Principle of Indemnity On the happening of insured event for which insurance policy is taken up insured should be replenished the amount of loss Insured should not derive any unwarranted benefit from a loss Made in following ways Cash payment Repair Replacement Reinstatement
- 10. Fundamental Principles Of Insurance (Contd.) Principle of Subrogation Restitution of rights of an assured in favour of Insurer against third party for any damages caused by him in place of assured after Insurer has indemnified him for the loss Objectives of the principle : Prevents insured from profiting from damage. Enforces rule of law that guilty is brought to book and made to pay for the loss. Helps Insurer to partially or fully recover amount paid for loss. Helps to lower insurance rates.
- 11. Fundamental Principles Of Insurance (Contd.) Principle of Contribution It means indemnity provided for loss occurring on asset, which is insured with several insurers has to be shared pro rata Corollary of doctrine of Indemnity and hence is applicable in case of GI. Requisites Insured asset/Person (in case of hospitalization insurance) must be common to all policies Risk insured against must be common to all policies All policies must be in force during the occurrence of loss
- 12. Fundamental Principles Of Insurance (Contd.) Principle of Proximate Cause Literally means nearest cause or direct cause. Immediate cause of mishap, which resulted in the loss . While determining ‘proximate cause’ sequence of events according to their time of occurrence is irrelevant. Many court judgments act as precedents in arriving at decisions while making settlements. The insurance company is liable to indemnify only against the insured perils.
- 13. SOME OTHER IMPORTANT CONCEPTS Underwriting - assumption of liability; formal acceptance of a risk by IC for a price (Premium) Objectives Producing a large volume of premium income sufficient to maintain and enlarge IC’s operations and to achieve a better spread of risk portfolio; Earning a reasonable amount of profit on insurance operations; Maintaining a profitable book of business More spread – across the profile and geography
- 14. Some other important concepts (Contd.) Proposal Form (application for insurance) - The insurance proposal has to be in writing or confirmed in writing and can not be oral alone Cover Notes - an evidence of insurance; a temporary and limited agreement, sent prior to completion of preparation of final policy document, or pending some information to be filled in, or when proposal is under consideration or policy is being prepared for delivery. The Slip - document mentioning all the essential information needed for assessing risk proposed Certificate of Insurance - generally printed, dated, signed, numbered. Mentions brief details of insured, location and situation of property, sum insured and period of insurance.
- 15. CLASSIFICATION OF INSURANCE LIFE GENERAL (NON-LIFE) PURE TERM FIRE MARINE MOTOR ENGINEERING AVIATION AGRICULTURAL CONSEQUENTIAL (LOSS) FIRE LIABILITY
- 16. GOVERNING LEGISLATIONS THE INSURANCE ACT, 1938 Important provisions Registration; ; Accounts and audit; Investments; Limitation on management expenses; Prohibition of Rebates; Powers of Investigation by CG GENERAL INSURANCE BUSINESS NATIONALIZATION ACT, 1972 To provide need-based, low cost insurance covers to rural population, crop insurance scheme, social security benefits; benefits of insurance available to the masses
- 17. INSURANCE REGULATOR INSURANCE REGULATORY AND DEVELOPEMNT AUTHORITY (IRDA) After opening up of insurance sector, IRDA is Regulator for monitoring of operations of ICs. HO in Hyderabad Focus on three areas - Protection of interest of consumers Ensure financial soundness of insurance industry Pave way to help a healthy growth of insurance market
- 18. SOME OTHER IMPORTANT STATUTES The Motor Vehicles Act, 1939 Marine Insurance Act, 1963 The Merchant Shipping Act, 1958 The Bill of Lading Act, 1856 The Indian Ports (Major Ports) Act, 1963 Indian Railways Act, 1989 The Carriers Act, 1865 The Indian Post Office Act, 1898 The Carriage by Air Act, 1972 Multi-modal Transportation Act, 1993 Public Liability Insurance Act, 1991 The Indian Stamp Act, 1899 FEMA 1999 The Consumer Protection Act, 1986
- 19. INSURANCE MARKET PARTICIPANTS Buyers - general public, traders, corporates, clubs, hospitals, schools, etc. Intermediaries Agents - governed by IRDA (Licensing of Insurance Agents) Regulations, 2000. Qualifications and disqualification prescribed Testing & Certification -to pass stipulated examination after undergoing training program of 50 (75 hours for composite) at accredited institutions (online / off-line). Corporate Agents – professionals e.g. ICAI,ICSI, ICWA, MBA , Actuarial Society of India, CAIIB Brokers
- 20. Insurance market participants (Contd.) Development Officers (DO) This arrangement in vogue in Public Sector Insurers. Purely an internal arrangement in organizing marketing force of IC. Link between branch manager and Agent Some of the main functions Disseminating information, Soliciting, negotiating, procuring, or effectuating an insurance contract or renewal Inspecting risk, Setting a rate, Investigating or assessing claim Direct Sales DSA - sales activity procured by staff of IC itself