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Chapter 1 FUNDAMENTALS AND TERMINOLOGY1

Chapter Objectives1

Introduction2

Insurance Defined　2

Financial Definition3

Legal Definition4

Loss，Chance of Loss，Peril，Hazard，and Proximate Cause5

Loss 5Chance of Loss5

Proximate Cause6

Peril and Hazard6

Risk7

Risk Management9

The Mathematical Basis for Insurance9

Four Basic Components10

Building Blocks of an Insurance Premium10

A Mathematical Example of an Insurance System's Operations10

Cash Flow Underwriting11

ContentsPrefce13

Benefits13

Costs13

The Benefits and Costs to Society of Insurance Systems13

Arson：Who Really Pays for Insured Losses14

Summary16

Review17

Review Terms17

Suggestions for Further Study18

Research Assignment18

Discussion Questions18

Chapter Objectives21

Chapter 2 INSURABLE LOSS EXPOSURES21

Gambling and Speculative Risks22

Introduction22

A Large Group of Similar Units Exposed to the Same Peril（s）23

Ideally Insurable Loss Exposures23

Losses Must be Accidental and Beyond the Insured's Control24

Catastrophic Losses25

Losses Must be Definite，Measurable，and of Sufficient Severity to Cause Economic Hardship25

When Only the People Most Exposed to Loss Want Coverage，Insurance Becomes Unfeasible29

Subsidization31

Risk Classification31

Adverse Selection32

Principles of Risk Classification33

AIDS （Acquired Immune Deficiency Syndrome）34

Important Social Issues34

Automobile Insurance36

Pension Benefits37

Branches of Insurance38

Conclusion38

Review Terms40

Summary40

Discussion Questions41

Review41

Suggestions for Further Study42

Research Assignment42

Chapter Objectives43

Chapter 3 RISK MANAGEMENT 1：ESSENTIALS43

The Risk Management Function44

Introduction44

Statement of Objectives and Principles45

Risk Management Staff45

Step One：Identification and Measurement of Exposures47

The Risk Management Process47

Direct Property Losses48

Liability Losses50

Loss of Income50

Loss of Key Personnel51

Emergency Planning—Disastor Recovery52

Estimation of Maximum Loss52

Step Two：Loss Control and Risk Financing53Loss Control53

Risk Financing55

Step Three：Regular Review of the Risk Management Program61

Summary63

Chicago Tunnel Collapse：A Risk Management Problem63

Review Terms65

Research Assignment：Case Study66

Review66

Appendix：Personal Risk Management67

Suggestions for Further Study67

Chapter Objectives71

Chapter 4 RISK MANAGEMENT 2：ADVANCED TOPICS71

Loss Data72

Risk Management Information Systems（RMIS）72

Introduction72

Other Information74

Deductibles and Policy Limits75

Financial and Other Considerations76

British Petroleum：A Case Study78

International Risk Management79

Identification and Measurement of Exposures80

Regular Review and Evaluation81

Development and Implementation of Plans81

Foreign Insurance82

Financial Risk Management87

Summary89

Review90

Review Terms90

Suggestions for Further Study91

Research Assignment91

Discussion Questions91

The Story92

Introduction92

Case Study：Blue Star Airlines92

The Risk Management Process93

Facts and Assumptions94

Assignment95

Chapter Obiectives99

Chapter 5 PRIVATE INSURANCE COMPANIES99

Two Different Types of Insurance Companies100

Introduction100

Mutual Insurance Companies101

Demutualization103

Stock Versus Mutual：A Consumer's Viewpoint103

Stock Insurance Companies103

Lloyd's of London Is an Insurance Market104

Lloyd's of London104

Lloyd's History105

Lloyd's and the Risk Management Function106

Typical Transaction106

The Reciprocal Exchange107

Other Legal Forms of Insurance Companies107

American Lloyds107

Blue Cross and Blue Shield108

Savings Bank Life Insurance108

Fraternal Insurers108

Health Maintenance Organizations（HMOs）and Preferred Provider Organizations（PPOs）110

Industrial Organization112

Insurance Industry113

Summary114

Discussion Questions115

Review115

Review Terms115

Introduction116

Appendix：Insurance and Private Enterprise：The Potential for Eastern Europe116

Research Assignment116

Suggestions for Further Study116

Why Private Insurance？117

Why Insurance？117

Competition and Efficiency118

The Requirements of a Private Insurance System119

Essential Requirements of a Free Enterprise（Capitalist）System119

Difficulties Starting a Private Insurance System in Eastern Europe120

The Future122

Chapter Objectives123

Chapter 6 INSURANCE OCCUPATIONS123

Agency Law124

Insurance Agents and Brokers124

Introduction124

Insurance Brokers126

Property and Liability Insurance Agents and Brokers128

Licensing Requirements128

Life Insurance Agents and Brokers129

An Insurance Agent's Duties130

Loss Adjuster131

Employees，Independent Adjustment Bureaus，and Public Adjusters133

Adjusters Are Agents134

Underwriter135

Property Insurance Underwriting137

Underwriting and Privacy138

Life Insurance Underwriting138

Actuary139

Finance140

Attorney140

Summary141

Other Occupations141

Review142

Review Terms142

Suggestions for Further Study143

Research Assignment143

Discussion Questions143

Case 1144

Appendix：Legal Issues Involving Insurance Agents and Brokers144

Introduction145

Appendix：The Ethical Choice145

Case 2145

Vocabulary146

Ethical Norms147

Three Practice Cases149

Suggestions for Further Study152

Chapter Objectives153

Chapter 7 THE INSURANCE MARKET：THE ECONOMIC PROBLEM153

Supply and Demand154

Economic Theory154

Introduction154

Historical Problems157

The Insurance Consumer158

The Consumer's Choice：Company，Agent or Broker，Policy，Amount，and Price159

The Courts164

Consumer Protection：The Role of the Courts，the Law，and the Insurance Commissioner164

The Insurance Commissioner165

The Law165

Summary166

Discussion Questions167

Review167

Review Terms167

Elasticity of Supply and Demand for Insurance168

Appendix：Further Consideration of Supply and Demand168

Research Assignment168

Suggestions for Further Study168

Shifting Supply and Demand Curues170

Chapter Objectives171

Chapter 8 INSURANCE REGULATION171

Insurance Regulation172

Introduction172

Solvency173

The Reasons for Insurance Regulation173

Prices174

Unequal Knowledge and Bargaining Power174

The History of Insurance Regulation175

Promotion of Social Goals175

South-Eastern Underwriters Association（SEUA）176

Armstrong and Merritt Investigations176

Paulv．Virginia176

State or Federal Regulation？177

The McCarran Act177

The National Association of Insurance Commissioners （NAIC）178

State Insurance Regulation178

Repeal of P．L．-15179

Both Sides of the Argument180

Legal Reserves and Surplus182

Regulated Activities182

Regular Audits and Solvency Testing185

Rate Regulations187

Guaranty Funds187

Investment Activities188

Qualifications or Licenses for Companies，Agents，Brokers，Loss Adjusters，and Company Officers189

Policy Form Approval and Expense Limitations189

Consumer Complaints190

Summary191

Taxation191

Review192

Review Terms192

Suggestions for Further Study193

Research Assignment193

Discussion Questions193

Appendix：The McCarran Act（P．L．-15）194

Chapter Objectives197

Chapter 9 INSURANCE CONTRACTS197

Contract Terminology198

Introduction198

Conditional Receipt199

Binder199

Consideration200

Offer and Acceptance200

Elements of a Valid Contract200

Distinguishing Characteristics of Insurance Contracts201

Legal Purpose201

Capacity201

Principle of Indemnity202

Insurable Interest203

Actual Cash Value204

Subrogation205

Contract of Adhesion207

The Personal Feature209

Utmost Good Faith（Latin：Uberrimae Fidei）210

The Aleatory Feature213

The Entire Contract andIncontestability Clauses213

Discharge of Insurance Contracts214

Summary215

Review216

Review Terms216

Material Misrepresentation217

Appendix：Cases for Discussion217

Research Assignment217

Suggestions for Further Study217

Contract of Adhesion：The Metpath Case218

Breach of Warranty：General Chicken Case219

Chapter Objectives221

Chapter 10 BASIC PROPERTY AND LIABILITY INSURANCE CONTRACTS221

Introduction222

Standard Policies223

Insuring Agreement224

Declarations224

Basic Parts of an Insurance Policy224

Deductibles225

Exclusions226

Definitions226

Fraud227

Conditions227

Endorsements227

Cancellation229

Suspension of Coverage229

Duties After a Loss230

Other Insurance230

Salvage232

Appraisal232

Summary233

Conclusion233

Claims Payment233

Review234

Review Terms234

Suggestions for Further Study235

Research Assignment235

Case for Discussion：Vacancy Clause235

Chapter Objectives237

Chapter 11 HOMEOWNERS INSURANCE237

Introduction238

Policy Layout239

A General Description of the HO Insurance Policies239

Declarations240

Definitions242

Section 1—Property Coverages243

Additional Coverage245

Section 1—Perils Insured Against in the Broad Form，HO-2246

Specified Perils247

HO-2：Section 1—Exclusions249

Other Exclusions250

Ordinance-or-Law Exclusion250

Replacement Cost and Coinsurance251

Loss Settlement251

Section 1—Conditions251

Reasons for the Coinsurance Requirement253

Mortgage Clause254

Section 2—Liability Coverages255

Section 2—Exclusions256

Claims Not Covered Arising from Bodily Injury or Property Damage256

Sections 1 and 2—Conditions258

Summary259

Reduction of Insurance Resulting from Previous Losses259

Endorsements259

Review261

Review Terms261

Practice Questions262

Research Assignment263

Appendix：Buying Homeowners Insurance264

Suggestions for Further Study264

Chapter Objectives267

Chapter 12 THE PERSONAL AUTO POLICY267

The Tort Liability System and Automobile Insurance：A Review Case268

Introduction268

The Personal Auto Policy Layout269

Definitions270

Part A—Liability271

Limit of Liability272

Exclusions273

Insureds273

Part B—Medical Payments274

Coverage under the PAP275

Part C—Uninsured Motorist Coverage275

Contact or No-Contact Rules276

Part D—Damage to Your Auto277

Underinsured Motorists277

The State's Response to Uninsured Motorists277

Loss Settlement278

Part E—Duties After an Acddent or Loss279

Summary280

Part F—General Provisions280

Review281

Review Terms281

Practice Questions282

Suggestions for Further Study283

Research Assignment283

Chapter Objectives285

Chapter 13 COMMERCIAL PROPERTY INSURANCE285

Property and Marine（Transportation）Insurance286

Commercial and Personal Property Insurance286

Introduction286

Commercial Insurance286

Commercial Package Policy287

Property Covered288

Building and Personal Property Form288

The Insurance Services Office（ISO）288

Perils Covered289

Property Excluded from Coverage289

Definition of Fire290

Fire Insurance History290

Reporting Forms291

Business Income Coverage292

Property Insurance Rating293

Additional Forms293

Ocean Marine Insurance295

Transportation Insurance295

Inland Marine Insurance297

Aviation Insurance301

Business Automobile Insurance302

Automobile Property Insurance302

Review Terms304

Summary304

Review305

Suggestions for Further Study306

Research Assignments306

Discussion Questions306

Chapter Objectives307

Chapter 14 GENERAL LIABILITY INSURANCE307

Legal Background308

Introduction308

Categories of Torts（Civil Wrongs）309

Establishing Negligence and Damages310

Negligence Lawsuits310

Defenses in a Negligence Suit314

Legal Judgements315

Questions of Fact315

The Relationship Between Negligence and Legal Liability Insurance315

Ethics and Liability Insurance316

The Facts317

Social Host Liquor Liability：An Example317

Business General Liabilihy Insurance318

Categories of Liability Insurance318

Business Liability Umbrella Policies321

Automobile Liability Insurance322

Review Terms326

Summary326

Review327

Suggestions for Further Study328

Research Assignment328

Discussion Questions328

Case for Discussion328

Chapter Objectives331

Chapter 15 SPECIAL LIABILITY INSURANCE331

Claims-Made Policies332

Claims-Made and Occurrence Policies332

Introduction332

Occurrence-Basis Policies333

Environmental Impairment Liabilitv334

Insurance History335

Products Liability Insurance337

Insurance Principles and EIL Coverage337

Risk Management Strategy337

The Continuing Controversy339

Risk Management Strategy339

What Is a Professional？340

Professional Liability Insurance340

Types of Professional Liability Coverage341

Claims Settlement341

Coverage Clause341

Employment Practices Liability343

Nuclear Liability Insurance345

Americans with Disabilities Act（ADA）345

Summary348

Review349

Review Terms349

Suggestions for Further Study350

Research Assignments350

Discussion Questions350

Case Study：Sexual Harassment352

Appendix352

Case Study：Americans with Disabilities Act（ADA）353

Chapter Objectives355

Chapter 16 BONDING，CRIME INSURANCE，AND REINSURANCE355

The Reasons for Surety Bonding356

Introductory Terminology356

Introduction356

Surety Bonding356

The Difference Between Suretyship and Insurance357

Underwriting Bonds358

Types of Bonds359

Crime Insurance360

Reinsurance Arrangements361

Introductory Terminology361

Reinsurance361

Reinsurance Coverage362

Reasons for Reinsurance364

Providers of Reinsurance365

Reinsurance and Risk Management365

Summary366

Concluding Comments366

Discussion Questions367

Review367

Review Terms367

Suggestions for Further Study368

Research Assignment368

Chapter Objectives369

Chapter 17 LIFE INSURANCE POLICIES369

Three Ways Life Insurance Is Distributed370

Introduction370

Group Life Insurance371

Individual Life Insurance372

Industrial Life Insurance372

Types of Term Life Insurance374

Term Insurance374

Uses of Term Life Insurance377

Cash Values378

Whole Life Insurance378

Types of Whole Life Policies379

A Whole Life Ledger Sheet381

Reasons for Saving with Life Insurance381

The Uses of Whole Life Insurance381

Buy Term and Invest the Difference：The Consumer's Viewpoint382

Universal Life Insurance Policies384

Universal Life Insurance384

Universal Life Insurance Death Benefits385

Ledger Sheet for Universal Life Insurance386

Uses of Universal Life Insurance386

Variable Life Insurance387

Summary388

Review389

Review Terms389

Research Assignment390

Discussion Questions390

Endowment Life Insurance391

Appendix391

Suggestions for Further Study391

Chapter Objectives393

Chapter 18 ANNUITIES393

Definitions394

Introduction394

Beginning of Benefits396

Method of Premium Payment396

Classification of Annuities396

Promises Purchased398

Determination of Annuity Benefits400

Number of Annuitants400

Types of Benefits401

Uses of Annuities401

Taxation of Annuities402

Withdrawals in Liquidation403

Withdrawal before Liquidation403

Review Terms404

Summary404

Research Assignment405

Discussion Questions405

Review405

Suggestions for Further Study406

Chapter Objectives407

Chapter 19 LIFE INSURANCE PLANNING407

The Economic Value of the Human Life408

Introduction408

The Needs-Based Purchase of Life Insurance409

Planning Process410

Life Insurance Planning410

The Early Adult Years411

Life Insurance Planning：A Case Study412

Insurance for Wives，Children，and College Students413

Life Insurance Planning：The Middle Years417

Federal Estate Tax418

Wills418

Life Insurance Planning：The Later Years418

Business Uses of Life Insurance420

Funding Business Continuation Agreements with Life Insurance421

Death Proceeds422

The Taxation of Life Insurance422

Summary423

Living Benefits：Dividends，Savings，and Accelerated Death Benefits423

Review424

Review Terms424

Research Assignment425

Discussion Questions425

Suggestions for Further Study426

Facts and Data426

Chapter Objectives429

Chapter 20 STANDARD LIFE INSURANCE CONTRACT PROVISIONSAND OPTIONS429

Beneficiary Designation430

Insured，Owner，and Beneficiary430

Introduction430

General Life Insurance Policy Provisions431

Grace Period432

The Incontestable Clause433

The Reinstatement Provision433

Annual Apportionment of Divisible Surplus434

The Misstatement-of-Age Provision434

The Entire-Contract Provision434

The Suicide Clause and Other Restrictive Clauses436

Nonforfeiture Options437

Dividend Options437

Four Options Providing the Insured with Choices437

Policyholder Loans438

Settlement Options439

Available Riders and Options440

The Double-Indemnity Option441

The Waiver-of-Premium Option441

The Guaranteed-Insurability Option441

Summary442

Review443

Review Terms443

Discussion Questions444

Suggestions for Further Study445

Research Assignment445

Chapter Objectives447

Chapter 21 SIMPLIFIED LIFE INSURANCE MATHEMATICS447

The 1980 CSO448

Mortality Tables448

Introduction448

Some Simplifying Assumptions453

Interpretation of Mortality Tables453

Other Mortality Tables453

Single-Premium，Five-Year Term Insurance454

Single-Premium，One-Year Term Insurance454

Single-Premium，Whole Life Insurance459

Leveling the Whole Life Premium463

A Complex Issue465

The Cost of Life Insurance and Sales Illustrations465

Interest-Adjusted Method466

Traditional Calculation466

The Sales Illustration Controversy467

Review468

Review Terms468

Summary468

Suggestions for Further Study469

Research Assignment469

Chapter Objectives471

Chapter 22 MEDICAL EXPENSE AND DISABILITY INSURANCE471

Introduction472

Increasing Health Care Costs473

Background Information473

Medical Inflation474

Cost Containment475

Entire Contract476

Common Contract Provisions476

Legal Action477

Physical Exam and Autopsy477

Grace Period477

Reinstatement477

Incontestable Clause477

Claims477

Definitions and Exclusions478

Optional Contract Provisions478

Change of Beneficiary478

Basic Medical Expense Insurance479

Five Kinds of Health Insurance Coverage479

Major Medical Insurance480

Disability Income Insurance481

Medicare Supplement Insurance483

The Financial Problem484

Demographics484

Long-Term Care Insurance484

Long-Term Care Policy Development485

The Continuing Debate486

Health Insurance Providers487

Review Terms489

Summary489

Discussion Questions490

Review490

Suggestions for Further Study491

Research Assignment491

Chapter Objectives493

Chapter 23 EMPLOYEE BENEFITS493

Introduction494

The Government495

The Goals of the Government，Employer，and Employee495

The Employee497

The Employer497

General Features498

Qualification Rules498

Insured Employee Benefits498

Group Life Insurance499

Long-Term Disability501

Group Disability Income Insurance501

Social Problems502

Group Health Insurance502

Health Insurance Contracts503

Health Insurance Providers503

General Provisions of Group Health Insurance Contracts505

Two Federal Regulations506

Introduction507

Insured Pension Plans507

Federal Regulation of Pension Plans508

Requirements for Qualified Plans508

The Role of Insurance in Pension Plans509

Keogh Plans511

403（b）Plans or Tax-Deferred Annuities （TDAs）511

Profit-Sharing，401（k），403（b），Keogh，and Cafeteria Plans511

Profit-Sharing Plans511

401（K） Plans511

Cafeteria Plans512

Individual Retirement Account（IRA）512

Eligibility for Deductible Contributions512

Investment Alternative513

Rollovers513

Taxation514

Summary514

Review Terms515

Review515

Discussion Questions516

Research Assignment516

Suggestions for Further Study516

Appendix：Tax Deferral517

The Advantages of Tax Deferral519

Chapter 24 SOCIAL SECURITY521

Chapter Objectives521

In troduction522

Social Insurance Background522

The History and Philosophy of the American Social Security System524

Social Security Is Not a Public Assistance Program524

Social Security and Private Insurance Are Different525

Social Security Is an Insurance System525

The Program Is Compulsory for Almost Every Worker526

A Tax on Wages Is the Main Source of Funds526

The Operation of the Social Security Program526

Insured Status and Eligibility for Benefits527

Quarters of Coverage527

Benefits Are Not Fully Funded527

Calculation of Benefits528

Categories of Benefits528

Retirement Benefits529

Survivor Benefits530

Disability Benefits531

Medicare（Health Insurance for the Aged and Disabled）533

Some Current Issues Facing the Social Security System535

Will Social Security“Be There”for Young and Middle-Aged Americans？535

The Social Security Surplus and the Federal Deficit536

Other Criticism536

Summary537

Review Terms537

Review538

Research Assignment539

Suggestions for Further Study539

Discussion Questions539

Chapter 25 UNEMPLOYMENT AND WORKERS'COMPENSATION INSURANCE541

Chapter Objectives541

Introduction542

Unemployment Insurance542

Some Backround Information543

Operations of the Unemployment Insurance Program544

Is Unemployment Insurance Really Insurance？545

General Provisions of State Programs546

Summary—Unemployment Insurance546

Workers'Compensation547

The Problem547

The Solution548

The Purposes of Workers'Compensation Laws550

Operations of Workers'Compensation Systems551

Current Concerns About Workers'Compensation552

Summary—Worker's Compensation554

Review Terms555

Review555

Research Assignment556

Suggestions for Further Study556

Discussion Questions556

Glossary557

Appendix A：Homeowner's Insu rance Policy569

Appendix B：Personal Auto Policy587

Appendix C：Sample Whole Life Insurance Policy and Application599

Index615