Showing posts with label Insurance. Show all posts
Showing posts with label Insurance. Show all posts

Tuesday, November 5, 2013

Insurance Law - An Indian Perspective



INTRODUCTION

"Insurance should be bought to protect you against a calamity that would otherwise be financially devastating."

In simple terms, insurance allows someone who suffers a loss or accident to be compensated for the effects of their misfortune. It lets you protect yourself against everyday risks to your health, home and financial situation.

Insurance in India started without any regulation in the Nineteenth Century. It was a typical story of a colonial epoch: few British insurance companies dominating the market serving mostly large urban centers. After the independence, it took a theatrical turn. Insurance was nationalized. First, the life insurance companies were nationalized in 1956, and then the general insurance business was nationalized in 1972. It was only in 1999 that the private insurance companies have been allowed back into the business of insurance with a maximum of 26% of foreign holding.

"The insurance industry is enormous and can be quite intimidating. Insurance is being sold for almost anything and everything you can imagine. Determining what's right for you can be a very daunting task."

Concepts of insurance have been extended beyond the coverage of tangible asset. Now the risk of losses due to sudden changes in currency exchange rates, political disturbance, negligence and liability for the damages can also be covered.

But if a person thoughtfully invests in insurance for his property prior to any unexpected contingency then he will be suitably compensated for his loss as soon as the extent of damage is ascertained.

The entry of the State Bank of India with its proposal of bank assurance brings a new dynamics in the game. The collective experience of the other countries in Asia has already deregulated their markets and has allowed foreign companies to participate. If the experience of the other countries is any guide, the dominance of the Life Insurance Corporation and the General Insurance Corporation is not going to disappear any time soon.
The aim of all insurance is to compensate the owner against loss arising from a variety of risks, which he anticipates, to his life, property and business. Insurance is mainly of two types: life insurance and general insurance. General insurance means Fire, Marine and Miscellaneous insurance which includes insurance against burglary or theft, fidelity guarantee, insurance for employer's liability, and insurance of motor vehicles, livestock and crops.

LIFE INSURANCE IN INDIA

"Life insurance is the heartfelt love letter ever written.

It calms down the crying of a hungry baby at night. It relieves the heart of a bereaved widow.

It is the comforting whisper in the dark silent hours of the night."

Life insurance made its debut in India well over 100 years ago. Its salient features are not as widely understood in our country as they ought to be. There is no statutory definition of life insurance, but it has been defined as a contract of insurance whereby the insured agrees to pay certain sums called premiums, at specified time, and in consideration thereof the insurer agreed to pay certain sums of money on certain condition sand in specified way upon happening of a particular event contingent upon the duration of human life.

Life insurance is superior to other forms of savings!

"There is no death. Life Insurance exalts life and defeats death.

It is the premium we pay for the freedom of living after death."

Savings through life insurance guarantee full protection against risk of death of the saver. In life insurance, on death, the full sum assured is payable (with bonuses wherever applicable) whereas in other savings schemes, only the amount saved (with interest) is payable.

The essential features of life insurance are a) it is a contract relating to human life, which b) provides for payment of lump-sum amount, and c) the amount is paid after the expiry of certain period or on the death of the assured. The very purpose and object of the assured in taking policies from life insurance companies is to safeguard the interest of his dependents viz., wife and children as the case may be, in the even of premature death of the assured as a result of the happening in any contingency. A life insurance policy is also generally accepted as security for even a commercial loan.

NON-LIFE INSURANCE

"Every asset has a value and the business of general insurance is related to the protection of economic value of assets."

Non-life insurance means insurance other than life insurance such as fire, marine, accident, medical, motor vehicle and household insurance. Assets would have been created through the efforts of owner, which can be in the form of building, vehicles, machinery and other tangible properties. Since tangible property has a physical shape and consistency, it is subject to many risks ranging from fire, allied perils to theft and robbery.
Few of the General Insurance policies are:

Property Insurance: The home is most valued possession. The policy is designed to cover the various risks under a single policy. It provides protection for property and interest of the insured and family.

Health Insurance: It provides cover, which takes care of medical expenses following hospitalization from sudden illness or accident.
Personal Accident Insurance: This insurance policy provides compensation for loss of life or injury (partial or permanent) caused by an accident. This includes reimbursement of cost of treatment and the use of hospital facilities for the treatment.

Travel Insurance: The policy covers the insured against various eventualities while traveling abroad. It covers the insured against personal accident, medical expenses and repatriation, loss of checked baggage, passport etc.

Liability Insurance: This policy indemnifies the Directors or Officers or other professionals against loss arising from claims made against them by reason of any wrongful Act in their Official capacity.

Motor Insurance: Motor Vehicles Act states that every motor vehicle plying on the road has to be insured, with at least Liability only policy. There are two types of policy one covering the act of liability, while other covers insurers all liability and damage caused to one's vehicles.

JOURNEY FROM AN INFANT TO ADOLESCENCE!

Historical Perspective

The history of life insurance in India dates back to 1818 when it was conceived as a means to provide for English Widows. Interestingly in those days a higher premium was charged for Indian lives than the non-Indian lives as Indian lives were considered more risky for coverage.

The Bombay Mutual Life Insurance Society started its business in 1870. It was the first company to charge same premium for both Indian and non-Indian lives. The Oriental Assurance Company was established in 1880. The General insurance business in India, on the other hand, can trace its roots to the Triton (Tital) Insurance Company Limited, the first general insurance company established in the year 1850 in Calcutta by the British. Till the end of nineteenth century insurance business was almost entirely in the hands of overseas companies.

Insurance regulation formally began in India with the passing of the Life Insurance Companies Act of 1912 and the Provident Fund Act of 1912. Several frauds during 20's and 30's desecrated insurance business in India. By 1938 there were 176 insurance companies. The first comprehensive legislation was introduced with the Insurance Act of 1938 that provided strict State Control over insurance business. The insurance business grew at a faster pace after independence. Indian companies strengthened their hold on this business but despite the growth that was witnessed, insurance remained an urban phenomenon.

The Government of India in 1956, brought together over 240 private life insurers and provident societies under one nationalized monopoly corporation and Life Insurance Corporation (LIC) was born. Nationalization was justified on the grounds that it would create much needed funds for rapid industrialization. This was in conformity with the Government's chosen path of State lead planning and development.

The (non-life) insurance business continued to prosper with the private sector till 1972. Their operations were restricted to organized trade and industry in large cities. The general insurance industry was nationalized in 1972. With this, nearly 107 insurers were amalgamated and grouped into four companies - National Insurance Company, New India Assurance Company, Oriental Insurance Company and United India Insurance Company. These were subsidiaries of the General Insurance Company (GIC).

The life insurance industry was nationalized under the Life Insurance Corporation (LIC) Act of India. In some ways, the LIC has become very flourishing. Regardless of being a monopoly, it has some 60-70 million policyholders. Given that the Indian middle-class is around 250-300 million, the LIC has managed to capture some 30 odd percent of it. Around 48% of the customers of the LIC are from rural and semi-urban areas. This probably would not have happened had the charter of the LIC not specifically set out the goal of serving the rural areas. A high saving rate in India is one of the exogenous factors that have helped the LIC to grow rapidly in recent years. Despite the saving rate being high in India (compared with other countries with a similar level of development), Indians display high degree of risk aversion. Thus, nearly half of the investments are in physical assets (like property and gold). Around twenty three percent are in (low yielding but safe) bank deposits. In addition, some 1.3 percent of the GDP are in life insurance related savings vehicles. This figure has doubled between 1985 and 1995.

A World viewpoint - Life Insurance in India

In many countries, insurance has been a form of savings. In many developed countries, a significant fraction of domestic saving is in the form of donation insurance plans. This is not surprising. The prominence of some developing countries is more surprising. For example, South Africa features at the number two spot. India is nestled between Chile and Italy. This is even more surprising given the levels of economic development in Chile and Italy. Thus, we can conclude that there is an insurance culture in India despite a low per capita income. This promises well for future growth. Specifically, when the income level improves, insurance (especially life) is likely to grow rapidly.

INSURANCE SECTOR REFORM:

Committee Reports: One Known, One Anonymous!

Although Indian markets were privatized and opened up to foreign companies in a number of sectors in 1991, insurance remained out of bounds on both counts. The government wanted to proceed with caution. With pressure from the opposition, the government (at the time, dominated by the Congress Party) decided to set up a committee headed by Mr. R. N. Malhotra (the then Governor of the Reserve Bank of India).

Malhotra Committee

Liberalization of the Indian insurance market was suggested in a report released in 1994 by the Malhotra Committee, indicating that the market should be opened to private-sector competition, and eventually, foreign private-sector competition. It also investigated the level of satisfaction of the customers of the LIC. Inquisitively, the level of customer satisfaction seemed to be high.

In 1993, Malhotra Committee - headed by former Finance Secretary and RBI Governor Mr. R. N. Malhotra - was formed to evaluate the Indian insurance industry and recommend its future course. The Malhotra committee was set up with the aim of complementing the reforms initiated in the financial sector. The reforms were aimed at creating a more efficient and competitive financial system suitable for the needs of the economy keeping in mind the structural changes presently happening and recognizing that insurance is an important part of the overall financial system where it was necessary to address the need for similar reforms. In 1994, the committee submitted the report and some of the key recommendations included:

o Structure

Government bet in the insurance Companies to be brought down to 50%. Government should take over the holdings of GIC and its subsidiaries so that these subsidiaries can act as independent corporations. All the insurance companies should be given greater freedom to operate.
Competition

Private Companies with a minimum paid up capital of Rs.1 billion should be allowed to enter the sector. No Company should deal in both Life and General Insurance through a single entity. Foreign companies may be allowed to enter the industry in collaboration with the domestic companies. Postal Life Insurance should be allowed to operate in the rural market. Only one State Level Life Insurance Company should be allowed to operate in each state.

o Regulatory Body

The Insurance Act should be changed. An Insurance Regulatory body should be set up. Controller of Insurance - a part of the Finance Ministry- should be made Independent.

o Investments

Compulsory Investments of LIC Life Fund in government securities to be reduced from 75% to 50%. GIC and its subsidiaries are not to hold more than 5% in any company (there current holdings to be brought down to this level over a period of time).

o Customer Service

LIC should pay interest on delays in payments beyond 30 days. Insurance companies must be encouraged to set up unit linked pension plans. Computerization of operations and updating of technology to be carried out in the insurance industry. The committee accentuated that in order to improve the customer services and increase the coverage of insurance policies, industry should be opened up to competition. But at the same time, the committee felt the need to exercise caution as any failure on the part of new competitors could ruin the public confidence in the industry. Hence, it was decided to allow competition in a limited way by stipulating the minimum capital requirement of Rs.100 crores.

The committee felt the need to provide greater autonomy to insurance companies in order to improve their performance and enable them to act as independent companies with economic motives. For this purpose, it had proposed setting up an independent regulatory body - The Insurance Regulatory and Development Authority.

Reforms in the Insurance sector were initiated with the passage of the IRDA Bill in Parliament in December 1999. The IRDA since its incorporation as a statutory body in April 2000 has meticulously stuck to its schedule of framing regulations and registering the private sector insurance companies.

Since being set up as an independent statutory body the IRDA has put in a framework of globally compatible regulations. The other decision taken at the same time to provide the supporting systems to the insurance sector and in particular the life insurance companies was the launch of the IRDA online service for issue and renewal of licenses to agents. The approval of institutions for imparting training to agents has also ensured that the insurance companies would have a trained workforce of insurance agents in place to sell their products.

The Government of India liberalized the insurance sector in March 2000 with the passage of the Insurance Regulatory and Development Authority (IRDA) Bill, lifting all entry restrictions for private players and allowing foreign players to enter the market with some limits on direct foreign ownership. Under the current guidelines, there is a 26 percent equity lid for foreign partners in an insurance company. There is a proposal to increase this limit to 49 percent.

The opening up of the sector is likely to lead to greater spread and deepening of insurance in India and this may also include restructuring and revitalizing of the public sector companies. In the private sector 12 life insurance and 8 general insurance companies have been registered. A host of private Insurance companies operating in both life and non-life segments have started selling their insurance policies since 2001

Mukherjee Committee

Immediately after the publication of the Malhotra Committee Report, a new committee, Mukherjee Committee was set up to make concrete plans for the requirements of the newly formed insurance companies. Recommendations of the Mukherjee Committee were never disclosed to the public. But, from the information that filtered out it became clear that the committee recommended the inclusion of certain ratios in insurance company balance sheets to ensure transparency in accounting. But the Finance Minister objected to it and it was argued by him, probably on the advice of some of the potential competitors, that it could affect the prospects of a developing insurance company.

LAW COMMISSION OF INDIA ON REVISION OF THE INSURANCE ACT 1938 - 190th Law Commission Report

The Law Commission on 16th June 2003 released a Consultation Paper on the Revision of the Insurance Act, 1938. The previous exercise to amend the Insurance Act, 1938 was undertaken in 1999 at the time of enactment of the Insurance Regulatory Development Authority Act, 1999 (IRDA Act).

The Commission undertook the present exercise in the context of the changed policy that has permitted private insurance companies both in the life and non-life sectors. A need has been felt to toughen the regulatory mechanism even while streamlining the existing legislation with a view to removing portions that have become superfluous as a consequence of the recent changes.

Among the major areas of changes, the Consultation paper suggested the following:

a. merging of the provisions of the IRDA Act with the Insurance Act to avoid multiplicity of legislations;

b. deletion of redundant and transitory provisions in the Insurance Act, 1938;

c. Amendments reflect the changed policy of permitting private insurance companies and strengthening the regulatory mechanism;

d. Providing for stringent norms regarding maintenance of 'solvency margin' and investments by both public sector and private sector insurance companies;

e. Providing for a full-fledged grievance redressal mechanism that includes:

o The constitution of Grievance Redressal Authorities (GRAs) comprising one judicial and two technical members to deal with complaints/claims of policyholders against insurers (the GRAs are expected to replace the present system of insurer appointed Ombudsman);

o Appointment of adjudicating officers by the IRDA to determine and levy penalties on defaulting insurers, insurance intermediaries and insurance agents;

o Providing for an appeal against the decisions of the IRDA, GRAs and adjudicating officers to an Insurance Appellate Tribunal (IAT) comprising a judge (sitting or retired) of the Supreme Court/Chief Justice of a High Court as presiding officer and two other members having sufficient experience in insurance matters;

o Providing for a statutory appeal to the Supreme Court against the decisions of the IAT.

LIFE & NON-LIFE INSURANCE - Development and Growth!

The year 2006 turned out to be a momentous year for the insurance sector as regulator the Insurance Regulatory Development Authority Act, laid the foundation for free pricing general insurance from 2007, while many companies announced plans to attack into the sector.

Both domestic and foreign players robustly pursued their long-pending demand for increasing the FDI limit from 26 per cent to 49 per cent and toward the fag end of the year, the Government sent the Comprehensive Insurance Bill to Group of Ministers for consideration amid strong reservation from Left parties. The Bill is likely to be taken up in the Budget session of Parliament.

The infiltration rates of health and other non-life insurances in India are well below the international level. These facts indicate immense growth potential of the insurance sector. The hike in FDI limit to 49 per cent was proposed by the Government last year. This has not been operationalized as legislative changes are required for such hike. Since opening up of the insurance sector in 1999, foreign investments of Rs. 8.7 billion have tipped into the Indian market and 21 private companies have been granted licenses.

The involvement of the private insurers in various industry segments has increased on account of both their capturing a part of the business which was earlier underwritten by the public sector insurers and also creating additional business boulevards. To this effect, the public sector insurers have been unable to draw upon their inherent strengths to capture additional premium. Of the growth in premium in 2004-05, 66.27 per cent has been captured by the private insurers despite having 20 per cent market share.

The life insurance industry recorded a premium income of Rs.82854.80 crore during the financial year 2004-05 as against Rs.66653.75 crore in the previous financial year, recording a growth of 24.31 per cent. The contribution of first year premium, single premium and renewal premium to the total premium was Rs.15881.33 crore (19.16 per cent); Rs.10336.30 crore (12.47 per cent); and Rs.56637.16 crore (68.36 per cent), respectively. In the year 2000-01, when the industry was opened up to the private players, the life insurance premium was Rs.34,898.48 crore which constituted of Rs. 6996.95 crore of first year premium, Rs. 25191.07 crore of renewal premium and Rs. 2740.45 crore of single premium. Post opening up, single premium had declined from Rs.9, 194.07 crore in the year 2001-02 to Rs.5674.14 crore in 2002-03 with the withdrawal of the guaranteed return policies. Though it went up marginally in 2003-04 to Rs.5936.50 crore (4.62 per cent growth) 2004-05, however, witnessed a significant shift with the single premium income rising to Rs. 10336.30 crore showing 74.11 per cent growth over 2003-04.

The size of life insurance market increased on the strength of growth in the economy and concomitant increase in per capita income. This resulted in a favourable growth in total premium both for LIC (18.25 per cent) and to the new insurers (147.65 per cent) in 2004-05. The higher growth for the new insurers is to be viewed in the context of a low base in 2003- 04. However, the new insurers have improved their market share from 4.68 in 2003-04 to 9.33 in 2004-05.

The segment wise break up of fire, marine and miscellaneous segments in case of the public sector insurers was Rs.2411.38 crore, Rs.982.99 crore and Rs.10578.59 crore, i.e., a growth of (-)1.43 per cent, 1.81 per cent and 6.58 per cent. The public sector insurers reported growth in Motor and Health segments (9 and 24 per cent). These segments accounted for 45 and 10 per cent of the business underwritten by the public sector insurers. Fire and "Others" accounted for 17.26 and 11 per cent of the premium underwritten. Aviation, Liability, "Others" and Fire recorded negative growth of 29, 21, 3.58 and 1.43 per cent. In no other country that opened at the same time as India have foreign companies been able to grab a 22 per cent market share in the life segment and about 20 per cent in the general insurance segment. The share of foreign insurers in other competing Asian markets is not more than 5 to 10 per cent.

The life insurance sector grew new premium at a rate not seen before while the general insurance sector grew at a faster rate. Two new players entered into life insurance - Shriram Life and Bharti Axa Life - taking the total number of life players to 16. There was one new entrant to the non-life sector in the form of a standalone health insurance company - Star Health and Allied Insurance, taking the non-life players to 14.

A large number of companies, mostly nationalized banks (about 14) such as Bank of India and Punjab National Bank, have announced plans to enter the insurance sector and some of them have also formed joint ventures.

The proposed change in FDI cap is part of the comprehensive amendments to insurance laws - The Insurance Act of 1999, LIC Act, 1956 and IRDA Act, 1999. After the proposed amendments in the insurance laws LIC would be able to maintain reserves while insurance companies would be able to raise resources other than equity.

About 14 banks are in queue to enter insurance sector and the year 2006 saw several joint venture announcements while others scout partners. Bank of India has teamed up with Union Bank and Japanese insurance major Dai-ichi Mutual Life while PNB tied up with Vijaya Bank and Principal for foraying into life insurance. Allahabad Bank, Karnataka Bank, Indian Overseas Bank, Dabur Investment Corporation and Sompo Japan Insurance Inc have tied up for forming a non-life insurance company while Bank of Maharashtra has tied up with Shriram Group and South Africa's Sanlam group for non-life insurance venture.

CONCLUSION

It seems cynical that the LIC and the GIC will wither and die within the next decade or two. The IRDA has taken "at a snail's pace" approach. It has been very cautious in granting licenses. It has set up fairly strict standards for all aspects of the insurance business (with the probable exception of the disclosure requirements). The regulators always walk a fine line. Too many regulations kill the motivation of the newcomers; too relaxed regulations may induce failure and fraud that led to nationalization in the first place. India is not unique among the developing countries where the insurance business has been opened up to foreign competitors.

The insurance business is at a critical stage in India. Over the next couple of decades we are likely to witness high growth in the insurance sector for two reasons namely; financial deregulation always speeds up the development of the insurance sector and growth in per capita GDP also helps the insurance business to grow.

Fire Insurance Under Indian Insurance Law

A contract of Insurance comes into being when a person seeking insurance protection enters into a contract with the insurer to indemnify him against loss of property by or incidental to fire and or lightening, explosion, etc. This is primarily a contract and hence as is governed by the general law of contract. However, it has certain special features as insurance transactions, such as utmost faith, insurable interest, indemnity, subrogation and contribution, etc. these principles are common in all insurance contracts and are governed by special principles of law.

FIRE INSURANCE:

According to S. 2(6A), "fire insurance business" means the business of effecting, otherwise than incidentally to some other class of insurance business, contracts of insurance against loss by or incidental to fire or other occurrence, customarily included among the risks insured against in fire insurance business.

According to Halsbury, it is a contract of insurance by which the insurer agrees for consideration to indemnify the assured up to a certain extent and subject to certain terms and conditions against loss or damage by fire, which may happen to the property of the assured during a specific period.
Thus, fire insurance is a contract whereby the person, seeking insurance protection, enters into a contract with the insurer to indemnify him against loss of property by or incidental to fire or lightning, explosion etc. This policy is designed to insure one's property and other items from loss occurring due to complete or partial damage by fire.

In its strict sense, a fire insurance contract is one:

1. Whose principle object is insurance against loss or damage occasioned by fire.

2. The extent of insurer's liability being limited by the sum assured and not necessarily by the extent of loss or damage sustained by the insured: and

3. The insurer having no interest in the safety or destruction of the insured property apart from the liability undertaken under the contract.

LAW GOVERNING FIRE INSURANCE

There is no statutory enactment governing fire insurance, as in the case of marine insurance which is regulated by the Indian Marine Insurance Act, 1963. the Indian Insurance Act, 1938 mainly dealt with regulation of insurance business as such and not with any general or special principles of the law relating fire of other insurance contracts. So also the General Insurance Business (Nationalization) Act, 1872. in the absence of any legislative enactment on the subject , the courts in India have in dealing with the topic of fire insurance have relied so far on judicial decisions of Courts and opinions of English Jurists.

In determining the value of property damaged or destroyed by fire for the purpose of indemnity under a policy of fire insurance, it was the value of the property to the insured, which was to be measured. Prima facie that value was measured by reference of the market value of the property before and after the loss. However such method of assessment was not applicable in cases where the market value did not represent the real value of the property to the insured, as where the property was used by the insured as a home or, for carrying business. In such cases, the measure of indemnity was the cost of reinstatement. In the case of Lucas v. New Zealand Insurance Co. Ltd.[1] where the insured property was purchased and held as an income-producing investment, and therefore the court held that the proper measure of indemnity for damage to the property by fire was the cost of reinstatement.

INSURABLE INTEREST

A person who is so interested in a property as to have benefit from its existence and prejudice by its destruction is said to have insurable interest in that property. Such a person can insure the property against fire.

The interest in the property must exist both at the inception as well as at the time of loss. If it does not exist at the commencement of the contract it cannot be the subject-matter of the insurance and if it does not exist at the time of the loss, he suffers no loss and needs no indemnity. Thus, where he sells the insured property and it is damaged by fire thereafter, he suffers no loss.

RISKS COVERED UNDER FIRE INSURANCE POLICY

The date of conclusion of a contract of insurance is issuance of the policy is different from the acceptance or assumption of risk. Section 64-VB only lays down broadly that the insurer cannot assume risk prior to the date of receipt of premium. Rule 58 of the Insurance Rules, 1939 speaks about advance payment of premiums in view of sub section (!) of Section 64 VB which enables the insurer to assume the risk from the date onwards. If the proposer did not desire a particular date, it was possible for the proposer to negotiate with insurer about that term. Precisely, therefore the Apex Court has said that final acceptance is that of the assured or the insurer depends simply on the way in which negotiations for insurance have progressed. Though the following are risks which seem to have covered Fire Insurance Policy but are not totally covered under the Policy. Some of contentious areas are as follows:

FIRE: Destruction or damage to the property insured by its own fermentation, natural heating or spontaneous combustion or its undergoing any heating or drying process cannot be treated as damage due to fire. For e.g., paints or chemicals in a factory undergoing heat treatment and consequently damaged by fire is not covered. Further, burning of property insured by order of any Public Authority is excluded from the scope of cover.

LIGHTNING : Lightning may result in fire damage or other types of damage, such as a roof broken by a falling chimney struck by lightning or cracks in a building due to a lightning strike. Both fire and other types of damages caused by lightning are covered by the policy.

AIRCRAFT DAMAGE: The loss or damage to property (by fire or otherwise) directly caused by aircraft and other aerial devices and/ or articles dropped there from is covered. However, destruction or damage resulting from pressure waves caused by aircraft traveling at supersonic speed is excluded from the scope of the policy.

RIOTS, STRIKES, MALICIOUS AND TERRORISM DAMAGES: The act of any person taking part along with others in any disturbance of public peace (other than war, invasion, mutiny, civil commotion etc.) is construed to be a riot, strike or a terrorist activity. Unlawful action would not be covered under the policy.

STORM, CYCLONE, TYPHOON, TEMPEST, HURRICANE, TORNADO, FLOOD and INUNDATION: Storm, Cyclone, Typhoon, Tempest, Tornado and Hurricane are all various types of violent natural disturbances that are accompanied by thunder or strong winds or heavy rainfall. Flood or Inundation occurs when the water rises to an abnormal level. Flood or inundation should not only be understood in the common sense of the terms, i.e., flood in river or lakes, but also accumulation of water due to choked drains would be deemed to be flood.

IMPACT DAMAGE: Impact by any Rail/ Road vehicle or animal by direct contact with the insured property is covered. However, such vehicles or animals should not belong to or owned by the insured or any occupier of the premises or their employees while acting in the course of their employment.

SUBSIDENCE AND LANDSLIDE INCULUDING ROCKSIDE: Destruction or damage caused by Subsidence of part of the site on which the property stands or Landslide/ Rockslide is covered. While Subsidence means sinking of land or building to a lower level, Landslide means sliding down of land usually on a hill.

However, normal cracking, settlement or bedding down of new structures; settlement or movement of made up ground; coastal or river erosion; defective design or workmanship or use of defective materials; and demolition, construction, structural alterations or repair of any property or ground-works or excavations, are not covered.

BURSTING AND/OR OVERFLOWING OF WATER TANKS, APPARATUS AND PIPES: Loss or damage to property by water or otherwise on account of bursting or accidental overflowing of water tanks, apparatus and pipes is covered.

MISSILE TESTING OPERATIONS: Destruction or damage, due to impact or otherwise from trajectory/ projectiles in connection with missile testing operations by the Insured or anyone else, is covered.

LEAKAGE FROM AUTOMATIC SPRINKLER INSTALLATIONS: Damage, caused by water accidentally discharged or leaked out from automatic sprinkler installations in the insured's premises, is covered. However, such destruction or damage caused by repairs or alterations to the buildings or premises; repairs removal or extension of the sprinkler installation; and defects in construction known to the insured, are not covered.

BUSH FIRE: This covers damage caused by burning, whether accidental or otherwise, of bush and jungles and the clearing of lands by fire, but excludes destruction or damage, caused by Forest Fire.

RISKS NOT COVERED BY FIRE INSURANCE POLICY

Claims not maintainable/ covered under this policy are as follows:

o Theft during or after the occurrence of any insured risks

o War or nuclear perils

o Electrical breakdowns

o Ordered burning by a public authority

o Subterranean fire

o Loss or damage to bullion, precious stones, curios (value more than Rs.10000), plans, drawings, money, securities, cheque books, computer records except if they are categorically included.

o Loss or damage to property moved to a different location (except machinery and equipment for cleaning, repairs or renovation for more than 60 days).

CHARACTERICTICS OF FIRE INSURANCE CONTRACT

A fire insurance contract has the following characteristics namely:

(a) Fire insurance is a personal contract

A fire insurance contract does not ensure the safety of the insured property. Its purpose is to see that the insured does not suffer loss by reason of his interest in the insured property. Hence, if his connection with the insured property ceases by being transferred to another person, the contract of insurance also comes to an end. It is not so connected with the subject matter of the insurance as to pass automatically to the new owner to whom the subject is transferred. The contract of fire insurance is thus a mere a personal contract between the insured and the insurer for the payment of money. It can be validly assigned to another only with the consent of the insurer.

(b) It is entire and indivisible contract.

Where the insurance is of a binding and its contents of stock and machinery, the contract is expressly agreed to be divisible. Thus , where the insured is guilty of breach of duty towards the insurer in respect of one subject matters covered by the policy , the insurer can avoid the contract as a whole and not only in respect of that particular subject mater , unless the right is restricted by the terms of the policy.

(c) Cause of fire is immaterial

In insuring against fire, the insured wishes to protect him from any loss or detriment which he may suffer upon the occurrence of a fire, however it may be caused. So long as the loss is due to fire within the meaning of the policy, it is immaterial what the cause of fire is, generally. Thus , whether it was because the fire was lighted improperly or was lighted properly but negligently attended to thereafter or whether the fire was caused on account of the negligence of the insured or his servants or strangers is immaterial and the insurer is liable to indemnify the insured. In the absence of fraud, the proximate cause of the loss only is to be looked to.

The cause of the fire however becomes material to be investigated

(1). Where the fire is occasioned not by the negligence of, but by the willful

(2) Where the fire is due is to cause falling with the exception in the contract.

LIMITATION OF TIME

Indemnity insurance was an agreement by the insurer to confer on the insured a contractual right, which prima facie, came into existence immediately when the loss was suffered by the happening of an event insured against, to be put by the insurer into the same position in which the accused would have had the event not occurred but in no better position. There was a primary liability, i.e. to indemnify, and a secondary liability i.e. to put the insured in his pre-loss position, either by paying him a specifying amount or it might be in some other manner. But the fact that the insurer had an option as to the way in which he would put the insured into pre-loss position did not mean that he was not liable to indemnify him in one way or another, immediately the loss occurred. The primary liability arises on the happening of the event insured against. So, the time ran from the date of the loss and not from the date on which the policy was avoided and any suit filed after that time limit would be barred by limitation.[2]

WHO MAY INSURE AGAINST FIRE?

Only those who have insurable interest in a property can take fire insurance thereon. The following are among the class of persons who have been held to possess insurable interest in, property and can insure such property:

1. Owners of property, whether sole, or joint owner, or partner in the firm owning the property. It is not necessary that they should possession also. Thus a lesser and a lessee can both insure it jointly or severely.

2. The vender and purchaser have both rights to insure. The vendor's interest continues until the conveyance is completed and even thereafter, if he has an unpaid vendor's lien over it.

3. The mortgagor and mortgagee have both distinct interests in the mortgaged property and can insure, per Lord Esher M.R."The mortgagee does not claim his interest through the mortgagor , but by virtue of the mortgage which has given him an interest distinct from that of the mortgagor"[3]

4. Trustees are legal owners and beneficiaries the beneficial owners of trust property and each can insure it.

5. Bailees such as carriers, pawnbrokers or warehouse men are responsible for there safety of the property entrusted to them and so can insure it.

PERSON NOT ENTITLED TO INSURE

One who has no insurable interest in a property cannot insure it. For example:

1. An unsecured creditor cannot insure his debtor's property, because his right is only against the debtor personally. He can, however, insure the debtor's life.

2. A shareholder in a company cannot insure the property of the company as he has no insurable interest in any asset of the company even if he is the sole shareholder. As was the case of Macaura v. Northen Assurance Co.[4] Macaura. Because neither as a simple creditor nor as a shareholder had he any insurable interest in it.

CONCEPT OF UTMOST FAITH

As all contracts of insurance are contracts of utmost good faith, the proposer for fire insurance is also under a positive duty to make a full disclosure of all material facts and not to make any misrepresentations or misdescreptions thereof during the negotiations for obtaining the policy. This duty of utmost good faith applies equally to the insurer and the insured. There must be complete good faith on the part of the assured. This duty to observe utmost good faith is ensured b requiring the proposer to declare that the statements in the proposal form are true, that they shall be the basis of the contract and that any incorrect or false statement therein shall avoid the policy. The insurer can then rely on them to assess the risk and to fix appropriate premium and accept the risk or decline it.

The questions in the proposal form for a fire policy are so framed as to get all information which is material to the insurer to know in order to assess the risk and fix the premium, that is, all material facts. Thus the proposer is required too give information relating to:

o The proposer's name and address and occupation

o The description of the subject matter to be insured sufficient for the purpose of identifying it including,

o A description of the locality where it is situated

o How the property is being used, whether for any manufacturing purpose or hazardous trade.etc

o Whether it has already been insured

o And also ant personal insurance history including the claims if any made buy the proposer, etc.

Apart from questions in the proposal form, the proposer should disclose whether questioned or not-

1. Any information which would indicate the risk of fire to be above normal;

2. Any fact which would indicate that the insurer's liability may be more than normal can be expected such as existence of valuable manuscripts or documents, etc, and

3. Any information bearing upon the more; hazard involved.

The proposer is not obliged to disclose-

1. Information which the insurer may be presumed to know in the ordinary course of his business as an insurer;

2. Facts which tend to show that the risk is lesser than otherwise;

3. Facts as to which information is waived by the insurer; and

4. Facts which need not disclosed in view of a policy condition.

Thus, assured is under a solemn obligation to make full disclosure of material facts which may be relevant for the insurer to take into account while deciding whether the proposal should be accepted or not. While making a disclosure of the relevant facts, the

DOCTRINE OF PROXIMATE CAUSE

Where more perils than one act simultaneously or successively, it will be difficult to assess the relative effect of each peril or pick out one of these as the actual cause of the loss. In such cases, the doctrine of proximate cause helps to determine the actual cause of the loss.
Proximate cause was defined in Pawsey v. Scottish Union and National Ins. Co.,[5]as "the active, effective cause that sets in motion a train of events which brings about a result without the intervention of any force started and working actively from a new and independent source." It is dominant and effective cause even though it is not the nearest in time. It is therefore necessary when a loss occurs to investigate and ascertain what is the proximate cause of the loss in order to determine whether the insurer is liable for the loss.

PROXIMATE CAUSE OF DAMAGE

A fire policy covers risks where damage is caused by way of fire. The fire may be caused by lightening, by explosion or implosion. It may be result of riot, strike or on account of any, malicious act. However these factors must ultimately lead to a fire and the fire must be the proximate cause of damage. Therefore, a loss caused by theft of property by militants would not be covered by the fire policy. The view that the loss was covered under the malicious act clause and therefore .the insurer was liable to meet the claim is untenable, because unless and until fire is the proximate cause f damage, no claim under a fire policy would be maintainable.[6]

PROCEDURE FOR TAKING A FIRE INSURANCE POLICY

The steps involved for taking a fire insurance policy are mentioned below:

1. Selection of the Insurance Company:

There are many companies that offer fire insurance against unforeseen events. The individual or the company must take care in the selection of an insurance company. The judgment should rest on factors like goodwill, and long term standing in the market. The insurance companies can either be approached directly or through agents, some of them who are appointed by the company itself.

2. Submission of the Proposal Form:

The individual or the business owner must submit a completed prescribed proposal form with the necessary details to the insurance company for proper consideration and subsequent approval. The information in the Proposal Form should be given in good faith and must be accompanied by documents that verify the actual worth of the property or goods that are to be insured. Most of the companies have their own personalized Proposal Forms wherein the exact information has to be provided.

3. Survey of the Property/ Consideration:

Once the duly filled Proposal Form is submitted to the insurance company, it makes an "on the spot" survey of the property or the goods that are the subject matter of the insurance. This is usually done by the investigators, or the surveyors, who are appointed by the company and they need to report back to them after a thorough research and survey. This is imperative to assess the risk involved and calculate the rate of premium.

4. Acceptance of the Proposal:

Once the detailed and comprehensive report is submitted to the insurance company by the surveyors and related officers, the former makes a thorough perusal of the Proposal Form and the report. If the company is satisfied that their is no lacuna or foul play or fraud involved, it formally "accepts" the Proposal Form and directs the insured to pay the first premium to the company. It is to be noted that the insurance policy commences after the payment and the acceptance of the premium by the insured and the company, respectively. The Insurance Company issues a Cover Note after the acceptance of the first premium.

PROCEDURE ON RECEIPT OF NOTICE OF LOSS

On receipt of the notice of loss, the insurer requires the insured to furnish details pertaining to the loss in a claim from relating to the following information-

1. Circumstances and cause of the fire;

2. Occupancy and situation of the premises in which the fire occurred;

3. Insured's interest in the insured property; that is capacity in which the insured claims and whether any others are interested in the property;

4. Other insurances on the property;

5. Value of each item of the property at the time of loss together with proofs thereof , and value of the salvage ,if any; and

6. Amount claimed

Furnishing such information relating to the claim is also a condition precedent to the liability of the insurer. The above information will enable the insurer to verify whether-

(1) The policy is in force;

(2) The peril causing the loss is an insured peril;

(3) The property damaged or lost is the insured property.

Rules for calculation of value of property

The value of the insured property is-

1) Its value at the time of loss, and

2) At the place of loss, and

3) Its real or intrinsic value without any regard for its sentimental vale. Loss of prospective profit or other consequential loss is not to be taken into account.

FILING OF CLAIMS

How a claim arises?

After a contract of fire insurance has come into existence, a claim may arise by the operation of one or more insured perils on an unsecured property. There may in addition one or more uninsured perils also operating simultaneously or in succession of the property. In order that the claim should be valid the following conditions must be fulfilled:

1. The occurrence should take place due to the operation of an insured peril or where both insured and other perils operated , the dominant or efficient cause of the loss must have been an insured peril;

2. The operation of the peril must not come within the scope of the policy exceptions;

3. The event must have caused loss or damage of the insured property;

4. The occurrence must be during the currency of the policy;

5. The insured must have fulfilled all the policy conditions and should also comply with requirements to be fulfilled after the claim had arisen.

MATERIAL FACTS IN FIRE INSURANCE: PREVIOUS CONVICTION OF THE ACCUSED

The criminal record of an assured could affect the moral hazard, which insurers had to assess, and the non-disclosure of a serious criminal offence like robbery by the plaintiff would a material non-disclosure.

INSURED'S DUTY ON OUTBREAK OF FIRE, IMPLIED DUTY

On the outbreak of a fire the insured is under an implied duty to observe good faith towards the insurers and the in pursuance of it the insured must do his best to avert or minimize the loss. For this purpose he must (1) take all reasonable measures to put out the fire or prevent its spread, and (2) assist the fire brigade and others in their attempts to do so at any rate not come in their way.
With this object the insured property may be removed to a place of safety. Any loss or damage the insured property may sustain in the course of attempts to combat the fire or during its removal to a place of safety etc., will be deemed to be loss proximately caused by the fire.

If the insured fails in his duty willfully and thereby increases the burden of the insurer, the insured will be deprived of his right to revive any indemnity under the policy.[7]

INSURER'S RIGHTS ON THE OUTBREAK OF FIRE

(A) Implied Rights

Corresponding to the insured's duties the insurers have rights by the law, in view of the liability they have undertaken to indemnify the insured. Thus the insurers have a right to-

o Take reasonable measures to extinguish the fire and to minimize the loss to property, and

o For that purpose, to enter upon and take possession of the property.

The insurers will be liable to make good all the damage the property may sustain during the steps taken to put out the fire and as long as it in their possession, because all that is considered the natural and direct consequence of the fire; it has therefore been held in the case of Ahmedbhoy Habibhoy v. Bombay Fire Marine Ins. Co [8] that the extent of the damage flowing from the insured peril must be assessed when the insurer gives back and not as at the time when the peril ceased.

(B) Loss caused by steps taken to avert the risk

Damage sustained due to action taken to avoid an insured risk was not a consequence of that risk and was not recoverable unless the insured risk had begun to operate. In the case of Liverpool and London and Globe Insurance Co. Ltd v. Canadian General Electric Co. Ltd., [9] the Canadian Supreme Court held that "the loss was caused by the fire fighters' mistaken belief that their action was necessary to avert an explosion , and the loss was not recoverable under the insurance policy, which covered only damage caused by fire explosion., and the loss was not recoverable under the insurance policy, which covered only damage caused by fire or explosion."

(C) Express rights

Condition 5- in order to protect their rights well insurers have prescribed for better rights expressly in this condition according to which on the happening of any destruction or damage the insurer and every person authorized by the insurer may enter, take or keep possession of the building or premises where the damage has happened or require it to be delivered to them and deal with it for all reasonable purposes like examining, arranging, removing or sell or dispose off the same for the account of whom it may concern.

When and how a claim is made?

In the event of a fire loss covered under the fire insurance policy, the Insured shall immediately give notice thereof to the insurance company. Within 15 days of the occurrence of such loss, the Insured should submit a claim in writing, giving the details of damages and their estimated values. Details of other insurances on the same property should also be declared.

The Insured should procure and produce, at his own expense, any document like plans, account books, investigation reports etc. on demand by the insurance company.

HOW INSURANCE MAY CEASE?

Insurance under a fire policy may cease in any of the following circumstances, namely:

(1) Insurer avoiding the policy by reason of the insured making misrepresentation, misdescription or non-disclosure of any material particular;

(2) If there is a fall or displacement of any insured building range or structure or part thereof , then on the expiry of seven days wherefrom, except where the fall or displacement was due to the action of any insured peril; notwithstanding this, the insurance may be revived on revised terms if express notice is given to the company as soon as the occurrence takes place;

(3) The insurance may be terminated at any tie at the request of the insured and at the option of the company on 15 days notice to the insured

CONCLUSION

Tangible property is exposed to numerous risks like fire, floods, explosions, earthquake, riot and war, etc. and insurance protection can be had against most of these risks severally or in combination. The form in which the cover is expressed is numerous and varied. Fire insurance in its strict sense is concerned with giving protection against fire and fire only. So while granting a fire insurance policy all the requisites need be fulfilled. The insured are under a moral and legal obligation to be at utmost good faith and should be telling true facts and not just fake grounds only with the greed to recover money. Further all insurance policies help in the development of a Developing nation. Hence insurance companies have a burden to help the insured when the insured are in trouble.

Insurance For Beginners



INTRODUCTION

Welcome to the global business guide. In this context, we will be taking about the insurance industry, the general definition of insurance, adequate and precise explanation of the definition, brief talk about the history, the insurer, the insured, classes of insurance, the role of the underwriter in the industry and how you as an individual can benefit maximally when you get yourself, your car, your house, even that your business insure. We do hope you will enjoy reading this article and the essence of your quest for the topic above will be met.

Insurance is a financial institution classified as a non bank financial institution. They are important financial inter-mi diaries. It is believed to have originated from the ancient practices of inhabitants of the valleys of rivers Tigris and Euphrates in the present day Iraqi in about 4.000BC. History has it that in 1800BC, the Babylonians code of Hammurabi contained provisions which had elements of insurance in the laws that govern their commerce. But today what we have in the industry, both locally and internationally had moved from just an agreement between two persons into a very big industry across the globe.

Going by definition, we learn that insurance means a situation whereby someone protects his or herself against risk and reduce effects of uncertainties as well as distribute loss. Other explanation to this owe it to the situation whereby a certain amount of money when collected from someone by an insurance company agrees to pay a compensation or render services to that person if and whenever that person suffers the kind of loss specified in the insurance agreement; and from the explanation, this is where an insurance company comes into play since they are the people that will go into agreement with the person taking any insurance policy against any of his belongings. This industry has widely been believed as a means whereby people reduce the risk of unforeseen circumstances. As financial intermediaries, they act as middlemen between the surplus units and deficit units of the economy thereby sustaining the general growth of the economy.

One may ask, how do insurance companies generate the money used in compensating their policy holder when affected by any mishap? The answer to this question, will lead us into talking about the various means via which the insurance companies make their money and how their policy holders are compensated. The truth is that, the money they collect from their policy holder (i.e one that has an agreement with the insurance company) is invested in the form of premiums (an extra sum of money paid in addition to the normal cost of something. by BBC. Eng. dict) and that money is invested in Bonds, in stocks, mortgages (i.e house) and government securities (in our subsequent article, we will explain more of this: Bonds, stocks, mortgages and govt. securities). They generate income for themselves and those who are in their service. They invest their policy holder's money in better business that has short term maximum returns on investment and from there meet their numerous needs when needed in claims and losses. These funds themselves are invested, that not only do they earn interest to be added to the funds, but they also benefit the government, public authorities, and industries whose securities the investment are spread, because of the investment policy of the insurer (we will explain later), their reserve funds are not left idle butt are used productively.

Another way via which the insurance companies compensate those who are in their service is that the contribution of many is used to compensate the few among them who were affected by the misfortune insured against. So the loss of few people is share by many.

We hope that to this extend, you must have understood the above explanation about insurance company. Now the next thing we will be considering is the functions of the insurance companies.

Amongst other functions, the main function of the insurance company is risk bearing, the financial losses of individuals are judiciously distributed among many people, for example, in the case of fire, the policy holder in fire insurance pays a premium into a common pool, out of which those who suffer loss are compensated.

FUNCTIONS INCLUDE

1. The insurance industry encourages thrift (i.e money conservation) especially via it's life policies which provide funds for family, welfare and old age provisions. It provides employment opportunity for those that have the interest of working with the industry.

The insurance companies works hand in hand with commerce. It owes it's existence to commerce (i.e business in general both industrial etc) and commerce in return owes it's strong stability to insurance, this is because it helped in various ways to enhance the general trend in business.

Before we proceed further to other functions, let's explain this two terms: the insurer; the insured as it will aid us in our understanding.

The insured: This is the party affecting the insurance in other words, the individual or individuals which is taking the insurance policy. This can be done either directly or indirectly or via an agent or broker.

The insurer: This is the party providing the protection to cover by the policy. The insurer covers every other terms which includes the underwriter who is a senior official of an insurance company whose business lies in undertaking new business for the company.

The insurance company has a contract which promises to pay compensation at a future date for a consideration known as premium (i.e. the money paid by the insured to the insurer for the insurance cover provided in the policy). Like the way we have it in other contracts, i.e having it that contracts is based on the principles of offer and acceptance, consideration and capacity to contract. These contract, especially in insurance involves two parties i.e. the insurer and the insured.

FUNCTIONS 2

Insurer, by reason of their principal function accumulate large funds which they hold as custodians and out of which claims and losses are met. Like in some countries, their insurers operate in many parts of the world and earn vast sums in overseas market in terms of underwriting profit and investment income. This tells us that insurance forms a considerable part of that country's invisible exports.

As we continue in our functions, let's see the role of the insured and the insurer.

ROLES OF THE INSURED:

In insurance, when the proposer becomes insured the party effecting an insurance is known as the proposer throughout the negotiations, and until the contract is in full force. The insurer plays a vital role in making this aforementioned contract to come into force, knowing that in insurance contract, just like we said before is base on the principle of offer and acceptance, consideration and capacity to contract, the contracts are always evidenced in writing which is made up of various forms to be filled and signed. If the insured does not accept the insurance offer and giving meticulous consideration to that, there can hardly be capacity to contract i.e the insurance contract can never be. So, from this, we now learn that this two parties (i.e the insurer and the insured) must be involved before an insurance contract can becomes a policy.

ROLES OF THE INSURER

Here we are considering the roles of the insurer as a subsidiary functions of insurance; this is because in general sense (they have a very wide range of function), the insurer is the one providing the necessary insurance services, benefits to the insured, should any mishap, depending on the insurance policy undertaken. The insurer helps also in loss-prevention in the following ways:

We know that the extend to which loss prevention is seen, is mostly on property. An individual or a population can suffer great loss materially, if it were not for the intervention of loss prevention scheme by insurance companies to their policy holders.

The insurer also assists in boasting business venture: Many large -scale enterprise today can make their business in good faith, having transferred all their risk to the insurance company, in other words. The insurance companies help to maintain and to stabilize the atmosphere of the present day large-scale business and organizations.

Many questions had risen by on onlookers, as on how the policy holder can be compesated, should there be any mishap on the policy covered. It is better for us to note that the insurance company, when a loss is incurred to the policy holder can make for his or her loss, but that can only compensate him and make him return to his normal financial position before the occurrence of the incidence and not to profit him from the misfortune. This is generally because, no amount of financial compensation can pay adequately for the life and health of persons, so life and personal accidents are regarded as benefit policies. So let there be no misconception on this fact when mishap occurs, where the public is looking for the victim to be given everything lost, and having a meager compensation given to him or her. So let's not distrust insurance companies in this area, knowing that it's only the restoration to the exact position before the loss that is provided.

Now, as we have gone so far in understanding the functions of the insurance companies, the roles of the insured and the insurer, we will be proceeding forward to look at the various ways via which one can benefit from being insured in all spheres of life. For those who against all odds, accept insurance policy adequately, benefits, awaits them in areas like

1. pecuniary insurance

2. personal insurance

3. property insurance

4. liability insurance

We will take our time to give you enough explanation in all the sub-sections of these areas that will be of help to you.

1. PECUNIARY INSURANCE: This has to do with money or relating to something of such nature. This insurance policy benefits mostly company owners, directors, managers e.t.c This insurance policy provides cover to the employer against the loss of money unintentionally, or in a situation where an employee defrauds his or her employer on certain amount of money placed under his or her custody or in things relating to other occurrence/loss. Other policies under pecuniary insurance are; fidelity guarantee (known also as surety ship), legal expenses, credit insurance and business interruption insurance. All of these have their various function which in one way or the other relates to pecuniary. Like earlier stated, pecuniary insurance provides cover for C.E.O., M.D'S etc in case of loss of money either by intent or accident placed under the care of their employee or any officer of higher responsibility. These type of insurance cover, which their employee has will help to compensate them (i.e the employer's) and also ease the employee the fear and tension which the mishap might generate for him or her. It is therefore advisable you consider this policy very well as an MD, C.E.O. etc, especially with the assistance of your insurance broker so as to adequately know, and be directed properly on how to go about it.

2. PERSONAL INSURANCE

This involves all classes of life assurance and also accident policies. There are other types of person insurance, and the purpose of each is to meet the different need of individuals in their aim to provide for the future either for themselves or for their dependents. Other sub-divisions of personal insurance are:

i. Life assurance

ii. Personal accident and sickness insurance,

iii. Permanent health insurance,

iv. Social security

These sub-divisions has various similarities which come out at the end to meet the same aim, like in life assurance, personal accident and sickness insurance, this policy ensures that the policy holder when befallen by any misfortune, which resulted into permanent disability or death will still be able to fend for his or herself and also for his or her dependants in the case of death.

3. PROPERTY INSURANCE

Property insurance policy involves insurance cover for property should any risk of damage or loss by fire, accident, burglary or other risks that may occur. Under this, there are other sub-divisions which include:

i. Motor Insurance

ii. Marine Insurance

iii. Fire Insurance

iv. Burglary Insurance

v. Special peril Insurance

vi. All risk Insurance

In all these sub-divisions of property insurance, respective insurance cover is given to them all should there be any damage or loss relating to the type of policy the holder has.

4. LIABILITY INSURANCE

This provides cover for the insured against his legal liability to others. This can arise via negligence of the insured in failing to act in a reasonable manner. Such manners like crossing the road without properly looking on both side of the road which might result in accident. This may also arise via the insured's unlawful disturbance of another person in the enjoyment of his or property (i.e constituting a nuisance to them) or via the insured's trespass which is an unlawful act committed with force or violent on another person's property. Liability insurance is also sub-divided into employer's liability to his employee and public liability by the insured. The two sub-divisions of liability insurance owe their explanation to their respective liabilities, and since liability generally arises from lawsuits, liability policy covers only claims which the insured becomes legally obligated to.

We should also bear in mind that no insurance policy can prevent theft, fire, or other misfortune or the creation of legal liability, but can provide financial assistance in such situations. It does not also protect for example, the material property which is the subject matter of the insurance, but the financial interest of the insurer. This mean that the insurer can only get a financial compensation when any mishap happens to any thing insured against and not having the property restored back in case of fire or collapse (for building).

CONCLUSION

In all, we do hope that all these explanation will give you a better insight towards getting what you want on the good step to take while taking your insurance policy. But, always make sure that you don't do anything without first of all consulting your insurance broker ( who will take more time to tell you one-on-one the policy that will be suitable for you) before going to any insurance company knowing already that the cost of insurance is less than what would be the cost of insurance because the cost of insurance to industrialist for e.g is passed on to consumers along with other product cost and the consumers benefits from the existence of insurance via reduced prices. So make sure you get insured today. Till I see you again. Thank you.

What Should You Look For in an Auto Insurance Company?

What is a car insurance? What will an auto insurance cover?

Auto insurance companies cover you and your passengers in the event of an accident. But it is up to you to decide the level of cover you will get.

Will the damages to your property be covered by the company? Will all the passengers be covered or only your family? What if your daughter was driving your car?

What questions should you ask your auto insurance company when it comes to auto insurance? This article help you choose between the various insurance policies.

Types of auto insurance

Liability insurance, or third party insurance.

This is general the lowest form of insurance offered by an auto insurance company. This is the basic insurance, if you are involved in an accident, and it is proven to be your fault, the auto insurance company will pay damages to the other party.

The cover offered by the auto insurance company is usually set beforehand. These are the maximum amount the auto insurance company will pay in case of accident

For example the agent will agree on a $10000 coverage per person, (bodily injury) and/or $40000 coverage in bodily injury and/or $10000 in property damage per accident

You need to confirm with your auto insurance company what they will cover and what are the limits.

You might be offered a very low premium by some auto insurance company only to realize that your cover is minimal and unrealistic.

Collision and comprehensive coverage, comprehensive insurance and full comprehensive insurance

An auto insurance company will also offer you a comprehensive insurance, as the name indicates, you will be comprehensively covered.

In simple terms it means that if you are responsible for a collision the insurance company will pay for the repair of the vehicle.

But it is not so simple, an auto insurance company will almost always have the final say on what amount will be paid out, so if it is cheaper to give you market value for the car, then they will.

You might think that your car is worth $1000.00 but the real market value might be $500.00. This is not an uncommon scenario. So if the repair of your car are more than $500.00 then the auto insurance company will simply pay the book value of the car.

You must make sure that the insurance company is not in control of the market value of the car, normally organisations like the AA will give an impartial market value.

As with the third party insurance, the auto insurance company will almost certainly limit the amount that will be paid out, but in general terms, a comprehensive insurance will have higher limits.

Recreation Vehicle

A recreation vehicle needs its own insurance, a Recreation vehicle insurance is not the same as auto insurance.
You should not assume that because your car is comprehensively insured, so is your recreation vehicle.

Other Types of auto insurance

Medical (MedPay), Persona Injury protection (PIP) and no fault cover

This insurance will cover you and your passengers medical expenses in the event of a collision.

The no fault cover means that the auto insurance company will pay regardless of who is at fault. This give you the piece of mind that, at the very least, your family and friends are covered.

PIP is often a minimum requirement in some countries or states, ask your auto insurance company what the requirements are.

Uninsured/Underinsured motorists' coverage

This cover, (also sometimes a minimum requirement in some states), will cover you if the person at fault is not insured or is underinsured.

You must ask your auto insurance company what you will be charged in case of such a situation. Normally the auto insurance company should not charge you some extra premiums.

Rental reimbursement, towing and labour

Those 'extras' often given with a comprehensive insurance is often use by auto insurance companies as specials.

So in case your car is damaged the auto insurance company will pay for rental costs, (sometimes only for a few days).

The auto insurance company might also offer to pay for the towing of your vehicle, (not always included).

As always you should ask your auto insurance company what is included in the cover.

The legal requirements.

Most states, and most countries will require a certain level of cover, from full comprehensive car insurance to third party auto insurance.

In most cases it is up to you, the driver, to ensure that your auto insurance company offers you the minimum required. In most cases the insurance company, (the auto insurance company), is under no obligation to instruct you of the requirements.

But of course, a good auto insurance company will, (should?), try its outmost to advise you on the best deal for you.

Insurance for Your Business



The importance of insurance cannot be over-emphasized and neither can the danger of paying for insurance you don't need. It is strongly recommended you solicit the advice of an in-dependent business insurance agent. Don't forget to SHOP! Talk to three or four independent agents and compare notes and prices. An insurance agent will lay out a vast array of insurance coverage much of which you simply may not need. Your situation will be unique and you must consider each insurance element carefully to ensure comprehensive coverage.

Whatever your final insurance program looks like, you should review it at least every six months. Your business can change rapidly, especially in the first few years and insurance needs change with it. Keep your program up to date by calling in your agent and reviewing your coverage. Make changes where necessary.

LIABILITY INSURANCE

This is probably the most important element of your insurance program. Liability insurance provides protection from potential
losses resulting from injury or damage to others or their property. Just recall some of the big cash awards you have read about that have resulted from lawsuits concerning liability of one kind or another and you will understand the importance of this insurance. Your insurance agent can describe the various types of liability insurance coverage that are available. If you will end up with a comprehensive general policy, make certain that the general policy does not include items you don't need. Pay for only the insurance you need. For example, your business may not need product liability insurance.

Do not confuse business liability coverage with your personal liability coverage, both of which you need. Your personal coverage will not cover a business-generated liability. Check to be certain.

Compare the costs of different levels of coverage. In some cases a $2 million policy costs only slightly more than a $1 million policy. This economy of scale is true with most forms of insurance coverage. That is, after a certain value, additional insurance becomes very economical.

KEY PERSON INSURANCE

This type of insurance is particularly important for the sole proprietorship or partnership where the loss of one person through illness, accident, or death may render the business inoperative or severely limit its operations. This insurance, although not inexpensive, can provide protection for this situation. Key person insurance might also be necessary for others involved in your business.

SGC was a small firm run by three partners, a software programmer, marketer, and a general manager. Their product was a complex computer program used by aerospace firms. Al, the programmer, was involved in a severe automobile accident, became totally disabled, and SGC lost their programming capability. The problem was that the computer program written by Al was essentially the company's sole product. Modifications to accommodate the customer became impossible and the time to bring another programmer up to speed was excessive. SGC lost considerable business as a result of this situation. These losses could have been offset by key person insurance.

DISABILITY INSURANCE

You, as a business owner, should be covered by disability insurance whether or not you decide on key person insurance. This insurance, along with business-interruption insurance, described below, will help ensure your business will continue to operate in the unfortunate situation where you are unable to work. Your disability insurance policy needs to provide satisfactory coverage. Particular attention should be paid to the definition of "disability," delay time until payments start, when coverage terminates, and adjustments for inflation.

FIRE INSURANCE

Fire insurance, like all insurance is complicated and you should understand what IS and IS NOT covered. For example, a typical fire insurance policy covers the loss of contents but does not cover your losses from the fact that you may be out of business for 2-months while your facility is rebuilt. Fire insurance is mandatory whether you're working out of a home office or you have a separate facility. You should discuss a comprehensive policy with your agent. Take the time to understand the details. For example, will the contents be insured for their replacement value or for actual value at the time of loss?

Consider a co-insurance clause that will reduce the policy cost considerably. This means that the insurance carrier will require you to carry insurance equal to some percentage of the value of your property. (Usually around 85%.) With this type of clause it is very important that you review coverage frequently so you always meet the minimum percentage required. If this minimum is not met, a loss will not be paid no matter what its value.

If you are working out of your home, your existing homeowner's policy may not cover business property. If this is the case, have your insurance agent to add a home-office rider to your policy.

AUTOMOBILE INSURANCE

You probably already have automobile insurance but it might not include business use of your vehicle. Make sure that it does.

WORKER'S COMPENSATION INSURANCE

If you make the decision to hire employees, you will be required, in most states, to cover them under worker's compensation. The cost of this insurance varies widely and depends on the kind of work being performed and your accident history. It is important that you properly classify your employees to secure the lowest insurance rates. Work closely with your insurance agent.

BUSINESS INTERRUPTION INSURANCE

This protects against loss of revenue as the result of property damage. This insurance would be used, for instance, if you could not operate your business during the time repairs were being made as a result of a fire or in the event of the loss of a key supplier. The coverage can pay for salaries, taxes, and lost profits.

CREDIT INSURANCE

This will pay for unusual losses as the result of nonpayment of accounts receivables above a certain threshold. As with all policies, you must thoroughly understand the details so discuss it with your insurance agent. One of the largest providers of this coverage is American Credit Indemnity, Baltimore, MD. (800) 879 1224.

BURGLARY/ROBBERY/THEFT INSURANCE

Comprehensive policies are available that protect against loss from these perils, including by your own employees. Make certain you understand what is excluded from coverage.

RENT INSURANCE

This policy covers the cost of rent for other facilities in the event your property becomes damaged to the extent that operations cannot continue in your normal location.

DISABILITY INSURANCE

This insurance will pay you an amount each month slightly less than your current salary in the event you become disabled and are unable to work. Cost for this coverage varies considerably depending on your profession, salary level, how quickly benefits start, and when they end. Benefits paid are tax-free only if you, not your company, pay the premiums.

This list could be continued since it is possible to purchase insurance for just about any peril you can imagine ... if you can pay the premium! When considering your insurance coverage, use the following checklist:

INSURANCE COVERAGE CHECKLIST:

o Can you afford the loss?

o What coverage is required by Federal, state, or local law?

o What SPECIFIC items are covered by the policy?

o Are items to be insured for their replacement cost or original value?

o What SPECIFIC items are EXCLUDED by the policy?

o If there is a co-insurance clause, do you have adequate coverage?

o Have you chosen deductibles wisely in order to minimize costs?

o Do any of the policies you are considering duplicate or overlap one another?

o Do you need any insurance based on location, e.g., flood, earthquake?

Use the following checklist to review your insurance plans:

INSURANCE PLAN CHECKLIST:

o Employ an independent insurance agent rather than going to individual insurance companies. Ensure the agent shops for your insurance.

o Talk to and get quotations from at least THREE agents and pick the best one for you.

o Use money saving comprehensive policies, if possible.

o Perform periodic (every 6-months) reviews of your insurance program.

o Have business assets professionally appraised to determine coverage needs.

o Ensure existing personal insurance coverage includes business-related activities and add riders as necessary or obtain additional coverage.

Is Buying Business Insurance the New Texas Holdem Poker?



If you're looking to buy Business Insurance you'll have a certain level of power over a number of insurance brokers, insurance companies and insurance providers all wanting to do business with you.

With this in mind we'll put you in the position of the dealer in our game of Business Insurance Poker so you can watch the game develop. Are you sitting comfortably? Then let's begin:

If you already have Business Insurance we'll give your existing insurance provider the dealer button as they really have the best seat at the table. They've already built some kind of relationship with you and they can sit back and wait to see what the competition does before they decide to act.

So next is the small blind. The small blind has an interest in your business as they've put in some of their own money in the hope they can win your business. You may have seen an advert for them, they may have sent you a letter or they may have called you to see if you'd like a quote for your Business Insurance.

Next is the big blind. The big blind when it comes to Business Insurance could well be an insurance provider you've heard of. They've spent a sizeable amount of money to get your attention (maybe a television advert or some promotion in the National press) and they aren't likely to give up without a struggle. So those are the 3 insurance providers who definitely are interested in you and your Business Insurance:

- Dealer button - Your existing insurance provider

- Small blind - Maybe an insurance broker who would like to help you

- Big blind - Perhaps an insurance company who has a large marketing spend and has got your attention.

It's possible that this is only a 3 player game but as is becoming more common with insurance brokers and insurance companies other parties enter the game. These other insurance providers generally fall into 2 categories:

1. They are likely to offer something (or have a hand) similar to either your existing insurance provider (who still has the button) or the small or big blind.

2. These new insurance providers will offer you something different. They get your attention as they have noticed an element of weakness with the other people at Business Insurance table and are planning on showing you how good they are. So how are they going to do this? Well more often than not they will raise and when it comes to Business Insurance this means they will give you more than the other people at the Business Insurance table.

Let's play the Business Insurance Poker hand to explain in more detail:

1. Your existing insurance provider sends you your renewal terms but you decide to look around for alternative insurance quotes as it's either more expensive than last year or you just want to see what else is available.

2. You receive a letter from an insurance broker who seems similar to your existing insurance broker but they save you a little on your insurance premium. It gets your attention but it is enough?

3. You are now contacted by a direct insurer. You know their name, you've seen their adverts and they knock even more off your renewal price. Sounds great yes? Well maybe but let's see how the game develops.

4. Another player enters the game and makes a bet (or in this case makes you an offer). Their offer is different in that:

a. They specialise in the type of business insurance you are actually looking for

b. They appear to focus more on you and your business rather than on how good they are and how cheap they can get your premium

c. They quote you a very good premium but in addition to this offer you advice, guidance and tell you that if you do suffer a loss with them they will be there to help you. They don't have call centres', they don't keep you waiting in queues. Instead they employ people who understand your business, understand your needs and are here to help you.

So with the bets (or business insurance quotes) all on the table it's possible you may want to play one off against the others with bluffs, raises (or in this case reductions in premiums) until everyone has played their hand and you have to decide who to look after your insurance for another year.

Will you choose?

1. Your existing insurance provider - who gave you your renewal premium but only really started to play when under threat from other providers

2. Someone who offers you the same thing but saves you a little money

3. A company who saves you a little more money but doesn't really stand out from crowd

4. An insurance broker who seems to understand what you need and will do whatever it takes to make sure you are satisfied

Insurance companies and insurance brokers need to pay attention as although insurance is still a very price sensitive business the reality is customers and people buying business insurance want more than a cheap premium.

They want cover tailored to their needs, they want an insurance provider who will work for them and with their interests at heart and they want someone to speak to when they need them most.

They don't want to be held waiting in queues or even worse be keep waiting only to be cut off. They also don't want to speak to someone they don't understand or who doesn't understand them.

Texas Holdem Poker is a great game but insurance for your business is a serious matter. Make sure you get the cover, service and insurance provider you deserve and don't muck it up.

Is buying Business Insurance the new Texas Holdem Poker was brought to you by Mark Burdett, Marketing Manager of Northern Counties Insurance Brokers. As one of the UK's Leading Insurance Brokers Northern Counties have been providing Business Insurance to companies since 1928 and specialise in Business Insurance, Motor Trade Insurance, Nursery Insurance and Care Home Insurance.


This article was written by Mark Burdett, Marketing Manager of Northern Counties Insurance Brokers. Mark has over 17 years Marketing experience in the Financial Services industry and has worked on campaigns for companies including Norwich Union, Kia and Zurich.

Now based in Newcastle upon Tyne Mark is Marketing Manager for one of the UK's Leading Insurance Brokers - Northern Counties Insurance Brokers.

Where Can You Get Affordable Health Insurance?



What is health Insurance

The main reason why you need an affordable health insurance is to help you plan ahead in case of unexpected costly emergencies. The only way you can accomplish this is to compare prices from most leading insurance companies and also choosing a health insurance plan that best suits you. Back in the days, getting a cheap health insurance plan was simply unaffordable. But these days, individuals, small groups, families and students can choose a health insurance plan that is best for them, e.g. like acquiring a help insurance plan that ensures that an individual suffering from any previous medical condition is not excluded.

Private health insurance plan is totally an unrestricted open market, so those who do not yet have a health insurance plan should consider taking out a plan. For those who are seeking good medical health insurance program, having one is possible through the help of specific companies which specializes in providing health care insurance for individuals and also meeting their requirements and also staying within your budget.

Also for individuals who do not want to use a company, then they can use the internet. One major way Americans get health insurance coverage is mostly through their employers. Many employers them receive health insurance coverage for their workers for a limited time thus enabling them receive health insurance coverage. The internet provides an option for a cheaper health insurance. There are lots of companies that provide all types of health insurance plans, making it possible for you and your family to have a specific reasonable and affordable health care insurance plan. Finding out what kind of reputation the company has and how long the company has been in business is a smart idea.

Having a kind of ideal they have for you is advisable also making sure they have been licensed in your state, because it is of no use getting an insurance with a form which has no license and cant get the exact health insurance you want, many agents will help work hard for you, so you could have an affordable health insurance plan which you and your family could live with without great cost. Everyone wants the best health insurance both for themselves and for their families, but only the best health care insurance can do this with low premiums and full coverage.

What are the advantages of health insurance?

Having the right and the best health care insurance is difficult. In order not to get confused, one needs to decide which the best is by doing his or her research thoroughly. The first step to take includes checking out the credentials and also their past performances of the very company you are considering. Just as on insurance outfits does a background check of individuals before accepting proposals, one should also review the financial status including the customer care services of the insurer, by so doing; you stand the chance to know which health insurance company's best for you. One major way for you to get ratings of these agencies such as A.M best or Moody's is by using the better business bureau. Many employers use the health insurance scheme to either attract or even retain their quality employers. The health insurance coverage might be a personal scheme or a group scheme organized and sponsored by the employers for employers who work between 20-29 hours per week.

Companies also do not add cost of fringe benefits alongside health insurance, to the price of their product and service. Over the past decades, the cost of health insurance has increased tremendously, surpassing the general rate of inflation in most past years.

The different types of health insurance includes individual health insurance, affordable employee health insurance which is also known as group health insurance, affordable family health insurance, affordable business health insurance etc, your monthly insurance is determined by certain numerous different things. For instance, most premiums based on or according to your age. So your health insurance rates changes accordingly with the type of health policy you have. If your health insurance is basically for yourselves or your entire family, the procedures must surely have an impact on any quote you are young or advanced in age, self employed receiving health insurance companies will adjust your premium based upon your age and this will also affect the cost of your health insurance.

What are the Disadvantages of health insurance?

Since unforeseen occurrences may occur any time, one will never know when an accident is likely to happen, be it the need to be admitted in the hospital for stitches or a broken bone, you may be in the position to receive help quickly without the worry of receiving a huge bill, unlike when you don't have a health insurance your credit rating beers all the cost. But you can prevent all this problems from happening and also protecting your credits for your future health financially. Increasing the amount of your health insurance deduction is another way in which you can help make sure your insurance rates are lowered. This higher monthly premium is necessary for anyone who has an existing health problem that requires an extensive medical treatment getting variety of quotes from insurance companies which meets for your health and budgets standards, is a wise decision when selection an health insurance. Searching can be done online and this will have saved you money as well.

Many people feel that they are healthy enough, so they don't need health insurance because they have never had any major medical problems but one thing to note against the possible health insurance is the protection against the possible health problem that may happen in future. It might happen to you in particular or any member of your family, so why not plan on having an affordable health insurance plan today.

Auto Insurance Principles Should Apply to Health Insurance



Many Americans rely on their automobiles to get to work. No automobile means no job, no rent or mortgage money, no food. A single parent, struggling to make ends meet in the suburbs with 100,000 miles on the odometer, would presumably welcome the guaranteed opportunity for low-priced insurance that would take care of every possible repair on her auto until the day that it reaches 200,000 miles or falls apart, whichever comes first. Especially if the insurance is valid regardless of whether she even changes the oil in the interim.

So why aren't the auto insurance companies writing such coverage, either directly or through used auto dealers? And given the importance of reliable transportation, why isn't the public demanding such coverage? The answer is that both auto insurers and the public know that such insurance can't be written for a premium the insured can afford, while still allowing the insurers to stay solvent and make a profit. As a society, we intuitively understand that the costs associated with taking care of every mechanical need of an old automobile, particularly in the absence of regular maintenance, aren't insurable. Yet we don't seem to have these same intuitions with respect to health insurance.

If we pull the emotions out of health insurance, which is admittedly hard to do even for this author, and look at health insurance from the economic perspective, there are several insights from auto insurance that can illuminate the design, risk selection, and rating of health insurance.

Auto insurance comes in two forms: the traditional insurance you buy from your agent or direct from an insurance company, and warranties that are purchased from auto manufacturers and dealers. Both are risk transfer and sharing devices and I'll generically refer to both as insurance. Because auto third-party liability insurance has no equivalent in health insurance, for traditional auto insurance, I'll examine only collision and comprehensive insurance -- insurance covering the vehicle -- and not third-party liability insurance.

Bumper to Bumper

The following are some commonly accepted principles from auto insurance:

* Bad maintenance voids certain insurance. If an automobile owner never changes the oil, the auto's power train warranty is void. In fact, not only does the oil need to be changed, the change needs to be performed by a certified mechanic and documented. Collision insurance doesn't cover cars purposefully driven over a cliff.

* The best insurance is offered for new models. Bumper-to-bumper warranties are offered only on new cars. As they roll off the assembly line, automobiles have a low and relatively consistent risk profile, satisfying the actuarial test for insurance pricing. Furthermore, auto manufacturers usually wrap at least some coverage into the price of the new auto in order to encourage an ongoing relationship with the owner.

* Limited insurance is offered for old model autos. Increasingly limited insurance is offered for old model autos. The bumper-to-bumper warranty expires, the power train warranty eventually expires, and the amount of collision and comprehensive insurance steadily decreases based on the market value of the auto.

* Certain older autos qualify for additional insurance. Certain older autos can qualify for additional coverage, either in terms of warranties for used autos or increased collision and comprehensive insurance for vintage autos. But such insurance is offered only after a careful inspection of the automobile itself.

* No insurance is offered for normal wear and tear. Wiper blades need replacement, brake pads wear out, and bumpers get dings. These aren't insurable events. To the extent that a new car dealer will sometimes cover some of these costs, we intuitively understand that we're "paying for it" in the cost of the automobile and that it's "not really" insurance.

* Accidents are the only insurable event for the oldest automobiles. Accidents are generally insurable events even for the oldest autos; with few exceptions service work isn't.

* Insurance doesn't restore all vehicles to pre-accident condition. Auto insurance is limited. If the damage to the auto at any age exceeds the value of the auto, the insurer then pays only the value of the auto. With the exception of vintage autos, the value assigned to the auto goes down over time. So whereas accidents are insurable at any vehicle age, the amount of the accident insurance is increasingly limited.

* Insurance is priced to the risk. Insurance is priced based on the risk profile of both the automobile and the driver. The auto insurer carefully examines both when setting rates.

* We pay for our own insurance. And with few exceptions, automobile insurance isn't tax deductible. As a result, the fear of increasing insurance rates due to traffic violations and/or accidents changes our driving behavior and we sometimes select our automobiles based on their insurability.

Each of the above principles is supported by solid actuarial theory. Although most Americans can't describe the underlying actuarial theories, most everyone understands the above principles of auto insurance at the intuitive level. For sure, as indispensable automobiles are to our lifestyles, there is no loud national movement, accompanied by moral outrage, to change these principles.

Unsustainable Market

In contrast, similar principles are routinely violated in health insurance. To demonstrate this, let's return to the same suburban mother from the opening paragraph. She's busy working, driving to and from work, and driving her kids to school and activities. She ends each day exhausted, sitting on the couch with fast food. She's obese, has a sedentary life, a bad diet, and hasn't taken the time to go to the doctor in years. After a simple injury doesn't heal for weeks, she turns up at the emergency room and learns she has type II diabetes. Although type II diabetes is controllable, changing diet and exercise habits and properly tracking her condition takes time and effort and she's never quite successful in implementing the necessary lifestyle changes.

So the initial emergency room visit is only the first of a long list of health care related to non-controlled diabetes and other problems associated with obesity. Whether she has individual or group insurance, her insurance pays for each episode of care, without singling her out for a premium increase, and without charging her any more cost sharing than is charged to the healthiest and most medically diligent insureds. Her coverage continues until she voluntarily changes insurance companies and/or employers or becomes eligible for Medicare. If she's covered under group insurance she may not even pay any premium. Her insurance continues unabated, even though the disease was caused by neglecting her body and she maintains her poor lifestyle even after the disease becomes known.

This just wouldn't happen in auto insurance. This scenario is the auto insurance equivalent of guaranteed access to low-priced auto insurance that takes care of every possible repair, including damage already done, until the day the car falls apart so completely it's unsalvageable (death) or reaches 200,000 miles (Medicare), regardless of whether she even changes the oil (takes care of herself) in the interim.

As a society, we don't expect this in private-market auto insurance, but we expect it in private-market health insurance. Furthermore, there's a chorus of national and state interests, which continuously pushes us further away from the auto insurance principles.

The current private health insurance market isn't sustainable. Prices have been consistently increasing faster than inflation for decades. Each year, insureds use more health care than ever before and more people have no insurance at all. Most actuaries and other people in the private health insurance market don't want national health insurance with its bureaucracy and one-size-fits-all benefits. Yet, we're trying to sustain a private insurance system, which violates the very principles we know are necessary for private insurance markets.

Yes, health insurance involves the sacredness of human life and is therefore different from auto insurance. But if we're to sustain a private-market solution to health insurance, actuaries need to explain to the larger society, in terms that society understands, the rationale for the following principles:

* As sacred as health care is, it's still an economic transaction that has to be balanced by individuals and societies, against other economic choices. It can't be unlimited. Sometimes it will be secondary to other choices. On a given day, for example, the mother in our scenario may value her car more than her health.

* Insurance premiums should be paid by the individual and tied to controllable risk factors. This will provide the best incentive for the control of risk factors.

* Although it's hard to draw the line between abuse, neglect and ignorance, self-abuse shouldn't be insured and we need to draw that line somewhere.

* The private market can't provide unlimited, self-directed health insurance.

* Routine care and ongoing treatments of chronic conditions can be pre-funded, can even be subsidized, but they don't constitute "insurable events."

* Insurance can't be expected to keep every human body in pristine condition. No amount of health care will prevent everyone's ultimate death.

* Comprehensive, unlimited, non-subsidized private-market coverage isn't possible for people with severely impaired health.

* The private health market can provide limited non-subsidized health insurance, such as protection from accidents, to even health-impaired individuals.

* Individuals who can afford to do so and who take good care of themselves should be able to "buy up" to better coverage. People have the option of buying up for everything else in life.

Discussion of these principles is lacking from most of the current health insurance debate. If society can intuitively understand how similar principles apply to health insurance, then they should be able understand the principles in the health insurance context. We need to initiate the debate.

This commentary is solely the opinion of its author. It does not express the official policy of the American Academy of Actuaries; nor does it necessarily reflect the opinions of the Academy's individual officers, members, or staff