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The Fundamentals of Insurance Law

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Insurable Interest

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A legal requirement for obtaining an insurance policy, insurable interest exists when the policyholder stands to suffer a financial loss or certain kinds of loss from the damage to the insured property or person.

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Indemnity

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A principle that ensures that the policyholder is compensated for a loss, with the intent to restore them to the financial position they were in prior to the incident, not to allow them to make a profit.

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Utmost Good Faith

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A legal doctrine stipulating that all parties in an insurance contract must act with honesty and disclose all relevant facts, thus preventing misrepresentation or fraud.

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Subrogation

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The legal right for an insurer to pursue a third party that caused an insurance loss to the insured, in order to recover the amount of the claim paid to the insured.

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Contribution

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A principle that allows multiple insurers to share the cost of a claim when more than one policy covers the same insured risk.

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Proximate Cause

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The primary cause of the loss, which sets off a foreseeable sequence of events leading to an insurance claim, without being an interrupted by another cause.

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Exclusion

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Provisions in an insurance policy that outline the risks that are not covered, essentially limiting the insurer's liability for particular kinds of risks or events.

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Deductible

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The amount of loss that the insured is required to pay before the benefits from the insurance policy can be accessed.

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Rider

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An addendum to an insurance policy that modifies the terms and conditions, often providing additional coverage for specific items or conditions.

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Premium

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The recurring amount paid by the insured to the insurer for coverage under a policy, which can be based on various risk factors.

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Policy Limit

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The maximum amount that an insurer will pay under a policy for a covered loss.

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Endorsement

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A document that amends an insurance contract by adding, deleting, or modifying its terms or coverage.

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Moral Hazard

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The risk that a party insured against a certain event might in fact be motivated to make the event happen because they have insurance cover.

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Coverage

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The scope of protection provided by an insurance policy, including what is covered in the case of a loss and its limits.

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Underwriting

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The process insurers use to assess the risks of insuring a person or asset and determine the appropriate premium and terms of coverage.

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Actuary

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A financial professional who analyzes risks and estimates how events will affect insurance policies using mathematics, statistics, and financial theory.

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Claim

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A formal request by the insured to the insurance company for payment of a loss under the terms of the insurance policy.

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Adjuster

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An individual employed or contracted by the insurer to evaluate the extent of the insurer's liability in a claim situation.

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Risk Pooling

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The practice of spreading out financial risks among a large number of contributors to the insurance program to make losses more manageable.

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Reinsurance

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A contract between two or more insurers whereby the reinsurer agrees to cover all or part of the risks that the original insurer has assumed.

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Liability

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The state of being responsible for something, in insurance it refers to the insurer's responsibility to provide compensation for covered losses.

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Excess

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The initial amount that the insured is responsible to pay out-of-pocket before the insurer starts to reimburse for a covered loss; similar to a deductible but applied differently depending on policy terms.

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Fiduciary Duty

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The obligation that insurers and agents have to act in the best interest of their policyholders, placing the policyholders' interests above their own.

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Bad Faith

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A term used to describe dishonest or unfair practices by an insurer, such as unwarranted denial of a claim or failure to investigate a claim properly.

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