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Insurance Law Fundamentals

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Premium

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The amount paid by the insured to the insurance company in exchange for the coverage provided under the insurance policy.

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Endorsement (or Rider)

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An amendment to an insurance policy that alters the coverage by adding, excluding, or modifying the terms or provisions of the policy.

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Aggregate Limit

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The maximum limit on the total of all claims that an insurer will pay under a liability policy during a specified period, such as a policy year.

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Fiduciary Duty

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An obligation of one party to act in the best interest of another when dealing with matters of insurance, particularly in the case of an insurance agent or broker representing clients.

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Deductible

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The portion of a claim that the insured is required to pay out-of-pocket before the insurance coverage applies to cover the remaining costs.

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Material Fact

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Any fact that would influence the decision of an insurer in determining whether to accept a risk, set the premium, or include specific terms and conditions in the insurance policy.

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Proximate Cause

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The action or event that is legally considered to be the direct cause of the damage in an insurance claim, which determines whether the policy covers the loss.

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Risk Management

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The practice of identifying, analyzing, and controlling risks faced by individuals or organizations to minimize the impact of losses.

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Co-Insurance

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An arrangement in which the insured and the insurer share the costs of insurance claims according to a specified ratio after the deductible is met.

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Reinsurance

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The practice of insurers transferring portions of risk portfolios to other parties by some form of agreement to reduce the likelihood of paying a large obligation resulting from an insurance claim.

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Actuarial Science

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The discipline that applies mathematical and statistical methods to assess risk in the insurance and finance industries.

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Insurance Binder

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A temporary agreement issued by an insurer that provides proof of insurance coverage until a formal policy is issued.

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Indemnity

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A principle that insurance contracts should restore the insured person to their financial position before the loss, without allowing them to profit from the insurance claim.

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Moral Hazard

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The situation where an individual may be more likely to engage in risky behavior because they are protected from the consequences, due to having insurance.

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Claim

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A formal request to an insurance company asking for a payment based on the terms of the insurance policy.

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Beneficiary

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The person or entity designated to receive the proceeds from an insurance policy upon the occurrence of a specified event.

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Adverse Selection

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A situation in which the tendency is for only those who expect to use the insurance product to the fullest extent to purchase coverage, thus leading to unanticipated high costs for insurers.

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Underwriting

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The process by which insurers assess the risks associated with insuring a person or asset and set the price and terms of the insurance policy.

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Exclusion

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Specific conditions or circumstances that are not covered by the insurance policy.

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Subrogation

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

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Tort

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A civil wrong for which the law provides a remedy, often in the form of monetary damages to the injured party.

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Policy Limits

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The maximum amount an insurance company will pay for covered losses under an insurance policy.

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Insurance Broker

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A professional who represents consumers in their search for the best insurance policy for their needs, acting as an intermediary between the consumer and the insurer.

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Utmost Good Faith

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The legal doctrine requiring parties in the insurance process to act honestly and not mislead or withhold critical information from one another.

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Insurable Interest

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A requirement that the person purchasing the insurance policy has a financial stake in the safety and preservation of the item or life being insured.

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