INTRODUCTION TO

INSURANCE

By M.Vedavalli

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WHAT IS INSURANCE?

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WHAT IS INSURANCE? Insurance from economic

perspective is a financial

intermediation function by

which individuals exposed to a

specific financial contingency

contribute to a pool from

which covered events suffered

by participating individuals are paid .

Insurance in legal sense is a

contract by which one party in

consideration of the price paid

to him agrees to pay an agreed

amount of money to other

party to make good for the

loss, damage or injury to

something of value, in which

the other part has a pecuniary

interest, by the happening of

certain specified events.

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WHAT IS INSURANCE?

Insurance is an arrangement

between one entity (Insured) and

another (insurance company,

insurer ) to protect the insured

against risk to something of

value in which the insured has a

pecuniary interest . The

consideration paid by the insured

is called premium.

Insurance is a form of risk

management which is used

primarily to hedge against the

risk of a contingent, uncertain

loss.

Risk is the uncertainty

about a situation’s

outcome- may be an

unpredictable event

which leads to loss or

damage

Risk is a potential problem – it might

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EQUITABLE TRANSFER Insurance is an equitable

transfer of risk of a

potential loss from one

entity to another in

exchange for a premium.

No Protection of Assets

Only Compensation

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INSURANCE: A SOCIAL DEVICE Main Function of

Insurance is to spread the

loss over a large number

of persons who are

exposed to a particular

risk.

Co-operative mechanism

Risk not averted

Loss minimised

Transfer of Risk

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NATURE OF INSURABLE RISKS Large Number of Similar exposure units to be present for spreading the loss as insurance is subject to the Law of large Numbers. Greater the number of exposures the

actual results will approach more closely the probable results.

Loss caused by the risk must be definite. The peril must produce the loss that is

definite in time or place. Since cost of insurance depends on the extent of hazard.

Occurrence of Loss must be accidental or Fortuitous

Potential of loss must be large enough to cause hardships but not catastrophic.

Cost of insuring must be economically feasible.

Must be possible to calculate the chance of the loss

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ESSENTIALS OF INSURANCE CONTRACT

Essentials

Lawful Offer and

Acceptance Legal

Relationship Lawful

Consideration Capacity of

Parties Free and Genuine

Consent Others

Legal

Formalities Lawful

Objectives Certainty and possibility of

performance

Requirements of Section 10 of Indian Contract Act 1872.

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FUNDAMENTAL LEGAL PRINCIPLES OF INSURANCE CONTRACTS

Principle of Utmost Good Faith

Principle of insurable interest

Principle of Indemnity

Principle of Subrogation

Principle of Contribution

Principle of Causa Proxima

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PRINCIPLE OF UTMOST GOOD FAITH - UBERRIMAE FIDEI

A higher degree of honesty is imposed on an insurance

contract than imposed on other contracts to fully

disclose all material facts.

A material fact is a fact that influence the mind of the

prudent underwriter in assessing a risk.

Honesty is mainly imposed on the insurance applicants.

It is supported by three legal doctrines:

Representation Concealment Warranty

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PRINCIPLE OF UTMOST GOOD FAITH R

EP

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AT

ION

• Statements made

by an applicant • Insurance is

voidable at the

insurer’s option. • Material • False • Reliance

• cf: Innocent

misrepresentation

CO

NC

EA

LM

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• Intentional failure to disclose a

material fact

WA

RR

AN

TY

• A statement of fact or a promise made by the insured, which is part of the insurance contract and must be true if the insurer is to be liable under the

contract. • In exchange for

a reduced premium, a store owner warrants that a burglar alarm will be

always on.

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PRINCIPLE OF INSURABLE INTEREST

Pecuniary Interest of a person in the subject matter of insurance. The insured must be in a position to financially suffer if a loss occurs.

Why? 1) To prevent gambling.

> Insurance on a property and wait for a loss

to occur. 2) To reduce moral hazard.

> Life insurance on a person and pray for

his/her death for insurance proceeds. 3) In order not to indemnify more than an insured’s financial interest.

> It supports the principle of indemnity.

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PRINCIPLE OF INSURABLE INTEREST

Property-Casualty insurance

At the time of a loss, an insured must have insurable interest.

>

Life Insurance

Insurable interest must exist at the time of a policy inception, but not at the time of a loss (death)

No insurable

interest no financial

loss no

indemnity Support

Principle of

Indemnity

Marine Insurance: Insurable interest either at the time of making the contract or at the time of making the claim.

Fire Insurance: It should be present at both ends

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PRINCIPLE OF INDEMNITY The insurer agrees to pay no more than the actual amount

of the loss suffered by the insured.

Why?

The purpose of the insurance contract is to restore the insured to the same economic position as before the loss.

The insured should not profit from a loss.

It reduces the moral hazard by eliminating the profit incentive.

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PRINCIPLE OF INDEMNITY To support the principle of indemnity an

insurance contract uses Actual Cash Value (ACV) method. Broad evidence rule

The determination of ACV should include all relevant factors an expert would use to determine the value of the property

Replacement cost (RC) less depreciation RC – current cost of restoring the damaged property with new

materials of like kind and quality.

Fair market value The price, a wiling buyer would pay a willing seller in a free

market.

.

Repair to the satisfaction of the Insured.

Reinstatement: Restoration or rebuilding to the original condition in fire insurance cases

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PRINCIPLE OF INDEMNITY To support the principle of indemnity insurance

contract includes “Other Insurance Provisions”. Escape clause

The policy (or insurance) would not apply if the insured was covered by another policy.

Primary-Excess It (or This insurance) is excess insurance over any other valid

and collectible insurance.

Pro-rata provision Proration by face amounts

Proration by amounts otherwise payable

Contribution by equal shares

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PRINCIPLE OF INDEMNITY

Pro-ration by Face Amounts

It limits an insurer’s maximum obligation to the proportion of the loss that the insurer’s policy limit bears to the sum of all applicable policy limits.

Assume that there are three polices covering the same loss and the loss amount is Rs.150,000.

Insurer A Insurer B Insurer C

Policy Limit Rs.100,000 Rs.200,000 Rs.300,000

Share 1/6 2/6 3/6

Payment Rs.25,000 Rs.50,000 Rs.75,000

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PRINCIPLE OF INDEMNITY

Pro-ration by Amounts Otherwise Payable

The amount what would be payable under each policy in

the absence of other insurance

Assume that there are three polices covering the same loss

and the loss amount is Rs.150,000.

Insurer A Insurer B Insurer C

Policy Limit Rs.100,000 Rs.200,000 Rs.300,000

Payable Rs.100,000 Rs.150,000 Rs.150,000

Share 1/4 1.5/4 1.5/4

Payment Rs.37,500 Rs.56,250 Rs.56,250

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PRINCIPLE OF INDEMNITY

Pro-ration by Amounts Otherwise Payable

What if the loss amount is Rs.60,000?

Insurer A Insurer B Insurer C

Policy Limit Rs.100,000 Rs.200,000 Rs.300,000

Payable Rs.60,000 Rs.60,000 Rs.60,000

Share 1/3 1/3 1/3

Payment Rs.20,000 Rs.20,000 Rs.20,000

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PRINCIPLE OF INDEMNITY

Contribution by Equal Shares

Each insurer contributes equal amount until it has paid its

applicable limit of insurance or none of the loss remains,

whichever comes first.

Assume that there are three polices covering the same loss

and the loss amount is Rs.150,000

Insurer A Insurer B Insurer C

Policy Limit Rs.100,000 Rs.200,000 Rs.300,000

Equal Share Rs.50,000 Rs.50,000 Rs.50,000

Payment Rs.50,000 Rs.50,000 Rs.50,000

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PRINCIPLE OF INDEMNITY

Contribution by Equal Shares

What if the loss amount is Rs.400,000?

Insurer A Insurer B Insurer C

Policy Limit Rs.100,000 Rs.200,000 Rs.300,000

Equal Share 1 Rs.100,000 Rs.100,000 Rs.100,000

Equal Share 2 N/A Rs.50,000 Rs.50,000

Payment Rs.100,000 Rs.150,000 Rs.150,000

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PRINCIPLE OF INDEMNITY

Valued policy (or

agreed value) • Pays face value

of insurance if a

total loss occurs • Life insurance,

disability insurance, fine arts, antiques

• eg. Value of a fine art is agreed at Rs.250,000.

Valued policy

law • A law that

requires payment of the face amount of insurance to the insured if a total loss to real property occurs from a covered peril, regardless of the property’s

ACV.

Replacement cost

• No deduction for depreciation in determining the amount paid

for a loss.

Exceptions to the Principle of Indemnity

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DOCTRINE OF SUBROGATION Substitution of the insurer in place of the insured for the

purpose of claiming indemnity from a third party wrongdoer for a loss paid by the insurer.

Why?

To prevent collecting twice

To hold the negligent party responsible

To hold down insurance rates

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PRINCIPLE OF SUBROGATION

The insurer is entitled only to the amount it has paid

under the policy.

What if the insurer collects more, from the negligent party,

than the amount the insurer paid to its insured?

The insured cannot impair the insurer’s subrogation rights.

Subrogation does not apply to life insurance and to

individual health insurance contracts.

The insurer cannot subrogate against its own insured.

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PRINCIPLE OF CONTRIBUTION According to this principle, the insured can claim the compensation

only to the extent of actual loss either from all insurers or from any

one insurer. If one insurer pays full compensation then that insurer

can claim proportionate claim from the other insurers who have

covered the same loss.

4 essential conditions for the application of this doctrine are:

The insured must be the same person.

The policies concerned must all cover the same risk which

has caused the loss.

The policies must protect the same interest.

The policies must be in force at the time of loss

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The principle states that the active and most efficient cause that sets in motion a chain of events which brings about a result, without the intervention of any

force started and working actively from a new independent source.

The Principle of Proximate (i.e Nearest) Cause, means when a loss is caused by more than one cause, the proximate or the nearest or the closest cause

should be taken into consideration to decide the liability of the insurer.

To find out whether the insurer is liable for the loss or not, the proximate (closest) and not the remote (farthest) must be looked into.

To entitle an insured to recover, the chain of events from an insured event leading from the insured peril to actual financial losses suffered by the insured

must be unbroken.

Principle Of Causa Proxima M

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PRINCIPLE OF CAUSA PROXIMA - APPLICABILITY

Suicide within one year of policy: Payment restricted only upto the interest of 3rd

party, provided interest of 3rd party expressed atleast one

month prior to the suicide.

Accident Benefit : when an insured under

accident policy is killed or suffered an injury

which has an immediate cause and also a remote cause. Double the policy

amount paid.

War Risk: Where policy is issued on exclusion of war risk, the proximate

cause of death is

important.

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Financial support sufficient to

replace loss, not to create gain

Loss is limited to the amount

of premium for the limit upto

which the carriers would

accept to insure.

Existing risk transferred

Insured are risk avoiders

Risk mitigation practices to be

put in place in some cases.

Greater predictability

Possibility of either loss or

gain

Gamblers may buy more risk

than they can afford to pay for.

Gamblers create new risk

transfer.

Risk seekers.

No risk mitigation

Can’t be predicted.

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IMPORTANCE OF INSURANCE TO BUSINESS Instrument of Employees’ Welfare Attracting and retaining

employees- Injury, Disability, old age – Group Insurance

Loss of key person

Credit Enhancer

Security,stability and Peace of Mind

Economic risks

Consumer spending

Supplier risks

Protecting intellectual property

Credit risks

Operational risks

Catastrophic risks

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INSURANCE AND SOCIETY

Equitable Spreading of Risk

Accelerates the Process of

Economic Growth

Encourages Foreign Trade

Enhances Invisible Exports

Solving Complex Social

Problems

Spreading Education

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WHY IS IT IMPORTANT TO HAVE INSURANCE?

Helps limit financial losses when a loss/damage/injury

occurs

Helps an individual/family be prepared for the unexpected

Plays a large role in most financial management plans-

Profitable investment and

Good tax planning

Insurance is a

source of Peace of Mind

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GENERAL USES OF LIFE INSURANCE

1. • Create an estate

2. • Pay taxes at death

3. • Income replacement

4. • Capital loss due to death

5. • Fairness at inheritance time

6. • Provide for retirement funds

7. • Excellent for business transfers

8. • Gifts to charities

9. • Payoff mortgages, guarantees, loans

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CLASSIFICATION OF INSURANCE

LIFE Non_Life Social

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TYPES OF INSURANCE

Types of Insurance

Automobile

Health

Life Disability

Homeowners/

Renters

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LIFE INSURANCE Life insurance is a contract

between an insurer and

policyholder specifying a sum

to be paid to a beneficiary

upon the insured’s death or

excessive longevity.

A beneficiary is the recipient

of any policy proceeds if the

insured person dies.

Provides money for family

members or dependents when a

wage earner dies.

A dependent is a person who

relies on someone else financially.

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WHAT IS AN INSURANCE POLICY?

A policy is a contract between the individual and the insurer specifying the terms of the

insurance arrangements

A policyholder is a consumer who purchases the policy

A premium is a fee paid to the insurer to be covered under

specified terms outlined in the policy

A deductible is the amount paid out of pocket by the policyholder for the initial portion of a loss before the

insurance coverage begins- the deductible is stated in the

policy

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AUTOMOBILE INSURANCE

Automobile

Insurance

Liability

insurance Medical payment

insurance

Uninsured or underinsured

motorists insurance

Physical damage insurance

Collision Comprehensive

arrangement between an individual (consumer) and insurer (insurance company) to protect the individual

against risk from automobile accidents

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HEALTH INSURANCE Health insurance provides

protection against financial losses resulting from injury, illness, and disability.

May cover hospital, surgical, dental, vision, long-term care, prescription, or other major expenditures.

Specific coverage depends upon the individual policy

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Why is it important to have Health Insurance? Health care costs are extremely high Large medical expenses could deplete an individual’s savings

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HEALTH INSURANCE

May be purchased by the individual or through their employer

Individual’s often seek coverage for dependents (spouses and children)

Many health insurance policies offer dependent coverage but there is no requirement to do so

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DISABILITY INSURANCE

Disability Insurance

replaces a portion of

one’s income if they

become unable to work

due to illness or injury

Insurance typically pays

between 60-70% of one’s

full-time wage

Factors such as the length

or severity of a disability

influence the percentage

of income a person will

receive

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HOMEOWNER’S INSURANCE

Homeowner’s Insurance -combines property and liability

insurance into one policy to protect a home from damage costs due

to perils

Peril -an event which may cause a financial loss like fire,

falling trees, lightning and others

Property Insurance -protects the insured from financial

losses due to destruction or damage to property or

possessions

Liability Insurance- protects the insured party from being

held liable for other’s financial losses

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RENTER’S INSURANCE Renter’s Insurance protects

the insured from loss of the

contents of the dwelling rather

than the dwelling itself.

Necessary because a landlord’s

insurance policy on the

dwelling does not cover the

renter’s personal possessions.

Covers major perils, provides

liability protection and

provides for additional living

expenses if the dwelling is

rendered uninhabitable.

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FIDELITY INSURANCE A contract of Guarantee

to which insurance

principles apply

Guarantees the employer

for any damages or loss

resulting from the

employee’s dishonesty or disloyalty.

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INSURANCE NEED ANALYSIS By M.Vedavalli

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LIFE STAGE ANALYSIS

It is important to

understand that according

to the typical life cycle

stage one currently is in ,

insurance needs change .

So it is vital that one

knows the financial

commitments and long

term financial needs

before choosing a

product.

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MOST COMMON LIFE CYCLE STAGES

Ages – 18 to 26 years ( unmarried , young professionals )

Still be in higher education

First job

May or may not have spouse

May or may not own home

May or may not have dependents

Financial needs –

May still have support from parents

May be saving towards future

Family needs – eg. Buying home

May be paying off education loan

Likes to spend money

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YOUNG PROFESSIONAL

Life insurance needs are probably

zero as no dependents

There is possibly a need for

saving .

can take Equity Linked Insurance

Scheme ( Insurance + Investment)

Short Term Endowment

Assurance Policy

Insurance Needs:-

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POST MARRIAGE Ages – 26 to 35 ( married , with or without kids )

Probably in debt ( ex. Home loan )

Earn moderate income

high expenditure

Not much accumulated wealth

financial status –

Worried about protecting dependents in case of

prolonged illness or disability

Need to save for children

Need to support elderly parents

Need for planning a comfortable retirement phase

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This stage needs maximum insurance protection because of

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High debt , high

expenditure phase Family’s dependency Low accumulated

wealth Need for planning

retirement phase

Insurance needs are due to:

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POST MARRIAGE Ages above 35-60 ( pre-

retirement )

Older , financially independent

children

Reduced debt or repaid loans

Decreased expenditure

financial needs –

save for retirement

Enjoy a life time holiday on

retirement

Save for children

Protect dependents financially

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POST MARRIAGE AND PRE RETIREMENT Insurance needs –

Retirement planning

Wealth transfer or other saving vehicles could be used .

Emphasis should be on returns on investment

Fixed Term Insurance, Money Back Policies, Children

Policies ULIP

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POST RETIREMENT Ages over 60 (post retirement)

Move from employment to

retirement.

Debts either paid off or

minimal.

Reduced income

More accumulated wealth,

savings

Risk of running out of money

in case of long life span.

Need for long term care

Financial needs-

Need to save for spouse , for

medical expenditure of both ,also

save for children

Need to save if you live longer

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POST RETIREMENT Insurance needs –

Protection in case you

live long

Protection for spouse in

case of death

Wealth accumulation for

children

Single Premium

immediate annuities,

retirement plans which

protect capital and give

steady income.

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DETERMINING THE AMT. OF LIFE INSURANCE

Simple rules of thumb

/Income replacement Value

Human Life Value

Approach

Need Replacement concept

Methods of Insurance Need

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INCOME REPLACEMENT VALUE

Simple guidelines that can be

easily applied to a situation

Easy to use and provide a

starting point for insurance

need evaluation .

Income Rule –

Annual Income X Number of

years left for Retirement

Another rule is the insurance

requirement is10 times of gross

annual income (10 is called

Income Replacement

Multiplier)

Income replacement

Multiplier changes with

age:

AGE INCOME MULTIPLIER 25-30 5-10 30-40 15-20 40-50 10-15 50-60 5-10

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METHODS OF INSURANCE NEED ANALYSIS Income plus expenses-

This rule considers gross annual income along with cash

needs at death and any special funding needs such as

private school or tuition fees.

Under this rule the insurance requirement is 5 times the

gross annual income plus the total of any mortgage ,

personal debt , final expenses etc.

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METHODS OF INSURANCE NEED ANALYSIS Premium as a % of income-

Under this rule , 6 % of the earning member’s gross

income plus an additional 1 % for each dependent should

be spent on life insurance .

Ex. For an earning member with a non-earning spouse

and 2 dependents , the insurance premium would be ???

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METHODS OF INSURANCE NEED ANALYSIS

Disadvantages of rule of thumb –

They fail to consider the need and

circumstances of the individual . No considerations of age of the insured or

the dependents No adjustment is made for special

circumstances .

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HUMAN LIFE VALUE APPROACH

Also called Income Replacement approach.

Every individual has a human life value and insuring

human life value is primary purpose of insurance.

an individuals net worth is the PV of that person’s

future income stream that will be allocated to fulfill the

lifestyle needs of people dependent on them .

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HUMAN LIFE VALUE APPROACH 1. Estimate the individual’s average annual income from

the person’s present age to retirement.

2. Deduct the amt. that is not allocated to others eg.

Income tax self life and medical insurance premiums ,

self maintenance expenses.

3. Using reasonable rate of interest determine the PV of

the amounts allocated to others for the working period

used in step 1 .

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HUMAN LIFE VALUE APPROACH Mr. A aged 35 , earning gross income of Rs.2 lac today

will retire at the age of 65 . His personal expenses are Rs.

56000 . Current interest rate in the economy is 8 %.

Calculate HLV of Mr. A.

PV is Rs. 16.21 lacs .

Thus if MR. A doesn’t return home today , his family

will lose earning , whereas they have Rs.16.21 lac

deposited earning 8 % interest , then the family will be

able to withdraw Rs. 1,44,000 every year for 30 years , at

the end the amt. will be nil.

Thus , HLV is Rs.16.21 lac

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HLV APPROACH -CONCERNS

It does not take into account actual

needs in future .

It does not integrate with

pension plans or other sources of

income .

Considers only replacement of

income and net the lumpsum needs in

case of death.

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FAMILY NEEDS APPROACH

It assumes that the goal of life insurance is to cover the

surviving family members immediate expenses after the

death of the insured as well as the ongoing expenses of

the family members in future .

It focuses on surviving members’ financial needs rather

than the expected earnings of the insured .

Family’s needs are divided in 2 categories –

1. Immediate needs

2. Ongoing needs

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FAMILY NEEDS APPROACH

immediate needs at

death pv of ongoing

family needs expected available

assets

Life insurance to meet family

needs

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NEED ANALYSIS WORKSHEET Tool to facilitate making of Need Analysis

Provides an opportunity to refine the assessment of life

insurance needs and arrive at a Profile after assessing various parameters and grading them

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UNDERSTANDING KEY CONCEPTS Risk cover v/s investment

returns

Insurance options range from low premium policies

with that offer almost no

returns, to high premium

ones that offer returns

depending on the fund option

you choose. Buy policies

skewed towards investment

returns only if you are in the

high-tax bracket, prefer to

invest in low-risk, fixed-

income options

Whole life v/s limited period

As you grow older, the

number of dependants may

decrease (since children

would be independent). Also,

your wealth may reach a

level where it can support

your dependents financial

needs in the event of your

death. You should therefore

consider whether if you need

to insure yourself for whole

life or for a limited term.

Obviously, the cost of

insurance for the latter is lower.

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UNDERSTANDING KEY CONCEPTS The premium paid for an insurance policy also qualifies

for tax deduction under Section 80C of the Income Tax

Act. But don't buy insurance only to save tax. Read why

insurance + investment + tax = a bad combo!

How long do you want to pay your insurance premium

for? This decision depend on the following factors:

1) How many years of regular income you expect.

2) Level of your regular savings.

3) How much insurance premium you can firmly commit

to.

4) How long you want to be insured versus how long you expect to pay a premium for.

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UNDERSTANDING KEY CONCEPTS Other important questions:

1) Do you want to participate in bonus/ profit share?

2) What is the primary objective - risk cover or

investment returns?

3) Do you want accident cover?

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THANK YOU!!!

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