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FIL 250 - ins oper

Insurance operations and regulation

actuary An applied mathematician who is involved in all phases of insurance company operations, but especially ratemaking and establishing reserves.
ratemaking Process by which insurance pricing or premium rates are determined for an insurance company
Reinsurance An agreement by which the primary insurer that writes an insurance policy transfers part of the risk (and premiums) to another insurer (called the reinsurer)
ceding company (primary writer) Insurer that writes the policy initially and later shifts part or all of the coverage to a reinsurer
claims adjustor Person who settles claims: can be an agent, company adjustor, independent adjustor, adjustment bureau, or public adjustor
independent adjustor A claims adjustor who offers services and is hired by insurance companies to help pay claims on their behalf
public adjustor Claims adjustor who represents the insured and is paid a fee based on the amount of the claim settlement; often employed in cases where the insured and insurer cannot resolve a dispute over a claim, or in a complex loss situation
Production department Department where the sales and marketing activities of insurers takes place
underwriting The selection and classification of applicants for insurance through a clearly stated company policy consistent with company objectives
Mutual insurer Insurance company owned by the policy owners, who elect the board of directors. The board appoints managing executives, and the company may pay a dividend or give a rate reduction in advance to insureds.
Advance premium mutual Mutual insurer that does not issue assessable policies but charges premiums expected to be sufficient to pay all claims and expenses
assessment mutual Mutual insurer that has the right to collect additional money (above charged premiums) from policy owners for higher than expected losses and expenses
agent Someone who legally represents the insurer, has the authority to act on the insurer’s behalf
broker Often used to help companies find insurance, brokers legally represents the insured. They are still compensated by the insurer who wins the business
Agency building system Including the general agency system and the managerial system, it is used in life insurance by which an insurer builds its own agency force by recruiting, financing, training, and supervising new agents
general agency system Agency building system in which the general agent is an independent businessperson who represents only one insurer and is responsible for hiring, training, and motivating new agents
managerial system Agency building system where branch offices are established and the branch manager is an employee of the company with the responsibility of hiring and training new agents. The expenses of the office are paid by the insurer.
demutualization The conversion of a mutual insurer into a stock insurer
direct response system A method where insurance is sold without the services of an agent; potential customers are solicited by media advertisements
fraternal insurer a type of mutual insurer that provides life and health insurance to members of a social organization
Independent agency system A system in which the agent is an independent businessperson representing several insurers.
Lloyd’s of London World’s leading insurance market that provides services and physical facilities for its members to write specialized lines of insurance
Non-admitted insurer Insurer used only when insurance cannot be obtained from an admitted insurer
Reciprocal exchange an unincorporated mutual in which insurance is exchanged among members and which is managed by an attorney-in-fact
stock insurer An insurance corporation owned by stockholders
Non-building agency system System by which a life insurer sells its products, not by building its own system of agents, but rather through established agents who are already engaged in selling life insurance or similar products
Personal producing general agent An above-average salesperson with a proven sales record who is hired primarily to sell life insurance under a contract that provides commissions
Surplus line broker Specialized broker licensed to place business with a non-admitted insurer
Medical information bureau (MIB) An organization that supplies underwriting information in life insurance to member companies, which report any health impairments of an applicant for insurance
policyholder surplus difference between an insurance company’s assets and its liabilities. Heavily scrutinized by regulators
file and use Law for regulating insurance rates under which companies are required only to file the rates with the state insurance department before putting them into effect
use and file Law where insurers can put into effect immediately any insurance rate changes, but the rates must be filed with regulatory authorities within a certain period after first being used
open competition Law for regulating insurance rates under which insurers are not required to file rates at all with the state insurance department but may be required to furnish rate schedules and supporting data to state officials
guaranty funds provide for the payment of unpaid claims of insolvent property and casualty insurers
Paul v. Virginia 1868 US Supreme Court case that established the rights of states, and not the federal government, to regulate insurance, ruling that insurance was not interstate commerce
South-Eastern Underwriters Association case 1944 ruling that overturned Paul v. Virginia, finding that insurance was interstate commerce when conducted across state lines and was subject to federal regulation
McCarran Ferguson Act 1945 law stating that continued regulation of the insurance industry by the states is in the public interest and that federal anti-trust laws apply to insurance only to the extent that the industry is not regulated by state law
Financial Modernization Act (Gramm-Leach-Bliley) states that insurers, banks, and investment firms are no longer prevented from competing in other financial markets not in their ‘core’ area of operations
NAIC (National Association of Insurance Companies) a group founded in 1871 that meets periodically to discuss industry problems and draft model laws in various areas and recommends adoption of these proposals by state legislators
Rebating a practice, illegal in virtually all states, of giving a premium reduction or some other financial advantage to an individual as an inducement to purchase the policy
twisting illegal practice of inducing a policyowner to drop an existing policy in one company and take out a new policy in another through misrepresentation or incomplete information
risk-based capital (RBC) Under NAIC standards, insurers are required to have a certain amount of capital that is based on the riskiness of their investments and operations
proportional reinsurance includes pro rate and surplus share. All premiums, claims, and policy limits are shared are a straight percentage basis.
quota share (pro rata) reinsurance premiums, claims, and policy limits are shared on a percentage basis that is specified in the contract (e.g., 25% / 75%)
surplus share reinsurance premiums, claims, and policy limits are shared on a percentage basis that varies from contract to contract based on a specified retention level chosen by the direct writer
non-proportional reinsurance primary insurer pays claims to a specified level and reinsurer pays losses above that amount.
Created by: isufil250
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