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Providers of insurance may organize themselves in several different ways. In some societies, people informally group together and pool their funds to help each other in times of need. Some much larger, formal insurance organizations work in much the same way. Others operate for profit.
A. Stock Insurance Companies
Some insurance providers, such as Allstate Insurance Company, operate as corporations, the form of organization common to many large businesses that operate for profit. These kinds of insurance organizations, called stock insurance companies, sell stock to shareholders whose investment provides the capital for company operations. Stock insurance companies represent the largest number of insurance companies in operation, and nearly all newly formed insurance companies.
B. Mutual Insurance Companies
Historically, individuals seeking to share risk joined together without the motivation of earning profits. This principle carries on today in mutual insurance companies. Everyone who purchases insurance from a mutual company owns a small piece of that company. In contrast to the first small mutual insurance associations, however, today’s large mutual companies, such as State Farm insurance companies and Northwestern Mutual Life, compete against stock companies for business and generally operate much like those companies. Mutuals have boards of directors elected by policyholders, and excess income goes back to policyholders as dividends.
C. Reciprocals, Lloyd’s Associations, and Cooperatives
Other forms of insurance organizations include reciprocals, Lloyd’s associations, and cooperatives. These organizations serve an important role in making insurance available to specialized businesses. Most reciprocals and Lloyd’s associations do not sell insurance to individuals.
In reciprocal insurance organizations, also known as reciprocal exchanges or interinsurance exchanges, each policyholder is directly insured by all the others. Attorneys-in-fact (contractually bound agents) manage the affairs of reciprocals for the members, and members commonly know how much liability each member of the group assumes.
Lloyd’s associations, modeled after the longstanding British insurance association Lloyd's of London, are groups of businesses and individuals who come together to underwrite (assume a portion of risk for) specific types of insurance risks. Lloyd’s associations employ independent underwriters—agents who establish insurance rules, assess the qualifications of customers to purchase insurance, and set policy rates—to make insurance contracts on their behalf. Lloyd’s associations insure a wide variety of risks faced by international businesses and, in some cases, individuals.
Cooperative organizations are nonprofit membership groups maintained and operated for the benefit of their members and subscribers. Cooperatives are prohibited by law from paying dividends or distributing profits and are exempt from most forms of taxation. Many fraternal orders also provide insurance in the same manner as cooperatives.
Buying Insurace
People face many choices when buying insurance policies. They commonly choose an insurance provider based on several criteria. Some of the most important of these include: (1) the financial stability of the insurance company, (2) the price of policies, and (3) details of coverage and service.
Only a financially sound company can fulfill its promise to pay in all circumstances. Companies with proven records of stability can provide insurance security. Choice of a provider based solely on price, on the other hand, may result in poor service and coverage, even if the provider advertises comprehensive coverage and high quality service.
Policy prices vary significantly among companies, but competition usually forces most companies’ prices into a narrow range. The greater cost of some policies may pay off in the long run through better protection. Thus, a detailed examination of coverage in policies provided by different, well-regarded companies can help consumers make the best choice based on the risks they face, their needs, and their finances.
People seeking to buy insurance often use the services of an insurance agent or broker to assist in their purchase. Precisely what services these intermediaries provide, and what they can charge, varies somewhat from state to state in the United States and among provinces in Canada. But insurance agents and brokers typically help people choose among the hundreds of policies available and among the hundreds of companies that provide insurance. Some people, however, choose to buy insurance from direct providers, who sell policies without intermediaries. Direct-provider insurance may be purchased through the mail, by telephone, or via computer on the Internet.
Claims, Benefits, and Dividens
Insured individuals who have suffered losses and want to receive payments must notify their insurance company through a process called a claim. Insurance contracts always contain a condition that the insured must provide a proof of loss in order to be paid.
A claim begins when someone who suffers a loss completes and signs a statement describing exactly what happened that led to the loss. Most insurance claims require additional supporting evidence as well. For example, a person filing a life insurance claim must provide a copy of the policyholder’s death certificate. For a health or disability claim, the insured typically must provide a doctor’s report. Someone claiming damage to an automobile usually has to provide a repair estimate to the insurance company.
Once someone files a claim and provides necessary evidence, the insurance company’s claims representative, known commonly as a claims adjuster or claims service representative, reviews it. A claims representative verifies that a claimant (person filing a claim) is entitled to the payment requested.
First, the claims representative verifies that the claimant actually purchased an insurance policy from the company and paid a premium that covered the time period when the loss occurred. For example, if a policyholder misses payments, allowing a policy to expire, the insurer would make no payments on claims made after the policy’s expiration.
The claims representative also verifies that the terms agreed upon in the policy cover the specific claim, including the particular events that caused a loss. For example, standard policies to insure people’s homes generally cover damage from such natural events as lightning and storms. However, they do not cover damage from floods or earthquakes (those kinds of coverage are sold separately). Ultimately, careful claims processing assures that other members of a claimant’s insurance group pay out as little as possible in premiums to adequately cover valid claims.
Determining The Value of Insured Property
Although policies often set coverage as a fixed amount, the value of most items or services covered by insurance changes. When someone acquires a new car, for instance, it depreciates (loses part of its value) over time. Other items, such as houses and jewelry, may appreciate (increase in value). Insurance policies can include inflation protection for very valuable items, such as houses, to allow coverage to match such increases in value.
The value of damaged property can be difficult to determine. Insurance policies often contain a promise to pay the value of an item at the time of its damage or loss, also known as its actual cash value. Publicly available resources, such as used automobile price guides, track the average market value of some used items. Insurance policies may also allow the replacement of used items with comparable used items, such as used cars purchased from classified advertisements or used car dealers.
For most types of destroyed property insurance usually covers the actual cash value of the damaged item toward the price of a new replacement. The policyholder must pay the difference. Assume, for example, that a refrigerator lasts 15 years on average. If a house fire destroys a five-year-old refrigerator, its owner loses two-thirds of the appliance’s use—that is, two-thirds of its total value. An insurance policy covering the actual cash value of the property will pay two-thirds of the cost of a new refrigerator.
Replacing used property with new items, especially in larger losses such as house fires, can create considerable financial burdens. To relieve property owners of the risks posed by large unexpected expenditures, many policies offer an option to purchase replacement cost coverage. This option, which increases a policy’s premium, pays the full cost to replace used property with new items in the event of a loss.
Insurance Policies And Coverage
An insurance policy covers the insured party (known also as the insured or the policyholder) for a specified period of time, called a term. When choosing an insurance policy, a person must decide what type of coverage to buy. This means deciding at what dollar amount of loss the coverage will begin (known as the deductible) and at what amount coverage ends (known as the policy limit). Both influence the cost of a policy, which is expressed as the price of a regular, repeated payment (known as the premium).
Different types of insurance policies provide different amounts of coverage. They also provide coverage in different ways. Some policies, such as life insurance, determine an amount of coverage in advance. An insurance company pays the full amount of such a policy, called its face value, whenever a covered loss occurs. Most other types of insurance policies determine how much to pay according to what kinds of losses policyholders experience. Such policies specify a maximum amount they will pay. For example, a policy covering a home against fire for $100,000 would pay for damages up to $100,000, but no more.
A.Policy Term
Policy terms commonly range from six months to many years. At the end of that term, the seller and buyer may agree to renew the contract if they wish. Only permanent life insurance does not specify a finite term. These policies, also called ordinary life insurance or whole life insurance, commit the insurance company to provide coverage for the lifetime of the person insured.
B. Policy Limit
Insurance policies also specify an amount at which coverage ends, known as the policy limit. Most types of insurance specify the limit as a dollar amount written in the contract. For example, an automobile insurance policy with $10,000 of collision coverage pays up to $10,000 for damage caused by an accident. For property insurance, the policy limit may not exceed the value of the property, which may either be a fixed amount or an amount based on figures such as the costs of replacing property.
C. Deductible
Insurance policies generally include an initial amount of expense that an insured person must pay when a loss occurs. This expense is known as the policy’s deductible. The deductible is the amount of loss a policyholder agrees to pay without protection from an insurance company.
Selecting a $500 deductible on auto insurance, for instance, equals an agreement to pay up to $500 for damage to a car in the event of an accident. Under such an agreement, the insurance company will pay for losses exceeding $500. Therefore, if someone holding such a policy has an accident costing $1000 to repair, the insurance company will pay $500 toward that repair.
The premium for an insurance policy varies according to the level of its deductible. For example, a policy with a $500 deductible costs less than one with a $250 deductible, because the lower the deductible, the more the insurance company has to pay for a loss.
D. Premium
An insurance company sets a policy’s premium by multiplying a rate for each unit of insurance coverage by the total amount of coverage being purchased. Assume, for example, that term life insurance for 35-year-old men has a rate of $1.10 for $1000 of coverage for one year. Based on this rate, a 35-year-old father who wants $500,000 of coverage to protect his family in the case of his death will pay a premium of $1.10 times 500, or $550 for one year of coverage. Most people pay insurance premiums once or twice a year. Other people choose to make automatic monthly payments to their insurance company from a bank account.
Actuaries, experts in determining insurance rates, compute insurance rates using information not available to consumers. To compute rates, they first estimate expected losses in the coming year, based on statistics from previous years. Next they figure how much money will be needed to pay for those losses. They then divide that amount by the number of people needing insurance protection.
Consider, for example, the risks faced by 1000 people, each of whom just purchased a $25,000 car. Using statistics from past losses, an insurance company predicts that 10 of the 1000 cars will be destroyed in accidents during the next year, and 65 will be damaged. The company estimates that payments to cover the damage and destruction to these 75 cars will cost a total of $450,000. If the company collects $450 that year from each of the 1000 car owners, it should have almost exactly the funds it needs to cover those 75 out of 1000 car owners who experience losses.
In this example, each car owner would actually have to pay more than $450 to support part of the costs of the insurance company’s operations, leave some profit for the company, and leave some room for error in the company’s estimates. Also, 925 of the people who buy the insurance will have no accidents and will make no claims. Their payments will go to cover the losses of the 75 people who have accidents. But since none of the 1000 car owners knows whether or not they will have an accident, they each agree to pay the premium, even though it may go toward paying for a portion of someone else’s losses.
Although this example of computing premiums appears fairly simple, real life examples prove far more complicated. For instance, different cars have different repair costs. Car owners drive different distances and have different driving habits. Each accident can result in a different kind and degree of damage. In addition, car insurance policies typically cover much more than just damage to the driver’s automobile. By U.S. state laws, for instance, drivers generally must have some coverage for damage they cause to other cars and for medical care for other drivers and passengers injured in an accident. Taking all of these factors into consideration, the task of determining insurance rates becomes quite complex. Actuaries use statistical calculations and computer programs to make these computations.
Different types of insurance policies provide different amounts of coverage. They also provide coverage in different ways. Some policies, such as life insurance, determine an amount of coverage in advance. An insurance company pays the full amount of such a policy, called its face value, whenever a covered loss occurs. Most other types of insurance policies determine how much to pay according to what kinds of losses policyholders experience. Such policies specify a maximum amount they will pay. For example, a policy covering a home against fire for $100,000 would pay for damages up to $100,000, but no more.
A.Policy Term
Policy terms commonly range from six months to many years. At the end of that term, the seller and buyer may agree to renew the contract if they wish. Only permanent life insurance does not specify a finite term. These policies, also called ordinary life insurance or whole life insurance, commit the insurance company to provide coverage for the lifetime of the person insured.
B. Policy Limit
Insurance policies also specify an amount at which coverage ends, known as the policy limit. Most types of insurance specify the limit as a dollar amount written in the contract. For example, an automobile insurance policy with $10,000 of collision coverage pays up to $10,000 for damage caused by an accident. For property insurance, the policy limit may not exceed the value of the property, which may either be a fixed amount or an amount based on figures such as the costs of replacing property.
C. Deductible
Insurance policies generally include an initial amount of expense that an insured person must pay when a loss occurs. This expense is known as the policy’s deductible. The deductible is the amount of loss a policyholder agrees to pay without protection from an insurance company.
Selecting a $500 deductible on auto insurance, for instance, equals an agreement to pay up to $500 for damage to a car in the event of an accident. Under such an agreement, the insurance company will pay for losses exceeding $500. Therefore, if someone holding such a policy has an accident costing $1000 to repair, the insurance company will pay $500 toward that repair.
The premium for an insurance policy varies according to the level of its deductible. For example, a policy with a $500 deductible costs less than one with a $250 deductible, because the lower the deductible, the more the insurance company has to pay for a loss.
D. Premium
An insurance company sets a policy’s premium by multiplying a rate for each unit of insurance coverage by the total amount of coverage being purchased. Assume, for example, that term life insurance for 35-year-old men has a rate of $1.10 for $1000 of coverage for one year. Based on this rate, a 35-year-old father who wants $500,000 of coverage to protect his family in the case of his death will pay a premium of $1.10 times 500, or $550 for one year of coverage. Most people pay insurance premiums once or twice a year. Other people choose to make automatic monthly payments to their insurance company from a bank account.
Actuaries, experts in determining insurance rates, compute insurance rates using information not available to consumers. To compute rates, they first estimate expected losses in the coming year, based on statistics from previous years. Next they figure how much money will be needed to pay for those losses. They then divide that amount by the number of people needing insurance protection.
Consider, for example, the risks faced by 1000 people, each of whom just purchased a $25,000 car. Using statistics from past losses, an insurance company predicts that 10 of the 1000 cars will be destroyed in accidents during the next year, and 65 will be damaged. The company estimates that payments to cover the damage and destruction to these 75 cars will cost a total of $450,000. If the company collects $450 that year from each of the 1000 car owners, it should have almost exactly the funds it needs to cover those 75 out of 1000 car owners who experience losses.
In this example, each car owner would actually have to pay more than $450 to support part of the costs of the insurance company’s operations, leave some profit for the company, and leave some room for error in the company’s estimates. Also, 925 of the people who buy the insurance will have no accidents and will make no claims. Their payments will go to cover the losses of the 75 people who have accidents. But since none of the 1000 car owners knows whether or not they will have an accident, they each agree to pay the premium, even though it may go toward paying for a portion of someone else’s losses.
Although this example of computing premiums appears fairly simple, real life examples prove far more complicated. For instance, different cars have different repair costs. Car owners drive different distances and have different driving habits. Each accident can result in a different kind and degree of damage. In addition, car insurance policies typically cover much more than just damage to the driver’s automobile. By U.S. state laws, for instance, drivers generally must have some coverage for damage they cause to other cars and for medical care for other drivers and passengers injured in an accident. Taking all of these factors into consideration, the task of determining insurance rates becomes quite complex. Actuaries use statistical calculations and computer programs to make these computations.
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