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Insurance is a special form of contract
between insured and insurer (policy holder and insurance company). In return for the payment of premiums
the insurers indemnify the insured against certain insurable
(measurable) risks.
Indemnity means that the insurers agree
to compensate in the event of loss such that the insured is
left substantially in the same position financially after the loss
as she was before it - the insured cannot profit from a loss!
An insurance contract is one of utmost good
faith. What this means is that all material facts
about an insured risk must be disclosed to the insurers at
the time of completing the proposal form, or subsequently if
the facts change.
If you misrepresent the facts about a risk to your
insurers they will quite happily take your premiums without
question. However, in the event of a loss everything is investigated
- your insurance becomes void - in fact if you misrepresent material
facts you are not insured!
You must have an interest (insurable
interest) in the thing insured. If you could insure something
which you did not have an insurable interest in (ownership of) it
would be possible to gain in the event of another's loss!
In the event of a claim and where the thing
reinstated improves the insured's position, the principle of betterment
applies. In this case a financial payment is required of the
insured.
For example, following a fire, it may not be
possible to replace a
roof in the same dilapidated condition as the old one. Following
the principle of indemnity, the insured is now in a better
financial position with a new roof than before, therefore betterment
applies.
The insured therefore must pay something
towards the cost of the replacement.
The betterment principle can be varied where
the final compensation for loss is an agreed value beforehand, or
where the policy is based on an agreed replacement of new-for-old.
If more than one policy covers the same risk
it is not possible for the insured to claim on both and make a gain.
In this situation each of the insurers involved would be required to
contribute a proportionate amount of the loss - this is known as the principle
of contribution.
In the event of a claim and where the insurers
have fully indemnified the insured, the insured's original interests
can be taken over by the insurers - this is known as the principle
of subrogation.
For example, where a third party causes damage
to the insured's property, after the insurers have settled the claim
they can pursue the third party for the cost of the
damage.
Underinsurance can have serious
implications when insuring a property. Underinsurance means that the
replacement value of the property or the value of the contents has
been understated on the proposal, thereby lowering the premiums
paid.
In an underinsurance situation, in the
event of a claim, the loss adjuster will average the compensation
paid.
The principle of average means that the
amount of the claim payment will be reduced proportionality if the
property was not insured to the full amount of its replacement cost.
An important point for landlords: if you rely
on an insurance agent to complete your proposal form and to
set replacement values, bear in mind that the agent is usually your
agent and not the insurance company's agent.
If your agent makes a mistake,
misrepresents material facts or miscalculates values and replacement
costs, then it is your mistake, not the insurance company's
mistake.
Your only redress on facing a loss in this
instance would be against your insurance agent on professional negligence
grounds!
In the event of a claim the insurers will want
to ascertain if the cause of the loss was an insured risk. The principle
of proximate cause relates to this and is define as: The
efficient cause which brings about a loss with no other intervening
cause which breaks the chain of events. An
example of this might be where belongings were removed from a house
in the event of a flood, stored in an outside yard and subsequently
damaged by rain. Was the proximate cause of the loss of the
belongings the flood or the rain? If
the owner had made every attempt to protect the items quickly that
the proximate cause would be deemed to be the flood. If however, the
owner had neglectfully left the good unprotected for an
excessive length of time the proximate cause would be deemed to be
the rain.
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