Insurance Project : Risk
Insurance Project : Risk
Insurance Project : Risk
Assignment
TOPIC: Risk
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INDEX
1. General Introduction 3
2. Underwriting of Risk 3
9. Conclusion 20
10. References 22
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Acknowledgment
Thanking you.
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INTRODUCTION
In the today’s complex and busy life risk is at every step. So, these days insurance
has become essential for managing risk. The insurance company collects the premium from
insuring public and act as a trustee to the amount so collected. In case of any unexpected
incident the loss is paid out of the premium so collected. Today, it is only the insurance
company which prays for the longer life of insured.
UNDERWRITING OF RISK
The most complicated aspect of the insurance business is the underwriting of policies.
Using a wide assortment of data, insurers predict the likelihood that a claim will be made
against their policies or not and price the products accordingly. To this end, insurers use
actuarial science to quantify the risks they are willing to assume and the premium they will
charge to assume them. Data is analyzed to fairly and accurately project the rate of future
claims based on a given risk. Upon termination of a given policy, the amount of premium
collected and the investment gains thereon minus the amount paid out in claims is the
insurer’s underwriting profit on that policy. From the insurer’s perspective, some policies are
“winners” and some are “losers”, the insurance companies essentially use actuarial science to
attempt to underwrite enough “winning” policies to pay out on the “losers” while
stillmaintaining the profitability. Thus, underwriting is the process of deciding to reject or
accept an insurance proposal depending upon the risk factor.
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Meaning and Definition of Risk
There is no definite or commonly accepted definition of term ‘risk’. However for the
purpose of insurance, this term refers to the future risk of loss. A few definitions of the term
‘risk’ as given by well known authorities on the subject are as follows:
Risk is the name of uncertainty and uncertainty is one of the basic realities of life. “In
this world, nothing can be said to be certain except death and taxes”. Therefore, uncertainty
and risk remain in every part of life.
-Benjamin Franklin
“Risk is the chance of loss or injury”
- Frank H. Knight
“Risk is the variation in the possible outcome that exists in nature in a given
situation”.
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Risk Covered in Life Insurance Policy
Human life has many probable uncertainties and risks such as untimely death,
disability, fatal illness as well as a very long life. These risks can be successfully countered
with the help of life insurance.
The ultimate objective of life insurance contract is to save the insured from economic
loss caused by the loss of life or any other unfortunate event. Thus, the scheme of life
insurance policy basically covers the risk of death. In case of death, insurance company pays
full sum assured, which is several times larger than the total of the premium paid and thereby
saves the family from the financial strain due to unforeseen and premature death.5
Risk in life insurance is the risk of death at an early date due to disease as
distinguished from accident. In Thomson v. Weems (1884) 9 AC 671, 681 ,it was observed that
those insurers whose business is to insure lives calculated on the average rate of mortality and
charge a premium which on that average will prevent losses.
Hence, in life insurance, facts which tend to shorten the span of the life assured would
amount to the circumstances affecting the risk and these facts are regarded as material facts
for purposes of the duty of disclosure.
(a) Age
The age of the life who is assured is the most important factor to affect mortality. The
insurance company asks for the age nearer to birth days. A person of 22 years 7 months and
another person of 23 years 5 months are treated of the age of 23 years. The age proof is very
essential for calculating premium rate. The maximum and minimum limit of age is fixed to
avoid risk of mortality.
(b) Build Up
It includes- height, weight, and the distribution of weight and chest expansion of the
person to be insured. Overweight is the indication of certain hidden diseases, underweight is
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also not very desirable. If the assured life is not within the standard the proposal may not be
accepted.
(f) Occupation
The nature of his/her occupation and the factors in occupation that contribute to
enhancing the risk are taken into consideration. If the nature of work is hazardous it will
surely increase the degree of insurance risk. Factory workers employed in chemical factories,
match factories run the risk of contacting poison. The dirty and unhealthy environment
deteriorates the health of the workers.
(g) Residence
The insurance risk will be lesser in a good climate area and more in a bad climate.
The geographical location, atmosphere, political stability, climate, travel, etc. greatly affect
the degree of risk. Therefore, all these factors are given due consideration while assessing
risk and the amount of premium.
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(h) Present Habits
Living standard and personal habits of a person like smoking, drinking, yoga, cycling,
walking etc. also have an impact on the risk factor involved. Non temperate habits cause
increase in mortality and temperate habits tend to increase longevity of a person.
(i) Morals
Departure from accepted standards of ethical and moral conduct involves extra
mortality. Unethical conduct is considered to be a moral hazard. So, insurance is not given to
bankrupt and reputed dishonest persons.
(k) Gender
Mortality among female sex is higher than that of male sex, because of the physical
hazard of maternity in the former case.15 Other factors which are also given due
consideration in selection of risk are economic status of the person to be insured, nature of his
Based on these risk inducing factors, the underwriter assess the premium, if the life
falls within any substandard class, extra premium is levied. Besides these factors, the
underwriter also takes into account the type of cover required by the proponent, the sum
assured and the possibility of any moral hazard.
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Meaning and Definition of Underwriting
Underwriting basically means investigating and verifying the economic, physical and
social conditions of a person while accepting the risk for his life.
2. “Underwriting is selection of risks for the insurers and determination of what amounts and
what terms acceptable risks will be insured”.
In light of above definitions, we may conclude that underwriting is the process of deciding
whether to accept or reject an insurance proposal based on the risk factors.
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So, it primarily involves assessment and evaluation of risk involved in a life insurance
proposal. If the risk is wrongly assessed, the premium charged would not be appropriate. A
lower premium affects the solvency of the fund. The cost of the additional risk, not recovered
from the proposer would have to be borne by the rest of the policy holders. That is not fair to
them. A decision to charge a premium higher than necessary would not be fair to the
proposer, because of the principle of utmost good faith. ‘Underwriting’ has implications of
fairness to the insurer and to policyholders, individually and collectively. The need and
importance of underwriting has been discussed under following heads:
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Underwriting Process
Such kinds of information can be obtained from the agents, reports of inspectors,
The next step is to classify the collected information qualitatively and quantitatively.
When the collected information is classified, the next step should be to analyze the
information with the help of statistical methods. In order to analyze the individual based
information, the underwriter should use his own rationality and experience, so that accurate
analysis would be possible.
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(d) Developing Alternatives
In case the report of the analysis reveals that a proposal is unsuitable for acceptance,
the underwriter should consider the following alternatives:
iii. Is it beneficial to change the premium rate and accept the proposal?
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Doctrine of Utmost Good Faith
Insurance contracts are a special class of contracts, one of the distinctive features of
which is that they are based on the rocky foundation of utmost good faith. Such good faith is
not a matter of art, but has to be really and sincerely appreciated by the insured.30 Therefore,
a higher duty is expected from the parties to an insurance contract in order to ensure the
disclosure of all material facts so that the contract may accurately reflect the actual risk being
undertaken.
(a) Evolution
The doctrine of uberima fides owes its origin to British Maritime Insurance Law. The
principles underlying this rule were stated for the first time by lord Mansfield in Carter v.
Boehm (1766) 97ER 1162, 1164 “Insurance is a contract of speculation, the special facts upon
which the contingentchance is to be computed lie most commonly in the knowledge of the
insured only; the underwriter trust his representations and proceed upon confidence that he
does not keep back any circumstance in his knowledge, to mislead the underwriter into a
belief that the circumstances does not exist. Good faith forbids either party from concealing
what he privately knows, to draw other into a bargain from his ignorance of that fact, and his
believing the contrary”. This principle was confirmed by Lord Blackburn in Brownlie v.
Campbell (1880) 5 App Cas 925 over a hundred years later. Soon after Lord Blackburn’s
statements, the commonlaw of marine insurance was codified in the Marine Insurance Act,
1906.
(b) Meaning
Uberima fides is a Latin phrase which means utmost good faith. It is a legal doctrine
which governs insurance contracts. This legal doctrine lays down a minimum standard that
requires both the buyer and seller in a transaction to act honestly towards each other not to
mislead or withheld critical information from one another. In insurance market the doctrine
of utmost good faith requires that each party to a proposed insurance contract must disclose
to the other all information which would influence his decision to enter into the contract,
whether such information is requested or not. For example, if you are taking a life insurance
policy, you are required to disclose any previous health problem you may have had likewise,
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the insurance agent selling you the coverage must disclose the critical information you need
to know about you contract and its terms.
“As the underwriter knows nothing and the man who comes to him to ask him to insure
knows everything, it is the duty of the assured...... to make a full disclosure to the underwriter
without being asked of all material circumstances.
Thus, a contract of life insurance survives essentially on principle of utmost good faith.
The duty to make full and complete disclosure rests on both the parties i.e. the insurer
as well as the insured. In Lakshmi Insurance Company v. Bibi Padmavati, it was held that the
contracting parties are placed under a special duty towards each other, not merely to refrain
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from active misrepresentation but also to make full disclosure of all material facts within their
knowledge.
In a life insurance contract if the proposer has answered all the questions of proposal
form fully and correctly to the best of his knowledge and belief he has done his duty unless
he has knowledge of some other facts which are material to the contract. In defense of a non-
disclosure the proposer cannot say that he had omitted to disclose it by carelessness or
mistake or that he did not regard the matter as material. The facts on which no questions are
asked are assumed to be considered immaterial or waived off by the insurer. However, in the
case of Asima Sarkar v.Western India Life Insurance Co. Ltd. the Calcutta appellate Court
held that the fact that the previous declined card (with information that earlier on insurer had
considered this person as uninsurable) was available with the insurer, would not by itself
suffice to draw the inference of waiver of this information. 'Waiver' would operate if the
office had actually taken such facts into consideration.
The insured's duty to make full and complete disclosure continues during the period
of negotiations for the formation of the contract of insurance and up to the moment when a
binding contract is finally concluded and covers any material alteration in the character of
risk which may take place between the proposal and acceptance of risk by payment of first
premium.45 Thus, the duty of disclosure operates till the risk commences. Circumstances
which may have arisen after the risk has commenced do not affect the validity of the contract,
unless the conditions of the contract make relevant stipulations to that effect. For example,
any change in occupation does not affect the contract unless the policy is issued with a
condition that any change in occupation must be notified to the insurer. However, if the terms
of policy are altered, or for any reason the continuance of the contract is subject to approval
by the insurer, there would be a duty to disclose all material facts at that time. Thus, there is
no duty to inform the insurer about changes in the nature of risk taking place after the risk has
commenced.
A material fact is one which would affect the judgment of a prudent insurer in fixing
the premium or in considering whether and upon what terms the insurer would accept . It
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means that the duty of disclosure extends not only to facts which the insured knows, but also
to those which he, as a reasonable person, ought to have known and which are in fact material
whether he thinks them to be so or not. Joel v. Law Union and Crown Insurance Company, (1908) 2 KB
863CA. According to Evamy, the duty of disclosure is confined to such facts which he ought
in the ordinary course of business to have known and he cannot escape the consequences of
not disclosing them on the ground that he did not know them.
In Banarsi Devi v. New India Assurance Co. AIR 1959 Patna 540 it was laid down that
material fact has a direct bearing on the degree of risk in relation to the subject matter of
insurance. For example, in life insurance contracts, material facts are age, income, type of
occupation, habits, health, family history, earlier policies and loss, if any, suffered in past. As
the material facts are determined not on the basis of opinion, the proposer should disclose not
only those matters which the proposer may feel are material but all the facts which are
material. The burden of proving that a fact not disclosed or misrepresented is material, lies
upon the insurer. Stebbing v. Liverpool & London and Globe Insurance Co. L.t.d, (1917) 2 KB 433. When
the insured proves his policy and proves his loss, that puts the insurance company on their
defense and if they fail to make out their defense their case would fail. If they fail to prove
that there was a misrepresentation or concealment of material facts, they would be liable.
Thus, every circumstance that would have a bearing on the judgment of a prudent insurer in
fixing the premium or determining the acceptability of the proposal for insurance is a material
fact.
Facts which must be disclosed are circumstances which would influence the insurer in
accepting or declining a risk or in fixing the premium or terms and conditions of the contract.
It was held that the duty of the assured to disclose all material facts is limited only to facts
known to him. There is no obligation on the assured to give details as to the factual basis of
his belief. The fact must be material at the date at which it should be communicated to the
insurer. A fact which was immaterial when the contract was made, but becomes material later
on, need not be disclosed. There is one exception to the rule and it occurs when there is a
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policy condition requiring continuous disclosure, otherwise, the facts which must be
disclosed are:-
i. Facts, which show that the particular risk represents a greater exposure than, would be
expected from its nature or class;
ii. External factors which make the risk greater then would normally be expected;
iii. Previous losses and claims under other policies;
iv. Any special term imposed on previous proposals by other insurers;
v. The existence of other non-indemnity policies such as life and accident; and
vi. Full facts relating to the description of the subject matter of insurance.
(j) Facts need not be Disclosed by the Insured
The following facts, however, are not required to be disclosed by the insured:-
In Bhagwani Bai v. LIC of India, AIR 1984 M.P.126 (130). it was held that insurer cannot avoid or
repudiate an insurance policy on the ground of non-disclosure of lapsed policies by the
assured which had no bearing on the risk taken by the insurer.
It is worth-mentioning here that in absence of utmost good faith the contract would be
voidable at the option of the person who suffered loss due to non-disclosure or
misrepresentation. The inadvertent concealment will be treated as fraud and the contract will
be void ab-initio. But misrepresentation or even silence amounting to fraud will not entitle a
party to avoid the contract if he had the means of discovering the truth with ordinary
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iligence and did not do so. However, as and when the voidable contract has been validated by
the party not at fault, the contract cannot be avoided by his later on.
company and the onus is a heavy one. The duty of good faith is of a continuing nature as such
no material alteration can be made to the terms of the contract without the mutual consent of
parties.
Good faith and malicious intention cannot go hand in hand. A life insurance contract
being a contract of good faith cannot accommodate a term which might inherently
incorporate moral hazards and a self-inflicting harm to one by obliging the insurance
company to pay the dependents. For example, the holder of a life insurance policy may kill
himself. Moral hazard is a situation where an insured deliberately brings about the loss
insured against. Moral and Morale hazards are controversial issues of uberima fides in a life
insurance contract. In life insurance, suicide or any wrongful act by the assured leading to his
death should ordinarily vitiate the liability of the insurance from the liability under insurance
contract. But keeping in mind the psychological stress the person undergoes to commit
suicide, will it be alright to absolve, the insurance company from liability to pay the agreed
amount, by far fetching and far stretching interpretation of the principle of moral hazard in
life?
The principle of Uberimma Fides is an integral part of insurance law. It gives a fair
chance of risk assessment to the insurer and also ensures that the ensured fully understands all
the terms and conditions of the contract. Developments in law and technological
advancement have further made it possible for both the parties to see to it that their interest is
taken care of. But still, there are several grey areas to this doctrine as well. All these issues
need to be taken care of and an effective solution must be provided considering that the
principle of utmost good faith is one of the most fundamental principles associated with
Insurance Law.
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Conclusion
However, unless premium is paid there is no insurance cover. In case of unexpected event the
insurance company gives the claim.
Details of the contingencies under which benefits are payable, are specified in the
policy. When these contingencies occur, the benefits have to be claimed by the policy holder
or the beneficiaries, as determined under various provisions of the policy and law. Claims
may arise because of survival up to the end of the policy term, which is the date of maturity
(Maturity Claims), survival up to a specified period during the term (Survival Benefits), death
of the life assured during the term (Death Claims).
While settling the claim insurer desires certain documents like proof of death, cause of
death, proof of title, the certificate of disability and any other document to pay the sum
assured along with bonus after deducting the unpaid premium if any to the legal heirs. The
Insurer will also verify that there is no attachment of policies from the Court or Income Tax
Department.126 Most claims are settled by issuing a cheque within 7 days from the time they
receive the documents. However, if the insurer is unable to deal with the claim or any part
thereof he notifies the same to the insured in writing. However, settlement of claim does not
always mean paying all the claims promptly but rather to pay the genuine claims and reject
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the in genuine ones. The life insurance industry is suffering from inefficiencies in the claim
management process and life insurers across the globe are looking to reduce cost and improve
customer retention.
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References
http:// www.investopedia.com/terms/d/doctrine-of-utmost-good-faith/asp.
www.ericjeanvinney.blogspot.com/2010/04/doctrine-of-utmost-good-faith.html.
M.J. Mathew, “Insurance: Principles and Practice”, (2013) Seventh Edition, , RBSA
Publishers, Jaipur
B.S. Bodla and M.C. Garg, “Insurance: Fundamentals, Environment and Procedure”,
(2004), Deep & Deep Publications, New Delhi.
J.K. Choudhary, “Career in Insurance”, (2011), p.7, Holiday Book Store, Panchkula.
M.J. Mathew, “Risk Management and Insurance”, (2010), p.113, RSBA Publishers,
Jaipur.
Kshitiz Patukale, “Insurance for Everyone”, (2009), , Macmillan India Ltd., New Delhi
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