Home > Flashcards > Print Preview
The flashcards below were created by user
on FreezingBlue Flashcards. What would you like to do?
Who has insurable interest?
The REGISTERED OWNER.
An auto policy (OAP1) is purchased by the registered owner of the auto. They have insurable interest. The owner is the named insured.
What is Liability Coverage for?
to provide financial protection for the insd's legal liability for: Bodily Injury and Property Damage arising from the ownership or directly or indirectly from the use or operation of the automobile.
How can one be held legally liable?
the driver or owner must have deliberately caused the injury or damage or be considered negligent to some degree.
Is TP liability insurance mandatory?
YES - TP liability insurance is mandatory in all provinces and no auto policy may be issued for less than $200,000 ($500,000 in NS and $50,000 in QC).
Why do we need adequate TP liability insurance?
The possibilities of being involved in an accident and being found negligent and therefore responsible to TP's are increasing constantly. They are mainly caused by:
- 1. the increasing # of cars & drivers
- 2. the continual increase in the # of accidents
What are the exclusions to liability insurance?
- - Insd's own property or carried contents
- - Contamination of property being carried
- - Nuclear hazards
- - Amounts over the policy limits purchased
Under liability coverage, who will be indemnified?
- Every owner's policy insures:
- - the person named
- - every other person who drives w/owners consent
- - is an occupant
Under liability coverage, outline what 2 types of coverages provided.
- For property = DCPD
- --> damages to auto; its contents; & loss of use
- For injuries = Liability for Injury Claims
- --> right to sue threshold of "death or permanent serious disfigurement or permanent serious impairment of an important physical, mental or psychological function"
What is the basic rule regarding jurisdiction for accidents outside of Ontario?
Basic rule is that the insurer will follow the laws of the jurisdiction where the loss occurred, not the laws where the insured lives.
How is liability determined?
- Fault Determination Rules.
- Liability is determined taking into consideration all parties who contributed to mva. Used in Ontario, similar to QC approach
Are Fault Determination Rules used if insured hits a tree?
NO - fault determination rules apply ONLY to vehicle-to-vehicle damage, not to other damage such as collision w/ a building, bridge or tree. Tort will apply in these cases.
Why is it so important that only the names of the registered owner(s) are on the policy?
Only the owners have an insurable interest. By incorrectly showing individuals that do not own the vehicle, you could be extending perceived benefits.
Why was DCPD introduced?
Ontario introduced DCPD in June 1990 to act similarly to previous tort procedures where insd recovered at-fault amounts from TP's insurer.
DCPD allows insureds to recover from and deal with their OWN insurers.
What does DCPD cover?
- Their own insurers will indemnify them for:
- 1. The cost of repairs
- 2. Damage to contents carried in the vehicle
- 3. Loss of use
What are the 2 main conditions to DCPD?
- 1. extent that they are NOT at-fault, and
- 2. the damage occurs in ONTARIO, both vehicles have ON policies, or outside ON are bound by DCPD
Give an example of a DCPD claim.
If you are for example, 100% at-fault, you cannot claim anything under DCPD.
If you are 50% at-fault, DCPD will pay 50% & the rest must come from either an endorsement or out-of-pocket.
If endorsements (such as own damage) were not purchased, only DCPD applies.
Describe "struck" as it relates to DCPD.
A claim could be made under DCPD even if the other driver has not directly struck the vehicle. The other driver could indirectly force the insd off the road causing vehicle damage.
When vehicles involved in auto business (such as towing, garage, parking, etc.) are found negligent for causing an accident, what may the insurer do?
If a contents loss is over $20,000, what may the insurer do?
The insurer may recover from the insurer of the at-fault party the amount that is over $20k
Can the insured sue the at-fault party if they are both covered by DCPD?
NO - the insured is prevented from suing any other person involved in the accident for damage or loss of use unless the negligent party is insured w/ an insurer outside of ON and that insurer is not a subscriber to the DCPD agreement.
With regards to fault determination rules, what can an insured do if they do not agree?
If insured is unsatisfied with the degree of fault and/or the settlement, they may sue their own insurer (not the TP's insurer)
What is the standard deductible in Ontario for all physical damage claims?
All physical damage claims (ie. collision, comprehensive, and all perils, as well as DCPD) are subject to a standard deductible of $500.
There are provisions to reduce or eliminate this deductible on all these coverages.
Does DCPD for contents apply to contents being carried for reward?
The right to sue for injuries is based on a "threshold" which defines the conditions to sue. Define "threshold".
Threshold definition is currently: "death or permanent serious disfigurement or permanent serious impairment of an important physical, mental or psychological function"
A threshold is the degree of injury a claimant must establish before being allowed to commence a legal action against the responsible party. It may be a dollar amount or a verbal description of the severity of the injuries.
With regards to suing in Ontario - what are the exceptions in Ontario?
- We can sue in ON without a threshold for economic loss
- We cannot sue in ON for pain & suffering unless a threshold is met
What are the suing limits to ECONOMIC loss.
Limited to 70% of gross income after 7 days. Post-trial recovery for future losses is on a 100% gross income basis.
What is a "protected defendant"?
owner, occupant(s), and any person present at the incident
For liability coverage, what does the insurer agree to pay & do?
- To reimburse insd for out-of-pocket expenses for immediate medical aid to TP's (whether or not insd is legally liable)
- To investigate, negotiate, & settle all reported claims
- To defend any civil action brought against insd, even if it is groundless
- To pay up to the minimum limits of the right jurisdiction in CA or USA
How does Priorities of Payment work?
- Only applied when the total liabilities are MORE than the limit purchased.Heavily weighted in favour of BI claims (vs. PD)
- ON=$190k BI & $10k PD
What is OWN DAMAGE coverage?
- Own Damage indemnifies insd for:
- --> direct & accident loss to car & equipment
- - "equipment" generally excludes anything not permanently attached
- - own damage aka: physical damage ins or 1st party ins
Is Own Damage coverage mandatory?
In many jurisdictions, Own Damage coverage is optional, however, insd's leasing or financing a vehicle may be required under their contracts.
What are the 4 types of coverages under Own Damage?
- A) Specified Perils
- B) Comprehensive
- C) Collision or Upset
- D) All Perils
Describe Specified Perils coverage.
This coverage specifies the perils/causes of loss insured against. May be sold in combo w/ collision or alone.
PERILS: fire, theft or attempted, lightening, windstorm, hail, rising water, earthquake, explosion, riot or civil disturbance, falling or forced landing of aircraft or parts, or stranding/sinking/burning/derailment/collision of auto carried in land or water
EXCLUSIONS: vandalism, malicious mischief, glass breakage, or impact w/ animal (Comprehensive coverage needed to protect these perils)
Describe Comprehensive coverage.
- This coverage protects against all perils other than collision or upset. Usually sold in combo w/ collision.
- Standard ded. $300.
all from specified perils; falling or flying objects, missiles & vandalism
Describe Collision or Upset
- This coverage protects insd for damage to vehicle caused by collision w/ another vehicle, person, object or surface of the road, or by upset.Standard ded. $500
Collision w/ animal is usually covered under comprehensive b/c it is more favourable to insd.
Describe All Perils coverage.
This is the broadest of all the coverages. Combines collision/upset and comprehensive.
Also covers certain types of theft that are excluded under comp, including theft of the auto by a person residing w/ insd or employee who uses vehicle
What are some Own Damage EXCLUSIONS?
Tires, mechanical fracture or breakdown, rusting, corrosion, wear & tear, freezing, or explosion in engine, radioactive contamination, contents other than equipment, in excess of $25 for recorded material, illegal use, DUI or more than 80mg of blood alcohol, causing death or BI by criminal negligence, failure to stop at scene of accident, unlicensed or suspended, illegal race.
**therefore, flat tires not covered
What is the purpose of deductibles?
- To keep premiums down
- Encourages insd's to be more prevention conscious
What are some additional benefits (agreement of the insurer) in Own Damage coverage?
- In addition to the coverage for physical damage to the auto, the policy also covers some related expenses which often arise as a result of an mva:
- - general salvage (applies when auto being transported by water)
- - salvage
- - fire dept
- - CDN or US customs duties (ie. CDN insd in mva in US)
In regards to Own Damage, when does insurer have right to recover and when can subrogation be waived?
- Per the Insurance Act insr has right of subrogation against the responsible person if:
- - person in auto business (ie. towing, garage, parking), OR
- - person is in violation of policy conditions (ie. DUI)
--> subrogation is waived if person driving w/ insd's permission
What is a Temporary Substitute Auto?
An auto not owned by the insd or anyone living in the same dwelling. It is a vehicle which replaces a described auto due to it breakdown, theft, repair, servicing, sale or destruction.
What jurisdiction is auto insurance under?
Why do we need Uninsured Auto Coverage?
- ie. "hit-and-run"
- If victims of such mva's had no way of protecting themselves, they could suffer serious financial hardship b/c of lost income, medical care cost, and vehicle damage costs.
Under what section of the policy is Uninsured Motorist coverage provided?
There may be distinct mandatory uninsured motorist coverage under the Standard Auto Policy (SPF1) or under other policy coverages such as Own Damage or AB.
What is the difference between an "uninsured" auto vs. "unidentified" auto?
- Uninsured: neither the owner nor driver has liability insurance to cover BI or PD.
- Unidentified: owner nor driver cannot be determined (i.e. hit and run); deemed to be in fact "uninsured"
What conditions must be met to claim under Uninsured Motorist coverage?
- To claim under Uninsured Motorist coverage, the uninsured/unidentified motorist must be at-fault.The determination of legal liability and the amount of damages are matters for negotiation between the insd & the insr.
What are "unsatisfied judgment funds"?
Some jurisdictions also have special funds to indemnify victims of uninsured or unidentified motorists.
Typically, insureds who are indemnified by an unsatisfied judgment fund will not be indemnified again for the same loss by their policy's Uninsured Motorist coverage.
Describe the Uninsured Auto Coverage in Ontario.
- Section 5 of the Owner's Policy
- Gives protection to the insured by permitting recovery from their "own insurer" of the amounts which insd would be entitled to recover from the uninsured or unidentified auto owner.
Can you sue if you are driving an uninsured vehicle but you are not at-fault for the mva?
NO - if you are driving an uninsured vehicle and you are hit by another vehicle, you are NOT permitted to sue the other owner in Ontario for the damage to your vehicle, even though they are totally at-fault.
What is covered under Uninsured Auto coverage?
- - BI or death
- - Damage & loss of use to auto & contents
- --> subject to $300 deductible, up to $25,000
Persons covered: any occupant, the insd & spouse/dependent
Claims for PD = TP is uninsured AND identified
Priority of payment = 95% BI/death & 5% PD
Describe the Highway Victims Indemnity Fund.
- ie. pedestrians hit by stolen vehicles
- To ensure that innocent victims of such mva's are compensated, HVIF's have been set up in all Canadian provinces. Some funds are financed by the gov't, others by the insurance industry.
Persons who suffer injury or PD must apply to the Fund. If paid, the Fund may file a judgment w/ the court against at-fault driver to have license suspended until judgment amount is repaid to Fund.
Payments from the Fund are based on the extent of the uninsured driver's legal liability. If the claimant is at-fault, the Fund does not pay.
In Ontario, the enactment of the Compulsory Auto Insurance Act
substantially reduced the role of MVAC.
Describe policy provisions regarding territory.
- Policy only applies in Canada, US or any other jurisdiction in the SABS.
- All dollar limits are in CDN funds.
- No coverage in Mexico.
a person, including the driver, in or on an auto, getting into, on, out of, or off an auto.
- "Described" and "newly acquired" autos are owned by the insured.
- --> described: should be registered in the name of the policyholder
- --> newly acquired: is when an insd purchases an additional or replacement auto; coverage is automatically extended to it but insd must notify insr w/in 14 days
Examples: rental car; a friend buys a new car and invites you to take it for a spin; you aunt asks you to park her car for her.
- "Temporary substitute" and "other" are autos that belong to someone else.
- --> TSA: being used as a substitute for insd's described vehicle b/c of its breakdown, repair, servicing, theft, destruction, or sale
- --> Other: non-owned or "borrowed"
Can you insure a vehicle that you do not own?
NO - you cannot insure a vehicle under the physical damage coverage of the Owner's Policy if you do not own the vehicle. That section specifically applies to a described automobile.
What are the factors involved in RATEMAKING?
Ratemaking = actuarial science.
- Risks are divided in the following order:
- - by CLASS (ppv, commercial, garage, public auto)
- - by HAZARD (territory, auto class & use, drivers, the auto itself)
- 1) Territory: urban vs. rural; for rating purposes each province is divided into a number of zones, each w/ a symbol or letter and a rate
- 2) Auto Class & Use: pleasure vs heavy commute, loss exposure risk (ie. taxi has constant pressure to drive a fare as fast as possible)
- 3) Drivers: age, gender, claims history
- 4) The Auto Itself: MRSP (manufacturer's suggested retail price), cost & age of auto, its susceptibility to damage
Ratemaking uses statistics based on the Law of Large Numbers. Define.
The Law of Large Numbers holds that: Large sample of past observations = more accurate prediction of future occurrence
What are the 2 components of a rate?
1. PURE PREMIUM
(pays only anticipated losses)
- 2. EXPENSE LOADING (added to pure premium and includes:
- - acquisition costs
- - admin costs
- - taxes
- - contingencies (ie. catastrophies)
- - profit
What is the "Green Book?"
All private auto insurers are required to record and file data with the IBC (QC Groupement des assureurs automobiles - Grey Book).
The results are published annually in what is known as the GREEN BOOK. The book shows a 5-year history for various types of vehicles (PPV's, commercials, snow, motorcycles, trucks, public vehicles, garages)
What is the difference between "Policy year" vs. "Accident year"?
all policies w/ effective dates w/in the year grouped together. Weak b/c it does not utilize the most up-to-date data.
all losses in a given year regardless of the policy years to which applies.
- Accident year is now preferred over policy year b/c it gives most up-to-date info.
- Example: policy effective date Dec 1, 2010, but claim occurs in Jan 2011 - claim is reported as a 2011 claim.
A car year
is a measurement of an insurer's exposure; an auto insd for 12 months.
What are the components of Loss Costs?
- a) Paid losses - known amounts
- b) O/S losses - reported but not yet paid
- c) Incurred but not reported (IBNR) - occurred but not yet reported
What is a rate group?
A numerical value assigned to a vehicle based on its expected claims cost. Based on a few factors including horsepower, body style, cost of repairs, etc.
List types of control exercised by rate boards.
- a) Prior approval
- b) File & use
- c) File & use following a "deemer" period
- d) Benchmark
What is the difference between residual markets vs voluntary markets.
Residual Markets: are special programs to ensure insurance availability for risks that, from an u/w standpoint are less desirable and more hazardous
Voluntary Markets: normal insurance, meets u/w guidelines
What are the 2 primary objectives of residual markets?
- 1) immediate availability of a market
- 2) equitable sharing of the residual market by all insurers
To develop a residual market program it is essential that it have the support of all segments of the industry and be the result of a cooperative effort.
What is the Facility Association?
- Is an unincorporated association of insurers created in 1977.
- It provides auto insurance to owners who may otherwise have difficulty obtaining insurance.
- The operations of the association are conducted according to the Plan of Operation approved by members & regulatory authorities.
- Each servicing carrier have special accounts to deposit Facility premiums into, separate from its normal business account.
- Service carriers receive expense allowances to compensate them for the cost of acting on behalf of the Association.
BC, MB & SK do not have a industry or government programs for insurance availability b/c basic coverage is already provided to all residents who have a registered vehicle.
What are servicing carriers?
Insurers who must issue policies and provide policyholder services for a Facility
What is the difference between Risk Sharing Pools vs. the Facility Association?
- Risk sharing pools are managed by the Facility Association but present a "grey" risk - meets some of the companies u/w guidelines but are still a higher than average risk. B/c these "grey" risks meet u/w guidelines, insurers cannot decline them, and they must still be written in the voluntary market at insurer's normal rates.
- Risk sharing pools give companies the option of keeping such business for their own account or transferring it to the pool.
- Insurers who are members of the pool cede the entire "grey" policies to the pool, but retain 15% of the premiums & claims.
Only risks that do not
meet u/w guidelines can be considered residual market risks & have policies issued through the Facility
What are the 4 legal concepts that regulate the settlement of mva claims?
1) Negligence: omission to do something a reasonable person would/would not do.
2) Onus of Proof: burden of proof rests on the person suing; onus probandi; if mva w/ pedestrian or cyclist onus of proof rests on motorist to prove they were not negligent
3) Subrogation: right to recover from responsible party; ie. truck over 4500kg at-fault
4) Absolute Liability: insd violates policy conditions & not covered; absolute liability ensures that innocent TP's are protected & do not face delay in payments; insurers have right to recover from their insured after; insurer only obligated to pay minimum limits in applicable jurisdiction
(Liable = legally responsible)
No-fault concepts are considered separately in relation to auto insurance. What are the 2 categories of no-fault concepts?
- 1) No-fault in relation to PD
- 2) No-fault in relation to BI
Describe no-fault concepts for PD/vehicle damage.
AIMS of no-fault for PD:
- - The 1st applications of no-fault for PD were "knock-for-knock" agreements by British insurers. Under knock-for-knock each insurer paid for repairs for their own policyholders regardless of fault. Recovery was not permitted but attitude that what was lost in some situations were gained in others - overall cost being less.
- - However, knock-for-knock had some drawbacks; some insr's didn't agree w/ the philosophy
- - Knock-for-knock laid the groundwork for the modern DCPD concept - insd's compensated by their own insurers regardless of fault
less investigation, subrogation activity, litigation; speedier settlements; insd's deal only w/ their insurers; lower premiums
Describe no-fault concepts for Injury/BI.
Insureds recover from their own insurers for medical bills up to a small limit or threshold. They cannot sue the at-fault TP for amounts up to the limit, but can sue them for amounts above it, such as pain & suffering.
QC & MB - insd's completely barred from suing; compensated entirely by AB
List the information required on the Ontario Application for Auto Insurance (OAF1)
The OAF1 is the only form approved for use in u/w auto insurance for the OAP1 (owners policy).
- Info required:
- 1. Applicant's name and postal address
- 2. Policy period (expires 12:01am local time at postal address)
- 3. Described Automobile(s) - model, VIN, etc
- 4. Driver Information - license #, DOB, sex, marital status, retired, past license/insurance experience
- 5. Previous Accidents & Insurance Claims
- 6. Convictions
- 7. Rating Info
- 8. Insurance Coverages Applied For
- 9. Remarks
- 10. Method of Payment
- 11. Declaration of Applicant
- 12. Report of Broker/Agent
List the MANDATORY coverages in an auto policy.
- 1) Liability (BI & PD)
- 2) AB
- 3) Uninsured Auto
- 4) DCPD
What are the INSURED's obligations when there has been a loss/damage to persons or property?
- Give written notice of incident or claim
- Verify whether claim arose from the operation of the vehicle, and the person operating the auto is insured
- Forward immediately to insurer all writs, claims, correspondence, etc.
- Do NOT assume or admit liability
What conditions apply to the insurer vs. the insured in relation to policy cancellation/termination?
Insured may cancel at any time; no special conditions apply. Refund premium on a short-rate basis. Refund payment to be made asap.
Insurer may terminate policy under strict conditions. Reason for termination must be valid per Insurance Act. Give 15 days written notice by registered mail.
Who is the board that administers insurance regulations in Ontario?
- FSCO - Financial Services Commission of Ontario
- - board
- - tribunal
- - superintendent
List 3 unfair or deceptive practices.
- - obtain a different premium for an insurance policy than the premium in the policy
- - refund or discount a premium for the person applying
- - using credit info to process app
What are the 3 functions of Underwriting?
- 1. Acceptance or rejection of a risk
- 2. If accepted, the terms of the policy
- 3. The premium for the policy
Describe the differences between Head Office U/W & Individual U/W.
- Head office underwriting: Mgmt establishes a marketing philosophy that will produce a profit;
- Insurers can write/market to selected groups or a combination of groups; An U/W manual is created which may include: an acceptance/rejection list, limit table, a classification guide, etc.
- The more comprehensive the u/w manual, the greater the description provided for acceptable risks and the more likely the corporate goals will be
Classification, rating drivers according to driving records (autoplus, convictions history, fraudulent claims), placing risks in the correct rate groups, using correct endorsements.
- The 2 levels work together to ensure a profitable auto insurance business. All underwriters have a duty to the insurance buying public and to their employers to avoid embarrassing mistakes
- which may result in penalties from insurance regulators.
How does underwriting in provinces w/ government insurance work?
SK, BC, MB – the gov’t is the sole u/w of the legislated basic coverages; since there is the responsibility to provide insurance to “all persons”, declining risks is illegal for them – they cannot deny anyone the basic coverages.
U/W criteria such as age, sex, marital status and region of the province is prohibited based on ‘discrimination’.
Private insurers compete w/ the gov’t for non compulsory coverages. No Facility or Risk Plan in these provinces.
List 5 different types of endorsements.
OPCF 20 – Coverage for Transportation Replacement:
- OPCF 5 – Rented or Leased Automobiles: the standard Owner’s Policy expressly excludes coverage if an automobile is rented or leased.
- This endorsement is available for long-term leases. In this case, the lessor is the R/O & the lesee is applying for insurance on behalf of the R/O for an Owner’s Policy. The lesee and lessor are protected by the policy.
- OPCF 19a – Valued Automobile: If the value of the car exceeds the actual cash value (ACV). The OPCF 19a will ensure that the insured is paying
- the correct amount of premium to cover the ACV of the car in the event of a loss. The insured is also
- responsible for paying for an appraiser to substantiate this evidence to the insurer.
- OPCF 43 – Removing Depreciation Deduction: in the event of a loss, the insurer will pay the value or price of the vehicle (as defined in the endorsement wording) without deduction or
- depreciation. (Does not apply to tires or batteries).
The insured may choose a limit per day and per occurrence, or the insurer may have standard limits. An additional premium is charged.
List the types of insurance forms approved for use in Canada.
- SPF = standard policy form
- OAP = Ontario Auto Policy
- QPF = Quebec Policy Form
The wording of policy forms & endorsements are controlled by gov’t in each prov.
In Canada there are 6 policy forms approved for use:
- 1) OWNER’S
- SPF1, Standard Auto Policy (Owner’s Form)
- OAP1, Ontario Auto Policy (Owner’s Policy)
- 2) DRIVER’S
- SPF2, Standard Auto Policy (Driver’s Form)
- OAP2, Ontario Auto Policy (Driver’s Policy)
4) SPF6, Standard Non-Owned Auto Policy Coverage
- 3) GARAGE
- SPF4, Standard Garage Auto Policy
- OAP4, Ontario Auto Policy (Garage Policy)
, applies to a business entity when the business & its owners could be held liable for damages caused by a vehicle that they do not own
5) SPF7, Excess Auto Policy
, provides excess liability coverage for use w/an SPF1, 2, 4, and/or 6
6) SPF8, Lessor’s Contingent Auto Policy
, provides a coverage for businesses that lease vehicles on a long-term basis
Briefly describe the Quebec Plan.
- All QC residents & their dependents who suffer BI/death in or out of QC are entitled to compensation under the no-fault SAAQ.
- No right to sue for BI/death in QC
- Visitors are also entitled to benefits but only to the extent that they were not at-fault for an mva occurring in QC
- QC residents get SAAQ benefits if they have an mva outside QC plus they retain the right to sue outside of QC
- Uninsured motorist coverage = Fonds d'indenmisation, administered by SAAQ, $50k limit
List the plans in SK, MB, BC
- Government operated plans in SK, MB, BC (crown)
- - SK: Auto Fund
- - MB: Auto Pac
- - BC: Auto Plan