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Insurance - General Provisions

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(1)

CONCEPT OF RISK 

CONCEPT OF RISK 

Risk is prospect of loss on the happening or Risk is prospect of loss on the happening or non happening of an event

non happening of an event

In risk two elements are present 1. In risk two elements are present 1. the outthe out

come is uncertain 2.these outcomes one is come is uncertain 2.these outcomes one is favorable and other is not

favorable and other is not

There are different types of risk like:-There are different types of risk

like:-PURE AND

PURE AND SPECULASPECULATIVETIVE

Pure risk is one where is a loss or no loss butPure risk is one where is a loss or no loss but

no gain and a speculative is one where is a no gain and a speculative is one where is a chance of gain or loss

chance of gain or loss

(2)

Meaning of

Meaning of

Insur

Insur

ance

ance

Insurance is defined as a cooperative device toInsurance is defined as a cooperative device to

spread a particular risk .It does not reduce

spread a particular risk .It does not reduce risk orrisk or change the probability of risk ,it only

change the probability of risk ,it only reduces thereduces the financial losses

financial losses

In legal terms insurance is In legal terms insurance is a contract where by onea contract where by one

party agrees for a consideration called premium to party agrees for a consideration called premium to compensate the other party for losses Thus it

compensate the other party for losses Thus it involves the following

involves the following

:-

1.Insurer 2. Insured 3 .Premium 4. Policy1.Insurer 2. Insured 3 .Premium 4. Policy 

The person or tThe person or the compahe company ny who is who is covering covering the rthe riskisk

is called insured is called insured

(3)

Insurance And Assurance

Insurance And Assurance

Insurance(n0n-life)Insurance(n0n-life) 

Assurance(life)Assurance(life) 

It is used for nonIt is used for non

life insurance life insurance

It is used for lifeIt is used for life

insurance contracts insurance contracts

(4)

F

F

unctio

unctio

ns

ns

And

And

BENIFIT

BENIFIT

S

S

Of Insurance

Of Insurance

It helps in It helps in capital formationcapital formation 

It increases the business efficiency as theIt increases the business efficiency as the

executives can freel

executives can freely work without worryingy work without worrying about the insurable interest

about the insurable interest

It helps in It helps in risk sharing and risk transferrisk sharing and risk transfer 

It provides certainty as risks are calculated inIt provides certainty as risks are calculated in

advance advance

It provides protection as on the It provides protection as on the happening of happening of 

uncertainty paym

uncertainty payment is made and ient is made and is true fors true for all non life insurances

all non life insurances

(5)

Insurable Risk

Insurable Risk

The risk involved must have a The risk involved must have a Financial valueFinancial value 

Homogeneous exposureHomogeneous exposure 

It is concerned with only pure risks and notIt is concerned with only pure risks and not

speculative speculative

The loss must be The loss must be uncertain and it should notuncertain and it should not

be based on a certain event be based on a certain event

It should not be against public policyIt should not be against public policy 

Insurance is undertaken not to pay any kindInsurance is undertaken not to pay any kind

of fines of fines

(6)

Essentials of

Essentials of

insur

insur

ance

ance

contract

contract

OFFEROFFER 

The person who wants to cover a risk wilThe person who wants to cover a risk willl

make an offer. Offer and invitation to offer make an offer. Offer and invitation to offer are different

are different

An invitation precedes offer An invitation precedes offer and any act thatand any act that

precedes acceptance is offer precedes acceptance is offer

ACCEPTANCEACCEPTANCE 

Consent given offer is acceptance and itConsent given offer is acceptance and it

should be absolute and unqualified any should be absolute and unqualified any variation is no acceptance

variation is no acceptance

(7)

CONSIDERATION

CONSIDERATION

Something in return is consideration and itSomething in return is consideration and it

must:---1.mov

must:---1.move from promises 2. e from promises 2. need moveneed move to promisor 3. be sufficient

to promisor 3. be sufficient

PPremium being remium being a valuable considea valuable consideration mustration must

be given for starting an insurance contract be given for starting an insurance contract and a promise to compensate or indemnify and a promise to compensate or indemnify asas per the terms and conditions of the policy

per the terms and conditions of the policy

A contract of insurance without payment of A contract of insurance without payment of 

premium is void premium is void

CAPACITYCAPACITY 

(8)

FREE CONSENT

FREE CONSENT

Where the consent of Where the consent of one party or other hasone party or other has

been induced by coercion, undue influence, been induced by coercion, undue influence, or fraud misrepresentation, contract is

or fraud misrepresentation, contract is voidable at the option of i

voidable at the option of insurernsurer

A A 56 year man insured himse56 year man insured himself but dielf but diedd

within 2 years the insurer refused to pay

within 2 years the insurer refused to pay butbut court said man of such age carries

court said man of such age carries own riskown risk and insurance company accepted it with and insurance company accepted it with open eyes

open eyes

The burden of proof lies on the insurer t oThe burden of proof lies on the insurer t o

show that the fact was misstated show that the fact was misstated

(9)

Discharge

Discharge

of contract

of contract

A contrA contract terminates in act terminates in following situations:following situations: 

1.P1.Performance: when all erformance: when all the terms of the terms of 

contract in terms of performance have been contract in terms of performance have been carried out

carried out

RRelease: when one elease: when one party agrees to excuseparty agrees to excuse

performance like denial of claim in case of  performance like denial of claim in case of  fraud

fraud

Discharge by implied consent or impossibilityDischarge by implied consent or impossibility

of performance. contract is discharged when of performance. contract is discharged when performance becomes impossible;

performance becomes impossible;

(10)

Principals of

Principals of

Insur

Insur

ance

ance

1.Utmost good faith:-Insurance is a 1.Utmost good faith:-Insurance is a contractcontract

of uberrimae fidei. The assured must disclose of uberrimae fidei. The assured must disclose to the insurer all material facts known to him to the insurer all material facts known to him . A mis-statement or withholding of any

. A mis-statement or withholding of any material information is fatal to the

material information is fatal to the contractcontract of insurance. Both the parties are under

of insurance. Both the parties are under obligation for the full disclosure

obligation for the full disclosure of materialof material information. The rule ‘ caveat emptor ’ does information. The rule ‘ caveat emptor ’ does not apply to them. To them. However the

not apply to them. To them. However the following facts are not to be disclosed

following facts are not to be disclosed

 A. facts common to the publicA. facts common to the public 

(11)

. Example…1.Utmost good faith [London. Example…1.Utmost good faith [London

Insurance Co. vs. Mansel (1879)] In making a Insurance Co. vs. Mansel (1879)] In making a proposal for insurance, M, in reply to

proposal for insurance, M, in reply to aa

question asking whether previous proposals question asking whether previous proposals on his life had been made to any other

on his life had been made to any other office. He omitted to disclose that his office. He omitted to disclose that his

proposal for life insurance had been declined proposal for life insurance had been declined by several other offices. Held , this was a

by several other offices. Held , this was a material failure to disclose and the policy material failure to disclose and the policy could be set aside.

could be set aside.

 A A proposer should disclose proposer should disclose all material factsall material facts

at the time of making the proposal for at the time of making the proposal for

(12)

2. P2. Principle of rinciple of Indemnity:- Indemnity:-

Indemnity means to make Indemnity means to make good the loss good the loss . . AllAll

contracts of insurance are contracts of  contracts of insurance are contracts of  indemnity except life insurance.

indemnity except life insurance.

Indemnity can be achieved Indemnity can be achieved in following ways:-cash payment,

in following ways:-cash payment, Reinstatement ,Repair ,Replaced Reinstatement ,Repair ,Replaced

Insurance is not allowed to be Insurance is not allowed to be used to earnused to earn

profit and loss is

profit and loss is limited to the amountlimited to the amount insured .The insured has to prove

insured .The insured has to prove

:-

(13)

Castellion vs. Preston(1883) P insured hisCastellion vs. Preston(1883) P insured his

house against fire. Subsequently he agreed to house against fire. Subsequently he agreed to sell his house to R. Before the sale, the

sell his house to R. Before the sale, the house was destroyed by fire and

house was destroyed by fire and P receivedP received his value from the insurance company. P then his value from the insurance company. P then received the price from R as per the contract received the price from R as per the contract of sale. Held , the insurance company could of sale. Held , the insurance company could recover from P the money they had paid.

(14)

3. Insurable Interest :-It is 3. Insurable Interest :-It is subject matter of subject matter of 

insurance contract and its absence renders insurance contract and its absence renders the contract void and without it there is no the contract void and without it there is no sanction of law and renders the contract void sanction of law and renders the contract void and hence unenforceable

and hence unenforceable

It is insurable interest that distinguishesIt is insurable interest that distinguishes

insurance from gambling insurance from gambling

It should exist both at time It should exist both at time of proposal andof proposal and

at the time of claims at the time of claims

It can be acquired by It can be acquired by ownership ,legalownership ,legal

possession custody of p

possession custody of property ,husband androperty ,husband and wife have insurable interest in

(15)

4. SUBROGATION:-Indemnity is a fundamental4. SUBROGATION:-Indemnity is a fundamental

principle of insurance law, and the principle principle of insurance law, and the principle of Subrogation is a corollary of this principle of Subrogation is a corollary of this principle

The most common form of

The most common form of subrogation issubrogation is when an insurance company pays a claim when an insurance company pays a claim

caused by the negligence of another. Thecaused by the negligence of another. The

doctrine of subrogation confers two specific doctrine of subrogation confers two specific rights on the insurer.

rights on the insurer.

1. the insurer is entitled to all the remedies 1. the insurer is entitled to all the remedies which the insured has against the third party which the insured has against the third party

2., the insurer is entitled to the benefits2., the insurer is entitled to the benefits

received by the assured f

(16)

5.Proximate Cause5.Proximate Cause 

A loss is due to a cause and that cause whichA loss is due to a cause and that cause which

is

is dominant dominant is is proximate proximate causecause

This is a Latin term means neThis is a Latin term means nearest orarest or

immediate immediate

The insurer has to make good the loss of theThe insurer has to make good the loss of the

insured

insured that that clearly clearly and and proximately proximately results,results, whether directly or indirectly, from the

whether directly or indirectly, from the event insured against in the policy. The event insured against in the policy. The burden of proof that the loss

burden of proof that the loss occurred onoccurred on account of the proximate cause, lies on

account of the proximate cause, lies on thethe insured.

(17)

A ship insured against damage by enemyA ship insured against damage by enemy

action was damaged while passing over a action was damaged while passing over a torpedo. Held the insurance co. was not torpedo. Held the insurance co. was not liable as no enemy action took p

(18)

6.CONTRIBUTION6.CONTRIBUTION 

If an insured obtains more than one policyIf an insured obtains more than one policy

covering the same risk he

covering the same risk he cannot recover thecannot recover the same loss from more than one source

same loss from more than one source

The insured can not be The insured can not be allowed to gainallowed to gain

profits from indemnity profits from indemnity

It checks that each policy pays only It checks that each policy pays only aa

rateable portion under each separate policy. rateable portion under each separate policy.

The contribution arises when ---1 there The contribution arises when ---1 there are different policies which relate to the

are different policies which relate to the subject-matt

References

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