Professional/Stream-Specific Knowledge
Professional/Stream-Specific Knowledge
Candidates choose a stream - commonly Medical, Actuarial, IT, or Legal - and are tested on applying that discipline inside an insurance or reinsurance context, not on isolated academic theory. Medical candidates face underwriting and claims adjudication; actuarial candidates face pricing, reserving, and solvency; IT candidates face insurance systems, data controls, and cybersecurity; legal candidates face contract law, policy wording, and insurance regulation.
Core rules
- Policy wording prevails over general assumptions; sub-limits, waiting periods, exclusions, and deductibles are applied in the order the policy states.
- Medical: BMI = weight (kg) / height (m)²; disclose pre-existing disease and apply the waiting period; a room-rent cap breach triggers proportionate deduction of associated expenses.
- Actuarial: loss ratio = incurred claims / earned premium; combined ratio = loss ratio + expense ratio; below 100% indicates underwriting profit.
- IT: separate UAT from production; enforce least privilege; preserve an audit trail for reinsurance transactions.
- Legal: insurance is a contract of indemnity and utmost good faith; subrogation follows payment; ambiguities are construed contra proferentem, against the drafter.
Worked example (Medical stream)
Sum insured ₹5,00,000; room-rent cap ₹5,000 per day; actual room rent ₹8,000 per day for 5 days; other eligible expenses ₹1,20,000. Because room rent exceeds the cap, associated expenses are reduced proportionately: 5,000/8,000 = 0.625. Other expenses payable = ₹75,000; room rent payable = ₹25,000; total = ₹1,00,000. Non-payables and deductibles, if any, are then applied as per policy.
Traps
Do not apply a sub-limit after ignoring the deductible. Do not quote a regulation when the policy wording is stricter. In legal questions, reinsurance does not extinguish the insurer's duty to the insured. In IT, 'tested' does not mean 'approved for production'.