III IC-99 cheat sheet
III IC-99 · Keep the key ideas within reach.
Insurance Regulation, Licensing, and Market Conduct
State insurance departments enforce the McCarran-Ferguson Act framework: insurance is regulated primarily by states, and federal antitrust law applies only to the extent states do not regulate.
A certificate of authority is the license that authorizes an insurer to transact specified lines of business in a state; transacting without one is an unauthorized-insurance violation.
Producer licensing requires a resident license in the home state plus nonresident licenses elsewhere; the NAIC Producer Database and NIPR support uniform electronic applications.
Continuing education typically requires 24 credit hours per 2-year license term, including a state-mandated ethics component (commonly 3 hours).
Appointment is the insurer's authorization of a producer to act on its behalf; termination of appointment triggers notice requirements to the state and, in many states, to the producer.
Market conduct examinations review sales, underwriting, rating, claims, and complaint handling; findings can result in fines, license suspension, or mandated corrective action.
Unfair trade practice acts prohibit misrepresentation, twisting, rebating, false advertising, boycott, coercion, and unfair claim settlement practices.
Twisting is inducing a policyholder to lapse or surrender a policy through misrepresentation to sell a replacement; rebating is offering inducements not stated in the policy.
Rate regulation follows prior-approval, file-and-use, or use-and-file systems; rates must be adequate, not excessive, and not unfairly discriminatory.
General Insurance Principles and Policy Contract Provisions
Insurable interest requires a financial loss from the insured event; it must exist at policy inception for property coverage and at the time of loss for life insurance.
Indemnity restores the insured to pre-loss financial position, no better; valued policies, replacement cost, and agreed-value clauses modify strict indemnity.
Utmost good faith obligates both parties to disclose material facts; concealment, misrepresentation, and breach of warranty can void coverage.
The principle of proximate cause traces loss to the dominant efficient cause; if an excluded peril sets an unbroken chain of events, coverage may be denied.
Subrogation transfers the insured's recovery rights against a negligent third party to the insurer after payment, preventing double recovery.
A deductible is the insured's retained first-dollar loss; a coinsurance clause in property policies requires carrying a percentage of value or faces a reduced claim payment.
Coinsurance penalty formula: (insurance carried ÷ insurance required) × loss, subject to the policy limit and deductible.
A warranty is a condition the insured promises to fulfill; a representation is a statement believed true but not guaranteed, and material misrepresentation can rescind the contract.
Policy structure order: declarations, insuring agreement, conditions, exclusions, and definitions; endorsements amend and control over conflicting form language.
Property Insurance Coverages and Exposures
HO-3 covers the dwelling on an open-peril basis and personal property on a named-peril basis; HO-5 covers both on an open-peril basis.
Replacement cost pays to repair or replace without depreciation, subject to policy limits; actual cash value equals replacement cost minus depreciation.
Extended replacement cost endorsements add a percentage (commonly 20-25%) above the dwelling limit; guaranteed replacement cost has no fixed ceiling.
Ordinance or law coverage pays for code-required upgrades after a loss; it is excluded or limited in unendorsed forms.
Business income coverage pays lost net income plus continuing expenses during the period of restoration, triggered by direct physical loss to covered property.
Equipment breakdown coverage addresses mechanical, electrical, and pressure-system failures, which property forms typically exclude.
Flood and earthquake are excluded under standard property forms and require separate policies or endorsements; flood is written through the NFIP or private carriers.
Coinsurance applies to commercial property; reporting forms allow fluctuating values with a deposit premium and periodic reporting.
Blanket coverage applies one limit across multiple locations; specific coverage applies a separate limit to each location.
Casualty and Liability Insurance Coverages
Commercial general liability Coverage A covers bodily injury and property damage; Coverage B covers personal and advertising injury; Coverage C covers medical payments.
Occurrence vs. claims-made trigger: occurrence coverage responds to injury during the policy period; claims-made responds to claims reported during the policy period, subject to retroactive date.
The CGL aggregate limit caps total payments for the policy period; the per-occurrence limit caps each loss; products-completed operations has its own aggregate.
Additional insured endorsements extend coverage to parties such as landlords or general contractors; certificate of insurance is evidence, not a contract.
Personal auto liability split limits are expressed as per-person bodily injury / per-accident bodily injury / property damage, e.g., 100/300/50.
Workers compensation is no-fault statutory coverage for work-related injury; employers liability covers suits outside the exclusive remedy.
Professional liability (errors and omissions) covers negligent acts, errors, or omissions in rendering professional services; medical malpractice is a specialty form.
Umbrella policies provide excess limits over underlying coverage and may drop down for gaps; they typically require maintaining underlying limits.
Comparative negligence reduces an award by the plaintiff's share of fault; contributory negligence in a few jurisdictions bars recovery entirely.
Commercial Lines Coverages and Risk Management
Businessowners policy (BOP) bundles property and general liability for eligible small-to-medium businesses; eligibility is defined by class, size, and occupancy.
Commercial package policies combine property, general liability, and inland marine with a common declarations page and shared conditions.
Business income with extra expense covers lost income and costs to resume operations quickly; extended period of indemnity continues coverage after restoration.
Commercial auto coverage includes liability, physical damage, medical payments, and uninsured/underinsured motorists; hired and non-owned auto extends to business use of employee vehicles.
Risk management steps: identify exposures, measure frequency and severity, select techniques (avoidance, retention, transfer, reduction), implement, and monitor.
Risk control reduces frequency or severity through prevention, protection, and separation; risk financing funds retained losses through reserves or insurance.
Loss runs document prior claims history and drive commercial underwriting and pricing decisions.
Builders risk covers property under construction, including materials and fixtures, until completion or occupancy.
Inland marine covers property in transit and mobile equipment, filling gaps left by property forms that require a fixed location.
Personal Lines Coverages
HO-3 Coverage A covers the dwelling; Coverage B other structures; Coverage C personal property; Coverage D loss of use; Coverage E personal liability; Coverage F medical payments.
HO-4 renters covers personal property and liability but not the building; HO-6 condo covers unit interiors and improvements.
HO-3 special limits apply to categories such as jewelry, silverware, money, and firearms; scheduled endorsements raise limits for valuables.
Personal auto Part A is liability; Part B medical payments; Part C uninsured motorists; Part D damage to your auto, including collision and other than collision.
Personal auto exclusions include intentional damage, racing, and use of a vehicle for livery or delivery-for-hire; ride-share endorsements address gaps.
Personal umbrella policies require underlying auto and homeowners limits and provide excess liability plus coverage for some gaps such as libel and slander.
Flood coverage for personal lines is written through the NFIP or private flood insurers and is excluded from homeowners forms.
Loss of use pays additional living expenses and fair rental value when the home is uninhabitable due to a covered peril.
Underwriting, Rating, and Claims Handling
Underwriting evaluates the risk, determines eligibility, classifies it, and sets terms and premium; it uses application data, inspections, loss history, and credit-based insurance scores where permitted.
Rating components: rate per exposure unit × exposure base × rating factors such as territory, class, and experience modification.
Experience modification compares an employer's losses to expected losses for its class; a mod below 1.00 indicates better-than-average loss experience.
Claims handling steps: report and acknowledge, investigate, evaluate coverage and damages, negotiate, settle or deny, and document the file.
Reservation of rights letters inform the insured that the insurer is investigating while coverage questions remain unresolved.
Bad faith claims arise from unreasonable delay, failure to investigate, or denial without a reasonable basis; states impose unfair claim settlement practice rules.
Subrogation recovery reduces net loss cost and can improve future experience modification and loss ratios.
Loss ratio equals incurred losses divided by earned premium; combined ratio adds the expense ratio and indicates underwriting profitability below 100%.
Insurance Ethics and Fiduciary Responsibilities
A fiduciary duty requires a producer holding premiums or funds to act in the client's best interest and to account for and remit funds promptly.
Commingling client premiums with personal or general business funds is prohibited; premium trust accounts must be maintained separately.
Errors and omissions exposure arises from failure to place coverage, inadequate limits, missed renewal dates, or failure to disclose material policy terms.
Suitability requires recommending products consistent with the client's needs, objectives, and financial capacity, documented in the file.
Conflicts of interest must be disclosed, including commissions, contingent compensation, and referral arrangements.
Privacy rules limit sharing nonpublic personal financial and health information; opt-out and authorization requirements apply.
Recordkeeping requirements mandate retaining applications, policies, and transaction records for the period set by state law or the insurer.
A producer who collects premium acts in a fiduciary capacity; failure to remit to the insurer can trigger license discipline and personal liability.
Insurance Regulation, Licensing, and Market Conduct (Producer Conduct)
A producer must be licensed for the line of business sold; selling outside the licensed authority is an unauthorized transaction.
Cease-and-desist orders and fines are common market conduct sanctions; repeat violations can lead to license revocation.
Continuing education noncompliance can result in license expiration or a late fee; ethics hours are a separate requirement in many states.
Unfair claim settlement practices include misrepresenting policy provisions, failing to act promptly on communications, and offering less than the claim is worth.
Rebating and twisting are prohibited in all states; some states allow limited rebating of title insurance or under specific statutes.
A producer's fiduciary duty extends to timely premium remittance, accurate records, and disclosure of compensation on request.
State guaranty associations protect policyholders of insolvent insurers, subject to coverage limits and residency rules.
Property and Casualty Coverage Interactions
Concurrent causation: when a covered and excluded peril combine, courts apply efficient proximate cause or concurrent causation rules depending on jurisdiction.
Other insurance clauses determine contribution among policies: pro rata, excess, or primary depending on the clause wording.
Pairing deductibles: a percentage windstorm or hurricane deductible is calculated as a percentage of the dwelling limit, not the loss amount.
Business interruption requires direct physical loss to covered property; utility service interruption and civil authority endorsements extend coverage.
Liability coverage responds to sums the insured is legally obligated to pay; defense costs are usually outside the limit unless the policy states otherwise.
A certificate of insurance does not amend or extend coverage; only an endorsement does.
Total loss settlement under replacement cost requires repair or replacement within a stated period, often 180 days, or payment reverts to ACV.
Policy Conditions, Endorsements, and Claims Documentation
Duties after loss typically include prompt notice, proof of loss, cooperation, and protection of property from further damage.
Proof of loss is a sworn statement of the claim amount and supporting documentation, due within the period stated in the policy.
Appraisal clauses resolve valuation disputes; each party selects an appraiser, and an umpire resolves disagreement.
Salvage and abandonment: the insured cannot abandon damaged property to the insurer; salvage may be retained or sold to offset loss.
Mortgagee clauses protect the lender's interest; loss payment may be made jointly to the insured and mortgagee.
Endorsements modify the base form and control in a conflict; the declarations page controls limits and named insureds.
Cancellation rules vary by policy age and reason: nonpayment, underwriting, or nonrenewal each carry different notice periods.
Commercial Casualty and Specialty Exposures
Products liability covers bodily injury or property damage arising from products sold or distributed; the products-completed operations aggregate applies.
Completed operations coverage applies after work is finished; ongoing operations are covered under the general liability occurrence limit.
Cyber liability covers data breach response, notification costs, and network security liability; many property forms exclude cyber losses.
Employment practices liability covers wrongful termination, discrimination, and harassment claims; it is excluded under standard CGL.
Directors and officers liability covers management decisions and securities claims; side A coverage protects personal assets of directors.
Surety bonds guarantee performance or payment; they are three-party contracts among surety, principal, and obligee, not insurance.
Environmental liability covers pollution cleanup and third-party claims; standard CGL includes a total pollution exclusion with limited exceptions.
Personal Lines Exposures and Endorsements
Homeowners water backup and sump overflow endorsements add coverage for sewer or drain backup, which is otherwise excluded.
Scheduled personal property endorsements provide broader perils and higher limits for jewelry, art, and collectibles.
Personal injury endorsements add coverage for libel, slander, and invasion of privacy to homeowners liability.
Identity theft endorsements cover expenses to restore identity and credit records.
Rental car and loss-of-use coverage may be addressed by the personal auto policy's transportation expenses provision.
Replacement cost on contents requires the insured to replace the item; otherwise payment is on an actual cash value basis.
Business pursuits exclusion in homeowners forms excludes home-based business liability unless endorsed.
Underwriting Data, Rating Variables, and Profitability
Rating variables must be actuarially justified and not unfairly discriminatory; protected characteristics are prohibited.
Loss costs are advisory pure premium components published by rating bureaus; insurers add expenses and profit to derive final rates.
Premium = rate × exposure units; exposure units include payroll per $100, sales per $1,000, or vehicle-years.
Experience rating uses the insured's own loss history; schedule rating applies discretionary debits and credits for risk characteristics.
Retention is the portion of loss the insured keeps through deductibles or self-insured retentions.
Combined ratio = loss ratio + expense ratio; a value above 100% indicates an underwriting loss.
Catastrophe models estimate probable maximum loss and inform reinsurance purchasing and capacity decisions.
Ethics, Disclosure, and Suitability in Sales
Replacement notices are required when a new life or annuity policy replaces existing coverage; the producer must disclose the comparison.
Illustrations must be clearly labeled and not misleading; guaranteed and nonguaranteed elements must be distinguished.
Advertising rules prohibit false or misleading statements about policy benefits, dividends, or insurer financial strength.
Suitability documentation should record client needs, alternatives considered, and the basis for the recommendation.
Compensation disclosure may be required on request; contingent commissions and bonuses can create conflicts.
A producer must not sign a client's name or falsify an application; doing so constitutes a fraudulent insurance act.
Safeguards for nonpublic personal information include secure storage, limited access, and disposal procedures.
Claims Handling Standards and Timelines
Acknowledge claims promptly, typically within a set number of days after notice, and provide claim forms and instructions.
Investigate thoroughly and communicate coverage decisions in writing; a denial must state the policy provisions relied upon.
Unfair claim practices include failing to adopt reasonable standards, unreasonable delay, and failing to explain a denial.
Prompt payment statutes impose interest on late payments of undisputed amounts.
Total loss valuation may use actual cash value, replacement cost, or agreed value, depending on the policy and state rules.
Claim files should document all contacts, decisions, and payments to support defense against bad faith allegations.
Subrogation should be pursued promptly to preserve recovery rights against third parties.
Licensing Administration and Producer Duties
License renewal requires completing continuing education and paying fees before expiration; late renewal may require reinstatement.
Change of address or name must be reported to the state within the required period.
Appointments must be filed by the insurer; a producer may not solicit business for an unappointed insurer in states requiring appointment.
Fiduciary premium handling requires trust accounts, prompt remittance, and accurate records of receipts and disbursements.
Commissions may only be paid to licensed producers; paying commissions to unlicensed persons is prohibited.
License discipline includes fines, suspension, revocation, and restitution; grounds include fraud, misrepresentation, and misappropriation.
Reciprocal nonresident licensing allows a producer licensed in good standing in the home state to obtain nonresident licenses.
Insurance Principles Applied to Commercial Risk
Risk transfer moves loss exposure to an insurer in exchange for premium; retention keeps the exposure with the insured.
Avoidance eliminates the exposure entirely; reduction lowers frequency or severity; separation limits a single event's impact.
Loss frequency is the number of losses per exposure unit; severity is the average size of each loss.
A self-insured retention is the amount the insured pays before insurance responds; it differs from a deductible in that the insured may control defense.
Captive insurers are owned by the insured to finance retained risk; they are regulated as insurers.
Hold-harmless and indemnity agreements shift liability contractually; additional insured status supports the transfer.
Risk management is continuous: exposures change with operations, so programs must be reviewed and updated.
Personal Auto and Liability Details
Financial responsibility laws require proof of liability coverage; minimum limits vary by state.
No-fault states require personal injury protection and restrict tort claims above a threshold.
Uninsured motorist coverage pays for injury caused by a driver with no insurance; underinsured motorist covers limits below the insured's.
Named driver exclusions remove coverage for a specified driver; they require insurer approval and vary by state.
Medical payments coverage pays medical expenses regardless of fault, up to the limit.
Collision covers damage from impact with another object; other than collision covers theft, fire, and weather.
Business use of a personal auto may be excluded; commercial auto or a business-use endorsement may be needed.
Property Valuation and Settlement Rules
Actual cash value = replacement cost − depreciation; some states use a broader definition including market value.
Replacement cost settlement requires replacing the damaged property; a holdback is paid after replacement.
Agreed value policies pay a stated amount without a coinsurance test.
Functional replacement cost pays for less costly modern materials that restore function.
Coinsurance requires insurance to value at a stated percentage, commonly 80% or 90%, or the claim is reduced proportionally.
Pairing deductible: percentage deductibles apply to the coverage limit, such as 2% of the dwelling limit for hurricane losses.
Total loss settlements may include taxes, fees, and transfer costs under some state rules.
Liability Coverage Triggers and Exclusions
Bodily injury includes sickness, disease, and death; property damage includes physical injury to tangible property and loss of use.
Personal and advertising injury covers offenses such as libel, slander, and wrongful eviction, not bodily injury.
Expected or intended injury is excluded; the insured's intentional act may still result in coverage if injury was not intended.
The pollution exclusion bars most pollution claims; limited exceptions exist for hostile fire and some heating equipment.
The care, custody, and control exclusion bars damage to property in the insured's care; a bailee or inland marine policy may fill the gap.
Contractual liability coverage is limited to liability assumed in an insured contract, such as a lease or sidetrack agreement.
Damage to your product and damage to your work exclusions limit products and completed operations claims.
Insurance Market Regulation and Solvency
Risk-based capital ratios compare an insurer's capital to the amount required for its risk profile; low ratios trigger regulatory action levels.
IRIS ratios are early-warning tools regulators use to identify financially troubled insurers.
Guaranty associations pay covered claims of insolvent insurers, subject to statutory limits and exclusions.
Holding company transactions and affiliate agreements require regulatory approval or notice.
Reinsurance reduces net loss exposure and supports surplus; ceded premium and recoverables appear on statutory statements.
Annual statement filings and periodic financial examinations monitor solvency.
Surplus lines insurers are not admitted in the state and may be placed only through licensed surplus lines brokers after diligent search.
Commercial Property and Time Element Coverages
Business income coverage requires direct physical loss to covered property and pays during the period of restoration.
Extended period of indemnity continues business income after restoration while sales rebuild.
Extra expense pays costs to avoid or minimize shutdown, without a coinsurance test.
Contingent business income covers loss caused by damage to a supplier's or customer's property.
Civil authority coverage pays when access is prohibited by government order due to nearby damage.
Leasehold interest covers the value of a favorable lease lost after a covered loss.
Spoilage coverage addresses loss of perishable stock from equipment failure or power outage.
Ethical Decision Frameworks for Producers
Identify the client's interest first; place the client's needs above the producer's compensation.
Disclose conflicts, including ownership interests in agencies or managing general agents.
Document recommendations and client decisions to support suitability and defend against E&O claims.
Do not backdate policies or alter application information; both are fraudulent acts.
Protect client funds in a fiduciary account and never use premium for operating expenses.
Report suspected fraud to the insurer and state fraud bureau as required.
Maintain confidentiality and share information only with authorization or as required by law.
Regulatory Compliance and Consumer Protection
Unfair discrimination prohibits rate distinctions based on protected characteristics without actuarial justification.
Tie-in arrangements requiring the purchase of one product to obtain another are prohibited.
Free-look periods allow the policyholder to return a policy for a refund within a stated number of days.
Grace periods allow premium payment after the due date without lapse, commonly 10 to 31 days.
Claims and policy records must be retained per state requirements.
Complaint records and responses are reviewed in market conduct exams.
Insurers must file policy forms and rates where required and use approved forms.
Coverage Gaps and Coordination of Benefits
Coordination of benefits determines primary and secondary payers when multiple health plans cover a claim.
Other insurance clauses determine contribution: pro rata by limits, excess, or primary depending on wording.
An umbrella policy may drop down when underlying coverage is exhausted or absent, subject to a self-insured retention.
Workers compensation is generally primary for work-related injury; health insurance may be secondary.
Auto medical payments and health insurance may coordinate; policy language controls the order.
Business auto and personal auto policies may both apply to a borrowed vehicle; other insurance clauses resolve the order.
Gaps commonly arise from excluded perils, exhausted limits, and uninsured drivers.
Underwriting Process and Information Sources
Underwriting begins with the application, which the insured signs and warrants as accurate to the best of their knowledge.
Inspections, motor vehicle reports, loss runs, and credit-based insurance scores are common underwriting tools where permitted.
Adverse underwriting decisions may require notice under the Fair Credit Reporting Act when consumer reports are used.
Binding authority allows a producer to bind coverage on the insurer's behalf within stated limits.
A binder is temporary evidence of coverage until the policy is issued.
Declination and nonrenewal rules require written notice and reasons in many states.
Moral hazard refers to risk characteristics suggesting increased loss potential, such as poor maintenance or claim history.
Claims Investigation and Fraud Detection
Red flags include late reporting, inconsistent statements, prior similar claims, and documentation alterations.
Special investigation units handle suspected fraudulent claims and coordinate with law enforcement.
Material misrepresentation on a claim can void coverage and constitute insurance fraud.
Examinations under oath may be required by policy conditions for suspicious claims.
Documentation should include recorded statements, photographs, and independent estimates.
Reservation of rights preserves the insurer's position while investigation continues.
Recovery efforts include subrogation against third parties and salvage disposal.
Personal Lines Liability and Umbrella Details
Homeowners liability covers bodily injury and property damage to third parties on or off premises, subject to exclusions.
Medical payments to others pays small medical bills regardless of fault, without a liability claim.
Personal umbrella policies provide excess limits and may cover personal injury offenses not covered by underlying policies.
Business pursuits and rental of the residence are commonly excluded or limited in homeowners forms.
Watercraft and recreational vehicle liability may be excluded or limited; endorsements or separate policies fill gaps.
Animal liability may be excluded for certain breeds or prior bite history.
Intentional acts by an insured are excluded from liability coverage.
Insurance Mathematics and Financial Analysis
Loss ratio = incurred losses ÷ earned premium.
Expense ratio = underwriting expenses ÷ written premium.
Combined ratio = loss ratio + expense ratio; below 100% indicates underwriting profit.
Pure premium = losses ÷ exposure units; it excludes expenses.
Experience modification = actual losses ÷ expected losses, adjusted for credibility.
Retention = premiums retained by the insurer; ceded premium is paid to reinsurers.
Premium audit adjusts premium based on actual exposure, such as payroll or sales.
Producer Operations and Compliance Records
Maintain a client file with applications, correspondence, policies, and proof of coverage decisions.
Document coverage recommendations and client declinations to defend against E&O claims.
Use written procedures for renewals, cancellations, and claims reporting.
Retain records for the period required by state law and insurer agreements.
Verify licenses and appointments before soliciting or selling.
Reconcile premium trust accounts regularly and remit promptly.
Report changes in ownership or agency structure to regulators as required.
Regulatory Framework and Federal Interaction
The McCarran-Ferguson Act delegates insurance regulation to states, subject to federal law where states do not regulate.
The Gramm-Leach-Bliley Act requires privacy notices and safeguards for nonpublic personal information.
The Terrorism Risk Insurance Act provides a federal backstop for certified acts of terrorism, subject to thresholds.
The National Flood Insurance Program provides flood coverage and sets participating-community requirements.
State insurance departments issue licenses, approve forms and rates, and conduct market conduct exams.
The NAIC develops model laws and coordinates multi-state regulation but does not itself regulate insurers.
Federal crop insurance and flood programs operate alongside private markets under federal rules.
Ethics and Professional Responsibility in Claims
Claims professionals must investigate thoroughly and evaluate coverage objectively.
Denials must be based on policy language and facts, not on the insurer's financial interest.
Settle promptly when liability and damages are clear; unreasonable delay can constitute bad faith.
Explain the basis for a settlement offer and respond to the insured's questions.
Avoid conflicts of interest, such as using vendors with which the adjuster has a financial relationship.
Protect confidential claim information and share it only as authorized.
Document all decisions and communications in the claim file.
Commercial Auto and Transportation Exposures
Commercial auto liability covers owned, hired, and non-owned autos used in the business.
Motor truck cargo coverage insures goods in transit; it is distinct from auto physical damage.
Hired auto and employer's nonownership liability cover business use of employee vehicles.
Garagekeepers coverage protects customers' vehicles in the insured's care.
Uninsured and underinsured motorist coverage may be required or offered in commercial auto.
Trailer interchange agreements allocate liability when trailers are exchanged among carriers.
Fleet rating uses combined experience across vehicles and can reduce premium volatility.
Policyholder Rights and Complaint Resolution
Policyholders may file complaints with the state insurance department; complaints are tracked in market conduct exams.
Insurers must respond to department inquiries within required timeframes.
Cancellation and nonrenewal notices must state reasons where required by state law.
The free-look period allows return of a policy for a full refund within a stated period.
Unfair claim practices statutes give policyholders remedies for unreasonable handling.
Policyholders may request copies of their policy and claim records.
Appeals and internal review processes should be documented by the insurer.
Ethical Marketing and Advertising Rules
Advertisements must not misrepresent policy benefits, conditions, or insurer financial strength.
Testimonials must be genuine and authorized; they cannot imply typical results when atypical.
Illustrations and projections must distinguish guaranteed from nonguaranteed values.
Comparative advertising must be accurate and based on current information.
Advertising must not use misleading titles or designations implying official affiliation.
Records of advertisements may be required to be retained and filed with regulators.
Endorsements and professional designations used in advertising must be accurately described.
Insurance Contract Interpretation Principles
Ambiguity in policy language is generally construed against the drafter, the insurer.
Plain meaning controls; technical terms are interpreted as understood in the industry.
Reasonable expectations of the insured may support coverage in some jurisdictions.
Exclusions are read narrowly; coverage grants are read broadly.
The entire policy, including endorsements, is read together.
Specific provisions control over general provisions.
Statutory requirements override conflicting policy language.
Reinsurance and Risk Transfer Basics
Treaty reinsurance covers a defined class of business automatically; facultative reinsurance is negotiated per risk.
Quota share reinsurance cedes a fixed percentage of premium and losses.
Excess of loss reinsurance responds above a retention up to a limit.
Reinsurance reduces net exposure and supports growth in surplus.
Reinsurers may require underwriting guidelines and reporting.
Recoverables are amounts due from reinsurers and affect solvency analysis.
Catastrophe reinsurance protects against accumulation of losses from a single event.
Insurance Regulation of Rates and Forms
Rates must be adequate, not excessive, and not unfairly discriminatory.
Prior approval requires regulator approval before use; file-and-use allows use upon filing.
Loss costs are advisory components that insurers may adopt or modify with support.
Form filings must be approved where required; unapproved forms cannot be used.
Rate deviations and deviations from bureau loss costs require actuarial support.
Rating organizations collect data and develop loss costs under regulatory oversight.
Rate filings may be subject to public inspection and intervention.
Managing Ethical Dilemmas and E&O Prevention
Follow written procedures for coverage comparisons and renewal reviews.
Confirm coverage changes in writing and retain client acknowledgments.
Avoid advising on matters outside your license or expertise.
Refer clients to qualified professionals for legal, tax, or financial advice.
Maintain professional liability coverage appropriate to the practice.
Report errors promptly to the insurer and E&O carrier.
Use checklists for applications, binders, and policy delivery.