NY Property & Casualty flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Regulation 64 acknowledgment

New York requires an insurer to acknowledge notification of a first-party claim within 15 business days and to pay or deny the claim within 30 calendar days after receiving proof of loss.

Insurance Law section 2601

Defines unfair claim settlement practices, including misrepresenting policy provisions, failing to act promptly on claims communications, and refusing to pay without a reasonable investigation of the claim.

Free-look period

A right granted by New York law allowing the policyowner to return a newly delivered life insurance policy for a full premium refund, typically within 10 days of delivery.

Superintendent of Financial Services

New York's chief insurance regulator, appointed by the Governor, who heads the Department of Financial Services and enforces the Insurance Law through published regulations.

Principle of indemnity

The insured is restored to approximately the same financial position held before the loss and never profits from insurance; it is the basis for actual cash value and policy limits.

Law of large numbers

As the number of similar exposure units increases, actual loss experience converges on the expected loss, allowing insurers to predict losses and set accurate rates.

Adverse selection

The tendency for applicants with greater-than-average risk to seek or retain insurance, which raises loss costs unless the insurer underwrites and prices for the difference.

Subrogation

After paying a loss, the insurer acquires the insured's legal right to recover from the responsible third party, preventing double recovery and helping control premium costs.

Actual cash value

Replacement cost minus depreciation. It reflects the used value of the damaged property at the time of loss and is the default valuation method in many property forms.

Coinsurance formula

Insurance carried divided by insurance required, multiplied by the loss, minus the deductible; insurance required equals the coinsurance percentage times the property value at loss.

Mortgagee clause

Protects a lender's interest in insured property by allowing the mortgagee to receive loss payments and notice of cancellation, even if the insured's own acts impair coverage.

Appraisal provision

A method of resolving disputes over the amount of loss: each party selects a competent appraiser, the appraisers choose an umpire, and agreement by any two binds all.

HO-3 special form

The most widely used homeowners form. It insures the dwelling and other structures on an open-peril basis and personal property against broad named perils.

Coverage D loss of use

Pays additional living expenses and fair rental value when the residence is uninhabitable because of a covered loss, for the time reasonably needed to repair or relocate.

Coverage C special limits

Caps recovery for categories such as money, securities, jewelry theft, firearms theft, silverware theft, and business property, regardless of the overall personal property limit.

HO-4 tenants form

Covers a renter's personal property and personal liability, plus limited building additions and alterations made by the tenant; the landlord insures the building separately.

Business income coverage

Pays net income plus continuing normal operating expenses during the period of restoration following a covered loss, subject to a 72-hour waiting period.

Agreed value option

A commercial property option that suspends the coinsurance requirement when the insured carries a limit equal to 100 percent of the covered property's value.

Filed value inland marine

An inland marine policy that states a fixed value for the covered property and pays that amount without coinsurance or further proof of value after a total loss.

Builders risk coverage

Covers a building under construction, including materials, supplies, and equipment intended to become part of the structure, until the project is completed and accepted.

Res ipsa loquitur

A doctrine allowing an inference of negligence when the injuring instrument was under the defendant's exclusive control and the event would not normally occur without negligence.

Pure comparative negligence

A rule used in New York that reduces a plaintiff's recovery by his or her percentage of fault and does not bar recovery unless the plaintiff is 100 percent at fault.

Claims-made trigger

Coverage applies to claims first made and reported during the policy period, subject to a retroactive date, rather than to the date the injury actually occurred.

Additional insured

A person or organization added to a liability policy by endorsement, usually protected only for liability arising out of the named insured's work or premises.

New York serious injury threshold

To sue for pain and suffering after an auto accident in New York, the injured person must have a serious injury such as fracture, death, or 90 days of impairment.

PIP lost earnings benefit

No-fault pays 80 percent of lost earnings up to $2,000 per month for as long as three years after the accident, in addition to necessary medical expenses.

Commercial auto symbol 9

A covered auto designation meaning nonowned autos only, such as employees' personal vehicles used with permission in the employer's business.

Collision coverage

Pays for damage to the insured auto caused by impact with another vehicle or object, subject to the deductible, generally regardless of who was at fault.

Exclusive remedy doctrine

Workers compensation benefits are the employee's sole remedy against the employer for work-related injury or disease, barring most negligence suits against that employer.

Products-completed operations

General liability coverage for bodily injury or property damage occurring away from the premises and arising from the insured's product or completed work.

Umbrella drop-down

The umbrella policy pays when a claim exceeds the required underlying limit or is not covered by underlying insurance, usually subject to a self-insured retention.

Crime discovery period

The stated time after a crime policy expires in which the insured may still report a loss that occurred during the policy period, typical of loss-sustained forms.