CAS Exam 5
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- According to Finger, List the 4 Summarized Categories of Criteria for Selecting a Rating Variable
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1 Actuarial
2 Operational
3 Social
4 Legal - According to Finger, List the 4 Actuarial Criteria for Selecting a Rating Variable
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1 Credibility
2 Homogeneity
3 Accuracy
4 Reliability - According to Finger, List the List the 5 Operational Criteria for Selecting a Rating Variable
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1 Objective Definition
2 Avoidance
3 Verifiable
4 Administrative Defense
5 Intuitively Related - According to Finger, List the List the 4 Social Criteria for Selecting a Rating Variable
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1 Privacy
2 Affordability
3 Causality
4 Controllability - According to Finger, List the List the 3 Legal Criteria for Selecting a Rating Variable
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1 Constitutions
2 Statutes
3 Regulations - According to Finger, What are the 4 Ramifications of restriction if no replacement rating variable is found?
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1 Rates will be leveled and subsidies will be created
2 Availability will diminish
3 Profit and solvency may be affected if the book is mal distributed
4 Less accurate pricing may reduce accident prevention incentives - According to Finger, What are the 5 methods to obtain more data or more reliable data in order to determine classification relativities
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1 Use more years of data
2 Use data from several states
3 Using claim counts
4 Using basic limits data or otherwise limiting the size of claims
5 Using partial premiums - According to Finger, What is the Definition of Efficiency
- Efficiency is defined as a measure of accuracy of a classification system.
- According to Bouska, List the 4 characteristics that a good exposure base should have
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1 An Accurate measure of the exposure to loss
2 Easy to determine for the insurer
3 Difficult to manipulate by the insured
4 (Bouska adds) Immune to manipulation by underwriters - According to Bouska, List the 3 types of problems in the selection of an Exposure Base
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1 A Temporal Mismatch between Expected Losses and an Acceptable Exposure Base (Products Liability or claims made)
2 Interpretive Mismatch (Polution liability "tons of waste disposed"
3 Complexity of Hazard (D&O) - According to Bouska, What are the 2 steps in the process of selecting an exposure base?
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1 Analyze the coverage offered and the coverage trigger to determine what factors influence the expected losses
2 Those which are usable will be divided into 2 groups: the first group, consisting of 1 factor, will be the exposure base, and the second group will be the rating variables, which influence the projected expected losses indirectly by affecting the rate - According to Bouska, What are 2 alternative rating plans used for LARGE RISKS that modify the usual exposure Base
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1 Composite Rating Plan
2 Loss-Rated - According to Bouska, What are 2 serious problems caused by varying company practices?
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1 The poor coding of Exposure Information
2 The manipulation of Exposure estimates can be "low balled" causing a mismatch in recording premium and loss - According to Bouska, Summarize the OREGON STUDY, "Premium EQUITY BY Employer Group"
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Was a WC study, focusing on small to medium companies.
The study found no bias against Union/High Wage small employers, but did for medium size employers
NCCI had Loss Ratio Adjustment Program for Construction Classes to make the experience rating plan more responsive to company's 3-year Loss Ratio - According to Bouska, What is the distinction between a Rating Variable and an Exposure Base?
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An Exposure Base has
a) a uniform and continuous multiplicative relationship to E[loss costs] and rates
b) has a simple and obvious relationship to losses
A rating variable has a discrete nonlinear relationship with E[loss] - According to Bouska, Summarize ISO's GL study, "ISO's Commercial Lines Policy and Rating Simplification Project"
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1) GL Exposure bases changed to Gross Sales instead of Area/Receipts in some sublines
It simplified Rating
It made the Exposure Base Inflation Sensitive
It made the Exposure Base Sensitive to Economic Cycles - According to WC Feldblum, List the 4 factors that affect class refinement
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1 Competition
2 Coverage Costs
3 Larger Markets
4 Technology - According to WC Feldblum, List the 3 causes that impact Loss Cost Trends
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1 Economic Inflation
2 Social Inflation
3 Other - systematic non-monetary changes that impact insurance values (changes in economy/work environment) - According to WC Feldblum, What are the 6 things that Statuatory Benefit Revisions affect in Workers Comp
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1 Claim Filing
2 Duration
3 Mix of Claims
4 Non-compensation Medical Benefits
5 Attorney involvement
Compensable Injuries and Diseases - According to WC Feldblum, List the 5 NCCI programs designed to Reduce the competitiveness of the Pools (depopulating them)
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1 Higher Premium Deposity Requirements for Involuntary Risks
2 Payroll Verification Plans
3 Elimination of Premium Discounts
4 Premium Rate Differentials between voluntary and involuntary markets
5 Two loss-sensitive rating plans, ARAP and ARRP, to reflect adverse loss experience - According to WC Feldblum, What are the 6 things that the disparity between wage inflation and benefit trends stem from?
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1 Technological Advances in Medical Treatment
2 Increasing utilization of medical services
3 PatientClaims shifting and Physician Cost shifting
4 Lengthening of disability durtations
5 Increasing Frequency and compensability of costly psychological injuries
6 Greater Attorney Involvment - According to WC Feldblum, List 3 reasons why Large Risks have lower loss ratios than small risks
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1 Larger Risks have More incentive to reduce loss expenses since their size gives their own loss experience more credibility in Experience Rating
2 LArge Expenditures required to implement safety programs are more cost effective for larger risks
3 Post Injury and Back-to-Work programs may not be offered by smaller risks - According to WC Feldblum, List 3 reasons for using Total Payroll as the exposure base
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1 Accuracy: it may be more predictive of the losses resulting from providing both indemnity and medical benefits
2 Inflation Sensitive
3 Reliability: Since it is used for federal income Tax purposes, it is available and reliable - According to WC Feldblum, List the 2 factors for INCREASING the Involuntary Market Burden
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1 Risks leaving the voluntary market for self-insurance plans or excess coverage
2 Regulatory supression of voluntary market rates - According to WC Feldblum, state 3 facts about a law ammendment that changes the payment base from a gross earnings to net earnings
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1 Within any tax band, if the minimum OR maximum limitation affects all insureds, before and after the change, there is no direct effect
2 Within any tax rate band, the effect of the change is uniform accross wage rates if the minimum AND maximum limitations do affect the reimbursment, either before or after the change
3 The direct effect can be quantified using a wage distribution table and an income tax schedule - According to WC Feldblum, List the 3 factors for REDUCING the Involuntary Market Burden
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1 Higher Premium Deposit Amounts
2 Elimination of Premium Discounts
3 Payroll Verification plans - According to WC Feldblum, list 1 reason AGAINST using total payroll as an exposure base
- High wage paying employers may perceive the exposure base as unfair and are more likely to self-insure, because medical benefits are not directly related to wage level.
- According to WC Feldblum,list 3 reasons why higher unemployment may increase average claims severity
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1 Higher unemployment levels lead to an increase in utilization, since unemployeds people seek whatever income they can get and other people want to extend their benefits because fearing of not having a job to return to
2 Higher unemployment makes people scared to file small claims for fear of job loss
3 The experience and injury mix changes: more older/experienced (low freq. high sev.) employees are returned; and Younger (high freq./low sev.) employees are laid off - According to WC Feldblum, what are the direct and indirect effects of legislative change that increases the statutory WC indemnity benefit 15%
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Direct- More indemnity payments will be paid even if reported claims, avg duration, etc do not change. Effect may not be exactly 15% due to max/min benefits. Avg WC loss will increase
Indirect- Increase in claims reported and claim duration. More incentive for old employees to use WC as early retirement - According to Finger, Describe 2 ways an insurance company can react to counter the effects due to the abolition of a rating variable.
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1 Insurers have incentive to, and should try and find a replacement variable
2 Insurers may withdraw from marketing to certain groups or refuse to insure them - According to McClenahan, The 3 goals of ratemaking are to determine rates which will provide ____,___, and ____
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1 Sufficient Funds
2 Adequate MArgin
3 Reasonable Return - According to McClenahan, List the 4 factors affecting the selection of an Exposure Base
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1 Reasonableness
2 Ease of Determination
3 Responsiveness to Change
4 Change in Historical Practice - According to McClenahan, Describe the Distinction between the profit factor and the contingency factor
- The profit factor is based generally on some target rate of return, and the contingency factor addresses the potential for adverse deviation
- According to McClenahan,Why are Other Aquisition Expenses related to Written Premium, while General Expenses are related to Earned Premium
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Other Aquisition Expenses are assumed to be incurred mainly at the begining of the poilicy, so it makes more sense to relate it to Written Premium
General Expenses would continue to be incurred even if policies ceased to be written, so it makes more sense to relate to EP - According to McClenahan, what is a pos and neg of Report Yr. What LOB should use this
- Convenient for claims made pricing since # of claims reported are frozen at the end of the year. LOB- claims made
- According to McClenahan, what is a pos and neg of Policy Yr. What LOB should use this
- Data not available until 2 calendar years after first policy written. Data more mature but the delay in availability makes it less responsive to identifying change. LOB – Comm GL – more stable
- According to McClenahan, what is a pos and neg of Calendar Yr./Acc Yr What LOB should use this
- Data is readily available at the end of the yr. Acc Yr losses at the end of the first yr are very immature. LOB- Auto Liability- responsive to change
- According to McClenahan, what is a pos and neg of Calendar Yr. What LOB should use this
- Available in annual statement pg 14. Susceptible to changes in reserve level adequacy for yr to yr. LOB- Auto PD pricing – short tail
- According to McClenahan, what is the diff between LRM and PPM
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PPM 1 Develops indicated rates
2 Based on exposure
3 does not require existing rates
4 does not use on-level prem
LRM 1 Develops indicated rate change
2 Based on Prem
3 Requires existing rates
4 Uses on-level earned premium - According to McClenahan, what is skimming the cream vs adverse selection
- Skimming the cream is when a rate fails to reflect a positive characteristic and adverse selection is it fails to reflect a negative characteristic
- According to McClenahan, List the 3 causes of Loss Development
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1 Development on Known Claims
2 Newly Reported Claims
3 Re-opening of prior closed claims - According to McClenahan,why is it appropriate to both Develop and Trend Losses?
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Because ther is no double counting of severity trend and loss development factors in the ratemaking process
The Trend factor reflects the severity trend from the midpoint of the experience period to the midpoint of the exposure period
The loss development factor reflects the underrlying severity trend from the midpoint of the exposure period to ultimate - According to McClenahan,Briefly describe each of the 3 methods available for the review of Imcreased Limits factors
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1 A severity Trend Factor is applied to each closed claim from the date of closure to the effective period for the ILF's
2 Loss Development patterns by layer
3 A theoretical size of Loss Distribution is fit to individual loss data - According to Graves and Castillo, Give 5 major changes to Premises and Operations ratemaking since McManus's 1980 Update
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1 Inclusion of Multiline datain the rate level review
2 Loss Development by state
3 Use of Bailey Min. Bias to determine Type of policy and class group relativities
4 Changes were made to the standards for full credibility by subline
5 Changes were made to the number of policy years used - According to Graves and Castillo, What are the 4 advantages of using a Monoline-ML database?
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1 More Stable Rate level indications
2 Creation of more accurate GL Trend factors
3 Creation of more stable loss development factors
4 Resolves regulator concern that only a portion of the data was being used - According to Graves and Castillo, How many years of experience do you use in the indication?
- 3 policy years of experience
- According to Graves and Castillo, What are the weights assigned to the years
- 50% 30% 20%
- According to Graves and Castillo, Dou you use BL or TL losses, prem, ULAE, ALAE
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Use BL losses (except in calculation of ULAE factor)
Use BL Premiums
Use Total ALAE
Use Total ULAE - According to Graves and Castillo, State 2 reasons why it is appropriate to use Basic Limits data when calculating a rate level indication
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1 Basic limits data is less effected by single large severity events (catastrophes)
2 Basic Limits data is not affected by shifts in policy limit distribution - According to Graves and Castillo, why is appropriate to both Trend and develop losses
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Trending projects losses from the midpoint of the experience period to the midpoint of the exposure period.
Loss Development considers a different period in time. Losses are developed from the midpoint of their exposure period to their ultimate value. - According to McClenahan, why is it important to use base exposures instead of actual exposures
- It corrects for the varying exposure levels in the non-reviewed relativities
- According to Graves and Castillo, what is the Implicit Package Modification Factor (IPMF)
- IPMF is the discount, implied for a particular coverage, written on a package policy rated with a given published Package Modification Factor (PMF)
- According to Jones, what are the 3 items that can reduce the usefulness of the historical loss ratio?
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1) If the future book of business is significantly different from the past book of business, due to either cancellations, nonrenewals, or writing new business, this could affect the expected loss ratio.
2) The economic, legal, and social environments of insurance are constantly changing, affecting loss severity and loss frequency.
3) Changes in an insurer's rate levels will affect average premiums. - According to Jones, what are 4 items that can cause the future avg. premium level to differ from the past avg. prem level?
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1) Past rate changes: one-time, abrupt, and measurable
2) Past rating plan changes: one-time, abrupt, and measurable
3) The existence of rating plans which change the premium level over time: measurable, gradual, and continuous
4) Past and expected future shifts in the mix of business: gradual and continuous - According to Jones, what are 2 methods of adjusting historical experience for changes that affected the average premium level?
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1) A direct adjustment
2) Apply premium trend - According to Jones, What is the advantage of the 2-step trending procedure over the 1-step trending procedure?
- The 2-step method recognizes situations where a singl;e annual premium trend may not be appropriate for each year in the experience period.
- According to Jones, What are the 2 trending periods in the two step trending procedure?
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Step 1: Trend the premium to the midpoint of the latest trend data point in the series
Step 2: Trend the Premium from the midpoint of the latest trend data point to the average written date for future the future policy period - According to Jones, Discuss the appeal of using average Written trend vs. Average Earned Trend in a 2-step Trending procedure.
- A trend analysis based on average written premium will have a longer trending period for step 1 and a shorter period for step 2. This adds to the appeal of using Ave. Written, in that the length of the inherently uncertain projection period is minimized.
- According to Jones, what are 2 challenges in the task of adjusting for the changes affecting the average premium level?
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1) Choosing an adjustment method
2) Avoid double counting - According to Marker/Mohl, Give 3 situations in which a tail policy (in claims-made) is able to provide necessary coverage
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1) Insureds entering retirement
2) Death and Disability situations
3) Changing Insurance Carriers - According to Marker/Mohl,List the 5 principles of Claims-Made Rating
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1) A CM should always cost less than an occurrence policy, as long as claim costs are rising
2) Whenever there is a sudden, unpredictable CHANGE (positive or negative) in the underlying TREND, CM policies priced on basis of prior trend will be closer to the correct price than the pricing of occurrence policies
3) Whenever there is a sudden, SHIFT in the REPORTING pattern, the cost of CM coverage will be affected very little if at all, relative to occurrence coverage.
4) CM policies incur no liability for IBNR claims so the risk of reserve inadequacy is greatly reduced. If the claim is not reported, it is not covered. The IBNR need for a CM policy is always 0.
5) The investment income earned from a CM policy is substantially less than under an occurrence policy. The longer the reporting lag or the shorter the settlement lag, the greater the difference will be. - According to Schofield, What are 3 the 3 assumptions made in the study note?
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1 All Quantities are accurately measured
2 All Rates are at an adequate level
3 Rating plans are multiplicative - According to Schofield, What are the 2 methods of calculating Fixed Expenses (policy/Exposure)?
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1 Expense fee Method (per exposure basis)
2 Worker's Comp Method (per policy basis) - According to Schofield, When is it good to use the Expense Fee Method?
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In the Expense Fee Method, Fixed and Variable Expenses are treated on a per Exposure Basis.
It should be used when the range of exposures written on a policy is small (Ex: Personal Auto) - According to Schofield, When is it good to use the Workers' Comp Method?
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In the Worker's Comp Method, Fixed and Variable Expenses are treated on a per Policy Basis.
It should be used with a wider range of exposures written on a policycan exist (Ex: Worker's Comp) - According to Schofield, In the McClenahan Pure Premium Method, on which basis are expense fees calculated?
- Per Exposure Basis
- According to Werner, List the 3 considerations when deciding whether to calculate fixed expenses on an exposure or a policy basis
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1) The range of exposures on a policy
2) The correlation of overhead expenses with policy exposures
3) Current company practices with regard to allocation of expenses - According to Werner, what are 3 items which can cause an excessive or inadequate overall rate indication
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1) Rate changes
2) Significant premium trend
3) Countrywide expense ratio usages - According to Werner, what are 5 concerns that remain after using the proposed procedure?
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1) Splitting expenses
2) Average expense levels by location
3) Fixed expenses that vary slightly with premium
4) Fixed expenses that vary by other statistics
5) Economies of scale - According to Werner, what are the 4 things that may affect the selection of a provision for each expense category?
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1) Future changes in expenses 2) A one-time shift in the expense levels
3) Non-recurring expense items
4) State restrictions on expense recovery - What are the 5 expense categories used by Werner?
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1) General Expense
2) Other Acquisition
3) Commissions and Brokerage
4) Taxes
5) Licenses & Fees - According to CAS, What are the 4 items that the Standard of Practice states that the actuary should consider in trending model evaluation?
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1) the historical data being used
2) The success of the model in making prior projections
3) The statistical goodness of fit of the model to the historical data
4) The impact of any sudden, nonrecurring changes (tort reform) not yet incorporated in the data - According to CAS, What are the 4 specific areas of evaluation of trending procedures recommended by Standard 13
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1) Those established by precedent or common usage in the actuarial profession
2) Those used in previous analyses
3) The choice of the database and methodology, with emphasis given to the credibility of the data
4) The effect of known biases or distortions (Cats, Seasonality, Policy limits etc.) - According to CAS, What is social inflation and give 2 examples of it
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It’s the impact on insurance costs from changes in claim consciousness, court practices, judicial attitudes and other non-economic factors. Examples:
1) Changes in claim consciousness spark insureds to file more claims
2) Changes in judicial attitudes results in more liberal awards for plaintiffs - According to CAS, What are the 3 sources of data that actuaries rely on for trend selections
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1 Company data
2 Insurance data
3 Non Insurance data - According to CAS, List the 4 principles of P&C Insurance Ratemaking
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1) A rate is an estimate of the expected value of future costs
2) A rate provides for all costs associated with the transfer of risk
3) A rate provides for the costs associated with an individual risk transfer
4) A rate is reasonable and NOT excessive, inadequate, or unfairly discriminatory if it is an actuarially sound estimate of the expected value of all future costs associated with an individual risk transfer - According to CAS, what are the 3 desirable features for exposure units to have
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1 vary with hazard
2 be practical
3 be verifiable - According to Boor, what are the 4 types of issues to consider when selecting the complement
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1) Practical issues
2) Competitive market issues
3) Regulatory issues
4) Statistical issues - According to Boor, what are the 6 desirable qualities for the statistic which is assigned the complement of credibility
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1) unbiased
2) accurate
3) independent
4) available
5) easily computed
6) explainable relationship - According to Boor, what are the 3 desirable and 3 undesirable characteristics of using competitor rates for a credibility comp
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Desirable 1 Independence Prediction error in competitor rates is independent of loss costs 2 Availability 3 Process Error – More dataUndesirable 1 Explainable Relationship 2 Bias – might be biased due to different underwriting and Desirable 1 Independence Prediction error in competitor rates is independent of loss costs 2 Availability 3 Process Error – More dataUndesirable 1 Explainable Relationship
2 Bias – might be biased due to different underwriting and claim practices
3 Computation - According to Brown & Schmitz, what are 3 reasons for use of small deductibles
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1) To avoid expenses associated with processing and investigating claims for a small payment
2) Most insureds can afford to pay a small deductible (since it does not have a significant impact on the insured's financial condition)
3) Can discourage the filing of small nuissance claims and frivolous claims and also controlling moral hazard - According to Brown & Schmitz, what are 4 reasons for the increased use of large deductibles
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1) Insurance cost savings to the insured
2) Loss control incentives for the insured
3) Reduced residual market burdens for the insurer
4) Cash flow advantages to the insured - According to Brown & Schmitz, What are 5 considerations when pricing a deductible policy? How are...
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1 the insurer's net losses affected?
2 ALAE costs affected?
3 other expenses affected? (should larger relative profit/risk margin be charged for the deductible policy?
4 prices impacted give that policy cash flows are affected
5 insured bankruptcy situations handled? - According to Brown & Schmitz, what are 3 additional fixed expense categories an insurance company is subject to issueing deductible policies?
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1 billing insureds for deductible payments
2 monitering payment of deductibles
3 pursuing in some cases deductible funds through collection agency/lawsuit. - According to Feldblum PAP, what are 3 attributes that motivate asset share pricing
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1) commissions
2) cancellations
3) loss costs - According to Feldblum PAP, what are 4 reasons why asset share pricing is not common
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1) The data needed are not always available
2) Casualty pricing techniques are still somewhat undeveloped
3) The casualty insurance policy allows great flexibility in premiums and benefit levels
4) Liability claim costs are uncertain, both in magnitude and in timing - According to Feldblum PAP, what are 3 things that the correct rate relativities depend on
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1) Classification system
2) Average losses and persistency rates by classification
3) Strength of loss ratio improvement by policy year - According to Feldblum, what are the 4 factors that affect the differing ratemaking philosophies of life vs. P&C?
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1) Cancellation
2) Claim Costs
3) Expenses
4) Level Premiums - According to Feldblum PAP, what are the 4 reasons for the relationship between the duration of an auto policy and the claim frequency for that policy?
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1) Experience
2) Youth
3) Transience
4) Acquisition of vehicle - According to Feldblum PAP, Why is it not appropriate to assume the same pattern of persistency rates for both direct writers and independent agency companies?
- Direct writers have high retention rates because they offer low premium rates and provide renewal premium discounts. Many independent agency companies have low retention rates because the agent can move the insured to whichever company has the lowest rates.
- According to Feldblum PAP, explain how assett share pricing models and property and casualty insurance ratemaking models differ in their consideration of the profitability of an insurance policy.
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Traditional P&C ratemaking consider only the profitability of the future policy period.
Assett share pricing models look at profitability over the life of the policy, taking into account policy persistency patterns. - According to Lange, what 3 factors tend to increase with each layer of loss
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1) LDFs
2)Trend
3) Risk or security loadings - According to Lange, list the four difficulties involved in ascertaining the profitability of writing increased limits of liability
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1) Inflationary trends have a substantially different impact in the increased limits area
2) Large liability losses may not be settled for many years
3) Since IL's losses are in the tail of the distribution of losses by size, considerable statistical variation exists
4) IL's premiums are generally lumped together with BL's premiums and other unrelated charges - According to Lange, what are the 2 advantages to his method for calculating ILFs over the Pure Premium Method?
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In PPM, since IL’s data is of lesser volume and subject to greater statistical variation, the resulting PPs would have little credibility
2 The PP approach is not useful in testing the present rating procedure in which IL's charges are expressed as a function of BL's rates. - According to Lange, what are the advantages to his method for calculating ILFs over the Loss Ratio Method?
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In LRM, premiums must be known with accuracy, but IL and BL are usually clumped together. Even if one were to reconstruct separate IL premiums the utility of the resulting loss ratios would be low.
Increased limit rates are a function of BL limits rates so the IL experience cannot provide an indication of the relationship between IL losses and BL losses - According to Lange, list 2 reasons why IL losses increase more rapidly than BL loss trends
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1) For loss> BLs, the whole effect of the trend is in the excess portion of the claim, with 0 effect on the BL portion
2) A rising cost trend will cause an increased freq. of ILs losses since additional claims will break through the lower boundary of the IL layer and become new excess claims - According to Lange, list 2 reasons why increased limits losses increase more rapidly than basic limits losses
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1) For a loss greater than the Basic limit, the whole effect of the trend is in the excess portion of the claim, with 0 effect in the basic limits portion.
2) A rising cost trend will cause an increased frequency of increased limits losses (additional claims will bnreak through the basic limit) - According to Lange, Basic limits rates include only a provion for the expenses of the direct primary insurer; why i sthat a problem?
- Unless some provision is made for the expenses of the reinsurer, the increased limits charges would be inadequate
- According to Tiller, what are 6 attributes of a good individual risk rating system
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1) Honest
2) Useful
3) Simple
4) Balance
5) Understandable
6) Stable - According to Tiller, what are the 3 types of prospective individual risk rating plans
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1) Schedule Rating
2) Experience Rating
3) Composite Rating - According to Tiller, what are the 3 qualities the credibility must have when weighting the actual vs Expected LRs
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1) 0 < Z < 1
2) Cred should increase as the size of the risk increases
3) The % charge for any loss of a given size should decrease as the size of the risk increases - According to Tiller, what 5 elements are included in basic premium
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1) Profit and Cont
2) LAE in excess of those provided by the LCF
3) Acquisition and service costs
4) Net charge for limiting the retro prem between the min and max
5) Risk control services, prem audit, and general administration of insurance - According to Tiller, what is the purpose of the D-ratio in the experience rating plan
- It adjusts the expected basic limits losses for the impact of the Maximum Single Limit, by reducing the expected basic limits losses and ALAE by the proportion of expected loss and ALAE higher than the MSL
- According to Tiller,Briefly describe internal manipulation with regard to individual risk rating systems and give an example.
- Internal manipulation occurs when an entity to which costs are being allocated can influence the cost allocation. Ex: an entity that sets its cases reserves (used in individual risk rating calculation)
- According to Tiller,Briefly describe external manipulation with regard to individual risk rating systems and give an example.
- External manipulation occurs when some agency, other than the entity to which costs are being allocated, influences the cost allocation. EX: marketing manager overrides the pricing results of the individual risk rating calculation without justifiable cause
- According to Tiller, explain why the retrospective rating process tends to produce back and forth payments between insurer and insured?
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Retrospective premium adjustments that modify the premium based on loss experience cause back-and-forth paymernts.
The first adjustment (typically 18 month after inception is ussually a refund of premium because minimal loss experience is reported, Subsequent adjustments typically require more premium as losses develop. - According to Fitzgerald, what are the 5 major limitations in determining loss costs in states that have significant hurricane exposures
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1)Not enough historical insurance data
2)Over reliance on long term premium and loss information
3)Grouping states into regions can mask hurricane potential
4)Individual storms can have a disproportionate impact
5)Not all portions of a state are equally exposed to hurricanes - According to Fitzgerald, what is used for cred weighting for modeled loss costs
- No credibility weighting is performed, because modeled territorial loss cost is considered fully credible. Credibility is taken into account only for the non-hurricane loss costs
- According to Fitzgerald, what are the 4 steps in calculating net MDRs
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1) Express damage ratios on a 1st dollar basis
2) Derive a beta cumulative distribution function
3) Calculate a net MDR for EACH event
4) Calculate a net MDR for ALL events - According to Fitzgerald, what are the 6 limitations of the hurricane model
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1) Limitations of Meteorological History
2) Limitations of Understanding Hurricanes
3) Limitations of Exposure Inventory
4) Demand Surge
5) Limitations of Damageability Information
6) Limitations of the Model in specific pricing situations - According to Fitzgerald, what are the 4 other uses of the model
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1) Pricing Optional Coverages
2) Development of Territory Definitions
3) Building Code Effectiveness Grading
4) Risk Load - According to Fitzgerald, List 3 key partamters in RMS model that pertain to the hurricane event
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1 Observed Central Pressure Differentials (fit to Weibull distribution)this is the key parameter of the stroms strength
2 Observed Forward velocities (lognormal)
3 Track Angles (normanl distribution - According to Fitzgerald,why is the risk load important?
- The distribution of losses around the expected value is often just as important as the expectation itself. The distribution around the average determines the degree of risk underlying the coverage. The model provides this information!
- According to Fitzgerald, what is one impootant advantage of the hurricane Model?
- It provides more accurate estimates of hurricane losses by territory within a state. The prior territory reviews were limited by the sparsness of the data.
- According to Fitzgerald, state 3 reasons why full credibility is given to the model
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1 The MDR's are based on all available meteorlogical data over the past century
2 There is no credibility standard for the volume of data needed to determine reliable estimates from the model
3 There is an absence of a source to use as the compliment of credibility - According to Fitzgerald, Explain why you should give caution about this assignment of credibility
- Since the hurricane model determines the hurricane loss cost by fitting the parameters of a hurricane to probability distributions, the user should be aware that there is parameter uncertainty in the results
- According to Anderson, what are 7 assumptions that simplify the general pure premium rate equation?
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1) Premium rates are equitable and just adequate
2) All insured properties are homogeneous
3) The rate determinants (frequency and severity) are known and stable
4) Losses are precisely adjusted
5) Each insured carries no ohter property insurance
6) There is no interest on the pure premium collected
7) Each policy has no more than one loss per period. - According to Anderson, What are the 3 forms that the designated insurance represented in the numerator of the coinsurance apportionment ratio may take?
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1) The face amount of the policy requiring insurance
2) The total face amounts of the insured's applicable policies
3) Under provisional reporting form policies, such as on inventories, full insurance on the property values last reported before a loss. - According to Anderson, when does a premium reversal occur?
- A reversal occurs if the percentage decrease in gross premium rate is greater than the percentage increase in the policy face
- According to Anderson, do the rates for percentage coinsurance requirements vary by policy size?
- NO
- According to Anderson, what are 3 criteria that the coinsurance rate tables should satisfy?
-
1) A wide range of coinsurance percentages should be offered at separate rates.
2) Premium reversals should not occur, inevitably, at the borders between bands of premium rates.
3) Whenever losses less than the policy face are possible, the pure premium rate should fall as the policy face increases. - According to Kelly, what is a disadvantage to the company of offering GRC?
- It’s dependence on it inspections, inflation coverage, etc. to ensure that the dwelling is initially and ultimately insured at full replacement cost
- According to Kelly, what is an adjustment clause and what is it’s purpose on the homeowners policy?
- Adjustment clauses are designed to automatically update the dwelling coverage amounts at policy renewal for inflation
- According to Kelly, what are the 6 potential rating impacts of changing levels of insurance to value?
-
1) The additional premium (per policy) generated by larger coverage amounts from actions such as inspections and reinspections.
2) The additional total, and near total, losses which accompany the larger coverage amounts generated by additional inspections and reinspections.
3) The reduced premium (in total) from increased numbers of cancellations and non-renewals.
4) The reduced claim payouts (in total) from increased numbers of cancellations and non-renewals
5) The reduced claim payouts (per policy) if broader reinspection programs result in suggestions to reduce the risk of loss which are then carried out.
6) Changes in expenses. - According to Prevesto, what are the 4 date fields collected on each transactional record?
-
1) Accounting
2) Inception
3) Effective/Expiration
4) Date of Loss - According to Prevesto, what are 3 examples where coded as rated may not be followed?
-
1) Extra detail collected
2) Regulatory requirements for a data element to be captured and maintained
3) Less detail collected - According to Prevesto, what are the 3 amount fields collected for the ISO statistical plans
-
1) Written premium
2) Loss indemnity
3) Loss-ALAE - According to Prevesto, what are the 4 additional data elements collected for the lines of insurance subject to natural disasters?
-
1) zip code
2) day of loss
3) expanded cause of loss detail
4) Building Code Effectiveness Grading Schedule code - According to Prevesto, what are the 3 areas that regulators monitor and regulate in the insurance business?
-
1) Financial solvency and solidity of insurance companies
2) Market conduct
3) Rate regulation - According to Prevesto, Describe "Summary-Based" Statistical Plans
-
"Summary-Based" Statistical Plans - data is summarized by line of business, state, class and by coverage and sent to the statistical agent
The purpose of "summary Based" is to satisfy regulatory requirements - According to Prevesto, Describe "Transaction-Based" Statistical Plans
-
"Transaction-Based" Statistical Plans transaction level records are sent to the statistical agent. These records include the dollar amount of the premium and substantial information about risk characteristics. On th eloss side, transaction records eveytime a loss is paid, including partial payments an the establishing of a case reserve.
The purpose of transaction based statistical plans is to collect more detailed information to support the business need for data. - According to Prevesto, Define "Code as rated"
- Means there is a direct correlation between the statistical coding of data that is collected to rate the policy and rating criteria. Example Homeowners: COVA, Deductible, policy form
- According to Prevesto,State the 2 braod categories of Exposure Bases used for General Liability.
-
1 Fixed Exposure Base - The exposure base is a definate known quantity at the inception of the policy EX: square feet
2 Variable Exposure base, EX: gross sales - According to Prevesto, what are the two main needs a statistical plan is developed to provide
-
1 Regulatory Purposes
2 Business purposes - According to Moncher, list the 5 major data collection programs at NCCI
-
1) Annual Financial Call Data
2) WC Statistical Plan Data (WCSP)
3) Detailed Claim Info Data (DCI)
4) Policy Issue Capture System Data (PICS)
5) Residual Market Data - Which two data collection programs are the primary data sources used for Worker's Compensation Ratemaking?
-
1) Annual Financial Call Data
2) WC Statistical Plan Data (WCSP) - According to Webb, give the 3 benefits participants get through insurance
-
1) Reimbursement of losses
2) Reduction of uncertainty
3) Services provided by the insurer to reduce the possibility of loss - According to Webb, list the 4 things in which the insurer accomplishes the principle function
-
1) Marketing
2) Loss control
3) Underwriting
4) Premium auditing, and claims handling - According to Webb, list the 4 things which a property and liability business in the U.S. can be classified by
-
1) Legal form of ownership
2) Place of incorporation
3) Licensing status
4) Marketing or distribution system used - According to Webb, what are the 4 types of participants in the risk transfer process
-
1) Risk Manager
2) Consultants
3) Insurance Agents and Brokers
4) Insurers - According to Webb, what are the 8 insurer functions that facilitate the risk transfer process
-
1) Policy Contract Development
2) Pricing
3) Marketing
4) Underwriting
5) Claim Adjustment
6) Loss Control
7) Reinsurance
8) Investments - According to Webb, what are the four types of distribution systems
-
1) Independent Agency System
2) Exclusive Agency System
3) Direct Writer System
4) Direct Response System - According to Webb, what are the 7 factors to consider when selecting a distribution system
-
1) Geographic location
2) Expertise and Reputation of Producers
3) Nature of Existing Business
4) Ability to Service Products
5) Markets to be Targeted (Buyers to be Reached)
6) Insurer Characteristics
7) Degree of Control Required or Desired - According to Webb, what are the 3 widely used bases for transmitting premium to the insurer
-
1) the item basis
2) the statement basis
3) the accound current basis - According to Webb, what are 3 types of proprietary insurers
-
1 Stock Companies
2 Lloyd's
3 Insurance Exchanges
Proprietary Insurers are formed to make a profit for their owners - According to Webb,Describe Lloyd's
- Lloyd's of London is not an insurance company. It is a marketplace, similar to a stock exchange. The insurance is written on behalf of individual or corporate members. The insurance is backed by their entire personal forunes. Each member belongs to one ore more syndicate, and delegateds the day-to-day management to the syndicate manager
- According to Webb,List the 4 types of Cooperative Insurers
-
1 Mutual Companies
2 Reciprical Exchanges
3 Fraternal Organizations
4 Other (Captive Insurers, Risk Retention Groups, Purchasing Groups)
Cooperative Insurers are not necessarilty formed for profit. Owned by the policyholders, ussually formed to provide insurance at a minimal cost. - According to Webb, Describe Pools/Associations
- Consist of Several insurers not otherwise related. These are ussually used to insure risks that individual companies are not willing to cover alone.
- According to Webb, List 8 types of Federal Insurance
-
1 Deposit Insurance for Banks
2 Export Credit Insurance
3 "Alll risks" Crop Insurance
4 Flood Insurance
5 Crime Insurance
6 Insurance against expropriation of foreign investments
7 Mortgage Insurance
8 Life Insurance for some veterans of armed forces - According to Webb, What are 3 alternatives ot risk transfer
-
1 risk avoidance
2 risk retention
3 loss control - According to Webb, What are the 6 principal steps in the risk management process?
-
1 Identify loss exposures
2 Analyze loss exposures
3 Examine available risk managment techniques
4 Select Technique to be used
5 Implement technique
6 Moniter Results and implement necessary changes - According to Webb, list 7 functions performed by agents
-
1 prospecting - finding new clients
2 sales
3 risk analysis
4 policy issuance
5 collection of premiums
6 claims handling
7 consulting - According to Webb, list the 8 major staff underwriting activities
-
1) Formulation of underwriting policy
2) Evaluation of Experience
3) Research and development of Coverages and policy forms
4) Review and revision of Rating plans
5) Conduct of underwriting Audits
6) Education and training
7) Participation in industry associations and bureaus
8) Preparation of Underwriting guides and bulletins - According to Webb, list the 5 major line underwriting activities
-
1) Selection of insureds
2) Classification
3) Determination of the proper Coverage
4) Determination of the appropriate Rate or price
5) Producer and Policyholder service - According to Webb, What is the definition of Adverse Selection
-
Occurs when applicants for insurance present a higher than average probability of loss than is expected from a truely random sample of all aplicants.
Example Flood Insurance - According to Webb, What are the 3 principle dimensions of an insurer's underwriting policy?
-
1 Lines of business and classes to be written
2 territories to be developed
3 forms, rates, and rating plans - According to Webb, List 4 major constraining factors of underwriting policy
-
1 capacity - relationship between premiums written and policyholder surplus
2 regulation -
3 personel
4 reinsurance - According to Webb, what are the 4 specific areas on which property underwriters focus
-
1) Construction
2) Occupancy
3) Protection
4) External Exposures - According to ISO, what are the 6 classes of building construction
-
1) Class #6 - fire resistive
2) Class #5 - modified fire resistive
3) Class #4 - masonry noncombustible
4) Class #3 - noncombustible
5) Class #2 - joisted masonry
6) Class #1 - frame - According to Webb, what are the six categories of occupancies
-
1) Habitational
2) Office
3) Institutional
4) Mercantile
5) Service
6) Manufacturing - According to Webb, as part of private protection, what are the 5 major detection systems
-
1) A guard system with a clock system
2) A private patrol service
3) Smoke and heat detectors
4) An automatic local alarm
5) A central Station alarm or remote station system - According to Webb, what are the 4 categories of private fire suppression
-
1) portable extinguishers
2) standpipes and hoses
3) automatic sprinkler system
4) private fire brigades - According to Webb, what are the 3 measures used to estimate the largest loss a property is likely to produce
-
1) Policy amount
2) Amount subject
3) Probable maximum loss (PML) - According to Webb, list 3 groups of factors affecting frequency and severity that vary by occupancy
-
1 Sources of ignition or fire causes
2 combustibility
3 damageability - According to Webb, list 9 "construction" things to consider when underwriting property
-
1 Types of load bearing members of construction (6 classes)
2 Interirior finish
3 Insulation
4 Roofing
5 Age
6 Building height
7 Fire Divisions
8 Building Openings
9 Duilding Codes - enforcement - According to Webb, list 3 "Occupancy" things to consider when underwriting property
-
1 sources of ignition (freindly fires, friction, electricity, exothermic reactions)
2 combustibility
3 damageability - to determine PML - According to Webb, list the 4 common hazards associated with Occupancy
-
1 housekeeping (uncollected litter, storage, disposal)
2 heating equipment
3 electrical equipment
4 smoking materials - According to Webb, list the 2 special hazards associated with occupancy
-
1 Specialized Hazards of the CLASS
2 Special Hazards of the RISK - According to Webb, what are the 3 recognized classes of persons whose rights the law protects
-
1) Invitee
2) Licensee
3) Trespasser - According to Webb, what are the 5 relationships that create vicarious liability
-
1) principle-agent relationship
2) employer-employee relationship
3) parent-child relationship
4) contractual relationship
5) partnership - According to Webb, what are the 6 legislated approaches in AL insurance that alter underwriting decisions
-
1) Financial responsibility laws
2) Compulsory automobile liability insurance
3) Shared automobile market mechanisms
4) Mandatory uninsured motorists coverage
5) No-fault automobile laws
6) Restrictions on cancellations and nonrenewals - According to Webb, list the 10 major underwriting factors in private passenger auto
-
1) Age of operators
2) Age and type of automobile
3) Use of the automobile
4) Driving record
5) Territory
6) Sex and marital status
7) Occupation
8) Personal characteristics
9) Physical condition
10) Safety equipment - According to Webb, list the 7 major industry classifications of commercial auto
-
1) Truckers
2) Food delivery
3) Specialized delivery
4) Waste disposal
5) Farmers
6) Dump and transit mix trucks and trailers
7) Contractors - According to Webb, list 4 auto residual market mechanisms
-
1 Automobile Insurance Plans
2 Joint Underwriting Associations
3 reinsurance facilities
4 State Funds (MD) - According to Webb, list 4 Commercial Automobile Underwriting Factors
-
1 Weight and Type of vehicle
2 Use of Vehicle (Service has lowest rate, Retail has highest)
3 Radius of Operation
4 Special Industry Classification - According to Webb, list 7 essential elements of a good fleet safety program
-
1 Driver Selection
2 driver training and motivation
3 equipment control
4 accident reporting and review
5 periodic checking of drivers and vehicles
6 enforcement and reinforcment of the program
7 management support of the program - According to Webb, list 3 sources of products liability
-
1 breach of warranty
2 tort of negligence
3 strict liability in tort - According to Webb, list 4 activities that generate "completed Operations Hazard"
-
1 Construction
2 Service
3 Repair
4 maintenance - According to Economics Boor, List 3 reasons why there is a relatively flat demand curve for insurance.
-
1 Requirements by law (personal auto, WC,commercial auto)
2 Requirements by lender - (homeowners, auto phys dam)
3 Preemptory Reasons - potential for lawsuits can drain a company's recources - According to Economics Boor,since insurance products are often the same, list 6 attributes a company can use to create a brand name.
-
1 claims department, and coverage extensions
2 financial strength of insurer
3 insurer flexibility in customizing insurance programs to meet individual's needs
4 insurer record on 3rd party claim defense
5 accessibility of insurer's claim department
6 quality of loss control program - According to Economics Boor, list the stages of the insurance cycle
-
1 Insurance is in low supply
2 Insurers raise prices
3 Insurer profitability is high
4 New insurance firms enter the market
5 Excess Capacity exists in market
6 Insurers lower prices
7 Insurer Profitability is low
8 Insurers Exit the market -
According to Economics Boor,
list 2 reasons why the insurance business cycle is exacerbated -
1 underwriters are not aware of true claims cost
2 companies continue to sell insurance when they are not making a profit (soft market) - According to Homeowners Weining, the definition of "Insured" icludes these 3 things
-
1 the person named in the declarations as the insured
2 Relativies who reside at the named insureds household, or othere persons under 21 in the care of named insured
3 A full-time student who lives away from home, but resided in household before leaving to school - According to Homeowners Weining, "Insured location" includes the residence premises and these 6 other places:
-
1 An unlisted residence aquired by the named insured during the policy period
2 A nonowned premises where insured is temporarily residing (hotel room)\
3 vacant land (owned or rented excluding farmland)
4 Insured's land on which a residence is being constructed
5 Family cemetery plots
6 Any premises temporarily rented to insured (excludes business use, ex: hall rented for wedding) -
According to Homeowners Weining, In the HO-3 policy, what is the special limit on:
Money, bank notes, gold and silverware other than silverware - $200
-
According to Homeowners Weining, In the HO-3 policy, what is the special limit on:
Securities, Accounts, deeds, evidence of debt, letters of credit, notes other than bank notes, manuscripts personal records, passports, tickets and stamps, airl - $1,500
-
According to Homeowners Weining, In the HO-3 policy, what is the special limit on:
Watercraft (including outboard motors, furnishings, equipment and trailers) - $1,500
-
According to Homeowners Weining, In the HO-3 policy, what is the special limit on:
Any trailor not used with watercraft - $1,500
-
According to Homeowners Weining, In the HO-3 policy, what is the special limit on:
The following are subject to loss only by theft:
Jewelry, watches, furs, pecious stones
Firearms
silverware, goldware, pewterware -
$1,500 - Jewelry, watches, furs, pecious stones
$2,500 - Firearms
$2,500 - silverware, goldware, pewterware -
According to Homeowners Weining, In the HO-3 policy, what is the special limit on:
Property used at anytime, in any manner, for any business purpose -
$2,500 on premises
$500 off premisies -
According to Homeowners Weining, In the HO-3 policy, what is the special limit on:
Electronic Aparatus, that can be plugged into cigarette lighter - this includes CD's/Tapes - $1,500
-
According to Homeowners Weining, In the HO-3 policy, what is the special limit on:
Electronic Apparatus in 7., that is not in or upon car, but awat from the residence, and is used at anytime for business purpose - $1,500
- According to Homeowners Weining, How are losses to Personal property valued and settled?
-
Losses to personal property listed under Cov C, are settled at the lesser of the following:
Actual Cash Value
The amount required to repair or replace the items - According to Homeowners Weining, How are losses to Coverage A and B valued and settled?
-
If it is not over 20% underinsured... the settlement will be Replacement cost up to the limit
If it is underinsured you do the math, and pay the greater of the Actual Cash value and the math. - According to Homeowners Weining, In Section II, what 3 things does Coverage E provide coverage for?
-
1) BI
2) PD
3) "personal injuries" (libel, slander, malicious prosecution, wrongful eviction, violation of privacy) - According to Trupin/Flitner, List the 6 major types of commercial property insurance
-
1) Commercial Property
2) Boiler and Machinery Insurance
3) Commercial Crime Insurance
4) Commercial Inland Marine Insurance
5) Farm Insurance
6) Businessowners Policies - According to Trupin/Flitner, List the 3 broad categories of property covered by BPP
-
1) Building
2) Your business personal property
3) Personal property of others - According to Trupin/Flitner, List the 7 things from "Other Personal Property" that coverage is not included for in a BPP
-
D.E.M.C.A.B.S.
1) Deeds
2) Evidences of debt
3) Money
4) Currency
5) Accounts
6) Bills
7) Security and notes - According to Malecki Commercial Liability, List the 3 elements of a tort
-
1) A legally protected right
2) A wrongful invasion of that right
3) Damages as a proximate, or direct, result of that invasion - According to Malecki Commercial Liability,List the 3 broad classifications of torts
-
1) Negligence
2) Intentional torts
3) Strict liability torts - According to Malecki Commercial Liability, List the 5 defenses to negligence actions
-
1) Contributory negligence
2) Comparative negligence
3) Assumption of risk
4) Statutes of limitations
5) Immunities - According to Malecki Commercial Liability, List the 3 common examples of strict liability torts
-
1) Abnormally Dangerous Instrumentalities
2) Ultra hazardous Activities
3) Dangerously Defective Products - According to Malecki Commercial Liability, List the 6 conditions for the insurer to pay damages on behalf of the insured
-
1) Insured must be legally obligated to pay damages
2) The damages must result from BI or PD
3) The policy must apply to the BI or PD
4) The BI or PD must be caused by an occurrence
5) The occurrence must take place in the coverage territory
6) The BI or PD must occur during the policy period - According to Malecki Commercial Liability, List the 3 types of damages paid by the insurer
-
1) Special damages
2) General damages
3) Punitive damages - According to Malecki Commercial Liability, List the 4 advantages to the plaintiff for filing suit in the US
-
1) The available of a trial by jury
2) The available of the contingency fee approach
3) Pre-trial discovery
4) Recognition of strict liability in products - According to Malecki Commercial Liability, List the 4 types of coverages in a CGL policy
-
1) Premises and operations liability coverage
2) Contractual liability coverage
3) Fire legal liability coverage
4) Products and completed operations coverage - According to Malecki Commercial Liability, What 3 conditions must be met for BI or PD to be included in the products hazard
-
1) The BI or PD must arise out of "your product"
2) The BI or PD must occur away from premises
3) The product causing the BI or PD must not be in the insured's physical possession when the BI or PD occurs - According to Malecki Commercial Liability, Give the 3 conditions that must be met for BI or PD to be included in the completed operations hazard
-
1) The BI or PD must arise out of "your work"
2) The BI or PD must occur away from premises
3) The work causing the BI or PD must be completed or abandoned when the BI or PD occurs - According to Malecki Commercial Liability, what are the 5 steps in the risk management process?
-
1 Identify and analyze loss exposures
2 Examine feasibility of alternative risk management techniques
3 Select best risk management techniques
4 Implement techniques
5 monitor program - According to Malecki Commercial Liability, How do liability limits apply with regards to supplementary payments?
- Defense costs, including all of the supplementary payments are payable in addition to the applicable limits of insurance
- According to Malecki Commercial Liability, in prem/ops does CGL cover moving and unloading of stuff?
-
CGL does NOT COVER property
1 loading onto aircraft, auto, or watercraft
2 while on aircraft, auto, watercraft
3 while being moved from aircraft, auto, watercraft to the place where it is finally delivered - According to Malecki Commercial Liability, list the 6 types of property NOT COVERED in CGL
-
1 named insured's own property
2 premises sold, given away, or abandoned
3 loaned property
4 property in care, custody, control of insured
5 property being worked on
6 faulty work - According to Malecki Commercial Liability, List the 2 major exceptions for when an employer is not vicariously liable for torts committed by an independent contractor
-
1 Non-delagable duties
2 inherently dangerous activites - According to Malecki WC and EL, List the 3 common-law defenses by an employer in negligence actions
-
1) Assumption of risk
2) Contributory negligence
3) Negligence of a fellow servant - According to Malecki WC and EL, Give the 5 specific objectives of the workers compensation system
-
1) Prompt payment of adequate benefits
2) Elimination of the delays and costs of litigation
3) Establishment of a guarantee of benefit payments
4) Promotion of industrial safety and industrial hygiene
5) Payment for medical care services - According to Malecki WC and EL, List the 4 classes of disability
-
1) Temporary total
2) Temporary partial
3) Permanent partial
4) Permanent total - According to Malecki WC and EL, List the 6 parts of the standard WC&EL policy form
-
1) Workers Compensation Insurance
2) Employers Liability Insurance
3) Other States Insurance
4) Your Duties If Injury Occurs
5) Premium
6) Conditions - According to Malecki WC and EL, List the 4 types of suits or claims that are covered by employers liability coverage
-
1) Third -party-over
2) Care and loss of services
3) Consequential bodily injury
4) Dual capacity - According to Malecki WC and EL, List the 5 methods of financing Work Comp benefits
-
1 State Funds
2 Assigned Risk Plans
3 Self-Insurance Plans
4 Private Insurance
5 Excess Insurance - According to Malecki WC and EL, Who is covered and what is remedy for Federal Employer's Liability Act
-
Employees of Interstate RAILROADS
- negligence suit against employer - According to Malecki WC and EL, Who is covered and what is remedy for Jones Act
- Member's of a vessel's Crew - same as Jones act
- According to Malecki WC and EL, Who is covered and what is remedy for Longshore and Harbor Workers' Comp Act
-
maritime workers with some exceptions (master of crew)
- no fault benefits as defined by statue - According to Malecki WC and EL, Who is covered and what is remedy for Defense Base Act
-
civilian employees at US military bases overseas, or civilian employees working overseas under contract with US Gov.
-no fault benefits as defined by statue - According to Malecki WC and EL, Who is covered and what is remedy for Outer Continental Shelf Lands Act
-
workers on a fixed offshore drilling and production platforms
-no fault benefits as defined by statue - According to Malecki WC and EL, Who is covered and what is remedy for Non-Appropriated Fund Instumentalities Act
-
civilian employee of same on US military bases
-no fault benefits as defined by statue - According to Malecki WC and EL, Who is covered and what is remedy for Death on the High Seas Act
-
member's of a vessel's crew
-survivors may sue employer for death occurring beyond a marine league from the shore of any state - According to Malecki WC and EL, Who is covered and what is remedy for Migrant and seasonal Agriculturer Worker act
-
migrant and seasonal worker
-suit against employer - According to Malecki WC and EL, Who is covered and what is remedy for Federal Employees's Compensation Act
-
non-military employees of US government
-no-fault benefits as defined by statute. - According to Malecki Professional Liability, List the 4 types of damages recoverable for a breech of contract
-
1) Compensatory Damages
2) Consequential Damages
3) Liquidated Damages
4) Nominal Damages - According to Malecki Professional Liability, List the 5 common allegations against medical professionals
-
1) Improper Diagnosis
2) Improper Tests
3) Surgical Error
4) Lack of Informed Consent
5) Use and Administration of Anesthetics and Drugs - According to Malecki Professional Liability, List the 5 common defenses available to medical professionals
-
1) Statute of limitations
2) Good Samaritan Statutes
3) Assumption of Risk
4) Contributory or Comparative negligence
5) Informed Consent - According to Malecki Excess and Umbrella, For Excess and Umbrella list the 3 basic issues involved in the use of liability insurance
-
1) Difficulty in estimating maximum possible loss
2) Layering of liability coverages
3) Effect of aggregate limits - According to Malecki Excess and Umbrella, List the 3 basic forms in Excess liability insurance
-
1) A "following form"
2) A self-contained policy
3) A combination of the two above - According to Malecki Excess and Umbrella, List the three basic functions of umbrella policies
-
1) Provide additional limits above the underlying policies occurrence limits
2) Provide drop-down coverage when underlying aggregate limits are reduced or exhausted
3) Provide drop-down coverage when some claims are not covered by the insured's underlying policies - According to Malecki Excess and Umbrella, with respect to umbrella liability policies, what is the distinction between a deductible and a self-insured retention from a claims handling process?
-
Under a deductible policy, the insurer pays the full claim and then collects the deductible amount from the insured. The insured must report all claims below the deductible for processing
Under a self-insured retention policy, the insured need not report claimsbelow the retention because the insured is responsible for processing and payment of these claims. The insurer only pays the amount of loss above the retention - According to Bourdon, Waht is the definition of CAPITATION?
- Capitation is a method of paying healthcare providers in which a fixed amount is paid per enrollee to cover a defined set of services over a specific period, regardless of the actual services provided.
- According to Bourdon, what are the 4 characteristics of HMOs that distinguish them from other structures?
-
1) HMOs assume contractual responsibility for providing certain healthcare services
2) HMOs receive a fixed periodic payment in return for their services
3) HMOs assume financial risk for the contracted services
4) HMOs have an organized delivery system - According to Bourdon, what are 3 key similarites among all managed care plans?
-
1) Provider restrictions
2) Utilization management
3) Financial incentives - According to Bourdon, what are the 4 key financing vehicles and risk management techniques in response to increased use of capitation contracts?
-
1) Specific excess loss insurance
2) Aggregate stop loss protection
3) Alternative risk financing vehicles
4) Administrative management services - According to Bourdon, what are the 4 fundamental differences between healthcare and P&C risks which affect the models?
-
1) Morale Risk
2) Independence of Events
3) Considerations Discussed in Specific Excess Pricing
4) Fortuitous versus Scheduled Costs - According to Bourdon, what are the 4 mechanisms in the alternate risk market?
-
1) Self-insurance
2) Captive insurance companies
3) Private label insurance
4) Administrative support organizations (ASOs) - According to Bourdon, what are his 8 predictions on the future of the healthcare industry?
-
1) Increase in insurance products and services
2) Increase in alternative markets
3) Integration and consolidation
4) Integration with workers compensation
5) Increase in regulation
6) Increase in professional liability exposure
7) Changed identity for healthcare professionals
8) Increased opportunities for actuaries - According to Bourdon, what are the 4 steps in the rating approach of excess deductibles?
-
1) Develop a net claim cost distribution (by deductible) based on historical/industry data
2) Adjust the claim cost distribution from step one (by deductible) to the characteristics of the provider being underwritten
3) Adjust the net claim cost, derived in step two, for product design aspects
4) Convert the net claim cost from step three to a gross premium rate by including loads for anticipated expenses (including profit, tax, claims handling, etc.) - According to Bourdon, what are 5 reasons why the paper should be of interest to actuaries?
-
1) The distinction between health and casualty insurance is blurring (e.g. 24 hour coverage)
2) Managed care affects exposure to loss in casualty coverages such as hospital and physician professional liability
3) The use of managed care in workers compensation is increasing
4) The healthcare industry values casualty actuaries' expertise in evaluating specific excess of loss coverages, aggregate excess of loss contracts, and alternative risk programs
5) Some states classify healthcare provider excess insurance as a casualty insurance product - According to Bourdon, what are the 3 categories of services provided to healthcare providers by Management Services Organizations (MSO's)?
-
1) General Business Support
2) Enrollment/Claim Administration
3) Medical Management - According to Bourdon, Why is coinsurance so important in specific excess of loss policies? - 2 reasons
-
1 Coinsurance is considered critical to ensuring that providers remain interested in actively managing ongoing claims which have pierced the deductible
2 Unlike P&C claims, capitated claims remain in the control of the insured until the close of the policy period forces a limit on the claim amount. - According to Bourdon, Why have insurers not aggressively developed and marketed aggregate stop loss protection for capitation risk? - 2 reasons
-
1 Subjectivity of measuring losses
2 lack of claim control by insurer - According to Bourdon, give 2 reasons why the hospital may consider buying aggregate stop loss protection for capitation.
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1 There may be a high number of catastrophic cases that could financially ruin the hospital otherwise
2 A difference as little as 5 years between the average age of insured CONTEMPLATED in the ratews and the average age in the INSURED POPULATION can have devistating effects on the hospital's profitability. - According to Weining contract analysis, Define Genuine Assent
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A contract may appear to be valid and enforceable, but if the consenty of either contracting party is nor genuinely given, the contract may not be legally binding.
Examples (fraud, Duress was used, Undue influence is shown, innocent misrepresentations have been made, a mistake was made by one of the parties) - According to Weining contract analysis, Define contracts of adhesion
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contracts of adhesion are prepared by 1 party , with the other party having no choice but to accept or reject all of the terms.
Ambiguities in the contract of adhesion will generally be constued against the party that drafted the contract.