风险管理与保险课件第4章

第一部分风险管理和保险基础第1章风险第2章风险管理第3章保险•第4章影响保险合同的基本因素第5章保险合同的内容及其分析第4章影响保险合同的基本因素§4.1AgencyLaw代理法•Thelawofagencydealsbasicallywiththelegalconsequencesofpeopleactingonbehalfofotherpeopleororganizations.•代理关系涉及到三方：principal委托人、agent代理人和athirdparty第三方。•Theprincipal(insurer)createsanagencyrelationshipwithasecondparty(agent)byauthorizinghimorhertomakecontractswiththirdparties(policyholders)ontheprincipal’sbehalf.Sothesourceoftheagent’sauthorityistheprincipal.ExpressedorImpliedAuthority明示权限与默示权限•明示权限•Whenanagentisappointed,theprincipalexpresslyindicatestheextentofhisorherauthority.•默示权限•Byenteringintotherelationship,theprincipalimpliesthattheagenthastheauthoritytofulfilltheprincipal’sresponsibilities.BindingAuthority约束权限•Abinder(暂保单)：theagreementthatexistsbeforeacontractisissued.在正式保险合同发出之前的协议。主要用于财产责任保单。•人寿健康保险代理人一般只能发出conditionalbinder(有条件的暂保单).Aconditionalbinderimpliesthatcoverageexistsonlyiftheunderwriterultimatelyaccepts(orwouldhaveaccepted)theapplicationforinsurance.WaiverandEstoppel弃权与禁止反言•Waiveristheintentionalrelinquishmentofaknownright.•弃权意味着有意放弃已知的权利。为了弃权，一个人必须知道他享有这种权利并有意放弃它。•Estoppeloccurswhentheinsureroritsagenthasledtheinsuredintobelievingthatcoverageexists.•当保险公司或代理人让被保险人相信保险关系已经建立起来的时候，禁止反言原则开始生效。AgencybyEstoppel禁止反言的代理关系•Anagencyrelationshipmaycreatedwhentheconductoftheprincipalimpliesthatanagencyexists-anagencybyestoppel.•如保险人暂停一个代理人的工作，但仍留有一些blankpolicies空白保单在代理人手中；或被停止工作的代理人把一些业务送给保险人而保险人接受了这些业务时。§4.2RequirementsofaContract合同的基本要件•保险合同又称保险契约，它是保险关系双方之间订立的一种在法律上具有约束力的协议。根据当事人的双方约定，一方支付保险费于对方，另一方在保险标的发生约定事故时承担经济补偿责任或者当约定事故出现时履行给付义务的一种法律行为。任何一份协议要具有法律效力，必须满足以下基本条件：•1、Theremustbeanofferandanacceptance.•2、Theremustbeconsideration.•3、Thepartiestothecontractmustbecompetent.•4、Itspurposemustbelegal.•5、Thecontractmustbeinlegalform.§4.3DistinguishingCharacteristicsofInsuranceContracts保险合同的特征1、basedonutmostgoodfaith最大诚信.Potentialinsuredsareheldtothehigheststandardsoftruthfulnessandhonestyinprovidinginformationfortheunderwriter.最大诚信(1)representations陈述•Whenyouarenegotiatingwithaninsurerforcoverage,youmakestatementsconcerningtheexposure.Thesestatementsarecalledrepresentations.(2)concealment隐瞒•Youmustalsorevealthosematerialfactsabouttheexposurethatonlyyouknowandthatyoushouldrealizearerelevant.MaterialFact重要事实•MaterialFact:theinsurermustprovethattheinformationwassoimportantthatifthetruthhadbeenknown,theunderwriterwouldnothavemadethecontractorwouldhavedonesoonlyondifferentterms.2、contractsofadhesion附和性合同.Mostinsurancecontractsarepreparedbytheinsurerandthenacceptedorrejectedbythebuyer.ExpectationsPrinciple预期原则•Theobjectivelyreasonableexpectationsofapplicantsandintendedbeneficiariesregardingthetermsofinsurancecontractswillbehonoredeventhoughpainstakingstudyofthepolicyprovisionswouldhavenegatedthoseexpectations.•投保人和未来的受益人有关保险合同的客观的合理预期是应当被满足的，即使煞费苦心解读出来的保单条款可能否定他们的预期。因此，现代方法在解释附和性保险合同时1.tofavortheinsuredwhentermsofthecontractdraftedbytheinsurerareambiguous.当合同条款出现歧义时作有利于被保险人的判决。2.toreadthecontractasaninsuredwould.从被保险人的角度来解读合同。3.todeterminethecoverageonthebasisofreasonableexpectationsoftheinsured.在被保险人的合理预期基础上理赔。3、contractsofindemnity补偿性.•Thatmeanstheinsureragreestopaynomore(andnoless)thantheactuallosssufferedbytheinsured.•Thepurposeoftheinsurancecontractistorestoreyoutothesameeconomicpositionyouhadbeforetheloss,nottoimproveyoursituation.(1)InsurableInterest可保利益•a.Apersonnotsubjecttolossdoesnothaveaninsurableinterest.•b.Wheninsurableinterestmustexist:inpropertyinsurance,theinterestmustexistatthetimeoftheloss;lifeinsurancerequiresaninsurableinterestonlyattheinceptionofthecontract.•c.Extentinsurableinterestlimitspayment.•theinsuredorthesubject:thepersonwhosedeathrequirestheinsurertopaytheproceedsofalifeinsurancepolicy.•thebeneficiary:thepersonorotherentityentitledtotheproceedsofthepolicyuponthedeathofthesubject.•theownerofthepolicy:thepersonorotherentitywhohastheauthoritytoexercisealltheprematurityrightsofthepolicy,suchasdesignatingthebeneficiary,takingapolicyloanandsoon.(2)Subrogation代位追偿•Thisrightgivestheinsurerwhateverclaimagainstthirdpartiestheinsuredmayhaveasaresultofthelossforwhichtheinsurerpaid.•在第三方给被保险人造成了损失，而保险人赔偿了这个损失后，被保险人将向第三方索赔的权利转给保险人。(3)ActualCashValueProvision实际现金价值•thereplacementcostatthetimeoftheloss,lessphysicaldepreciationincludingobsolescence.损失发生时的重置成本减去折旧。•或fairmarketvalue公平市价theamountawillingbuyerwouldpayawillingseller.(4)OtherInsuranceProvision重复保险条款•Thepurposeofotherinsuranceprovisionininsurancecontractsistopreventinsuredsfrommakingaprofitbycollectingfrommorethanoneinsurancepolicyforthesameloss.4、Personal个人性.•Insurancecontractsinsureagainstlosstoaperson,nottotheperson’sproperty.问题讨论•1、MichelleRawson刚从一个小城镇搬到Chicago居住。在买汽车保险时，她没有告诉代理人去年她收到了两张超速罚款单。请解释她将遇到什么问题。•2、保单是一份附和性合同，这一事实是否影响了保险人以一种简单易懂的方式来书写保单条款？•3、HenriettaHefner居住在Minnesota，冬天她用炉子烧木材来取暖，但是她在为自己的房屋买保险的时候没有告诉代理人自己用炉子烧木材来取暖，因为她知道这是一个不可保的风险因素。之后在一次风暴袭击中她的房屋遭到了破坏，保险人在查看现场的过程中发现了她烧木材用的炉子。请问保险公司将作出什么决定？