Insurance

VI

Determining the Value of Insured Property

Although policies often set coverage as a fixed amount, the value of most items or services covered by insurance changes. When someone acquires a new car, for instance, it depreciates (loses part of its value) over time. Other items, such as houses and jewelry, may appreciate (increase in value). Insurance policies can include inflation protection for very valuable items, such as houses, to allow coverage to match such increases in value.

The value of damaged property can be difficult to determine. Insurance policies often contain a promise to pay the value of an item at the time of its damage or loss, also known as its actual cash value. Publicly available resources, such as used automobile price guides, track the average market value of some used items. Insurance policies may also allow the replacement of used items with comparable used items, such as used cars purchased from classified advertisements or used car dealers.

For most types of destroyed property insurance usually covers the actual cash value of the damaged item toward the price of a new replacement. The policyholder must pay the difference. Assume, for example, that a refrigerator lasts 15 years on average. If a house fire destroys a five-year-old refrigerator, its owner loses two-thirds of the appliance’s use—that is, two-thirds of its total value. An insurance policy covering the actual cash value of the property will pay two-thirds of the cost of a new refrigerator.

Replacing used property with new items, especially in larger losses such as house fires, can create considerable financial burdens. To relieve property owners of the risks posed by large unexpected expenditures, many policies offer an option to purchase replacement cost coverage. This option, which increases a policy’s premium, pays the full cost to replace used property with new items in the event of a loss.

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VII

Claims, Benefits, and Dividends

Insured individuals who have suffered losses and want to receive payments must notify their insurance company through a process called a claim. Insurance contracts always contain a condition that the insured must provide a proof of loss in order to be paid.

A claim begins when someone who suffers a loss completes and signs a statement describing exactly what happened that led to the loss. Most insurance claims require additional supporting evidence as well. For example, a person filing a life insurance claim must provide a copy of the policyholder’s death certificate. For a health or disability claim, the insured typically must provide a doctor’s report. Someone claiming damage to an automobile usually has to provide a repair estimate to the insurance company.

Once someone files a claim and provides necessary evidence, the insurance company’s claims representative, known commonly as a claims adjuster or claims service representative, reviews it. A claims representative verifies that a claimant (person filing a claim) is entitled to the payment requested.

First, the claims representative verifies that the claimant actually purchased an insurance policy from the company and paid a premium that covered the time period when the loss occurred. For example, if a policyholder misses payments, allowing a policy to expire, the insurer would make no payments on claims made after the policy’s expiration.

The claims representative also verifies that the terms agreed upon in the policy cover the specific claim, including the particular events that caused a loss. For example, standard policies to insure people’s homes generally cover damage from such natural events as lightning and storms. However, they do not cover damage from floods or earthquakes (those kinds of coverage are sold separately). Ultimately, careful claims processing assures that other members of a claimant’s insurance group pay out as little as possible in premiums to adequately cover valid claims.

VIII

Buying Insurance

People face many choices when buying insurance policies. They commonly choose an insurance provider based on several criteria. Some of the most important of these include: (1) the financial stability of the insurance company, (2) the price of policies, and (3) details of coverage and service.

Only a financially sound company can fulfill its promise to pay in all circumstances. Companies with proven records of stability can provide insurance security. Choice of a provider based solely on price, on the other hand, may result in poor service and coverage, even if the provider advertises comprehensive coverage and high quality service.

Policy prices vary significantly among companies, but competition usually forces most companies’ prices into a narrow range. The greater cost of some policies may pay off in the long run through better protection. Thus, a detailed examination of coverage in policies provided by different, well-regarded companies can help consumers make the best choice based on the risks they face, their needs, and their finances.

People seeking to buy insurance often use the services of an insurance agent or broker to assist in their purchase. Precisely what services these intermediaries provide, and what they can charge, varies somewhat from state to state in the United States and among provinces in Canada. But insurance agents and brokers typically help people choose among the hundreds of policies available and among the hundreds of companies that provide insurance. Some people, however, choose to buy insurance from direct providers, who sell policies without intermediaries. Direct-provider insurance may be purchased through the mail, by telephone, or via computer on the Internet.

IX

Insurance Organizations

Providers of insurance may organize themselves in several different ways. In some societies, people informally group together and pool their funds to help each other in times of need. Some much larger, formal insurance organizations work in much the same way. Others operate for profit.

A

Stock Insurance Companies

Some insurance providers, such as Allstate Insurance Company, operate as corporations, the form of organization common to many large businesses that operate for profit. These kinds of insurance organizations, called stock insurance companies, sell stock to shareholders whose investment provides the capital for company operations. Stock insurance companies represent the largest number of insurance companies in operation, and nearly all newly formed insurance companies.

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