風(fēng)險管理與保險課件第4章

第一部分風(fēng)險管理和保險基礎(chǔ)第1章風(fēng)險第2章風(fēng)險管理第3章保險第4章影響保險合同的基本因素第5章保險合同的內(nèi)容及其分析第一部分風(fēng)險管理和保險基礎(chǔ)1風(fēng)險管理與保險課件第4章2第4章影響保險合同的

基本因素第4章影響保險合同的

基本因素3§4.1AgencyLaw

代理法Thelawofagencydealsbasicallywiththelegalconsequencesofpeopleactingonbehalfofotherpeopleororganizations.代理關(guān)系涉及到三方：principal委托人、agent代理人和athirdparty第三方。§4.1AgencyLaw

代理法4Theprincipal(insurer)createsanagencyrelationshipwithasecondparty(agent)byauthorizinghimorhertomakecontractswiththirdparties(policyholders)ontheprincipal’sbehalf.Sothesourceoftheagent’sauthorityistheprincipal.Theprincipal(insurer)creates5ExpressedorImpliedAuthority

明示權(quán)限與默示權(quán)限明示權(quán)限Whenanagentisappointed,theprincipalexpresslyindicatestheextentofhisorherauthority.默示權(quán)限Byenteringintotherelationship,theprincipalimpliesthattheagenthastheauthoritytofulfilltheprincipal’sresponsibilities.ExpressedorImpliedAuthority6BindingAuthority

約束權(quán)限

Abinder(暫保單)：theagreementthatexistsbeforeacontractisissued.在正式保險合同發(fā)出之前的協(xié)議。主要用于財(cái)產(chǎn)責(zé)任保單。人壽健康保險代理人一般只能發(fā)出conditionalbinder(有條件的暫保單).Aconditionalbinderimpliesthatcoverageexistsonlyiftheunderwriterultimatelyaccepts(orwouldhaveaccepted)theapplicationforinsurance.BindingAuthority

約束權(quán)限

Abinde7WaiverandEstoppel

棄權(quán)與禁止反言

Waiveristheintentionalrelinquishmentofaknownright.棄權(quán)意味著有意放棄已知的權(quán)利。為了棄權(quán)，一個人必須知道他享有這種權(quán)利并有意放棄它。Estoppeloccurswhentheinsureroritsagenthasledtheinsuredintobelievingthatcoverageexists.當(dāng)保險公司或代理人讓被保險人相信保險關(guān)系已經(jīng)建立起來的時候，禁止反言原則開始生效。WaiverandEstoppel

棄權(quán)與禁止反言

Wa8AgencybyEstoppel

禁止反言的代理關(guān)系

Anagencyrelationshipmaycreatedwhentheconductoftheprincipalimpliesthatanagencyexists-anagencybyestoppel.如保險人暫停一個代理人的工作，但仍留有一些blankpolicies空白保單在代理人手中；或被停止工作的代理人把一些業(yè)務(wù)送給保險人而保險人接受了這些業(yè)務(wù)時。AgencybyEstoppel

禁止反言的代理關(guān)系

A9§4.2

RequirementsofaContract

合同的基本要件保險合同又稱保險契約，它是保險關(guān)系雙方之間訂立的一種在法律上具有約束力的協(xié)議。根據(jù)當(dāng)事人的雙方約定，一方支付保險費(fèi)于對方，另一方在保險標(biāo)的發(fā)生約定事故時承擔(dān)經(jīng)濟(jì)補(bǔ)償責(zé)任或者當(dāng)約定事故出現(xiàn)時履行給付義務(wù)的一種法律行為?！?.2

RequirementsofaContra10任何一份協(xié)議要具有法律效力，必須滿足以下基本條件：1、Theremustbeanofferandanacceptance.2、Theremustbeconsideration.3、Thepartiestothecontractmustbecompetent.4、Itspurposemustbelegal.5、Thecontractmustbeinlegalform.任何一份協(xié)議要具有法律效力，必須滿足以下基本條件：11§4.3

DistinguishingCharacteristicsofInsuranceContracts

保險合同的特征1、basedonutmostgoodfaith

最大誠信.Potentialinsuredsareheldtothehigheststandardsoftruthfulnessandhonestyinprovidinginformationfortheunderwriter.§4.3

DistinguishingCharacteri12最大誠信(1)representations陳述Whenyouarenegotiatingwithaninsurerforcoverage,youmakestatementsconcerningtheexposure.Thesestatementsarecalledrepresentations.(2)concealment隱瞞Youmustalsorevealthosematerialfactsabouttheexposurethatonlyyouknowandthatyoushouldrealizearerelevant.最大誠信(1)representations陳述13MaterialFact

重要事實(shí)MaterialFact:theinsurermustprovethattheinformationwassoimportantthatifthetruthhadbeenknown,theunderwriterwouldnothavemadethecontractorwouldhavedonesoonlyondifferentterms.MaterialFact

重要事實(shí)142、contractsofadhesion附和性合同.Mostinsurancecontractsarepreparedbytheinsurerandthenacceptedorrejectedbythebuyer.風(fēng)險管理與保險課件第4章15ExpectationsPrinciple

預(yù)期原則Theobjectivelyreasonableexpectationsofapplicantsandintendedbeneficiariesregardingthetermsofinsurancecontractswillbehonoredeventhoughpainstakingstudyofthepolicyprovisionswouldhavenegatedthoseexpectations.投保人和未來的受益人有關(guān)保險合同的客觀的合理預(yù)期是應(yīng)當(dāng)被滿足的，即使煞費(fèi)苦心解讀出來的保單條款可能否定他們的預(yù)期。ExpectationsPrinciple

預(yù)期原則16因此，現(xiàn)代方法在解釋附和性保險合同時1.tofavortheinsuredwhentermsofthecontractdraftedbytheinsurerareambiguous.當(dāng)合同條款出現(xiàn)歧義時作有利于被保險人的判決。2.toreadthecontractasaninsuredwould.從被保險人的角度來解讀合同。3.todeterminethecoverageonthebasisofreasonableexpectationsoftheinsured.在被保險人的合理預(yù)期基礎(chǔ)上理賠。因此，現(xiàn)代方法在解釋附和性保險合同時173、contractsofindemnity補(bǔ)償性.Thatmeanstheinsureragreestopaynomore(andnoless)thantheactuallosssufferedbytheinsured.Thepurposeoftheinsurancecontractistorestoreyoutothesameeconomicpositionyouhadbeforetheloss,nottoimproveyoursituation.3、contractsofindemnity18(1)InsurableInterest可保利益a.Apersonnotsubjecttolossdoesnothaveaninsurableinterest.b.Wheninsurableinterestmustexist:inpropertyinsurance,theinterestmustexistatthetimeoftheloss;lifeinsurancerequiresaninsurableinterestonlyattheinceptionofthecontract.c.Extentinsurableinterestlimitspayment.(1)InsurableInterest可保利益19theinsuredorthesubject:thepersonwhosedeathrequirestheinsurertopaytheproceedsofalifeinsurancepolicy.thebeneficiary:thepersonorotherentityentitledtotheproceedsofthepolicyuponthedeathofthesubject.theownerofthepolicy:thepersonorotherentitywhohastheauthoritytoexercisealltheprematurityrightsofthepolicy,suchasdesignatingthebeneficiary,takingapolicyloanandsoon.theinsuredorthesubject:th20(2)Subrogation代位追償

Thisrightgivestheinsurerwhateverclaimagainstthirdpartiestheinsuredmayhaveasaresultofthelossforwhichtheinsurerpaid.在第三方給被保險人造成了損失，而保險人賠償了這個損失后，被保險人將向第三方索賠的權(quán)利轉(zhuǎn)給保險人。風(fēng)險管理與保險課件第4章21(3)ActualCashValueProvision實(shí)際現(xiàn)金價值thereplacementcostatthetimeoftheloss,lessphysicaldepreciationincludingobsolescence.損失發(fā)生時的重置成本減去折舊?；騠airmarketvalue公平市價theamountawillingbuyerwouldpayawillingseller.風(fēng)險管理與保險課件第4章22(4)OtherInsuranceProvision重復(fù)保險條款Thepurposeofotherinsuranceprovisionininsurancecontractsistopreventinsuredsfrommakingaprofitbycollectingfrommorethanoneinsurancepolicyforthesameloss.(4)OtherInsuranceProvisi234、Personal個人性.Insurancecontractsinsureagainstlosstoaperson,nottotheperson’sproperty.4、Personal24問題討論1、MichelleRawson剛從一個小城鎮(zhèn)搬到Chicago居住。在買汽車保險時，她沒有告訴代理人去年她收到了兩張超速罰款單。請解釋她將遇到什么問題。問題討論252、保單是一份附和性合同，這一事實(shí)是否影響了保險人以一種簡單易懂的方式來書寫保單條款？風(fēng)險管理與保險課件第4章263、HenriettaHefner居住在Minnesota，冬天她用爐子燒木材來取暖，但是她在為自己的房屋買保險的時候沒有告訴代理人自己用爐子燒木材來取暖，因?yàn)樗肋@是一個不可保的風(fēng)險因素。之后在一次風(fēng)暴襲擊中她的房屋遭到了破壞，保險人在查看現(xiàn)場的過程中發(fā)現(xiàn)了她燒木材用的爐子。請問保險公司將作出什么決定？3、HenriettaHefner居住在Minnesot27第一部分風(fēng)險管理和保險基礎(chǔ)第1章風(fēng)險第2章風(fēng)險管理第3章保險第4章影響保險合同的基本因素第5章保險合同的內(nèi)容及其分析第一部分風(fēng)險管理和保險基礎(chǔ)28風(fēng)險管理與保險課件第4章29第4章影響保險合同的

基本因素第4章影響保險合同的

基本因素30§4.1AgencyLaw

代理法Thelawofagencydealsbasicallywiththelegalconsequencesofpeopleactingonbehalfofotherpeopleororganizations.代理關(guān)系涉及到三方：principal委托人、agent代理人和athirdparty第三方?！?.1AgencyLaw

代理法31Theprincipal(insurer)createsanagencyrelationshipwithasecondparty(agent)byauthorizinghimorhertomakecontractswiththirdparties(policyholders)ontheprincipal’sbehalf.Sothesourceoftheagent’sauthorityistheprincipal.Theprincipal(insurer)creates32ExpressedorImpliedAuthority

明示權(quán)限與默示權(quán)限明示權(quán)限Whenanagentisappointed,theprincipalexpresslyindicatestheextentofhisorherauthority.默示權(quán)限Byenteringintotherelationship,theprincipalimpliesthattheagenthastheauthoritytofulfilltheprincipal’sresponsibilities.ExpressedorImpliedAuthority33BindingAuthority

約束權(quán)限

Abinder(暫保單)：theagreementthatexistsbeforeacontractisissued.在正式保險合同發(fā)出之前的協(xié)議。主要用于財(cái)產(chǎn)責(zé)任保單。人壽健康保險代理人一般只能發(fā)出conditionalbinder(有條件的暫保單).Aconditionalbinderimpliesthatcoverageexistsonlyiftheunderwriterultimatelyaccepts(orwouldhaveaccepted)theapplicationforinsurance.BindingAuthority

約束權(quán)限

Abinde34WaiverandEstoppel

棄權(quán)與禁止反言

Waiveristheintentionalrelinquishmentofaknownright.棄權(quán)意味著有意放棄已知的權(quán)利。為了棄權(quán)，一個人必須知道他享有這種權(quán)利并有意放棄它。Estoppeloccurswhentheinsureroritsagenthasledtheinsuredintobelievingthatcoverageexists.當(dāng)保險公司或代理人讓被保險人相信保險關(guān)系已經(jīng)建立起來的時候，禁止反言原則開始生效。WaiverandEstoppel

棄權(quán)與禁止反言

Wa35AgencybyEstoppel

禁止反言的代理關(guān)系

Anagencyrelationshipmaycreatedwhentheconductoftheprincipalimpliesthatanagencyexists-anagencybyestoppel.如保險人暫停一個代理人的工作，但仍留有一些blankpolicies空白保單在代理人手中；或被停止工作的代理人把一些業(yè)務(wù)送給保險人而保險人接受了這些業(yè)務(wù)時。AgencybyEstoppel

禁止反言的代理關(guān)系

A36§4.2

RequirementsofaContract

合同的基本要件保險合同又稱保險契約，它是保險關(guān)系雙方之間訂立的一種在法律上具有約束力的協(xié)議。根據(jù)當(dāng)事人的雙方約定，一方支付保險費(fèi)于對方，另一方在保險標(biāo)的發(fā)生約定事故時承擔(dān)經(jīng)濟(jì)補(bǔ)償責(zé)任或者當(dāng)約定事故出現(xiàn)時履行給付義務(wù)的一種法律行為?！?.2

RequirementsofaContra37任何一份協(xié)議要具有法律效力，必須滿足以下基本條件：1、Theremustbeanofferandanacceptance.2、Theremustbeconsideration.3、Thepartiestothecontractmustbecompetent.4、Itspurposemustbelegal.5、Thecontractmustbeinlegalform.任何一份協(xié)議要具有法律效力，必須滿足以下基本條件：38§4.3

DistinguishingCharacteristicsofInsuranceContracts

保險合同的特征1、basedonutmostgoodfaith

最大誠信.Potentialinsuredsareheldtothehigheststandardsoftruthfulnessandhonestyinprovidinginformationfortheunderwriter.§4.3

DistinguishingCharacteri39最大誠信(1)representations陳述Whenyouarenegotiatingwithaninsurerforcoverage,youmakestatementsconcerningtheexposure.Thesestatementsarecalledrepresentations.(2)concealment隱瞞Youmustalsorevealthosematerialfactsabouttheexposurethatonlyyouknowandthatyoushouldrealizearerelevant.最大誠信(1)representations陳述40MaterialFact

重要事實(shí)MaterialFact:theinsurermustprovethattheinformationwassoimportantthatifthetruthhadbeenknown,theunderwriterwouldnothavemadethecontractorwouldhavedonesoonlyondifferentterms.MaterialFact

重要事實(shí)412、contractsofadhesion附和性合同.Mostinsurancecontractsarepreparedbytheinsurerandthenacceptedorrejectedbythebuyer.風(fēng)險管理與保險課件第4章42ExpectationsPrinciple

預(yù)期原則Theobjectivelyreasonableexpectationsofapplicantsandintendedbeneficiariesregardingthetermsofinsurancecontractswillbehonoredeventhoughpainstakingstudyofthepolicyprovisionswouldhavenegatedthoseexpectations.投保人和未來的受益人有關(guān)保險合同的客觀的合理預(yù)期是應(yīng)當(dāng)被滿足的，即使煞費(fèi)苦心解讀出來的保單條款可能否定他們的預(yù)期。ExpectationsPrinciple

預(yù)期原則43因此，現(xiàn)代方法在解釋附和性保險合同時1.tofavortheinsuredwhentermsofthecontractdraftedbytheinsurerareambiguous.當(dāng)合同條款出現(xiàn)歧義時作有利于被保險人的判決。2.toreadthecontractasaninsuredwould.從被保險人的角度來解讀合同。3.todeterminethecoverageonthebasisofreasonableexpectationsoftheinsured.在被保險人的合理預(yù)期基礎(chǔ)上理賠。因此，現(xiàn)代方法在解釋附和性保險合同時443、contractsofindemnity補(bǔ)償性.Thatmeanstheinsureragreestopaynomore(andnoless)thantheactuallosssufferedbytheinsured.Thepurposeoftheinsurancecontractistorestoreyoutothesameeconomicpositionyouhadbeforetheloss,nottoimproveyoursituation.3、contractsofindemnity45(1)InsurableInterest可保利益a.Apersonnotsubjecttolossdoesnothaveaninsurableinterest.b.Wheninsurableinterestmustexist:inpropertyinsurance,theinterestmustexistatthetimeoftheloss;lifeinsurancerequiresaninsurableinterestonlyattheinceptionofthecontract.c.Extentinsurableinterestlimitspayment.(1)InsurableInterest可保利益46theinsuredorthesubject:thepersonwhosedeathrequirestheinsurertopaytheproceedsofalifeinsurancepolicy.thebeneficiary:thepersonorotherentityentitledtotheproceedsofthepolicyuponthedeathofthesubject.theownerofthepolicy:thepersonorotherentitywhohastheauthoritytoexercisealltheprematurityrightsofthepolicy,suchasde