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Journal articles on the topic 'Insurance contract/Risk/Claim'
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1
Haghbayan, Mahdi, and Fereshteh Nasrollahi heravi. "Decreasing Classification Risk in Term Life Insurance Considering the Interest rate and Period of Contract." Journal of Management and Accounting Studies 9, no. 01 (February 24, 2021): 23–31. http://dx.doi.org/10.24200/jmas.vol9iss01pp23-31.
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Term life insurance is a type of life insurance policy that provides coverage for a certain period of time. If the insured dies during the time period specified in the policy and the policy is active, a death benefit will be paid. One of the basic problem in insurance company is that insurers cannot classify high level risk individual from low level risk individual and cannot offer different premium to each individual. Therefore, the aim of this study was to show how insurers can decrease risk classification and increase demand of low level individual for insurance. We used Mahdavi’s model and it was expanded with contract duration, interest rate and individual’s age parameters. We found that if contract duration or interest rate increases, demand for insurance and risk classification also increase. However, if age of the individual or cost of claim increases, demand for insurance decreases. In additional, when cost of claim goes up, risk classification declines
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i S G, Prof Geethanajal. "Auto Insurance Claim System for Farmers." International Journal for Research in Applied Science and Engineering Technology 10, no. 7 (July 31, 2022): 1922–25. http://dx.doi.org/10.22214/ijraset.2022.45576.
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Abstract: Natural disasters such as droughts, floods, cyclones, and animal attacks commonly impair agriculture production and farm revenue in India. Contract farming and futures trading are two contemporary examples of procedures that are Price changes are expected to provide some protection, either explicitly or implicitly. Agricultural protection, on the other contrary, is considered a necessary tool for efficiently addressing the risk of output and revenue loss caused by a variety of natural and artificial disasters. For the benefit of farmers, the GOI (Government of India) has implemented a number of agricultural programmes around the country. Information about various government agricultural programmes is now available on the internet in the form of websites and mobile apps, thanks to advances in technology and internet services.
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Alkahfi, Muhammad Andre, and Yusrizal . "Analisis Penanganan Klaim Asuransi Proteksi Pembiayaan Syariah Pada PT. Asuransi Askrida Syariah Cabang Medan." El-Mal: Jurnal Kajian Ekonomi & Bisnis Islam 3, no. 6 (April 19, 2022): 1073–85. http://dx.doi.org/10.47467/elmal.v3i6.1233.
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A claim on insurance is a request made by a customer to an insurance company for payment for risks incurred under a previous contract. Claims submitted will be reviewed by the company and then paid to the policyholder upon approval. The insurance company is responsible for paying insurance claims for a risk that arises in a loan agreement based on a pre-agreed agreement and provided that the specified terms and conditions are met. The purpose of writing this article is to find out the procedure for handling sharia financing protection insurance claims at PT Asurasi Askrida Syariah Medan Branch. The research method used by the author in writing this article is to use the interview method, the observation method, and also the library research method. Primary data and secondary data are the data used. The data analysis method used is a technical data analysis method. Based on the otained analysis results it can e concluded that PT Asuransi Askrida Syariah Medan Branch has implemented process for handling sharia financing protection insurance claims by providing a good settlement in accordance with applicable standards.
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Valenzuela-Mahecha, Miguel Angel, Manuel Pulido-Velazquez, and Hector Macian-Sorribes. "Hydrological Drought-Indexed Insurance for Irrigated Agriculture in a Highly Regulated System." Agronomy 12, no. 9 (September 13, 2022): 2170. http://dx.doi.org/10.3390/agronomy12092170.
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Water scarcity is an increasingly recurring problem for irrigated agriculture in Mediterranean regions. It is, therefore, necessary to establish technical and financial measures to enable irrigators to deal with this problem. This study presents a new index-based drought insurance scheme in an irrigation district in the Jucar river basin in Spain, a highly regulated water system. Three insurance scheme options were evaluated and, the values of the fair risk premiums, the maximum compensation, and the deductible franchise were established. These insurance schemes were designed in agreement with the preexisting drought system operating rules to reduce moral hazard and adverse selection. Risk-reducing and effective evaluation methods were used to determine the insurance coverage’s viability for irrigators: standard deviation gross margin, minimum gross margin, and RMSL. The proposed insurances were also evaluated using synthetic hydrological time series generated with a stochastic ARMA model through a basin-wide water resource simulation model developed in the DSS Shell AQUATOOL. Financial indicators, such as the basis risk and claim ratio were applied to analyze the economic feasibility for insurance companies. The results show that a suitable and efficient option is an early-bird contract combined with a trigger of emergency or alert state in a multi-year contract. This type of specialized insurance helps to fill the existing gap in traditional insurance schemes for irrigated crops and offered additional coverage to farmers under drought and water scarcity conditions.
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Lohsse, Sebastian. "Vom Seedarlehen zur Versicherung in der mittelalterlichen Rechtswissenschaft." Zeitschrift der Savigny-Stiftung für Rechtsgeschichte: Romanistische Abteilung 133, no. 1 (September 1, 2016): 372–99. http://dx.doi.org/10.26498/zrgra-2016-0111.
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Abstract The Evolution from Sea Loans to Insurance in the Medieval Legal Discourse. In medieval law sea loan contracts are faced with the canon law prohibition of usury. The lender thus may not claim any interest on the loan. Moreover, by the decretal Naviganti the lender is also charged with usury when asking for a compensation for taking over the risk of transport by ship. The article considers the question of how and on which basis jurists subsequently justified the legitimacy of such a premium for the adoption of risk and how thereby the insurance contract originated as a spin-off of the sea loan.
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Burnecki, Krzysztof, Marek A. Teuerle, and Aleksandra Wilkowska. "Ruin Probability for the Insurer–Reinsurer Model for Exponential Claims: A Probabilistic Approach." Risks 9, no. 5 (May 3, 2021): 86. http://dx.doi.org/10.3390/risks9050086.
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In this paper, we consider a two-dimensional risk process in which the companies split each claim and premium in a fixed proportion. It serves as a classical framework of a quota-share reinsurance contract for a given business line. Such a contract reduces the insurer’s exposure to the liabilities created through its underwriting activities. For the analyzed model, we derive a joint infinite-time ruin probability formula for exponentially distributed claims. To this end, we apply a change of measure technique. We illustrate the admissible range of parameters of the risk process. We also justify our result using Monte Carlo simulations and compare it with Theorem 2 in Avram, Palmowski and Pistorius [Insurance: Mathematics and Economics 42 (2008) 227], which was obtained by explicitly inverting a Laplace transform of the ruin probability. Our formula leads to a correction of that result. Finally, we note that the obtained formula leads to efficient approximation of the ruin probability for other claim amount distributions using De Vylder’s idea.
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Denuit, Michel, Montserrat Guillen, and Julien Trufin. "Multivariate credibility modelling for usage-based motor insurance pricing with behavioural data." Annals of Actuarial Science 13, no. 2 (February 12, 2019): 378–99. http://dx.doi.org/10.1017/s1748499518000349.
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AbstractPay-how-you-drive (PHYD) or usage-based (UB) systems for automobile insurance provide actuaries with behavioural risk factors, such as the time of the day, average speeds and other driving habits. These data are collected while the contract is in force with the help of telematic devices installed in the vehicle. They thus fall in the category of a posteriori information that becomes available after contract initiation. For this reason, they must be included in the actuarial pricing by means of credibility updating mechanisms instead of being incorporated in the score as ordinary a priori observable features. This paper proposes the use of multivariate mixed models to describe the joint dynamics of telematics data and claim frequencies. Future premiums, incorporating past experience can then be determined using the predictive distribution of claim characteristics given past history. This approach allows the actuary to deal with the variety of situations encountered in insurance practice, ranging from new drivers without telematics record to contracts with different seniority and drivers using their vehicle to different extent, generating varied volumes of telematics data.
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Li, Chen, and Xiaohu Li. "On the Optimal Risk Sharing in Reinsurance with Random Recovery Rate." Risks 6, no. 4 (October 9, 2018): 114. http://dx.doi.org/10.3390/risks6040114.
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This paper studies a Pareto-optimal reinsurance contract in the presence of negative statistical dependence between the insurance claim and the random recovery rate. In the context of symmetric information model and asymmetric information model, we investigate properties of the Pareto-optimal indemnity schedules. For risk neutral reinsurer with proportional cost and associated expense, we present possible forms of the Pareto-optimal indemnity schedule as well.
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Møller, Thomas. "Risk-Minimizing Hedging Strategies for Unit-Linked Life Insurance Contracts." ASTIN Bulletin 28, no. 1 (May 1998): 17–47. http://dx.doi.org/10.2143/ast.28.1.519077.
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AbstractA unit-linked life insurance contract is a contract where the insurance benefits depend on the price of some specific traded stocks. We consider a model describing the uncertainty of the financial market and a portfolio of insured individuals simultaneously. Due to incompleteness the insurance claims cannot be hedged completely by trading stocks and bonds only, leaving some risk to the insurer. The theory of risk-minimization is briefly reviewed and applied after a change of measure. Risk-minimizing trading strategies and the associated intrinsic risk processes are determined for different types of unit-linked contracts. By extending the model to the situation where certain reinsurance contracts on the insured lives are traded, the direct insurer can eliminate the risk completely. The corresponding self-financing strategies are determined.
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Mall, Sunita, Prasun Ghosh, and Parita Shah. "Management of Fraud: Case of an Indian Insurance Company." Accounting and Finance Research 7, no. 3 (April 29, 2018): 18. http://dx.doi.org/10.5430/afr.v7n3p18.
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Frauds in insurance are typically where a fraudster tries to gain undue benefit from the insurance contract by ignorance or wilful manipulation. Using the claims data in motor insurance obtained from a Mumbai based insurance company for the time period of 2010-2016, this study focuses on studying the pattern exhibited by those claims which have been rejected and accepted as well. The prime objective of the study is to identify the important or the significant triggers of fraud and predicting the fraudulent behaviour of the customers using the identified triggers in an existing algorithm. This study makes use of statistical techniques like logistic regression & CHAID (Chi Square Automatic Interaction Detection) technique to identify the significant fraud triggers and to determine the probability of rejection & acceptance of each claim coming in future respectively. Data mining techniques like decision tree and confusion matrix are used on the important parameters to find all possible combinations of these significant variables and the bucket for each combination.This study finds that variables like Seats/Tonnage, No Claim Bonus, Type of Vehicle, Gross Written Premium, Sum Insured, Discounts, State Similarity and Previous Insurance details are found to be significant at 1% level of significance. The variables like Branch Code and Risk Types are found to be significant at 5% level of signify cance. The Gain chart depicts that our model is a fairly good model. This research would help the insurance company in settling the legitimate claims within less time and less cost and would also help in identifying the fraudulent claims.
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Wang, Shijie, and Wensheng Wang. "Precise Large Deviations for Sums of Random Variables with Consistently Varying Tails in Multi-Risk Models." Journal of Applied Probability 44, no. 4 (December 2007): 889–900. http://dx.doi.org/10.1239/jap/1197908812.
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Assume that there are k types of insurance contracts in an insurance company. The ith related claims are denoted by {Xij, j ≥ 1}, i = 1,…,k. In this paper we investigate large deviations for both partial sums S(k; n1,…,nk) = ∑i=1k ∑j=1niXij and random sums S(k; t) = ∑i=1k ∑j=1Ni (t)Xij, where Ni(t), i = 1,…,k, are counting processes for the claim number. The obtained results extend some related classical results.
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Mulhadi, Mulhadi, and Dedi Harianto. "MISREPRESENTATION SEBAGAI FRAUD DALAM PERKARA KONTRAK ASURANSI YANG DILAKUKAN PENANGGUNG." Arena Hukum 15, no. 1 (April 28, 2022): 59–78. http://dx.doi.org/10.21776/ub.arenahukum.2022.01501.4.
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Insurance companies in Indonesia are currently trapped in the stigma of seeking the highest premiums. Many agents do not work according to standards and do not explain in detail the insured party’s rights and obligations. This study aims to determine the meaning of misrepresentation and forms of misrepresentation made by the insurer in an insurance contract case based on court decisions. This normative juridical approach uses content analysis method. The results showed that the insurer failed to provide correct information about the importance of medical check-ups about life insurance, failed to explain the relationship between honesty in disclosing material circumstances with the risk of cancellation of the policy or the consequences of an insurance claim being rejected, failed to present the correct information to policyholders and gives the impression that insurance claims can be made easily, only with a photocopy of the receipt for payment of hospital fees, and the failed to present correct information that the policy can only be closed to other people if the prospective insured has a birth certificate and cannot be replaced by a statement only.
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Ajemunigbohun, Sunday Stephen, Folake Feyisayo Olowokudejo, and Ismaila Adeleke. "Claims Settlement and Risk Attitudes: Evidence from the Motor Insurance Policyholders." Studia Universitatis Babes-Bolyai Oeconomica 67, no. 2 (August 1, 2022): 33–49. http://dx.doi.org/10.2478/subboec-2022-0008.
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Abstract Claims, being the heartbeat of the workability of insurance, are the most critical contact influencer between the insuring public and the insurer. It serves as a critical path to truth that shapes the policyholders’ ultimate perceptions of their insurers. Therefore, this study aimed at evaluating the relationships between claims settlement and risk attitudes, with specific reference to motor insurance policyholders in Lagos, Nigeria. The study adopted a cross-sectional survey research design. A survey based questionnaire was applied to 287 motor insurance policyholders. The findings-show that claims settlements are significant in attracting reasonable risk attitudes. The study recommends that motor insurance providers should put in place fascinating claims packages in order to boost the confidence level of the motoring communities. Government should rejuvenate and empower the motor insurance public complaint commission to address issues relating to motor insurance claims of either party in the motor insurance contract. Future research work could direct attention to insurance fraud issues emanating from the insurance claims settlement manual.
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Wang, Shijie, and Wensheng Wang. "Precise Large Deviations for Sums of Random Variables with Consistently Varying Tails in Multi-Risk Models." Journal of Applied Probability 44, no. 04 (December 2007): 889–900. http://dx.doi.org/10.1017/s0021900200003612.
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Assume that there are k types of insurance contracts in an insurance company. The ith related claims are denoted by {X ij , j ≥ 1}, i = 1,…,k. In this paper we investigate large deviations for both partial sums S(k; n 1,…,n k ) = ∑ i=1 k ∑ j=1 n i X ij and random sums S(k; t) = ∑ i=1 k ∑ j=1 N i (t) X ij , where N i (t), i = 1,…,k, are counting processes for the claim number. The obtained results extend some related classical results.
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Chapman, Chris, and Jillian Mallon. "Conflicts of Interest Faced by Solicitors Instructed by Insurers to Conduct Litigation on Behalf of Insureds." Victoria University of Wellington Law Review 26, no. 4 (October 1, 1996): 679. http://dx.doi.org/10.26686/vuwlr.v26i4.6147.
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If an insurer pays on a claim for loss, either by the terms of the insurance contract itself or by virtue of its equitable right of subrogation, the insurer becomes entitled to stand in the shoes of the insured and pursue any person causing the loss. That may involve the insurer instructing solicitors to issue a proceeding in which the insured will be named as the plaintiff. The insured's co-operation is required by the terms of the insurance contract. Although remunerated by the insurer, the solicitors will be on the record as solicitors for the insured as the named plaintiff. In the course of conducting the litigation and, in particular, in the course of interviewing the insured, it may come to the solicitors' attention that the insurer did have grounds for rejecting the claim. In addition, the insured's lack of co-operation in the prosecution of the claim may amount to a breach of the insured's contractual obligation to assist. In such instances, conflicts of interest arise. In addition, where the policy provides for a deductible which is other than nominal, decisions made as to the conduct of the litigation, in particular, decisions relating to settlement of claims, may impact differently on insurer and insured and give rise to conflicts of interest. Part I of this article looks at conflicts faced by solicitors who, while acting for both insurer and insured, become aware of grounds upon which a claim under a policy could be rejected or, in the case of a claim which has already been accepted, could have been rejected. Part II examines a number of conflict problems which can arise in the conduct of litigation other than conflicts caused by the discovery of grounds for rejection.
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Riesner, Martin. "Locally Risk-minimizing Hedging of Insurance Payment Streams." ASTIN Bulletin 37, no. 1 (May 2007): 67–91. http://dx.doi.org/10.2143/ast.37.1.2020799.
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For the martingale case Föllmer and Sondermann (1986) introduced a unique admissible risk-minimizing hedging strategy for any square-integrable contingent claim H. Schweizer (1991) developed their theory further to the semimartingale case introducing the notion of local risk-minimization. Møller (2001) extended the theory of Föllmer and Sondermann (1986) to hedge general payment processes occurring mainly in insurance. We expand local risk-minimization to the theory of hedging general payment processes and derive such a hedging strategy for general unit-linked life insurance contracts in a general Lévy process financial market.
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Chernyakov, Mikhail, Maria Chernyakova, Irina Chernyakova, Sergey Gromov, and Saidmukhtor S. Mokhtarzada. "Forecasting the Agricultural Risk Insurance System Parameters." SHS Web of Conferences 110 (2021): 04010. http://dx.doi.org/10.1051/shsconf/202111004010.
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The current insurance market situation is characterised by a high degree of instability. Many factors influence insurance company premiums, including the number of contracts, the claim repayment ratio, capital structure, underwriting profitability and risk. The insurance sector serves as a protective barrier for the country’s economy, defending it from various risks. At the same time, insurance company premiums are influenced by risks too. The number of research articles testifies to a stable interest in this problem. However, there is no technique for establishing the connection between the insurance premium and the many factors it is sensitive to. The article is devoted to the development of new models and, based on them, some digital technologies for forecasting agricultural insurance risk parameters. Based on a paradoxical theory of regulation and inno-diversification approach, an author’s model was developed for forecasting activity. It was used to do calculations of the main indicators of the agiructural risk insurance system. As a result, it became possible to trace the main patterns and tendencies in the development of the agricultural risk insurance system in Russia. Special attention was paid to the period after 2017 when it started to stabilise and recover after the crises as a consequence of nonoptimal managerial solution as refers to the inclusion of the agricultural risk insurance system in the “single subsidy”.
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Cohen, Alma, and Liran Einav. "Estimating Risk Preferences from Deductible Choice." American Economic Review 97, no. 3 (May 1, 2007): 745–88. http://dx.doi.org/10.1257/aer.97.3.745.
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We develop a structural econometric model to estimate risk preferences from data on deductible choices in auto insurance contracts. We account for adverse selection by modeling unobserved heterogeneity in both risk (claim rate) and risk aversion. We find large and skewed heterogeneity in risk attitudes. In addition, women are more risk averse than men, risk aversion exhibits a U-shape with respect to age, and proxies for income and wealth are positively associated with absolute risk aversion. Finally, unobserved heterogeneity in risk aversion is greater than that of risk, and, as we illustrate, has important implications for insurance pricing. (JEL D81, G22)
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Hermawan, Iwan, Noer Azam Achsani, and Laily Dwi Asyanti. "Evaluating the Strategy to optimize the Retakaful Treaty Property Insurance: In the Perspective of the Sharia General Insurance Company in Indonesia." International Journal of Research and Review 9, no. 1 (January 21, 2022): 378–91. http://dx.doi.org/10.52403/ijrr.20220145.
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Purpose: This study on the potential strategy to optimize the retakaful treatyproperty insuranceof the Indonesian sharia general insurance company. Those potential strategies are the priority strategy and alternative strategy.The company can design a piority strategy to optimize the retakaful treaty contract so as to minimize problems arising from the implementation of the underwriting and claim handling. Design/methodology/approach: Thedesign of this research is descriptive - qualitative.A survey on the reinsured’s retakaful existing strategy, retakaful treaty program, internal and external factors, the company's position and implementation ofits business process werealso conducted for this study. Several alternative strategies were obtained using Strength, Weakness, Opportunity (SWOT) analysis and the priority strategyis determined by the Quantitative Strategic Planning Matrix (QSPM) analysis. Finding: The findings from the survey of the evaluation of reinsured’s retakaful existing strategies are: An alternative strategy obtained by using a SWOT matrix analysis, where the company's position in quadrant I with a progressive strategy. The strategy is in accordance with the results of the company's position analysis using the IE matrixwhere the company is in quadrant II in the position of Growth and build. The suitable strategy is to use intensive, forward, backward and horizontal integration. By using the QSPM, the priority strategy is that the company can design a quality retakaful treaty contract. Research Limitation/Implications: This study is limited to Indonesian’s retakaful experience. The strategy being evaluated is the reinsured’s retakaful existing strategy. The findings are the the priority strategy and alternative strategy. The company can design a priority strategy regarding the retakaful treaty contract to optimize the treaty program. Practical Implications: By evaluating the reinsured’s existing strategy in the retakaful treaty, the sharia general insurance company can design a quality retakaful treaty contract to optimize the treaty program. The study may also aid the researchers and regulators to discuss on the area for further development of sharia insurance industry. Social Implications: Based on the findings and implications, it can give managerial implication to the sharia general insurance company and convince the government to speed up the other retakaful business units to spin off becoming a professional reinsurance company. So the numbers of the sharia reinsurance companies in Indonesia will increase and moreover strengthen the sharia insurance industry. Originality/value: The insights on the respondent’s experience when explaining the internal and external factors, company’s position related to the strategy on optimizing retakaful treaty can assist the sharia generalinsurance companies to manage the risks and have a priority strategy to set up their underlying retention and get the claim recovery from the reinsurer. Keywords: Priority Strategy, Retakaful Treaty, Property insurance, Sharia general insurance company.
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Chen, Chin-Ling, Yong-Yuan Deng, Woei-Jiunn Tsaur, Chun-Ta Li, Cheng-Chi Lee, and Chih-Ming Wu. "A Traceable Online Insurance Claims System Based on Blockchain and Smart Contract Technology." Sustainability 13, no. 16 (August 21, 2021): 9386. http://dx.doi.org/10.3390/su13169386.
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In the current medical insurance claims process, there are problems of low efficiency and complex services. When a patient applies for medical insurance claims, he/she must go to the hospital to apply for a diagnosis certificate and receipt and then send the relevant application documents to the insurance company. The patient will not receive compensation until the company completes the verification with the patient’s hospital. However, we can improve the current dilemma through blockchain technology. Blockchain technology can effectively open up the information channels of the insurance industry and medical institutions, promote industry integration, and enhance the ability of insurance companies to obtain information. In this research, we used blockchain and smart contract technology to make the following contributions to the development of Internet insurance. First, blockchain and smart contract technology can effectively solve the problem of online underwriting. Second, it is conducive to improving supervision. Third, it is conducive to solving risk control problems. Fourth, it is conducive to effective anti-money laundering. The proposed scheme fulfills the following security requirements: mutual authentication of identities, non-repudiation between each of two roles, and other major blockchain-based security requirements. In the event of a dispute, we also proposed an arbitration mechanism to divide responsibilities.
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Frees, Edward W., Peng Shi, and Emiliano A. Valdez. "Actuarial Applications of a Hierarchical Insurance Claims Model." ASTIN Bulletin 39, no. 1 (May 2009): 165–97. http://dx.doi.org/10.2143/ast.39.1.2038061.
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AbstractThis paper demonstrates actuarial applications of modern statistical methods that are applied to detailed, micro-level automobile insurance records. We consider 1993-2001 data consisting of policy and claims files from a major Singaporean insurance company. A hierarchical statistical model, developed in prior work (Frees and Valdez (2008)), is fit using the micro-level data. This model allows us to study the accident frequency, loss type and severity jointly and to incorporate individual characteristics such as age, gender and driving history that explain heterogeneity among policyholders.Based on this hierarchical model, one can analyze the risk profile of either a single policy (micro-level) or a portfolio of business (macro-level). This paper investigates three types of actuarial applications. First, we demonstrate the calculation of the predictive mean of losses for individual risk rating. This allows the actuary to differentiate prices based on policyholder characteristics. The nonlinear effects of coverage modifications such as deductibles, policy limits and coinsurance are quantified. Moreover, our flexible structure allows us to “unbundle” contracts and price more primitive elements of the contract, such as coverage type. The second application concerns the predictive distribution of a portfolio of business. We demonstrate the calculation of various risk measures, including value at risk and conditional tail expectation, that are useful in determining economic capital for insurance companies. Third, we examine the effects of several reinsurance treaties. Specifically, we show the predictive loss distributions for both the insurer and reinsurer under quota share and excess-of-loss reinsurance agreements. In addition, we present an example of portfolio reinsurance, in which the combined effect of reinsurance agreements on the risk characteristics of ceding and reinsuring company are described.
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Mendoza, Roger Lee. "Which moral hazard? Health care reform under the Affordable Care Act of 2010." Journal of Health Organization and Management 30, no. 4 (June 20, 2016): 510–29. http://dx.doi.org/10.1108/jhom-03-2015-0054.
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Purpose – Moral hazard is a concept that is central to risk and insurance management. It refers to change in economic behavior when individuals are protected or insured against certain risks and losses whose costs are borne by another party. It asserts that the presence of an insurance contract increases the probability of a claim and the size of a claim. Through the US Affordable Care Act (ACA) of 2010, this study seeks to examine the validity and relevance of moral hazard in health care reform and determine how welfare losses or inefficiencies could be mitigated. Design/methodology/approach – This study is divided into three sections. The first contrasts conventional moral hazard from an emerging or alternative theory. The second analyzes moral hazard in terms of the evolution, organization, management, and marketing of health insurance in the USA. The third explains why and how salient reform measures under the ACA might induce health care consumption and production in ways that could either promote or restrict personal health and safety as well as social welfare maximization. Findings – Insurance generally induces health care (over) consumption. However, not every additional consumption, with or without adverse selection, can be considered wasteful or risky, even if it might cost insurers more in the short run. Moral hazard can generate welfare and equity gains. These gains might vary depending on which ACA provisions, insured population, covered illnesses, treatments, and services, as well as health outcomes are taken into account, and because of the relative ambiguities surrounding definitions of “health.” Actuarial risk models can nonetheless benefit from incorporating welfare and equity gains into their basic assumptions and estimations. Originality/value – This is the first study which examines the ACA in the context of the new or alternative theory of moral hazard. It suggests that containing inefficient moral hazard, and encouraging its desirable counterpart, are prime challenges in any health care reform initiative, especially as it adapts to the changing demographic and socio-economic characteristics of the insured population and regulatory landscape of health insurance in the USA.
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Kambali, Muhammad. "MEKANISME PENGELOLAAN DANA TABARRU’ ASURANSI SYARIAH PRUDENTIAL LIFE ASSURANCE." JES (Jurnal Ekonomi Syariah) 2, no. 1 (September 4, 2017): 91–101. http://dx.doi.org/10.30736/jes.v2i1.30.
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Sharia Insurance according to a binding ruling in religious matters (fatwa) of the National Shari'ah Board of the Indonesian Ulama Council no: 21 /DSN-MUI/ X / 2001 is a mutual effort to help among a number of people/parties through investment in assets or tabarru' which provides a pattern of return to face certain risks through engagement in accordance with the sharia. PRUlink sharia is an insurance product associated with sharia-based investment. PRUlink Syariah is designed to meet the society's need for future financial designs in accordance with Islamic principles of sharia. There are two types of product of PRUlink Syariah insurance, namely PRUlink Syariah Investor Account and PRUlink Syariah Assurance Account. Kind of Product in PRUlink Syariah is contract between policy holders using contract of tabarru which is called hibah and the owner of the policy/participant premises sharia insurance company using contract of tijarah called wakalah bin ujrah. In sharia insurance there is a surplus sharing that will be distributed to customers calculated at the end of the calendar year. This can be obtained if there are more funds than tabarru' accounts that have been reduced by claims and debt to the company if any. How is PRUlinksyariah managed in Prudential? The result of the research shows that PRUsyariah premium management in Prudential is separated by two accounts, namely tabarru' account and investment account. The own fund is managed by Eastpring Investment, that is manager company from Asia prudential, while allocation of fund is invested in stocks and obligation which is in accordance with sharia principles contained in the Jakarta Stock Exchange. For the choice of investment in PRUsariah, there are three options of investment, namely Sharia-Rupiah Equity Fund, Sharia-Rupiah Managed Fund or Sharia-Rupiah fixed Income fund, in accordance with the choice of the next participant. From the investment result the participant agrees to pay tabarru’ contribution directly input into tabarru' account. Tabarru’ funds are fully owned by participants and used to pay claims participants claim at any time, but if there is tabaaru’ funds excess with claims total in one year as of 31 December paid, then tabarru’ surplus or that is called surplus will be distributed participants that meet the requirements to get the surplus.
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Frostig, Esther, Doron Kliger, and Benny Levikson. "THE DEFERRAL OPTION IN LONG-TERM-CARE INSURANCE." Probability in the Engineering and Informational Sciences 16, no. 1 (January 2002): 101–19. http://dx.doi.org/10.1017/s0269964802161079.
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Long-term-care (LTC) insurance contracts provide the insured with different benefits for several nursing care levels, for a limited number of benefit eligibility periods. A common assumption in pricing these LTC contracts is that the insured will exercise the right to claim benefits as soon as the eligibility conditions are satisfied. This assumption, however, may contradict the insured's optimization, as it might be worthwhile not to claim when in low care levels and, by doing so, save the option of claiming higher (more expensive) care levels in the future. We term this option of the insured as the deferral option. The consequence of the traditional pricing (i.e., of ignoring the deferral option) is unexpected losses to the insurer. The factors affecting the deferral option's value are the risk of death, the discount factor, the benefit levels of the different care levels, and the transition probabilities between the different care levels.
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Skachkov, N. G. "Legal Regulation of Cross-Border Shipping of Dangerous Goods in the Conditions of Digitalization." Lex Russica 1, no. 2 (February 28, 2020): 133–40. http://dx.doi.org/10.17803/1729-5920.2020.159.2.133-140.
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The author explores the legal aspects of network space risks, when legal imperatives are laid for the transportation and stay of a consignment of dangerous goods on board a ship. It is concluded that it is difficult to choose the law to be applied. In this regard, the material norms that make up the operational risk space can serve as a guide. Their selection is often a precursor to earning assets net operating profit. At the same time, the variety of legal facts with which the acquirer on arrival of property associates his right to file an ownership claim is formulated either in the contract of connection or accession. Therefore, separate prerequisites for the emergence of business and legal risks at the stage of abandoning consumer insurance in favor of its property qualification are highlighted. The paper shows types of encumbrances that accompany the problems of optimizing the costs of insurance against cyber risks. Even if insurance companies find their offer profitable for customers, the basis of the risk of financial loss is still the recovery of lost data. The insurer is forced to dispose of advanced analytical developments, such as, for example, blockchain or smart contracts that are very common today. Policyholders, in turn, use digital distribution and other virtual service models to not only reduce costs to a minimum, but also gain competitive advantages. The author analyzes the norms of the Convention acts on the transboundary shipping of dangerous goods. The International standards of TV and radio communications ISO/IEC 11801 and ISO/IEC 27001 (ISMS — 2018) are studied, and the conclusion is made that the threat to technological resources is identified with a comprehensive legal strategy for owner protection.
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Rossouw, Laura, Frederik J. Mostert, and Jan Hendrik Mostert. "The underwriting process of property insurance in South Africa." Corporate Ownership and Control 7, no. 4 (2010): 303–10. http://dx.doi.org/10.22495/cocv7i4c2p6.
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Various underwriting factors pertaining to the owner of the property, the characteristics of the assets which are considered, and the risks involved with the property concerned should be evaluated by short-term insurers when underwriting property insurance. Two stipulations of insurance contracts can be employed to incorporate the underwriting factors, viz. the adjustment of the premium level due to a change in the risk profile, as well as the requirement of an excess (or deductible) when a claim is made. The most important problem areas experienced when underwriting property insurance receive the necessary attention, as well as the possible solutions to solve the intricate situations. As South Africa is a developing country with an emerging economy, the conclusions of the empirical study may serve as an illustration to short-term insurance industries in other developing countries.
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Woronkiewicz, Jacek. "The Application of the Principle of Risk in Claims Settlement in Voluntary Business Liability Insurance in the Light of Case Law." Prawo Asekuracyjne 1, no. 98 (March 15, 2019): 55–67. http://dx.doi.org/10.5604/01.3001.0013.5646.
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This article is an attempt to analyze the insured's liability for damages pursuant to art. 435 of the Civil Code in the context of voluntary business liability insurance. Above all, it is vital to lay down the criteria which decide about the application of the principle of risk while assessing the insured’s liability for damages.The establishment of the principle of the liability of the insured person points out the specific character of the insurance relationship in the business liability insurance contract in relation to the property insurance, as the insurer shall also assesses the legal situation of the insured person, in the light of the victim’s claims.This article explores the application of the principle of risk, according to which the insured entrepreneurs are liable and the criteria for its adoption. Besides, the roles and functions of the insurer and business liability insurance have been discussed in the context of formulating the liability rules of the insured.
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Aswin, Suhendro, and Indra Afrita. "SETTLEMENT OF DEFAULTS IN THE LIFE INSURANCE POLICY BETWEEN THE INSURER AND THE INSURED." JILPR Journal Indonesia Law and Policy Review 2, no. 2 (February 26, 2021): 57–72. http://dx.doi.org/10.56371/jirpl.v2i2.44.
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When the policy holder or insurance participant or the insured experiences a disaster or suffers a loss or damage as stated in the contract, the insured has the right to file an insurance claim. The recipient of this insurance is not only the insured whose name is listed as the policy holder of the insurance company but can also be another person appointed directly by the insured. The formulation of the problem in this study is the Default in the Life Insurance Policy between the Insurer and the Insured, howSettlement of Defaults in Life Insurance Policies Between the Insurer and the Insured and What are the Legal Consequences for Settlement of Defaults in a Life Insurance Policy between the Insurer and the Insured. The purpose of this research is to analyze Default in a Life Insurance Policy between the Insurer and the Insured, To Analyze Settlement of Defaults in Life Insurance Policies Between the Insurer and the Insured To Analyze Legal Consequences Settlement of Defaults in Life Insurance Policies Between the Insurer and the Insured.This research method is normative legal research. The conclusions in this study have answered the problems that arise, namely:Default in a Life Insurance Policy between the Insurer and the Insured that a life insurance agreement is made between the policy holder and the insurer, with the consequence that the policy holder pays the premium and the insurer provides risk protection to the policy holder and/or the insured within a certain time as stipulated in the agreement. Default can be done by the policyholder, one of which is by not paying life insurance premiums until the grace period ends.Settlement of Defaults in Life Insurance Policies Between the Insurer and the Insured that The insurer and the insured binding themselves in the insurance agreement must be in accordance with the provisions of the applicable laws and regulations, which are contained in Article 1338 Paragraph (1) of the Civil Code. This provision states that when the agreement has been agreed by both parties, then the agreement will apply as a law that will bind the parties therein. Because of lawSettlement of Defaults in Life Insurance Policies Between the Insurer and the Insured that if the premium is not paid by the policyholder, the life insurance agreement can be canceled by law and the policy will be canceled or called lapsed, namely the termination of insurance coverage as a result of not paying premiums until the insurance contract period ends and the premiums that have been paid will not be returned.
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Tomita, Masashi, Koichiro Takaoka, and Motokazu Ishizaka. "On the ruin probability of a generalized Cramér–Lundberg model driven by mixed Poisson processes." Journal of Applied Probability 59, no. 3 (September 2022): 849–59. http://dx.doi.org/10.1017/jpr.2021.99.
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AbstractWe propose a generalized Cramér–Lundberg model of the risk theory of non-life insurance and study its ruin probability. Our model is an extension of that of Dubey (1977) to the case of multiple insureds, where the counting process is a mixed Poisson process and the continuously varying premium rate is determined by a Bayesian rule on the number of claims. We use two proofs to show that, for each fixed value of the safety loading, the ruin probability is the same as that of the classical Cramér–Lundberg model and does not depend on either the distribution of the mixing variable of the driving mixed Poisson process or the number of claim contracts.
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Lin, Jyh-Horng, Fu-Wei Huang, and Shi Chen. "Sunflower management and life insurance: modeling the CEO’s utility function." Review of Behavioral Finance 11, no. 3 (August 12, 2019): 309–23. http://dx.doi.org/10.1108/rbf-05-2018-0053.
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Purpose The purpose of this paper is to develop a theoretical framework to answer the following question: What are the consequences of sunflower behavior as well as spread behavior for how asset-liability management is administrated in a life insurance company? Design/methodology/approach This paper takes into account the following: the chief executive officer (CEO) of a life insurance company confirms the board of directors’ belief – the preference of the like of higher return relative to the dislike of higher risk; the authors call such behavior sunflower management; the life insurance policyholder is entitled to a guaranteed interest rate and a participation percentage of the company’s investment surplus; and the authors examine the optimal insurer interest margin, i.e., the spread between the loan rate and the guaranteed rate. Findings Sunflower management translates into lower utility for the CEO and makes the CEO more prudent to risk-taking at an increased insurer interest margin for the provision of life insurance contracts. The effect of the guaranteed rate on the margin is ambiguous and depends on the level of guarantee itself. An increase in the participation level decreases the CEO’s loan risk-taking at an increased margin. It is shown that a trend toward higher return like of the board’s belief produces a corresponding trend toward the CEO’s decreasing risk-taking when the return like is revealed strongly. The results indicate that sunflower management as such is an important determinant in ensuring a safe insurance system. Originality/value This is the first paper to construct a contingent claim model to evaluate the expected value of the CEO’s utility function defined in terms of the equity returns and the equity risks of a life insurance company. The model explicitly considers CEO sunflower behavior, CEO spread behavior and the limited liability of shareholders.
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Moh. Asra and Rizqiyah. "Studi Komparatif Asuransi Shari’ah dan Konvensional." Istidlal: Jurnal Ekonomi dan Hukum Islam 3, no. 2 (October 15, 2019): 103–17. http://dx.doi.org/10.35316/istidlal.v3i2.155.
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Insurance is an institution engaged in services and helping people. In Arabic, insurance is called "Al-ta’mȋn", means to provide protection. According to the National Sharia Board-Indonesian Ulama Council (DSN-MUI), shari'ah insurance is an effort to protect one another and to help one another among people or groups through investments in the form of assets or tabarru’ funds (endowment), and repayment. The essential of the Islamic insurance implementation is cooperation (ta'âwun). To maintain consistency in the implementation of sharia in the financial sector and the enhancement of the nation’s prosperity, tabarru’ funds (endowment) are considered to be the same as grants (donation) so that the funds donated cannot be canceled. There are fundamental differences between conventional insurance and shari’ah insurance because shari’ah insurance uses the principle of risk-sharing so that sharia insurance companies called the operators wouldn’t call the guarantors. Customers in sharia insurance companies called participants wouldn’t call guaranteed. Besides other differences are the contract, premium elements, ownership of fund, investment of fund, payment of claims, profit sharing, there is Sharia Supervisory Board, vision and mission, accounting methods, there is no charred fund, and there is no charge (loading).
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Reiff, Marian, Erik Šoltés, Silvia Komara, Tatiana Šoltésová, and Silvia Zelinová. "Segmentation and estimation of claim severity in motor third-party liability insurance through contrast analysis." Equilibrium 17, no. 3 (September 30, 2022): 803–42. http://dx.doi.org/10.24136/eq.2022.028.
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Research background: Using the marginal means and contrast analysis of the target variable, e.g., claim severity (CS), the actuary can perform an in-depth analysis of the portfolio and fully use the general linear models potential. These analyses are mainly used in natural sciences, medicine, and psychology, but so far, it has not been given adequate attention in the actuarial field. Purpose of the article: The article's primary purpose is to point out the possibilities of contrast analysis for the segmentation of policyholders and estimation of CS in motor third-party liability insurance. The article focuses on using contrast analysis to redefine individual relevant factors to ensure the segmentation of policyholders in terms of actuarial fairness and statistical correctness. The aim of the article is also to reveal the possibilities of using contrast analysis for adequate segmentation in case of interaction of factors and the subsequent estimation of CS. Methods: The article uses the general linear model and associated least squares means. Contrast analysis is being implemented through testing and estimating linear combinations of model parameters. Equations of estimable functions reveal how to interpret the results correctly. Findings & value added: The article shows that contrast analysis is a valuable tool for segmenting policyholders in motor insurance. The segmentation's validity is statistically verifiable and is well applicable to the main effects. Suppose the significance of cross effects is proved during segmentation. In that case, the actuary must take into account the risk that even if the partial segmentation factors are set adequately, statistically proven, this may not apply to the interaction of these factors. The article also provides a procedure for segmentation in case of interaction of factors and the procedure for estimation of the segment's CS. Empirical research has shown that CS is significantly influenced by weight, engine power, age and brand of the car, policyholder's age, and district. The pattern of age's influence on CS differs in different categories of car brands. The significantly highest CS was revealed in the youngest age category and the category of luxury car brands.
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Rosenstein, Emilie, and Jean-Michel Bonvin. "Paradoxes of Universalism: The Case of the Swiss Disability Insurance." Social Inclusion 8, no. 1 (March 18, 2020): 168–77. http://dx.doi.org/10.17645/si.v8i1.2499.
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Social policies rely on specific expectations vis-a-vis their beneficiaries, who have to abide by certain eligibility criteria or behavioral standards to access the benefits or services provided. As such, they draw boundaries between the deserving and undeserving, which results in the following paradox: While social policies claim to be universal, they actually exclude potential beneficiaries by imposing on them the compliance with these eligibility criteria and behavioral standards. In other words, purportedly universal social policies may have exclusionary effects, in the form either of selectivity (street-level bureaucrats select what they perceive as legitimate beneficiaries) or of self-exclusion and non-take-up (people entitled do not claim benefits or services). Based on the case of the Swiss disability insurance, this article explores the extent of, and the reasons underlying, the paradoxes of universalism within active social policies. It relies on a mixed-methods research design, combining sequence analysis (showing the selectivity of active reforms regarding people’s access to disability benefits) and in-depth interviews. The conclusion of this article suggests that not all forms of universalism are equally exposed to such paradoxes and proposes a hypothesis to be explored in further research: The more requiring and precise in terms of eligibility criteria and behavioral standards social policies and activation strategies are (hard universalism), the higher the risk that they lead to selective practices in contradiction with their universal ambition. By contrast, fuzzier eligibility or behavioral criteria (soft universalism), which allow for adjustment to individual circumstances, may lead to more genuinely universal and inclusive social policies.
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Zhang, Zhimin, Eric C. K. Cheung, and Hailiang Yang. "ON THE COMPOUND POISSON RISK MODEL WITH PERIODIC CAPITAL INJECTIONS." ASTIN Bulletin 48, no. 1 (September 28, 2017): 435–77. http://dx.doi.org/10.1017/asb.2017.22.
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AbstractThe analysis of capital injection strategy in the literature of insurance risk models (e.g. Pafumi, 1998; Dickson and Waters, 2004) typically assumes that whenever the surplus becomes negative, the amount of shortfall is injected so that the company can continue its business forever. Recently, Nie et al. (2011) has proposed an alternative model in which capital is immediately injected to restore the surplus level to a positive level b when the surplus falls between zero and b, and the insurer is still subject to a positive ruin probability. Inspired by the idea of randomized observations in Albrecher et al. (2011b), in this paper, we further generalize Nie et al. (2011)'s model by assuming that capital injections are only allowed at a sequence of time points with inter-capital-injection times being Erlang distributed (so that deterministic time intervals can be approximated using the Erlangization technique in Asmussen et al. (2002)). When the claim amount is distributed as a combination of exponentials, explicit formulas for the Gerber–Shiu expected discounted penalty function (Gerber and Shiu, 1998) and the expected total discounted cost of capital injections before ruin are obtained. The derivations rely on a resolvent density associated with an Erlang random variable, which is shown to admit an explicit expression that is of independent interest as well. We shall provide numerical examples, including an application in pricing a perpetual reinsurance contract that makes the capital injections and demonstration of how to minimize the ruin probability via reinsurance. Minimization of the expected discounted capital injections plus a penalty applied at ruin with respect to the frequency of injections and the critical level b will also be illustrated numerically.
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REYES, GONZALO. "Market design for the provision of social insurance: the case of disability and survivors insurance in Chile." Journal of Pension Economics and Finance 9, no. 3 (July 14, 2009): 421–44. http://dx.doi.org/10.1017/s1474747209990059.
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AbstractAs part of the pension reform recently approved in Chile, the government introduced a centralized auction mechanism to provide the Disability and Survivors (D&S) Insurance that covers recent contributors among the more than eight million participants in the mandatory private pension system. This paper is intended as a case study presenting the main distortions found in the decentralized operation of the system that led to this reform and the challenges faced when designing a competitive auction mechanism to be implemented jointly by the Pension Fund Managers (AFP). When each AFP independently hired this insurance with an insurance company, the process was not competitive: colligated companies ended up providing the service and distortions affected competition in the market through incentives to cream-skim members, efforts to block disability claims, lack of price transparency, and the insurance contract acting as a barrier to entry. Cross-subsidies, inefficient risk pooling, and regulatory arbitrage were also present. The Chilean experience is relevant since other privatized systems with decentralized provision of this insurance may show similar problems as they mature. A centralized auction mechanism solves these market failures, but also gives raise to new challenges, such as how to design a competitive auction that attracts participation and deters collusion. Design features that were incorporated into the regulation to tackle these issues are presented here.
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Shymon, L. S. "NAMED AND UNNAMED KINDS OF PERSONAL ENSURING." Actual problems of native jurisprudence, no. 4 (August 30, 2019): 62–66. http://dx.doi.org/10.15421/391914.
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The article deals with the named and unnamed special kinds of enforcement of the obligation. Special kinds of the fulfillment of an obligation ensuring are proposed to be considered as a means of protecting the rights of the creditor in contractual obligations, where the fulfillment of obligations caused by the debtor is due to the fulfillment of the obligation of the third (other than the debtor) of the surety, guarantor, joint or subsidiary debtor, insurer. Among the named kinds of securing the fulfillment of the obligation is investigated surety and warranty. Surety as a special kind of ensuring the fulfillment of the obligation means that in the event of a debtor breaking the obligation secured by it, the creditor’s property interests are met by a third party – guarantor. Surety arises exclusively on the basis of the concluded contract on surety. A surety contract may be concluded not only between the creditor and the surety, but also as a tripartite agreement between the creditor, the debtor and the surety, for example, when a surety contract is concluded as one of the part of the main contract. A surety agreement gives the right to thecreditor in the event of breach of a secured obligation to require the guarantor to fulfill the obligation incurred by the debtor. The surety is liable to the creditor so as a debtor, including the payment of principal debt, interests, penalty, damages, that is, he bears full responsibility for the debtor. As a rule, the surety and the debtor act as solidary debtors. The guarantee, as personal kind of ensuring the fulfillment of the obligation, protects the violated rights of the creditor by the way of enforcing the guarantor to bear responsibility for breaching the obligation by the debtor. Under guarantee, a bank, another financial institution, an insurance organization (guarantor) guarantees to the creditor (beneficiary) the fulfillment of the debtor (principal) of his duty. The guarantor independently is responsible to the creditor for violation of the obligation by the debtor. He is not a solidary debtor. The article considers the possibility of recognizing insurance as one of the unnamed to the research of insurance financial risks and insurance. Оf responsibility of the personal kinds of enforcement of the obligation fulfillment. This problem is given special attention. The author also proposes to refer to the unnamed types of enforcement of the obligation fulfillment the following: factoring – financing in the case of the right deviation to money claim, which legal structure has found its securing in Article 1077 of the Civil Code of Ukraine.
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Ahn, Sungjin, Taehui Kim, and Ji-Myong Kim. "Sustainable Risk Assessment through the Analysis of Financial Losses from Third-Party Damage in Bridge Construction." Sustainability 12, no. 8 (April 23, 2020): 3435. http://dx.doi.org/10.3390/su12083435.
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Due to the recent introduction of innovative construction methods and technologies, construction projects increasingly require sustainability in their high degrees of specialization and complex work processes. This is due to a wide variety of new risk factors associated with construction projects that can lead to extensive and severe damage. When an accident occurs during a construction project, it can cause material, property, or bodily damage not only within the actual construction site but also outside, affecting third parties. This study analyzed the record of such third-party damage and the subsequent financial losses in bridge construction management, to identify the objective and quantified relationship of risk indicators related to the damage and losses. In order to assess the actual losses in construction projects, we adopted the loss claim payout data as recorded and provided by a major Korean insurance company, and conducted a multiple regression analysis to identify the loss indicators and to develop a loss estimation model. In this study, the analysis of the data indicated that the superstructure type, the foundation type, floods, and company ranking by the amount of the contract were the four statistically significant risk indicators that affected financial losses from third-party damage, among the nine variables used as independent variables, which included the superstructure type, foundation type, superstructure construction method, maximum span length, floods, typhoons, total construction cost, total construction period, and company ranking. As this study focused on identifying the risk factors and producing a loss assessment model quantified in numerical values, the results provide important references for assessing and minimizing the risks to third parties and the consequential financial losses in bridge construction, while promoting sustainability objectives.
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Aznar Mollá, Francisco, Carlos Fito-López, Jose Antonio Heredia Alvaro, and Francisco Huertas-López. "New Tools to Support the Risk Assessment Process of Nanomaterials in the Insurance Sector." International Journal of Environmental Research and Public Health 18, no. 13 (June 29, 2021): 6985. http://dx.doi.org/10.3390/ijerph18136985.
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During the last decade, the use of nanomaterials, due to their multiple utilities, has exponentially increased. Nanomaterials have unique properties such as a larger specific surface area and surface activity, which may result in health and environmental hazards different from those demonstrated by the same materials in bulk form. Besides, due to their small size, they can easily penetrate through the environmental and biological barriers. In terms of exposure potential, the vast majority of studies are focused on workplace areas, where inhalation is the most common route of exposure. The main route of entry into the environment is due to indirect emissions of nanomaterials from industrial settings, as well as uncontrollable releases into the environment during the use, recycling and disposal of nano-enabled products. Accidental spills during production or later transport of nanomaterials and release from wear and tear of materials containing nanomaterials may lead to potential exposure. In this sense, a proper understanding of all significant risks due to the exposure to nanomaterials that might result in a liability claim has been proved to be necessary. In this paper, the utility of an application for smartphones developed for the insurance sector has been validated as a solution for the analysis and evaluation of the emerging risk of the application of nanotechnology in the market. Different exposure scenarios for nanomaterials have been simulated with this application. The results obtained have been compared with real scenarios, corroborating that the use of novel tools can be used by companies that offer risk management in the form of insurance contracts.
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Skachkov, N. G. "ESG Factors in Corporate and Social Risk Management System as an Infrastructure Element of Cross-Border Business." Lex Russica 75, no. 9 (September 22, 2022): 20–32. http://dx.doi.org/10.17803/1729-5920.2022.190.9.020-032.
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The paper is devoted to the analysis of current factors of ESG (Environmental Social and Corporate Governance) sustainable development. The paper shows how the ESG agenda is implemented in practice, as well as what changes in legal regulation or behavior of investors, counterparties, consumers of products and services may be associated with it. The author examines to what extent ESG standards are included in the risk management strategy of cross-border business. The risk management system is a set of techniques and methods that allow you to accurately predict the occurrence of risk events. Risk management standards presuppose the choice of both «positive» and «negative» aspects (risks). The term «aspect» is intended to identify the consequences, probabilities of risk, its matrix in the long and short term. The most successful are the standards of the so-called best practice, most often they are called «integrated risk management».The paper highlights the chains of concluded contracts, considers the environmentally friendly management solutions embedded in them. The paper substantiates the categorical apparatus of two directions of risk management, influenced by ESG factors: social risk management and corporate risk management. The paper argues for a procreditor’s approach to the risks of improper distribution of corporate assets, the formation of valuation and regulatory capital reserves. It is shown which of the problematic debts gives rise to a corporate group of debtors-borrowers to claim and whether it is worth resorting to a foreign jurisdiction in this regard. The author admits that social risks range from such a root cause as conflicts of socially significant interests to more complex legal structures, the basis of which is formed by contradictory processes of coordination of corporate investment strategy. As a result, even the minimum legal standards detailing insurance risks are of lasting importance, with the comparability of the risks of social and credit groups.
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Masri, Esther. "PELANGGARAN PRINSIP ITIKAD BAIK DALAM PERJANJIAN ASURANSI PADA P.T. ASURANSI JIWASRAYA CABANG PADANG." KRTHA BHAYANGKARA 12, no. 1 (June 18, 2018): 116–39. http://dx.doi.org/10.31599/krtha.v12i1.33.
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This study uses empirical juridical method where research with a view to legal provisions in practice. This study concerns the basic factors underlying the onset of any breach of the principle of utmost good faith in the insurance agreement as well as how the settlement and legal consequences of the breach of the principle of utmost good faith in the contract of insurance. The author uses the qualitative data analysis to make an assessment of data that authors get on the field with the help of literatures related research. Based on the research that earned the author the P.T. Asuransi Jiwasraya (Persero) Padang Branch that the factors underlying the violation of the principle of utmost good faith can be caused by internal factors (the insurer) is an insurance agent and risk selectors (underwriter) and external factors i.e. insured parties. Violation of the dishonest agents caused the insurer gives a description of the products offered to the prospective insured because only the pursuit of targets and commissions, vice versa the insured provides false information when responding to a question from the insurer. Completion of the offence principle of utmost good faith this is done first by deliberation, if agreement was not reached will proceed through court proceedings. As a result of legal violations of principle of utmost good faith is the insurance agreement void or in other words the insurer has no duty to indemnify if the claims of the insured object.
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Chen, Chung-Yen, and Yawen Cheng. "O3A.1 Assessing the under-estimation of occupational respiratory diseases in taiwan: analyses of disease burdens and healthcare costs." Occupational and Environmental Medicine 76, Suppl 1 (April 2019): A22.1—A22. http://dx.doi.org/10.1136/oem-2019-epi.58.
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BackgroundRespiratory diseases, including pneumoconiosis, asthma, chronic obstructive pulmonary disease (COPD) and respiratory malignancies, are featured by their multi-etiological nature and long latency periods, adding to the difficulties in recognizing their work-relatedness. Due to their heavy overall disease burdens and high healthcare spending, examining the fraction of respiratory diseases attributable to occupational factors is helpful in understanding the magnitude of under-estimation of occupational injuries and diseases.MethodsPrevalence rates of various occupational exposures were assessed retrospectively with self-reported surveys or job-exposure matrices. Relative risks of theses exposures were drawn from international epidemiological literatures. The above two parameters were used to calculate population attributable risk percentages (PAR%), and with that the numbers of visiting and amounts of payment attributable to occupational factors were estimated based on the claim data of the National Health Insurance (NHI). The estimates were compared with the data of actual payment by the Workers’ Compensation Insurance (WCI).ResultsWe estimated that around 15 000 patients visited medical facilities for occupational respiratory diseases in 2015, costing a total of 10 million USD. In contrast, less than 200 cases were approved by WCI in the same year. A 100-fold gap between the estimated and actual payment was also noted. Estimation analyses further indicated that 9.6% of cases and 48.1% of healthcare costs were asbestos-related.ConclusionFor occupational respiratory diseases with long latency periods and great causal complexity, the scope of under-estimation was substantial, and their medical expenses had been largely paid by NHI rather than WCI. To increase the visibility of occupational respiratory diseases, workplace exposure assessment and disease surveillance should be improved and public awareness of occupational diseases should be raised.
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Ripollone, John E., Krista F. Huybrechts, Kenneth J. Rothman, Ryan E. Ferguson, and Jessica M. Franklin. "Evaluating the Utility of Coarsened Exact Matching for Pharmacoepidemiology Using Real and Simulated Claims Data." American Journal of Epidemiology 189, no. 6 (December 17, 2019): 613–22. http://dx.doi.org/10.1093/aje/kwz268.
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Abstract Coarsened exact matching (CEM) is a matching method proposed as an alternative to other techniques commonly used to control confounding. We compared CEM with 3 techniques that have been used in pharmacoepidemiology: propensity score matching, Mahalanobis distance matching, and fine stratification by propensity score (FS). We evaluated confounding control and effect-estimate precision using insurance claims data from the Pharmaceutical Assistance Contract for the Elderly (1999–2002) and Medicaid Analytic eXtract (2000–2007) databases (United States) and from simulated claims-based cohorts. CEM generally achieved the best covariate balance. However, it often led to high bias and low precision of the risk ratio due to extreme losses in study size and numbers of outcomes (i.e., sparse data bias)—especially with larger covariate sets. FS usually was optimal with respect to bias and precision and always created good covariate balance. Propensity score matching usually performed almost as well as FS, especially with higher index exposure prevalence. The performance of Mahalanobis distance matching was relatively poor. These findings suggest that CEM, although it achieves good covariate balance, might not be optimal for large claims-database studies with rich covariate information; it might be ideal if only a few (<10) strong confounders must be controlled.
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Di Lorenzo, Pierpaolo, Mariano Paternoster, Mariarosaria Nugnes, Giuseppe Pantaleo, Vincenzo Graziano, and Massimo Niola. "Professional dental and oral surgery liability in Italy: a comparative analysis of the insurance products offered to health workers." Open Medicine 11, no. 1 (January 1, 2016): 256–63. http://dx.doi.org/10.1515/med-2016-0051.
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AbstractIntroductionIn Italy there has been an increase in claims for damages for alleged medical malpractice. A study was therefore conducted that aimed at assessing the content of the coverage of insurance policy contracts offered to oral health professionals by the insurance market.Material and methodsThe sample analysed composed of 11 insurance policy contracts for professional dental liability offered from 2010 to 2015 by leading insurance companies operating in the Italian market.ResultsThe insurance products analysed are structured on the “claims made” clause. No policy contract examined covers the damage due to the failure to acquire consent for dental treatment and, in most cases, damage due to unsatisfactory outcomes of treatment of an aesthetic nature and the failure to respect regulatory obligations on privacy.DiscussionOn entering into a professional liability insurance policy contract, the dentist should pay particular attention to the period covered by the guarantee, the risks both covered and excluded, as well as the extent of the limit of liability and any possible fixed/percentage excess.ConclusionsWhen choosing a professional liability contract, a dentist should examine the risks in relation to the professional activity carried out before signing.
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Stone, Edward J. "Foes claim bank insurance rights violate GOP contract." Banks in Insurance Report 11, no. 4 (August 1995): 1–4. http://dx.doi.org/10.1002/bir.3820110402.
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Dimov, Tatjana. "SUBROGATION IN INSURANCE CONTRACT." Knowledge International Journal 28, no. 6 (December 10, 2018): 1985–91. http://dx.doi.org/10.35120/kij28061985t.
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Subrogation is a legal right characteristically reserved by property insurers. Subrogation occurs in property insurance and in some particular cases of liability insurance. The doctrine of subrogation operates to ensure protection of certain specific principles relevant to the property insurance including the principle of indemnification whereby the compensation received is no more and no less than a full indemnity for the insured loss or damage suffered by the insured due to loss occurrence, the principle of non-cumulation in terms of claims under the same insurance contract and the principle which excludes claiming indemnity from the person who is legally responsible for causing the loss, because otherwise the insurance contract may be an unjustified source of profit for the insured as the insured would get double recovery or paid out twice for the same claim.With the payment of the reimbursement from an insurance agreement on the insurer, all rights that the insured has towards the persons responsible for the damage up to the amount of the paid compensation are transferred. With the subrogation, the insurer takes up the legal position of the insured person and exercises his right to subrogation from the rights of the insured (derivative acquisition of the right), so that the insurer exceeds the claims in scope and amount as the insured had towards the perpetrator.Subrogation is the right of the insurer, it is not his obligation. The insurer is not obliged to use this right to transfer the rights to the responsible person.The notion of subrogation is often associated with the concept of insurance regression. But there is a difference between these two terms: recourse is the right of the insurer to claim the amount of compensation that he has paid to the insured (injured parties) from the harmful person, while subrogation is the transfer of the right (the claim for damages to the responsible person) from the insured to the insurer up to the amount of the compensation paid on the basis of an insurance contract. The right to recourse is a consequence of the existence of subrogation, i.e. transfer of the rights of the insured person to the responsible person, and which is reached by the law itself.Тhe subrogation doctrine also operates to ensure that the defendant or the person who is legally responsible for the loss shall not be absolved of liability under the civil law. Namely, the perpetrator should bear the consequences of his liability for the caused damage, and therefore the legislator of the insurer (as one of the contractual parties in insurance contract) has recognized the right what he has paid the injured party (as the contractual party in the insurance contract called the insured) to calm from the perpetrator.Furthermore, subrogation doctrine operates to ensure profit for the insurance companies whereby the reimbursement funds the claims or sum insured are covered from additionally grow; therefore, this doctrine is of great importance to the insurers.
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Sarkar, Sumit, and Sai Ranjani Bharathkumar. "Incorporating a “no claim bonus” in insurance agency contract." Managerial and Decision Economics 39, no. 6 (August 16, 2018): 682–89. http://dx.doi.org/10.1002/mde.2959.
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KeehoonKwon. "Direct Claim by Third Parties in Liability Insurance Contract." Ajou Law Review 2, no. 1 (June 2008): 25–48. http://dx.doi.org/10.21589/ajlaw.2008.2.1.25.
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Hassan, Abid, Md Iftekhar Ali, Rifat Ahammed, Mohammad Monirujjaman Khan, Nawal Alsufyani, and Abdulmajeed Alsufyani. "Secured Insurance Framework Using Blockchain and Smart Contract." Scientific Programming 2021 (November 24, 2021): 1–11. http://dx.doi.org/10.1155/2021/6787406.
Full textAbstract:
Traditional insurance policy settlement is a manual process that is never hassle-free. There are many issues, such as hidden conditions from the insurer or fraud claims by the insured, making the settlement process rough. This process also consumes a significant amount of time that makes the process very inefficient. This whole scenario can be disrupted by the implementation of blockchain and smart contracts in insurance. Blockchain and innovative contract technology can provide immutable data storage, security, transparency, authenticity, and security while any transaction process is triggered. With the implementation of blockchain, the whole insurance process, from authentication to claim settlement, can be done with more transparency and security. A blockchain is a virtual chain of data blocks that is a decentralized technology. Any transaction or change in the blocks is done after the decentralized validator entity, not a single person. The smart contract is a unique facility stored on the blockchain that gets executed when the predetermined conditions are met. This paper presents a framework where smart contracts are used for insurance contracts and stored on blockchain. In the case of a claim, if all the predetermined conditions are met, the transaction happens; otherwise, it is discarded. The conditions are immutable. That means there is scope for alteration from either side. This blockchain and intelligent contract-based framework are hosted on a private Ethereum network. The Solidity programming language is used to create smart contracts. The framework uses the Proof of Authority (PoA) consensus algorithm to validate the transactions. In the case of any faulty transaction request, the consensus algorithm acts according to and cancels the claim. With blockchain and smart contract implementation, this framework can solve all the trust and security issues that rely on a standard insurance policy.
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Ennis, Fiona. "Claim." After Dinner Conversation 2, no. 8 (2021): 18–28. http://dx.doi.org/10.5840/adc20212871.
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Are there certain things you shouldn’t be able to insure against? In this work of philosophical short story fiction, the narrator has an eating disorder, and mental health issues. Regardless, she is a good employee at an insurance company. Just before closing, a call arrives from a good client, the local diocese who inquires about getting insurance to protect them against sexual abuse of children by priests. She takes the issue, and her concerns, to her boss who threatens to fire her if she fails to write the policy. It’s not their job to judge, he says, it’s their job to insure. A flashback shows why this point strikes so close home with the narrator. As a young child she was bullied on the school bus for being overweight. In an attempt to lose weight she started getting off the bus early to walk the last three miles home. Later, her bully accused the bus driver of touching her when they were on the bus alone together. Having come full circle, not much has changed. The narrator writes the contract, and sends it to the diocese to sign and return.
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Kucharski, Bartosz. "Civil Law Consequences of the Non-Adjustment of an Insurance Product by the Distributor to the Demands and Needs of a Customer." Prawo Asekuracyjne 3, no. 100 (September 15, 2019): 18–35. http://dx.doi.org/10.5604/01.3001.0013.5730.
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According to the author, only in certain situations may the non-adjustment of insurance products to the demands and needs of the customer lead to the invalidity of insurance contract terms, or be remedied by the interpretation thereof in favour of the customer. Thus, the basic legal remedy which can be used by the customer in such case is to claim damages from the distributor. As a rule, distributors assume contractual liability based on the presumption of fault: in the case of brokers arising from brokerage contract, and in case of other distributors from obligations specified in the provisions of the Insurance Distribution Act. Insurers bear tortious non-fault liability for the activities of their dependent agents. Basically, clients may claim full damages according to the so called “difference theory”. In many cases however the damages will be restricted to the value of the overpaid insurance premium.