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Topic 23: Legal Aspects of Insurance - 67 (4) Estoppel prevents one from denying a fact if the fact was admitted to be true by previous actions If one party to a contract waives its right to enforce a part of the contract, and the other party relies on that waiver, the rst party is prevented (estopped) from enforcing it later (5) Rescission An insurance policy may be rescinded if one party can prove that the other party misrepresented material information in the preparation or negotiation of the insurance contract (6) Reformation is the changing of an existing contract, not the creation of a new one It is done when both parties agree to change the new contract from what was originally intended (7) Conditional The insurance company is obligated to pay a claim on the condition that a covered loss is sustained C Categories for analyzing insurance contracts (1) Declarations are factual statements identifying the speci c person, property, or activity being insured and the parties to the insurance transaction (2) The de nitions section of the policy is an explanation of the key policy terms (3) The insuring agreement is the heart of the insurance policy This agreement(s) spells out the basic premise of the insurance company An example is an agreement to pay the face amount of the policy in the event of the insured s death (4) Exclusions are items that the insurer does not intend to cover A practical result of exclusions is to hold down the premium cost of coverage for policy owners (5) Conditions The insuring agreement is a quali ed promise that is enforceable only if the policy owner ful lls the conditions that are spelled out in the policy An example of these conditions is timely payment of premiums (6) Policy continuation One of the most important miscellaneous provisions of a policy relates to the right of the owner to continue coverage These policy renewal provisions fall into ve categories: (a) Noncancelable This gives the policy owner the right to renew the coverage at each policy anniversary date, and future rates in the coverage are guaranteed in the contract itself (b) Guaranteed renewable Like a noncancelable policy, a guaranteed renewable policy gives the policy owner the right to renew the coverage at each policy anniversary date, but the insurer does not guarantee future rates for the coverage (c) Nonrenewable for stated reasons only These policies often qualify as guaranteed renewable, but allow the insurer to refuse to renew the policy for conditions speci cally listed in the policy (d) Optional renewable This gives the insurer the unilateral right to refuse to renew a policy at the end of any period for which premiums have been paid (e) Cancelable A few property and liability policies are cancelable during the period for which premiums have been paid (7) Valuation of losses Another type of miscellaneous provision concerns a required sharing in the amount of the loss by the insured For example, deductibles are common in homeowners insurance, auto insurance, and medical expense insurance (8) Endorsements and riders An endorsement or, in life insurance, a rider is a provision added to the policy, generally for an extra premium charge As a general legal principle, whenever the wording in an endorsement or rider con icts with the terms of the policy to which it is attached, the endorsement or rider takes precedence. birt pdf 417 Eclipse BIRT PDF417 Barcode Maker add-in makes PDF417 ...
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