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MindMap Gallery Basic principles of insurance

Basic principles of insurance

This is a mind map about the basic principles of insurance. These principles together constitute the basic norms of insurance activities, ensure the fairness, justice and effective execution of insurance contracts, and protect the legitimate rights and interests of all parties in insurance activities.

Edited at 2024-02-12 10:04:59

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Basic principles of insurance

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Outline

in principle
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Basic principles of insurance

insurable interest principle

Requirements for insurable interests

Must be a legally recognized interest

Must be a financial benefit

Must be a definite interest

The benefit can be valued in monetary terms

This interest is not a subjective valuation of the parties, but a factual or objective interest.

meaning

When applying for insurance, the policy holder must have an insurable interest in the subject matter insured, otherwise the contract will be invalid.

When making a claim, the insurance company's compensation to the insured is limited to the insurance benefits, and the insured cannot obtain additional benefits beyond the insurance benefits.

The principle of utmost good faith

inform

Contents to be informed

What the insured party informed

When the contract is concluded, based on the insurer's inquiries, answer truthfully the important facts that are known or should be known about the subject matter of the insurance and its risks.

After the insurance contract is concluded, if the risk of the insured subject increases, the insurer should be notified promptly

The insurance company should be notified promptly after an accident occurs

The policy holder of duplicate insurance shall notify the insurer of the relevant circumstances of the duplicate insurance.

When the subject matter insured is transferred, the insurance company shall be notified and the insurance shall continue after the insurance company agrees to change the contract.

What the insurer informed

When the contract is concluded, the insurer should take the initiative to explain the terms of the insurance contract to the policy holder.

When an insurance contract stipulates an exemption clause for the insurer's liability, it shall be clearly stated to the policy holder when concluding the insurance contract.

Legislative form of notification

Form of notification to the policy holder

Unlimited notification obligation

Obligation to inform questions and answers

Insurer’s notification form

clearly stated

Explain clearly

Legal consequences of breach of notification obligation

Policyholder

Intentionally failing to fulfill the obligation to truthfully inform

The insurer has the right to terminate the insurance contract and shall not be liable for compensation or payment of insurance premiums for insured accidents that occurred before the insurance contract was terminated, and shall not refund the insurance premiums.

Negligent failure to fulfill obligation to inform

The insurer has the right to terminate the insurance contract; if the undisclosed facts have a serious impact on the occurrence of the insured event, the insurer shall not be liable for compensation or payment of insurance premiums for the insured event that occurred before the insurance contract was terminated, but may refund the insurance premium.

The insured or beneficiary falsely claims that an insured accident has occurred and makes a request for compensation or payment of insurance benefits to the insurer when no insured accident has occurred.

The insurer has the right to terminate the insurance contract without refunding the insurance premium

The policy holder, the insured or the beneficiary intentionally causes an insured accident

The insurer has the right to terminate the insurance contract and is not liable for compensation or payment of insurance premiums. Unless otherwise provided in paragraph 1 of Article 43 of the Insurance Law, the insurer will not refund the insurance premium.

After an insured accident occurs, the policy holder, the insured or the beneficiary fabricates false causes of the accident or exaggerates the extent of the loss by forging or altering relevant certificates, materials or other evidence.

The insurer is not liable for compensation or payment of insurance premiums for the falsely reported portion.

If the circumstances are serious, criminal sanctions will be imposed; if the insurance premium or expense is caused to the insurer, it shall be refunded or compensated.

Insurer

If the insurance contract stipulates an exemption clause for the insurer's liability, the insurer fails to fulfill its obligation to clearly state the liability exemption when entering into the contract.

The liability exemption clause in the insurance contract is invalid, that is, it has no effect on the policyholder from the time the insurance contract is established.

Insurance companies and their staff conceal important information related to the insurance contract in the insurance business, deceive the policy holder, the insured or the beneficiary, or refuse to perform the obligation to compensate or pay insurance premiums stipulated in the insurance contract

Constitute a crime, be held criminally responsible

If it does not constitute a crime, according to the provisions of Article 162 of the Insurance Law, the insurance regulatory agency shall order correction and impose a fine of not less than 50,000 yuan but not more than 300,000 yuan.

If the circumstances are serious, their business scope shall be restricted, ordered to stop accepting new business, or their business license shall be revoked.

Article 174 of the Insurance Law stipulates: If an individual insurance agent violates the provisions of this law, the insurance regulatory agency shall give a warning and may also impose a fine of not more than 20,000 yuan; if the circumstances are serious, a fine of not less than 20,000 yuan but not more than 100,000 yuan may be imposed. be fined and may have his or her qualification certificate revoked

ensure

Classification

Classification based on whether the guarantee matters already exist

Confirm guarantee

Commitment Guarantee

Classification according to the form of guaranteed existence

express warranty

implied warranty

abstain

Either party waives certain rights that can be asserted in the insurance contract

estoppel

A party has given up a right that can be asserted in the contract and may not reassert such right in the future.

compensation principle

definition

After the insurance contract is concluded, once a loss occurs within the scope of insurance liability, the insured has the right to obtain comprehensive and adequate compensation in accordance with the provisions of the insurance contract.

The insurance company's compensation to the insured just restores the insured subject matter to the condition before the insured accident occurred. That is, insurance compensation is limited to the actual loss of the insured, and the insured cannot make any profit from the insurance compensation.

limit

Life Insurance

Personal insurance contracts are benefit contracts and the principle of compensation does not apply. This has been confirmed by insurance legislation and insurance practices in various countries. The principles of subrogation and contribution derived from the principle of compensation are also not applicable to personal insurance.

Fixed value insurance

replacement cost insurance

application

Determine actual losses based on market prices

The actual loss is determined based on the actual loss incurred by the insured

Determine the actual loss based on the costs required to restore the original condition

After restoration, the performance of the insured subject is improved, thus increasing its value. According to the insurance compensation principle, the insurer has the right to deduct part of the value of the additional benefits obtained by the insured accordingly.

If the function of the insured subject after repair is not as good as that of the insured subject in the past, the insurer should consider compensating the difference.

Determine actual losses based on replacement cost less depreciation

proximate cause principle

principle of subrogation

concept

In property insurance, after the insurer compensates the insured for losses, if a third party is responsible for the occurrence of the insured accident or the loss of the insured subject matter, the insurer has the right to recover compensation from the third party within the scope of insurance compensation, and the insured shall Transfer the rights related to the insured subject matter to the insurance company

Not applicable to personal insurance

premise

The loss of the insured subject matter is caused by the insured accident, and the insurer shall bear the liability for compensation.

The loss of the insured subject matter is also caused by the liability of a third party. The insured has the right to request compensation from the responsible party in accordance with the law, but has not yet made a request in accordance with the law and first files a claim with the insurer in accordance with the insurance contract.

The insurer fulfilled its liability for compensation

Rights and obligations

The insurer shall exercise the right of subrogation within the limit of the amount of compensation. If the amount of compensation obtained from the third party based on the right of subrogation exceeds the amount of compensation from the insurer, the excess of the compensation amount shall belong to the insured.

The insured has the right to request compensation from a third party for the portion that has not been compensated by the insurer.

The insured cannot damage the insurer's right of subrogation

After an insured accident occurs, but before the insurer pays the insurance money, if the insured gives up the right to request compensation from the third party, the insurer shall not be liable for the insurance money.

After the insurer pays insurance money to the insured, if the insured gives up the right to request compensation from a third party without the consent of the insurer, the act is invalid.

If the insured intentionally or due to gross negligence causes the insurer to be unable to exercise the right to claim compensation by subrogation, the insurer may deduct or require the return of the corresponding insurance money.

When the insurer exercises its right to request compensation from a third party through subrogation, the insured shall provide the insurer with the necessary documents and relevant information known to him.

apportionment principle

Applicable to compensatory insurance contracts such as property insurance, but not applicable to personal insurance

Determination of apportionment amount

Proportional shared responsibility system

limited liability system

sequential accountability