Chapter 5 and 6 Risk
Chapter 5 and 6 Risk
Chapter 5 and 6 Risk
(1) whether to approve that person for insurance coverage and if so,
(2) the risk classification to which the proposed insured should be
assigned”.
Factors Considered in Life Insurance Underwriting
• in life insurance underwriting the factors that are considered or
examined are those that influence mortality. These factors include the
followings:-
• Age: The death or illness generally increases with an increase in age.
• Gender (Sex): empirical studies indicate that women are generally live
longer than men.
• Current Physical Condition: refers to the proposed insured’s current
physical and health conditions regarding pulse rate, heart condition,
blood pressure, lung cancer, nervous system etc.
• Personal Medical Condition: the insured’s past medical history is
examined to check for any previous illness that may possibly reoccur in
the future.
Cont,,,
• Family Medical History: the medical history for the insured family is
examined to discover any possible hereditary diseases or deficiencies.
• Occupation: can affect the insured’s chance of suffering accidents of
premature death.
• Insurable Interest: The underwriter must make sure that there is an
insurable interest in applying for life insurance cover. This involves
identifying any relationship between the proposed insured and named
beneficiary.
• Moral Hazard: is that the proposed insured is making a deliberate attempt
to conceal or misrepresent information that might result in an unfavorable
underwriting decision.
Cont,,,
• Financial Position: the proposed insured’s financial position or his
level of income has become an important factor to consider in life
insurance underwriting. Particularly, close examination is to be made
when the amount of cover is appreciable large.
• Habits: such as drug or alcohol consumption and smoking could lead
to accident by retarding a person’s judgment, reducing flexibility and
damaging his reflex system.
• Avocation: is any activity that the insured undertake outside his
regular occupation during his spare time. It includes certain hobbies
like sport activities, gardening etc.
Sources of Information for Underwriting
• The assessment and evaluation of the risk is based on the
information collected by the underwriter.
• Pertinent information needed for underwriting purpose is obtained
from the following sources:
a. Proposal form (a formal application document that an
individual fills out when applying for an insurance policy)
b. Medical report
c. Attending physicians statement
d. Agents/salesman’s report
e. Questionnaires and interviews
Underwriting Guidelines
• It is widely accepted that “one of the most important prerequisite to
good underwriting is consistency” this means that the underwriter
must evaluate each proposed insured in line with a given
framework of standard procedure of evaluations.
• Life insurance is assessing the risk bought by a proposed insured by
considering two guidelines:
1. Numerical rating system
2. Underwriting manuals
• Numerical Rating System: is a method of assigning numerical values
for individuals proposed insured’s based on the degree of risk they
brings in to the group.
• The underwriter does by giving positive or negative values to the
various characteristics of the proposed insured depending on their
impact on the person’s mortality risk.
• After due evaluation of each factor, assigns plus value to those
characteristics that have a negative effect on mortality (increase an
average risk) and identifies them as debits. On the other hand, those
characteristics that have favorable impact on mortality (reduce an
average risk) are given minus value called credits.
• Underwriting Manuals: is a manual that contains information
on various types of common medical impairments such as:
blood pressure,
heart diseases,
diabetes,
respiratory diseases,
mental disorder,
infectious diseases and others.
• It is a manual used as a guideline in assessing and rating the
risk brought by a proposed insured. The manual first describes
the nature of each type of impairment and then provides the
recommended underwriting requirements.
Underwriting Decisions
• On the basis of the information collected from the various sources
and the subsequent analysis made that the underwriter assesses and
evaluates the risk and accordingly makes a decisions.
• There are four options/decision:
1. To accept the risk and issue an insurance policy immediately
2. To accept the risk immediately but with adjustments for substandard
factors
3. To postpone the underwriting decision until information ordered is received
or until an extra risk of temporary nature (pregnancy, child birth) is
expected to lapse.
4. Either to decline or reject the risk
Types of Life Insurance Policies
• The premiums are level but they are paid only for certain
period.
• For example, Mr. Chala, age 25, may purchase a 20 year limited
payment policy in the amount of birr 25,000. After 20 years, the
policy is completely paid up and no additional premiums are
required.
Other Types of Life Insurance
• Some policies are designed to meet special needs or have unique features.
Others combine term insurance and cash value life insurance to meet these
needs.
1. Endowment Insurance: - pays the face amount of insurance if the insured
dies within a specified period; if the insured survives to the end of endowment
period, the face value is paid to policy owner at that time.
For example, if Kebede, age 30, purchased a 20 years endowment policy and
died any time within 20 years period, the face value would be paid to his
beneficiary. If he survives to the end of the period, the face amount would be paid
to him.
Endowment insurance has a cash value and the policy owner is paid the
contract’s face amount at the end of the protection period if the insured is still
alive.
Cont,,,
2. Modified Life Insurance: - is a whole life insurance in which premiums
are lower than for the first three to five years and higher thereafter. The
initial premiums is slightly higher than for the term insurance, but
considerably lower than for an ordinary life policy issued at the same age.
3. Juvenile Life Insurance: -refers to life insurance purchased by a parent
or adult on the lives children younger than a certain age such as age 14 or 15.
Insurers generally require the child to be at least one month old before he/she
can be insured. Some insurers, however, will insure a child as young as one
day old.
Cont,,,
4. Industrial Life Insurance
sometimes called debit insurance
it is issued in small amounts and the premiums are payable weekly or
monthly.
In the past, the premiums were collected at the insured’s home by an
agent of the company.
More than nine out of ten such policies were cash value.
In recent years, it has also been called home service life insurance,
reflecting the fact that individual policies are serviced by agents who
call at the policy owner’s home to collect the premiums.
Cont,,,
5. Group Life Insurance
• is a type of insurance that provides life insurance on a group of people in a
single master contract.
• Physical examinations are not required and certificate of insurance are issued
as evidence of insurance.
• Most group life insurance contracts provide terms insurance coverage.
Rate Making in Life Insurance (Premium
Determination)
• Insurance pricing for life insurance is performed through three methods:
NSP at specific age = P. death x amount of insurance x PV of 1 birr at given Interest rate
Probability of Death =
Cont,,,
Age Probability of death Amount of Present value Cost of insurance
insurance of Birr 1 of
5%
45 x 1,000 x 0.9524 = 4.33(Year 1)
46 x 1,000 x 0.9070 = 4.44 (Year 2)
47 x 1,000 x 0.8638 = 4.55 (Year 3)
NALP =
• PVLAD of 1 Birr for the premium paying period = P. Survival x 1 birr pay’t
due immediately x PV of 1 birr
• P. Survival =
Term Insurance
• E.g. Calculate the NALP for a five year term insurance policy with
the amount of 1,000 Birr issued at age 45 and a 1 Birr payment is
due immediately.
• By referring to the 1980 CSO mortality table, out of 10 million males alive at
age zero, 9,210,289 are still alive at the beginning of age 45 and the market
interest rate is discounted at 5%.
Cont,,,
• Age 45 1 Birr due immediately = 1 Birr
1. MOTOR INSURANCE
• It is a major class of insurance providing the highest insurance premiums to
insurance companies.
• It is also relatively a complicated class of insurance due to the various types
of motor vehicles involved. Generally, two types of policies are issued:
a. private Vehicle Policy and
b. Commercial Vehicles Policy.
Cont,,,
• Furthermore, the policy provides two types of insurance cover:
Comprehensive Cover which indemnifies the insured for losses/ damage
caused by a wide range of perils; and
Third Party Liability which gives cover against third party liability death
or bodily injury to third parties or/and damages caused to the property of
such persons in the event of an accident caused with the use of the insured
motor vehicle.
2. MARINE INSURANCE
• This policy protects employers from all direct losses arising from any act or
acts of fraud or dishonesty committed by any of the employees listed in the
Schedule during uninterrupted service in the capacity and employee,
position of the employee, date of commencement of the risk and the amount
guaranteed in connection with each employee.
• The property manly insured include gold & silver, funs, pictures,
wearing apparels and other jewelers items.
8. PERSONAL ACCIDENT POLICY
• It provides compensation for death or bodily injuries caused by violent,
accidental, external and visible means.
• The injuries shall be the direct cause of death, loss or disablement.
• Death or disablement should occur within 12 calendar months from the
date of the accident.
• In the Schedule the insured specifies his occupation or profession; and
the policy remains valid for exposure to risk associated with the stated
occupation or profession.
Cont…
• If the insured engages himself in any occupation which greater risk
may prevail without informing the insurer, the policy becomes void and
no compensation would be paid.
• Moreover, the accident is bound to take place within the geographical
limit specified in the Schedule.
• It is issued to individuals or a group of individuals on named basis.
• Under this scheme, premiums are calculated based on the estimated
annual wage payment, which at expiry, is adjusted to reflect the actual
wages paid.
• And, the benefits will be based on 5 years salaries/ wages without
exceeding Birr 100,000 for any one person and medical expenses
limited to Birr 1,000 per person.
9. WORKMEN’S COMPENSATION POLICY
• It indemnifies the insured against all sums for which he is to be liable to pay
compensation for any worker who sustains death or bodily injury by an accident or
occupational diseases arising from his work and during the time of his work.
• The worker should be employed by the insured, and the category of work assigned to
him and the place of work should be specified in the Schedule.
• The policy does not provide compensation for death or disablement resulting from
suicide attempted suicide or intentional self injury.
• Other exceptions for which no compensation is paid by the insurer include: accidents
occurred while the insured is in a state of insanity, or is under the influence of
intoxicants or drugs.
• In the case of women, the policy does not cover accidents originating from pregnancy
on childbirth.
• The premium is based in the estimated amount of wages, salaries and other earnings.
10. PLATE GLASS POLCIY
• It protects the insured against the destruction or breakage of the glass fixed
in the insured’s premises by any accident of misfortune of a fortuitous
character.
• The glass to be insured is to be specified in the Schedule.
• The policy does not provide for compensation in respect of:
Damages directly or indirectly traceable to fire explosion, earthquake,
volcanic eruption, hostilities, riots, sticks and he like.
Cracked or imperfect glass
Damage to window frames and other fittings.
Consequential losses and any legal liability, etc…
11. BURGLARY and HOUSEBREAKING INSURANCE