Insurers are in the business of accepting risks and insuring against financial loss associated with those risks. This does not mean that they want to (or have to) accept every application for insurance. Accepting too many bad risks threatens an insurer with insolvency.
An insurer’s underwriting department will carefully review each application for insurance to determine whether or not it represents an acceptable (standard) risk. The objective of risk selection is to provide equity among all classes of risks.
There are many components involved in determining premium rates. Among these are loss experience, the occupancy or operation involved, construction of the structure (i.e. brick or frame) and the overall exposures. Underwriters also look at loss ratios which assist in future analysis.
Underwriting involves a legal form of discrimination based on risk profiles. They separate people into high-risk (substandard) and low-risk (Preferred) categories to determine premiums and encourage customers to reduce their risky behaviors.
While certain discrimination based on statistical fact is considered acceptable, insurers must not make underwriting decisions based on unfair discrimination. Unfair discrimination targets protected classes, such as race, national origin, sex, or religion.
How do underwriters determine if an applicant is standard, substandard, preferred, or uninsurable? There are several sources that an underwriter utilizes to reach his/her decision, including:
Application
The most important source of information is the application. The application contains a considerable amount of information, all of which helps the underwriter determine an adequate premium level. The questions on the application are intended to provide a complete picture of the applicant, revealing any physical, moral, or morale hazards.
Producer’s Report
Field underwriting is an initial risk assessment by insurance agents or producers during client interactions. It helps determine if a client meets basic underwriting criteria before formal application, saving time and resources, improving client experience, and reducing insurer risk. Field underwriting by producers may involve gathering information, asking probing questions, observing client demeanor, identifying red flags, and documenting observations.
The producing agent or broker provides information to an underwriter regarding his/her opinion and/or recommendation regarding the applicant and the proposed insured.
Inspections
With property insurance, the underwriter wants to make sure that the property to be covered actually exists and is in the condition claimed. Physical inspection of the property is usually required by the underwriter. Inspection may be conducted by the producing agent or broker or a company representative.
Consumer Reports
An underwriter may wish to investigate the applicant in more detail. When an applicant signs the application, they give the insurer the authorization to obtain a consumer report. This consumer report may include a credit report of the applicant or be of an investigative nature where an insurer representative interviews current or previous employers or neighbors regarding the applicant and the exposure.
If an applicant is denied coverage due to information collected, this regulation grants access to the information and reasons for the denial. After receiving notice that an adverse underwriting decision has been made, an individual has 90 business days within which to request a copy of the report.
Financial Status
Independent rating services help the consumer identify insurers who are financially sound. Consumers commonly look to ratings services prior to making a decision on which insurer to purchase coverage from. Ratings services gauge a corporation’s financial ability to make the interest and principal payments of the bonds they have issued. Ratings services include Moody’s, Fitches, A.M. Best, and Standard & Poor’s, to name a few.
It’s widely accepted that AAA is the highest financial rating, D being the lowest. A “D” rating indicates the insurer is in default and is unable to pay its claims.
Waiver & Estoppel
The legal concept of Waiver & Estoppel is often used in matters relating to insurance, particularly with underwriting decisions and during the claims process. This concept holds an entity (the insurer) to “standards of established behavior”.
Waiver occurs when an insurer gives up a right, like the right to cancel a policy for nonpayment, by accepting a late payment and continuing coverage. Waivers can be express or implied.
Estoppel stops an insurer from changing its stance if it harms the insured, assuring policyholder protection. For example, an insurer can’t cancel a policy for a late payment if it has a history of accepting late payments from others, as this implies late payments are acceptable.
Lesson Summary
Underwriting insurers assess and insure risks. Here are some key points:
Accepting bad risks can lead to financial trouble for insurers.
Underwriters review applications to decide if the risk is acceptable.
Premium rates are based on various factors.
Loss experience, occupancy, construction, and exposure impact rates.
Loss ratios are crucial for future analysis.
Underwriters classify applicants as standard, substandard, preferred, or uninsurable using the following sources:
Application: Contains vital information for the underwriter.
Producer’s Report: Provides the agent’s input.
Inspections: Verifies the property condition.
Consumer Reports: May include credit or investigative reports.
Consumers can check an insurer’s financial status through rating services:
AAA is the highest rating, and D indicates default.
Ratings from Moody’s, Fitches, A. M. Best, and Standard & Poor’s help assess financial strength.
Rating services are not regulated by the NAIC.
Chapter Vocabulary
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