The Law Of Insurance Contracts
A brief overview of the complexities
In general, an insurance contract must meet four conditions in order to be legally valid: it must be for a legal purpose, the parties must have a legal capacity to the contract, there must be evidence of a meeting of minds between the insurer and the insured, and there must be a payment of consideration a paragraph. Click here to add your own text and edit me. It's easy.
To meet the requirements for legal purposes, the insurance contract must support an insuraable interest (see more below). It may not be issued in such a way as to encourage illegal ventures.
The requirement for the capacity to contract usually means that the individual obtaining insurance must be of a minimum age and must be legally competent; the contract will not hold if the insured is found to be insane or intoxicated, or if the insured is a corporation operating outside the scope of its authority as defined in its charter, bylaws, or articles of incorporation.
The requirement for meeting of minds is met when one party makes a valid offer and is accepted by another. The offer is generally made on a written application for insurance. In the field of Property and Liability insurance insurance, the agent generally has the right to accept the insured’s offer for coverage and bind the contract immediately. In the field of Life insurance, the agent generally does not have this power, and the contract is not valid until the home office of the insurer has examined the application and has returned it to the insured through the agent.
The payment or consideration is generally made up of two parts—the premiums and the promise to adhere to all conditions stated in the contract. These may include, for example, a warranty that the insured will take certain loss-prevention measures in the care and preservation of the covered property.
In applying for insurance, the applicant makes certain representations of warranties. If the applicant makes a false representation, the insurer has the option of voiding the contract. Concealment of vital information may be considered misrepresentation. In general, the misrepresentation of concealment must concern a material fact—defined as a fact that would, if it were known, cause the insurer to change the terms of the contract or be unwilling to issue it in the first place. If the agent of the insurer asks the applicant a question, the answer to which is a matter of opinion, and if the answer turns out to be wrong, the insurer must demonstrate bad faith or fraudulent intent in order to void the contract. If, for example, in answer to an agent’s question, the applicant reports no history of serious illness, in the mistaken belief that a past illness was minor, the court may find the statement to be an honest opinion and not a misrepresented fact.
A basic principle of property liability insurance contracts is the principle of subrogation, under which the insurer may be entitled to recovery from liable third parties. In fire insurance, for example, if a neighbor carelessly sets fire to the insured’s house and the insurance company indemnifies the insured for the loss, the company may then bring a legal action in the name of the insured to recover the loss from the negligent neighbor.
The principle of subrogation is complemented by another basic principle of insurance contract law, the principle of indemnity. Under the principle of indemnity, a person may recover no more than the actual cash loss; one may not, for example, recover in full from two separate policies if the total amount exceeds the true value of the property insured.
Closely associated with the above legal principles is that of insurable interest. This requires that the insured be exposed to a personal loss if the peril insured against should occur. Otherwise, it would be possible for a person to take out a fire insurance policy on the property of others and collect if the property burned. Any financial interest in property, or reasonable expectation of having a financial interest, is sufficient to establish insurable interest. A secured creditor such as a mortgagee has an insurable interest in the property on which money has been lent.
In the field of personal insurance, one is held to have an unlimited interest in one’s own life. A corporation may take life insurance on the life of a key executive. A wife may insure the life of her husband, and a father may insure the life of a minor child, because there is a sufficient pecuniary relationship between them to establish an insurable interest.
In life insurance, the insurable interest must exist at the time of the contract. Continued insurable interest, however, need not be demonstrated. A divorced woman may continue life insurance on the life of her former husband and legitimately collect the proceeds upon his death even though she is no longer his wife.
In the field of property insurance, on the other hand, the insurable interest must be demonstrated at the time of the loss. If an individual insures a home but later sells it, no recovery can be made if the house burns after the sale, because the insured has suffered no loss at the time of the fire.
In most countries, an individual may be held legally liable to another for acts or omissions and be required to pay damages. Liability insurance may be purchased to cover these contingencies.
Legal liability exists when an individual commits a legal injury that wrongly encroaches on another person’s rights. Such injuries include slander, assault, and negligent acts. A negligent act involves failure to behave in a manner expected when the results of this failure cause a financial loss to others. An act may be classed as negligent even if it is unintentional. Negligence may be imputed from one person to another. For example, a master is liable not only for his own acts but also for the negligent acts of servants or others legally representing him. It is not uncommon for a municipality to require that businesses using city property assume what would otherwise have been the city’s negligence for the use of its property. Statutes may impute liability on individuals when no liability would exist otherwise; thus, a parent may be legally liable for the acts of a minor child who is driving the family automobile.
In common-law countries such as the United States and the United Kingdom, three defenses may be used in a negligence action. These are assumed risk, contributory negligence, and the fellow servant doctrine. Under the assumed risk rule, the defendant may argue that the plaintiff has assumed the risk of loss in entering into a given venture and understands the risks. Employers formerly used the assumed risk doctrine in suits by injured employees, arguing that the employee understood and assumed the risks of employment in accepting the job.
The contributory negligence defense is frequently used to defeat negligent actions. If it can be shown that one party was partly to blame, then that party may not collect from any negligence of the other party. Some courts have applied a substitute doctrine known as comparative negligence. Under this, each party is held responsible for a portion of the loss corresponding to the degree of blame attached to that party; a person who is judged to be 20 percent to blame for an accident may be required to pay 20 percent of the injured person’s losses.
The fellow servant defense has been used at times by employers; an employer would argue in some cases that the injury to an employee was caused not by the employer’s negligence but by the negligence of another employee. However, workers’ compensation statutes in some countries have nullified such common law defenses in industrial injury cases.
In many countries, the courts have tended to apply increasingly strict standards in adjudicating negligence. This has been termed the trend toward strict liability, under which the plaintiff may recover for almost any accidental injury, even if it can be shown that the defendant has used “due care” and thus is not negligent in the traditional sense. In the United States, manufacturers of polio vaccine that was found to have caused polio were required to pay large damage claims although it was demonstrated that they had taken all normal precautions and safeguards in the manufacture of the vaccine.