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GENERAL FEATURES


The insurance contract is a contract whereby the insurer will pay the Insured (the person whom benefits would be paid to, or on the behalf of), if certain defined events occur. Subject to the 'fortuity principle', the event must be uncertain. The uncertainty can be either as to when the event will happen (i.e. in a life insurance policy, the time of the insured's death is uncertain) or as to if it will happen at all (i.e. a fire insurance policy).

  • Insurance contracts are generally considered contracts of adhesion because the insurer draws up the contract and the insured has little or no ability to make material changes to it. This is interpreted to mean that the insurer bears the burden if there is any ambiguity in any terms of the contract.


  • Insurance contracts are aleatory in that the amounts exchanged by the insured and insurer are unequal and depend upon uncertain future events.


  • Insurance contracts are unilateral, meaning that only the insurer makes legally enforceable promises in the contract. The insured is not required to pay the premiums, but the insurer is required to pay the benefits under the contract if the insured has paid the premiums and met certain other basic provisions.


  • Insurance contracts are governed by the princple of utmost good faith ( Uberrima Fides ) which requires both parties of the insurance contact to deal in good faith and in particular it imparts on the insured a duty to disclose all material facts which relate to the risk to be covered. This contrasts with the legal doctrine that covers most other types of contracts, Caveat Emptor (let the buyer beware).



PARTS OF AN INSURANCE CONTRACT


  • Definitions

  • Insuring agreement - the part of the contract where the insurer agrees to pay the insured for covered losses

  • Declarations - section that notes the identifying information about the insured and/or the insured property, such as name, address, etc.

  • Exclusions - section where certain perils that are not covered under the policy are enumerated.



Life insurance specific features


  • Incontestibility - in the United States , life insurance contracts may not be contested by the insurer at any point after the contract has been in force for two years. The insurer has the burden to investigate fully anything they wish to make sure the insured is an acceptable risk within those two years. Any material mistatements on the insurance application (which generally forms a part of the contract) cannot be used as a reason for the insurer not to pay th death benefit, as long as it does not constitute Fraud on the part of the insured. The insurer's only recourse if there is no fraud is they can adjust the death benefit to correct for the correct age or sex of the insured if they are different from what the application noted.



DEFINITIONS

  • insured - the person whom benefits would be paid to, or on the behalf of, if certain defined events occur.