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Definite Loss. The event that gives rise to the loss that is subject to
insurance should, at least in principle, take place at a known time, in a known
place, and from a known cause. The classic example is death of an insured person
on a life insurance policy. Fire, automobile accidents, and worker injuries may
all easily meet this criterion. Other types of losses may only be definite in
theory. Occupational disease, for instance, may involve prolonged exposure to
injurious conditions where no specific time, place or cause is identifiable.
Ideally, the time, place and cause of a loss should be clear enough that a
reasonable person, with sufficient information, could objectively verify all
three elements.
3. Accidental Loss. The event that constitutes the
trigger of a claim should be fortuitous, or at least outside the control of the
beneficiary of the insurance. The loss should be ‘pure,’ in the sense that it
results from an event for which there is only the opportunity for cost. Events
that contain speculative elements, such as ordinary business risks, are
generally not considered insurable.
4. Large Loss. The size of the loss
must be meaningful from the perspective of the insured. Insurance premiums need
to cover both the expected cost of losses, plus the cost of issuing and
administering the policy, adjusting losses, and supplying the capital needed to
reasonably assure that the insurer will be able to pay claims. For small losses
these latter costs may be several times the size of the expected cost of losses.
There is little point in paying such costs unless the protection offered has
real value to a buyer.
5. Affordable Premium. If the likelihood of an
insured event is so high, or the cost of the event so large, that the resulting
premium is large relative to the amount of protection offered, it is not likely
that anyone will buy insurance, even if on offer. Further, as the accounting
profession formally recognizes in financial accounting standards, the premium
cannot be so large that there is not a reasonable chance of a significant loss
to the insurer. If there is no such chance of loss, the transaction may have the
form of insurance, but not the substance. (See the U.S. Financial Accounting
Standards Board standard number 113)
6. Calculable Loss. There are two
elements that must be at least estimable, if not formally calculable: the
probability of loss, and the attendant cost. Probability of loss is generally an
empirical exercise, while cost has more to do with the ability of a reasonable
person in possession of a copy of the insurance policy and a proof of loss
associated with a claim presented under that policy to make a reasonably
definite and objective evaluation of the amount of the loss recoverable as a
result of the claim.
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