CU-BBA-SEM-V-Underwriting & Claim Management

b. Interest and Expenses. c. Mortality and Expenses. d. Mortality, Interest and Expenses. 2. What does extra mortality rate increase? a. As the life assured grows older. b. As the life assured grows thinner. c. As the life assured grow smarter. d. As the life assured grows younger. 3. What does Pandemic mean? a. Is a disease that affects a large number of people within a community, population, or region? b. Machine learning. c. It is an outbreak of a disease that occurs over a wide geographic area (as multiple countries or continents) and typically affects a significant proportion of the population. d. A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism. 4. What is a chronic disorder? a. Diabetes. b. Morbidity. c. Mortality. d. Flu. 5. What does BMI in Insurance mean? a. Body Mass Index b. Bharath Metal Industry c. Body Mean Index d. Both a and c Answers 1-d, 2-a, 3-c, 4-a, 5-a 51 CU IDOL SELF LEARNING MATERIAL (SLM)

3.7 REFERENCES References  Abraham, Kenneth S.(1985). Efficiency 8 Fairness in Insurance Risk Classification 71 VaL Rev 403  American Academy of Actuaries. Brief of AAA as Amicus Curiae  American Academy of Actuaries, Committee on Risk Classifications. Risk Classification Statement of Principles (1980). Norris (1982) Textbooks  Michael C, Dan G and Robert M (February 2014) 2nd Edition, “The Essentials of Risk Management” US, New York City Publisher(s): McGraw-Hill  Gupta PK, (January 2016) “ESSENTIALS OF INSURANCE AND RISK MANAGEMENT” Publisher Location India, New Delhi, Himalaya Publishing House  Emmet J Vaughan and Vaughan T (November 2007), “Fundamentals of Risk and Insurance”, 10th Edition, US, New Jersey, Wiley Global Education Website  https://www.investopedia.com/terms/i/insurance-risk-class.asp  https://www.legalandgeneral.com/_resources/pdfs/life- cover/Underwriting%20Explained%20%20W10188%2011.11%20Web.pdf  https://course.uceusa.com/courses/content/405/page_167.htm 52 CU IDOL SELF LEARNING MATERIAL (SLM)

UNIT 4 – LEVEL PREMIUM STRUCTURE 4.0 Learning Objectives 4.1 Introduction 4.2 Temporary Extra Premium 4.3 Diminishing Lien Exclusions 4.4 Postponement of Acceptance of Risk 4.5 Declinature of the Acceptance of Risk 4.6 Summary 4.7 Keywords 4.8 Learning Activity 4.9 Unit End Questions 4.10 References 4.0 LEARNING OBJECTIVES After studying this unit, you will be able to:  Explain the meaning of Level premium.  Describe Temporary Flat Extra premium.  Describe postponement of Acceptance of risks.  Elucidate diminishing Lien exclusions. 4.1 INTRODUCTION Level-premium protection is a kind of term life coverage. With this kind of inclusion, charges are ensured to continue as before all through the agreement, while the measure of inclusion gave increments. Subsequently, the inclusion can be favourable throughout a significant stretch of time: a policyholder continues to pay a similar sum yet approaches expanded advantage inclusion as the arrangement develops. The most widely recognized terms are 10, 15, 20, and 30 years, in light of the necessities of the policyholder. Level-premium strategies are unique in relation to standard term extra security approaches, which have premium rates that ascent as the arrangements age. Level- premium protection expenses are at first higher than different approaches with comparable inclusion. Notwithstanding, before the finish of the agreement, the charges frequently end up 53 CU IDOL SELF LEARNING MATERIAL (SLM)

as a superior deal. This is on the grounds that the higher expenses have commonly been balanced by an increment in inclusion during a time-frame when a policyholder regularly has more clinical issues. Strategies with comparable inclusion and lower expenses typically don't consider to be in inclusion as they develop. For certain financial backers, this restricts any benefits that come from having starting lower premium instalments. The allure of better inclusion sometime in the future with no expansion in charges is a key motivation behind why financial backers will once in a while pick level-premium protection (if they can monetarily endure the higher instalments). This strategy is incorporated under term disaster protection, which means it gives inclusion just to a predetermined length and it has just a demise advantage, rather than a reserve funds segment (as in entire life inclusion). To decide if even out premium protection is liked, consider the length of inclusion required. A few types of life coverage are powerless against rate climbs. With level-premium protection, charges are ensured and won't ever be liable to change (except if the policyholder demands a change). The compensation out for the strategy additionally stays as before all through the term, except if the policyholder demands in any case. On the off chance that the policyholder dies during the term of the approach, the individual's family could get a money pay-out to be utilized to take care of a current home loan, assist with continuous family bills, and help with other fundamental requirements or even compensation for the policyholder's memorial service or remembrance administration. 4.2 TEMPORARYEXTRA PREMIUM At the point when someone is going for disaster protection strategies and have a high-hazard circumstance. Maybe it very well may be a genuine sickness or might be an individual have a perilous side interest or work? It's conceivable that level additional charges for life coverage will be added to their approach. Before forthcoming candidate imagine that there isn't any way imaginable that H/she can get endorsement for protection – attempt to comprehend that every extra security organization takes a gander at candidate's circumstance in an unexpected way. A few organizations are stricter and some more merciful. This is perhaps one of the issues that is generally befuddling to extra security customers. A level additional expense is an extra charge or cost that is attached to the customary expense of your disaster protection strategy. This level additional expense can be added for a brief time frame or the whole existence of your protection strategy. One technique insurance agencies use when dealing with more noteworthy wellbeing hazards is utilizing the Flat Extra Premium or Flat Extra Charge. This is utilized when a danger is 54 CU IDOL SELF LEARNING MATERIAL (SLM)

higher than a \"Standard\" wellbeing class hazard. The level extra can be present moment, maybe 2-4 years, or it tends to be long haul. An example of something that would require a drawn out level extra is if a disaster protection customer has a dangerous leisure activity or vocation. Example to Understand Flat Extra Premium This is a fundamental illustration of a Flat Extra premium. Suppose Mr. Obscure was looking for a 10-year term INR 500,000 extra security strategy. In view of his age and a \"Standard\" wellbeing class rating, his yearly premium ought to be INR 500 every year. In any case, in view of his danger, the disaster protection organization is adding a level extra of INR 5 for each INR 1000 of inclusion (5 x 500 = INR 2500). The real all out yearly premium would now be INR 500 + INR 2500 = INR3000 each year. In this model, if Mr. Obscure's wellbeing wasn't adequate to be qualified for a standard rate class, the organization has a couple of choices to make. To start, if organizations think he has a high mortality hazard, extra security inclusion can be declined by and large. A life coverage decrease doesn't imply that inclusion is unimaginable. In that capacity, other insurance agencies would need to perceive any reason why he was being dismissed. Whenever that was known, different organizations could shop his case and check whether he can get an appraised strategy all things considered. At the point when an arrangement is \"Appraised\", it is regarding an exceptional assurance approach named \"table rating.\" This is the place where each table addresses a 25% increment over the standard life coverage rate. 55 CU IDOL SELF LEARNING MATERIAL (SLM)

Table 4.1: Rates class and risk class Risk Classifications and Premium Costs The life insurance risk class you're assigned to can directly impact what you pay for life insurance premiums. Here's an overview of how individual risk classes compare.  Preferred Plus/Elite: The most minimal danger class. Individuals in this danger class are in fantastic wellbeing, are commonly more youthful, and have no other prompt reason for concern. These individuals can hope to pay the most minimal expenses for life coverage.  Preferred: a little advance down from liked in addition, favoured class policyholders appreciate lower charges because of amazing wellbeing however may have some unobtrusive warnings like more elevated cholesterol.  Standard Plus: Above normal wellbeing, yet things like pulse or weight list (BMI) might be outside the best reach. Charges are greater than Standard danger class yet you might pay more than somebody in the Preferred or Preferred Plus gathering.  Standard: This implies common danger, and for life guarantors, it implies a normal future. You might have some medical problems in your family or from quite a while ago, which keeps you out of more favoured danger gatherings, coming about in higher charges. 56 CU IDOL SELF LEARNING MATERIAL (SLM)

 Substandard/Rated: If you are named a higher danger than standard, you are dependent upon different degrees or appraisals of unsatisfactory, which every safety net provider moves toward a piece in an unexpected way. This can be a direct result of medical problems or an unsafe past. Your expenses might be among the most elevated rates, ordinarily at the Standard cost in addition to an extra 25 percent at each progression down in the evaluations.  Smoker: Smokers will pay essentially more because of expanded wellbeing hazard. Back up plans will inquire as to whether you smoke or have in the previous quite a long while and may test for the presence of nicotine in routine blood work. 4.3 DIMINISHINGLIEN EXCLUSIONS Lien alludes to a diminished aggregate guaranteed for a specific period. At the point when the guarantor puts a lien, inclusion sum is decreased for a predefined period. After the predetermined period is finished, the full inclusion sum is re-established consequently. This is to oversee hazard when the guarantor is dubious about the soundness of the individual being guaranteed. Creditors come in two essential sorts: got and unstable. Albeit the measure of the obligation might be something similar, the cures accessible to the leaser are altogether different. Gotten leasers have a case against a particular resource, though unstable lenders don't. Creditors can be unstable or gotten. An unstable, or general, loan boss has an overall case against a borrower - this case isn't gotten by a specific resource of the debt holder. An unstable loan boss has the most fragile case, which might go neglected in an insolvency continuing. Nonetheless, an unstable lender might turn into a got loan boss get-togethers claim and judgment. A got lender, who has an interest (alluded to as a lien) on a specific resource, can utilize the court framework to hold onto the resource and to fulfil the obligation. This unmistakably presents a critical danger for the entrepreneur. Liens Enable Creditors to Assert Rights over Property Except if the debt holder is reasonable and has taken measures to protect his resources, there is a danger that the lenders can hold onto resources and take your riches. To know whether your resources are in danger, it is basic that you have a comprehension of the various kinds of liens you might experience as an entrepreneur:  Consensual  Purchase-Money Security Liens  Non-Purchase-Money Security Liens  Statutory  Mechanic's Liens Tax Liens 57 CU IDOL SELF LEARNING MATERIAL (SLM)

 Judgment When we talk about the various kinds of liens, we'll then, at that point look at how lenders may try to get your resources through these sorts of liens, and what you can do, as an individual and as an entrepreneur, to augment your insurance against those leasers. The procedures laid out will address a wide range of points, from types of property possession to organizing obligation to limit openness. Consensual Liens are Voluntary As the name suggests, consensual liens are those to which you intentionally assent, because of an advance or other development of credit. The property bought ties down the purchaser's commitment to pay for the property. One normal model is the private home loan: a home purchaser agrees to a bank taking a security premium in the home when a home loan is acquired. Essentially, a security interest likewise is made when a vehicle seller masterminds financing for a vehicle purchaser. There are two wide classes of consensual liens:  Purchase-Money Security Interest Liens. Here, the loan boss stretches out credit to the borrower explicitly for the acquisition of the property that gets the obligation. Models remember a first home loan for a home, a vehicle advance, and circumstances in which the dealer funds the acquisition of property, like furnishings, through a credit arrangement.  Non-Purchase-Money Security Interest Liens. Here, the borrower sets up property the person as of now possesses as insurance for a credit. The advance returns are then used to pay costs (or maybe to purchase other property). Models incorporate a subsequent home loan (or renegotiating of a home loan) on a home or an advance used to pay working costs with recently possessed office gear set up as guarantee. The two kinds of consensual liens are generally non-possessory. This implies that the leaser doesn't take or hold ownership of the property; rather, the account holder takes, or holds, ownership of the property. Nonetheless, it's feasible for one or the other kind of consensual lien to be possessory. All things considered, the loan boss claims the guarantee. An advance from a pawnbroker, for instance, for the most part would make a possessory, non-buy cash security premium lien in the insurance. While this appears to be extremely clear, the sort of obligation can to a great extent affect the lender's privileges if an account holder defaults. The principles fluctuate from one state to another; however attributes of an obligation are basic to comprehend in case resources are to be ensured. Issues include:  Who is holding the property that gets the obligation: the indebted person or the lender? In a vehicle advance, the indebted person has ownership of the property. At the point when an advance is gotten from a second hand store, the leaser has ownership of the property getting the credit. 58 CU IDOL SELF LEARNING MATERIAL (SLM)

 Was the obligation brought about to buy property or not? For instance, a first home loan advance is a buy cash advance since the returns were utilized to buy a home. Conversely, a renegotiating credit isn't a buy cash advance. The mortgage holder previously possessed the property.  What is the idea of the property to which the lien is appended? This is frequently the fundamental request with regards to resource insurance. The states, just as the national government, have a wide assortment of laws identifying with what resources are shielded from leasers and how they are ensured. The essential instrument for securing chosen resources is an idea called exceptions. Basically, the law might announce that specific property essentially can't be seized by a bank. It is sometimes used as a peril gadget. Protection offices like to offer not so great, charge higher cost, or deny consideration completely. Statutory and Judgment Liens Arise by Operation of Law Notwithstanding consensual liens, there are a wide range of sorts of liens that loan bosses can use to get at your resources for fulfil an obligation. In specific conditions, banks get security interests by the activity of state (or government) laws. These liens include:  Mechanic's Liens. This kind of lien emerges when a project worker or repairman performs work on property and isn't paid. Models incorporate a project worker who introduces a heater in a home, or a technician who performs fixes to a vehicle. This lien is a security interest in the property. On the off chance that the proprietor attempts to sell the property, the borrower will have a gotten interest in the piece of the returns expected to pay the obligation. Moreover, having a technician's lien can defer or forestall the offer of genuine property until obligation is fulfilled and the lien delivered.  Tax Liens. This kind of lien is set against property by the nearby, state or national government, as approved by rule, for delinquent assessments, including property, pay and domain charges. Judgment Liens Arise as a Result of a Lawsuit Of the three sorts of liens (consensual, legal and judgment,) the judgment lien is the most hazardous structure, yet one which the educated entrepreneur might have the option to dispense with. A legal lien is made when a court gives a bank a premium in the borrower's property, after a court judgment. Judgment liens can emerge in a wide assortment of conditions - essentially, any occurrence that can land you in court can wind up producing a judgment lien. For instance, in case you are driving carelessly and harm somebody in a mishap, the harmed individual may to sue for harms. To the degree that your protection doesn't cover the judgment, a legal lien might be set against your property to tie down instalment of the case to the harmed party. An offended party who acquires a money related judgment is named a 59 CU IDOL SELF LEARNING MATERIAL (SLM)

\"judgment bank.\" The litigant turns into a \"judgment account holder.\" The judgment in the claim gives the premise to the lien. In the event that the obligation isn't paid, the judgment leaser can look to uphold (or execute) the judgment. This can be cultivated by decorating compensation, holding onto a financial balance, or putting a lien against the indebted person's property. The lien is the initial step by the judgment leaser in a cycle that will finish in an offer of the appended property, to fulfil the judgment obligation. Any lien set on the litigant's resources because of a court judgment is known as a judgment lien. In the event that a lien was put on a home, the judgment lender could try to abandon the property, similarly a home loan holder, for example, a bank could dispossess in case it was not paid. In this segment, the expression \"judgment lien\" is utilized in its strictest sense: a lien credited to a court judgment, where the court judgment itself is the reason for the lien. A model would be an offended party who is granted a money related judgment against a litigant in a claim dependent on carelessness, and what then identity is allowed a request for connection against the account holder's property. Conversely, this definition prohibits a judgment dependent on a previous lien (i.e., an earlier consensual lien or legal lien). Along these lines, for instance, this definition would prohibit a judgment in home loan abandonment. This differentiation is basically significant in knowing what sorts of liens against excluded property can be disposed of. In developments Lien laws are integral asset when utilized effectively. The primary concern is right utilization, when to utilize. Lien laws are an integral asset accessible to project workers, subcontractors, and providers to guarantee they are paid for the work and materials they give. The danger of abandoning a property hinders numerous proprietors from preposterously retaining instalment when it is expected. Be that as it may, similar to any device, you need to utilize it effectively to get the best outcomes. They are specialized in nature and we need to stay away from normal errors by ensuring you (a) convenient serve a total fundamental notification on every essential gathering inside 20-days of beginning the work or first giving materials, b) update your starter notice if the agreement sum surpasses the sum expressed in the notification by over 20%, (c) ideal record your lien in the right district and (d) document suit before the legal time limit lapses. Lessening lien provision its applied when the danger is of diminishing sort with the expansion in age in regard of youthful (up to age 32 Yrs.), underweight, additional mortality will be more in early years. Construction Lien Policy Coverage The advance strategy contains a progression of arrangements which fit together to build up the extent of this inclusion. The development lien arrangements of the strategy have been tremendously examined by researchers. The arrangements concerning development liens that are found in the ALTA (American Land and Title Association) Loan strategies are the accompanying: 60 CU IDOL SELF LEARNING MATERIAL (SLM)

 Covered Risk 2, which repays the protected against misfortune brought about by \"[a]ny deformity in or lien or encumbrance on the Title.\"  A Covered Risk repays the protected bank against a development lien that acquires need over the guaranteed contract, regardless of whether recorded previously or after the date of strategy, if the lien is for turn out contracted for or started before the approach date, or after arrangement date if the work is financed essentially to some extent by advance assets got by the safeguarded contract.  These Covered Risks might be nullified by a Schedule B special case for development liens and undeveloped development lien rights.  Liens connecting after the date of strategy might be avoided from inclusion under the post-approach rejection.  Certain activities by the protected loan specialist might be considered to have been made, endured, accepted or consented to buy it, accordingly refuting development lien inclusion.  Construction liens emerging from projects contracted for or started after the date of strategy and not financed in entire or to some degree by the safeguarded contract credit are barred.  Some adaptations of the ALTA Loan strategy don't safeguard the need of development progresses made after the date of strategy for which the bank was not committed on date of strategy.  The strategy might contain at least one supports altering the arrangement's terms as expressed previously 4.4 POSTPONEMENT OF ACCEPTANCE OF RISK Thought of proposition is delayed for a period, when the underlying danger is substantial to such an extent that there is little any desire for offering protection promptly and the proposition is deferred. Candidates can revalidate in future when their wellbeing improves, and the proposition can be acknowledged. Deferments in various sort of hazard are unique. It has been seen that the deferment shifts from 90 days to 3 years. The additional premium or line and so on might be taken out later on when the extra-hazard is improved and the extra-mortality was ostensible cautious and zero chance of repeat. By and by the extra is taken out in extraordinary situations when there are arrangements for this. Options if Applicant’s Insurance is Postponed. i. Applicant can accept the postponement 61 CU IDOL SELF LEARNING MATERIAL (SLM)

On account of Mortgage Protection, the candidate going to lose the house except if the bank permits the individual to sign a waiver. In the event that candidate has any clinical issues, they can apply for Mortgage Protection prior to giving up a non-refundable store. ii. Applicant can Apply to a Different Insurer Every safety net provider handles each case in an unexpected way. This is particularly obvious in case the candidate's application is deferred in view of a clinical explanation. Each insurance agency has an endorsing office that crunches the numbers and thinks about the danger of every application. A portion of the backup plans treats explicit diseases or clinical issues significantly more thoughtfully than others. What it implies is that since one says no, another may not. Simply be ready to pay somewhat more for the advantage of the protection. iii. Go to an Expert Insurance Consultant for Help Swiping directly on that load of safety net providers and their various strategies can get tedious quickly, so consider working with a specialist expert who works with all the insurance agencies. On the off chance that a candidate has a clinical issue, make certain to work with an abundant specialist experience in that field. What's more, ensure they manage every one of the backup plans. Additionally, the candidate should ensure that the individual knows the intricate details of their ailment, stunningly better in the event that they can share clinical reports. The more data you have for your specialist, the readier a candidate would be. Examples of Being Turned Down / Postponed for Life Insurance This article was inspired by an email from a woman called Janaki, who wrote in: “Hi. My Life Insurance has been postponed, and I need it for a mortgage and am wondering if there is Life Insurance out there that I can get?” Obviously, for Janaki, this is not good. Janaki’s done the hard part and saved the deposit and went and found a house to buy. However, to buy a home in Ireland, you have to get Mortgage Protection, which pays off your mortgage to the bank if you die. As we all know, we love the banks here so very much, and that’s why we look after them so well. Anyway, Janaki can’t actually buy the house until she gets Mortgage Protection, so you can see why she’s in a soup. In Janaki’s case, her postponement isn’t a hard a – it’s because something made the insurer pause and consider that the risk is too high, so they may ask her to change some things or do some things and then reapply. There may be several reasons the insurer postponed her application:  Janaki might have a pre-existing condition that means she’s too “high-risk” for the insurer. 62 CU IDOL SELF LEARNING MATERIAL (SLM)

Remember: insurers don’t want you to die! They want you to pay your premiums for however long your policy is so they can scoop up all your money without having to pay out a big ole lump sum. A pre-existing condition could be any number of things – from cancer to obesity or diabetes.  In a similar vein, Annie may have recently overcome an illness or have upcoming tests/scans/new medication/something medical that the insurer wants to see. After a certain amount of time has passed or once the tests have taken place, the insurer will give a ‘yes’ or ‘no’. Why Would an Insurer Postpone an Application for Mortgage Protection? All of the insurers ask the following question on their application form:  Are you awaiting the results of any tests/investigations or referral to any hospital, clinic or doctor? Answer yes to this question and the insurer is likely to postpone your application for mortgage protection until the test or investigation that you have been referred for is complete. If you’re due to close on a mortgage in the near future and this has come as a massive shock, then there is not much can be done. You see it’s not the insurers being smart or difficult. They are led by your medical professional. So if your doctor due to an abundance of caution refers you for a scan on something harmless like a nasal polyp, the insurer will also be abundantly cautious and wait for the scan results. After all, it’s the insurer who is stumping up the hundreds of thousands of mortgage protection cover. What Can You Do If You Have Been Referred For a Test That Holds Up Your Mortgage? Sometimes, people are on the public waiting list for so long that the insurers are happy to overlook the referral if the GP is happy to sign off that you no longer need it. Apart from that situation, in all other cases, you will have to have the test. I know that might mean going private and playing through the nose but there is no other way. If your GP believes a test is necessary, the insurer is going to agree. What Do You Doif You’ve Been Postponed for Life Insurance? Just a note here in case you’re confused: we’re using the term Life Insurance and Mortgage Protection interchangeably. Mortgage Protection is a type of Life Insurance. The big difference is that if you’re trying to get Life Insurance and you’re postponed, it’s not the end of the world if there is a 6-month delay. 63 CU IDOL SELF LEARNING MATERIAL (SLM)

However, if you’re getting a mortgage, without mortgage protection, you may lose the house! That’s why mortgage protection requires much more urgency than life insurance. This means it’ll also change how you react to the postponement. The first thing you should do is find out why you were postponed for Life Insurance. Ask the Chief Medical Officer (CMO) of the insurance company that postponed you to write to your GP with their reasons why letter. Once the GP receives the letter, have a chat with them to see how they feel. Usually, you can tell by their reaction whether it’s worth appealing. Your options if postponed: 1. You can accept the postponement In the case of Mortgage Protection, you’re going to lose the house unless your bank allows you to sign a waiver. If you have any medical issues, apply for Mortgage Protection BEFORE handing over a non-refundable deposit. 2. You can apply to a different insurer. Each insurer handles each case differently. This is especially true if you’ve been postponed because of a medical thing. Every insurance company has an underwriting department that do the math’s and considers the risk on each application. Some of the insurers treat specific illnesses or medical issues much more sympathetically than others. What I’m saying is that just because one says no, another may not. Just be prepared to pay a little more for the luxury of the insurance. Basically, it’s a bit like Tinder for insurance. The more insurers you apply to, the more likely you are to get a match. 3. Go to a good broker for help Swiping right on all those insurers and their different policies can get time-consuming fast, so consider working with a broker who works with all the insurance companies. If you have a medical issue, be sure to work with a broker who has ample experience in that field. And make sure they deal with all the insurers. Also, make sure you know the ins and outs of your medical condition, even better if you can share medical reports. The more information you have for your broker; the better set you’ll be. They’ll use their nous to present your case to the most sympathetic insurer to increase your chances of nabbing mortgage protection and buying your dream home. 4. If all else fails, plead for a waiver Let us understand what’s a mortgage protection waiver? If you can’t get cover and you can prove this by showing the bank your postponement/decline letter, the bank may allow a waiver A waiver is a piece of paper you sign confirming you understand the consequence of getting a mortgage without life insurance. 64 CU IDOL SELF LEARNING MATERIAL (SLM)

i.e. if you die, your partner will have to continue to pay it from their income. Usually, the banks will only allow waivers in the following scenario: i. Joint application ii. One applicant can get cover iii. That applicant’s income is strong enough to support the mortgage repayments on their own. Basically, waivers are at the discretion of the lender. 4.5DECLINATURE OF THE ACCEPTANCE OF RISK Protection isn't generally pretty much as direct as different items, and safety net providers can deny inclusion in various occurrences, here are some ways an insurance agency can deny you inclusion. 1. Non-Renewal of Insurance Coverage An insurance agency isn't committed to re-establish a protection strategy for any of its policyholders. Should a policyholder have unnecessary cases or an adjustment of conditions that make them uninsurable, the organization might decide not to restore. In different cases, they might expand the premium to mirror the expanded danger. 2. Denied Claims Regardless of whether you pay your expenses consistently and on schedule, an insurance agency may not pay out claims you report. To begin with, the circumstance encompassing the case may not be covered under the strategy since it is one of the recorded rejections. One illustration of this is if property holders have a flood and record a case with their home insurance agency. Since floods are not covered by home protection, yet by flood protection, these cases will probably be denied. Second, the case probably won't be more than the deductible, which implies the safeguarded is answerable for paying it. At last, the insurance agency might discover the harm to have been brought about by the safeguarded which might permit them to deny the case. 3. Denied Policies On the off chance that you have one sort of protection with a transporter that offers numerous lines of inclusion, they are under no commitment to endorse any applications you submit for extra inclusion. They will guarantee and assess your application similarly as they would some other candidate and will either endorse or decay the approach, in view of the dangers you present. As individuals of protection area realize that tolerant danger, or hazard acknowledgment, happens when a business or individual recognizes that the expected misfortune from a danger 65 CU IDOL SELF LEARNING MATERIAL (SLM)

isn't sufficiently incredible to warrant going through cash to stay away from it. Otherwise called \"hazard maintenance,\" it is a part of hazard the executives normally found in the business or venture fields. Hazard acknowledgment places that rare and little dangers ones that that don't can be calamitous or in any case excessively costly merit tolerating with the affirmation that any issues will be managed if and when they emerge. Such a compromise is an important device during the time spent prioritization and planning. Numerous organizations use hazard the board procedures to distinguish, survey and focus on chances to limit, checking, and controlling said chances. Most organizations and hazard the board work force will find that they have more prominent and more various dangers than they can oversee, relieve, or keep away from given the assets they are distributed. Thusly, organizations should discover a harmony between the likely expenses of an issue coming about because of a known danger and the cost implied in staying away from or in any case managing it. Kinds of dangers remember vulnerability for monetary business sectors, project disappointments, legitimate liabilities, credit hazard, mishaps, normal causes and calamities, and excessively forceful rivalry. Tolerating hazard can be viewed as a type of self-protection. All dangers that are not acknowledged, moved or kept away from are supposed to be \"held.\" Most instances of a business tolerating a danger imply chances that are moderately little. In any case, in some cases elements might acknowledge a danger that would be cataclysmic to such an extent that safeguarding against it isn't doable because of cost. Also, any likely misfortune from a danger not covered by protection or over the safeguarded sum is an instance of tolerating hazard. Let us run through Example of Mr Shah to understand Declinature or Rejection. When 60-year-old Ajay Shah (name changed) approached a private general insurer for a health cover, he was asked to undergo a pre-issuance medical test. Confident of sailing through, an otherwise fit Shah was stumped when his application was rejected on detection of a urine infection. Days later, Shah approached another insurance company. This time, the check-up did not reveal any infection as he had overcome the same in the intervening period. Cause and Effect Shah’s case demonstrates the extreme caution health insurers are exercising these days. Underwriting processes have become stringent, resulting in increased proposal rejections. “Insurance companies have become extremely conservative. Even proposals from those with lifestyle diseases are not being approved, unlike earlier when only major surgeries and ailments were treated as pre-existing diseases that warranted rejections,” The life-long renewability clause introduced by Insurance Regulatory and Development Authority of India (Irdai) has also increased the risks for insurers. It’s primarily insurance companies which have priced their products low or do not conduct medical tests for those 66 CU IDOL SELF LEARNING MATERIAL (SLM)

under 45 which are taking extra care. Those who charge relatively higher premium continue to issue policies like earlier, Adverse medical history, specifically pre-existing diseases, are the most common cause of rejection of a policy proposal. Even those in the younger age-groups with lifestyle diseases like diabetes or slipped disc are being denied covers. The rationale is that they are unable to take proper care of themselves, which translates into higher risk for the insurer. Other common reasons for denial of coverage include age and financial position. Insurers tend to see those in the higher age bands as riskier customer, irrespective of the state of their health. Income is also a factor, particularly if someone with a lower income were to opt for a high sum insured, even if it means paying a high premium. Make your Case Given that insurers are jittery when it comes to taking on ‘riskier’ proposals, you need to take certain steps to make sure your application goes through. For one, you can start by being cautious yourself to avoid cases like Shah’s. Before buying a policy, get a check-up done on your own to rule out minor illnesses that can lead to proposal rejection or even loading of premium, where insurers issue policies, but hike premiums citing adverse health history. This apart, ensures you disclose all the information asked for. Remember, you would be weakening your case if you do not reveal any health conditions in the proposal form and they are discovered at the time of medical check-ups. Even in case of no-medicals policy, it’s best to be transparent. After all, in general insurance, unlike life insurance where claims have to be paid after three policy years, claims can be rejected on the grounds of suppression of facts. The policy is issued on the basis of warranties given by the insured. Any inconsistency can result in claim rejection, defeating the purpose of policy purchase. Also, once the procedure to assess your medical status begins, do not cede complete control to the insurance company. Insist on getting examined at a reputed laboratory as their findings have a major role to play in issuance of policy. If in an ill-equipped lab, the officials reading your ECG are not qualified, they could release potentially adverse reports, which could influence the insurer’s decision to extend the cover. While the ultimate decision will rest with the insurer, small measures at your end can go a long way in ensuring a hassle-free policy processing procedure. To Reveal or Not to Reveal Policy buyers often suppress facts:  49%: Policyholders are not sure whether they should disclose their pre-existing ailments at policy inception  27%: Policyholders would rather not declare any PED while purchasing the policy 67 CU IDOL SELF LEARNING MATERIAL (SLM)

 34%: Feel they do not need to disclose pre-existing lifestyle diseases like diabetes and hypertension if they are under control Some Alternatives to Accepting Risk In addition to accepting risk, there are a few ways to approach and treat risk in risk management. They include:  Avoidance: This involves changing designs to dispose of a danger. This procedure is useful for hazards that might actually fundamentally affect a business or task.  Transfer: Applicable to projects with different gatherings. Not every now and again utilized. Regularly incorporates protection. Otherwise called \"hazard sharing,\" protection strategies viably shift hazard from the guaranteed to the safety net provider.  Mitigation: Limiting the effect of a danger so that if an issue happens it will be simpler to fix. This is the most widely recognized. Otherwise called \"upgrading hazard\" or \"decrease,\" supporting systems are normal types of hazard moderation.  Exploitation: Some dangers are acceptable, for example, if an item is so mainstream there are insufficient staffs to stay aware of deals. In such a case, the danger can be abused by adding more deals staff. 4.6 SUMMARY  A level additional expense is an extra charge or cost that is attached to the ordinary charge of your disaster protection strategy.  Each life coverage organization takes a gander at candidate's circumstance in an unexpected way. A few organizations are stricter and some more merciful. This is conceivably one of the issues that is generally confounding to extra security customers  One strategy insurance agency's utilization when taking care of more noteworthy wellbeing hazards is utilizing the Flat Extra Premium or Flat Extra Charge. This is utilized when a danger is higher than a \"Standard\" wellbeing class hazard.  Lien alludes to a decreased total guaranteed for a specific period. At the point when the safety net provider puts a lien, inclusion sum is diminished for a predefined period.  Consideration of proposition is delayed for a period, when the underlying danger is hefty to the point that there is little any desire for offering protection quickly and the proposition is deferred  Options in case candidate's protection is deferred Applicant search for an option as every safety net provider handles each case in an unexpected way. This is particularly 68 CU IDOL SELF LEARNING MATERIAL (SLM)

evident in case candidate's application is delayed due to a clinical explanation. Each insurance agency has an endorsing office that figures it out and thinks about the danger on every application.  An insurance agency isn't committed to restore a protection strategy for any of its policyholders. Should a policyholder have inordinate cases or an adjustment of conditions that make them uninsurable, the organization might decide not to restore.  The reasoning behind hazard acknowledgment is that the expenses to relieve or keep away from chances are too extraordinary to even consider supporting given the little probabilities of a risk, or the little assessed sway it might have. 4.7 KEYWORDS  Regular Premium-A normal charge is cash paid to purchase protection inclusion in portions at specific time spans, like month to month or every year. You may likewise decide to pay a solitary premium toward the beginning of the strategy, rather than orchestrating customary premium installments.  Level Premium-Level-premium protection is a kind of term life coverage. With this sort of inclusion, expenses are ensured to continue as before all through the agreement, while the measure of inclusion gave increments.  Smokers in Health Insurance-Smokers will pay fundamentally more because of expanded wellbeing hazards. Guarantors will inquire as to whether you smoke or have in the previous quite a while and may test for the presence of nicotine in routine blood work  Lien-Lien alludes to a decreased aggregate guaranteed for a specific period. At the point when the safety net provider puts a lien, inclusion sum is decreased for a predefined period. After the predefined period is finished, the full inclusion sum is reestablished naturally  Denied Claims-Even in the event that you pay your expenses consistently and on schedule, an insurance agency may not pay out claims you report. In the first place, the circumstance encompassing the case may not be covered under the strategy since it is one of the recorded avoidances. 4.8 LEARNING ACTIVITY 1. Find out the factors which affects postponement of accepted risks ___________________________________________________________________________ ___________________________________________________________________________ 69 CU IDOL SELF LEARNING MATERIAL (SLM)

2. Corona pandemic has left many young executive /techies jobless, interview one of them to list down alternatives to accepting risk and help them in their insurance plan ___________________________________________________________________________ ___________________________________________________________________________ 4.9 UNIT END QUESTIONS A. Descriptive Questions Short Questions 1. What do you mean by Level Premium? 2. What do you understand by Lien? 3. Explain Temporary Extra premium. 4. Define: a. Denied Policies. b. Avoidance in Risk Management. 5. Explain the meaning Flat Extra Premium. Long Questions 1. DescribeRisk Classifications and Premium Costs. 2. Think of 4 Options if applicant’s insurance is postponed and list it down. 3. Explain Diminishing Lien Exclusions. 4. Illustrate with an example for charging flat Extra premium and explain. 5. Describe the ways where insurance companies can deny you an insurance coverage. B. Multiple Choice Questions 1. What type of term life insurance is level-premium insurance a type of? a. Where coverage, premiums are guaranteed to remain more or less the same throughout the contract. b. Where premiums are very high. c. Premiums are very low. d. Premiums are hard to predict. 2. What, other than a cost that is tacked on to the regular premium of your life insurance policy is a flat extra premium? a. Additional Charges. b. Zero Charges. 70 CU IDOL SELF LEARNING MATERIAL (SLM)

c. 100% increase in charges. d. There are actually no extra charges. 3. What are some alternatives to accepting risk? a. Avoidance. b. Transfer. c. Mitigation. d. All of these. 4. What is a policy when it is in reference to a premium determination approach named “table rating”? a. Corrupted. b. Non-descriptive. c. Rated. d. Beneficial. 5. Who will pay significantly more due to increased health risk? a. Cricketers. b. Healthy Person. c. Smokers. d. Musician. Answers 1-a, 2-a, 3-d, 4-c, 5-c 4.10 REFERENCES References  Bescor, Inc. v. Chicago Title and Trust Co., 113 Ill.App.3d 65, 446 N.E.2d 1209, 1213 (1983)  Kerr Dana, (January 2005) The Journal of Legal Studies. The Effect of Ownership Structure on Insurance Company Litigation Strategy Volume 34, Number 1  Morgan Stanley An Introduction to Alternative Risk Premia SOLUTIONS & MULTI- ASSET Textbooks 71 CU IDOL SELF LEARNING MATERIAL (SLM)

 J. Bushnell Nielsen (2020) Title and Escrow Claims Guide. US Washington DC, Publisher, American Land Title Association  BoobierTony (2016) Analytics for Insurance. The real business for big data, Hoboken, New Jersey, United States, John Wiley & sons  Jones B AN INTRODUCTION TO PREMIUM TREND (February 2002) Websites  https://www.investopedia.com/terms/l/lien.asp  https://www.investopedia.com/ask/answers/12/can-insurance-company-refuse- coverage.asp  https://lion.ie/life-insurance/postponed-for-life  https://www.lifeinsuranceblog.net/flat-extra-charges-for-life-insurance/  https://www.lifeinsuranceblog.net/flat-extra-charges-for-life-insurance/ 72 CU IDOL SELF LEARNING MATERIAL (SLM)

UNIT5 – STRUCTURE AND PROCESS STRUCTURE 5.0 Learning Objectives 5.1 Introduction 5.2 ProcessingoftheProposal 5.3 Summary 5.4 Keywords 5.5 Learning Activity 5.6 Unit End Questions 5.7 References 5.0 LEARNING OBJECTIVES After studying this unit, you will be able to:  Explain the Concept of Structuring in the Process of Proposal.  Learn about Proposal Contents.  Explain the role of Underwriting in Insurance Proposal Policy.  Describe the UnderwritingFactors for the Primary Types of Policy. 5.1 INTRODUCTION It is significant that each business comprehends its inclusion. On the off chance that the entrepreneur has never perused his approach, it would be a smart thought to take some time and gain an agreement. Particularly in Insurance area, it is organized show of substance to customers, so it gives clearness and all the more significantly straightforwardness pushing ahead with proposition, strategy show are constantly organized Policies are planned with the accompanying targets of giving inclusion that is appealing in the commercial centre, restricting dangers to those that can be actuarially evaluated, spreading chances over an enormous pool of strategy holders, rating (estimating) approaches dependent on quantifiable danger factors and controlling the expense of cases the executives and settlement. Protection is an agreement, addressed by a strategy, where an individual or substance gets monetary security or repayment against misfortunes from an insurance agency. The organization pools customers' dangers to make instalments more reasonable for the guaranteed. Protection approaches are utilized to support against the danger of monetary misfortunes, both of all shapes and sizes, that might result from harm to the safeguarded or her property, 73 CU IDOL SELF LEARNING MATERIAL (SLM)

or from obligation for harm or injury caused to an outsider. There is a large number of various kinds of protection approaches accessible, and for all intents and purposes any individual or business can discover an insurance agency willing to safeguard them—at a cost. The most widely recognized sorts of individual protection approaches are auto, wellbeing, mortgage holders, and life. Most people in the United States have somewhere around one of these kinds of protection, and vehicle protection is legally necessary. Organizations require uncommon kinds of protection arrangements that guarantee against explicit sorts of dangers looked by a specific business. For instance, a drive-through joint necessity a strategy that covers harm or injury that happens because of cooking with a profound fryer. A vehicle vendor isn't dependent upon this kind of hazard however requires inclusion for harm or injury that could happen during test drives. To choose the best arrangement for you or your family, focus on the three basic segments of most protection approaches—the deductible, premium, and strategy limit. There are additionally protection strategies accessible for quite certain requirements, for example, grab and payment (K&R), clinical negligence, and expert obligation protection, otherwise called mistakes and exclusions protection. It is even more significant that there is an organized interaction to follow, directly from the insurance agencies to the imminent customer so last agreement offered and taken by customers get rid of any uncertainty and follows the agreement deed without limit. Financiers follow the goal and guidelines indicated in the authoritative prerequisite and select the right candidate as per set arrangement of protection offered to particular qualifying candidate by making the right equilibrium hazard versus benefit. 5.2PROCESSING OF THE PROPOSAL Figure 5.1: Insurance proposal form Proposal form 74 CU IDOL SELF LEARNING MATERIAL (SLM)

Definition:Proposition structure is the most significant and fundamental record needed for a life coverage contract between the guaranteed and insurance agency. It incorporates the guarantee’s crucial data like location, age, name, instruction, occupation and so on It additionally incorporates the individual's clinical history. Figure 5.2: Process Flow for Enrolling an Insurance Policy Description: An extra security organization offers a strategy based on a proposition structure. The structure is the most essential prerequisite for the working of the extra security contract between you and the life coverage organization. It should be finished by the proposer who might look for the help of a disaster protection counsel to top it off. A proposition structure looks for essential data of the proposer and the life guaranteed. This incorporates the name, age, address, schooling, and work subtleties of the proposer. The proposition structure likewise assembles data on the clinical history of the life to be guaranteed. There are questions relating to the well-being status of relatives of the life to be guaranteed. The proposer and the life to be guaranteed need to specify their salaries in the proposition structure to fulfil the backup plan about their capacity to pay for the protection and the requirement for protection, separately. 75 CU IDOL SELF LEARNING MATERIAL (SLM)

Proposition structure helps the insurance agency to ascertain every one of the likely dangers according to the protection strategy and subsequently choosing the top-notch sum. The financiers are liable for endorsing plans and observing new approaches to guarantee that strategies stay inside the transporter's rules. Solicitations for approaches with higher innate danger are either declined or evaluated into a higher valuing classification. Underwriting Factors for the Primary Types of Policies 1. Property insurance i. Location of the property ii. Condition of the building iii. Crime statistics in the area iv. Type of construction v. Safety features available 2. Liability insurance i. Types of exposure being insured ii. Track record of industry iii. Claims experience of the specific business iv. Presence of risk management techniques (or quality control measures) 3. Auto insurance i. Type/cost of automobile. ii. Age and marital status of drivers. iii. Number of miles typically driven each day. iv. Length of time at residence. v. Demographics of area. 4. Health and life insurance i. Age. ii. Sex. iii. Occupation. iv. Personal health history. v. Family health history. vi. Legislated requirements in the state. Role of Underwriter in the Processing of the Proposal 76 CU IDOL SELF LEARNING MATERIAL (SLM)

Endorsing comprises of two parts; hazard appraisal and valuing. Fruitful endorsing requires an arrangement of hazard choice to get a gathering wherein misfortune results will be sensibly unsurprising through the theory of probability. To achieve this objective there should be a harmony between acquiring volume and getting homogeneous dangers. On the off chance that an insurance agency giving individual life strategies, for example, embraced such severe norms that it would just acknowledge people who were basically amazing truly, ideal from an ethical stance, and in hazard free occupations, there would be just a tiny gathering from which to pick. Such a gathering would be exceptionally homogeneous, with all the danger units- - for this situation the individual lives- - subject to about a similar possibility of misfortune. However, the mass or volume of hazard units would be tiny, and along these lines the consistency of misfortune may be antagonistically influenced. Another component entering in to make determination of such a gathering unreasonable would be that choice methods important to acquire this close ideal arrangement of people. The cost included would more than offset the investment funds from the death pace of the gathering. In guaranteeing, determination cost is a factor to be thought of. There must be a harmony between the severity of determination norms and the need of having a huge volume of hazard units to be protected. To Achieve Profitability, the Underwriting Function Serves Additional Purposes: 1. Guarding against adverse selection 2. Ensuring adequate policy holder 3. Enforcing underwriting guidelines. The goal of endorsing is to deliver a pool of protector’s, by classes, whose genuine misfortune experience will intently surmise the normal misfortune experience of a given speculative pool of guarantee’s. That is, if a financier is informed that a pool of openings with indicated qualities (e.g., a pool of block structures found close to 5 miles from a fire station) will deliver a predetermined misfortune pace of, say, 1% of the worth of the safeguarded property, then, at that point the guarantor should attempt to put in this pool every one of the openings whose attributes match the determinations. Underwriting Policy When evaluating applicants, underwriters determine whether insurance on the applicant will be: i. Rejected; ii. Issued on a substandard basis; iii. Issued on a standard basis; or iv. Issued on a preferred basis. v. Rejecting Applicants 77 CU IDOL SELF LEARNING MATERIAL (SLM)

 Rejected Guarantors reject applications for protection when they track down that the candidate addresses a danger that falls outside of the guaranteeing guidelines set up by the insurance agency. These endorsing norms think about numerous things, for example, guidelines that require the guarantor to set up satisfactory rates, laws that order that specific elements can't be utilized to dismiss an application, protection standards like insurability and repayment, the commercial center wherein the back up plan sells its items and the benefit the safety net provider desires to make on its business.  Issuing Policies on a Substandard Basis The choice to give an approach on an unsatisfactory premise happens when a danger isn't considered to be outside endorsing principles, yet is viewed as of high danger inside those guidelines. The back up plan by and large has three essential alternatives when it offers an unacceptable strategy issue to an Applicant. It might: i. Issue the approach with a higher premium than would be needed for a standard strategy ii. Issue the approach with restricted advantages iii. Issue the strategy with specific prohibitions  Higher Premium The guarantor might charge a higher premium to candidates considered to be of higher danger than the individuals who might be viewed as a standard danger as long as those higher rates fall inside specific Parameters. In the first place, if the protection strategy is one that necessitates that rates be documented with the state where the arrangement is given, the rate should be supported by the state. Furthermore, the rate may not be unfair. The safety net provider should accuse each protected of similar qualities a similar rate. Thirdly, in certain states higher premium may not be charged dependent on specific things as characterized in state resolutions. The safety net provider should obviously agree with such resolutions in deciding if to charge higher premium rates.  Limit Policy Benefits Back up plans may likewise react to inadequate candidates by offering an approach with restricted arrangement Insurers may likewise react to unacceptable candidates by offering a strategy with restricted arrangement benefits. Once more, regardless of whether the safety net provider might restrict benefits is managed by state law. For instance, under long haul care approaches, a few states necessitate that arrangements offer a base home medical services advantage limit as a specific proportion of the nursing home advantage limit. Subsequently, a drawn out care guarantor couldn't restrict the home medical advantage on an approach in a way that would not conform to such a 78 CU IDOL SELF LEARNING MATERIAL (SLM)

law. Accepting state guidelines are followed, a safety net provider could offer lower strategy limits on certain inclusion to an unacceptable candidate, or could offer lower strategy limits for all inclusion to such a candidate Dealing with inadequate candidates by restricting arrangement benefits is generally normal in business inclusions.  Excluding Certain Provisions from Coverage Another alternative a back up plan might have is to bring to the table an unacceptable candidate a strategy that rejects inclusion for certain property, insureds or tasks that are considered too high a danger for the safety net provider to cover. Likewise with different choices talked about, such rejections should be suitable under state guidelines. This kind of rejection is generally normal in business property and obligation inclusions. For instance, a back up plan might cover all the property claimed by a business, then again, actually inside a structure whose activities have been suspended. Or on the other hand, a guarantor might offer to give obligation inclusion to all business activities with the exception of that divide that has potential contamination responsibility that is excessively high for the back up plan to cover.  Issuing Policies on a Standard Basis Guarantors base their assurance that an arrangement ought to be given on a standard premise on an examination of the qualities of the danger addressed by the candidate. Candidates who are given strategies with standard rates fall inside the ordinary limits of guaranteeing norms for that sort of strategy.  Issuing Policies on a Preferred Basis In the event that an application falls inside the most minimal danger limits of the endorsing principles, the approach is given on a favored premise. Favored rates address the least rates offered by a safety net provider for its inclusion. Rates offered on a favored premise should stick to the protection guidelines appropriate to them, similarly as rates offered on an unsatisfactory and standard premise must. Protection controllers don't need safety net providers to offer rates that are low to such an extent that the guarantor can't meet its authoritative commitments to pay covered cases.  Formulating Underwriting Policy Staff guarantors attempt to figure an endorsing strategy that successfully deciphers the objectives of a safety net provider's proprietors and the executives into decides and techniques that guide individual and total guaranteeing choices. Guaranteeing strategy decides the organization of the guarantor's book of business. Objectives for a safety net provider's book of business may be set up by kinds of protection and classes of business to be composed; domains to be created; or frames, protection rates, and rating intends to be utilized. A guarantor's guaranteeing strategy is impacted by the board's ideal situation in the protection commercial center. Most guarantors consider their to be as standard 79 CU IDOL SELF LEARNING MATERIAL (SLM)

back up plans that is, they look for better-than-normal records. A few safety net providers, notwithstanding, see a chance to offer inclusion in regions that are underserved by the standard market. These nonstandard or claim to fame back up plans may utilize misfortune control, more prohibitive inclusion structures, or greater costs to make a benefit protecting records thought about peripheral or unsuitable in the standard market. Underwriting policy is always being reviewed and it is subject to these Limitations of Underwriting Policy  Financial capacity  Regulation  Personnel and physical resources  Reinsurance Terms at Policy Issue Other than setting determining rates, the candidate might be needed to meet guaranteeing necessities with the goal for protection to be given or stay in power. For instance, a business might be needed to introduce a sprinkler framework, a mortgage holder might be needed to add railing to a deck, and a person with an important currency assortment might be needed to put it in a security store enclose request for the protection to apply. Sources of Underwriting Information Numerous assets are utilized during the endorsing interaction. The most significant of these assets is the application. In this segment, we will audit the essential parts of uses for different lines of protection, alongside different assets utilized in guaranteeing, including reports, site examinations, protection maps, insurance agency records, and industry measurable reports and information Insurance Applications The protection application is a basic endorsing asset. From it, the guarantor finds the vast majority of the essential data expected to decide if to give a strategy and provided that this is true, at what premium and terms.  Life Insurance Applications Each life application generally requires the following type of information: i. Applicant and insured name, address and other general information ii. Medical information iii. Agents statement iv. Selection of riders or optional features 80 CU IDOL SELF LEARNING MATERIAL (SLM)

v. Signatures General Information The overall data segment of life coverage applications by and large requests the name, address, birth date, government-backed retirement number and sex of the protected and proprietor. The relationship of the proprietor to the guaranteed is likewise required. The name or names of recipients is additionally mentioned, alongside the rate for every recipient or other recipient assignment, and the relationship of every recipient to the proprietor. A few applications additionally require the recipient's federal retirement aide number. This is to help the guarantor in distinguishing the legitimate recipient, if essential. Medical Information Medical questions include asking whether tobacco or nicotine products have been used, and if the insured had been diagnosed, treated or hospitalized for: i. ·Cancer; ii. Heart attack; iii. Stroke; iv. Diabetes; v. Kidney disorders; vi. Alzheimer’s disease; vii. Liver disorder; viii. Organ transplant; ix. Alcohol or drug use treatments; x. AIDS or HIV; xi. Irregular heart beat; xii. High blood pressure; xiii. fainting spells; xiv. Emphysema or other chronic lung or respiratory disorder; xv. Inability to work for more than a week in the past six months or year; and xvi. Other similar questions. If there is a ―yes‖ response to the medical questions asked, the application will generally ask for more details. Once the application reaches the home office, medical reports or an attending physician statement may also be requested. Or, the insurer may have issued underwriting guidelines to the agent, who requests such reports through his or her agency office. 81 CU IDOL SELF LEARNING MATERIAL (SLM)

Replacement Every application additionally finds out if this proposed protection will supplant or change any current or forthcoming protection. In the event that the candidate responds to ―yes‖ to this inquiry, the specialist might be needed by state guidelines to finish state supplanting structures with the candidate. State substitution frames for the most part incorporate relative data for the candidate to peruse with respect to the proposed protection and the approach to be supplanted. They may likewise incorporate revelation explanations for the candidate to sign demonstrating that the candidate comprehends that there might be give up charges associated with dropping the current strategy, that the new approach by and large incorporates commission loads and that another acquiescence charge period might apply to the new arrangement. An insurance agency required 1035 Exchange‖ or Absolute Assignment‖ structure should likewise be finished in a substitution circumstance The most significant endorsing devices incorporate the Proposal Form, Age Proof, Income Documents, Questionnaires Sales Report and a Client Confidential Report (CCR). These devices are utilized to carry out the accompanying interaction: Various Steps of Application Processing and Associated Risk Management. Stage 1: Application Quality Check Your application is first gone through to ensure the data gave is finished and right. Hence, it is significant you fill your proposition structure cautiously and totally. Except if the missing data is identified with your clinical history, a minor change needed in an application doesn't regularly hinder the endorsing cycle. After this, your application goes into the authority endorsing the measure. Every one of the accompanying checks can expand the turnaround time, yet it is great to get you the right top-notch value you should pay over the arrangement term. Stage 2: Medical Examination This progression includes taking a gander at the aftereffects of your paramedical test, led just whenever needed for wellbeing verification. This clinical trial is a basic registration with the specialist suggested by the insurance agency. After the clinical assessment, the outcomes are shipped off to the financier for assessment. The data utilized by the financier is principal of three sorts – fundamental estimations, your blood test, and medication test. Essential estimations incorporate standard measurements like stature, weight, pulse. A blood test can get a ton of data on potential wellbeing dangers like coronary illness, stroke, diabetes, and blood-borne ailments, among others. At long last, a pee test for a full medication board will make the guarantor aware of the utilization of medications, smoking, and liquor utilization. Stage 3: Final Application Rating When the endorsing interaction is finished and all your clinical and monetary foundation has been checked, you are either made a counteroffer proposing the progressions premise on the 82 CU IDOL SELF LEARNING MATERIAL (SLM)

candidate's approach assessment, or you are gladly offered the extra security strategy. Contingent on your acknowledgment or dismissal of the new arrangement term, your approach is then given. The entire interaction can take anyplace between three to about two months. After this, all that is left to be done is to affirm the superior rate, sign the arrangement to place it in power to keep your family secured. While only one out of every odd candidate will require an itemized clinical assessment, guarantors may at times demand an investigation report or autonomous data on the candidate's monetary circumstance and way of life. The top-notch that you need to pay for your extra security strategy relies significantly upon this assessment done premise factors like your age, your clinical history, sexual orientation, way of life, and work. Nonetheless, you should recollect that a disaster protection strategy ought not to be purchased based on lower charges. While term protection plans are typically known to have the most minimal expenses, you can pick a protection supplier that offers a moderately higher inferred speculation return, a high demise advantage and somewhat lower give up charges, alongside a high case settlement proportion. Applying for a life coverage strategy is simple. Particularly when applied for on the web, it might require a couple of moments. Whenever you have given your fundamental subtleties and gave essential data, your protection application is then sent for the endorsing interaction. This interaction decides whether you can get inclusion, how much inclusion can be endorsed for you, and at what cost. The financier, the individual who assesses your application, deals with the sake of or for the life coverage organization to take a gander at your wellbeing and monetary data to sort out in case you are qualified to get the rate you were initially cited. Guarantors use endorsing rules dependent on mortality insights that are determined by statisticians. All protection items include some level of endorsement. For live coverage, the financier sees information like your wellbeing and clinical history just as a way of life data like your diversions and monetary capacity. There are Extensively Two Sections to Endorsing 1. Financial underwriting It assists the guarantor with ensuring the sum you're buying is in accordance with your families and your requirements. Each application for independently endorsed extra security incorporates a pay factor being utilized to forestall or diminish hypothesis. This is regularly founded on acquired pay, yet can be changed dependent upon the situation by different points of interest of a person's circumstance. Models (for extra security) could incorporate all out total assets, domain charge outcomes, and age. The requirement for monetary endorsing turns out to be more significant with bigger face sums, and for business cases. Furnishing monetary data with the application assists with qualifying the measure of hazard all the more rapidly. 83 CU IDOL SELF LEARNING MATERIAL (SLM)

As a rule, the less than ideal passing of an individual will make a monetary misfortune. The motivation behind monetary endorsing is to decide if the measure of inclusion applied for and as of now in power bears a sensible relationship to this misfortune. Basic financial underwriting is concerned with i. Establishing a valid insurable interest ii. Relating insurance to demonstrable needs iii. Ensuring a reasonable level of persistency. 2. Medical underwriting Here, the financiers decide the amount of a danger you are to safeguard by assessing factors that might influence your mortality. The organizing of proposition ought to likewise consider the debate goal options on the off chance that, the agreement might land in question between two gatherings, similar to an advanced scope of elective question goal openings.Medical underwriting is the way toward assessing an application for health care coverage inclusion by looking at the candidate's clinical history. The cost of inclusion is dictated by the danger variables of the candidate. Contingent upon the insurance agency's approaches and on government and state guidelines, clinical endorsing for high-hazard up-and-comers might prompt rejection of inclusion for specific conditions, forswearing of inclusion inside and out, or inclusion offered uniquely at an extremely excessive cost Medical underwriting additionally is polished in deciding individual rates for disaster protection and incapacity protection strategies. Medical underwriting might be embraced for an individual or for a little gathering, for example, an organization looking for inclusion for its workers. Such individual examination would not be achievable when setting rates for an enormous organization. During the medical underwriting measure, insurance agencies look at the clinical history, segment profile, way of life, and different components that might identify with an up- and-comer's current and future clinical requirements. Through actuarial examination, a gauge of the danger related with giving wellbeing inclusion to that not really settled and estimated. Prevention of Disputes i. Allocating fair contract risk- It is normal neighbourhood practice for hazard supervisors to get ready protection contract archives essentially by adding to or erasing from a bunch of recently utilized agreement records, and keeping in mind that this reorder technique might save time in setting up the protection contract, it frequently prompts issues, since reports are not perused and ready overall for the 84 CU IDOL SELF LEARNING MATERIAL (SLM)

particular protection contracts. Such practices increment the unexpected dangers for the candidate. It shocks no one that gatherings to an agreement regularly incorporate agreement language intended to move hazard to the next party so the bases for cases and debates are killed. ii. Drafting Dispute Resolution Clauses - as well as distinguishing obligations and allotting chances, an agreement ought to contain language for tending to debates and claims at the important stage in a protection contract. This incorporates provisos containing unequivocal arrangements and guidelines for gatherings to determine debates as they emerge, throughout the undertaking. Better preparing in the space of agreement the executives to the experts can be supposed to be of incredible assistance for better comprehension of the agreement. 5.3 SUMMARY  Role of Underwriter in the handling of the proposition comprises of two segments; hazard appraisal and estimating. Fruitful guaranteeing requires an arrangement of hazard choice to get a gathering wherein misfortune results will be sensibly unsurprising through the theory of probability.  Insurance approaches are utilized to fence against the danger of monetary misfortunes, both of all shapes and sizes that might result from harm to the guaranteed or her property, or from obligation for harm or injury caused to an outsider.  To accomplish benefit, the guaranteeing capacity fills extra needs: 1. guarding against unfriendly determination, 2. Guaranteeing sufficient arrangement holder 3. Authorizing endorsing rules.  Many assets are utilized during the guaranteeing cycle. The most significant of these assets is the application.  Medical questions incorporate finding out if tobacco or nicotine items have been utilized, and if the safeguarded had been analysed, treated or hospitalized for Chronic Health condition like Diabetes.  Property protection, Liability protection, Auto protection and Health and Life protections are the guaranteeing factors for the Primary Types of Policies.  A successful case the executives cycle is fundamental in agreement drafting to guarantee that any authoritative cases emerging are managed in a manner that is reasonable for each elaborate gathering  Better preparing in the space of agreement the executives to the experts can be supposed to be of an extraordinary assistance for better comprehension of the agreement. 85 CU IDOL SELF LEARNING MATERIAL (SLM)

 The advancement of debate goal measures has prompted the improvement of a scope of elective question goal openings.  Drafting Dispute Resolution Clauses as well as recognizing obligations and apportioning chances, an agreement ought to contain language for tending to questions and claims at the important stage in a protection contract. 5.4KEYWORDS  Proposal Form in Insurance-Proposal structure is the most significant and essential report needed for extra security contract between the protected and insurance agency. It incorporates the protected's essential data like location, age, name, schooling, occupation and so forth It likewise incorporates the individual's clinical history.  Indemnity Insurance-It is a sort of protection strategy where the insurance agency ensures pay for misfortunes or harms supported by a safeguarded. Repayment protection is intended to ensure experts and entrepreneurs when discovered to be to blame for a particular occasion like a misjudgment.  Adverse Selection-In health care coverage, unfriendly determination alludes to the situation where higher-hazard or wiped out people, who have more prominent inclusion needs, buy health care coverage, while sound individuals postpone or choose to decline. This can prompt an abnormal conveyance of sound and undesirable individuals joining.  Liability Insurance-The term obligation protection alludes to a protection item that furnishes a safeguarded party with assurance against claims coming about because of wounds and harm to others or property. Obligation protection strategies cover any legitimate expenses and pay-outs a safeguarded party is answerable for in case they are found lawfully at risk.  Homogeneous Risk-Homogeneous dangers are chances that have comparable qualities either in the portrayal of hazard its self and in claims. for instance, family protection is viewed as a homogeneous danger in which you can survey the danger that many danger information and cases patterns are accessible for similar dangers. furthermore, you would have the option to foresee future misfortunes dependent on the recorded cases information. 5.5LEARNING ACTIVITY 1. As an underwriter list down 4 pointers to find in application form/proposal form of Insurance. ___________________________________________________________________________ ___________________________________________________________________________ 86 CU IDOL SELF LEARNING MATERIAL (SLM)

2. Interview a prospective applicant and list down risk issues which may arise in future in an insurance contract. ___________________________________________________________________________ ___________________________________________________________________________ 5.6 UNIT END QUESTIONS A. Descriptive Questions Short Questions 1. What do you mean by a proposal/application form in insurance? 2. What do you understand by standard term policy? 3. What information does a proposal form seek? 4. Define: a. Higher premium policy. b. Limited benefit policy. 5. Describe the role of underwriter in processing an insurance policy. Long Questions 1. What types of information underwriter seek in health insurance? 2. Describe the various steps of application processing associated with risk management. 3. What are the factors influences in issuing substandard policy? 4. How anticipated risk can be prevented in an insurance contract? 5. Elucidate the role of underwriter in forming a policy in a construction contract. B. Multiple Choice Questions 1. What are the underwriting factors for property insurance? a. Age of the Driver. b. Location of the property. c. Construction of the building. d. Both b and c. 2. Which is the most important and basic document required for life insurance contract? a. Proposal Form. b. Correspondence mail. c. Recommendation letter. d. Bank statement. 87 CU IDOL SELF LEARNING MATERIAL (SLM)

3. What are the underwriting factors for Health and Life insurance? a. Age b. Demography of the area. c. Personal Health History. d. Both a and c. 4. What do insurers do with the applications for insurance when they find that the applicant represents a risk that falls outside of the underwriting standards established by the insurance company? a. Corrupt. b. Reject. c. Accept. d. Postpone. 5. What is done after Application quality check and Medical examination in health Insurance? a. Raising doubts. b. Application rating c. Partying. d. Erasing application. Answers 1-b, 2-a, 3-d, 4-b, 5-b 5.7 REFERENCES Reference  Emre C, Pinar C, (2014) “An Analysis of Causes of Disputes in the Construction Industry Using Analytical Network Process,” 2nd World Conference on Business Economics and Management.  Moravian Mohammad Yusuwana, HamimahAdnanb, (2013) “Issues Associated with Extension of Time (EOT) Claim in Malaysian Construction Industry,” International Conference on Health and Social Care Information Systems and Technologies, Proceedings of Technology 88 CU IDOL SELF LEARNING MATERIAL (SLM)

 George Rejda, Michale J (2017) Principles of Risk Management and Insurance, Global Edition UK London Pearson’s Publication Textbooks  Pal S, Sodhi KNS (Second Edition: January 2013) Principles of Insurance, India Chandigarh, Publisher Insurance Founders.  Viswanathan K, Cummins D (September 2003) Journal of Risk and Insurance Ownership Structure Changes in the Insurance Industry: An Analysis of Demutualization Vol 70 Wiley Online Library  Proschool I (September 2012) Risk Management and Insurance Planning US New York, Publisher McGraw Hill Websites  https://nios.ac.in/media/documents/VocInsServices/m2--f3.pdf  https://lion.ie/life-insurance/postponed-for-life-insurance/  https://www.canarahsbclife.com/knowledge-centre/blog/what-is-life-insurance- underwriting-process.html  https://www.livemint.com/Money/Krxp02uVxO75cQ76kPuKhM/Explained-What-is- a-proposal-form-and-why-its-important-to.htm 89 CU IDOL SELF LEARNING MATERIAL (SLM)

UNIT 6 – POLICY ISSUANCE PROCESS STRUCTURE 6.0 Learning Objectives 6.1 Introduction 6.2 Non-medical and Medical Underwriting 6.3 Medical Examination process 6.3.1 Pre-examination 6.3.2 Examination 6.3.3 Post-examination 6.4 Summary 6.5 Keywords 6.6 Learning Activity 6.7 Unit End Questions 6.8 References 6.0 LEARNING OBJECTIVES After studying this unit, you will be able to:  Explain the role of underwriter in non-medical and medical insurance.  Describe the importance of IME and ME in Medical insurance.  Explain the Medical Examination Process.  Explain the stages of Medical Examination Process. 6.1 INTRODUCTION Disaster protection organizations need to get a reasonable picture of who they will guarantee—and that implies taking a gander at the candidate (you) from each point to decide your extra security charges. A one-size-fits-all arrangement basically doesn't exist—that is the reason there's an application interaction behind buying your protection plan. Each individual will have novel inclusion needs and an alternate extra security premium rate, as well. Guarantors take a gander at various information focuses, including your way of life, occupation, clinical record, monetary history, and driving record to put your application in a danger class. Your danger 90 CU IDOL SELF LEARNING MATERIAL (SLM)

class decides the amount you pay for life coverage. Before a candidate buys his/her term life coverage strategy, a financier assesses their application and decides whether they are insurable, that implies that they can be viewed as a satisfactory protection hazard. On the off chance that they confirm that you are insurable, they will audit the measure of inclusion that you are qualified for dependent on your pay, lastly, how much your disaster protection premium will be. At the point when a financier evaluates your application to decide your disaster protection charge, they utilize a complex endorsing cycle to decide their danger in covering you with term life coverage. This implies that the insurance agency will take a gander at various information focuses, including non-clinical and clinical information of yours and decide your danger class. Your danger class decides the amount you pay for disaster protection. A disaster protection hazard class mirrors an appraisal of a mix of components that sway a candidate's future. Guarantors allocate these danger classes dependent on how measurably reasonable it is that the candidate will have a long and sound life which implies the candidate may not liable to foster a genuine sickness and pass on at an early age. On the off chance that term life coverage financiers assess your application and discover that your profile doesn't satisfy the necessities for guideline life coverage hazard classes, then, at that point your application will be table appraised (assessed by an alternate arrangement of rules for non-standard danger) and your extra security premium will cost more. This arrangement of cycles is tirelessly followed before a protection contract is given to the candidate. 6.2 NON-MEDICAL AND MEDICAL UNDERWRITING Non-Medical Underwriting Life insurance applications that don't need clinical evaluation for the supplier are frequently alluded to as 'non-clinical disaster protection' or 'non-clinical term life coverage'. While applying for life coverage, you will be posed various straightforward inquiries about your wellbeing and way of life. These inquiries will incorporate whether you or your close family have experienced any ailments. This is to help the protection supplier acquire a superior image of your wellbeing, which can assist with deciding the amount of danger you may present. Contingent upon your present wellbeing condition(s), the protection supplier might ask you further inquiries, require a report from your GP, request that you attempt a clinical assessment or you might be offered cover straight away. On the off chance that the supplier is glad to acknowledge your application following your underlying clinical survey, this is regularly alluded to as non-clinical term extra security. While addressing clinical inquiries during the application cycle, be straightforward. This is on the grounds that protection suppliers need to assemble a precise image of your wellbeing and the danger you present to them. This assists the supplier with seeing the amount to charge you for your 91 CU IDOL SELF LEARNING MATERIAL (SLM)

protection strategy. In the event that the data gave isn't exact, it could prompt a case being dismissed or not settled completely. We generally prescribe addressing a consultant while finishing your clinical poll. An expert counsel can direct you through the phrasing to guarantee that you get what the supplier is inquiring about. This assists you with guaranteeing total precision. Realize that regardless of whether you have or have had past ailments, it doesn't really mean you will be rejected cover. A few suppliers additionally spend significant time in covering certain sicknesses’; a counsellor can tell you where you are best applying. What is Non-Medical Life Insurance? There might be a few occasions where the safety net provider requires extra data prior to having the option to offer cover. This may incorporate an actual clinical assessment or getting a report from the candidate's GP. The safety net provider will utilize this data to assist them with deciding your danger and the amount to charge a candidate. In any case, in case candidate is healthy, it is far-fetched that candidate will be asked to go through additional clinical inquiries or be needed to go through an actual assessment. The protection supplier will probably offer the terms of cover straight away, and they won't request that candidate go through any further assessments or checks following the underlying wellbeing and way of life application. This might be alluded to as non-clinical life coverage. It is feasible to get monetary insurance without addressing any clinical inquiries. This is known as a non-therapeutically guaranteed strategy. This sort of strategy contrasts from non- clinical term extra security and gives an alternate kind of monetary assurance than disaster protection. You may choose a non-medicinally endorsed strategy in the event that you would not in any case meet all requirements for a restoratively guaranteed disaster protection strategy, because of past medical problems. How to Get Non-Medical Life Insurance? Applicant's health and way of life factors hugely affect their extra security strategy. On the off chance that a backup plan believes the applicant to be at okay of fostering any or further medical issues, they are typically glad to give cover, without requiring additional subtleties other than the underlying inquiries candidate replied to during the application interaction. It is subsequently significant that applicants give however much important data as could reasonably be expected concerning their actual wellbeing, psychological wellness, and their way of life. With disaster protection, trustworthiness is consistently the best arrangement. Medical Underwriting Clinical underwriting is the way toward assessing an application for health care coverage inclusion by looking at the candidate's clinical history. The cost of inclusion is controlled by the danger variables of the candidate. 92 CU IDOL SELF LEARNING MATERIAL (SLM)

Figure 6.1: Medical underwriting Contingent upon the insurance agency's strategies and on government and state guidelines, clinical underwriting for high-hazard up-and-comers might prompt prohibition of inclusion for specific conditions, refusal of inclusion through and through, or inclusion offered distinctly at an exceptionally exorbitant cost. Clinical underwriting additionally is rehearsed in deciding individual rates for life coverage and incapacity protection approaches. Clinical underwriting might be attempted for an individual or for a little gathering, for example, an organization looking for inclusion for its representatives. Such individual examination would not be done when setting rates for an enormous organization. During the clinical underwriting measure, insurance agencies look at the clinical history, segment profile, way of life, and different elements that might identify with an applicant's current and future clinical requirements. Through actuarial investigation, a gauge of the danger related to giving wellbeing inclusion to that individual is resolved and evaluated.  Medical endorsing includes exploring the clinical history of a candidate for protection to recognize hazard factors and value inclusion in a like manner.  In ongoing years, guidelines have restricted the utilization of clinical endorsing in deciding rates.  Regulations can change, and medical services guideline is profoundly disputable. The utilization of clinical underwriting might be restricted by law. For example, organizations that offer Medicare supplement plans, in case they are bought inside a half year of Medicare qualification, can't consider a person's wellbeing history when setting their rates for singular candidates. 93 CU IDOL SELF LEARNING MATERIAL (SLM)

The Affordable Care Act of 2010, prevalently known as Obama care, restricted the capacity of insurance agencies to set rates dependent on singular wellbeing history for Americans who bought protection through its trades. Age, sex, and cigarette smoking could be thought of. The demonstration additionally restricted organizations from denying inclusion dependent on prior conditions or restricting inclusion of previous conditions. That discredits one of the essential objectives of clinical endorsing. That is, the work of a guarantor is to recognize prior conditions that add hazards for the insurance agency. Due Diligence The measure of due ingenuity a backup plan does while considering a health care coverage application relies upon the assets it dedicates to the investigation into a person's clinical history. The most complete assessment is alluded to as full clinical underwriting (FMU). Full clinical underwriting includes an exhaustive investigation of a person's clinical records. The interaction requires the health care coverage candidate to give a clinical history of returning years, and the backup plan might contact medical services suppliers that the individual has utilized. Medical Underwriting Pros and Cons  Advocates of clinical underwriting say the interaction keeps singular health care coverage charges as low as feasible for most clients.  Critics keep up with it forestalls individuals with somewhat minor and treatable previous conditions from acquiring medical coverage.  Diseases that could make an individual uninsurable incorporate genuine conditions like joint inflammation, malignant growth, and coronary illness, and normal sicknesses like skin break out, being 20 pounds over or under the best weight, and old games wounds.  In the United States, the Affordable Care Act changed a significant number of the principles related to the manner in which backup plans qualify people searching for medical coverage. An entire decade after the demonstration passed, it is as yet hazy whether those principles will stand and, if not, what will supplant them. 6.3 MEDICAL EXAMINATION PROCESS At the point when a candidate goes out to purchase a clinical protection strategy, many rumoured protection suppliers request that candidates go through certain tests. These pre- clinical trials are required for them to get medical coverage as they are an enormous central consideration in deciding a candidate's qualification for protection. It doesn't mean anyway that a candidate can't get an approach without clinical trials and it is genuinely simple to succumb to the health care coverage with no clinical test. It may seem like a significant 94 CU IDOL SELF LEARNING MATERIAL (SLM)

suggestion for the greater part of the occasions. Yet, actually, the guarantor that requests that candidate go for health care coverage test is most clients amicable at the hour of making a case. Figure 6.2: Medical examination requirement It ought to anyway be noticed that regardless of whether the protection supplier has not requested that the candidate goes through these tests, it no place suggests that an individual ought to retain a prior ailment. Lying about their infirmities or concealing realities is viewed as misrepresentation and may prompt dismissal of guarantee. Along these lines, in the event of no clinical trials, one is necessary to present a revelation of good wellbeing before your guarantor chooses your exceptional sum. Avoiding the tests might appear to be a smart thought. It saves candidates the difficulty of visiting a demonstrative Centre and sets aside their cash. However, it might lead them to pay intensely later. In this way, if a candidate is a sound individual, going for health care coverage clinical registration will be even more valuable for them. In the event that they finish these assessments with no illnesses being analysed, the safety net provider will repay them for the wellbeing registration on the off chance that the proposition is acknowledged. What's more, on the off chance that candidates have a previous condition, they will become more acquainted with exhaustively about avoidances and holding up periods relating to their 95 CU IDOL SELF LEARNING MATERIAL (SLM)

condition. However, it may lead them to pay a marginally higher premium; it is awesome toward the end. Keep in mind, it is smarter to pay a higher premium and get covered instead of saving a couple of pennies today and getting your case dismissed later. Figure 6.3: Medical insurance Most protection, lawful, and restoration experts have had basically some involvement in the Independent Medical Examination (IME) measure. IMEs fill different needs in clinical lawful issues, however, a large portion of us consider the IME a second assessment that responds to certain reference questions. Individuals from the offending party bar attempting individual injury cases likewise have the chance to look for second suppositions, yet shockingly, most offended parties see the IME as something for the insurance agency or the business. Clearly, some gathering is answerable for the clinical assessment, and basically, in light of the fact that instalment is included; one ought not to assume that the IME isn't autonomous. Just the autonomous clinical inspector can decide the degree of objectivity associated with the assessment interaction. Current challenges in Medical Examination for Health Insurance 96 CU IDOL SELF LEARNING MATERIAL (SLM)

Figure 6.4 : Coronavirus’s impact All About Tele medical Check-Ups for Term Insurance during COVID-19 From normalising the use of masks and sanitizer’s in our daily lives to working from home, the Covid -19 pandemic has changed our ways of life altogether. Moreover, companies from all sectors have moulded their policies and rules to adhere to the government guidelines strictly and spread awareness by practicing and promoting social distancing. For instance, several Indian banks have started providing their customers with online video conferencing for the KYC procedure to open a new account instead of the traditional visit to a branch. Many insurance companies like Max Bupa, HDFC Ergo, Tata AIA, and Religare have caught up with the trend and have introduced tele medical check-up services for term insurance policies. The following article elaborates on the facility, but first, let’s learns about these medical examinations and their benefits. What Happens in a Medical Examination? The medical test mainly included weight and height measurements for Body Mass Index (BMI), urine tests, cholesterol, complete blood count, differential count, fasting plasmaglucoseand HIV I and II. Moreover, additional tests can be conducted according to your age, sum assured, family history of illness and the type of the purchased term insurance policy. What are the Benefits of a Medical Examination? 97 CU IDOL SELF LEARNING MATERIAL (SLM)

A term insurance policy with a medical examination can help a fit and healthy individual get a suitable plan with high coverage and sum assured at low premium rates because of the low risk evaluation. Moreover, the test also gives a reality check about the individual’s health and medical conditions. Tele Medical Check-Ups for Term Insurance During COVID-19 A tele medical check-up is done through a phone call with the doctor instead of physical consultations. The life assured has to provide the doctor with all details and information about his/her history of the family disease, any pre-existing illness and prescriptions of past ailments over the phone call made at the pre-decided time. The insurance policy can reject the application if it finds out that the disclosed information is false. This facility has helped ensure the continuity of the insurance policies without exposing doctors and policyholders to the threat of the Covid-19 virus. Take Away Although only a few insurance companies have adopted the practice of tele medical check- ups, that too on a limited scale; it is expected that the facility would be implemented all over the country to help people get a life insurance policy from the comforts of their safe house. Despite the inclinations of invested individuals, the total, practical IME requires crafted by different gatherings including, obviously, the free clinical analyst. Nonetheless, preceding orchestrating an IME, an alluding gathering would profit with considering the IME as a three- venture measure: 1. Pre-examination 2. Examination 3. Post-examination 6.3.1 Pre-examination It is significant that who demands the IME is less significant than what questions the alluding party needs replied. Reference sources ought not accept that the autonomous clinical inspector gets what is generally anticipated of him/her as far as the issues to be researched and tended to in a report. i. First thing alluding gatherings ought to do is to painstakingly think about what questions they need the inspector to address. ii. Secondly, nothing can disrupt the IME cycle quicker than deficient records. IMEs should respond to all inquiries posed of the inspector, and in the event that he/she isn't completely educated, the analyst cannot do as such. Trauma centre records can be basic. Moreover, pre-mishap records are quite often critical to the assurance of causality, for instance. History taking from the patient alone is just insufficient, particularly in a contested circumstance. Crude information (i.e., 98 CU IDOL SELF LEARNING MATERIAL (SLM)

genuine movies instead of interpretive reports) from indicative testing are consistently significant. The more in the method of relevant data that the reference source can get or find and ship off the free clinical inspector, the better. In case there is any uncertainty about what may be appropriate, ask the free clinical inspector. On the off chance that you can't speak with the IME expert or dependable individuals from his/her staff, discover another specialist. Nothing will squander cash or result in a terrible result more than awful or lacking information. This cycle would recommend that correspondence and planning are basic, and they are. \"Such a large number of gourmet experts in the kitchen\" can bring about helpless correspondence and awful results. In case it is the protection agent's strategy or method to work through outsiders (organizations that plan IMEs, for instance), the agent should be guaranteed that the booking party is approved to ask for and equipped for social affair the fundamental pre-assessment data to make the IME a triumph. What is a triumph? An assessment that really explains a circumstance inside \"a healthy level of expert sureness.\" Do not double-cross the IME by neglecting to pose proper inquiries, ones that can be replied by the expert you hold, or potentially by fail to assemble the essential data so the IME can finish up with proficient conviction. iii. Thirdly, select a fitting inspector given the disabilities of concern and the inquiries at issue. Clearly, if the hindrance is a mental issue, don't look for the assessment of the family specialist or, besides, a nervous system specialist. Discover a board- affirmed therapist, ideally a criminological specialist who knows something about the finding being referred to. Few out of every odd criminological specialist, be that as it may, has insight in conditions related with injury. iv. Lastly, when the issue of incapacity is of worry to the patient and the reference source, then, at that point the doctor basically needs a set of working responsibilities depicting the fundamental elements of the position in question. It is vital that all gatherings (the reference source, the doctor, and the patient) fathom that there is a critical differentiation among hindrance and incapacity, and doctors are only occasionally prepared to assess inability. Impairment Does Not a Disability Make. The American Medical Association's (AMA) Guide to the Evaluation of Permanent Impairment recognizes “impedance\" and a \"handicap\" as an essential for its individuals to appreciate. The AMA characterizes impedance as \"any misfortune or irregularity of mental, physiological or anatomical construction or capacity.\" Simply expressed, disability is a 99 CU IDOL SELF LEARNING MATERIAL (SLM)

change in a person's wellbeing status (i.e., injury or ailment) that is evaluated by clinical means. A weakened individual isn't really debilitated. The AMA proposes acknowledgment of the meaning of inability offered by the World Health Organization as \"any limitation or need (coming about because of a debilitation) of capacity to play out a movement in the way or inside the reach thought about typical for people, especially in friendly or word related settings.\" Disability, as a rule, might be considered as the hole between what an individual can do and what an individual necessities or needs to do. Word related incapacity is the distinction between what a disabled individual can do and what a specific occupation requests. Doctors analyse, measure, and endeavour to enhance disability and its impacts on working. Professional recovery staffs assess word related inability. At the point when the doctor says, \"Venkat can work,\" the doctor's revelation for the most part has little legitimacy except if the doctor has cautiously and precisely comprehended the fundamental occupation capacities and requests of Venkat's particular work. And, after it’s all said and done, the doctor's professional decision must be required to address that work, given that Venkat was the officeholder. Something else, a doctor has commonly no information on Venkat's aptitudes for the work. In like manner, the clinical analyst's explanation that \"Venkat is impaired\" should be explicit to a task, and ideally a particular occupation interest or set of requests. Something else, the end that Venkat is \"completely handicapped\" is essentially inefficacious on the grounds that the doctor doesn't have the foggiest idea about the entirety of Venkat's potential work alternatives inside medicinally resolved limitations. The key, then, at that point, is for the doctor to depict unmistakable limitations as far as capacity. Clearly, there are exertional limitations and non-exertional limitations, and the inspecting doctor ought to be equipped for indicating which, contingent upon his/her preparation and discipline. For instance, a visual hindrance might create a non-exertional impediment or require the doctor's suggested limitation and, accordingly, ought not be tended to by a muscular specialist. At last, to be exact, all invested individuals should know the contrast among limit and limitation. They are unique. A constraint is the thing that an individual can't do; a limitation is a forbiddance gone ahead by a clinical expert. The clinical expert by and large limits an individual since he/she accepts the individual ought to stay inside a specific boundary of working. 6.3.2 Examination There is no specialist patient advantage for IMEs. Patients and autonomous clinical analysts ought to comprehend this totally prior to starting the cycle. Ideally, the doctor ought to disclose this unmistakably to the examinee. In addition, when a free clinical inspector starts the interaction, he/she would be delinquent to start treating the patient, regardless of whether the doctor feels morally obliged to do as such. That isn't the free clinical analyst's job. 100 CU IDOL SELF LEARNING MATERIAL (SLM)