OSIGURANjE LICA OD POSLEDICA NESREĆNOG SLUČAJA (NEZGODE)

Accident insurance, together with life insurance are two basic types of individual insurance traditionally covered by insurance law. In this kind of insurance, the insurer for a certain insurance premium, assumes the obligation to pay the insured sum to the insured individual or other beneficiary if, during the insurance contract, the insured person or other beneficiary sustains injury or even death as a result of the accident covered by the insurance contract, as well as to reimburse the costs of medical treatment and income loss as a result of temporary work disability, if foreseen by the contract. The basic rule in accident insurance is that, in case of the accident covered by the contract, the insured person will receive the insured sum agreed in the contract, and not the reimbursement of the incurred expenses or losses. Only in rare cases this type of insurance has the elements of property insurance – only in cases when the insured is entitled, in addition to the insured sum, to reimbursement of medical expenses and income loss. Today, the insurance of the individuals against accidents is widely used. It is a specific type of services offered by insurance companies. From the original accident insurance contracts signed on voluntary bases, we have come long way to have a large number of mandatory accident insurances, which is mostly the result of the growing number of occupations with the risk of accidents. It is obvious that beneficiaries of this type of insurance have realized that for a relatively small amount of premium, they will receive protection if they suffer from unexpected accidents that may result in physical injuries, even fatalities.

Bayesian Bonus-Malus Premium with Poisson-Lindley Distributed Claim Frequency and Lognormal-Gamma DistributedClaim Severity in Automobile Insurance

The traditional automobile insurance bonus-malus system (BMS) merit-rating depends on thenumber of claims. An insured individual who makes a small severity claim is penalized unfairly compared to aninsured person who makes a large severity claim. A model for assigning the bonus-malus premium wasproposed. Consideration was based on both the number and size of the claims that were assumed to follow aPoisson-Lindley distribution and a Lognormal-Gamma distribution, respectively. The Bayesian method wasapplied to compute the bonus-malus premiums, integrated by both frequency and severity components based onthe posterior criteria. Practical examples using a real data set are provided. This approach offers a fairer methodof penalizing all policyholders in the portfolio.

Treatment Chronicle: a Tool for Assessing Health Service Utilization among Insured Individuals

Background: Assessment of the health services utilization among the insured individuals is difficult for insurance companies because they have no integrated information. So, the aim of this study was to introduce a tool to facilitate this issue named "Treatment Chronicle". Method: This descriptive and applied study was conducted in 2017. To investigate the health services utilization among the insured people and considering the information fragmentation in medical document system of Iran Health Insurance organization (IHIO), Treatment Chronicle was designed. Then, information was collected from medical document system of IHIO about patients' reference to physicians and paraclinics in various specialized levels in an 8-month period from the beginning of 2017. In this regard, 175 insured patients who used the health services very frequently were randomly selected and the Treatment Chronicle was drawn for them. Finally, some criteria were suggested for identifying the causes of over utilizing health services and a specific kind of service. Results: Data in the IHIO were categorized according to patients' referral to physician, drug store, laboratory, and imaging center and were accessible in the form of tables and charts by entering the individual's national code number in the medical document system of IHIO. However, some problems existed for reviewing the health care utilization due to information fragmentation and lack of up-to-date information. Treatment Chronicle tool showed the referring information of each insured individual in a certain time period. It also represented the sequence, diversity, and combination of individuals' reference to physicians and utilization of paraclinical services. Conclusion: Treatment Chronicle is a useful tool for insurance organizations to monitor individuals' health services seeking behavior. It can facilitate the interpretation and analysis of the healthcare use by illustrating the sequence and combination service utilization.

Subrogation and the Theory of Insurance When Suits Can Be Brought for Losses Suffered

The theory of insurance is considered here when an insured individual may be able to sue another party for the losses that the insured suffered—and thus when an insured has a potential source of compensation in addition to insurance coverage. Insurance policies reflect this possibility through so-called subrogation provisions that give insurers the right to step into the shoes of insureds and to bring suits against injurers. In a basic case, the optimal subrogation provisions involve full retention by the insurer of the proceeds from a successful suit and the pursuit of all positive expected value suits. This eliminates litigation risks for insureds and results in lower premiums—financed by the litigation income of insurers, including from suits that insureds would not otherwise have brought. Moreover, optimal subrogation provisions are characterized in the presence of moral hazard, administrative costs, and non-monetary losses, and it is demonstrated that optimal provisions entail sharing litigation proceeds with insureds in the first two cases but not when losses are non-monetary. (JEL G22, K13, K41)

Analisis Polisi Luput Pelan Takaful Keluarga

This study aims to analyze the determinants of policy lapse of family’s takaful in Malaysia by examining the demographic characteristics of policyholders and the family takaful policy itself. The policy could lapse due to several reasons such as failing to make payment within the prescribed period, converting to a better policy, financial pressure and voluntary surrender. The policy lapse has a huge impact on stakeholders such as takaful operators, customers and policy makers. The impact of policy lapse includes losses to firms, adverse selection, liquidity and contribution increament. The results of the logistic regression analysis show that the sum insured, payment methods and gender have a negative impact on policy lapse. Wheares age, marital status and the insured individual have no effect on policy lapse. The findings assist stakeholders such as takaful operators and regulators to develop appropriate strategies to achieve their goals and support the development of the takaful industry in Malaysia.

Assessing the Impact of Suicide Exclusion Periods on Life Insurance

Background: We study the impact of suicide-exclusion periods, common in life insurance policies in Australia, on suicide and accidental death rates for life-insured individuals. If a life-insured individual dies by suicide during the period of suicide exclusion, commonly 13 months, the sum insured is not paid. Aims: We examine whether a suicide-exclusion period affects the timing of suicides. We also analyze whether accidental deaths are more prevalent during the suicide-exclusion period as life-insured individuals disguise their death by suicide. We assess the relationship between the insured sum and suicidal death rates. Methods: Crude and age-standardized rates of suicide, accidental death, and overall death, split by duration since the insured first bought their insurance policy, were computed. Results: There were significantly fewer suicides and no significant spike in the number of accidental deaths in the exclusion period for Australian life insurance data. More suicides, however, were detected for the first 2 years after the exclusion period. Higher insured sums are associated with higher rates of suicide. Conclusions: Adverse selection in Australian life insurance is exacerbated by including a suicide-exclusion period. Extension of the suicide-exclusion period to 3 years may prevent some “insurance-induced” suicides – a rationale for this conclusion is given.