Insurance in the United States

Insurance in the United States refers to the market for risk in the United States, the world's largest insurance market by premium volume.[1] Of the $4.640 trillion of gross premiums written worldwide in 2013, $1.274 trillion (27%) were written in the United States.[1]

Insurance, generally, is a contract in which the insurer agrees to compensate or indemnify another party (the insured, the policyholder or a beneficiary) for specified loss or damage to a specified thing (e.g., an item, property or life) from certain perils or risks in exchange for a fee (the insurance premium).[2] For example, a property insurance company may agree to bear the risk that a particular piece of property (e.g., a car or a house) may suffer a specific type or types of damage or loss during a certain period of time in exchange for a fee from the policyholder who would otherwise be responsible for that damage or loss. That agreement takes the form of an insurance policy.[3]

Insurance provides indemnification against loss or liability from specified events and circumstances that may occur or be discovered during a specified period.

—FASB Statement of Financial Accounting Standards No. 113, "Accounting for Reinsurance of Short-Duration and Long-Duration Contracts" December 1992

History

See also: History of insurance

The first insurance company in the United States underwrote fire insurance and was formed in Charleston, South Carolina, in 1735.[4] In 1752, Benjamin Franklin helped form a mutual insurance company called the Philadelphia Contributionship, which is the nation's oldest insurance carrier still in operation.[5][6] Franklin's company was the first to make contributions toward fire prevention. Not only did his company warn against certain fire hazards, it refused to insure certain buildings where the risk of fire was too great, such as all wooden houses.

The first stock insurance company formed in the United States was the Insurance Company of North America in 1792.[7] Massachusetts enacted the first state law requiring insurance companies to maintain adequate reserves in 1837. Formal regulation of the insurance industry began in earnest when the first state commissioner of insurance was appointed in New Hampshire in 1851. In 1859, the State of New York appointed its own commissioner of insurance and created a state insurance department to move towards more comprehensive regulation of insurance at the state level.[8]

Insurance and the insurance industry has grown, diversified and developed significantly ever since. Insurance companies were, in large part, prohibited from writing more than one line of insurance until laws began to permit multi-line charters in the 1950s. From an industry dominated by small, local, single-line mutual companies and member societies, the business of insurance has grown increasingly towards multi-line, multi-state and even multi-national insurance conglomerates and holding companies.[4]

Regulation

State-based insurance regulatory system

Historically, the insurance industry in the United States was regulated almost exclusively by the individual state governments. The first state commissioner of insurance was appointed in New Hampshire in 1851 and the state-based insurance regulatory system grew as quickly as the insurance industry itself.[9] Prior to this period, insurance was primarily regulated by corporate charter, state statutory law and de facto regulation by the courts in judicial decisions.[10][11]

Under the state-based insurance regulation system, each state operates independently to regulate their own insurance markets, typically through a state department of insurance or division of insurance. Stretching back as far as the Paul v. Virginia case in 1869, challenges to the state-based insurance regulatory system have risen from various groups, both within and without the insurance industry. The state regulatory system has been described as cumbersome, redundant, confusing and costly.[12]

The United States Supreme Court found in the 1944 case of United States v. South-Eastern Underwriters Association that the business of insurance was subject to federal regulation under the Commerce Clause of the U.S. Constitution.[13] The United States Congress, however, responded almost immediately with the McCarran-Ferguson Act in 1945.[14] The McCarran-Ferguson Act specifically provides that the regulation of the business of insurance by the state governments is in the public interest. Further, the Act states that no federal law should be construed to invalidate, impair or supersede any law enacted by any state government for the purpose of regulating the business of insurance, unless the federal law specifically relates to the business of insurance.[15]

A wave of insurance company insolvencies in the 1980s sparked a renewed interest in federal insurance regulation, including new legislation for a dual state and federal system of insurance solvency regulation.[16] In response, the National Association of Insurance Commissioners (NAIC) adopted several model reforms for state insurance regulation, including risk-based capital requirements, financial regulation accreditation standards and an initiative to codify accounting principles. As more and more states enacted versions of these model reforms into law, the pressure for federal reform of insurance regulation waned.[17] However, there are still significant differences between states in their systems of insurance regulation, and the cost of compliance with those systems is ultimately borne by insureds in the form of higher premiums. McKinsey & Company estimated in 2009 that the U.S. insurance industry incurs about $13 billion annually in unnecessary regulatory costs under the state-based regulatory system.[18]

The NAIC acts as a forum for the creation of model laws and regulations. Each state decides whether to pass each NAIC model law or regulation, and each state may make changes in the enactment process, but the models are widely, albeit somewhat irregularly, adopted. The NAIC also acts at the national level to advance laws and policies supported by state insurance regulators. NAIC model acts and regulations provide some degree of uniformity between states, but these models do not have the force of law and have no effect unless they are adopted by a state. They are, however, used as guides by most states, and some states adopt them with little or no change.[19]

There is a long-running debate within and among states over the importance of government regulation of insurance which is noticeable in the different titles of their state insurance regulatory agencies. In many states, insurance is regulated through a cabinet-level "department" because of its economic importance. In other states, insurance is regulated through a "division" of a larger department of business regulation or financial services, on the grounds that elevating too many government agencies to departments leads to administrative chaos and the better option is to maintain a clear chain of command.

Federal regulation of insurance

Nevertheless, federal regulation has continued to encroach upon the state regulatory system.[16] The idea of an optional federal charter was first raised after a spate of solvency and capacity issues plagued property and casualty insurers in the 1970s. This OFC concept was to establish an elective federal regulatory scheme that insurers could opt into from the traditional state system, somewhat analogous to the dual-charter regulation of banks. Although the optional federal chartering proposal was defeated in the 1970s, it became the precursor for a modern debate over optional federal chartering in the last decade.[20]

President Obama signing Dodd-Frank Reform Act into law

In 1979 and the early 1980s the Federal Trade Commission attempted to regulate the insurance industry, but the Senate Commerce Committee voted unanimously to prohibit the FTC's efforts. President Jimmy Carter attempted to create an "Office of Insurance Analysis" in the Treasury Department, but the idea was abandoned under industry pressure.[21]

Over the past two decades, renewed calls for optional federal regulation of insurance companies have sounded, including the Gramm-Leach-Bliley Act in 1999, the proposed National Insurance Act in 2006 and the Patient Protection and Affordable Care Act ("Obamacare") in 2010.[16]

In 2010, Congress passed the Dodd–Frank Wall Street Reform and Consumer Protection Act which is touted by some as the most sweeping financial regulation overhaul since the Great Depression. The Dodd-Frank Act has significant implications for the insurance industry. Significantly, Title V of created the Federal Insurance Office (FIO) in the Department of the Treasury. The FIO is authorized to monitor all of the insurance industry and identify any gaps in the state-based regulatory system. The Dodd-Frank Act also establishes the Financial Stability Oversight Council (FSOC), which is charged with monitoring the financial services markets, including the insurance industry, to identify potential risks to the financial stability of the United States.[16][22][23]

Organization

Admitted v. surplus

An important artifact of the state-based insurance regulation system in the United States is the dichotomy between admitted and surplus insurers. Insurers in the U.S. may be "admitted", meaning that they have been formally admitted to a state's insurance market by the state insurance commissioner, and are subject to various state laws governing organization, capitalization, policy forms, rate approvals, and claims handling. Or they may be "surplus", meaning that they are nonadmitted in a particular state but are willing to write coverage there. Surplus line insurers are supposed to underwrite only very unusual or difficult-to-insure risks, to prevent them from undermining each state's ability to regulate its insurance market. Although experienced insurance brokers are well aware of what risks an admitted insurer will not accept, they must document a "diligent effort" at actually shopping around a risk to several admitted insurers (typically three, who will promptly reject it) before applying for coverage with a surplus line insurer.[24]

To relieve insurers and brokers of that tedious and time-consuming chore, many states now maintain "export lists" of risks that the state insurance commissioner has already identified as having no coverage available whatsoever from any admitted insurer in the state. In turn, brokers presented by clients with those risks can immediately "export" them to the out-of-state surplus market and apply directly to surplus line insurers without having to first document multiple attempts to present the risk to admitted insurers.[24] However, many states have refused to establish export lists, including Florida, Illinois, and Texas.

By their very nature, export lists illustrate what U.S. insurers consider to be hard-to-insure risks. For example, the California export list includes ambulance services, amusement parks, fireworks displays, moving a building, demolition, hot air balloons, product recalls, sawmills, security guards, and tattoo shops, as well as particular types of insurance like Employment Practices Liability and kidnap and ransom.[25]

Although surplus line insurers are still regulated by the states (or countries) in which they are actually admitted, the disadvantages of obtaining insurance from a surplus line insurer are that the policy will usually be written on a nonstandard form (that is, not from the Insurance Services Office), and if the insurer collapses, its insureds in states in which it is nonadmitted will not enjoy certain types of protection available to insureds in the states (or countries) in which the insurer is admitted. However, for persons trying to obtain coverage for unusual risks, the choice is usually between a surplus line insurer or no coverage at all.

One long-running issue with the surplus lines concept is that it makes less sense when applied to sophisticated insureds with many risks spread across multiple states. Congress enacted the Nonadmitted and Reinsurance Reform Act of 2010 in an attempt to clarify which state gets to regulate the sale of surplus lines insurance to such insureds, and to exempt certain elite categories of insurance purchasers from the normal requirement of a diligent effort to procure coverage from admitted insurers.

Insurance groups

Only the smallest insurers exist as a single corporation. Most major insurance companies actually exist as insurance groups. That is, they consist of holding companies which own several admitted and surplus insurers (and sometimes a few excess insurers and reinsurers as well). There are dramatic variations from one insurance group to the next in terms of how its various business functions are divided up among its subsidiaries or outsourced to third party corporations altogether. All major insurance groups in the U.S. that transact insurance in California maintain a publicly accessible list on their Web sites of the actual insurer entities within the group, as required by California Insurance Code Section 702.[26]

An example of how insurance groups work is that when people call GEICO and ask for a rate quote, they are actually speaking to GEICO Insurance Agency, which may then write a policy from any one of GEICO's eight insurance companies. When the customer writes their check for the premium to "GEICO", the premium is actually deposited with one of those eight insurance companies (the one that actually wrote their policy). Similarly, any claims against the policy are charged to the issuing company. However, as far as most layperson customers know, they are simply dealing with GEICO.

Obviously, it is more difficult to operate an insurance group than a single insurance company, since employees must be painstakingly trained to observe corporate formalities so that courts will not treat the entities in the group as alter egos of each other. For example, all insurance policies and all claim-related documents must consistently reference the relevant company within the group, and the flows of premiums and claim payments must be carefully recorded against the books of the correct company.

The advantage of the insurance group system is that a group has increased survivability over the long run than a single insurance company. If any one company in the group is hit with too many claims and fails, the company can be quietly placed into "runoff" (in which it continues to exist only to process remaining claims and no longer writes new coverage) but the rest of the group continues to operate.

By way of contrast, when small insurers fail, they tend to do so in a rather wild and spectacular fashion, as was often the case during the economic cycles of the 1970s and 1980s. Sometimes the result may be a state-supervised takeover by which a state agency may have to assume part of their residual liabilities.

Types

A common typology of insurance in the United States is to divide the industry into life and health insurers, on the one hand, and property and casualty insurers on the other:

• Life, Health
  • Health (dental, vision, medications, others)
  • Life (long-term care, accidental death and dismemberment, hospital indemnity)
  • Annuities (securities)
  • Life and Annuities
• Property and Casualty (P & C)
  • Property (flood, earthquake, home, auto, fire, boiler, title, pet)
  • Casualty (errors and omissions, workers' compensation, disability, liability)

Reinsurance is usually treated as a separate category from the above types.

Home insurance

A home in Louisiana damaged by Hurricane Katrina

Main article: Home insurance

In the United States, most home buyers borrow money in the form of a mortgage loan, and the mortgage lender often requires that the buyer purchases homeowner's insurance as a condition of the loan, in order to protect the bank if the home is destroyed. Anyone with an insurable interest in the property should be listed on the policy. In some cases the mortgagee will waive the need for the mortgagor to carry homeowner's insurance if the value of the land exceeds the amount of the mortgage balance. In such a case even the total destruction of any buildings would not affect the ability of the lender to be able to foreclose and recover the full amount of the loan.

Home insurance in the United States may differ from other countries; for example, in Britain, subsidence and subsequent foundation failure is usually covered under an insurance policy.[27] United States insurance companies used to offer foundation insurance, which was reduced to coverage for damage due to leaks, and finally eliminated altogether.[28] The insurance is often misunderstood by its purchasers; for example, many believe that mold is covered when it is not a standard coverage.[29]

History

The first homeowner's policy per se in the United States was introduced in September 1950, but similar policies had already existed in Great Britain and certain areas of the United States. In the late 1940s, US insurance law was reformed and during this process multiple line statutes were written, allowing homeowner's policies to become legal.[30]

Prior to the 1950s there were separate policies for the various perils that could affect a home. A homeowner would have had to purchase separate policies covering fire losses, theft, personal property, and the like. During the 1950s policy forms were developed allowing the homeowner to purchase all the insurance they needed on one complete policy. However, these policies varied by insurance company, and were difficult to comprehend.[31]

The need for standardization grew so great that a private company based in Jersey City, New Jersey, Insurance Services Office, also known as the ISO, was formed in 1971 to provide risk information and it issued simplified homeowner's policy forms for reselling to insurance companies. These policies have been amended over the years.

Modern developments have changed the insurance coverage terms, availability, and pricing.[32] Homeowner's insurance has been relatively unprofitable, due in part to catastrophes such as hurricanes as well as regulators' reluctance to authorize price increases.[32] Coverages have been reduced instead and companies have diverged from the former standardized model ISO forms.[32] Water damage due to burst pipes in particular has been restricted or in some cases entirely eliminated.[32] Other restrictions included time limits, complex replacement cost calculations (which may not reflect the true cost to replace), and reductions in wind damage coverage.[32]

Policies

Homeowner's insurance was first introduced in the 1950s. Today, most homeowner's insurance policies are based on forms developed by the Insurance Services Office (ISO) and the American Association of Insurance Services (AAIS).[33]

Policy form	Structural coverage[34]	Property coverage[34]
HO1 – Basic	Minimal	Minimal
HO2 – Broad	Broad "named perils"	Broad "named perils"
HO3 – Special	Special "open risks"	Broad "named perils"
HO4 – Tenants	No coverage	Broad "named perils"
HO6 – Condominium	Varies	Broad "named perils"

HO0 – Dwelling Fire Form

A form that provides coverage on a home against fire, smoke, windstorm, hail, lightning, explosion, vehicles, and civil unrest. It does not cover the assured's personal property, personal liability, or medical expenses. It is the type of policy a mortgage lender will buy for a borrower if the latter's homeowner policy lapses.

HO1 – Basic Form

A basic policy form that provides coverage on a home against 11 listed perils; contents are generally included in this type of coverage, but must be explicitly enumerated. The perils include fire or lightning, windstorm or hail, vandalism or malicious mischief, theft, damage from vehicles and aircraft, explosion, riot or civil commotion, glass breakage, smoke, volcanic eruption, and personal liability. Exceptions include floods, earthquakes. Most states no longer offer this type of coverage.

HO2 – Broad Form

A more advanced form that provides coverage on a home against 16 listed perils (including all 11 on the HO1). The coverage is usually a "named perils" policy, which lists the events that would be covered.

HO3 – Special Form

The typical, most comprehensive form used for single-family homes. The policy provides "all risk" coverage on the home with some perils excluded, such as earthquake and flood. Contents are covered on a named-peril basis. (Note: "all risk" is poorly termed as it is essentially named exclusions (i.e., if it is not specifically excluded, it is covered).)

HO4 – Contents Broad Form

The Contents Broad, or Tenants, form is for renters. It covers personal property against the same perils as the contents portion of the HO2 or HO3.[35] An HO4 generally also includes liability coverage for personal injury or property damage inflicted on others.

HO5 – Comprehensive Form

Covers the same as HO3 plus more. On this policy the contents are covered on an open peril basis, therefore as long as the cause of loss is not specifically excluded in the policy it will be covered for that cause of loss.

HO6 – Unit-Owners Form

The form for condominium owners. It insures personal property, walls, floors and ceiling against all of the perils in the Broad Form. The rest of the condo is covered by a separate policy purchased by the association.

HO8 – Modified Coverage Form

The form is for the owner-occupied older home whose replacement cost far exceeds the property's market value.

Coverage rates

According to a 2015 National Association of Insurance Commissioners (NAIC) report on data from 2012, 76.8% of homes were covered by owner-occupied homeowners' policies. Of these, 62.9% had the HO3 Special, and 9.4% had the more expensive HO5 Comprehensive. Both of these policies are "all risks" or "open perils", meaning that they cover all perils except those specifically excluded. 2.7% were the HO2 Broad, which covers only specific named perils. Others, at about 1% each, include the HO1 Basic and the HO8 Modified, which is the most limited in its coverage. HO8, also known as older home insurance, is likely to pay only actual cash value for damages rather than replacement.[36]

The remaining 21.3% of home insurance policies were covered by renter's or condominium insurance. 14.8% of these had the HO-4 Contents Broad form, also known as renters' insurance, which covers the contents of an apartment not specifically covered in the blanket policy written for the complex.[36] This policy can also cover liability arising from injury to guests as well as negligence of the renter within the coverage territory. Common coverage areas are events such as lightning, riot, aircraft, explosion, vandalism, smoke, theft, windstorm or hail, falling objects, volcanic eruption, snow, sleet, and weight of ice. The remainder had the HO-6 Unit-Owners policy, also known as a condominium insurance, which is designed for the owners of condos and includes coverage for the part of the building owned by the insured and for the property housed therein. Designed to span the gap between the coverage provided by the blanket policy written for the entire neighborhood or building and the personal property inside the home. The condominium association's by-laws may determine the total amount of insurance necessary. E.g., in Florida, the scope of coverage is prescribed by statute – 718.111(11)(f).[37]

In addition, about 1.9% of homes were covered by a dwelling fire policy[36] (the term dwelling fire comes from the fact that, originally, these home owner's policies only covered fires) which covers property damage to a structure and is typically sold to noncommercial owners of rented houses. It may also cover the owner's personal property (such as appliances and furnishings). The owner's liability may be extended from their own primary home insurance and, thus, may not comprise part of the Dwelling Fire policy.

Not all states allow the ISO forms to be utilized or may require that additional clauses are included to meet state insurance regulations.

Typically consumers can save money by purchasing their insurance directly from a company rather than through an agent, but there are not many companies selling home insurance directly.[38] However, an experienced agent can provide expertise (especially expertise with the local insurance environment) that a company may lack.[39]

Coverage classifications

While coverage limits can vary, there are 6 core coverage components make up a standard policy in the United States. These are based on standard Insurance Services Office or American Association of Insurance Services forms.

Coverage component[40]	Typical limit of coverage[40]
Coverage A – Dwelling	Policyholder chooses
Coverage B – Other structures	10% of Dwelling coverage limit
Coverage C – Personal property	50% of Dwelling coverage limit
Coverage D – Loss of use	20% of Dwelling coverage limit
Coverage E – Personal liability	Policyholder chooses
Coverage F – Medical payments	Policyholder chooses

Section I – Property Coverage

Coverage A – Dwelling

Covers the value of the dwelling itself (not including the land). Typically, a coinsurance clause states that as long as the dwelling is insured to 80% of actual value, losses will be adjusted at replacement cost, up to the policy limits. This is in place to give a buffer against inflation. HO-4 (renter's insurance) typically has no Coverage A, although it has additional coverages for improvements.

Coverage B – Other Structures

Covers other structures around the property that are not used for business, except as a private garage. Typically limited at 10% to 20% of the Coverage A, with additional amounts available by endorsement.

Coverage C – Personal Property

Covers personal property, with limits for the theft and loss of particular classes of items (e.g., $200 for money, banknotes, bullion, coins, medals, etc.). Typically 50–70% of Coverage A is required for contents, which means that consumers may pay for much more insurance than necessary. This has led to some calls for more choice.[41] There are two types of policies for personal property: cash value policy and replacement cost policy. Cash value policy will pay the cost to replace belongings, minus deprecation. Replacement cost policy will reimburse the assured for the full, current cost of replacing belongings.[42]

Coverage D – Loss of Use/Additional Living Expenses

Covers expenses associated with additional living expenses (i.e. rental expenses) and fair rental value, if part of the residence was rented, however only the rental income for the actual rent of the space not services provided such as utilities.

Section II – Liability Coverage

Coverage E – Personal Liability

Covers damages which the insured is legally liable for and provides a legal defense at the insurer's own expense. About a third of the losses for this coverage are from dog bites.[43] Acts which are "expected or intended" are typically not covered.[44]

Coverage F – Medical Payments

Designed to pay for medical expenses to others who are accidentally injured on an insured location or by the activities of an insured, resident employee, or an animal owned by or in the care of an insured. These payments are not based on the law of negligence; that is, no negligence on the part of the insured has to be proven for payment to be made.[45]

Section III – Additional Coverage Options

Flood Insurance

Flood damage is typically excluded under standard homeowners' and renters' insurance policies. Flood coverage, however, is available in the form of a separate policy both from the National Flood Insurance Program (NFIP) and from a few private insurers.[46]

Earthquake Coverage

Earth movement is a common exclusion for home insurance policies around the world. A separate policy, rider, or endorsement must usually be purchased in order for this peril to be covered. Because of the catastrophic nature of this risk, earthquake related coverage is typically backed by some form of government organization or specialized organization to assist with claims payout and regulation.[47]

Additional Coverages

Includes a variety of expenses such as debris removal, reasonable repairs, damage to trees and shrubs for certain named perils (excluding the most common causes of damage, wind and ice), fire department charges, removal of property, credit card / identity theft charges, loss assessment, collapse, landlord's furnishing, and some building additions. These vary depending upon the form.

Section IIII – Exclusions

In an open perils policy, specific exclusions will be stated in this section. These generally include earth movement, water damage, power failure, neglect, war, nuclear hazard, septic tank back-up expenses, intentional loss, and concurrent causation (for HO3).[48] The concurrent causation exclusion excludes losses where both a covered and an excluded loss occur. In addition, the exclusion for building ordinance can mean that increased expenses due to local ordinances may not be covered.[49] A 2013 survey of Americans found that 41% believed mold was covered, although it is typically not covered if the water damage occurs over a period of time, such as through a leaky pipe.[50]

Causes of loss

According to the 2008 Insurance Information Institute factbook, for every $100 of premium, in 2005 on average $16 went to fire and lightning, $30 to wind and hail, $11 to water damage and freezing, $4 for other causes, and $2 for theft. An additional $3 went to liability and medical payments and $9 for claims settlement expenses, and the remaining $25 was allocated to insurer expenses.[51] One study of fires found that most were caused by heating incidents, although smoking was a risk factor for fatal fires.[52]

Claims process

After a loss, the insured is expected to take steps to mitigate the loss. Insurance policies typically require that the insurer be notified within a reasonable time period. After that, a claims adjuster will investigate the claim and the insured may be required to provide various information.

Filing a claim may result in an increase in rates, or in nonrenewal or cancellation. In addition, insurers may share the claim data in an industry database (the two major ones are CLUE and A-PLUS[53]), with Claim Loss Underwriting Exchange (CLUE) by Choicepoint receiving data from 98% of U.S. insurers.[54]

Institutions

Various associations, government agencies, and companies serve the insurance industry in the United States. The National Association of Insurance Commissioners provides models for standard state insurance law, and provides services for its members, which are the state insurance departments or divisions. Many insurance providers use the Insurance Services Office, which produces standard policy forms and rating loss costs and then submits these documents on the behalf of member insurers to the state insurance departments or divisions.

See also

Other US insurance topics:

• Health insurance in the United States
• Insurance Regulatory Information System
• McCarran-Ferguson Act
• National Association of Insurance Commissioners

General insurance topics:

• Travel insurance
• Casualty insurance
• Health insurance
• History of insurance
• Insurance
• Life insurance

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