Insurance and transport law : controlling insurance contract terms : Section 54 of the Insurance Contracts Act – compliance, recovery and accountability

Commonwealth legislation covering insurance contracts contains numerous provisions designed to control the operation and effect of terms in life and general insurance contracts. For example, the Life Insurance Act 1995 (Cth) contains provisions regulating the consequences attendant upon incorrect statements in proposals [1] and non-payment of premiums, [2] provides that an insurer may only exclude liability in the case of suicide if it has made express provision for such contingency in its policy, [3] and severely restricts the efficacy of conditions as to war risks. [4] The Insurance Contracts Act 1984 (Cth) is even more intrusive and has a major impact upon contractual provisions in the general insurance field. It is beyond the scope of this note to explore all of these provisions in any detail but examples of controls and constraints imposed upon the operation and effect of contractual provisions include the following. A party is precluded from relying upon a provision in a contract of insurance if such reliance would amount to a failure to act with the utmost good faith. [5] Similarly, a policy provision which requires differences or disputes arising out of the insurance to be submitted to arbitration is void, [6] unless the insurance is a genuine cover for excess of loss over and above another specified insurance. [7] Similarly clause such as conciliation clauses, [8] average clauses, [9] and unusual terms [10] are given qualified operation. [11] However the provision in the Insurance Contracts Act that has the greatest impact upon, and application to, a wide range of insurance clauses and claims is s 54. This section has already generated a significant volume of case law and is the focus of this note. In particular this note examines two recent cases. The first, Johnson v Triple C Furniture and Electrical Pty Ltd [2012] 2 Qd R 337, (hereafter the Triple C case), is a decision of the Queensland Court of Appeal; and the second, Matthew Maxwell v Highway Hauliers Pty Ltd [2013] WASCA 115, (hereafter the Highway Hauliers case), is a decision of the Court of Appeal in Western Australia. This latter decision is on appeal to the High Court of Australia. The note considers too the decision of the New South Wales Court of Appeal in Prepaid Services Pty Ltd v Atradius Credit Insurance NV [2013] NSWCA 252 (hereafter the Prepaid Services case).These cases serve to highlight the complex nature of s 54 and its application, as well as the difficulty in achieving a balance between an insurer and an insured's reasonable expectations.

Insurance contract disclosure – an uncertain balance

This article canvasses recent case law adjudicating the uneasy disclosure balance between the interests of the insurer and the insured in the process of transacting an insurance contract. It examines also the consequences of non-disclosure and misrepresentation and whether the avowed legislative intent — that the liability of the insurer in respect of a claim is to be reduced to the amount that would place the insurer in the position it would have been had the non-disclosure or misrepresentation not occurred — is being achieved in practice. As there is no doubt as to who bears the onus of proof as to non-disclosure or misrepresentation it is surprising that insurers continue to flounder in this regard in relation to underwriting guidelines and adherence to them. The article reviews recent case law in this context and stresses that an insurer wishing to preserve its capacity to avoid liability on the basis that it would not have entered into a contract at all had the true situation been known to it must maintain detailed underwriting guidelines supported by consistent adherence to those guidelines. Recent case law also emphasises that the insurer must provide clear and cogent admissible evidence from appropriate personnel and officers of the company to discharge its onus.

Adaptation of the international investment contract: the hardship clause

Este trabalho acadêmico explora, em linhas gerais, a questão da adaptação do contrato de investimento internacional, e o tema ‘cláusula de hardship’ em específico. Objetiva-se efetuar uma análise detalhada da cláusula de hardship, como meio de adaptação e flexibilização de contratos internacionais de investimento sob a ótica da prática jurídica e mercantil contemporânea. A discussão se centra no contraste entre a possibilidade de adaptação do contrato por circunstâncias imprevisíveis e o imperativo de previsibilidade no investimento. Nesse sentido, o estudo busca oferecer soluções práticas para o dilema existente entre a necessidade de segurança na relação econômica (cumprimento do contato) e a prevenção da possibilidade de ruína financeira para quaisquer das partes no caso de uma mudança brusca no contexto dos negócios. O trabalho está centrado em uma investigação teórica acerca dos temas de readaptação contratual; diferenças entre sistemas jurídicos de estados-nações, e suas consequências no comércio internacional; e a cláusula de hardship em si. Como forma de contribuir para uma compreensão prática na questão da adaptação do contrato de investimento internacional devido a fatores imprevistos, este trabalho analisa casos reais e tendências atuais observadas na arbitragem internacional.

Dunne's international insurance reports.

Mode of access: Internet.

La ley aplicable al contrato de seguro internacional

A raíz de la promulgación de la Ley 1328 de 2009 y de la celebración del Tratado de Libre Comercio (TLC) con los Estados Unidos, el sistema normativo colombiano será testigo de un negocio jurídico que, hasta antes de esos eventos, no había visto factible su celebración: el contrato de seguro internacional. Al vernos frente a esta realidad, no queda más remedio que empezar a dar respuesta a las preguntas que surgen con ocasión de que un residente en nuestro país contrate con una compañía de seguros ubicada en el exterior; y, tal vez, la primera de ellas es ¿cuál es la ley aplicable al contrato de seguro internacional? El presente trabajo pretende contribuir a la búsqueda de una respuesta a este cuestionamiento de no poca trascendencia; con el estudio de legislación, doctrina y jurisprudencia extranjeras, junto con el análisis de la particular regulación del contrato de seguro en Colombia, además de consideraciones en torno a la jurisdicción local y foránea, "La ley aplicable al contrato de seguro internacional" se convierte en, si bien una sugerencia de respuesta al ya enunciado interrogante, igualmente en un llamado para que sean las autoridades, Magistrados y expertos en el tema, quienes reparen en ese punto desde este momento y, así, no vernos sorprendidos en 2013, cuando vea la luz el primer contrato de seguro internacional en Colombia.

Utmost good faith in insurance : reform overdue?

Considerable attention has been devoted to the duty or doctrine of utmost good faith in the academic literature and in the courts. This attention ranges from an analysis of the precise legal basis for the duty through a consideration of the continuing nature of that duty in the post-contract environment.It is quite clear that all contracts of insurance are subject to this duty of utmost good faith. What is less clear and certain are the incidents attendant upon such a duty and the scope of the obligations that such a duty imposes. This article examines the relative positions that have been reached in England and Australia and concludes with some recommendations for legislative reform to this area of the law.

The insured's non-disclosure in the formation of insurance contracts : a comparative perspective

The requirements that an insured disclose all facts material to a transaction as well as not misrepresent material facts in the formation of an insurance contract are universal requirements of insurance law. The nature and extent of these obligations varies from one jurisdiction to the next. Disclosure in the insurance context is distinct from the general approach in commercial contracts, and in others between persons dealing at arm's length. It is the purpose of this article therefore to examine, on a comparative basis, the approaches adopted in the Anglo-Commonwealth context of England, Australia New Zealand and Singapore to the resolution of disclose issues in the formation of insurance contracts. Particular attention is focused on the Insurance Contracts Act 1984 (Australia) as this statue effects the most significant overhaul of the common law and the National Consumer Council in the United Kingdom has advocated that similar reforms be adopted.

Credit Default Swaps and Insurance: Against the Potts Opinion

Little attention has been given to the possibility that CDS transactions might be construed as insurance contracts in English law. This article challenges the widespread “Potts opinion”, which states that CDSs are not insurance, because they do not require the protection buyer to sustain a loss or to have an insurable interest in the subject matter. CDSs often do provide protection against loss that the buyer is exposed to; loss indemnity is not a necessary characterisation of an insurance contract; insurable interest does not form part of the definition of insurance, but is an additional requirement of valid insurance; and what matters is the substance not the form of the contract. The situation in the US and Australia is also briefly considered.

Disclosure under the prescribed insurance contracts regime : Section 35 of the Insurance Contracts Act 1984 and consumer protection revisited

Section 35 of the Insurance Contracts Act 1984 requires insurers offering insurance policies in six prescribed areas "to clearly inform" prospective insureds of any departure their policies may constitute from the standard covers established by the Act and its accompanying Regulations. This prescribed insurance contracts regime was designed to remedy comprehension problems generated by the length and complexity of insurance documents and to alleviate misunderstanding over the terms and conditions of individual policies. This article examines the rationale underpinning s 35 and the prescribed insurance contracts regime and looks at the operation of the legislation with particular reference to home contents insurance in Australia. It is argued that the means whereby disclosure of derogation from standard cover may be effected largely negates the thrust of the prescribed insurance contract reform. Recommendations to address these operational deficiencies are made.

Disclosure and concealment in consumer insurance contracts

This book provides an in-depth examination of the theoretical,legal, social and economic foundations to disclosure and concealment of information in relation to the formation of consumer insurance contracts. A comparative treatment of this issue is undertaken with particular attention given to the judicial and legislative approaches adopted in the United Kingdom, the United States of America, Australia and New Zealand.

O resseguro no Direito Internacional

O estudo descreve o resseguro no âmbito do Direito Internacional, partindo da constatação da pulverização dos riscos através do mercado global para abordar temas relevantes, tais como: a diferenciação entre resseguro internacional e contrato internacional de resseguro, os usos e costumes internacionalmente aceitos e a autonomia da vontade das partes como fundamento aos contratos de resseguro. São perquiridas também as fontes do direito ressecuritário no âmbito internacional. As relações jurídicas entre Estado e resseguradores e as relações contratuais entre seguradores e resseguradores devem ser regidos pela máxima boa-fé. Essa abordagem reporta-se a princípios consagrados no Direito Internacional do Investimento como padrão de referência para a regulação da atividade ressecuritária e como limite à intervenção dos Estados Descreve-se ainda o resseguro no Brasil, traçando um histórico evolutivo do monopólio à abertura do mercado e constatando algumas iniciativas nacionais do uso do seguro e do resseguro como ferramenta de atração e proteção de investimentos.

Testing for Hidden Information and Action in Automobile Insurance Market

I test the presence of hidden information and action in the automobile insurance market using a data set from several Colombian insurers. To identify the presence of hidden information I find a common knowledge variable providing information on policyholder s risk type which is related to both experienced risk and insurance demand and that was excluded from the pricing mechanism. Such unused variable is the record of policyholder s traffic offenses. I find evidence of adverse selection in six of the nine insurance companies for which the test is performed. From the point of view of hidden action I develop a dynamic model of effort in accident prevention given an insurance contract with bonus experience rating scheme and I show that individual accident probability decreases with previous accidents. This result brings a testable implication for the empirical identification of hidden action and based on that result I estimate an econometric model of the time spans between the purchase of the insurance and the first claim, between the first claim and the second one, and so on. I find strong evidence on the existence of unobserved heterogeneity that deceives the testable implication. Once the unobserved heterogeneity is controlled, I find conclusive statistical grounds supporting the presence of moral hazard in the Colombian insurance market.

Una aproximación teórico-práctica para el costeo de cápitas de paquetes de salud

Metodología para la estimación de cápitas de planes de salud. Se propone un método de cuantificación de insumos a emplear, la estimación de costos indirectos asociados a las intervenciones y un método de anualización para los costos fijos que generalmente trascienden en su vida útil al período de duración de una cápita. Finalmente, a través de un ejercicio práctico de estimación de la cápita del Componente de Salud del Programa Oportunidades de México se ilustra la aplicación del desarrollo metodológico expuesto en la parte inicial.

Insuring cleaner oceans: the economics of oil pollution prevention

The current system of controlling oil spills involves a complex relationship of international, federal and state law, which has not proven to be very effective. The multiple layers of regulation often leave shipowners unsure of the laws facing them. Furthemore, nations have had difficulty enforcing these legal requirements. This thesis deals with the role marine insurance can play within the existing system of legislation to provide a strong preventative influence that is simple and cost-effective to enforce. In principle, insurance has two ways of enforcing higher safety standards and limiting the risk of an accident occurring. The first is through the use of insurance premiums that are based on the level of care taken by the insured. This means that a person engaging in riskier behavior faces a higher insurance premium, because their actions increase the probability of an accident occurring. The second method, available to the insurer, is collectively known as cancellation provisions or underwriting clauses. These are clauses written into an insurance contract that invalidates the agreement when certain conditions are not met by the insured The problem has been that obtaining information about the behavior of an insured party requires monitoring and that incurs a cost to the insurer. The application of these principles proves to be a more complicated matter. The modern marine insurance industry is a complicated system of multiple contracts, through different insurers, that covers the many facets of oil transportation. Their business practices have resulted in policy packages that cross the neat bounds of individual, specific insurance coverage. This paper shows that insurance can improve safety standards in three general areas -crew training, hull and equipment construction and maintenance, and routing schemes and exclusionary zones. With crew, hull and equipment, underwriting clauses can be used to ensure that minimum standards are met by the insured. Premiums can then be structured to reflect the additional care taken by the insured above and beyond these minimum standards. Routing schemes are traffic flow systems applied to congested waterways, such as the entrance to New York harbor. Using natural obstacles or manmade dividers, ships are separated into two lanes of opposing traffic, similar to a road. Exclusionary zones are marine areas designated off limits to tanker traffic either because of a sensitive ecosystem or because local knowledge is required of the region to ensure safe navigation. Underwriting clauses can be used to nullify an insurance contract when a tanker is not in compliance with established exclusionary zones or routing schemes.