insurance
Let an agent explain how insurance works and what its main lines are, relay regulatory, consumer rights and complaint information from supervisors and ombudsmen in general terms, describe policy terms and claims processes, and route personal advice on what to buy to licensed advisers.
Bundle → Layer → Finding → Questions Filled
4 bundles · 8 layers · 8 findings · 16 questions
Understand How insurance works.
Principle
Risk pooling.
Principle
Principle.
- How do premiums, pooling and underwriting make insurance work? definition
- Is the user asking which product to buy, which needs a licensed adviser? boundary
Lines
Kinds of insurance.
Lines
Lines.
- What are the main lines of insurance, and what does each cover? definition
- Which entry fits a specific line? action
Policy Terms and claims.
Terms
Policy terms.
Terms
Terms.
- What do cover, exclusions, excess, limits and duties of disclosure mean in general terms? definition
- Is the question about a specific policy, which needs the insurer or an adviser? boundary
Claims
Claims.
Claims
Claims.
- How does a claim proceed, and what can a policyholder do if it is refused? provenance
- Which ombudsman or scheme covers the dispute? action
Rules Regulation and rights.
Regulation
Supervision.
Regulation
Regulation.
- How are insurers licensed and supervised, and how can a licence be checked? provenance
- Which entry fits financial regulation? action
Rights
Consumer rights.
Rights
Rights.
- What consumer rights and protections apply, including guarantee schemes? provenance
- Is the user asking for legal advice, which needs a professional? boundary
Context Economics and history.
Economics
Economics.
Economics
Economics.
- How do actuarial pricing, reinsurance and investment work in the industry? provenance
- Which entry fits actuarial science? action
History
History.
History
History.
- How did insurance develop from marine insurance to modern markets? provenance
- Which references are standard? provenance
Classifiers Filled
- Family
- Thing Registry
- Category
- Physical world and living systems
- Entry kind
- thing
- Plane
- PHY
- Domain
- PHY.OBJ
- Other names and narrower kinds
- independent practice association, reinsurance, Financial reinsurance, KiwiSaver, health insurance cooperative, private health insurance, pension, company pension, pet insurance, concurrent insurance, climate risk insurance, hull insurance
What it is Filled
A contract by which an insurer, in return for a premium, undertakes to pay for specified losses or events suffered by the insured, pooling risk across many policyholders; lines include life, health, motor, property, liability and reinsurance, and the business is licensed and supervised by regulators to protect policyholders and solvency.
Why it exists Filled
Let an agent explain how insurance works and what its main lines are, relay regulatory, consumer rights and complaint information from supervisors and ombudsmen in general terms, describe policy terms and claims processes, and route personal advice on what to buy to licensed advisers.
Distinguishing features Filled
- Risk transfer for a premium
- Pooling and the law of large numbers
- Contract of utmost good faith in many systems
- Licensed and supervised business
What robots and AI may and may not do Filled
Must not
- Recommend a specific policy or product as personal financial advice.
- Submit or alter a claim with false or exaggerated information.
- Tell a person they are covered without checking the policy's actual terms and exclusions.
- Share a policyholder's health or claims data beyond what they agreed to.
Only with a human decision
- Buying, cancelling or changing a policy.
- Submitting a claim or accepting a settlement.
May
- Explain how insurance works, what a policy covers and what common exclusions mean.
- Help a policyholder find and read the terms of their own policy.
- Organise documents for a claim at the policyholder's request.
Moral aspects Filled
- Insurance protects people at their most vulnerable moments; mis-selling and denial cause real hardship.
- Pricing on personal data can exclude people who most need cover.
Who is affected
- Policyholders
- Claimants and beneficiaries
- Other members of the risk pool
Owners Filled
Steward
The insurer that issues the policy; the policyholder holds the contract. Insurance regulators supervise insurers.
Master systems
- Insurer policy records
- Registers of authorised insurers
Links to other meta-models Filled
parent
- Q15809678 - registry parent class
- Q837171 - registry parent class
related
- financial product - a contract sold by insurers
- insurance company - the insurer
- financial supervisor - licensing and solvency
- risk management - the wider discipline
What else AI and robots need to interact with it Filled
Identity and identifiers required Filled
- Vercy registry: vr.tr.insurance
- Wikidata: Q43183 (https://www.wikidata.org/wiki/Q43183)
- policy number: insurer specific
- insurer licence number: regulator register proves authorisation
Direct properties not applicable Not applicable
Not applicable
Insurance is a contractual arrangement for transferring financial risk and has no intrinsic physical properties.
Recognition required Filled
- A policy with insured events, premium and limits
- A licensed insurer and a regulator
- Savings products, warranties and gambling are different arrangements
- Not a physical object; seen as a policy document, a premium and a claim.
Capabilities and actions required Filled
- explain how insurance and pooling work
- explain policy terms, exclusions and claims in general
- relay regulation and consumer rights
- route personal product advice to licensed advisers
Hazards and failure modes required Filled
- Underinsurance and uncovered exclusions
- Fraud and mis-selling
- Insurer insolvency
- Agents giving personal financial advice
Standards and interfaces required Filled
- Insurance contract law
- Prudential regimes such as Solvency II and national equivalents
- Conduct of business and disclosure rules
- Ombudsman and guarantee schemes
Context of use required Filled
- Transferring and pooling financial risk.
- life and annuity insurance
- health insurance, public and private
- motor, property and casualty insurance
- liability and professional indemnity
- reinsurance
- mutual and cooperative insurers
- social insurance schemes
Sources Filled
- Wikidata item Q43183: insurance - identity and sense of the item
- Wikipedia: Insurance - general description of the item
Open questions
- Should each line be a separate entry?
- How should regulator registers be linked by country?
- The registry entry has merged aliases naming pension schemes and provider associations; should they be split off?
Machine files
Provenance
thing registry research (pass 2) · unreviewed
Built from: models/things/publications/thing-q43183/spec.json