Insurance Law: Cases and Materials
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Insurance Law: Cases and Materials

John Lowry, P J Rawlings

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eBook - ePub

Insurance Law: Cases and Materials

John Lowry, P J Rawlings

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About This Book

This book is intended as a complement to the authors' Insurance Law: Doctrines and Principles, following its general pattern but integrating the jurisprudence from other common law jurisdictions, particularly the USA, as a means of demonstrating how problems which have long confronted the English courts frequently receive different legislative/judicial responses elsewhere. Although the emphasis of the book lies with the case law spanning some two centuries, the authors introduce each section with a brief narrative designed to focus the reader's attention as he or she works through the cases. A critical approach is adopted and emphasis is given to major journal articles and to the current UK and EU reform agenda. Readership: undergraduates, external students taking the London LL.M Insurance Law course, CII candidates and those who lack access to a law library.

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Information

Year
2004
ISBN
9781782253457
Edition
1
Topic
Law
Index
Law

Part I

Introduction

1

The Insurance Contract

1.1 Introduction

At its root, an insurance contract is a means by which the risk of loss is shifted from the person who otherwise might suffer on to an insurer and, through the insurer, on to other insureds. It is true that an important part of life insurance business is concerned with investment, but even there the element of risk-shifting will be present (eg see [114]). Of course, the skilful insurer is able to persuade people that they should not bear the risks to which they are subject, and is able also to calculate matters so as to take in more income in premiums than is paid out in claims (although in reality the picture is rather more complex than this since insurers earn income by investing premiums and they cover part of their potential liabilities by reinsurance). The insurance contract contemplates, therefore, the possibility, not just that the insurer will become liable to the insured, but also that the insurer will never become so liable. In other words, this is an unusual sort of contract in that it requires performance by one party — the insured — in the shape of the payment of a premium, while the other party — the insurer — is only required to promise to perform if a loss is sustained that comes within the terms of the policy.

1.2 Risk

[101] F Ewald (trans J-M Dautrey and CF Stifler), “Risk in Contemporary Society” (2000) 6 Connecticut Insurance Law Journal 365 [footnotes omitted]

‘THE SOCIAL PERCEPTION OF RISK’
This is the domain of insurance. Here, risk pertains to a future event, one that may also be possible, probable, contingent, fortunate or unfortunate. In any case, one that is feared for its possible consequences to property. In this realm, risk is always potential. However, insurance gives a current value to risk and ascribes it a cost — an insurance premium or fee. Thus, with regard to insurance, risk remains within the confines of monetary valuation. In fact, insurance risk is nothing but the assessment of a value. Insurance is what gives a price to risk in the economic sense, a monetary value, which is really what quantifies value.
How does one establish the cost of risk? Two theories apply. Under the first one, of a largely psychological nature, the cost of risk is measured by the aversion to risk of the individual who wishes to avoid it. In this case, quantification is not required. The cost of risk is the total premium agreed upon between the individual who wishes to transfer it and the one who agrees to assume it. The following anecdote illustrates this point. In an effort to promote his whisky, the president of the Cutty Sark distillery had offered a large monetary sum to the first person to see the Loch Ness Monster. It may be that one night he had a nightmare or suffered remorse, but he would have to keep his foolish promise none the less, which would undoubtedly endanger his company’s financial well-being. He therefore hastened to find an insurer, someone to whom he could transfer the risk he had taken so brashly. And he found one, Lloyd’s of London, with which he agreed on a premium. The coverage of this unsurpassable, potential, and exceptional risk involved a cost — a risk transfer. There was insurance without any need to quantify. The concept of insurance risk is not so much tied to the notion of danger as it is to that of expectation or fear. Risk is the measure of an expectation — a mathematical expectation that, according to Pascal, is the product of the probability of the event multiplied by its value. A moral expectation
which relates to what I am willing to and what I ought to pay, in terms of mathematical expectation in order to avoid risk. The “additional cost” would measure exactly what the value of the risk is for me.
In the words of Michel Albert who initially made the distinction, this purely contractual vision of insurance corresponds to a more “maritime” than “riparian” view of insurance. In continental Europe, France in particular, one views insurance as tied to the concept of mutuality, or as a function of statistics and probability. This view stems from the fact that, in France, insurance had to set itself apart from gambling and betting to be recognised. It follows that risk reflects the probability that an event will take place in a given population. Consider the population of French drivers, the road conditions, and the number of cars on the road. There are currently about 8,000 annual road deaths. In the words of the well-known sociologist Adolphe Quetelet, these deaths represent the “budget” that the French population commits to road travel each year. One can anticipate that, all things being equal, this figure will remain constant from year to year, within a few standard deviations. The average premium per inhabitant or per driver can then be established. At the same time, it is possible to assess the chance that any one individual has of being among the 8,000 victims. This chance is a function of a car’s power, a driver’s experience, the places where he drives and so forth, and these criteria are used to calculate an individual’s insurance premium. Indeed, not everyone represents the same risk to the group. Some individuals drive less carefully than others. This is another way of establishing the cost of risk; it corresponds to the greater or lesser probability of incurring an accident in relation to the average. This cost is called the equitable cost.
Under this second analysis (more sociological than psychological) the group outweighs the individual. Risk influences the group. It affects it with depressing regularity and affects every individual as members of the group. Risk has a defining and unifying effect on the group and gives it a personality and an identity. This is the paradox of freedom: each member can feel as free as he will; through his actions he will contribute in one way or another to reproducing the common statistics. Such a group, identified on the basis of its risk, is what is called a mutuality.
By assessing the cost of risk so that it can become the subject of a contract, insurance gives existence to non-existence, immediacy to the non-current, and form to potential. It inverts the course of time. The feared event exists whereas it has not taken place and may in fact never take place. Risk exists, materialised through a contract, in the form of an infinitesimal fraction of what it will become. That is, it exists in such a manner that its presence, while thoroughly real, remains almost imperceptible. This is what makes insurance doubly effective. The fragmentation of that risk renders feared events no longer feared. Insurance eradicates and decimates adversity. It makes these fears more bearable. Sometimes too much so.
But the merit of insurance extends beyond what would otherwise closely amount to a public-aid dynamic. It transforms the perception of events in such a way so that not to carry insurance becomes a fault. This point was well illustrated last century by Edmond About in his booklet insurance [L’Assurance (1865)]:
As you know, as the wheels of horse-drawn carriages wear out on cobbles, they shed more than 20 kilos of iron every day on the streets of Paris. These 20 kilos of precious metal are not completely destroyed but they are lost. If you will, their infinitesimal division makes them useless by dint of making them irretrievable. Suppose that a patient and ingenious worker manages, however, to pick up these atoms of iron, restore their cohesion, resistance and all useful qualities. Further suppose that he forges thern into a lever. Will he not have created capital for individuals to use? A centime is no more capital than a wisp of iron is a lever. It has barely any value. You will find very few individuals who are sensitive to the loss or gain of a centime because a single centime amounts to nothing. But he who would obtain by honest means this useless centime from his fellow citizens would create a capital of 10 million centimes; that is, a nice lever for moving mountains.
The merit of insurance ensues from pricing expectation and giving reality to potentiality so that any individual who does not account for the possibility of risk in his conduct becomes a factor of individual and collective loss. An individual loss with regard to what his situation will be if the risk becomes real; a collective one as he deprives society of the power to move mountains. Insurance owes its economic effectiveness to solidarity. As it turns potential events into reality, insurance becomes the mechanism by which a possible loss transforms itself into capital. It is simultaneously a combination of protection and an economic mechanism that inverts symbols and turns a loss into a principle of yield. Its value lies in its being much more than a simple mechanism of allocation of liability.
Insurance suggests a social experience of risk to both liberalism and democracy. To the former because liberalism is a political philosophy that advocates risk management as a principle of government. Individuals must face risk in order to become truly aware of their real identity; finding resources in themselves in the form of foresight and, in others, in the form of voluntary association. But insurance, at least in its practical form, is also the product of democracy to which it gives its image of solidarity. Thus, for two centuries, insurance has continuously prompted us to be aware of ourselves both individually and collectively. As the Baron de Beauverger said in 1868 during a parliamentary debate on industrial accidents: “As a system, our society is nothing but an all encompassing insurance, insurance against weaknesses, insurance against misfortune, insurance against ignorance. Look at institutions through that prism and you will see that they all seek the same goal, a noble and generous goal.”
This analysis of risk was seriously undermined when an attempt was made to make insurance resolve social problems linked to the development of an industrial society. With the rise of social insurance, insuring oneself becomes mandatory
It is a matter of seeing to it that individuals are protected against certain risks of a welfare nature. The concept is twofold: regardless of his income, every individual must be protected from these risks since such risks are not equally allocated throughout society
. If there are social risks, it is because society itself generates them as it develops without regard to a fair allocation. Compensating for inequalities in the face of risks, establishing equalities in the face of opportunities
. Social insurance makes coverage against social risks no longer an act, but an entitlement. It is first a salaried worker’s entitlement, and the institution of social security makes it a citizen’s entitlement. The actualisation of the potential, of which the economic translation is capitalisation, gives way to a sort of generalised assistance based on allocation.
This rationale regarding insurance became extremely widespread. Today, welfare outlays in the nation of France exceed the budget of the state of France. And the gap continues to widen in accordance with a rationale under which the nature of covered risks (health and retirement) hardly suggests a shift. Yet, the limit beyond which welfare outlays seem destined to ruin their own sources of supply has been reached: social costs are exhausting the economy. The economic rationale couples with a moral rationale: instead of creating an incentive to take risks, health and welfare services engender phenomena of “demoralization” that are counterproductive. Insurance no longer operates as an incentive to take risks, indeed, it directs us to never have to take any.
We have considered some of the issues regarding the necessary limit to risk-taking and the danger of excessive risk-taking. We now find ourselves facing an inverse situation: what we may fear is not excessive risk-taking, but, on the contrary, the absence thereof. Once again, there arises an issue of balance.
THE LEGAL PERCEPTION OF RISK

In an industrial society, it is believed that there can be no risk-free activity, or business
. Risk is inevitable and beyond debate; the only issue therefore is the allocation of its cost.
The issue is not to inflict a penalty, but to determine who, between the one who caused the risk and the one who suffered from it, must bear the cost. Penal considerations are irrelevant; only social considerations come into play. It is not property speaking an issue of liability but an issue of risks: who must bear the risks? Reason and legal fairness dictate that it must be borne by the individual who by virtue of his actions has assumed the consequences of his deed and activity. [R Saleilles, Les Accidents du Travail et La Responsabilité Civile (1897)]
It is inconceivable to require that, as a condition of acceptance, an activity or a business must be free from risk to others. There is none the less a condition. The burden must not be borne by those individuals who are subjected to the risks, those who impose such risks must bear their costs. Rules governing liability regulate such transfers on the basis of risk, hence the existence of objective liability and presumptions of liability whose rationale lies in placing the burden of risk on the individual who creates or profits from it. Thus, the response to risk is indemnification rather than prevention. In other words, insurance has developed considerably with the multiplication of required liability coverage (there are about a hundred of them in France). Until recently, nobody was concerned about this new social contract the contract of solidarity according to which, risk is acceptable so long as it is indemnified and its cost not borne by the victim.
Today, we are witnessing a remarkable shift in this pattern. The issue is no longer so much that of multiplying risk liabilities and structuring through insurance the solvency of those liable as it is to prevent certain risks from being taken. Not only is prevention outpacing indemnification, but efforts are also made to avert risks that have not yet been recognised. Precaution governs. Several factors account for these recent developments. First, damages no longer pertain to individual accidents as much as they pertain to catastrophes. The amounts currently involved exceed the limits of what can be insured as well as indemnified. Secondly, the cost of liability is also being reevaluated. The First World War provides a good scale by which to weigh this new method of measuring risk. During the war, a general could send 300,000 men every two weeks off to be killed, as was the case during the Chemin des Dames battle. Today, only “zero-risk” wars can be waged. A peculiar transmutation of values, indeed! Under the traditional cost-benefit analysis, it was enough that advantages outweighed risks to feel justified in taking risks and thus in accepting a portion of loss. Today, risk tends to be measured on the basis of the loss portion: what justifies the sacrifice? Do not those unfortunate enough to make up the loss portion count as much as others? Such is the method of valuation underlying the zero-risk problematic.
The rationale of precaution does not advocate, as it has been said, a change of focus from risk to fault. It results from a twofold reassessment of risk. First, it results from the technological powers that are now at work and over which we know we fail to exercise full control. We are witnessing an excess of might over power that we do not really know how to express from a legal standpoint. It can be characterised as a developmental risk, principle of precaution depending on whether we look at it from a legal or political standpoint. Secondly, the rationale of precaution results from a sort of backlash of victims who no longer accept the cynicism arising from the traditional formula for the acceptance of liability. What they challenge is not so much the amount of damages as the imbalance of power linked to technological risks. And, today, as a result of this backlash, liability tends to be assessed on the basis of what was hitherto considered negligible.
Here again is another case of how the experience of risk has its limits. Given the inordinate power now in existence (which can be measured by the fact that we cannot measure its effects), the relations of asymmetry and dependence (with the sense of a loss of autonomy that ensues), and the magnitude of the risks created, should it be appropriate, short of putting an end to the process, at least to take a pause that would allow us to regain control over the changes governing us? Time for precaution is time for moratoria.
CONCLUSION

The purpose [of this paper] was not to consider every experience of risk. The intent was solely to understand how risk could be at the core of contemporary society. Not simply because of the threats hovering over us, but more importantly, as a general principle of valuation. By seeking the value of values through risk, contemporary society found itself inexorably subjected to the dialectic of risk. The morality of risk, while encouraging sacrifice, sets it as its limit.
The perception of risk constitutes a defining experience for contemporary society: how far is too far? While valuing risk, adventure and entrepreneurship, contemporary society seeks to keep it within measure. Thus, while risk stands as a principle of valuation, motivation, and action, it also constitutes a principle of limitation, restriction, and prohibition. When overvalued or undervalued, risk quickly turns human experiences into inhuman ones. There is therefore no need to set a morality of risk against a morality of protection. Indeed, the morality of risk is inextricably a morality of protection. Risk and safety are not opposite concepts independent from each other, Risk both affirms and negates. It arises from the need to surpass oneself, from the necessity to tran...

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