CHAPTER 3 : LEGAL ASPECTS OF UNDERWRITING INDIVIDUAL POLICIES

 LIFE AND HEALTH INSURANCE UNDERWRITING

PART 2 : UNDERWRITING INDIVIDUAL LIFE AND HEALTH INSURANCE

CHAPTER 3
LEGAL ASPECTS OF UNDERWRITING INDIVIDUAL POLICIES

After studying this chapter, you should be able to:

• Define the terms valid contract, void contract and voidable contract
• Identify the requirements for the creation of the valid insurance contract
• Distinguish between a misrepresentation and a material misrepresentation made in the formation insurance contract
• Distinguish between binding premium receipts and conditional premium receipt
• Identify factors that nondiscrimination laws and regulations prohibit insurers from considering during underwriting of insurance (mengidentifikasi faktor2 yang dilarang undang-undang dan hukum nondiscrimination yang menjadi pertimbangan selama underwriting of insurance)
• Describe the medical testing and disclosure requirements associated with the underwriting of AIDS-related conditions (menjelaskan persayaratan medical testing dan pengungkapan yang berhubungan dengan underwriting atas kondisi penyakit AIDS
• Identify the elements that insurers must include in their anti-money laundering program (mengidentifikai elemen-elemen anti-money laundering program)
• Recognize the responsibilities of an underwriter in handling applicants, acting promptly on applicants and documenting underwriting (mengenali tangung jawab underwriter dalam menangani pemohon, bertindak tepat dan melakukan dokumentasi

Contract Law Issues that Affect Underwriting (masalah hukum kontrak yang mempengaruhi underwriting)

An Insurance policy is a contract between the insurer that issued the policy and the individual or organization that purchased the policy. (insurance policy adalah suatu kontrak antara insurer yang menerbitkan polis dan individu atau organization yang membeli polis)

A contract is a legally enforceable agreement (perjanjian yang memiliki kekuatan hukum) between two or more parties; the agreement consists of a promise or a set of promises.

The fact that a contract is legally enforceable means that the parties are bound to carry out the promises they made when entering into the contract. (fakta bahwa suatu kontrak secara hukum kuat artinya bhw para pihak terikat untuk melaksanakan janji yang mereka buat)

If a party does not carry out is promise, then that party has breached the contract. (jika satu pihak tidak melaksanakan janji, maka pihak tersebut telah menciderai/melanggar kontrak)

Laws provide an innocent party with remedies for losses resulting from a breach of contract. (hukum memberikan pemulihan atas kerugian kepada pihak yang tidak bersalah akibat pelanggaran kontrak)

If the parties are unable to resolve any dispute that result from a contract, they typically have the right to file a lawsuit and ask the courts to resolve the dispute. (jika para pihak tidak dapat menyelesaikan persilihan yang berasal dari kontrak, secara khusus para pihak mempunyai hak untuk mengajukan gugatan dan meminta pengadilan untuk menyelesaikan perselisihan)

An insurance policy :

1. provides physical evidence that an individual or business has purchased some type of insurance coverage and (menyajikan bukti phisik bahwa individu atau business telah membeli beberapa jenis insurance coverage)
2. spells out the terms of the insurance agreement (menguraikan ketentuan dari perjanjian asuransi)

When an insurer issues an insurance policy, the insurer makes a contractual promises to pay a stated  benefit amount if the event insured against occurs while the policy is in force. (ketika insurer menerbitkan polis asuransi, insurer membuat janji kontraktual untuk membayar sejumlah benefit yang ditetapkan jika peristiwa yang diasuransikan terjadi ketika polis berlaku)

Underwriting is an important part of the process of forming an insurance contract, and an underwriter's actions can affect the insurer's contractual rights and duties. (underwriting adalah bagian penting dari proses pembentukan kontrak asuransi, dan kegiataan underwriter dapat mempengaruhi hak dan kewajiban kontraktual insurer)

During most of the underwriting process, underwriters are focused on evaluating the insurability of the proposed insured, who typically is the applicant for insurance. (Pada waktu underwriting process, underwriter difokuskan pada evaluasi insurability dari proposed insured, yaitu pemohon asuransi)

In evaluating an application for insurance, underwriters also must ensure that the applicant for insurance meets certain legal requirements (selama proses underwriting, underwriter fokus pada evaluasi insurabilty dari proposed insured, underwriter juga harus memastikan bahwa pemohon asuransi memenuhi persyaratan hukum)

Creating a Valid Insurance Contract (membuat kontrak asuransi yang sah)

Not all contracts are legally enforceable. (tidak semua kontrak memiliki kekuatan secara hukum)

The principles of contract law within each jurisdiction determine whether contracts that are governed by the jurisdiction's laws are enforceable and who has the right to enforce such contracts. (principles of contract law dalam setiap jurisdiction menentukan apakah kontrak yang diatur oleh jurisdiction's law dapat dilaksanakan dan siapa yang memiliki hak untuk melaksanakan kontrak tersebut)

As a general rule, a contract is governed by the laws of the place in which the contract is created. (sebagai aturan umum, sebuah kontrak diatur oleh hukum tempat dimana kontrak dibuat)

In describing the legal status of a contract, the words valid, void and voidable often are used. (dalam menjelaskan status hukum suatu kontrak, sering digunakan kata-kata sah, batal dan dapat dibatalkan)

• Valid contract. A contract that satisfies all legal requirements and thus, is enforceable at law. (kontrak yang memenuhi persyaratan hukum)
• Void contract. A contract that does not satisfy one or more of the legal requirements to create a valid contract and, thus, is never enforceable at law. The term void is used in law to describe something that was never valid. (kontrak yang tidak memenuhi satu atau lebih kekuatan hukum yang membuat kontrak tersebut sah,sehingga tidak dapat ditegakkan secara hukum)
• Voidable contract. A contract under which a party has the right to avoid his obligations under the contract without incurring legal liability (kontrak dimana salah satu pihak mempunya hak untuk menghindari kewajibannya berdasarkan kontrak tanpa menimbulkan tanggung jawab hukum.

To create a valid contract, the parties must meet certain requirements. (untuk membuat kontrak yang sah/valid, para pihak harus memenuhi persyaratan tertentu)

Although the specific requirements that must be met vary from jurisdiction to jurisdiction, the requirements are quite similar in most jurisdictions; (meskipun persyaratan kontrak yang harus dipenuhi bervariasi dari jurisdiction satu dengan yang lain, tapi tetap sama.)

In most of the US, the following requirements  must be met to form a valid contract: (di US, persyaratan berikut harus dipenuhi untuk bentuk kontrak yang sah).

• The parties must mutually assent (agree) to the terms of the contract (saling menyetujui dengan syarat syarat kontrak)
• The parties must exchange legally adequate consideration (bertukar pertimbangan yang memadai secara hukum)
• The parties must have contractual capacity (memiliki kapasitas kontraktual)
• The contract must be for a lawful purpose (tujuan yang halal)

Mutual Assent (saling menyetujui)

Mutual assent to the formation of a contract occurs when the parties reach a "meeting of the minds" concerning the terms of their agreement. (saling menyetujui pembentukan kontrak terjadi ketika para pihak mencapai pertemuan pikiran mengenai ketentuan kesepakatan )

Mutual assent requires the parties (mutual assent mengharuskan para pihak)

1. intend to be bound to the contract's terms and (berniat untuk terikat dengan syarat-syarat kontrak)
2. clearly manifest the intent to be bound by making some outward expression of that intent. (dengan jelas mewujudkan niat untuk terikat dengan membuat beberapa pernyataan dari niat itu)

The parties manifest their mutual assent to a contract when one party makes a definite offer to contract and the other party accept that offer unconditionally. (para pihak mewujudkan persetujuan timbal balik ketika satu pihak membuat penawaran yang pasti dan pihak lain menerima penawaran tanpa syarat)

As genral rule, applicant for insurance make an offer to enter into an insurance contract by completing an applications for insurance and submitting it to an insurer along with payment of the initial premium for the policy applied for. (sesuai aturan umum, pemohon asuransi membuat penawaran untuk masuk kedalam kontrak asuransi dengan melengkapi permohonan asuransi dan menyerahkannya kepada perusahaan asuransi bersamaan dengan membayar premi awal)

The insurer can accept an applicant's offer by : (perusahaan asuransi dapat menerima penawaran pemohon melalui:

1. issuing a policy that contains the same terms as those contemplated by the applicant's offer and (menerbitkan polis dengan isi ketentuan yang sama seperti yang dimaksudkan dalam penawaran pemohon dan)
2. delivering the policy to the applicant (mengirimkan polis kepada pemohon)

When a valid contract is created, the applicant becomes the policyowner. (saat kontrak yang sah dibuat, pemohon menjadi policyowner)

An underwriter occasionally approves an application for insurance but on a rated basis or with conditions or exclusion. (underwriter kadang-kadang menyetujui permohonan asuransi tetapi berdasarkan peringkat atau dengan conditions or exclusion)

In such a case, the insurer has rejected the applicant's offer and made a counter offer to the applicant. (dalam  kasus spt itu, insurer telah menolak penawaran pemohon dan membuat penawaran balasan kepada pemohon,

If the applicant accepts delivery of the rated or modified policy and pays any additional premium required, then the applicant has accepted the insurer's offer. (jika pemohon menerima penyerahan polis yang dinilai atau di modifikasi dan membayar tambahan premi yang diminta, maka pemohon telah menerima penawaran insurer)

Within certain limits, insurers have the right to reject offer to contract.(dalam batas tertentu, insurer mempunyai hak untuk menolak penawaran kontrak)

For example insurer reject applicants of proposed insured when the insurer's underwriter find the proposed insured present too great  a risk to be eligible for insurance. (contoh, insurer meolak permohonan proposed insured saat underwriter insurer menemukan risiko yang besar untuk diasuransikan)

In such instances, the insurers are rejecting offers to contract.(dalam contoh ini, insurer menolak penawaran kontak)

Underwriters often are involved in this process of offer and acceptance, and they work with producers and applicants to negotiate the terms of policies that cannot be approved as applied for. (underwriter sering dilibatkan dalam proses penawaran dan akseptasi, dan mereka bekerja dengan producer dan pemohon untuk merundingkan ketentuan polis yang tidak disetujui sebagai pengajuan)

Legally Adequate Consideration (pertimbangan yang memadai secara hukum)

Consideration is whatever a promisor asks for and receives in exchange for making a contractual promises. (pertimbangan/ganjaran/hitungan adalah apapun yang diminta dan diterima oleh pembuat janji sebagai imbalan untuk membuat perjanjian kontraktual)

As a general rule, consideration is legally adequate if it was bargained for and exchanged between the parties. (sesuai aturan umum, consideration secara legal memadai jika ditawarkan untuk dan dipertukatkan antara para pihak)

When an insurer issues an insurance policy, the insurer makes a legally enforceable promises to pay policy benefits if the event insured against occurs while this policy is in force. (ketika insurer menerbitkan polis asuransi, insurer membuat janji yang memiliki kekuatan secara hukum untuk membayar benefit jika peristiwa yang diasuransikan terjadi saat polis berlaku)

In exchange for the promise, the applicant must pay legally adequate consideration. (sebagai imbalan atas janji tersebut, pemohon harus membayar hitungan yang cukukp secara hukum)

The application and the initial premium are given by the applicant as consideration for life or health insurance contract. (permohonan dan premium awal yang diberikan oleh pemohon sebagai perhitungan untuk kontrak asuransi jiwa dan kesehatan)

A valid contract is not formed until the initial premium has been paid. (kontrak yang sah tidak terbentuk sampai dengan premium awal dibayar)

Contractual Capacity

For a contract to be binding (mengikat) on all parties, the parties must have contractual capacity, which mean the legal capacity to make a contract. (untuk mengikat semua pihak atas kontral, para pihak harus mempunyai kapasitas contractual, yang artinya kapasitas legal untuk membuat kontrak)

Insurers that have met applicable legal and regulatory requirements to conduct an insurance business have the legal capacity to issue insurance and enter into insurance contract. (insurer yang telah memiliki persyaratan legal dan regulasi yang berlaku  untuk menjalankan bisnis asuransi mempunyai legal capacity utk menerbitkan asuransi dan mengadakan kontrak asuransi)

When reviewing applications for insurance, underwriters determine whether the applicant for insurance has contractual capacity. (saat meninjau kembali permohonan asurnasi, underwriter menentukan apakah pemohon asuransi memiliki kapasitas kontraktual)

Applicants from a business or individual who lacks (kurang) contractual capacity are rejected. (pemohon dari business atau individual yang kurang kapasitas untuk berkontrak akan di tolak)

Individuals are presumed to have the legal capacity to enter into valid contract. (individu-individu dianggap mempunyai kapasitas secara hukum untuk membuat kontrak yang sah)

Most jurisdictions, however, limit the contractual capacity of individuals who: (namun sebagian besar yurisdiksi membatasi kapasitas kontratual individu yang):

1. are minors or (minor)
2. lack mental capacity (kurang kapasitas mental)

Lawful Purpose (tujuan yang sah/halal)

When the purpose of an agreement is illegal, then the agreement is illegal and void. (apabila tujuan suatu perjanjian illegal, maka perjanjian menjadi tidak sah dan batal)

Laws in each jurisdiction define the agreements that are illegal. (hukum-hukum di setiap jurisdiksi mendefinisikan perjanjian-perjanjian yang tidak sah)

For example, some agreements are illegal because they agreements to commit an act that has been declared illegal by law. (contoh, beberapa perjanjian yang tidak sah karena perjanjian mereka untuk bertindak tidak sah menurut undang-undang)

An agreement also is illegal if it violates public policy.(perjanjian juga tidak sah jika melanggar kebijakan publik)

Laws in most jurisdictions make wagering and wagering agreements illegal. (hukum di banyak jurisdiction membuat taruhan dan perjanjian taruhan ilegal)

A wagering agreement is an agreement under which either party may gain or lose depending on the outcome of uncertain event, such as a lottery or a soccer game (perjanjian taruhan adalah perjanjian dimana salah satu pihak dapat menang atau kalah tergantung pada hasil dari peristiwa yang tidak pasti , seperti permainan loterai atau sepak bola)

To guard against insurance contract being purchased as wagering agreements, laws in many jurisdiction impose an insurable interest requirements. (untuk mencegah pembelian kontrak asuransi sebagai perjanjian taruhan, hukum di banak jurisdiction menentukan persyaratan insurable interest)

Typically (secara khusus), individual life and health insurance policies are applies for and owned by the person who is insured by the policy. (polis asuransi jiwa dan kesehatan berlaku untuk dan dimiliki oleh orang yang ditanggung oleh polis)

Sometimes, however, a policy is issued to someone other than the insured.

Insurable interest requirements vary depending on whether  a policy insures the policyowner or someone other than the policyowner (persyaratan insurable interest sangat tergantung pada apakah polis mengasuransikan policyowner atau orang lain selain policyowner)

According to laws in most jurisdiction, a person has an unlimited insurable interest in his own life. ( menurut hukum di banyak wilayah hukum, setiap orang mempunyai insurable interest yang unlimited dalam kehidupannya.)

As a result, an applicant who seeks to insure his own life may lawfully name anyone he wishes as beneficiary. (akibatnya,  pemohon yang mengasuransikan dirinya dapat secara sah menyebutkan nama siapa saja yang diinginkan sebagai penerima manfaat.)

Even though an insurable interest is not required by law when a person seeks to insure his own life, insurers' underwriting guidelines typically require the proposed beneficiary to have an insurable interest in the proposed insured's life in all cases. (meskipun insurable interest tidak disyaratkan oleh hukum ketika seseoang ingin mengasuransikan dirinya, insurers' underwriting guidelines secara khusus mensyaratkan ahli waris yang diusulkan untuk mempunyai insurable interest dalam kehidupan proposed insured di semua kasus).

In the case of a third party policy, the applicant generally must provide the insurer with evidence that she has an insurable interest in the proposed insured's life. (pada kasus polis pihak ketiga, secara umum pemohon harus memberikan bukti kepada insurer bahwa pihak ketiga ini mempunya insurable interest dalam kehidupan proposed insured)

Two types of relationships create an insurable interest

• An insurable interest is presumed to exist between certain close family members (keluarga dekat). Each jurisdiction specifies the family relationships that create an insurable interest. Typically, a proposed insured's spouse, mother, father, child, grandparent, grandchild, brother and sister.
• An insurable interest exist when someone other than a close relative has a financial interest in the continued life of the insured. A person, for example, may be financially dependent on the proposed insured or have a business relationship with the proposed insured and would be harmed (dirugikan)  if the proposed insured died. Insurable interest and business relationship;
• Partners are each considered to have an insurable interest in the lives of the other partners
• An employer has an insurable interest in the lives of its key employees
• A creditor has an insurable interest in the lives of its debtors

Other Issues

A number of other legal issues that affect the validity of an insurance contract sometimes arise.

Material Misrepresentation

When insurers collect information from applicants and proposed insureds, they need to verify that the information provided is accurate.

Applicants for insurance and proposed insureds have a duty to answer truthfully and completely any questions contained in the application for insurance or asked during a medical examination. 

Nevertheless (namun demikian), sometimes an application contains an untrue statement of a fact, know as a misrepresentation.

Some misrepresentation do not affect the insurer's underwriting decisions.

For example, assume that an applicant for life insurance mistakenly (salah) stated that he had received treatment for a broken hip (pinggul patah) four years ago when if fact he had broken his hip five years ago.

The insurer's underwriting decision likely would not change if he had know the true date of the treatment. (...kemungkinan tidak akan berubah jika underwriter mengetahui kebenaran tanggal sebenarnya dari treatment)

Many misrepresentations, however, would affect the insurer's underwriting decision.

A material misrepresentation is a misrepresentation that induces the other party - in this case, the insurer - to enter into a contract that it would not have entered into had it known the truth. (....adalah misrepresentation yang mempengaruhi pihak lain - dalam kasus ini, insurer - untuk membuat kontak yang tidak akan dilakukan seandainya diketahui kebenarannya)

In such a case, the contract is voidable by innocent party. (dalam demikian, kontrak dapat dibatalkan oleh pihak yang tidak bersalah)

Generally, a misrepresentation is material to the formation of an insurance contract if an insurer that knew the true facts would have either 

1. declined to issue the policy
2. increased the premium rate charged for life policy or
3. excluded coverage for certain risk

As a general rule of law, an insurer has the right to rescind (membatalkan) - or avoid - a life or health insurance contract if the insurer discovers that the applicant for the policy contained a material misrepresentation.

Rescission is a remedy provided by law to an insurer that discovers it issued a policy based on material misrepresentation in the application. (pembatalan adalah pemulihan yang diberikan oleh hukum kepada insurer yang menemukan policy yang diterbitkan didasarkan pada material misrepresentation dalam pengajuan)

If an insurer rescinds an insurance contract because of a  material misrepresentation in the application, the contract is cancelled.

An insurer's right to rescinds an insurance contract is a limited right.

Insurance contract typically include an incontestability provision that denies the insurer the right to avoid the contract on the grounds of a material misrepresentation in the application after the contract has been in force for stated period during the life of the insured.

In the US and many jurisdictions, the typical contestable period is two years from the date the policy was issued, because two years is the maximum contestable period permitted by law.

Insurers are free to include a shorter contestable period in policies they issue because a shorter period is more favorable to policyowners.

Premium Receipts (kwitansi premi)

Underwriting some life insurance coverage, such as large amount policies or coverage for applicants with complicated medical histories, can take weeks or event months.

If the applicant for life insurance policy pays the initial premium with the application, the insurer generally issue the applicant a premium receipts, which is a written agreements that provides the proposed insured with some type of temporary insurance coverage while the application is being underwritten. (jika pemohon polis life insurance membayar initial premium, umumnya insurer menerbitkan applicant premium receipts, yaitu perjanjian tertulis yang memberikan proposed insured beberapa jenis insurance coverage sementara selama pengajuan sedang di underwrite)

Some insurers issue premium receipts to applicants for individual health insurance policies who pay the initial premium along with the applications. (...yang membayar premi awal beserta aplikasinya)

Often, however, applicant for health insurance does not pay the initial premium until the insurers has approved the application and issued a policy. (namun, seringkali, pemohon asuransi kesehatan tidak membayar initial premium sampai insurer menyetujui permohonan dan menerbitkan polis)

A premium receipts may be either a binding premium receipts or a conditional premium receipts.

A binding premium receipts, typically referred to as a temporary insurance agreement (TIA), provides temporary coverage from the time applicant receives the receipts.

If the proposed insured dies before the insurer completes its evaluation of the application, the binding premium receipts generally provides a death benefit though the benefit may not be the same amount as the amount of insurance applied for. (jika proposed insured meninggal dunia sebelum insurer menyelesaikan evaluasi permohonan, the binding premium receipts umumnya memberikan dead benefit meskipun manfaat nya tidak sama dengan nilai asuransi yang diajukan)

A binding premium receipt also typically lists conditions  for which no coverage is provided, such as death of the proposed insured from suicide or a self-inflicted injury. (binding premium receipt biasanya mencantumkan kondisi yang tidak diberikan pertanggungan, seperti kematian dari proposed insured karena bunuh diri atau cedera yang diakibatkan oleh diri sendiri)

Temporary coverage under a binding premium receipt generally remains effective until the earliest of the following occurrences : (temporary coverage dibawah binding premium receipt umumnya tetap effective sampai dengan :

1. the insurer issues the applicant a policy
2. the insurer declines the application
3. the insurer terminates or suspends coverage under receipt, or (mengakhri atau menangguhkan coverage under receipt)
4. a specified time - usually 45 to 60 days - expires. (kadaluarsa)

Other premium receipts, known as conditional premium receipts, specify certain conditions that must be met before the temporary coverage provided by the receipt becomes effective. (conditional premium receipt, menentukan syarat-syarat tertentu yang harus dipenuhi sebelum temporary coverage diberikan oleh kwitasi menjadi efektif)

• An approval premium receipt is a conditional receipt under which temporary insurance coverage becomes effective when the insurer approves the application; should be (jika) proposed insured die before the application is approves, the receipt provides no coverage. (jika proposed insured meninggal sebelum permohonan disetujui, receipt tidak memberikan coverage)
• An insurability premium receipt is a conditional premium receipt under which temporary insurance coverage becomes effective when the receipt is issued if the insurer finds (mengetahui) the proposed insured to be insurable. Should a proposed insured die before the applications is approved, the insurer completes the underwriting process as if the proposed insured were still alive. If the underwriter determines that the proposed insured was insurable at the time of death, the the receipt provides coverage an a death benefit is payable.

Underwriters must be aware of the type of premium receipt that was issued to a given applicant and the amount of coverage provided by such a receipt. (underwriter harus peduli jenis jenis premium receipt yang diterbitkan kepada pemohon tertentu dan jumlah coverage yang diberikan oleh kwitansi spt itu.)

The protect the insurer against liability for a risk it otherwise would not have accepted, the underwriter must act quickly to make a decision on a proposed insured covered under the terms of a premium receipt. (untuk melindungi insurer terhadap liability atas risiko yang tidak akan diterimanya, underwriter harus bertindak cepat untuk membuat keputusan atas proposed insured covered dibawah  terms of a premium receipt.)

If the underwriter's decision is to decline an application, the insurer returns the initial premium paid and coverage under the premium receipt terminates. (jika keputusan underwriter adalah menolak permohonan, insurer mengembalikan initial premium yang dibayar dan coverage dibawah premium receipt berakhir)

The underwriter also must be able to explain the terms of the premium receipt to the producer and how to the underwriting decision affects the proposed insured's coverage under the premium receipt. (underwriter juga harus dapat menjelaskan terms of premium receipt kepada producer dan bagaimana underwriting decision mempengaruhi proposed insured's coverage dibawah premium receipt)

Regulatory Compliance Issues that Affect Underwriting

Underwriting is such a basic part of the design of insurance products that insurance companies generally are free to develop their own underwriting guidelines.

Nevertheless (namun demikian), laws in many countries impose requirements that affect the life and health insurance underwriting process. (undang-undang dibanyak negara memberlakukan persyaratan yang mempengaruhi life and health insurance underwriting process)

In this section, we discuss regulatory compliance issue that affect underwriting (...membahas kepatuhan terhadap peraturan yang mempengaruhi underwriting)

• Privacy protection
• Nondiscrimination
• Medical testing
• Replacement
• Money laundering

Privacy Protection

Applicants for life and health insurance often provide insurers with personal information about their finances and their health status. (Pemohon  life and health insurance sering memberikan personal information kepada insurer mengenai finances dan health mereka.)

Jurisdictions around the world have enacted laws designed to ensure that business such as insurance companies protect the confidentiality of consumers' personal information. (jurisdiction around the world memberlakukan undang-undang yang dirancang untuk menyakinkan bahwa busine spt perusahaan asuransi melindungi kerahasiaan consumers' personal information)

Nondiscrimination

An underwriter seeks to weigh all the evidence presented by an application for insurance and arrive at a sound decision that is equitable  to the insurer and proposed insured. (underwriter berusaha menimbang semua bukti yang diajukan oleh pemohon asuransi , sampai pada keputusan yang wajar untuk insurer dan proposed insured)

An underwriter's job duties require the underwriter to distinguish among risks to identify those risks that are acceptable and those risks that are unacceptable and to classify the risks into appropriate, equitable risk classes, equitable risk classes. (underwriter's job duties mengharuskan underwriter membedakan  risiko-risiko untuk diidentifikasi apakah dapat diaksep dan tidak dapat diaksep serta mengklasifikasi kelas-kelas risiko yang sesuai/wajar).

Thus, underwriting involves discriminating among risks. (dengan demikian, underwriting meliputi dircriminating risiko)

As a general rule, discrimination among risks is permissible when it is based on (sebagai aturan umum, discrimination risiko dapat diijinkan jika didasarkan pada:

1. recognized actuarial principles or (prinsip aktuari yang diakui)
2. actual or reasonably anticipated experience (pengalaman aktual atau yang dapat diantisipasi secara wajar)

Laws in many jurisdictions, including most states in the US, prohibit insurers from unfairly discriminating against proposed insureds based on stated factors. (hukum dibanyak wilayah jurisdiction, termasuk di negara bagian US, melarang insurer secara tidak adil mendiskriminasikan terhadap proposed insured berdasarkan faktor-faktor tertentu. 

The specific factors that insurers are prohibited from using as underwriting criteria vary from jurisdiction to jurisdiction. (faktor-faktor khusus yang dilarang digunakan oleh insurer sebagai underwriting criteria bervariasi dari jurisdiction ke jurisdiction lainnya)

The following examples illustrate nondiscrimination laws in the US:

• In many states, insurers may not deny benefits or coverage on the basis of a proposed insured's sex and/or material status. (dibanyak negara , insurer tidak boleh menolak benefits atau coverage atas dasar jenis kelamin dan/atau staus perkawinan dari proposed insured. Because mortality rates and morbidity rates differ from men and women, most states permit insurers to charge different premium rates to men and women as long as those rates are based on sound actuarial principles.
• Many states prohibit insurers form basing an underwriting decision on a proposed insured sexual orientation. (banyak negara melarang insurer mendasarkan underwriting decision atas sexual orientation proposed insured
• Most stated prohibit insurers form basing an underwriting decision solely on the fact that the insured is blind or partially blind. (banyak negara melarang insurer mendasarkan underwriting decision semata-mata pada fakta bahwa tertanggung buta atau buta sebagian)

Medical Testing

Two sensitive topics, acquired immune deficiency syndrome (AIDS) and genetic testing, present insurers with unique underwriting challenges. (dua topik sensitif, pengujian AIDS dan genetik, menimbulkan tantangan underwriting yang unik untuk insurer.

Mortality and morbidity risks increase for proposed insureds who have been infected with the human immunodeficiency virus (HIV) or who have developed AIDS.

As a result, insurers typically include questions about those physical conditions on applications for individual life and health insurance.

The fact that certain segments of the population - homosexual and bisexual men and intravenous drug users - have been most affected by AIDS has raised a variety of issues about how insurers collects and use such information in the underwriting process.

Replacements

Producers sometimes advise their clients to surrender (melepaskan) one life insurance policy and replace it with another policy.

In some cases, replacement benefits the client. (replacement menguntungkan client)

In other case, however, a policy replacement benefits the producer more than  the client.

Because most producers earn high first-year commissions on new sales, producers sometimes are tempted (tergoda) to place their own financial interest above the interest of their clients and of the insurers they represent.

The primary abuses associated with replacement are the prohibited practices of twisting and churning. (Primary abuse yang berhubungan dengan replacement adalah pelarangan praktik dari twisting dan churning)

Twisting occurs when a producer misrepresents the features of a policy to induce a client to purchase a policy. (twisting terjadi ketika producer salah menggambarkan fitur polis untuk mendorong client membeli polis)

Churning occurs when a produces induces a customer to replace one policy after another so that the producer can earn a series of first-year commission on the replacements, (churning terjadi ketika producer mendorong customer me-replace salah satu polis setelah yang lainnya sehingga producer mendapat keuntungan dari komisi tahun pertama atas replacement tersebut)

Underwriters should be alert to evidence that indicates that producers are engaged in twisting or churning. (underwriter harus waspada terhadap bukti yang meng-indikasikan bahwa producer terlibat dalam twisting dan churning)

Although most states permit replacements, they impose requirements that producers and insurers must meet when a transaction involves the replacement of an in-force individual life insurance policy. (meskioun banyak negara mengizinkan replacement, mereka memberlakukan persyaratan yang harus dipenuhi oleh producers dan insurers ketika transaksi melibatkan replacement dari individual life insurance policy yang berlaku).

State replacement requirements are designed to make sure that insurers and produces provide consumers with fair and accurate information about policies do consumers can make purchase decisions that are in their own best interest. (state replacement requirements didisain untuk meyakinkan bahwa insurer dan produces memberikan informasi yang fair dan akurat kepada konsumers tentang polis sehingga konsumen dapat mengambil keputusan membeli sesuai dengan keinginannya sendiri)

Underwriter often play a role in ensuring that policy replacements are handled in accordance with applicable regulatory requirements. (underwriter sering memaikan peran dalat meyakinkan bahwa policy replacement yang dihandle sesuai dengan persyaratan regulator yang berlaku)

In most states, a replacement is any transaction in which an individual life insurance policy is to be purchased and the producer - or the insurer if there is no producer - knows or should know that, as a result of the transaction, an existing life insurance policy will be:

• lapsed (kadaluarsa) , forfeited (hangus), surrendered or partially surrendered (, or otherwise terminated (diakhiri dengan cara lain)
• Concerted to reduced paid-up insurance, continued as extended terms insurance, or otherwise reduced in value by the use of nonforfeiture benefits or other policy values (konversi untuk mengurangi asuransi yang dibayar, dilanjutkan sebagai extended terms insurance, atau dengan cara lain dikurangi nilainya dengan menggunakan nonferfeiture benefits atau nilai polis lainnya)
• Amended so as affect either a reduction in benefits or in the terms for which coverage would otherwise remain in force which benefits would be paid (di amandemen sedemikian rupa sehingga mempengaruhi pengurangan benefit atau dalam  terms yang mana coverage akan tetap berlaku dimana benefit akan dibayarkan)
• Reinsured with any reduction in cash value (direasuransikan dengan pengurangan cash value)
• Used in a financed purchase, which is the purchase of a new policy for which the owner pays premiums or intends to pay premiums using fund taken from another policy. (digunakan dalam pembelian yang dibiayai, yaitu pembelian polis baru dimana owner membayar premi atau bermaksud membayar premi menggunakan dana dari polis lainnya)

The transactions that are exempted from the foregoing definition of a replacement include credit life insurance purchases and replacement include credit life insurance purchases and replacements of existing policies by the same insurer under a program that has been filed with and approved by the state insurance department. (transaksi yang dikecualikan dari definisi replacement diatas termasuk purchase dan replacement credit life insurance serta replacement dari existing policies oleh insurer yang sama dibawah program yang telah diajukan dan disetujui oleh state insurance departement)

State replacement regulations impose duties on both insurance producers and insurers. (state replacement regulation memberlakukan tugas kepada insurance producers dan insurers)

A producer generally is required to provide an applicant for life insurance with a replacement statement that indicates whether the policy applied for will replace an in-force policy. (pada umumnya producer diminta untuk menyediakan replacement statement untuk pemohon life insurance yang menunjukkan apakan polis yang diajukan untuk menggantikan police yang berlaku)

Typically, the application for insurance includes the replacement statement.(secara khusus, permohonan asuransi termasuk replacement statement)

Both the producer and the applicant must sign the replacement statement (producer dan pemohon keduanya harus menandatangani replacement statement)

If the applicant does not intend to replace an in-force policy, then the producer's duties are fulfilled when he submits the signed replacement statement to the insurer. (jika pemohon tidak berniat untuk mengganti polis yang berlaku, maka tugas producer terpenuhi ketika producer mengirim replacement statement yang telah ditandatangani kepada insurer)

However, if the applicant plans to replace an in-force policy, then the producer has the following additional duties: (namun, jika pemohon berencana mengganti polis yang berlaku maka producer mempunyai  tugas sebagai berikut:

• Provide the applicant with a written notice regarding replacement. (memberikan pemberitahuan tertulis kepada pemohon mengenai replacement). The notice gives the applicant general information about the potential effects of a replacement and advises the applicant to receive all the relevant facts before making a replacement. Both the applicant and producer must sign the notice regarding replacement.
• Obtain from the applicant a list of all existing life insurance policies that will be replaced and ensure those policies are listed on the notice regarding replacement. (dapatkan dari pemohon daftar semua polis existing life insurance yang akan diganti dan pastikan polis polis tersebut tercantum pada pemberitahuan repalcement)
• Submit to the insurer the completed and signed notice regarding replacement and provide the applicant a copy of the completed notice. (mengirim pemberitahuan replacement secara lengkap dan telah ditandatangani kepada insurer dan memberikan copy nya kepada pemohon)
• Leave with the applicant copies of all sales materials that the producer showed the applicant and provide the insurer with a list of all such material (menyerahkan semua copy sales material pemohon kepada producer dan berikan semua daftar material kepada insurer)

Money Laundering (Pencucian Uang)

Money laundering is the practice of engaging (menarik) in financial transaction in order to hide the identity, source, and/or destination of money associated with criminal activity.

In the past, criminals sometimes used account in banks and other depository institutions to launder the proceeds of their criminal activities.

Governments have recognized that some insurance products also can be used to launder money.

As a result, laws have been enacted in many jurisdiction requiring insurers to establish anti-money laundering programs.

Beginning in 2006, US insurance companies are required to implement an anti-money laundering program if they issue certain types of products.

The following insurance products are covered by this regulatory requirement because such products have features that allow them to be used to launder money:

• Individual annuities
• Individual permanent life insurance products
• Any individual product that has a cash value or an investment feature

An insurer that issue such product establish a program that is reasonably designed to prevent the insurer form being used to facilitate money laundering.

At a minimum, such a program must include the following elements:

• The insurer must appoint a compliance officer who is responsible for ensuring that the program is implemented effectively
• The insurer must develop policies, producers, and internal controls based on the insurer's assessment of the money laundering risk associated with its business to prevent the insurer's being used by money launders
• The insurer must undertake ongoing training of appropriate persons within the company to ensure they understand their responsibilities for implementing the program
• The insurer must select a person organization that does not work for the compliance officer to test and monitor the program to determine whether it complies with the regulatory requirements and functions as designed.

Insurance producers often are able to detect suspicious (mencurigakan) transactions that my involve money laundering. (insurance producer sering dapat mendetek transaksi mencurigakan yang melibatka money laundering)

For example, when they interact with consumers, producers may get information about the source of premium funds, the nature of the clients, and the reasons that insurance is being purchase. (contoh, ketika mereka berinteraksi dengan consumers, producers mungkin memperoleh tentang source of premium funds, the nature of the clients, dan alasan asuransi dibeli)

Insurers are required to train their producers to ensure their participation in the insurers' anti-money laundering programs. (insurers diminta melatih producer mereka untuk memastikan partisipasi mereka dalam program insurers; anti-mone laundering)

Such programs also must include procedures by which an insurer can obtain relevant customer-related information from either its producers or other sources (program tersebut juga harus mencakup prosedur dimana insurer dapat memperoleh informasi terkait pelanggan yang relevan baik dari producer maupun sumber lain)

Underwriter must be alert to cases that could involve money laundering activities. (underwriting harus waspada terhadap kasus-kasus yang dapat melibatkan kegiatan money laudering)

The following examples illustrate situations that should alert an underwriter to the potential that a transaction may be an effort to launder money: (contoh berikut mengilustrasikan apa yang harus diwaspadasi seorang underwriter terhadap potensi suatu transaksi yang merupakan upaya mencuci uang)

• A customer applies for an insurance product that seems inconsistent with the customer's needs (seorang cusomer mengajukan produk asuransi yang inconsistent dengan kebutuhan)
• A customer indicates a desire to use an unusual method of paying premiums, such as paying in cash (customer menunjukkan suatu keinginan untuk menggunakan metode yang tidak sesuai dengan pembayaran premi, seperti membayar secara cash)
• A customer shows little concern for the financial performance of a product but a great deal of concern about the product's early termination features. (customer menunjukkan concern yang kecil utk financial performance produk tetapi concer besar sekali mengenai fitur pengakhiran dini dari produk)
• A customer is reluctant to provide identifying information when purchasing a product or provides minimal or seemingly fictitious information.(customer enggan memberikan informasi ketika membeli produk atau memberikan informasi minimal atau samar)

Underwriting Standards

Underwriters review applications and assess risks in accordance with standards established to ensure that risks are evaluated fairly, without bias or prejudice, (underwriter meninjau permohonan dan menilai risiko sesuai standar yang ditetapkan untuk menyakinkan bahwa risiko tersebut dievaluasi seccara fair, tanpa bias atau samar)

These standards include :

1. handling the application carefully
2. acting promptly on the application, and (bertindak segera)
3. accurately and fully documenting every step in underwriting the application. (mendokumentasikan secara akurat dan lengkap setiap tahap underwriting permohonan)

BY following these standards, underwriters protect the insurer's legal rights and help the insurer meet its legal duties. (dengan mengikuti standar ini, underwriter melindungi legal right insurer dan membantu insurer memenuhi kewajiban hukumnya)