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Liability Insurance
Protects responsible party from personally having to pay the losses they caused up to policy limit and indirectly compensate the innocent injured
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Injury Insurance
Directly protect the injured by covering the losses up to policy limit regardless of who was responsible
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Is Injury Insurance truly "no fault"?
- No
- Fault as basis for setting premium
- Criminal sanction still in place
- Compensation reduced for responsible party who committed invidious fault and caused their own injury (e.g. driving intoxicated)
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Is Liability Insurance truly 'Fault'?
- Responsible party protected from having to pay the very losses they caused
- But not entitled to compensation for own injury (however still covered by social safety net, e.g. health insurance)
- Not much distinction by degree of willfulness
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Liability Insurance Philosophy
People should compensate anyone they've wronged by paying a sum of money equiv to the losses caused, to restore the injured as nearly as possible to pre-injury condition
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Liab Compensation in Practice - Advantages
Highly individualized
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Liability Compensation in Practice - Disadvantages
Process is adversarial and uncertain - Delay in compensation
- Sig process or 'transac' costs (lawyers, med experts, lawyer fees)
- Overcompensate less severe injuries (non-eco losses) and undercompensate more severe injuries
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Injury Insurance Philosophy
People (both AF and innocent) should be assisted and their losses compensated without regard to cause
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Injury Compensation in Practice - Advantages
- Less adversarial and certain:
- Fault is not a factor so more straightforward
- Compensation (eco losses) paid out quickly
- Lower costs (no lawyer involvement)
- Compensates those with minor errors
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Injury Compensation in Practice - Disadvantages
- Overcompensate less severe and undercompensate more severe
- Compensation not individualized
- Violate the principle of retribution
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3 types of combined systems
- Choice plans: choose between liability-based and injured-based plans
- Systems based on liability but with add-on injury benefits
- Threshold systems: not AF defendants whose injuries exceed a certain definition are allowed to sue
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Choice Plan
Choose between primarily liab or injury plan. difficulties: - default for p.h. who do not make a choice (?)
- How to compensate injured (pedestrians) who never made a choice
- How to handle claims involving both 'tort' and 'no-fault'
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Threshold System
Compensate most cases on injury basis regardless of fault, but allow those not AF injured whose losses exceed a specified threshold to sue
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Threshold System - Advantages
- compromise: intro of injury insurance more palatable by retaining liability access
- vs. injury system:
- more fair and individualized;
- proper compensation for severely injured
- vs. liab system:
- quicker settlement for minor injuries
- transac costs reduced (less lawyer involvement) to make overall system more affordable
- cost savings make it possible to improve compensation for more severe cases
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How to Define Threshold
- Descriptive basis: in words what types of injuries exceed threshold
- Monetary basis: permit liab claims when eco loss portion exceed $ threshold
- Combination of both
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Preferred Threshold
Descriptive or combination of both - monetary tends to encourage inflation in awards over time so that liab action can be pursued
- Permits fast settlement for minor claims and limits cases that go to court
- More easily interpreted by courts
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Types of Benefits and Losses
- Eco losses:
- income support (wage, fatality)
- care costs
- expenses (replacement services, med service plan
- Non-eco losses ("general damages" in tort):
- pain and suffering
- lost opportunity (trilogy)
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Key Factors that Affect the Nature of Benefits
- Payer priority and collateral benefits
- Net vs. gross wage losses
- Structured settlements
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Payer Priority and Collateral Benefits
- Tort liab law: can double dip (compensation for the same losses from insurance and 'collateral' sources (EI, LTD))
- Injury ins:
- Try to prevent double dip
- Insurer as 1st or 2nd payer
- As 2nd payer, compensate only if no or not enough collateral coverage
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Issues with Being the 2nd Payer
- Claimants may still feel entitled regardless of other sources
- May limit insurer's ability to manage med care, rehab and promote recovery until 1st payer resources exhausted
- Difficult to ontain complete data for studying med costs
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Net vs. Gross Wage Losses
- Should receive only AT take-home pay
- 10%-20% for expenses of holding a job -> should be 80%-90% of net loss
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Structured Settlements
Advantage: prevent squandering of large awards for future needs
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Design Req'ts for 'Social Req'ts'
- Equitable / fair benefits
- Affordable and sustainable coverage
- Personal responsibility
- Promotion of wellness
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