Do US or Australia have laws that prevent insurance companies from racking up too much margin? Are claim ration in US or Australia much higher and if so, what laws differences cause it. What are the typical claim ratio of insurance companies in US, Australia, and Indonesia? https://www.investopedia.com/ask/answers/042315/what-difference-between-loss-ratio-and-combined-ratio.asp Claim ratios are the ratio between reimbursement and premium. Say I buy insurance. From a gambler points of view, I want to know how much, on average, I will be reimbursed compared to how much money I pay. For example, if I pay $1000k for life insurance, I want to know that on average, I will get $900. The amount I get if I die may be $1m., But the chance that I will die is 0.09 percent, for example, I will on average, collect $900 out of my $1k premium. Of course, on average I lose. But because I am risk avert it's still worth it. However, given that I don't lose a lot and I want security, I am okay with that. Of course, if the loss ratio is very low, it's stupid to buy insurance. If premium fees are very clear and insurance companies compete with one another, I would expect the loss ratio to be very high. If premium fees are unclear and customers insurance companies avoid competition, I would expect the loss ratio to be very low. Most extra money goes to marketing and profit. Do US and Australian companies have much higher claim ratio? Can we know? What sort of laws on western countries that ensure that that differs from those in Indonesia. I asked a friend of mine in some group and an Australian told me this An established, mature insurance company in Australia (and most western countries I would think) will expect, in the long term, to pay out more money in claims than they receive in premiums. They make their money by investing the premiums during the time interval between receiving the premiums and paying out claims. Insurance companies live or die on their funds management. That's not due to any legislative requirement. It's a competitive business. If their prices aren't competitive, they won't get any customers. It seems that in Australia, buying insurance may be &quot;worth it&quot; In Indonesia, insurance agents are told that it is unethical to compete on price. Also, companies can increase fees through various tricks or scam. One such trick is by using a combination of not writing fees clearly, combining investment with insurance, and simply having huge fees. For example, someone may pay $10k premium believing that most or all money is &quot;invested&quot;. The company can obfuscate contracts that make it very difficult for customers to see the fees. Agents can lie to customers claiming that all money are invested. Basically, it's like Sim Lim scam, but much more obfuscated. https://www.asiaone.com/singapore/sim-lim-scams-student-reduced-tears-after-being-charged-1k-iphone-warranty One agent told me that there is no way a customer can know about those fees unless the agents tell and most agents simply don't tell. Latter, even though the insurance benefit only worth $500, the customer can end up paying $5k in fees. Because the insurance and investment is joined, the customers do not know about it till it's very late. Also, it's very difficult to compare prices among different companies. So why Australian or us companies do not just pull the same trick? Why do they bother competing? In general, I think buying insurance in western country may be worth it but buying insurance in Indonesia may not be. I think the claim ratio, that is, ratio between reimbursement in western countries is high and the reimbursement ratio in Indonesia is low. Am I correct? If I am correct, or not, why? Update: I just found out that life insurance premium in Singapore is 1/10th the price in Indonesia, for the same amount. This is what I am talking about. I am very sure that mortality rate in Indonesia, while higher than in Singapore, isn't really 10 times more. So insurance in Indonesia is simply very inefficient
You can’t “mislead or deceive” in “trade or commerce” in Australia It is flat out against the law to mislead or deceive - you can’t lie, you can’t conceal salient facts, you can’t tell half truths, you can’t even tell the truth, the whole truth and nothing but the truth if that could be misleading. The fines are huge (for example), plus the contracts are unenforceable, plus the reputational damage is extreme. The types of practice that you describe would result in orders to return the premiums, plus fines plus probably revocation of the licence to be an insurer in Australia if they were systemic. This is particularly true of insurance companies - the legislation that applies to them is enumerated here.
united-states I am skiing and cause unintentional injury to another slope patron/client. How would I protect myself from being sued? Use reasonable care to avoid harming others, and follow all applicable rules of the ski area. Keep your equipment in good repair. Don't ski when you are drunk or high or in circumstances you can't handle. Try not to collide with people. If you do collide with someone do what you can to mitigate their injuries, identify ways to document facts favorable to you, and promptly contact your insurance company. Is there insurance if sued that could protect my assets if found negligent and cover legal costs of lawyer and trial, regardless if found negligent? For this, you need liability insurance. In the United States, liability insurance is typically included in homeowner's or renter's insurance. These kinds of liability insurance typically cover the cost of a legal defense of a covered claim and any damages awarded or paid in a settlement of those claims (up to the policy limits). These kinds of liability insurance would typically cover liability arising from a skiing accident and most other claims for negligence, but would typically not cover claims related to intentional acts or a criminal prosecution. A homeowner's or renter's insurance policy would also not typically cover vehicle accidents (e.g. your liability while operating a snowmobile), claims related to a business or an occupation, or claims related to contractual liability.
I assume you are talking about this case: FORIS GFS AUSTRALIA PTY LTD vs THEVAMANOGARI MANIVEL. For that amount, most people would be willing to break the law to keep it, and good advice what to do would be “ask a lawyer”. Needs citation. I certainly wouldn't: a) I think taking money that I know doesn't belong to me is wrong, b) even if I didn't believe that, the amount is so large the bank will certainly eventually come after it. The amount is so large I won't credibly be able to claim an innocent mistake. Simply hiding the money won't work, since the bank will be able to demonstrate that the money was deposited in my account, and I did withdraw it. I would be required to make restitution. This is exactly what happened to the defendant in the above case: they split up the money among friends and bought a house. The house is now being sold by the court, with the proceeds used to reimburse the plaintiffs. Would a lawyer be allowed to give me legal advice to help me keeping this money, for example by giving 500,000 each to twenty reliable friends, moving to Panama, or whatever would allow me to keep and spend the money? (Not asking whether two strategies that I came up with in ten seconds would actually work). Especially if it is advice if the form “X is illegal, but you can get away with it”. No. For example, the American Bar Association Model Rules of Professional Conduct, Rule 1.2 Scope of Representation &amp; Allocation of Authority Between Client &amp; Lawyer states: (d) A lawyer shall not counsel a client to engage, or assist a client, in conduct that the lawyer knows is criminal or fraudulent, but a lawyer may discuss the legal consequences of any proposed course of conduct with a client and may counsel or assist a client to make a good faith effort to determine the validity, scope, meaning or application of the law. That's just a suggested ethical standard, but most countries will have something along those lines. Note also that in the US there is also a &quot;Crime-Fraud&quot; exception to attorney-client confidentiality. If a lawyer assists a client in carrying out a criminal or fraudulent scheme then their communications are no longer privileged and can be subpoenaed and introduced as evidence in court.
Is it legal for a company to offer a different insurance rate based on the spouse's employer's offerings? Given the scenario you describe, your employer is not charging you a different rate if your spouse is eligible for insurance from your spouse's employer. Under the Affordable Care Act, when an employer decides to provide health coverage to their employees there is no requirement to provide insurance to the employee's spouse. Extending coverage to an employee's spouse carries additional cost to the employer. Many employers implement surcharges for those employee's spouses if coverage is otherwise available to the spouse. Essentially, when coverage is available to a spouse through their employer and they choose to be covered by their spouse's employer they are making a choice, one would presume, for better coverage. In this case, the employer is seeking to recover some of their cost for covering someone who would otherwise have coverage. From this article dated January, 2014, you can see that many employers are moving in this direction. That article references an article regarding UPS. UPS is excluding any spouses from coverage if they would otherwise have coverage from elsewhere. You ask what right do they have to this information [that your spouse has coverage available elsewhere]? You are asking your employer to extend health coverage to your spouse, a benefit that your employer apparently provides. Your employer has the right to ask you information regarding that benefit extension you have requested. If you don't have a spouse or you aren't seeking to have your employer increase their benefit cost by extending coverage to your spouse then there is no reason for them to know if your spouse is covered. What other legal means do they have to find out this information? They should only be seeking this information because you've decided to ask them to provide a benefit to your spouse. If you were to lie about this information then they would have the same facilities available for any other fraudulent act to gain a benefit contrary to the employer's policy. Does this constitute illegal discrimination? Based on what? The employer is not required to extend the benefit to your spouse. The employer's policy for extending that benefit is to charge $50 for any spouse who could otherwise be covered by their employer. If you want the benefit then answer the question truthfully and, if your spouse is otherwise eligible for coverage, then pay the $50. If you don't want to answer the question then don't request the benefit. I am aware of similar policies regarding smoking which are similarly controversial. What conclusions can we draw from that precedent? What precedent, that it is legal to charge smokers more for health insurance? The Affordable Care Act allows insurance providers to charge up to 50% higher premiums for smokers. Here's an article from the Society for Human Resource Management: Most employers using a spousal surcharge require an employee who enrolls a spouse in the plan to pay the surcharge unless the employee can verify that the spouse is not eligible to enroll in his or her plan, is eligible but not allowed to participate for a particular reason, or is not employed.
This very much depends in BigCorp and the whole situation. BigCorp has three sums of money: what they pay you, the cost of turning it into a product, and the profits of the product. Usually the first amount is much smaller than the second, and that is much less than the third. Ripping you off won’t save them much. Having a contract that rips you off but can be challenged later successfully would be the worst case for them. So the best case for BigCorp is lawyers that set up a contract that is fair, bullet proof, and is created by lawyers that cooperate to keep the cost down. BigCorps lawyers probably know someone who will work in your interest just fine. Their worst bet would be lawyers that don’t work for your benefit, and then you manage to throw the contract out when it turn out to be not in your interest.
This is a context where you need to lawyer up. There are two issues, his share of the costs, and his permission to construct in part on his property. You mother has the same rights, so she likewise can refuse to sign off on his scheme (the lawyers negotiate a resolution). Assuming both parties are insured and (to make it more complex) have different insurance companies, the companies limit how much they will contribute for their part of the damage. Normally, you find a contractor who will do it for a given price, let's say $10,000, and the parties split the cost. Both parties have an interest in the choice of contractor because of cost issues, and quality of product and service (though the insurance company cares about the cost). If one of the parties is a contractor, they too can legitimately submit a bid, and then the parties can decide which is the best bid. It is not fraud if a contractor, who is an insured, submits a bid and makes a profit on the job. It would be fraud if that party withheld material facts from an insurance company. In the context of massive disaster insurance claims, the insurance companies may not perform a rigorous investigation (e.g. may not ask for multiple bids). It would then be a material fact that one of the insureds stood to profit from this arrangement, so the insurance companies would likely wish to see evidence that the costs were not unreasonably inflated. If the neighbors bid is in line with industry standard (and the insurance companies know who the contractor is), there is nothing fishy about the arrangement. This assumes that both parties are being cooperative with each other. When that is not the case, lawyers are good at getting cooperation (not letting the other party push their client around).
My findings so far are: It does appear to be against public policy at least in California and Oregon. In California outlawed statutorily — Ins. Code § 533 provides: “An insurer is not liable for a loss caused by the wilful act of the insured; but he is not exonerated by the negligence of the insured, or of the insured’s agents or others.” Also on point is Civ. Code, § 1668: “All contracts which have for their object, directly or indirectly, to exempt anyone from responsibility for his own fraud, or willful injury to the person or property of another, or violation of law, whether willful or negligent, are against the policy of the law.&quot; Affirmed, for e.g., in Tomerlin v. Canadian Indem. Co., 61 Cal.2d 638, 39 Cal. Rptr. 731, 394 P.2d 571 (Cal. 1964) “[A]n insurer may not indemnify against liability caused by the insured's wilful wrong (Civ. Code, § 1668; Ins. Code, § 533; see, e.g., Abbott v. Western Nat. Indem. Co. (1958) 165 Cal.App.2d 302, 305 [ 331 P.2d 997])” In Oregon, Outlawed by case law: “Despite variations in the language of the policies, this court has interpreted various policy provisions excluding insurance coverage for intentionally-caused injuries similarly. [...] For an exclusion from insurance coverage for intentional conduct to apply, &quot;[i]t is not sufficient that the insured's intentional, albeit unlawful, acts have resulted in unintended harm; the acts must have been committed for the purpose of inflicting the injury and harm before either a policy provision excluding intentional harm applies or the public policy against insurability attaches.&quot; [Citation.]” Ledford v. Gutoski, 319 Or. 397, 877 P.2d 80 (Or. 1994)
First, while Law and Order should not be taken as an accurate depiction of a New York trial, it especially should not be taken as an accurate depiction of an Australian trial. Australian law, while it has some major similarities with US law (both ultimately derive from the law of England), is not US law. With procedural matters (such as "may jurors ask questions of witnesses"), it can potentially differ from court to court. In general, jurors may not simply ask a witness a question. The jury's job is not to investigate and figure out if the defendant was guilty or not; it's to evaluate the cases presented by each side. US (and Australian, as far as I know) courts use what's known as the adversarial model, where the prosecution and the defense both present the best cases they can and a neutral third party decides which case was stronger. In a US criminal trial, the state is expected to justify why someone should be in jail; the jury shouldn't be helping them justify it. This isn't how all jurisdictions around the world work, but it's how the US does. One concern with juror questions is that it has the risk that the juror will not be impartial. Jurors are not supposed to get into arguments with witnesses, or to go after them to try to prove a point. In your case, the juror might be introducing an entirely different line of reasoning from the one either side is presenting, and that's simply not their job. People have raised the concern that a juror thinking up questions might be deciding the case before they hear all the evidence, and might give too much weight to the answers to their own questions (or read a lot into it if a question is denied). There are also rules on what questions may be legally asked; lawyers know these and jurors generally don't, which is why jurors may almost never directly ask a question to a witness. Where they can ask questions, it's virtually always written questions, which the judge reviews, gives to both sides to see if anyone objects, and then reads to the witness in a neutral tone.