Ethical Behavior: Are You Operating

on Solid Ground?
Objective
Distinguish among these foundations of ethical behavior:

 Morals
 Laws
 Ethics
Mutually beneficial insurance and risk management transactions all rely on the same
thing: trust. Policyholders must trust they're receiving the coverage they need at a fair
price, and insurers have to believe they're being presented with trustworthy information
about the risks they're covering.
Industry professionals establish this trust by engaging in ethical behavior—which is, in
fact, the bedrock upon which successful insurance transactions are built. Are you
operating on solid ground?

The Importance of Ethical Behavior

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Maintaining high ethical standards isn't simply the right thing to do. It's necessary for
survival and advancement within the industry. Plus, the law requires insurance
professionals to act with utmost good faith and trust in executing their duties.
Ethical behavior is built on three elements.

Foundations of Ethical Behavior

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By developing a strong understanding of ethical behavior, insurance professionals

position themselves to make decisions that are in the best interests of their employers;
colleagues; customers; and, ultimately, careers.

What's the difference between making decisions based on morals, laws, or ethics?
Feedback

Morals
Morals define right and wrong behavior. An individual's moral values are defined or
influenced by religion, society, governmental entities, and other individuals.
Moral values dictate the appropriate response when a decision must be made between
right and wrong. Actions such as engaging in corporate cheating and corruption, lying
on a resume to secure a job, failing to deposit premiums, and issuing claims checks to
friends are all moral issues. These actions are wrong and indicate a breakdown of
morality in decisions and behavior.

Reacting to a Suspicious Claim

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As the morals of a society change, so do its expectations of individual behavior. So

some behaviors that were considered acceptable in past generations could be
considered unacceptable or disrespectful today.
Over the long term, moral behavior supports continued success by establishing mutual
trust and respect.

Laws
The moral values of governmental bodies are expressed in laws and regulations. Laws
exist to protect people and property and to establish a code of appropriate behavior.
The insurance industry is highly regulated. These regulations are meant to define what's
right and wrong regarding the business of insurance. Regulations apply to products
offered and rights afforded to insurance consumers.
Insurance professionals who fail to comply with applicable laws or regulations are
subject to fines, lost business opportunities, and loss of licensure. They may even lose
their livelihood.

The Purpose of Insurance Laws and Regulations

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Laws can govern which products insurers may offer, who can sell insurance products,
prices charged, contract provisions, and settlement practices. For example, in the
United States, the behavior of claims professionals is regulated by unfair claims
practices statutes, and agents must adhere to licensing requirements.
While laws that specify right and wrong behavior are important to the orderly behavior of
individuals and groups, they alone are not enough to dictate ethical behavior. Laws
cannot cover the entire spectrum of moral behavior or describe the ethical response to
each conflict. They are, however, an essential part of ethical decision making.

Ethics
Ethics are, in essence, codes of expected behavior that apply when the most
appropriate choice is not cut-and-dried. In these situations, there may be more than one
morally or legally "right" choice.
Ethics are derived from morals but applied when a purely moral response might not
necessarily be the most appropriate. For instance, it's morally wrong to murder.
However, people are sent to war for just that purpose, because, ethically, members of a
society have a duty and right to protect themselves. Contradictory laws or societal
norms also set up conflicts that must be resolved using ethics.
Individual values significantly influence ethical behavior. Values are what one believes.
They define what's important to an individual, a strong factor that influences which
“right” answer one chooses.
Business ethics are, in reality, applied ethics, meaning the actual application of ethics to
specific business scenarios.

Business Ethics Applied to Insurance

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By studying business ethics, professionals can gain more in-depth knowledge about an
organization's values as well as guidelines for resolving conflicts and an awareness of
stakeholders' rights.
Ethical conflicts frequently arise because of the inherent needs of different parties. For
example, when developing new products, underwriters must consider the exposures
faced by consumers and provide the broadest coverage possible. Conversely, they
must ensure that products can be sold in a manner and for a price that will create a
profit for the insurer.
So they must remain true to their own values and the values of the business, yet
understand the duty owed to the consuming public and society as a whole.

Tackling an Ethical Dilemma

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Summary
Ethical behavior requires risk management and insurance professionals to think through
each situation, bearing in mind moral values, laws, and codes of expected conduct.
Ethical decisions are considered to originate from thoughtful consideration of all the
issues surrounding a conflict. Being able to make carefully reasoned ethical decisions is
essential to the success of risk and insurance professionals.
Question 1
ID# 5519P175833
Points: 1

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Question text

Alexandria is a claims supervisor who demands that her claims representatives are up to date on the latest
insurance laws. She knows that laws are important because laws can be said to
Select one:
A. Establish a code of appropriate behavior.

B. Dictate moral behavior.

C. Encompass every type of ethical behavior.
D. Cover the entire spectrum of human activities.

Question 2
ID# 5519P180531
Points: 1

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Question text

Greater North American Insurance Company encounters a recurring claims situation in which it can choose to
pay out either of two different amounts for any given situation, depending on the interpretation of the claim.
There are no regulations that directly address the issue. The policy they choose to formulate will be primarily
based on which one of the following?
Select one:
A. Principles
B. Ethics

C. Laws
D. Morals

Feedback
Ethics entail following guidelines established to provide a course of action when a law is not applicable and
more than one course of action could be considered "right" from a moral or legal perspective.

Question 3
ID# 5519P180550
Points: 1

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Question text

Managers at Greater North American Insurance Company must deal with ethical conflicts on a regular basis.
Ethical conflicts frequently arise because of
Select one:
A. Overly rigorous state insurance regulations.
B. A lack of concern regarding an organization’s reputation.
C. The inherent needs of different parties.
D. A misunderstanding of laws or regulations.

Feedback
Ethical conflicts frequently arise because of the inherent needs of different parties. For example, an
underwriting department might want a new product to cover a wide range of exposures, while sales and
marketing want a low-priced offering to be more competitive.

Question 1
ID# 5519P175838
Points: 1

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Question text
Underwriter Jessica is confronted with an ethical issue involving an applicant. She wants to handle it ethically.
She should remember that ethical behavior is primarily based on
Select one:
A. Application of laws to personal values.
B. Consideration of applicable laws and morals.
C. What feels like the right thing to do.

D. Reasoned consideration of all issues surrounding a conflict.

Question 2
ID# 5519P175832
Points: 1

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Question text

Which one of the following statements concerning laws is true?

Select one:
A. Laws are enough to dictate moral behavior.
B. Laws describe moral responses to conflict.
C. Laws are ethical tenets.
D. Laws impose a sense of societal decency and order.

Question 3
ID# 5519P175836
Points: 1

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Question text

Anil is a new customer service representative in a busy insurance company sales department. In training, he is
finding that his employer greatly values acting professionally at all times. Anil should learn that
Select one:
A. Governmental entities cannot encourage moral behavior or discourage immoral actions.
 B. Business ethics entail doing what is right in the context of products and services and relationships with
stakeholders.

C. Ethical behavior requires sacrificing one’s own values for the good of the consuming public and society
as a whole.
D. Ethical insurance professionals need not concern themselves with laws and regulations.

Professionalism: Do You Have What

It Takes?
Objective
Illustrate how insurance practitioners should exhibit professionalism.

Because insurance is, in essence, a promise to customers and the public, people
must trust the practitioners with whom they conduct insurance transactions.
Practitioners can earn this trust by exhibiting professionalism. Do you have what it
takes to earn others' trust?
Insurance and risk practitioners demonstrate professionalism through their
knowledge and conduct. By exhibiting the key traits of professionalism,
practitioners maintain and advance the industry's reputation of integrity and help
earn the public's trust.

Traits of Professionalism: What It Takes

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High Ethical Standards

A professional's work should always reflect integrity. This is how you earn
consumers' trust. In the insurance industry, a "doctrine of utmost good faith" exists
to ensure the ethical nature of the relationship between insurers and insureds. This
standard extends beyond the insurer to agents, brokers, claims representatives,
 loss control representatives, and other practitioners who perform work on behalf
of the insurer.

What is the doctrine of utmost good faith?

Feedback
To demonstrate a commitment to high ethical standards and the doctrine,
insurance practitioners must act with integrity, be honest and trustworthy,
communicate openly, have a sense of equity and fairness, and accept personal
accountability.

Addressing Coverage Limitations

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To act with integrity, professionals must be open and candid. For example,
disclosing full information about coverage limitations requires insurance
practitioners to be forthright. At times, such full disclosure may present a conflict of
interest, but the professional should always give others' needs priority.

Maintaining High Ethical Standards

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Professional Competence
Insurance practitioners must know how different coverages apply in particular
situations, understand the implications of risk and its effect on individuals and
society, and apply that knowledge to help customers protect themselves from risk
exposures.
Practitioners who are professionally competent are aware of their abilities as well
as their limitations. Competence sometimes requires us to admit that we "don't
know what we don't know" and seek help from others.

The Opposite of Professional Competence

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Altruism
Altruism is an unselfish concern for the welfare of others. Insurance exists to meet
the vital needs of consumers. Although insurers strive to be profitable, insurance
practitioners must practice altruism when interacting with and serving insureds,
which may require looking beyond their own and their employer's needs to help
others.

Examples of Altruism

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Practicing altruism doesn't preclude seeking personal rewards. Few people would
pursue a career in risk management or insurance solely for altruistic reasons.
Insurance practitioners have the opportunity for personal (financial and other) gain
while striving to serve the needs of others.

Commitment to Continuing Education

Each area of insurance demands specific, specialized knowledge that must be built
on a broad educational foundation. To perform at an optimal level, insurance
professionals must continually update their knowledge in response to changes in
the legal environment, new regulations, emerging loss exposures, and new
statutes.
In some jurisdictions, continuing education is mandated by law as a prerequisite for
producer licensing and license renewals. The same requirements often apply for
claims representatives.

Participation in an Association or Society

Professional associations or societies, such as claims associations and agents'
groups, typically have established standards for ethical behavior specific to the
specialty of their members. To attract and retain members, most associations or
societies strive to make membership meaningful and serve as a valuable resource
for members.
For example, professional associations often provide formal continuing education
resources that satisfy licensing requirements. They also provide education and
information for all members, whether licensed or not, to ensure that members stay
abreast of trends and issues facing the industry.
Further, professional associations and societies have professional codes that
address the ethical standards and ideals that the group requires of its members.

Ability to Think and Act Independently

While professionals may consult with peers or mentors when handling a difficult
issue, professionals, ultimately, are accountable for their thoughts, decisions, and
actions. True professionals strive to make informed, independent decisions based
on careful review and consideration.

Dangerous Temptations and Barriers to Acting

Independently

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Recognition as a Professional
Practitioners who are perceived as professionals will gain an advantage over other
practitioners. As a result, practitioners should strive to be viewed as professionals
by both the public and peers.

Forms of Professional Recognition

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Summary
To fulfill the high level of trust needed to conduct insurance transactions with the
public, insurance and risk management practitioners should exhibit the traits of
professionalism. Aspiring to be a professional often requires practitioners to make
personal sacrifices, including spending time in training and away from family or
recreational pursuits.

Acting Responsibly: What Would You

Do?
Objective
Determine the ethical response, given an interaction with insurers, policyholders,
and the public.
Insurance professionals have responsibilities to different groups of stakeholders:
insurers, policyholders, and the public.
So that ethical decisions can be made, those professionals need to consider the
fundamental needs and expectations of each group.

Insurers
Insurers are in business to provide their customers with protection from financial
loss, and to do so, they must also earn a fair profit. Insurance professionals support
this goal by acting responsibly within that context. To ensure that their decisions
are ethical, they weigh and fully consider competing interests.

What's Your Mindset?

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While the policyholder receives a promise of future payment for a covered loss, the
insurer must trust that the policyholder has disclosed all requested pertinent facts
about the risk. The insurer must also trust that the agent has recommended
appropriate coverage by assessing the potential profitability of prospective policies
and considering prospective policyholders' loss histories. Additionally, the insurer
needs to be confident that the underwriter has priced the risk accurately and, after
a claim, that claims personnel will accurately determine liability and settlement
amounts.
Bottom line: Agents, underwriters, and claims representatives (as well as others
representing the insurer) must balance customers' need for a fair price and
comprehensive coverage with the duty they owe the insurer to market, issue, and
provide adequate coverage at a fair profit.

Responsibly Evaluating a Risk

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Accept the risk

Decline the risk

Policyholders
To understand the ethical responsibility owed to policyholders, insurance
professionals need to first understand the basis of the relationships between
themselves, the policyholder, and the insurer.
These are the four key facets of policyholder relationships:
Policyholders are parties to the insurance contract
Policyholders are consumers of insurance products
Policyholders are first-party beneficiaries
Policyholders can be legally liable to third-party claimants
Balancing Responsibilities to Multiple Parties

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What Decision Should Lucas Make?

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Follow the rules

Bend the rules

The Public
The general public depends on insurers to pay claims as much as each individual
policyholder does. Indemnification—the process of restoring an individual or
organization to a pre-loss financial condition—helps maintain order in society,
reducing the public's dependence on charitable organizations. Insurers' fulfillment
of their contractual obligations creates an orderly method for compensating injured
parties that benefits the public as a whole.
Insurance experts analyze risks and develop coverage that's in society's best
interests. This responsibility begins with developing policy wording to
prevent moral hazard and morale hazard. For example, an auto liability policy
that excludes intentional injury effectively helps protect the public from intentional
harm by preventing objectionable and harmful behavior.

Apply Your Knowledge

How do you—as an underwriter, producer (agent or broker), claims rep, or safety
professional—fulfill your ethical responsibility to protect the public interest?

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Summary
When insurance professionals act ethically, they can focus on the goals of insurers,
policyholders, and the general public rather than on personal enrichment.
Ethical Decision-Making Tools: Are
You Stocked With the Right Assets?
Objective
Apply decision-making tools to resolve ethical dilemmas.
Even after analyzing ethical dilemmas from a variety of perspectives, the correct
path forward may be unclear or riddled with barriers. When that's the case, risk and
insurance professionals must lean on their ethics toolbox. Is yours properly
stocked?

What are three common barriers to ethical decision making?

Feedback
When risk and insurance professionals encounter these barriers to ethical decision
making, they can reach for one or more tools to effectively construct an
appropriate solution.

Tools for Ethical Decision Making

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Codes of Ethics
Many organizations, including insurers, have developed codes of ethics, sometimes
referred to as codes of conduct or codes of market conduct, to help resolve ethical
dilemmas. These codes support compliance with laws and regulations and provide
guidance for ambiguous situations when the best decisions aren't clear. As with
rules and regulations, professionals must search for any applicable code, standard,
or guidance that may apply to a situation.
A code of ethics generally states the organization's principles and values. It also
communicates the organization's expectations of employees.
By articulating values and providing examples of or suggestions for conflict
resolution, ethics codes promote consistent management standards and practices.
Such codes can guide individuals and teams when they encounter the same or
similar issues as those addressed in a code.

The Benefits of Following a Code of Ethics

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Codes can comprise many components, which can include:

 A statement of the organization's values that employees must uphold

 A description of how the values correlate with the responsibilities of each employee

 Confirmation that employees must follow all regulatory rules and statutes

 Descriptions of conflicts employees must avoid, such as supervising immediate

family members

 A process for anonymously reporting code violations

 Guidance for handling "gray areas" with examples of unethical conduct and
appropriate responses

Flowcharts
Flowcharts and checklists provide logical ways for professionals to think through
ethical dilemmas and make sure they have considered the appropriate
stakeholders, perspectives, and duties.

Ethical Decision-Making Flowchart Example

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Apply Your Knowledge
Rasha is the operations manager for FirstHousehold Insurance Company, which
wants to launch an aggressive growth strategy. A marketing study found that
younger homebuyers are an underserved market for the business and a strong
target for growth. The research then confirmed that this group prefers to shop and
make instant product changes through a website or app, and wants round-the-
clock access to their accounts.
FirstHousehold prides itself on customer service. The company employs a large
customer service staff to field calls. FirstHousehold's long-time customers love that
they can speak to an actual person when they call.
However, the company's board of directors has charged Rasha with determining
the future of the customer service model. She's developed two options for the
company:

 Expand online and app-based services, combined with adding a 24-hour service line
that utilizes artificial intelligence (AI) to interact with customers and retaining only
minimal staff to field calls that cannot be handled by AI.

 Hire additional customer service staff so that the call center can be open 24 hours a
day; then heavily promote the expanded hours.

How would Rasha proceed using the flowchart model?

Feedback

Checklists
Checklists can also help professionals take a disciplined, logical approach to
resolving ethical dilemmas.

Ethical Decision-Making Checklist Example

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Ethical Decision-Making Checklist Example

Applying the Checklist

Play Video

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If you were in the same position as Marcos, which of these actions would you take next?

Ethical Guidelines for Insurance

Professionals: Can You Make the
Right Call?
Objective
Given an ethical dilemma, apply the Ethical Guidelines for Insurance
Professionals to arrive at a resolution.
Good news for your future self: When you one day face a challenging ethical
dilemma (and you undoubtedly will), there's an overarching code of professional
ethics that you can lean on for direction.
It's called Ethical Guidelines for Insurance Professionals, and it exists to help insurance
professionals do what's right and honorable in their public and private conduct. It's
a compilation of principles that promotes a profession-wide foundation for making
better ethical decisions.
The guidelines consist of seven individual canons, each of which prescribes a
specific goal for insurance professionals to strive for.

Code of Professional Ethics—Ethical Guidelines for

Insurance Professionals

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Code of Professional Ethics—Ethical Guidelines for Insurance Professionals

Canon 1—Altruism
The essence of Canon 1 is having unselfish concern for the welfare of others
(selflessness). In the context of ethics, it's the doctrine that the general welfare of
society should take precedence over one's self-interest. A practical application of
this canon is to use it as guidance when conflicts of interest arise.
For example, Sherry is a commercial underwriter for a small insurer. Occasionally,
her office receives applications for coverage for properties that Sherry has a
personal connection to. Applications have crossed her desk to insure her church, a
manufacturing business owned by her brother-in-law, and her husband's employer.

What Should Sherry Do?

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Sherry should pass the applications on to another underwriter because her working
with these risks presents a conflict of interests and may not best serve the public
interest. Of course, Sherry may be perfectly capable of evaluating each application
on its own merits and without bias, but her participation in underwriting decisions
for these organizations could be viewed as a violation of Canon 1.

Canon 2—Continuing Professional

Development

Although knowledge and skills alone don't ensure that an individual will adhere to
high ethical standards, they are requisites to the high levels of competence and
performance expected of all professionals. Knowledge and skill improvement is
particularly necessary in the insurance field because of the inherent complexities
and rapid changes in the industry.
Take Jennifer, for example. She was a customer service representative for a
national insurer for five years and then left to manage a customer service
department for a large retailer. Twelve years later, she applied to be a customer
service manager at another insurer. In her job interview, she downplayed the gap in
insurance-related experience, telling the hiring manager she'd compensate for it by
taking insurance education courses. Jennifer got the job.

What Should Jennifer Do?

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Canon 2 calls for Jennifer to follow through on her commitment to taking insurance
education courses to refresh her knowledge and understanding of the industry. Her
lack of recent experience and knowledge in the field could lead her to make costly
mistakes.

Canon 3—Legal Conduct

In addition to failing to obey laws and regulations, dishonesty, deceit, and fraud
also constitute violations of this canon, regardless of whether the actions
themselves are illegal. Other violations include misrepresentation or concealment
of a fact or other information that might influence an insurance transaction,
engaging in unfair competition, and receiving inappropriate compensation.
Let's say Julio, an insurance agent, is looking to grow the account of a long-time
commercial customer. The customer is expanding its business and just purchased
and plans to move into a large, older building with an outdated electrical system.
Because of the electrical system, Julio knows it'll be difficult to obtain coverage at
the price the customer wants. But at the same time, he knows the customer needs
coverage.

What Should Julio Do?

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While Julio wants to make sure his customer obtains affordable insurance,
misrepresenting facts on the application would likely do more harm than good and
would violate Canon 3. Failing to accurately inform the company of the condition of
the electrical system would harm the insurer's business (and, therefore, all of its
insureds).

Canon 4—Diligent Performance

All insurance professionals should do their part to help ensure the public's
protection and security as well as maintain or elevate the integrity of the insurance
industry by helping preserve and improve insurers' financial strength. They should
also strive to provide an adequate supply of insurance to meet public needs,
reduce the cost of insurance, encourage loss control, and conduct research that will
lead to improvement in the insurance industry. Insurance professionals accomplish
all of this by performing their duties conscientiously.
Take Marie, for example. She is a recent college graduate who just started working
for Greatview Insurance Company as a claims representative. She wants to fulfill
Canon 4 by improving how the insurance mechanism functions.

What Should Marie Do?

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Even as a new employee, Marie can do her part to "improve the function of the
insurance mechanism" by facilitating fair and timely settlements, which will help
fulfill the insurer's promise to its customers and enable customers to recover from
losses as soon as possible.

Canon 5—Professional Standards

Minimally, Canon 5 requires practitioners to foster competence and ethical conduct

among themselves and others in the industry. This includes attracting capable
people to the industry and encouraging their growth.
Insurance professionals should set examples through their professional conduct
and should support and participate in educational activities that assist others in
their professional development. Examples of such activities include participation in
seminars, lectures, research projects, training programs, and professional articles
for publication.
Let's say Rin manages the Human Resources Department of an insurance agency,
and the agency is having trouble finding and keeping qualified employees. The
employees don't always feel their job is very rewarding.

What Should Rin Do?

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Rin can start to solve the problem, and adhere to Canon 5, by looking for ways to
revamp the company's recruiting and training efforts. For example, she could visit
local high schools and colleges to tout the positive societal impact of insurance. She
could also develop a top-notch training program for new employees, as well as
continuing education offerings for existing employees that encourage their growth
and emphasize their impact on the industry and society.

Canon 6—Professional Relationships

Insurance has long been characterized as a business of utmost good faith.

Insurance transactions require customers to trust insurance professionals and
insurers. Fostering this trust requires:

 Keeping confidential information private and secure

 Remaining informed about the legal limitations imposed on the scope of

professional duties

 Genuinely seeking to meet customers' risk management needs

 Being open and honest about any limitations on their ability to provide high-quality,
professional services
Lachlan, for example, is the insurance agent for Tim and Billy, two friends who live
in Lachlan's neighborhood. Recently, Billy's house burned down, and Billy
complained to Tim about how long it was taking his insurer to settle the claim. This
greatly concerned Tim, who has his homeowners policy with the same insurer as
Billy. So Tim called Lachlan to ask whether it was typical for the insurer to take a
long time to settle claims. Tim's thinking about switching insurers. Meanwhile,
Lachlan knows there's more to the story; Billy is actually being investigated for
fraud, which is why the claim is still pending.

What Should Lachlan Do?

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Lachlan should avoid revealing any confidential information about Billy's claim.
Doing so would violate Canon 6 and Billy's trust. In fact, insurance professionals
shouldn't disclose details of any claims they handle, unless legally obligated to do
so.

Canon 7—Educating the Public

While not all insurance professionals are obligated to provide information to the
public directly, Canon 7 states the broader goal that they are ethically obligated to
support efforts to convey information to the public. A public understanding of
insurance can lead to increased public satisfaction and trust, expanded marketing
opportunities, reduced insurance fraud, and an enhanced reputation of integrity for
the industry.
An insurance professional can support efforts to provide the public with objective
information concerning their insurance and risk management needs and the
products, services, and techniques available to meet those needs.
Chloe, for example, is an actuary for a large insurer as well as a member of a local
insurance professional organization. The organization has found that recent local
graduates don't always think of working in insurance.

What Should Chloe Do?

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Chloe should seek to do her part to improve "the public understanding of insurance
and risk management." That could involve, for instance, helping the professional
organization develop a program to educate high school seniors about what
insurance is and the kinds of careers the industry offers.

Putting It All Together

Did This Claims Adjuster Receive an Improper Gift?
Play Video

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Case Analysis Tools and Information

Apply Your Knowledge

Marcy's situation raises several ethical, moral, and legal issues. How many can you
identify?

Feedback
Insurance professionals may use a variety of tools to help resolve ethical dilemmas.
Although any of them may be useful in this case, the Ethical Guidelines for Insurance
Professionals might be particularly helpful.
As is often the case with ethical dilemmas, more than one canon may apply, and
Marcy should begin by identifying those that could apply to her situation.

Apply Your Knowledge

Which canons might apply here?

Feedback
Possible Resolutions
Marcy might not determine a definitive resolution to her dilemma, but examination
of the canons will help her make the best decisions she can:
Canon 1
Canon 3
Canon 4
Canon 5
Canon 6

Summary
The Ethical Guidelines for Insurance Professionals outlines specific goals that
insurance professionals are obligated to strive for.