Insurance Terms & Definitions
Below are some standard terms and definitions used when describing business and personal insurance coverages.
The most important fundamental coverage available to any insured is – Liability. Liability insurance provides coverage that protects against, bodily injury, property damage or personal injury claims made by someone else. What about all the other hazardous elements of your operation? There are many different things that your general liability insurance will protect you from, and each policy is different so it is very important that you have the right liability coverage.
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• Absolute Liability: Liability for damages even though fault or negligence cannot
be proven.
• Accident: An event or occurrence which is unforeseen and unintended.
• Act of God: A flood, earthquake or other non preventable accident resulting from natural causes that occur without any human intervention.
• Activities of Daily Living: A list of activities, normally including mobility, dressing, bathing, toileting, transferring, and eating which are used to assess degree of impairment and determine eligibility for some types of insurance benefits.
• Actual Cash Value (ACV): 1) The cost of replacing or restoring property at prices prevailing at the time and place of the loss, less depreciation, however caused; 2) replacement cost minus depreciation.
• Additional Insured (AI): A person, company or entity protected by an insurance policy in addition to the insured. A person or organization not automatically included as an insured under an insurance policy, but for whom insured status is arranged, usually by endorsement. A named insured's impetus for providing additional insured status to others may be a desire to protect the other party because of a close relationship with that party (e.g., employees or members of an insured club) or to comply with a contractual agreement requiring the named insured to do so (e.g., customers or owners of property leased by the named insured)
• Additional Insured (AI) Blanket: This includes unlimited additional insured endorsements.
• Additional Insured (AI) Endorsement: This usually includes one or two additional insured endorsements.
• Additional Insured On A Primary And Non-Contributory Basis Clause: It's most easily understood with an example; Joe Construction subs out some work to Jack's Plumbing, with Joe Construction requesting this wording. It means, if Joe Construction is sued, Jack's Plumbing's policy covers... They pay first (primary), and Joe Construction's policy doesn't have to kick in (non-contributory).
To break it down even more, in the example of a contractor (or owner) and sub-contractor, if the contractor (or owner) requires the sub-contractor to have this wording in their policy, the contractor (or owner) will be less liable for damage done to the project. Primary wording means that if a contractor (or owner) of a project is partially responsible for damage or injury that occurs on a project, the sub-contractor’s policy will pay out FIRST. The Non-Contributory wording states that in the same situation, the sub-contractor's insurance will be the only insurance paying out.
• Adjuster: A person who investigates and settles losses for an insurance carrier.
• Adjusting: The process of investigating and settling losses with or by an insurance carrier.
• Amendment: A formal document changing the provisions of an insurance policy signed jointly by the insurance company officer and the policy holder or his
authorized representative.
• Application: A signed statement of facts made by a person applying for insurance and then used by the insurance company to decide whether or not to issue a policy. The application becomes part of the insurance contract when the policy is issued.
• Arbitration: Arbitration: A form of alternative dispute resolution where an unbiased person or panel renders an opinion as to responsibility for or extent of a loss.
• Arson: The willful and malicious burning of, or attempt to burn, any structure or other property, often with criminal or fraudulent intent.
• Assault &
• Assets: All funds, property, goods, securities, rights of action, or resources of any kind owned by someone.
• Assignment: The legal transfer of one person's interest in an insurance policy to another person.
• Automobile Insurance Plan: One of several types of "shared market" mechanisms where persons who are unable to obtain such insurance in the voluntary market are assigned to a particular company, usually at a higher rate than the voluntary market. Formerly called "Assigned Risk."
• Automobile Liability Insurance: Protection for the insured against financial loss because of legal liability for car-related injuries to others or damage to their property.
• Automobile Physical Damage Insurance: Coverage to pay for damage to or loss of an insured automobile resulting from collision, fire, theft, or other perils.
• Auto/Valet Liability: Restaurants, night clubs, bars and lounges have very specific auto related exposures. Whether you hire a valet service, provide your own or have a delivery service - these are important factors to consider when reviewing your insurance. Make sure you protect yourself from the potential problems that come along with auto liability. Provide your Valet service coverage with Auto/Valet Liability to insure the brief time you will be utilizing customers' cars.
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• Benefits: The amount payable by the insurance company to a claimant, assignee or beneficiary under each coverage.
• Binder: A written or oral contract issued temporarily to place insurance in force when it is not possible to issue a new policy or endorse the existing policy immediately. A binder is subject to the premium and all the terms of the policy to be issued.
• Binding Receipt: A receipt given for a premium payment accompanying the application for insurance. If the policy is approved, this binds the company to make the policy effective from the date of the receipt.
• Blanket Medical Expense: A provision which entitles the insured person to collect up to a maximum established in the policy for all hospital and medical expenses incurred, without any limitations on individual types of medical expenses.
• Boat Owners Package Policy: A special package policy for boat owners that combines physical damage insurance, medical expense insurance, liability insurance, and other coverage's in one contract.
• Boiler and Machinery Insurance: Coverage for loss arising out of the operation of pressure, mechanical, and electrical equipment. It covers loss of the boiler and machinery itself, damage to other property, and business interruption losses.
• Bond: A certificate issued by a government or corporation as evidence of a debt. The issuer of the bond promises to pay the bondholder a specified amount of interest for a specified period and to repay the loan on the expiration (maturity) date.
• Book of Business: the number, size and type of accounts (policyholders) that an agent "owns."
• Broker: A marketing specialist who represents buyers of property and liability insurance and who deals with either agents or companies in arranging for the coverage required by the customer.
• Burglary: Breaking and entering into another person's property with felonious intent.
• Burglary and Theft Insurance: Coverage against property losses due to burglary, robbery, or larceny.
• Business Insurance: A policy which primarily provides coverage of benefits to a business as contrasted to an individual. It is issued to indemnify a business for the loss of services of a key employee or a partner who becomes disabled.
• Business Interruption Insurance: Protection for a business owner against losses resulting from a temporary shutdown because of fire or other insured peril. The insurance provides reimbursement for lost net profits and necessary continuing expenses.
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• Cancellations: The discontinuance of an insurance policy before its normal expiration date, either by the insured or the company. Insurance contracts can be canceled for many reasons, either by you or your insurance company. State laws govern when and why an insurance company can cancel a contract but you as the policyholder have the right to cancel your policy at any time for any reason. You should be familiar with the three different methods of premium refunds so you are not surprised by the size of your refund check.
· FLAT RATE: You will receive your entire premium as a refund if your policy is canceled as if it never existed in the first place. Some policies, such as life insurance, come with a trial period and can be canceled for a full refund during that time. Insurance companies can rescind a policy for various reasons governed by state law. Flat rate cancellations mean the insurance company never accepted any risk under the policy and therefore earned none of your premium.
· PRO-RATE / PRO-RATA: Pro-rate or pro-rata cancellations are the most common type of premium refund. You will receive a refund of premium proportionate to the amount of the original policy period that remains. For example, if you paid $300 for a 12-month policy and it cancels after only six months you would receive $150 back. Insurance rates are calculated on a daily basis so a pro-rate cancellation will be accurate to the very day.
· SHORT RATE: A short-rate cancellation means you will receive a pro-rated refund minus a penalty. The penalty represents an administrative fee for costs incurred by the company, and is typically 10 percent of the pro-rated amount. A common reason for a short-rate refund is when you cancel your existing policy midterm in order to buy a new policy with a different company.
• Captive Insurance Company: A company owned solely or in large part by one or more non- insurance entities for the primary purpose of providing insurance coverage to the owner or owners.
• Captive Insurer: Insurance companies established and owned by a parent firm in order to insure its loss exposures while reducing premium costs, providing easier access to a re-insurer, and perhaps easing tax burdens.
• Cargo Insurance: Type of ocean marine insurance that protects the shipper of the goods against financial loss if the goods are damaged or lost.
• Casualty Insurance: Insurance concerned with the insider's legal liability for injuries to others or damage to other persons' property; also encompasses such forms of insurance as plate glass, burglary, robbery and workers' compensation.
• Catastrophe: Event which causes a loss of extraordinary magnitude, such as a hurricane or tornado.
• Causes-of-loss Form: Form added to commercial property insurance policy that indicates the causes of loss that are covered. There are four causes-of-loss forms: basic, broad, special, and earthquake.
• Certificate Holder: An entity which is provided with an insurance certificate as evidence of the insurance maintained by another entity.
• Certificate of Insurance: A statement of coverage issued to an individual insured under a group insurance contract, outlining the insurance benefits and principal provisions applicable to the member.
• Chartered Property and Casualty Underwriter (CPCU): Professional who has attained a high degree of technical competency in property and liability insurance and has passed ten professional examinations administered by the American Institute for Property and Liability Underwriters.
• Choice no-fault: Allows auto insureds the choice of remaining under the tort system or choosing no-fault at a reduced premium.
• Claim: A request for payment of a loss which may come under the terms of an insurance contract.
• Claims Adjustor: Person who settles claims: an agent, company adjustor, independent adjustor, adjustment bureau, or public adjustor.
• Claims Made Policies: As the name indicates, Claims Made Policies provide coverage for claims made in the period the policy is in force. Claims made policies provide coverage only so long as the insured continues to pay premiums for the initial policy and any subsequent renewals. Once premiums stop the coverage stops for any claims not known or made to the insurance company during the coverage period.
What this means to the business owner is that there is a risk of an unknown or unreported claim being made long after the policy period and not being covered because the claim was made outside of the coverage period.
To continue coverage after the coverage period, the business owner must purchase "a tail." Tail coverage (or, the Extended Reporting Endorsement) is an endorsement that extends the claims reporting period after the policy is ended. Tail coverage must be purchased to continue any risk protection afforded under the policy. Tail coverage can be expensive and can prove to be an unaffordable expense when winding down.
If you move from one insurer to the next with claims made coverage you must purchase tail coverage or your new insurer must include a prior acts endorsement. The new insurer assumes coverage for the prior acts occurring in the other carrier's coverage period.
• Coinsurance: 1) A provision under which an insured who carries less than the stipulated percentage of insurance to value, will receive a loss payment that is limited to the same ratio which the amount of insurance bears to the amount required; 2) a policy provision frequently found in medical insurance, by which the insured person and the insurer share the covered losses under a policy in a specified ratio, i.e., 80 percent by the insurer and 20 percent by the insured.
• Collision Insurance: Protection against loss resulting from any damage to the policyholder's car caused by collision with another vehicle or object, or by upset of the insured car, whether it was the insured's fault or not.
• Combined Ratio: Basically, a measure of the relationship between dollars spent for claims and expenses and premium dollars taken in; more specifically, the sum of the ratio of losses incurred to premiums earned and the ratio of commissions and expenses incurred to premiums written. A ratio above 100 means that for every premium dollar taken in, more than a dollar went for losses, expenses, and commissions.
• Commercial General Liability Policy (CGL): A broad commercial policy that covers all liability exposures of a business that are not specifically excluded. Coverage includes product liability, completed operations, premises and operations, and independent contractors. Commercial liability policy drafted by the Insurance Services Office containing two coverage forms, an occurrence form
and a claims-made form.
• Commercial Lines: Insurance for businesses, organizations, institutions, governmental agencies, and other commercial establishments.
• Community Property: A special ownership form requiring that one half of all property earned by a husband or wife during marriage belongs to each. Community property laws do not generally apply to property acquired by gift, by will, or by descent.
• Comparative Negligence: Under this concept a plaintiff (the person bringing suit) may recover damages even though guilty of some negligence. His or her recovery, however, is reduced by the amount or percent of that negligence.
• Completed Operations: Liability arising out of faulty work performed away from the premises after the work or operations are completed. Applicable to contractors, plumbers, electricians, repair shops, and similar firms.
• Comprehensive Automobile Insurance: Protection against loss resulting from damage to the insured auto, other than loss by collision or upset.
• Comprehensive Personal Liability Insurance: Protection against loss arising out of legal liability to pay money for damage or injury to others for which the insured is responsible. It does not include automobile or business operation liabilities.
• Compulsory Auto Liability Insurance: Insurance laws in some states required motorists to carry at least certain minimum auto coverage’s. This is called "compulsory" insurance.
• Compulsory Insurance Law: Law protecting accident victims against irresponsible motorists by requiring owners and operators of automobiles to carry certain amounts of liability insurance in order to license the vehicle and drive legally within the state.
• Concealment: Deliberate failure of an applicant for insurance to reveal a material fact to the insurer.
• Concurrent Causation: Legal doctrine that states when a property loss is due to two causes, one that is excluded and one that is covered, the policy provides coverage.
• Conditions: Provisions inserted in an insurance contract that qualify or place limitations on the insurer's promise to perform.
• Consideration: One of the elements for a binding contract. Consideration is acceptance by the insurance company of the payment of the premium and the statement made by the prospective policyholder in the application.
• Consequential Loss: Financial loss occurring as the consequence of some other loss. Often called an indirect loss.
• Contingent Liability: Liability arising out of work done by independent contractors for a firm. A firm may be liable for the work done by an independent contractor if the activity is illegal, the situation does not permit delegation of authority, or the work is inherently dangerous.
• Contract: A binding agreement between two or more parties for the doing or not doing of certain things. A contract of insurance is embodied in a written document called the policy.
• Contributory Negligence: Negligence of the damaged person that helped to cause the accident. Some states bar recovery to the plaintiff if the plaintiff was contributory negligent to any extent. Others apply comparative negligence.
• Coverage: The scope of protection provided under a contract of insurance; any of several risks covered by a policy.
• Covered: A person covered by a pension plan is one who has fulfilled the eligibility requirements in the plan, for whom benefits have accrued, or are accruing, or who is receiving benefits under the plan.
• Credit Insurance: A guarantee to manufacturers, wholesalers, and service organizations that they will be paid for goods shipped or services rendered. Applies to that part of working capital which is represented by accounts receivable.
• Crop-hail Insurance: Protection against damage to growing crops as a result of hail or certain other named perils.
• CSR: Customer service representatives support the work of insurance agents with a variety of tasks that must be done within a company or agency to deliver services to and handle requests from clients.
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• Declination: The insurer's refusal to insure an individual after careful evaluation of the application for insurance and any other pertinent factors.
• Deductible: An amount which a policyholder agrees to pay, per claim or per accident, toward the total amount of an insured loss.
• Dependent Benefits: Social Security benefits available to the spouse or children of a Social Security beneficiary.
• Depreciation: A decrease in the value of property over a period of time due to wear and tear or obsolescence. Depreciation is used to determine the actual cash value of property at time of loss. (See Actual Cash Value)
• DIC: Difference in Conditions.
• Direct Loss: Financial loss that results directly from an insured peril.
• D&O (Directors & Officers Insurance): Liability insurance payable to the directors and officers of a company, or to the organization(s) itself, to cover damages or defense costs in the event they suffer such losses as a result of a lawsuit for alleged wrongful acts while acting in their capacity as directors and officers for the organization. Such coverage can extend to defense costs arising out of criminal and regulatory investigations/trials as well; in fact, often civil and criminal actions are brought against directors/officers simultaneously. It has become closely associated with broader management liability insurance, which covers liabilities of the corporation as well as the personal liabilities for the directors and officers of the corporation
• Disability: a physical or a mental impairment that substantially limits one or more major life activities of an individual. It may be partial or total. (See Partial Disability; Total Disability.)
• Disability Benefit: Periodic payments, usually monthly, payable to participants under some retirement plans, if such participants are eligible for the benefits and become totally and permanently disabled prior to the normal retirement date.
• Disability Income Insurance: A form of health insurance that provides periodic payments to replace income when an insured person is unable to work as a result of illness, injury, or disease.
• Dismemberment: Loss of body members (limbs), or use thereof, or loss of sight due to injury.
• Dividend: A return of part of the premium on participating insurance to reflect the difference between the premium charged and the combination of actual mortality, expense and investment experience. Such premiums are calculated to provide some margin over the anticipated cost of the insurance protection.
• Dollar Threshold: In no-fault auto insurance states with the dollar threshold, it prevents individuals from suing in tort to recover for pain and suffering unless their medical expenses exceed a certain dollar amount.
• Dramshop Law: Law that imputes negligence to the owner of a business that sells liquor in the case that an intoxicated customer causes injury or property damage to another person. Usually excluded from general liability policies.
• Dwelling Property 1: Property insurance policy that insures the dwelling at actual cash value, other structures, personal property, fair rental value, and certain other coverage’s. Covers a limited number of perils.
• Dwelling Property 2: Property insurance policy that insures the dwelling and other structures at replacement cost. It adds additional coverage’s and has a greater list of covered perils than the Dwelling Property 1 policy.
• Dwelling Property 3: Property insurance policy that covers the dwelling and other structures against direct physical loss from any peril except for those perils otherwise excluded. However, personal property is covered on a named-perils basis.
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• Earned Income: Employment income derived from salary, wages, commissions, or fees.
• Earned Premium: The portion of an insurance written premium which is considered "earned" by the insurer, based on the part of the policy period that the insurance has been in effect, and during which the insurer has been exposed to loss. For instance, if a 365-day policy with a full premium payment at the beginning of the term has been in effect for 120 days, 120/365 of the premium is considered earned. Earned premium will not be returned to the insured if the policy is cancelled.
• Effective Date: The date on which the insurance under a policy begins.
• Elements of a Negligent Act: Four elements an injured person must show to prove negligence: existence of a legal duty to use reasonable care, failure to perform that duty, damages or injury to the claimant, and proximate cause relationship between the negligent act and the infliction of damages.
• Embezzlement: Fraudulent use or taking of another's property or money which has been entrusted to one's care.
• Endorsements: An additional piece of paper, not a part of the original contract, which cites certain terms and which, when attached to the original contract, becomes a legal part of that contract. An amendment of the policy usually by means of a rubber stamp or rider.
• E&O (Errors & Omissions Insurance): Liability insurance policy that provides protection against loss incurred by a client because of some negligent act, error, or omission by the insured.
• Estoppels: Legal doctrines that prevent a person from denying the truth of a previous representation of fact, especially when such representation has been relied on by the one to whom the statement was made.
• Excess and Surplus Insurance: 1) Insurance to cover losses above a certain amount, with losses below that amount usually covered by a regular policy. 2) Insurance to cover an unusual or one-time risk, e.g., damage to a musician's hands or the multiple perils of a convention, for which coverage is unavailable in the normal market. (See also "Umbrella Liability" and "Surplus Lines.")
• Exclusions: Specific conditions or circumstances listed in the policy for which the policy will not provide benefit payments.
• Exclusive Remedy Doctrine: Doctrine in workers compensation insurance which states that workers compensation benefits should be the exclusive or sole source of recovery for workers who have a job related accident or disease; doctrine has been eroded by legal decisions.
• Experience Modification Factor: Used in workers compensation rating to reflect the degree to which a particular employer has experience that is better or worse that expected for that industry. Weighted by employer's credibility factor.
• Experience Rating: The process of determining the premium rate for a group risk, wholly or partially on the basis of that group's experience.
• Exposure Unit: Unit of measurement used in insurance pricing.
• Extended Non-owned Coverage: Endorsement that can be added to an automobile liability insurance policy that covers the insured while driving any non owned automobile on a regular basis.
• Extortion: Surrender of property away from the premises as a result of a threat to do bodily harm to the named insured, relative, or invitee who is being held captive.
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• Fair Rental Value: Amount payable to an insured homeowner for loss of rental income due to damage that makes the premises uninhabitable.
• Fidelity Bond: A form of protection which reimburses an employer for losses caused by dishonest or fraudulent acts of employees.
• Fiduciary: A person who holds something in trust for another.
• Fire Following (Terrorism): In some states a doctrine know as “fire following” applies. This means that in the event of a terrorist-caused explosion followed by fire, insurers could be liable to pay out losses attributable to the fire (but not the explosion) even if a commercial property owner had not purchased terrorism coverage. laws requiring coverage for “fire-following” an event —known as the standard fire policy (SFP)—irrespective of the fire’s cause. Therefore, in SFP states, fire following a terrorist event is covered whether there is insurance coverage for terrorism or not. Therefore, when the insured elects to reject Terrorism coverage, Fire Following Terrorism coverage cannot be rejected from the policy.
• Fire Insurance: Coverage for losses caused by fire and lightning, plus resultant damage caused by smoke and water.
• Fire Legal Liability: Liability of a firm or person for fire damage caused by negligence of and damage to property of others.
• First Dollar Coverage: First dollar coverage in health insurance means that your insurance covers health care expenses without copayments or deductibles having to be paid first. It pays expenses beginning with the first dollar charged for health care or hospitalization depending on the type of policy purchased.
• First Party Claim: a demand made by a policyholder reporting an insured event directly to his company.
• Fire Legal Limit: Coverage for property loss liability as the result of negligent acts and/or omissions of the insured that allows a spreading fire to damage others' property. Negligent acts and omissions can result in fire legal liability. For example, an insured through negligence allows a fire to spread to a neighbor's property. The neighbor then brings suit against the insured for negligence. In another example, a tenant occupying another party's property through negligence causes serious fire damage to the property.
• First Party Coverage: An insurance coverage under which the policyholder collects compensation for losses from the insured's own insurer rather than from the insurer of the person who caused the accident.
• Floaters: Insurance policies that cover property that can be moved from one location to another for both transportation perils and perils affecting property at a fixed location.
• Flood Insurance: Coverage against loss resulting from the flood peril, widely available at low cost under a program developed by the private industry and the federal government.
• Food Contamination: "Food contamination" coverage protects you in the event of a patron getting or suspecting that they got food poisoning from food supplied by you. Check your current policy to see if you are covered for Food Contamination risks. Food contamination is one of the restaurant industries greatest areas of risk.
• Functional Capacity Evaluation (FCE) is a compilation information that 1) objectively assists in measuring functional abilities and consistency of efforts, 2) provides further data for the determination of permanent work capacity and 3) helps to promote safe work parameters.
• Future Increase Option: A provision found in some policies that allows the insured to purchase additional disability income insurance at specified future dates regardless of the insured's physical condition.
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• General Liability: General Liability insurance provides coverage that protects against, bodily injury, property damage or personal injury claims made by someone else. Some things that general liability protects you from are:
- Injuries sustained by patrons while at your restaurant
- Injuries that occur off premises due to your services
- Property damage caused by you or your employees
- Contractual issues
- Advertising
- Problems with your products
There are other more specific exposures that are not covered by general restaurant/bar liability coverage. General Liability provides coverage only for particular instances; look into the additional coverages that can be purchased to ensure you are correctly insured for all the services you provide.
• General Liability Aggregate: Liability insurance available for each year as a total (For example, 4 lawsuits at $250,000 each would be the max [1M aggregate]) \ - of course, you can get more coverage if you wish.
• General Liability Insurance: Coverage that pertains, for the most part, to claims arising out of the insured's liability for injuries or damage caused by ownership of property, manufacturing operations, contracting operations, sale or distribution of products, and the operation of machinery, as well as professional services.
• Glass Insurance: Protection for loss of or damage to glass and its appurtenances.
• Grace Period: A specified period after a premium payment is due, in which the policyholder may make such payment, and during which the protection of the policy continues.
• Gross Negligence: the intentional failure to perform a manifest duty in reckless disregard of the consequences as affecting the life or property of another
• Group Insurance: Insurance written on a number of people under a single master policy, issued to their employer or to an association with which they are affiliated.
• Guaranty Fund: A fund, derived from assessments against solvent insurance companies, to absorb losses of claimants against insolvent insurance companies.
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• Hazard: Condition that creates or increases the chance of loss.
• Health Maintenance Organization (HMO): An organization that provides a wide range of comprehensive health care services for a specified group at a fixed periodic payment. The HMO can be sponsored by the government, medical schools, hospitals, employers, labor unions, consumer groups, insurance companies, and hospital medical plans.
• High Risk Automobile Insurer: Company that specializes in insuring motorists who have poor driving records or have been canceled or refused insurance.
• Hired/Non-Owned Vehicle Liability: Hired/Non-Owned Vehicle Liability coverage provides contingent excess liability for Hired (rented) vehicles and Non-Owned vehicles (vehicles owned by employees and driven for company business.) Hired/Non-Owned Vehicle Liability limits are the same as the General Liability policy. Hired & Non-owned coverage is essential for risks that have a delivery service as you can be held responsible for accidents that your employees get into.
• Hold Harmless Clause: Clause written into a contract by which one party agrees to release another party from all legal liability, such as a retailer who agrees to release the manufacturer from legal liability if the product injures someone.
• Homeowners Policy: A package of insurance providing home owners with a broad range of property and liability coverage’s.
• Hurricane: A tropical storm marked by extremely low barometric pressure and circular winds with a velocity of 75 miles an hour or more.
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• Imputed Negligence: Case in which responsibility for damage can be transferred from the negligent party to another person, such as an employer.
• Indemnification: Compensation to the victim of a loss, in whole or in part, by payment, repair, or replacement.
• Indemnity: Legal principle that specifies an insured should not collect more than the actual cash value of a loss but should be restored to approximately the same financial position as existed before the loss.
• Independent Adjustor: Claims adjustor who offers his or her services to insurance companies and is compensated by a fee.
• Independent Agent: an independent business person who usually represents two or more insurance companies in a sales and service capacity and who is paid on a commission basis.
• Independent Medical Examination (IME): A medical examination used to determine whether an injured party claiming injuries is actually injured or to the extent they claim. Independent medical examiners are registered medical practitioners who provide impartial medical assessments of an injured worker to assist decisions about: accepting a claim, ongoing liability and the worker’s level
of fitness for work.
• Inland Marine Insurance: A broad form of insurance, generally covering articles in transit as well as bridges, tunnels and other means of transportation and communication. Besides goods in transit (generally excepting trans-ocean), it includes numerous "floater" policies, such as those covering personal effects, personal property, jewelry, furs, fine arts, and other items.
• Inspection Report: A report (usually written) of an investigation of an applicant, conducted by an independent agency that specializes in insurance investigations. The report covers such matters as occupation, financial status, health history, and moral problems.
• Insurability: Acceptability to the company of an applicant for insurance.
• Insurable Risk: The conditions that make a risk insurable are (a) the peril insured against must produce a definite loss not under the control of the insured, (b) there must be a large number of homogeneous exposures subject to the same perils, (c) the loss must be calculable and the cost of insuring it must be economically feasible, (d) the peril must be unlikely to affect all insureds simultaneously, and (e) the loss produced by a risk must be definite and have a potential to be
financially serious.
• Insurance: A system under which individuals, businesses, and other organizations or entities, in exchange for payment of a sum of money (a premium), are guaranteed compensation for losses resulting from certain perils under specified conditions.
• Insurance Company: An organization chartered to operate as an insurer. Any corporation primarily engaged in the business of furnishing insurance protection to the public.
• Insurance Guaranty Funds: State Funds that provide for the payment of unpaid claims of insolvent insurers.
• Insurance Services Offices (ISO): Major rating organization in property and liability insurance that drafts policy forms for personal and commercial lines of insurance and provides rate data on loss costs for property and liability insurance lines.
• Insured: A person or organization covered by an insurance policy, including the "named insured" and any other parties for whom protection is provided under the policy terms.
• Insurer: The party to the insurance contract who promises to pay losses or benefits. Also, any corporation engaged primarily in the business of furnishing insurance to the public.
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• Joint-and-Several Liability: A legal principle that permits the injured party in a tort action to recover the entire amount of compensation due for injuries from any tort-feasor who is able to pay, regardless of the degree of that party's negligence.
• Joint Tenants: A form of joint property ownership with right of survivorship, i.e., in which the survivors automatically own the share of a deceased co-owner.
• Joint Underwriting Association: One of several types of "shared market" mechanisms used to make automobile insurance available to persons who are unable to obtain such insurance in the regular market. JUAs also have been created in some states to help alleviate availability problems in the fields of medical malpractice and commercial insurance.
• Joint Underwriting Association: A device used to provide insurance to those who cannot obtain insurance in the voluntary market. Certain companies (called carriers) issue policies at one rate level and handle claims, but the ultimate costs are borne by all companies writing insurance in that state.
• Judicial Bond: Type of surety bond used for court proceedings and guaranteeing that the party bonded will fulfill certain obligations specified by law, for example, fiduciary responsibilities.
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• Lapse: The termination or discontinuance of an insurance policy due to nonpayment of a premium.
• Lapsed Policy: A policy terminated for non-payment of premiums. The term is sometimes limited to a termination occurring before the policy has a cash or other
surrender value.
• Larceny-theft: The unlawful taking, carrying, leading or riding away of another person's property.
• Last Clear Chance Rule: Statutory modification of the contributory negligence law allowing the claimant endangered by his or her own negligence to recover damages from a defendant if the defendant has a last clear chance to avoid the accident but fails to do so.
• Liability: Any legally enforceable obligation.
• Liability Insurance: Insurance covering the policyholder's legal liability resulting from injuries to other persons or damage to their property. Provides protection for the insured against loss arising out of legal liability to third parties. Liability insurance protects your business if a lawsuit is filed for employee or business negligence. Depending on the type of work you do, your state may also require you to purchase professional liability which protects you against malpractice, errors and negligence.
• Liability Limits: The stipulated sum or sums beyond which an insurance company is not liable to protect the insured.
• Liability Without Fault: Principle on which workers compensation is based, holding the employer absolutely liable for occupational injuries or disease suffered by workers, regardless of who is at fault.
• Lifetime Disability Benefit: A benefit to help replace income lost by an insured person as long as he/she is totally disabled, even for a lifetime. Disability income payable for the life of the insured as long as he is totally disabled.
• Liquidation: Dissolving a company by selling its assets for cash.
• Liquor Liability: Liquor Liability coverage is for bodily injury or property damage caused by an intoxicated person who was served liquor by the policyholder. Liquor liability insurance provides coverage for bodily injury or property damage for which an insured may be held liable by reason of the following:
- Causing or contributing to the intoxication of any person;
- Furnishing alcoholic beverages to a person under the legal drinking age or under the influence of alcohol; or
- Violating any statute, ordinance, or regulation relating to the sale, gift, distribution, or use of alcoholic beverages.
This coverage applies only if the insured is involved in the following activities:
- Manufacturing, selling, or distributing alcoholic beverages;
- Serving or furnishing alcoholic beverages for a charge, whether or not such activity requires a license or is for the purpose of financial gain or livelihood; or
- Serving or furnishing alcoholic beverages without a charge, if a license is required for such activity.
Liquor liability insurance is business insurance that protects your business against loss or damages claimed as a result of a patron of your business becoming intoxicated and injuring themselves or others. If your business manufactures, sells, serves, or facilitates the uses or purchase of alcohol, then your business may need this coverage.
Liquor liability coverage may be sold as an add-on to a commercial liability policy or as a separate liability policy. But, if you do not purchase this extra coverage your standard liability policy DOES NOT protect your business against these kind of claims.
This coverage is expensive - depending on your location - and it is estimated by experts that only 35% of businesses that should have this coverage actually purchase this coverage. Part of this is because of misconceptions that exist in the hospitality industry regarding the industry's liability risks for intoxicated patrons. That issue is a topic in itself. Part of this is because the insurers continually add exclusions to the point that this coverage is seen as having no value.
If you live in a state with a "dram shop liability" statute, then purchase this insurance if your business will manufacture, sell, serve, or facilitate the use of alcohol.
What to look for/ask for in a liquor liability policy:
- Assault and Battery Coverage - Most claims against bars and restaurants are the results of fights. Your liquor liability policy should include coverage for assault and battery claims. If not, the policy has a much lower real value.
- Defense Costs Included - The biggest cost facing your business in these types of claims is the cost of retaining a lawyer against frivolous claims. Insurers know this. That is why they sell policies where "defense costs" are deducted from the total coverage. That is, your $500,000 policy is reduced to $400,000 because of $100,000 in attorneys' fees. Frankly, even with a lower premium, pass on the policy if it does not provide your business with skilled, appointed legal counsel that does not reduce coverage.
- Employees Included - If you serve, then employees will drink regardless of the rules. Insurers know this and sometimes exclude employees from coverage. Make sure employees are covered as patrons.
- Damage Definition Includes Mental Damages - Claimants may claim they were damaged in non-physical ways: stress, mental anguish, or psychological damage. Some policies exclude these types of damages. Don't purchase a policy with limited damage definitions.
- Reduced Premiums Based on Safety and Claims - Good insurers who are market leaders in bar and restaurant insurance will offer free classes and training to their insureds employees and discounts on premiums for having safety training and no claim history. Some insurers will reduce premiums by 15-20% for this basic safety training.
As a final note, liquor liability insurance WILL NOT cover sales that are contrary to law and sales to minors.
• Long-Term Disability Income Insurance: Insurance issued to an employer (group) or individual to provide a reasonable replacement of a portion of an employee's earned income lost through serious and prolonged illness or injury during the normal work career. (See also Integration.)
• Loss: The happening of the event for which insurance pays.
• Loss Ratio: The percent which losses bear to premiums for a given period. The ratio of claims to premiums. It may be calculated in several different ways, using paid premiums or earned premiums, and using paid claims with or without changes in claim reserves and with or without changes in active life reserves.
• Loss Reserve: The amount set up as the estimated cost of a claim. (See IBNR Reserve)
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• Malingering: The practice of feigning illness or inability to work in order to collect insurance benefits.
• Malpractice: Improper care or treatment by a physician, hospital, or other provider of health care.
• Malpractice Insurance: Coverage for a professional practitioner, such as a doctor or a lawyer, against liability claims resulting from alleged malpractice in the performance of professional services.
• Managed Care: Health care systems that integrate the financing and delivery of appropriate health care services to covered individuals by arrangements with selected providers to furnish a comprehensive set of health care services, explicit standards for selection of health care providers, formal programs for ongoing quality assurance and utilization review, and significant financial incentives for members to use providers and procedures associated with the plan.
• Market Price (or Market Value): The price at which a item can be bought or sold at any particular time.
• Material Damage: Insurance against damage to a vehicle itself. It includes automobile comprehensive, collision, fire and theft. Material damage and physical damage are terms that often are used inter- changeably.
• Maximum Medical Improvement (MMI) Maximum Medical Improvement (MMI) is a treatment plateau in each person’s healing process. It can mean that the patient has fully recovered from the injury or that the patient’s medical condition has stabilized to the point that no major medical or emotional change can be expected in the injured workers’ condition. This occurs despite continuing
medical treatment or rehabilitative programs the injured worker partakes in.
• Med Pay: Believe it or not, most of the cost associated with our insurance rates (how car insurance rates are determined) is based on the cost to settle a claim versus the amount of money actually paid for injury liability or physical damage. Think attorney fees and court costs.
“Med pay insurance,” or “medical payments to others,” is an optional coverage addition to your auto insurance policy that eases the necessity of court involvement after an accident.
Basically, Med Pay will cover the medical costs associated with bodily injury resulting from an accident, without having to prove any fault. However, you must be both injured and have expenses associated with treatment resulting from the accident. We are talking basic injury here. Limits do not typically exceed $5,000. Also, this coverage cannot be triggered in the future after an accident has occurred, e.g. no stiff neck two weeks down the road.
According to most policy language, any insured in your vehicle is eligible for Med Pay rewards. “Insured” often refers to the named insured, or the name on the policy, the named insured’s spouse and family members, anyone living in the insured’s household, or anyone you allow to drive your vehicle. However, there are also some exclusions to this type of policy.
Med Pay is purchased on a “by vehicle” basis. This means if you have one policy covering two cars, you must purchase Med Pay for both if you wish to be covered while in either vehicle. This is similar to physical damage coverage, where you may have two cars on a policy, but only wish to have one repaired in the event of an accident.
Med pay and personal injury protection (PIP) are no-fault coverage, conceived in an attempt to reduce the overall cost of car insurance and unclog the American court system. Whether it’s working or not is an ongoing debate.
No fault coverage refers to instances where an individual, other than the driver of the vehicle, is injured in a minor accident where fault may be difficult or impossible to determine. This coverage will pay a specified amount of money to the injured party. The typical coverage limits for med pay and PIP span from $1,000 to $10,000.
Let’s look at an example:
You’re driving a friend to work, when you careen off the road and hit a tree at low speed while avoiding a car that wandered into your lane. Your friend breaks her arm during the impact. She may choose not to file a claim against your insurance company, but still needs to go to the hospital and get treatment, resulting in a $2,500 hospital bill.
If you have med pay coverage, your insurance policy will cover the hospital costs without the need for your friend to file a claim to determine who was at fault or charged the deductible. The $2,500 hospital visit would be much cheaper than investigating the accident and paying court costs and attorney fees.
Med pay coverage limits are “stackable” in some states. This means if you have a $5,000 med pay limit on your policy and have an accident in which three people are injured, your insurance company would be responsible for up to $15,000 in injury expense.
Some argue that if you have health insurance there is no need to have med pay insurance, as health insurance may cover your injury expense in the example above.
As always, I recommend purchasing as much insurance coverage as you can afford. Get an online quote and speak to your insurance company or independent agent if you have questions about med pay coverage or cost. This will ensure you are full covered at a fair price.
• Medical Payments Insurance: A coverage, available in various liability insurance policies, in which their insurer agrees to reimburse the insured and others, without regard for the insured's liability, for medical or funeral expenses incurred as the result of bodily injury or death by accident under specified
conditions.
• Misrepresentation: A false, incorrect, improper, or incomplete statement of a material fact, made in the application or claim process.
• Mortgagee Clause: is how the lender will require their name, address and loan number to appear on the insurance documents.
• Mutual Insurance Company: An insurance company in which the ownership and control is vested in the policyholders and a portion of surplus earnings may return to policyholders in the form of dividends. No capital stock exists.
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• Named Perils: Coverage in a property policy that provides protection against loss from only the perils specifically listed in the policy rather than protection from physical loss. Examples of named perils are fire, windstorm, theft, smoke, etc.
• National Association of Insurance Commissioners (NAIC): The association of insurance commissioners of various states formed to promote national uniformity in the regulation of insurance.
• Negligence: Failure to use the care that a reasonable and prudent person would have used under the same or similar circumstances.
• No-Fault: A type of auto insurance mechanism whereby the right to sue another party for damages caused by negligence is limited and, in exchange, expanded first party benefits are offered.
• No-fault Automobile Insurance: A form of insurance by which a person's financial losses resulting from an automobile accident are paid by his or her own insurer regardless of who was at fault.
• Non-disabling Injury: An injury which may require medical care, but does not result in loss of working time or income.
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• Obligee (Bond): The party who is the recipient of the obligation. A business or person who asks for or requires the bond. Also called promisee.
• Occupational Hazards: Occupations which expose the insured to greater than normal physical danger by the very nature of the work in which the insured is engaged, and the varying periods of absence from the occupation, due to the disability, that can be expected.
• Occurrence: An accident, including continuous or repeated exposure to substantially the same general, harmful conditions, that results in bodily injury or property damage during the period of an insurance policy.
• Occurrence Coverage Policy: A liability insurance policy that covers claims arising out of
occurrences that take place during the policy period, regardless of when the claim is filed. Occurrence coverage is, in my opinion (and others differ), the better option for the business owner. Occurrence coverage is insurance that provides coverage for the act when it occurs - regardless of when it is reported. If you had coverage under an occurrence policy in 2000 and the claim is reported today (they just found the defect in the wall, like the example above, for example) then the claim is covered.
• Ordinance Or Law Insurance: Coverage designed to provide protection against financial loss for (1) the loss of value of an undamaged portion of the existing building which must be demolished and/or removed to conform with municipal ordinance, code, etc.; (2) the cost of demolition of the undamaged portions of the building necessitated by the enforcement of building, zoning or land use ordinance or law; (3) any increased expenses incurred to replace the building with one conforming to building laws or ordinances, or to repair the damaged building so that it meets the specifications of current building laws or ordinances.
• Overhead Insurance: A type of short-term disability income contract that reimburses the insured person for specified, fixed monthly expenses, normal and customary in the operation and conduct of his/her business or office.
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• Partial Disability: The result of an illness or injury which prevents an insured from performing one or more of the functions of his/her regular job. A benefit sometimes found in disability income policies providing for the payment of reduced monthly income in the event the insured cannot work full time and/or is prevented from performing one or more important daily duties pertaining to his occupation.
• Peril: The cause of a possible loss, such as fire, windstorm, theft, explosion, or riot.
• Per Occurrence: Liability insurance per each potential lawsuit. (For example; 500k Per occurrence/1M aggregate)
• Persistency: A term used to refer to the length of time insurance remains continuously in force.
• Personal Injury & Advertising Insurance: Your business' commercial liability policy has coverage you may not have realized was in the policy. This coverage is called "personal and advertising injury coverage" and may be set apart as separate coverage or "Coverage-B." The coverage can provide coverage for a variety of acts above and beyond typical physical damage claims. The purpose of this information below is to provide a brief overview of the coverage.
What is an Advertising Injury?
An advertising injury is an injury to a third-party brought about by the business' advertising its goods and services. This can occur by copyright or trademark infringement. It can also occur as a claim of libel, slander, or invasion of privacy. Typically, a competitor of your business complains that an act, advertisement, practice, or comment you or your staff has made has damaged their business. For example, in comparing products, your advertisement uses a photo of your competitor's product and makes a false claim about the competitor's product. The competitor sues your business for a variety of claims: defamation, trademark infringement, etc. Your commercial policy would provide a defense and indemnity for this kind of claim.
What Claims are Covered?
Your business is provided advertising injury coverage through your commercial general liability policy for claims such as:
- Libel
- Slander
- Invasion of Privacy
- Copyright Infringement
- Trademark or Trade Dress Claims
- Certain State Law Claims
- Certain Misappropriation Claims
- Unfair Competition Claims (older policies)
The typical commercial general liability defines advertising as:
A notice that is broadcast or published to the general public or specific market segment about your goods, products or services for the purpose of attracting customers or supporters.
The coverage provides your business a defense and indemnification for damages as long as the claim relates to a business advertising reason and is not an intentional non-advertising claim. However, the definition of "advertising" has been interpreted differently from state to state. Some courts require the activity to be wide ranging communication to a broad audience while other courts define the simple act of business promotion to be advertising without regard to the size of the audience.
There are exclusions from coverage in most standard CGL policies. Most of the exclusions look to whether the act causing the claim was an intentional act or knowing violation of the law. Typical exclusions from coverage include:
- Knowingly Publishing False Information - Coverage is meant to cover those instances where advertising or promotion unintentionally includes false or misleading information.
- Knowingly Violating the Rights of Another - As an example: If your business knows it has no permission to use a child's image in its advertising, and does so anyways, coverage will be excluded.
- Criminal Acts - Criminal copyright and trademark infringement, or other criminal acts are not covered.
- Breach of Contract and Contractual Liability - Your business cannot assume advertising liability by contract. For example, if your business rents a hall as part of a trade organization, and your business signs a hold harmless agreement with the organization and hall, if a visitor sues the trade organization or hall and your business becomes liable as a result of the hold harmless agreement - there is no coverage.
- Price, Quality, and Performance Claims - Generally damages incurred because of erroneous price, quality, or performance claims are not covered. If owing to a printer error you advertise a $10,000 used car for $1,000, and actually sell the car at the advertised price of $1,000, the insurer will not reimburse the other $9,000.
There are other exclusions that are less likely and you will want to review the exclusions with your insurance professional.
What About Websites, Bulletin Boards, and Forums?
First, understand that certain businesses are excluded from most advertising injury coverage:
- Internet Service Providers
- Web Site Designers and Publishers
- Advertising Companies
These companies will need to purchase a separate endorsement to be covered completely. However, creating your own company web site does not turn your business into an advertising company. Generally, if your business designs and builds a website coverage extends to the promotional advertising material on the site.
However, this coverage is being limited each year as insurers begin to recognize the risk of advertising claims related to internet activities. Today, most Standard CGL policies exclude coverage for electronic forums or bulletin boards hosted by the insured. CGL policies also now exclude from coverage claims related to "spam" or mass electronic advertising. Again, this is an area where you will want to speak with your insurance professional.
• Personal Articles Floater: A form of coverage designed to meet the needs for insurance on property of a moveable nature. The coverage usually protects against all physical loss, subject to special exclusions and conditions. Examples of property covered include jewelry, furs, silverware, and fine arts.
• Personal Injury Protection (PIP): First-party no-fault coverage in which an insurer pays, within the specified limits, the wage loss, medical, hospital and funeral expenses of the insured.
• Personal Lines: Those types of insurance, such as auto or home insurance, for individuals or families rather than for businesses or organizations.
• Personal representative: A person appointed through the will of a deceased or by a court to settle the estate of one who dies.
• Physical Damage: Damage to or loss of the auto resulting from collision, fire, theft or other perils.
• Policy: The printed legal document stating the terms of the insurance contract that is issued to the policyholder by the company. A contract of insurance. The legal document issued by the company to the policyholder, which outlines the conditions and terms of the insurance; also called the policy contract or the contract.
• Policy Term: That period for which an insurance policy provides coverage.
• Policyholder: The person who owns a life insurance policy. This is usually the insured person, but it may also be a relative of the insured, a partnership or a corporation. A person who pays a premium to an insurance company in exchange for the insurance protection provided by a policy of insurance.
• Premium: The sum paid by a policyholder to keep an insurance policy in force.
• Primary Insurance: Insurance that pays compensation for a loss ahead of any other insurance coverage’s the policyholder may have.
• Principal (Bond): A business or person who is required to purchase and secure a bond. The primary party who will be performing a contractual obligation.
• Probate: The court supervised process of validating or establishing a distribution for assets of a deceased including the payment of outstanding obligations.
• Probationary Period: A period from the policy date to a specified time, usually 15 to 30 days, during which no sickness coverage is effective. It is designed to eliminate a sickness actually contracted before the policy went into effect.
• Products/Completed Ops: Product liability insurance protects the business from claims related to the manufacture or sale of products, food, medicines or other goods to the public. It covers the manufacturer's or seller's liability for losses or injuries to a buyer, user or bystander caused by a defect or malfunction of the product, and, in some instances, a defective design or a failure to warn. When it is part of a commercial general liability policy, the coverage is sometimes called products-completed operations insurance.
To understand the need for this coverage it is critical to understand the potential liability. There are generally three types of products "claims" a company may face:
- Manufacturing or Production Flaws- A claim that some part of the production process created an unreasonably unsafe defect in the resulting product. Recent claims against Chinese manufacturers regarding the presence of dangerous chemicals in their products are an example of this type of claim.
- Design Defect- A claim that the design of the product is inherently unsafe. The most memorable example is the series of Pinto car cases against Ford in the 1970's.
- Defective Warnings or Instructions- The claim that the product was not properly labeled or had insufficient warnings for the consumer to understand the risk. The McDonald's "coffee case" is an example.
The damages awarded in these claims include medical costs, compensatory damages, economic damages, and, in some instances, attorneys' fees, costs and punitive damages. Product liability claims can and do put businesses out of business - just ask any of the officers from any asbestos manufacturer.
All to often, resellers, gray market commercial sellers, and retailers fail to secure this coverage. The logic is that, since they did not "manufacture" anything, the coverage is not necessary. However, manufacturers are not the only ones subject to product liability exposure, retailers and wholesalers are often brought into a lawsuit for alleged negligence by the consumer. Most states follow the "stream of commerce" model of liability. This means that if your company participated in placing the product into the "stream of commerce," it can be held liable for damages to the end user.
If your company provides any products to the consuming public, then your company needs product liability or completed-operations coverage. In most cases, some form of this coverage will be present in the standard commercial general liability or business owners' policy. You will need to confirm this with your insurance professional. You will want to have a clear understanding of what is covered (for example, some policies will cover economic damages, but not punitive or statutory damages).
Finally, the premiums on such policies are based upon the type of product, volume of sales, and the role of the insured in the process. Thus, underreporting the volume of sales may seem like a good way to lower premiums or the idea may be to insure only a part of the sales. Don't under report or try to insure less than the actual amount of sales. This is because there are usually substantial underinsurance penalties applied when the insured underinsures. On the other hand, you will want to make absolutely sure that your products are properly identified. For example, if you supply step stools, you do not want them categorized as ladders. Ladders will have a much higher premium because of the risk potential.
• Product Liability: legal liability incurred by a manufacturer, merchant, or distributor because of injury or damage resulting from the use of its product.
• Product Liability Insurance: Protection against financial loss arising out of the legal liability incurred by a manufacturer, merchant, or distributor because of injury or damage resulting from the use of a covered product.
• Proof of Loss: Documentation presented to the insurance company by the insured in support of a claim so that the insurer can determine its liability under the policy. Documentary evidence required by an insurer to prove a valid claim exists. It usually consists of a claim form completed by the insured and the insured's attending physician. For medical expense insurance itemized bills must also be included.
• Promisee (Bond): The party to which a promise is made.
• Promisor (Bond): A person who makes a promise.
• Property Damage Coverage: An agreement by an insurance carrier to protect an insured against legal liability for damage by an insured automobile to the property of another.
• Property Insurance: Insurance providing financial protection against the loss of, or damage to, real and personal property caused by such perils as fire, theft, windstorm, hail, explosion, riot, aircraft, motor vehicles, vandalism, malicious mischief, riot and civil commotion, and smoke.
• Proximate Cause: The dominating cause of loss or damage; an unbroken chain of events between the occurrence and damage.
• Punitive Damages: a court awarded amount that exceeds the economic losses and general damages of a defendant and is intended solely to punish the plaintiff
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• Qualification Period: The period during which the insured must be totally disabled before becoming eligible for residual disability benefits.
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• Rate: The pricing factor upon which the insurance buyer's premium is based.
• Rated Policy: Sometimes called an "extra risk" policy, an insurance policy issued at a higher-than-standard premium rate to cover the extra risk where, for example, an insured has impaired health or a hazardous occupation.
• Regulation: Supervision of business practices by a governmental entity.
• Rehabilitation: 1) Restoration of a totally disabled person to a meaningful occupation, 2) a provision in some long- term disability policies that provides for continuation of benefits or other financial assistance while a totally disabled insured is retraining or attempting to resume productive employment.
• Reimbursement: The payment of the expenses actually incurred as a result of an accident or sickness, but not to exceed any amount specified in the policy.
• Reinstatement: The resumption of coverage under a policy which has lapsed.
• Reinsurance: Assumption by one insurance company of all or part of a risk undertaken by another insurance company. The acceptance by one or more insurers, called re-insurers, of a portion of the risk underwritten by another insurer who has contracted for the entire coverage. The purchase of insurance by an insurance company from another insurance company (re-insurer) to provide it protection against large losses on cases it has already insured.
• Renewal: Continuance of coverage under a policy beyond its original term by the insurer's acceptance of the premium for a new policy term.
• Renter's Policy: A package type of insurance that includes coverage similar to a homeowner’s policy to cover the personal property of a renter or tenant in a building.
• Replacement: The substitution of health insurance coverage from one policy contract to another.
• Replacement Cost: The cost to repair or replace property at construction costs prevailing at time of loss; the cost to repair or rebuild property without considering depreciation. (See Actual Cash Value)
• Representation: Statements made by an applicant in the application, which he represents as being substantially true to the best of his knowledge and belief, but which are not warranted as exact in every detail.
• Rescission: Termination of an insurance contract by the insurer on the grounds of material misstatement on the application for insurance. The action of rescission must take place within the contestable period or Time Limit on Certain Defenses but takes effect as of the date of issue of the policy, thus voiding the contract from its inception.
• Reservation of Rights: An arrangement whereby an insurer defends a case without commitment to provide coverage in the event that the facts disclosed during the trial reveal that the occurrence is not covered.
• Reserve: 1) an amount representing liabilities kept by an insurer to provide for future commitments under policies outstanding. 2) An amount allocated for a special purpose. Note that a reserve is usually a liability and not an extra fund.
• Revocable Trust: A trust that can be terminated or revoked by its creator.
• Rider: 1) A document which amends the policy or certificate. It may increase or decrease benefits, waive the condition of coverage or in any other way amend the original contract. 2) A special policy provision or group of provisions that may be added to a policy to expand or limit the benefits otherwise payable. 3) A document that modifies the policy. It may increase or decrease benefits, waive a condition or coverage, or in any other way amend the original contract.
• Right of Survivorship: at the death of one co-owner of property, that person's interest in the property automatically passes to the surviving joint tenant or tenants.
• Risk: The chance of loss. Also used to refer to the insured or to property covered by a policy. (2) Any chance of loss. (3) A term used to refer to a person or the peril insured.
• Risk Classification: The process by which a company decides how its premium rates for life insurance should differ according to the risk characteristics of individuals insured (e.g., age, occupation, sex, state of health) and then applies the resulting rules to individual applications. (See: Underwriting)
• Robbery: The taking of property from a person by force or threat of violence.
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• Salvage: Recovery made by an insurance company by the sale of property which has been taken over from the insured as a part of loss settlement.
• Self-Insurance:(1) A program for providing group insurance with benefits financed entirely through the internal means of the policyholder, in place of purchasing coverage from commercial carriers. (2) A form of risk financing through which a firm assumes all or a part of its own losses.
• Settlement Options: The several ways, other than immediate payment in cash, which a policyholder or beneficiary may choose to have policy benefits paid.
• Short-Term Disability Income Insurance: The provision to pay benefits to a covered disabled person as long as he/she remains disabled up to a specified period not exceeding two years.
• Special Risk Insurance: Coverage for risks or hazards of a special or unusual nature.
• Spouse's Benefit: Payments to the surviving spouse of a deceased employee, usually in the form of a series of payments upon meeting certain requirements and usually terminating with the survivor's remarriage or death.
• State Fund: A fund set up by a state government to provide a specific line or lines of insurance. Some state permit private insurers to compete with the state fund.
• State Insurance Department: A department of a state government whose duty is to regulate the business of insurance and give the public information on insurance.
• Strict Liability: Liability for damages even though fault or negligence cannot be proven.
• Subrogation: Process by which one insurance company seeks reimbursement from another company or person for a claim it has already paid.
• Substandard Insurance: Insurance issued with an extra premium or special restriction to those persons who do not qualify for insurance at standard rates.
• Substandard Risk: An individual, who, because of health history or physical limitations, does not measure up to the qualification of a standard risk.
• Surety Bond: A bond issued by an entity (Surety) on behalf of a second party (Principal), guaranteeing that the second party will fulfill an obligation or series of obligations to a third party (Obligee). In the event that the obligations are not met, the third party (Obligee) will recover its losses via the bond (Surety), and the Surety will recover those losses from the Principal.
• Surety (Bond): The party (Inusrer) that ensures that the principal's obligations will be performed. Supplies the bond as a financial guarantee of the principal's commitment. Surety bond companies typically issue the bond and thus become an intermediary between the two parties (Principal and Obligee).
• Surplus Lines: (1) A risk or a part of a risk for which there is no normal insurance market available. (2) Insurance written by non-admitted insurance companies.
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• Temporary Total Disability (TTD): This benefit is payable when the injured worker is unable to work during a period when he/she is under active medical care and has not yet reached what is called “maximum medical improvement” (MMI). By virtue of simple common sense, once “maximum medical improvement” has been reached the condition can no longer be categorized as temporary.
• Temporary Partial Disability (TPD): An employee may be eligible for temporary partial disability when he or she is able to do some work but is still recuperating from the effects of the injury, and is, thus, temporarily limited in the amount or type of work which can be performed compared to the pre-injury work.
• Tenants in common: A form of joint property ownership in which the owners may have unequal shares and which does not involve a right of survivorship.
• Terrorism Insurance: Insurance purchased by property owners to cover their potential losses and liabilities that might occur due to terrorist activities. For commercial policies, a terrorist attack has to be declared a “certified act” by the Secretary of the Treasury.
• Third Party: The claimant under a liability policy. So called because the person making the claim is not one of the two parties, insured and insurer, to the insurance contract.
• Third party claim: a demand made by a person against a policyholder of another company and any payment that will be made by that company.
• Threshold (No-Fault): The point, measured in money, time or other ways, beyond which tort liability can be established. Until that point is reached, reparations must be paid within the provisions of the no-fault plan, with no recourse to the courts.
• Time Limit: The period of time during which a notice of claim or proof of loss must be filed.
• Tort: A civil wrong, other than a breach of contract, for which a court of law will afford legal relief, i.e. harming another by an act of negligence in driving an auto.
• Total Disability: An illness or injury which prevents an insured person from continuously performing every duty pertaining to his/her occupation or engaging in any other type of work. (This wording varies among insurance companies.)
• Travel Accident Policy: A limited contract covering only accidents while an insured person is traveling, usually on a commercial carrier.
• TRIA (Terrorism Risk Insurance Act): A United States federal law signed into law by President George W. Bush on November 26, 2002. The Act created a federal "backstop" for insurance claims related to acts of terrorism. The Act is intended as a temporary measure to allow time for the insurance industry to develop their own solutions and products to insure against acts of terrorism.
• Turnover Rate: The rate at which employees terminate covered service other than by death or retirement. Expected future turnover can be taken into account in translating contributions into benefits.
• Twisting: The practice of inducing by misrepresentation, or inaccurate or incomplete comparison, a policyholder in one company to lapse, forfeit or surrender his insurance for the purpose of taking out a policy in another company.
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• Umbrella Liability: Insures losses in excess of amounts covered by other liability insurance policies; also protects the insured in many situations not covered by the usual liability polices.
• Unearned Premium: The portion for an insurance written premium which is considered "unearned" by the insurer. It is the written premium less the earned premium. The unearned premium would be returned to the insured if the policy is canceled using pro rata cancellation method, when the policy is cancelled with no penalty.
• Underwriter: 1) a company that receives the premiums and accepts responsibility for the fulfillment of the policy contract; 2) the company employee who decides whether or not the company should assume a particular risk; 3) the agent who sells the policy.
• Underwriting: The process of selecting risks for insurance and determining in what amounts and on what terms the insurance company will accept the risk.
• Uninsured/Underinsured Motorist Coverage: A form of insurance that pays the policy holder and passengers in his/her car for bodily injury caused by the owner or operator of an uninsured or inadequately insured automobile.
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• Verbal Threshold: In no-fault auto insurance states with a verbal threshold, victims are allowed to sue in tort only if their injuries meet certain verbal descriptions of the types of injuries that render one eligible to recover for pain and suffering.
• Viatical Settlement: Payment of a portion of the proceeds from life insurance to an insured who is terminally ill.
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• Waiver: An agreement attached to a policy which exempts from coverage certain disabilities or injuries that otherwise would be covered by the policy.
• Workers Compensation: A system established under state law that provides payments, without regard to fault, to employees injured in the course and scope of their employment.
• Workers' Compensation Insurance: Insurance against liability imposed on certain employers to pay benefits and furnish care to employees injured, and to pay benefits to dependents of employees killed in the course of or arising out of their employment.
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