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Here are some key terms and definitions that you may find
helpful in understanding your insurance coverage. Simply search
the glossary of terms by clicking the letter that corresponds to
the first letter of the word.
DISCLAIMER: The definitions appearing in this Glossary are
provided solely for general informational purposes. They are not
intended to be complete descriptions of all terms, conditions and
exclusions applicable to the products and services defined. As
well, in the case of any inconsistency between the definitions in
this Glossary and the definitions appearing in the actual policy,
the definitions contained in the actual policy shall govern. |
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ABANDONMENT - A clause in property insurance policies prohibiting the insured from abandoning damaged property to the insurer for repair or disposal. Arranging for repair or disposal is the insured's responsibility, unless the insurer elects otherwise.
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ABATEMENT - The act or process of diminishing the presence of a pollutant (e.g., asbestos or lead) in either degree or intensity.
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ACCIDENT - An unexpected event, which happens by
chance and is not expected in the normal course of events. |
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accidental death and dismemberment (AD&D) - A type of coverage often written in conjunction with group life insurance plans. It essentially provides for (a) "double indemnity" when death is caused by an accident, and (b) defined dismemberment benefits. It will generally pay the full principal sum when death occurs or more than one member (e.g., hand, eye, or foot) is lost in an accident. One-half of the principal sum is generally paid when one member is lost.
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ACCIDENTAL DEATH - Death resulting directly and solely from (a) an accidental injury visible on the surface of the body or disclosed by an autopsy; (b) a disease or infection resulting directly from an accidental injury as described.
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ACT OF GOD - A sudden and violent act of nature,
which could not have been foreseen or prevented. Examples: flood,
earthquake. |
| ACTUAL CASH VALUE - Actual Cash Value (ACV) has many definitions. It is also known as market value, the current cost of replacing an article with a similar one of like kind and quality.
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actuary - An individual, often holding a professional designation, e.g., Fellow of the Casualty Actuarial Society (FCAS), who computes statistics relating to insurance, typically estimating loss reserves and developing premium rates.
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ADDITIONAL INTEREST INSURED
- Another person or
company who may be liable in a claim against an insured and
who has been named as an Additional Interest Insured under the
policy. |
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ADDITIONAL PREMIUM
- An extra charge for an
alteration, during the policy period, which increases the hazard
or the Company's liability. |
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additional living expense (ALE) coverage - A type of insurance included within homeowners policies. ALE coverage reimburses the insured for the cost of maintaining a comparable standard of living following a covered loss that exceeds the insured's normal expenses prior to the loss. For example, additional living expense insurance would cover an insured's motel bill while fire damage to the home is being repaired, the home is replaced, or until the insured moves to a permanent residence
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ADJUSTER - A person who investigates a loss and
negotiates settlement with the claimant on the Company's behalf. |
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AGGREGATE LIMIT
- The maximum amount the
insurer will pay during the policy period, irrespective of the
policy's limit of liability. |
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ALL PERILS - An optional coverage designed to
provide protection for your vehicle for all types of losses except
those specifically excluded in your policy. All perils coverage is
the most complete coverage you can select to protect yourself from
loss or damage to your own vehicle. This coverage is optional and
may be purchased in addition to the mandatory coverages required
by law, and it is subject to a deductible. |
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ALL RISK - Coverage against loss or damage from all
perils except those specifically excluded. |
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anti-theft device - A device in a car that reduces the chance that the vehicle will be stolen or vandalized or increases the chance of recovering a stolen car. Such devices include Global Positioning Satellite systems (GPS), local alarms, and starter disablers.
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APPLICATION -
A form on which the prospective
insured states facts requested by the insurance company and on the
basis of which (together with any information from other sources)
the insurance company decides whether or not to accept the risk,
modify the coverage offered, or decline the risk. |
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APPRAISAL - A valuation of property made for
determining its insurable value or the amount of loss sustained. |
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asbestos - A mineral fiber that can pollute air or water and cause cancer or asbestosis when inhaled. Asbestos has been banned or severely restricted its use in manufacturing and construction. Liability arising out of asbestos-related injuries is commonly excluded from coverage liability policies.
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ASSUMED LIABILITY
- Liability which would not rest
upon a person except that he has accepted responsibility by
contract expressed or implied. This is also known as contractual
liability. |
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assumption of risk - Based on the maxim "volenti non fit injuria." If a person knows the consequences of a particular act and voluntarily accepts that risk, he or she is solely responsible for any resulting injury.
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AUTHORIZATION
- The power or right to act on behalf
of another. |
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AUTOMOBILE INSURANCE
- Coverage on the risks
associated with driving or owning an automobile. It can
include liability, direct compensation & property
damage, accident benefits, collision, comprehensive, and uninsured
motorist coverages. |
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AVOIDANCE OF RISK
- Taking steps to remove a
hazard, engage in an alternative activity, or otherwise end a
specific exposure. |
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BASIC RATE – The standard charge for a given type
of risk. |
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bAD FAITH- A term describing blatantly unfair conduct that exceeds mere negligence by an insurance company. For example, a bad faith claim may arise if an auto liability insurer arbitrarily refuses to settle a claim within policy limits, where an insured's liability is incontrovertible
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bailee - A person or organization to whom possession of the property of others has been entrusted, usually for storage, repair, or servicing. Except for policies issued expressly for such purposes, most property policies specifically prohibit coverage for benefit of a bailee.
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bailee coverage - Inland marine coverage on property entrusted to the insured for storage, repair, or servicing. It is typically purchased by businesses such as dry cleaners, jewelers, repairers, furriers, etc.
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beneficiary - A person named by the insured to receive the proceeds or benefits accruing under a life policy.
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benefits - Compensation for loss and other services provided by insurers under terms of insurance contracts.
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betterment clause - a provision, often found in the physical damage section of automobile insurance policies, which stipulates that if the repair or replacement of the damaged parts results in better than "like kind or quality," the insurers will not pay for this net improvement. This clause is designed to preserve the concept of indemnity so the insured does not profit from the loss when the circumstances are such that it is impossible for the insurer to repair or replace the property without bettering the insured’s position.
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bid bond - Used in conjunction with construction bidding processes. The bond acts as a guarantee that, if awarded the contract based on the bid submitted, the contractor will enter into a contract to perform the work at the price quoted. If the contractor declines to enter into a contract to perform the work at the agreed-upon price, the bid bond will reimburse the obligee (owner or upper-tier contractor) the difference between the defaulting contractor's bid and the next lowest bid, up to the penal sum of the bond.
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bill of lading - A document that serves both as a receipt for goods being shipped and a contract defining the extent of the transporter's liability.
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BINDER – A temporary or preliminary agreement,
which provides coverage until a policy can be written or
delivered. |
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BI/PD– Bodily Injury / Property Damage Liability
Coverage. |
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blanket limit - A single limit of insurance that applies over more than one location or more than one category of property coverage, or both. This is in contrast to specific or scheduled limits of insurance, which are separate limits that apply to each type of property at each location. |
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BODILY INJURY – Term used in Auto and Casualty
policies meaning physical injury, including sickness, disease,
mental injury, shock or death. |
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BODILY INJURY LIABILITY – Pays when an insured
person is legally liable for bodily injury or death caused by your
vehicle or your operation of most non-owned vehicles. This
coverage also pays for your legal defense if you are sued. |
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boiler and machinery insurance - Coverage for loss due to mechanical or electrical breakdown of nearly any type of equipment, including photocopiers and computers. Coverage applies to the cost to repair or replace the equipment and any other property damaged by the equipment breakdown. Resulting business income and extra expense loss is often covered as well. Equipment breakdown insurance is increasingly replacing traditional boiler and machinery insurance, in part simply because the title is more descriptive of the coverage provided. Also, today’s equipment breakdown policies typically provide slightly broader coverage than traditional boiler and machinery policies, and they usually do not use the specialized terminology found in traditional boiler and machinery policies.
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bond - A three-party contract in which one party, the surety, guarantees the performance or honesty of a second party, the principal (obligor), to the third party (obligee) to whom the performance or debt is owed.
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bonding - The process by which bonds are written.
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breach - Failure to live up to the conditions or warranties contained in a contract.
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BROAD FORM -PERSONAL LINES POLICY– A
personal lines property form which provides All Risk coverage on
the building and named perils coverage on the contents.
This form normally adds the Extended Coverage and Vandalism and
Malicious Mischief coverages. |
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BROAD FORM - COMMERCIAL POLICY–
Coverage against loss or damage from all perils except those
specifically excluded. |
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BROKER– An independent person or firm who acts on
behalf of the insured in placing business with the insurance
company. Responsible for the collection of premiums but having no
authority to give coverage on the insurance company's behalf
without their specific agreement. Compensation is on a commission
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BROKER OF RECORD - The independent broker authorized to represent an insured in the purchase, servicing, and maintenance of insurance coverage with a designated insurer. Most insurance companies will not disclose any information or discuss an insured's account with any broker other than the broker of record. An insured wishing to change their broker must submit a revised broker of record letter to the insurer authorizing them to release the insured's information and to discuss the insured's coverage with the new broker.
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BUILDERS RISK – A special form dealing with the
unique loss exposure of property under construction. |
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BURGLARY – Unlawful removal of property from
premises involving visible forcible entry. |
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BUSINESS INTERRUPTION
– Insurance against business
expenses and loss of income resulting from fire or other insured
peril. |
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BUSINESSOWNERS POLICY (BOP)
– Similar to the
commercial package policy (CPP), it provides broad property and
liability protection in a single contract and is designed for
small and medium-sized mercantile, service, office or apartment
risks. |
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buy/sell agreement - A contract among members of a firm that provides for the continuation of the business through an agreement by which each principal agrees that, in the event of his or her death, his or her estate will sell its interest back to the business entity for a predetermined amount. The amount may be calculated as a fixed amount or as a variable amount, depending on business factors. The agreement is usually funded by life insurance.
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care, custody, or control (CCC) - An exclusion common to several forms of liability insurance, which eliminates coverage with respect to damage to property in the insured's care, custody, or control. In some cases, CCC has been determined to entail physical possession of the property; in others, any party with a legal obligation to exercise care with respect to property has been deemed to have that property in its CCC
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cargo insurance - Inland or ocean marine insurance covering property in transit.
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carrier - An insurance or reinsurance company that insures or "carries" the insurance or reinsurance.
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cash surrender value - The amount of cash available to the insured in an individual life insurance policy when the insured cancels and surrenders the policy. |
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CATASTROPHE – A sudden, great disaster. |
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causes of loss - The perils that can bring about or trigger loss or damage. Can be direct (the action immediately precedes the loss) or indirect (part of an uninterrupted chain of events leading to the loss).
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certificate holder - An entity which is provided with an insurance certificate as evidence of the insurance maintained by another entity.
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certificate of insurance - A document providing evidence that certain general types of insurance coverages and limits have been purchased by the party required to furnish the certificate.
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CLAIM – Notice to an insurer that under the terms of a policy, a loss may be covered. |
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claims-made - A term describing an insurance policy that covers claims first made (reported or filed) during the year the policy is in force for any incidents that occur that year or during any previous period during which the insured was covered under a "claims-made" contract. This form of coverage is in contrast to the Occurrence policy, which covers an incident occurring while the policy is in force regardless of when the claim arising out of that incident is filed—1 or more years later.
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commission - A certain percentage of premium produced that is retained as compensation by insurance agents and brokers. Also known as acquisition cost.
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common law - Unwritten law derived from court case decisions based on custom and precedent. It is contrasted to statutory law.
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COMPREHENSIVE FORM -PERSONAL LINES POLICY – A personal lines property form which provides All Risk coverage on both the building and contents.
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CONDOMINIUM
CONTINGENT COVERAGE –
Although a condo
association has coverage on its building, in some instances it may
not be enough. In the event of loss or damage to a policy holders
individual unit, if the condo association's insurance is
insufficient, the unit owner, is responsible for the
difference between the amount of damage and the amount available
from the building insurance. Contingent coverage addresses this
difference. |
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contingent beneficiary - Secondary beneficiary who receives policy benefits if the primary beneficiary predeceases the named insured under a life insurance policy.
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contractual liability - Liability imposed on an entity by the terms of a contract. As used in insurance, the term refers not to all contractually imposed liability, but to the assumption of the other contracting party's liability under specified conditions.
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defendant - In a civil trial, the party against whom the suit has been brought.
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deposit premium - The premium deposit required by the insurer on forms of insurance subject to periodic premium adjustment. Also called "provisional premium."
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dividend options - Varying ways in which insureds may elect to receive dividends under a life insurance policy. Dividends may be received in the form of cash payments, as increases to the policy's cash value, or as paid-up additional insurance.
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double indemnity - Payment by a life insurance policy of two times the face value when death results from an accident, e.g., an auto accident, as opposed to a health problem, e.g., cardiac arrest.
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due diligence - To give proper care and attention. This term is commonly used to refer to the review of financial and legal documents in a merger or acquisition, but is equally applicable to virtually any decision-making process.
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duty to defend - A term used to describe an insurer’s obligation to provide an insured with defense to claims made under a liability insurance policy. As a general rule, an insured need only establish that there is potential for coverage under a policy to give rise to the insurer's duty to defend. Therefore, the duty to defend may exist even where coverage is in doubt and ultimately does not apply. Implicit in this rule is the principle that an insurer’s duty to defend an insured is broader than its duty to indemnify. Moreover, an insurer may owe a duty to defend its insured against a claim in which ultimately no damages are awarded, and any doubt as to whether the facts support a duty to defend is usually resolved in the insured's favor. |
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easement - An interest that one party has in the land of another or a right of use over another party's property. An easement need not be written but may be implied or created by necessity or by prescription. Generally the party enjoying the benefit of being on the property of another assumes the liability of the property owner. Easements are "insured contracts" unless they are in connection with construction or demolition operations on or within 50 feet of a railroad.
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equipment floater - Property insurance covering equipment that is often moved from place to place. A form of inland marine insurance.
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estate plan - A plan for the systematic liquidation of one's estate. Conservation of estate assets is the uppermost consideration.
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estimated premium - A preliminary figure that may be adjusted to reflect the extent of coverage provided under a given contract.
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estoppel - A legal doctrine restraining a party from contradicting its own previous actions if those actions have been reasonably relied on by another party. For example, an insurer that has repeatedly accepted late premium payments from an insured may be estopped from later canceling the policy on the basis of nonpayment because the insured has been reasonably led to believe that late payments are acceptable.
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evidence - Anything that can be used to prove or disprove an alleged fact.
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executive officer - As defined in the standard CGL policy, an executive officer is a person holding any of the officer positions created by the name insured organization’s governing document.
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ex gratia payment - Latin: "by favor." A voluntary payment made by the insurer in response to a loss for which it is not technically liable under the terms of its policy.
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extended discovery period - A provision of coverage in claims-made policies, for claims brought against the insured following cancellation of the policy if the event(s) that caused the damage or injury occurred prior to the policy's cancellation.
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face amount - Generally used to mean the amount of insurance provided.
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fees - Fixed cost charges, as compared to percentage charges (called "commissions"). |
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fiduciary - A person entrusted with the responsibility for the property or assets of another.
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first dollar defense, umbrella - An umbrella or professional liability policy provision under which the insurer agrees to indemnify the insured for costs of claims defense in the self-insured retention area.
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flat cancellation - The cancellation of a policy as of its effective date, before the company has assumed liability. This requires the return of paid premium in full.
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FLEET - For classifying commercial vehicles under the business auto policy, five or more automobiles. Less than five is considered nonfleet. The distinction is made for statistical coding purposes. |
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FOB - See Free on Board
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Free on board (FOB) - One of several standard terms used in contracts of sale to indicate responsibility for damage to goods during shipment. When goods are shipped FOB, the seller's responsibility ends when a carrier takes possession of them, or, with respect to ocean shipments, when the merchandise is placed safely aboard the vessel or when an on-board bill of lading has been issued. The buyer is responsible for insuring the goods from that point on.
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garage policy - A commercial auto policy designed to address the needs of auto dealers and other auto-related businesses (e.g., repair shops, service stations, storage garages). Coverages include garage liability, garagekeepers, and auto physical damage; other coverages are available by endorsement.
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guaranteed renewable - A provision in a life or disability policy that requires the insurer to renew the policy on its anniversary. The premium can usually be changed if the change applies to the entire class of insureds covered by the policy. |
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GVW - Gross vehicle weight.
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HAZARD – A specific situation that increases
the probability of the occurrence of loss arising from a peril, or
that may influence the extent of the loss. For example, accident,
sickness, fire, flood, liability, burglary, and explosion are
perils. Slippery floors, unsanitary conditions, shingled roofs,
congested traffic, unguarded premises, and uninspected boilers are
also hazards. |
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hostile fire - A fire that becomes uncontrollable or expands outside its intended boundaries. For example, a fire set intentionally to burn brush becomes hostile if it spreads to other property; likewise, a fire that becomes much hotter than it is supposed to be or that cannot be extinguished is hostile even if it never spreads from the location where it was intentionally kindled.
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host liquor liability - Liability for bodily injury or property damage arising out of the serving or distribution of alcoholic beverages by a party not engaged in this activity as a business enterprise.
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IMPROVEMENTS AND BETTERMENTS – Additions or
changes made by a lessee at his own cost to a building that he is
occupying, which enhance its value. These become part of the
realty and require special insurance consideration. |
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impaired property - Under commercial general liability coverage, property that has sustained loss of use because it incorporates the insured’s defective product or work and can be restored to use by the repair, removal, or replacement of the defective product or work. Claims for loss of use of impaired property are excluded from CGL coverage.
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independent adjuster - A claims adjuster who provides services on a contract basis to insurance companies, self-insured firms, and governmental entities. Independent adjusters are used when an insurer is overloaded with claims (often due to a catastrophe), a claim occurs in a remote locale, or when special expertise is required to adjust a claim.
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independent contractor - An individual or company who has signed an agreement with another party to perform some job or function on behalf of that party without the direction or oversight of the party.
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installation floater - Inland marine coverage on property (usually equipment) being installed by a contractor.
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insurable interest - An interest by the insured person in the value of the subject of insurance, including any legal or financial relationship. Insurable interest usually results from property rights, contract rights, and potential legal liability. |
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joint and several liability - A legal doctrine a that allows an injured person to sue and recover from any one or more of several wrongdoers at his option, regardless of that wrongdoer's degree of negligence. The injured party cannot receive double compensation but can choose to recover 100 percent of a damages award from any defendant who is found liable to any extent.
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Liability - Any legally enforceable obligation. Within the context of insurance, the obligation to pay a monetary award for injury or damage caused by one's negligent or statutorily prohibited action
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life expectancy - The average number of years a person of a certain age is expected to live as shown on an annuity table or mortality table.
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litigation - The process of investigating and adjudicating the facts and law in a particular case. In general usage, the bringing or defense of a lawsuit.
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long-term disability (LTD) income insurance - LTD insurance replaces earnings lost due to illness or disability occurring on or off the job. Coverage may be purchased on an individual or group basis. Individual policies typically do not pay until the period of the disability exceeds a specified elimination period, usually 30 days or longer. Recovery under group disability income policies is often structured to begin after short-term disability income insurance benefits or uninsured salary continuance payments cease. One of the most important provisions in either group or individual policies is the definition of "disability." The broader the definition, the broader the scope of coverage. Most LTD policies are structured to pay benefits until the insured reaches age 65.
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LOSS ASSESSMENT COVERAGE –This coverage is for condominium owners. It pays for their share of any special assessments made by the Condominium Corporation that are the result of direct loss to the collectively owned condominium property, caused by an insured peril . |
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loss payable clause - An insurance provision authorizing payment in the event of loss to a person or entity other than the named insured having an insurable interest in the covered property. Under a typical loss payable clause, the insurer is under no obligation to make payment to the loss payee if payment for a loss can be denied to the insured.
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marine insurance - A type of insurance designed to provide coverage for the transportation of goods either on the ocean or by land as well as damage to the waterborne instrument of conveyance and to the liability for third parties arising out of the process. The two branches of marine insurance are ocean marine (primarily water-based exposures) and inland marine (primarily land-based exposures).
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maturity date - The date at which the face amount of a life insurance policy becomes payable either by death or other contract stipulation.
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mediation - The act of a third person in assisting two adverse parties adjust or settle their dispute.
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medical payments, auto - Optional coverage under an auto policy to pay for medical expenses for an insured who sustains bodily injury caused by an auto accident, without regard to fault.
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medical payments, homeowners - Coverage designed to pay for medical expenses to others who are accidentally injured on an insured location or by the activities of an insured, resident employee, or an animal owned by or in the care of an insured. These payments are not based on the law of negligence; that is, no negligence on the part of the insured has to be proven for payment to be made.
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minimum premium - The least amount of premium to be charged for providing a particular insurance coverage. The minimum premium may apply in any number of ways such as per location, per type of coverage, or per policy.
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moral hazard - A term used to describe a subjective hazard that tends to increase the probable frequency or severity of loss due to an insured peril. Moral hazard is measured by the character of the insured and the circumstances surrounding the subject of the insurance, especially the extent of potential loss or gain to the insured in case of loss. For example, insurance on a thriving business is not subject to a moral hazard to as great an extent as insurance on an unprofitable business. On the other hand, an insured with high moral standards may pose less of a moral hazard even with an unprofitable business than an insured with low moral standards. Moral hazards are considered when underwriting insurance, particularly fire insurance, and are also addressed by certain policy exclusions. For example, underwriters are hesitant to insure vacant and unoccupied buildings because of the possibility that an insured will be tempted to intentionally start a fire to obtain an insurance recovery.
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motor truck cargo - An inland marine form covering loss of property in the course of transit, either by common carrier or on the insured's own vehicles, depending on the form used.
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mutual company - A corporation owned and operated by and for its insureds. Every owner of the company is an insured; every insured is an owner. |
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natural death - Indicates death not caused by external sources; usually pertains to death from disease or old age.
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nonmedical - Life or health insurance coverage written without a medical exam. However, the insured completes a detailed questionnaire concerning his or her health. This information becomes a warranty so that any misstatements could potentially void the policy.
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nonparticipating (non-par) - Life insurance contracts in which no policy dividends are paid.
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notice of claim provision - A provision in a liability insurance policy requiring the insured to promptly notify the insurer in the event that a claim is made against the insured.
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obligee - A person or organization to whom another party (the "obligor") owes an obligation. In a bonding situation, this is the party that requires and receives the protection of the bond. For example, under a performance bond, the obligee is the project owner for whom the bonded contractor is required to perform the specified work.
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obligor - A person or organization that is bound by an obligation to another. In a bonding situation, this party, commonly called the "principal," purchases a bond to protect the party to whom it owes an obligation. For example, under a performance bond, the obligor is the contractor that is required to perform the specified work for the project owner.
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ocean marine coverage - nsurance covering the transportation of goods and/or merchandise by vessels crossing both foreign and domestic waters including any inland or aviation transit associated with the shipment. This type of marine insurance also encompasses coverage for damage to the vessels involved in shipments and any legal liability arising in the course of shipment.
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PACKAGE POLICY – A combination of
property-liability coverages of two or more separate policies in
one contract with one premium. The development of package policies
is a move toward economy and efficiency in giving the policyholder
one document instead of several. |
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PAID UP - Life insurance for which premiums have been paid but the policy has not yet matured.
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paid-up additions - Single premium life insurance coverage bought in addition to the face amount of the policy by using policy dividends.
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pair or set clause - Provision found in homeowners and commercial property forms dealing with losses involving part of a set or one of a pair. In this case, the insurer can either (1) repair or replace any part to restore the pair or set to its value prior to the loss, or (2) pay the difference between the actual cash value of the property before and after the loss.
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participating (par) - An insurance policy that pays dividends.
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POLICY LOAN - A loan from the insurer to a life insurance policy owner using the cash value as security for the loan.
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pollution exclusion - A provision in either first-party or third-party insurance policies that excludes coverage for losses caused by "pollution," a term usually defined to mean an irritant or contaminant, whether in solid, liquid, or gaseous form, including—when they can be regarded as an irritant or contaminant—smoke, vapor, soot, fumes, acids, alkalis, chemicals, and waste.
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premium audit - An audit of the exposure basis for an insurance policy, i.e., payroll, sales, or vehicle count, after the end of a policy period to determine the actual (audited) exposure for the purpose of making a final calculation of the premium and premium taxes.
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premium loan - A loan against the cash value of a life insurance policy to pay the policy premium.
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premium notice - Notice from the insurer that the premium is or will soon be due.
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primary beneficiary - The beneficiary named as being first to receive proceeds or benefits when they come due or are payable. If the primary beneficiary is not living at the time the proceeds are payable, the benefits are paid to the secondary beneficiary.
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primary cover - The policy that responds first to an insured loss, either on a first-dollar basis or after allowing for a deductible. When the primary coverage limits are paid, any remaining loss is covered by whatever excess layer of insurance may be in place.
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pro rata - Proportionately.
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pro rata cancellation - The cancellation of an insurance policy or bond with the return premium credit being the full proportion of premium for the unexpired term of the policy or bond, without penalty for interim cancellation.
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proximate cause - In the context of first-party property insurance, "proximate cause" refers to the cause of loss in a multiple-cause situation on which courts focus to determine if the loss is covered. For sequential-cause situations, where the first event sets in motion a chain of events that causes a second event that causes the loss, there are three common law tests for ascertaining the "proximate cause": (1) the last-cause test, (2) the first-cause test, and (3) the predominant-cause test. The last-cause test (which developed earliest) states that the loss will be covered if the last cause in the chain of events is covered. The first-cause test states that the loss will be covered if the first cause in the chain of events is covered. The predominant-cause test states that the loss will be covered if the covered cause of loss is "predominant" over the noncovered cause of loss. For concurrent-cause situations, where two or more events happen simultaneously to produce the same injury or damage, only the predominant-cause test can be used. In the context of third-party liability insurance, "proximate cause" refers to a doctrine by which a plaintiff must prove that the defendant's actions set in motion a relatively short chain of events that could have reasonably been anticipated to lead to the plaintiff's damages. If the defendant's actions were "proximate" or close enough in the chain of causation to have foreseeably led to the plaintiff's damages, courts will impose liability. Otherwise, if the defendant’s actions set in motion a long, bizarre chain of events that could not have reasonably been foreseen to lead to the plaintiff’s damages, courts will not impose liability.
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reasonable repairs - Additional coverage provided by the homeowners policy. The insurer will pay for any reasonable costs incurred by the named insured to protect his or her insured property from further damage, if the cause of loss is a covered peril. This is additional coverage, and does not affect the limit of insurance applicable to the covered property. This concept is referred to as the "sue and labor clause" in most commercial property and marine forms.
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release - The document relinquishing a claim. A plaintiff or claimant signs a release in exchange for monetary payment, thereby giving up the right to pursue further indemnity in connection with the claim.
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renewable term - Term life insurance that may be renewed periodically without evidence of insurability but often at a higher premium.
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sales - Exposure base in commercial general liability (CGL) insurance for insureds in the manufacturing/processing or mercantile business classifications. Gross sales as an exposure base is defined as "the gross amount charged by the named insured, concessionaires of the named insured or by others trading under the insured's name for all goods or products, sold or distributed; operations performed during the policy period; rentals; and dues or fees.
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salvage - (1) Property after it has been partially damaged by an insured peril such as a fire. (2) As a verb, to save endangered property and to protect damaged property from further loss.
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salvage value - The amount for which an asset can be sold at the end of its useful life. In insurance circles, this term commonly refers to the scrap value of damaged property. In property insurance, salvage value (e.g., scrap value) will be subtracted from any loss settlement if the insured retains the damaged property. In extra expense coverage, the salvage value of property purchased for temporary use while repairs are made will be deducted in determining the amount of loss recovery.
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schedule - A list of an insured's locations or property such as computers, mobile equipment, or vehicles. Can also refer to a list of primary or underlying insurance.
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self-insured retention (SIR) - A dollar amount specified in an insurance policy (usually a liability insurance policy) that must be paid by the insured before the insurance policy will respond to a loss. SIRs typically apply to both the amount of the loss and related costs, e.g., defense costs, but some apply only to amounts payable in damages, e.g., settlements, awards, and judgments. An SIR differs from a true deductible in at least two important ways. Most importantly, a liability policy's limit stacks on top of an SIR while the amount of a liability insurance deductible is subtracted from the policy's limit. As contrasted with its responsibility under a deductible, the insurer is not obligated to pay the SIR amount and then seek reimbursement from the insured; the insured pays the SIR directly to the claimant. While these are the theoretical differences between SIRs and deductibles, they are not well understood, and the actual policy provisions should be reviewed to ascertain the actual operation of specific provisions.
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short-rate cancellation - A financial penalty incurred when the insured cancels an insurance contract prior to the expiration date of the contract. The insurer keeps a percentage of unearned premium (UEP) to cover costs
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soft market - One side of the market cycle that is characterized by low rates, high limits, flexible contracts, and high availability of coverage
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specialty risks - Term used by commercial insurers to describe unusual coverage features or types of risks not underwritten by most insurers.
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speculative risk - Uncertainty about an event under consideration that could produce either a profit or a loss, such as a business venture or a gambling transaction. A pure risk is generally insurable while speculative risk is usually not.
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split dollar plans - A form of life insurance co-ownership that allows one party, often the employer, to help another person carry life insurance protection. Generally the insured pays the portion of the premium attributable to the life insurance protection while the other party pays the portion attributable to the cash value build-up. At the insured's death, an amount of the proceeds equal to the cash value is paid to the other party with the remaining amount paid to the insured's beneficiaries. This approach provides protection in a permanent life insurance contract at a very low cost to the insured.
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statutory law - That body of law which is enacted by legislative bodies. It is separate and distinct from common law.
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STATUTORY CONDITIONS - A set of conditions that are included in fire and automobile policies as stipulated by various insurance acts.
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TAIL COVERAGE – Insurance coverage available to
provide protection for tail exposures. The present occurrence
version of the commercial general liability (CGL) form already
provides protection for losses that occurred during the policy
period, regardless of when they are reported or claims made. The
claims-made version of the CGL must be endorsed to provide
coverage for claims that are not made during the policy period. |
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term life insurance - A policy that gives protection for only a definite period of time (e.g., 1, 3, or 5 years). If death occurs during the term for which the policy is written, proceeds are payable to the beneficiary. If the insured survives the term, the policy expires. There is no cash value build-up in a term policy. Guaranteed renewable term insurance can be renewed without proof of insurability. Under other types of term insurance, the insured must once again undergo an underwriting process (e.g., a medical examination).
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universal life insurance - A very flexible life insurance product that pays much higher interest than conventional whole life and allows the insured to adjust the premium and death benefits
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vacancy permit endorsement - A property insurance endorsement that suspends some or all of the coverage restrictions that apply to buildings that have been vacant for more than a specified period of time (typically, 60 days).
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valuable papers and records coverage - Inland marine coverage that pays the cost to reconstruct damaged or destroyed valuable papers and records. "Valuable papers and records" usually is defined to include almost all forms of printed documents or records except money or securities; data processing programs, data, and media are usually excluded.
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vicarious liability - The liability of a principal for the acts of its agents. Vicarious liability can result from the acts of independent agents, partners, independent contractors, employees, and children.
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void - Without legal effect; unenforceable. A number of actions on the part of the insured can render coverage under an insurance policy void.
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voidable - A policy that can be made void at the option of one or either of the parties to it.
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Voluntary Medical payments (property insurance) - Pay the medial bills for people accidentally hurt in your home. It also pays for people hurt away from your home by you, your household members, or by your pets. Often, this coverage is provided no matter who is at fault for the injury. It is intended to cover the costs of minor injuries without the need for a third part to sue for reimbursement. The medical payments coverage does not apply to injuries to you or to those who live with you . Nor does it cover injuries related to at-home business activities.
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WARRANTIES–
Warranties
are commonly used in commercial polices and express that a certain
set of conditions exist.
Breaking a warranty could violate the policy conditions and
cause denial of a claim. Warranties that are included your
policies are:
Locked
Vehicle Warranty – Items in vehicles must be locked in proper
containers and there must be signs of forcible entry before theft
losses are covered. Property Protection Systems This includes all alarms, warning system, including sprinklers. The systems shall be maintained in full operating order. In the event of any impairment or defect or if the systems becomes inoperative or are removed, then the insurance company must be notified. This also includes any notification from the police that they will suspend responding to alarm signals Notice To Authorities - losses including malicious acts, burglary, robbery, theft or attempt thereat, must be reported to Police
Vacancy:
The Insurance Company must be notified immediately of any
location insured, which becomes vacant
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Whole life insurance - Life insurance that has no expiration date and which provides for the payment of the face value upon death of the insured, regardless of when it may occur. This contrasts with term insurance, which pays benefits only if death takes place during the limited term (e.g., 1, 3, 5, or 10 years) of the policy. Under permanent life insurance policies, the insured pays a level premium rate all of his or her life. This approach results in an overpayment of premiums in the early years of the policy and an underpayment in the latter years—which is intended to average out over the life of the insured. Most types of permanent life insurance (e.g., whole life, universal life, and variable life insurance) accumulate a cash value that may be borrowed or otherwise used by the insured.
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