A
ABANDONMENT:
Giving up the proprietary rights in insured property to the Underwriter in
exchange for payment of a constructive total loss.
ACCIDENT:
An unexpected fortuitous event, unforeseen and unintended, not under the
control of an insured and resulting in a loss.
ACCIDENT
FREQUENCY: The number of times an accident occurs. Used in predicting
losses upon which premiums are based.
ACCIDENT
INSURANCE: A form of health insurance against loss by bodily injury.
ACCIDENTAL
DEATH: Coverage in the event of death due to an accident, usually in
combination with dismemberment insurance.
ACCOUNTS
RECEIVABLE POLICY: An inland marine (also burglary) policy written to
protect the insured from financial loss due to his inability to collect amounts
owed him because of the destruction of his records.
ACT OF
GOD: A flood, an earthquake or other accident or event that is without
any human intervention and that could not have been prevented by reasonable
care or foresight, but is the result of natural causes (A snowstorm is an Act
of God; driving in one is an act of man).
ACTUAL CASH
VALUE: The sum of money required to pay for damages or lost property,
computed on the basis of replacement value less its depreciation by
obsolescence or general wear.
ACTUAL TOTAL
LOSS: Occurs when:
(1) the insured property is completely destroyed or
(2) the Assured is irretrievably deprived of the insured property
or
(3) cargo changes in character so that it is no longer the thing
that was insured or
(4) a ship is posted "missing" at Lloyd's, in which case
both the ship and its cargo are deemed to be an actual total loss.
ACTUARY:
A professional trained in the mathematics of insurance and risk
management.
ADD-ONS:
Additional coverages to your basic policy.
ADDITIONAL
INSURED: A person or firm or corporation other than the named insured on
a policy or mortgage company named in a mortgagee clause, who is protected
against loss by the terms of the policy or mortgage company named in the
mortgage clause.
ADJUSTER:
An individual representing the insurance company and acting for the company in
working on agreements as to the amount of a loss and the liability of the
company in same.
ADVERSE
SELECTION: Selection against the insurance company; the tendency of more poor
risks to buy and maintain insurance than good risks.
AGENTS:
Two types of agents sell insurance: (1) Independent Agents are self-employed
business people who typically represent more than one insurance company and are
paid on a commission basis; and (2) Exclusive Agents represent only one
insurance company and may be salaried or work on a commission basis.
ALL
RISK: Insurance against loss or damage to property arising from any
fortuitous cause, except such as may be specifically excluded.
ANNUITY:
A life insurance company contract that pays a periodic income benefit for a
specified period of time.
APPLICATION:
A signed statement by a prospective insured client which becomes a part of the
insurance contract.
APPRAISAL:
A survey of property made for determining its insurable value or the amount of
loss sustained.
ASSIGNMENT:
The passing of beneficial rights from one party to another.
ASSIGNED
RISK: A risk which underwriters do not care to insure, but because of
state law or otherwise, the insured must be protected and the insurance is
therefore handled through the state and assigned to companies.
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.
AUTOMOBILE
INSURANCE PREMIUM DISCOUNTS: A discount offered to drivers for such safeguards
as air bags, seat belts, good driving record, anti-theft devices, multiple
vehicles, etc.
AUTOMOBILE
FLEET POLICY: A commercial automobile policy covering five or more
automobiles.
AVERAGE:
A marine partial loss. This can be particular average or general average (see
below).
AVERAGE
CLAUSE: A clause in a marine insurance policy, whereby partial
losses are subject to special conditions (e.g. a franchise or deductible is to
be applied to claims).
B
BAILEE:
A person or concern having possession of property committed in trust from the
owner.
BAILEE'S
CUSTOMERS POLICY: A policy providing for loss or or damages to property
of bailee's customers, payable either to bailees for their account or direct to
customers.
BASIC
COVERAGE FORM: Any of the commercial or personal insurance property forms
which provide basic coverages. These forms generally provide the most limited
coverage, which is surpassed by "Broad Forms" and "Special
Forms."
BASIC
RATE: The manual rate, from which are taken discounts or to which are
added charges to compensate for the individual circumstances of the risk.
BENEFICIARY:
Designation by the owner of a life insurance policy indicating to whom the
proceeds are to be paid upon the insured's death or when an endowment matures.
BENEFIT OF
INSURANCE CLAUSE: A clause by which the bailee of goods claims the
benefit of any insurance policy effected by the cargo owner on the goods in
care of the bailee. Such a clause in a contract of carriage, issued in
accordance with the Carriage of Goods by Sea Act, is void at law.
BILL OF
LADING: Contract of carriage and receipt for goods, issued by
carrier.
BINDER:
(Or Binding Receipt): In lines other than life and health, a binder is an
acknowledgement (usually from the agent) that insurance applied for is in force
whether or not premium settlement has yet been made or the policy issued. In
life and health insurance, binders are not issued, but if premium settlement is
made with the application, what is often erroneously referred to as a
"binder" is issued. Actually this is a conditional binding receipt.
BLANKET
INSURANCE: (1) Property-liability insurance that covers more than one
type of property in one location in one policy or form instead of under
separate items, or one or more types of property at more than one location; (2)
A contract of health insurance that covers all of a class of persons not
individually identified.
BODILY
INJURY LIABILITY: The liability which may arise from injury or death of
another person.
BOILER AND
MACHINERY POLICY: Insurance against loss due to accidents to boilers,
pressure vessels or other machinery including the equipment itself, as well as
liability arising out of the accident.
BOND:
An obligation of the insurance company to protect one against financial loss
caused by acts of another.
BUILDER'S
RISK COVERAGE FORM: A commercial property coverage form specifically
designed for buildings in the course of construction.
BUILDER'S
RISK INSURANCE: Insurance against loss to buildings or structures in the
course of construction.
BUILDINGS
AND PERSONAL PROPERTY COVERAGE FORM: A commercial property coverage form
designed to insure most types of commercial property (buildings or contents or
both). It is the most frequently used commercial property form, and has
replaced the General Property Form, Special Building Form, Special Personal
Property Form, and others.
BUSINESS
AUTO COVERAGE FORM: The latest commercial Automobile Insurance coverage
form, which may be written as a monoline policy or as part of a commercial
package. This form has largely replaced the Business Auto Policy.
BUSINESS
INCOME COVERAGE FORM: A commercial property form providing coverage for
"indirect losses" resulting from property damage, such as loss of
business income and extra expenses incurred. It has replaced earlier Business
Interruption and Extra Expense forms.
BUSINESS
INTERRUPTION INSURANCE: A type of policy that pays for loss of earnings
when operations are curtailed or suspended because of property loss.
BUSINESS
LIABILITY: The term used to describe the liability coverages provided by
the Businessowners Liability Coverage Form. It includes liability for bodily
injury, property damage, personal injury, advertising injury, and fire damage.
BUSINESS
PERSONAL PROPERTY: Traditionally known as "contents," this term
actually refers to furniture, fixtures, equipment, machinery, merchandise,
materials, and all other personal property owned by the insured and used in the
insured's business.
C
C &
F: A sale term relating to goods. Cost and Freight. The consignee
makes his own insurance arrangements for the goods throughout the period of
transit.
CANCELABLE
POLICY: A policy which may be terminated by the company or the insured by
proper notification sent to the other party according to terms set forth in the
policy.
CARRIER:
(1) An insurance company which "carries" the insurance. (The terms
"insurance company" or "insurer" are preferred because of
the possible confusion of "carrier" with transportation terminology).
(2) In transportation, the trucker, air carrier, ocean steamship company or
other entity which moves the goods. (See "Contract Carrier)
CASH
SURRENDER VALUE: Money the policyholder is entitled to receive from the
insurance company upon surrendering a life insurance policy containing a cash
value clause.
CASUALTY
INSURANCE: That type of insurance that is primarily concerned with losses
caused by injuries to persons and legal liability imposed for such injury or
for damage to property of others. It also includes such diverse forms as Plate
Glass, insurance against crime, such as robbery, burglary or forgery, Boiler
and Machinery insurance, and Aviation insurance. Many casualty companies also
write surety business.
CAUSES OF
LOSS: Under the latest commercial property forms, this term replaces the
earlier term "perils" insured against.
CLAIM:
(1) A formal request for payment of a loss under an insurance contract or
bond; (2) The actual amount of the final settlement.
CLAIMANT:
One who seeks reimbursement for loss under the terms and conditions of the
insurance contract.
CLAIMS-MADE
COVERAGE: A policy providing liability coverage only if a written claim
is made during the policy period or any applicable extended reporting period.
For example, a claim made in the current reporting year could be charged
against the current policy even if the injury or loss occurred many years in
the past. If the policy has a retroactive date, an occurrence prior to that
date is not covered. (Contrast this with "Occurrence Coverage)
CLASSIFICATION
CLAUSE (CARGO): A clause in a cargo insurance open cover which
details the minimum classification for an overseas carrying vessel that is
acceptable to the insurers for carriage of the insured goods at the premium
rate/s agreed in the contract. Goods carried by lower class vessels are
accepted under the open cover, subject to payment of an additional premium.
CLAUSE:
A section or paragraph in an insurance policy that explains, defines or
clarifies the conditions of coverage.
COBRA
(Consolidated Omnibus Budget Reconciliation Act): A federal law
under which group health plans sponsored by employers with 20 or more employees
must offer continuation of coverage to employees who leave their jobs,
voluntarily or otherwise, and their dependents; gives individuals and their
dependent families the right to continue their health care coverage for as long
as 18 months.
COINSURANCE:
(1) In property insurance, a clause under which the insured shares in losses to
the extent that he is underinsured at the time of loss. (2) In health
insurance, a provision that the insured and insurance company will shared
covered losses in agreed proportion. In health insurance, the preferred term is
"percentage participation."
COLLISION
COVERAGE: Physical damage protection for the insured's own automobile(s)
for damage resulting from a collision with another object or upset.
COMMERCIAL
GENERAL LIABILITY (CGL) - Protection against claims
of bodily injury or property damage for which your business may be liable, cost
of defending lawsuits stemming from accidents that cause bodily injury,
property damage, and claims such as libel, slander and false advertising
COMPREHENSIVE
COVERAGE: Traditional name for physical damage coverage for losses by
fire, theft, vandalism, falling objects and various other perils. On Personal
Auto Policies this is now called "other than collision" coverage. On commercial
forms, it continues to be called "comprehensive coverage."
COMPREHENSIVE
PERSONAL LIABILITY POLICY (CPL): A personal liability contract. It
provides personal liability coverage for the individual and family needs
arising out of numerous personal activities and situations, such as the
ownership of residential property, ownership of pets, sports activities, and
many other everyday activities.
CONDITIONALLY
RENEWABLE: A contract of health insurance that provides that the insured
may renew the contract to a stated date or an advanced age, subject to the
right of the insurance company to decline renewal only under conditions defined
in the contract.
CONSEQUENTIAL
LOSS: A loss arising indirectly from an insured peril.
CONSTRUCTIVE
TOTAL LOSS: A partial loss of sufficient degree to make the cost of
repairing as much or more than the property is worth or is insured for.
CONTRACT
CARRIER: A transportation company which carries the goods of only certain
customers and not the public in general as in the case of a common carrier.
CONTRACTUAL
LIABILITY: Liability assumed under any contract or agreement. Coverage is
generally limited in liability policies, but in most cases may be provided for
an additional premium.
CONTRIBUTION:
The term relates to circumstances where more than one party covers the risk.
Each party is deemed to be liable for his proportion of the loss. If the
Assured recovers in full from one insurer, that insurer is entitled to recover
from the other insurer for that part of the loss which should have been paid by
the latter. The term is used in marine insurance, also, in relation to
contributions paid by the Assured in connection with salvage and/or general
average.
CONTRIBUTORY
VALUE: The value on which a contribution to a general average loss
or salvage award is calculated.
CONVERSION
PRIVILEGE: A right granted to group certificate holders, by which they
may obtain an individual policy (upon leaving the group) regardless of physical
condition.
CO-PAYMENT:
The portion, either a percentage or a fixed dollar amount, of a medical
bill that a patient pays. The insurer pays the rest.
COUNTRY
DAMAGE: Marine term referring to damage to baled or bagged goods (e.g.
cotton) caused by excessive moisture from damp ground or exposure to weather,
or by grit, dust or sand forced into the insured property by windstorm or
inclement weather.
COVER:
(1) A contract of insurance; (2) To effect insurance; (3) To include within the
coverage of a contract of insurance.
COVERAGE:
The scope of protection provided under the contract of insurance.
COVERAGE
PART: Any one of the individual commercial coverage parts that may be
attached to a commercial policy.
COVERAGE
TRIGGER: A mechanism that determines whether a policy covers a particular
claim for loss. For example, the difference between the coverage triggers of
liability "occurrence" forms and "claims made" forms is
that the loss must occur during the policy period in the first case and the
claim must be made during the policy period in the second case.
D
DECLARATION
PAGE: That page of the insurance policy which lists the insurance
company, its address, name of the policyholder, starting and ending dates of
coverage, and the actual coverages given in the contract, including the
locations and amounts.
DEDUCTIBLE:
The amount of loss paid by the policyholder before the insurance policy
benefits become payable.
DENTAL
INSURANCE: Coverage for dental services under a group of individual policy.
DEPRECIATION:
Decrease in the value of any type of tangible property over a period of time
resulting from use, wear, tear, deterioration, and obsolescence.
DIRECT OR
HELD COVERED: A condition requiring that the insured voyage be
direct from one place to another. If the voyage is delayed en route or there is
a deviation from the direct route the insurance cover continues subject to
payment of an additional premium, but only if the Assured gives prompt notice
of such delay or deviation immediately on receipt of advices, unless the policy
provides otherwise.
DISABILITY:
A condition that curtails to some degree a person's ability to carry on his
normal pursuits. A disability may be partial or total, and temporary or
permanent.
DISABILITY
INSURANCE: A type of health insurance that pays a monthly income to the
policyholder when he or she is unable to work because of illness or accident.
DISCLOSURE:
The duty of the Assured and his broker to tell the Underwriter every material
circumstance before acceptance of the risk.
DISCOVERY
PERIOD: The time allowed the insured after termination of certain bond
and policy provisions to discover that he has sustained a loss which occurred
during the period covered by the contract.
DUTY OF
ASSURED CLAUSE: This appears in the Institute Cargo Clauses published for
use with the MAR form of policy. It directs the attention of the Assured, his
agents, etc. to the duty (as required by the MIA, 1906) to take reasonable
measures to avert or minimize any loss which is recoverable under the policy;
also to ensure that all rights against carriers and others are properly
preserved and exercised. Underwriters agree to reimburse the Assured for any
reasonable expenditure incurred by his compliance with the clause; in practice,
these expenses are termed "sue and labor" charges (see Sue &
Labor).
E
EARNED
PREMIUM: That portion of a premium for which the policy protection has
already been given during the now-expired portion of the policy term.
EFFECTIVE
DATE: The date on which an insurance policy or bond goes into effect, and
from which protection is furnished.
ELECTRONIC
DATA PROCESSING COVERAGE (EDP): Specialized type of insurance designed to
cover computer equipment, data systems, information storage media, and expense
or income losses related to EDP losses.
ELIMINATION
PERIOD: A loosely-used term sometimes designating the waiting period and
sometimes the probationary period.
EMPLOYERS
LIABILITY INSURANCE: Coverage against common law liability of an employer
for accidents to employees, as distinguished from liability imposed by workers
compensation law.
EMPLOYERS
NON-OWNERSHIP AUTOMOBILE LIABILITY: (1) Liability arising out of the
operation of an automobile not owned by the insured. This frequently results
when an employee uses his own personal car in the business activities of the
insured; (2) Insurance coverage for the liability exposure mentioned above.
ENDORSEMENT:
A form attached to the policy bearing the language necessary to change the
terms of the policy to fit special circumstances.
ENGLISH
JURISDICTION CLAUSE: A condition, printed in the MAR form of
policy, whereby Underwriters agree to recognize judgments only from courts
convened within English jurisdiction. Subscribing Underwriters may agree to
replace this clause with a foreign jurisdiction clause. Please note this is not
applicable to business emanating from the United States of America which is
subject to the Service of Suit Clause (USA) appearing in the Standard
Conditions.
ENGLISH LAW
AND PRACTICE: This clause appears in Institute clauses published
for use with the MAR form or policy. It applies where a foreign jurisdiction
clause attaches to the policy and requires that the foreign court shall base
its decisions on English law and practice.
ERISA
(Employment Retirement Income Security Act of 1974): A federal law that
established rules and regulations to govern private pension plans. Most
self-insured health plans are created under this act.
EVIDENCE OF
INSURABILITY: Any statement of a person's physical condition, occupation,
etc., affecting his acceptance for insurance.
EXCLUSIONS:
Specified hazards for which a policy will not provide benefit payments.
(Often called Exceptions)
EXPERIENCE:
The loss record of an insured, class of coverage, or of an insurance
company.
EXPERIENCE
RATING: Determination of the premium rate for an individual risk, made
partially or wholly on the basis of that risk's own past claim experience.
EXPOSURE:
(1) State of being subject to the possibility of loss; (2) extent of risk as
measured by payroll, gate receipts, area, or otherwise; (3) possibility of loss
to a risk being caused by its surroundings.
EXTENDED
COVERAGE ENDORSEMENT: A specific endorsement attached to a Standard Fire
policy, usually providing coverage of windstorm, hail, explosion, riot, riot
attending civil strike, aircraft, vehicular damage, smoke and civil commotion.
EXTENDED
REPORTING PERIOD (ERP): A period allowed for making claims after
expiration of a "claims made" liability policy. Also known as a
"tail."
F
FAS:
Incoterm meaning Free Alongside Ship"
FAC:
Incoterm meaning "Free Carrier"
FOB:
Incoterm meaning "Free On Board"
FPA:
Free of Particular Average (see Average or Particular Average)
FIDELITY
BOND: A bond which will reimburse an employer for loss up to the
amount of the bond, sustained by an employer (the insured) by reason of any
dishonest act of an employee (or employees) covered by the bond.
FIRE:
Combustion sufficient to product a spark, flame or glow and which is hostile
(as opposed to friendly - i.e. not in the place where it is intended to be as
in a furnace or fireplace.)
FIRE
INSURANCE: (1) Insurance contracts that indemnify an insured for
loss caused by the destruction of the insured's property resulting from a fire;
(2) The field of insurance that provides insurance policies on the insured's
property for a variety of perils, including fire.
FIRST NAMED
INSURED: The first named insured appearing on a commercial policy.
The latest forms permit the insurer to satisfy contractual duties by giving
notice to the "first" named insured rather than requiring notice to
all named insureds.
FLAT
CANCELLATION: Cancellation of an insurance policy as of the date of its
start with no premium charge.
FLOATER
POLICY: A policy under the terms of which protection follows
moveable property, covering it wherever it may be.
FRANCHISE:
A provision in freight insurance conditions which exempts the insurer from
particular average losses, in any one accident, under 3%. The provision is
waived if the loss is caused by fire, or by the ship stranding, sinking or
being in collision.
FREIGHT:
(1) Goods moved for another or, (2) The remuneration earned by a shipowner or
manager for the carriage of goods; including the profit derived from carrying
his own goods.
G
GARAGEKEEPERS
LEGAL LIABILITY POLICY: Coverage for losses for which the insured
is legally liable, caused by fire or explosion, theft of an entire vehicle,
riot and vandalism, collision, and upset to automobiles in his care, custody
and control.
GARAGE
LIABILITY POLICY: A liability contract designed to provide the
owner of a garage operation with the liability protection needed for the
special hazards that exist there.
GENERAL
AGGREGATE LIMIT: A Commercial General Liability limit that applies
to all damages paid for bodily injury, property damage, personal injury,
advertising injury, and medical expenses, except damages included in the
products-completed operations hazard.
GENERAL
AVERAGE: An Ocean Marine coverage meaning a partial loss which has
resulted from the voluntary and deliberate sacrifice of some cargo for the
benefit of all concerned, and which must be shared by all parties (owners of
ship, cargo and freight) in proportion to their interest. For example, if 100
containers were jettisoned from a 1000 container load in order to protect the
ship, the owners of the remaining 900 containers, the owners of the ship, and
the owners of the freight would all contribute to offset the losses of those
whose cargo was jettisoned for the benefit of the whole.
GENERAL
AVERAGE CONTRIBUTION: The proportion paid or payable by a saved
interest involved in a general average act.
GENERAL
AVERAGE DEPOSIT: Paid by a consignee to obtain release of the cargo
from the carrier following a general average act. This may be replaced by an
Underwriter's guarantee.
GENERAL
AVERAGE GUARANTEE: Paid by a consignee to obtain release of the
cargo from the carrier following a general average act. This may be replaced by
an Underwriter's guarantee.
GENERAL
AVERAGE IN FULL -aka- G-A IN FULL: An agreement in a cargo
insurance whereby Underwriters do not reduce a claim for general average
contribution in event of underinsurance.
GENERAL
EXCLUSION CLAUSE: A clause in the Institute Cargo Clauses 1982,
which specifies risks that are excluded, irrespective of the risks covered
elsewhere in the wording.
GLASS
COVERAGE FORM: A commercial property form used to insure plate
glass, lettering, frames and ornamentation. It has replaced earlier commercial
glass insurance forms.
GOOD FAITH:
A basic principle of insurance. The Assured and his broker must disclose and truly
represent every material circumstance to the Underwriter before acceptance of
the risk. A breach of good faith entitles the Underwriter to avoid the
contract. (Proposed changes in law may affect this definition - also see
"Utmost Good Faith".)
GUARANTEED
RENEWABLE POLICY: A policy which the insured has the right to continue in
force by the timely payment of premiums to a specified age, (usually age 50)
during which period the insurer has no right to make unilaterally any change in
any provision of the policy while the policy is in force but make changes in
premium rates for the entire policyholder classification. (See also
"Non-Cancelable Policy".)
H
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, explosion are perils.
Slippery floors, unsanitary conditions, shingled roofs, congested traffic,
unguarded premises, and uninspected boilers are Hazards.
HEALTH
INSURANCE: Protection against the costs of hospital and medical care or
lost income arising from an illness or injury (sometimes called Accident &
Sickness Insurance).
HELD
COVERED: A provisional acceptance of risk, subject to confirmation
at a later date that the agreed cover is needed. Where applicable to an
existing insurance, cover is conditional, in practice, on prompt advice to the
Underwriter as soon as the Assured is aware of the circumstances to be held
covered coming into effect, and a reasonable additional premium is payable if
the risk held covered comes into effect.
HIRED
AUTOMOBILE: Autos the insured leases, hires, rents or borrows but
not autos owned by employees or members of their households.
HIT AND
RUN: Collision between a motor vehicle with another motor vehicle, object
or pedestrian, where the driver of the vehicle leaves the scene of the accident
without identifying himself.
HMO (Health
Maintenance Organization): An organization that provides health care for
a monthly payment set in advance. In a traditional HMO, doctors and other
providers are salaried employees and the facilities are owned by the
organization. In recent years, however, other forms of HMOs have sprung up that
contract with doctors and hospitals to care for members at set, negotiated
fees. Many HMOs are hybrids, offering both kinds of care to members.
HOLD-HARMLESS
AGREEMENT: A contractual arrangement whereby one party assumes the
liability inherent in a situation, thereby relieving the other party of
responsibility. Such agreements are typically found in contracts like leases. A
typical lease may provide that the lessee must "hold harmless' the lessor
for any liability from accidents arising out of the premises.
I
ICC
CLAUSES: (see Institute Cargo Clauses)
INDEMNIFY:
To restore the victim of a loss, in whole or in part, by payment, repair or
replacement.
INDEMNITY
BOND: A bond which indemnifies the obligee against loss which arises as a
result of failure on the part of a principal to perform.
INDEPENDENT
ADJUSTER: An adjuster who works as an independent contractor, hiring
himself out to insurance companies or other organizations for the investigation
and settlement of claims
INDEPENDENT
CONTRACTOR: One who agrees to perform according to a contract and who is
not an employee.
INHERENT
VICE: A defect or cause of loss arising out of the nature of the goods in
question.
INLAND
MARINE INSURANCE: A branch of the insurance business which developed from
the insuring of shipments which did not involve ocean voyages. Exposures
eligible for this form of protection are described in the nationwide definition
of Marine Insurance. Such diverse properties as bridges, tunnels, jewelry, and
furs can now be written under Inland Marine forms.
INSTITUTE
CARGO CLAUSES: Treaty wordings developed by the International
Chamber of Commerce. There are three basic sets of these clauses (A, B and C).
The A clauses cover "all risks", subject to specified exclusions. The
B and C clauses cover specified "risks", subject to specified
exclusions. (See actual ICC Clauses treaty wordings via "Ocean
Reference" link at left.)
INSURABLE
INTEREST: A direct monetary interest in the insured property sufficient
to result in monetary loss should the property be damaged or destroyed.
INSURABLE
RISK: A risk which meets most of the following requisites: (1) The loss
insured against must be defined; (2) It must be accidental; (3) It must be
large enough to cause hardship to the insured; (4) It must belong to a
homogenous group of risks large enough to make losses predictable; (5) It must
not be subject to the same loss at the same time as a large number of other
risks; (6) The insurance company must be able to determine a reasonable cost
for the insurance; (7) The insurance company must be able to calculate the
chance of loss.
INSURANCE:
A system to protect persons, groups, or businesses against the risks of
financial loss by transferring the risks to a large group who agree to share
the financial losses in exchange for premium payments.
INSURED:
The person whose risk is transferred and shared; the party to an
insurance agreement whom the insurer agrees to indemnify for losses, provide
benefits for, or render services to.
INSURER:
The company or group offering protection through the sale of an insurance
policy to an insured; the party to an insurance agreement who undertakes to
indemnify for losses, provide pecuniary benefits, or render services.
J
JOINT LIFE
POLICY: Pays the insurance amount when the first of two or more
covered persons dies.
K
KEY MAN
(KEY EMPLOYEE) INSURANCE POLICY: An insurance policy on the life of
a key employee whose death would cause the employer financial loss, owned by
and payable to the employer.
KNOWN
LOSS: A loss known to one or both parties when a broker and
Underwriter are negotiating a placing.
L
LEASE:
Contract whereby the owner or user of property (the lessor) agrees to let
another party, (the lessee) use the property for a consideration (money or
rent).
LEASEHOLD
INSURANCE: Insurance for the tenant of a property leased against
the loss of value of the lease or of profit from a sub-lease through
termination of the lease by fire or other peril insured against.
LESSEE
(Leasee): The party to whom a lease is granted.
LESSOR:
The party who grants a lease to the lessee.
LIABILITY:
Broadly, any legally enforceable obligation; a responsibility of one person to
another, enforceable in law.
LIABILITY
INSURANCE: That insurance that pays and renders service on behalf
of an insured for loss arising out of his responsibility, due to negligence, to
others imposed by law or assumed by contract.
LIABILITY
LIMITS: The sum or sums beyond which a liability insurance company
does not protect the insured on a liability policy.
LIEN:
A word that indicates an encumbrance on property, either for discharge of
a duty or the payment of a debt. When a lien exists, the conditions attaching
to the issue of an insurance contract require that it be disclosed to the
insurance company
LIFE
INSURANCE: Protection against the death of the Insured in the form of
payment to a designated beneficiary, typically a family member or business.
LIQUOR
LEGAL LIABILITY - Provides coverage for bodily injury or property damage for
which you may become legally liable as a result of contributing to a person's
intoxication.
LONG-TERM
CARE INSURANCE: A type of insurance policy that covers the cost of
long-term custodial care in a nursing facility or at home.
LOCATION
CLAUSE: Used in cargo open covers this limits Underwriters'
liability in any one location.
LOSS OF USE
INSURANCE: Insurance against loss due to the inability to use property
because of its damage or destruction.
LOSS OF
HIRE INSURANCE: A type of marine insurance designed to pay for continuing
expenses and loss of profits to vessel owners while unable to work after a
claim. It provides the means to pay loans, insurance premiums, key clerical
staff, captain and essential crew, and other expenses. (Similar to
"Business Interruption" or "Loss of Income" policies.)
LOSS
PAYABLE CLAUSE: Clause in an insurance policy to specifically identify
interested parties (the insured, mortgagees, trustees, lienholders, etc.).
M
MALICIOUS
DAMAGE CLAUSE: A clause published by the Institute of London Underwriters for use in a cargo policy that is subject to the Institute Cargo Clauses
(1982) B or C. It adds the risks of malicious acts, vandalism and sabotage to
the cargo policy.
MALPRACTICE
INSURANCE: A professional liability coverage that insures physicians,
lawyers and other specialists against suits alleging their negligence.
MANAGED
CARE: A health plan that places limits on which treatments and which
doctors, hospitals and other providers a member can use and still receive full
coverage. Generally, under managed care an insurer negotiates lower fees with
doctors, hospitals, or laboratories who join in a network that members of the
plan are encouraged to use. Frequently, members of a managed care plan can use
health care providers outside their network, but they must pay a greater share
of the fees.
MANUAL
RATES: Usually the published rate for some unit of insurance. An example
is the Workers Compensation Manual where the rates shown apply to each $100 of
the payroll of the insured, $100 being the unit.
MAR
POLICY: A market term for the form of marine policy used by Lloyd's
and the London company market. It is a basic contract form to which the
conditions agreed by the insurers subscribing a marine insurance contract are
attached.
MARINE
INSURANCE: Insurance coverage for goods in transit, and for the vehicles
that transport them, over waterways, over land, and in air.
MARKET
VALUE CLAUSE: A provision that may be used in property damage insurance
form covering some risks which obligates the insurance company, in the event of
loss, to pay the established cash selling price of the destroyed or damaged
stock, rather than the actual case value as provided in the Standard Fire
Policy.
MATERIAL
FACT: Anything affecting an insurance contract significant enough to
change the agreement between the insurance company and the policyholder.
MEDICAID:
A federal/state program that helps pay for health care for the needy,
blind or disabled and for low-income families with children.
MEDICARE:
A federal health care program for people age 65 and over, and for the disabled.
MEDIGAP:
Insurance coverage sold by private insurers to supplement federal insurance
benefits and expenses not covered under the federal Medicare program.
MINIMUM
PREMIUM: The smallest premium which an insurance company will
accept for writing a particular policy or bond for a designated period.
MISREPRESENTATION:
An incorrect statement made about a material fact that, if made deliberately
and with intent to deceive, could cause the insurance contract to become null
and void.
MITIGATE:
To make less severe; steps to eliminate further damage after a loss occurs.
MORTGAGE
INSURANCE: Life insurance that pays the balance of a mortgage if the
mortgagor (insured) dies.
MORTGAGEE:
The person who has loaned his money to another and taken the security of the
property in exchange.
MOTOR TRUCK
CARGO - OWNER'S FORM: This form insures the owner of a truck
against loss to his own property while being transported. It pays for the loss
or damage of cargo for the perils insured against, regardless of the legal
liability.
MOTOR TRUCK
CARGO - TRUCKER'S FORM: This form indemnifies the policyholder, a trucker,
for loss or damage resulting from his legal liability as a carrier while
transporting the property of others. I does not insure against any loss for
which he is not legally liable.
MYSTERIOUS
DISAPPEARANCE: The disappearance of insured property in a mysterious,
unexplained manner.
N
NAMED
INSURED: Any person, firm, or corporation, or any member thereof,
specifically designated by name as insured(s) in a policy as distinguished
from the others who, though unnamed, are protected under some circumstances.
NAMED PERIL
POLICIES: Named Peril Policies specify what perils are insured against,
as opposed to so-called all-risk policies.
NEGLIGENCE:
Failure to use the degree of care expected from a reasonable and prudent
person.
NO-FAULT:
A system in which each driver's auto insurance coverage pays for injuries and
damage, no matter who caused the accident.
NON-CANCELABLE
POLICY: A policy which the insured has the right to continue in force by
the timely payment of premiums set forth in the policy, during which period the
insurer has no right to make unilaterally any change in any provision of the
policy while the policy is in force. (See also "Guaranteed Renewable
Policy".)
NOTICE OF
LOSS: Written notice of a loss to the insurance company as outlined in
the conditions of the insurance policy.
O
OBLIGEE:
Broadly, anyone in whose favor an obligation runs. This term is most frequently
used in surety bonds, where it refers to the person, firm or corporation
protected by the bond.
OBLIGOR:
Commonly called principal; one bound by an obligation. Under a bond, strictly
speaking, both the principal and the surety are obligors.
OCCUPANCY:
In insurance, this term refers to the type and character of the use of property
in question.
OCCURRENCE
COVERAGE: A policy providing liability coverage only for injury or
loss that occurs during the policy period, regardless of when the claim is
actually made.
OPEN
COVER: An agreement whereby the Assured undertakes to declare every
item (e.g. shipment, vessel, etc. as appropriate) that comes within the scope
of the cover in the order in which the risk attaches. The insurer agrees, at
the time of concluding the contract, to accept all valid declarations up to the
agreed limit for each declaration. An open cover may be for a fixed period or
always open; subject to a cancellation clause.
OVERAGE:
An additional premium charged on a cargo open cover declaration because the
carrying vessel is outside the scope of the classification clause.
P
PACKAGE
POLICY: An insurance policy including two or more lines or types of
coverages in the same contract.
PARTIAL
LOSS: A loss under an insurance policy which does not either (1)
completely destroy or render worthless the insured property; or (2) exhaust the
insurance applying thereto.
PARTICULAR
AVERAGE: Accidental partial loss of the subject matter insured
proximately caused by an insured peril. In a freight at risk policy the term
may be applied to a claim for loss of freight following particular average loss
of goods.
PAYROLL
AUDIT: An examination of the insured's payroll records by a
representative of the insurance company to determine the premium due on a
policy.
PERIL:
A term used in the Marine Insurance Act (1906) to denote a hazard. The
principle of proximate cause is applied to an insured peril to determine
whether or not a loss is recoverable. In modern practice the term
"risk" often replaces "peril".
PERSONAL
ARTICLES FLOATER: Provides all risk coverage for valuable items
such as furs, jewelry, etc. formerly insured under separate contracts.
PERSONAL
EFFECTS FLOATER: An Inland Marine Policy covering worldwide, except
in the insured's domicile, personal effects usually carried by a tourist.
PERSONAL
INJURY: Injury other than bodily injury arising out of false arrest
or detention, malicious prosecution, wrongful entry or eviction, libel or
slander, or violation of a person's right to privacy committed other than in
the course of advertising, publishing, broadcasting, publishing, or telecasting.
PERSONAL
INJURY COVERAGE: Liability insurance coverage for third party
claims for damages which are other than physical such as libel, slander, false
arrest, etc.
PERSONAL
INJURY PROTECTION: The formal name usually given to no-fault
benefits in states that have enacted mandatory or optional no-fault Automobile
Insurance coverages. PIP usually includes benefits for medical expenses, loss
of work income, essential services, accidental death and funeral expenses.
PERSONAL
LINES: This term is used to refer to insurance for individuals and
families such as private passenger automobile or homeowner insurance.
POLICY:
The written statement of a contract effecting insurance, or certificates
thereof, by whatever name called and including all causes, riders, endorsements
and papers attached thereto and made part thereof.
POLICY
PERIOD: The period during which the policy contract affords protection.
PRE-CERTIFICATION
AUTHORIZATION: A cost containment technique which requires
physicians to submit a treatment plan and an estimated bill prior to providing
treatment. This allows the insurer to evaluate the appropriateness of the
procedures, and lets the insured and the physician know in advance which
procedures are covered and at what rates benefits will be paid.
PRE-EXISTING
CONDITIONS: A physical condition of an insured person which existed prior
to the issuance of the policy.
PREMISES:
The particular location of a property or a portion thereof as designated in a
policy.
PREMIUM:
The payment for an insurance policy, usually paid periodically (annually,
semi-annually, quarterly, or monthly).
PRIOR
DAMAGE: Pre-existing damage that occurred prior to the loss in question.
PRO-RATA:
Cancellation of an insurance contract by the insurance company, allowing
a policyholder a share of the premium relating to the remainder of the time
under the contract that bears to the total contract premium.
PRODUCTS
LIABILITY INSURANCE: Provides protection against claims arising out
of the use, handling or consumption of a product.
PROFESSIONAL
LIABILITY INSURANCE: Liability insurance to indemnify
professionals, doctors, lawyers, architects, etc. for the loss or expense
resulting from claim on account of bodily injuries because of any malpractice,
error or mistake committed or alleged to have been committed by the insured in
his profession.
PROOF OF
LOSS: A statement made to the insurance company under oath setting out
the basis of an insured's claim under the insurance policy.
PROPERTY
DAMAGE (LIABILITY) INSURANCE: Protection against liability for damage to
the property of another not in the care, custody and control of the insured, as
distinguished from liability for bodily injury.
PROPERTY
INSURANCE: Insurance which indemnifies a person with an interest in
physical property for its loss or the loss of its income-producing ability.
PROSCRIPTION:
Outside of the time period in which a legal action can be commenced.
PROXIMATE
CAUSE: The immediate and effective cause of loss or damage. It is
an unbroken chain of cause and effect between the occurrence of an insured
peril or a negligent act and resulting injury or damage.
Q
QUALIFIED
PLAN: A plan under which contributions by the employer are allowed
as a deduction from taxable income, and which provides that the deposits for
his employees' future benefits are not to be considered as taxable income to
them in the year in which they are made.
R
RATING
BUREAU: An organization that classifies and promulgates and in some
cases compiles data and measures hazards of individual risks in terms of rates
in a given territory.
RECOVERY:
Amount recovered from a third party responsible for a loss on which a claim has
been paid.
REBATE:
A reduction of a premium.
REIMBURSEMENT:
Payment of an amount of money related to the amount of loss to or on
behalf of the insured upon the occurrence of a defined loss.
REINSTATEMENT:
(1) Putting a lapsed policy back in force; (2) The payment of a claim under
some forms of insurance reduces the principal amount of the policy by the
amount of the claim. Provision is usually made for a method of reinstating the
policy to its original amount.
REINSURANCE:
(1) A contract of indemnity against liability by which the insurance company
procures another insurance to insure against loss or liability by reason of the
original insurance; (2) Insurance by one insurance company of all or part of a
risk accepted by it with another insurance company which agrees to reimburse
the insurance company for the portion of the claim insured.
REPLACEMENT
CLAUSE: A clause limiting Underwriters' liability for damage to
machinery cargo.
REPLACEMENT
COST: The cash value representing what it would cost to replace the
specific property without deduction for depreciation.
REPORTING
FORM: Fire or other direct damage insurance written under a form of
policy that covers fluctuating values of stocks of merchandise, furniture and
fixtures and improvements by means of periodic reports submitted to the
insurance company by the insured, with an annual adjustment of premium on the
average value.
RETROACTIVE
DATE: Date on a "claims made" liability policy which
triggers the beginning of insurance coverage. A retroactive date is not
required. If one is shown on a policy, any claim made during the policy period
will not be covered if the loss occurred before the retroactive date.
RIDER:
An endorsement to an insurance policy that modifies clauses and provisions of
the policy, adding or excluding coverage(s).
RISK:
A fortuity. A term used to designate an insured of a peril insured against. It
does not embrace inevitable loss. The term is used to define causes of loss
covered by a policy.
S
SALVAGE:
(1) Property taken over by an insurance company to reduce its loss; (2) Award
recoverable by salvors under maritime law.
SALVAGE
CHARGES: The award due to a salvor for services rendered in saving
the insured property.
SALVAGE
LOSS: Occurs when the Underwriter agrees to settle a cargo claim by
paying the difference between the insured value and the proceeds realized by
selling the damaged goods.
SCHEDULE:
(1) A list of specified amounts payable for, usually, surgical procedures,
dismemberments, ancillary expenses or the like in Health Insurance policies;
(2) The list of individual items covered under one policy as the various
buildings or animals and other property in property insurance; (3) In Marine
policies, a list attached to a slip, open cover, policy or other document,
usually detailing the rates of premium for various voyages, interests and risks.
SCHEDULE OF
LOSS: Notice completed by the insured documenting loss or damage to
contents, personal property and/or stock.
SEAWORTHINESS
WARRANTY: There is an implied warranty in every voyage policy that
the ship must be seaworthy at the commencement of the insured voyage or, if the
voyage is carried out in stages, at the commencement of each stage of the
voyage. To be seaworthy, the ship must be reasonably fit in all respects to
encounter the ordinary perils of the contemplated voyage, property crewed,
fuelled and provisioned, and with all her equipment in proper working order.
Cargo policies waive breach of the warranty, except where the Assured or their
servants are privy to the unseaworthiness. Breach of the warranty is not
excused in a hull voyage policy, literal compliance therewith being required.
Although there is no warranty of seaworthiness in a hull time policy, claims
arising from unseaworthiness may be prejudiced if the ship sails in an
unseaworthy condition with the knowledge of the Assured.
SECURITY:
The Underwriters subscribing a risk. The Insurers.
SHORT-RATE:
Cancellation of an insurance contract at the request of the policyholder
with a refund of premiums to the policyholder less than would be given under
pro-rata consideration.
SOLVENCY:
Sufficient assets and income. It is the primary responsibility of a
state's insurance department is to monitor insurance companies licensed to
transact business within their state and make certain that they remain solvent
and have the ability to pay the claims of their policyholders.
SPECIFIED
DISEASE INSURANCE: A policy which provides stated benefits, usually of
large amounts, toward the expense of treatment of the disease or diseases named
in the policy.
STOP
LOSS: (1) Any provision in a policy designed to cut off the insurance
company's loss at a given point. Aggregate benefits and maximum benefits are an
example; (2) A type of reinsurance designed to transfer the loss from the
ceding company to the reinsurer at a given point.
SUBROGATION:
The legal process by which an insurance company seeks from a third party who
may have caused the loss, recovery of the amount paid to the insured.
SUBROGATION
WAIVER: A waiver by the named insured giving up any right of recovery
against another party. Normally an insurance policy requires that subrogation
(recovery) rights be preserved.
SUE AND
LABOR: Expenses incurred by the Assured or their representatives
with the intention of preventing or minimizing a loss for which the Underwriter
would have been liable. They do not include expenses incurred in general
average or salvage acts; these being recoverable under the policy only as part
of the Underwriters' liability for contribution to general average or salvage,
if any. Sue and labor charges are recoverable under a policy that incorporates
a sue and labor clause (SG policy), or in accordance with the wording of the
policy (e.g. under the "duty of the Assured" clause attached to a MAR
policy).
SURETY:
(1) A term loosely used to describe the business or suretyship or bonds.
Suretyship is an arrangement whereby one party becomes answerable to a third
party for the acts of neglect of a second party; (2) The party in a surety
arrangement who holds himself responsible to one person for the acts of another.
SURETY
BOND: A bond in which the surety agrees to answer to the obligee
for the non-performance of the principal (known as the obligor).
T
TAIL:
This term has been used to describe both the exposure that exists after
expiration of a policy and the coverage that may be purchased to cover that
exposure. On "occurrence" forms a claims tail may extend for years
after policy expiration, and the losses may be covered. On "claims
made" forms tail coverage may be purchased to extend the period for reporting
covered claims beyond the normal policy period.
TERM
INSURANCE: Life insurance issued for a stated temporary period of time.
TITLE
INSURANCE: Indemnifies the owner of real estate in the event clear
ownership of property is challenged by discovery of faults in the title.
TO PAY AS
CARGO: Used in an ancillary insurances relating to the cargo (e.g.
increased value) when the Assured is not required to show evidence of loss or
interest and can claim on the policy if he can show that a corresponding loss
has been settled on the main cargo policy.
TOTAL
LOSS: This can be actual total loss or constructive total loss,
where the cost of damage repair exceeds the value of the property insured.
TRANSIT
CLAUSE: A clause in the Institute Cargo Clauses, specifying the
attachment and termination of cover.
TRUCKMENS
LIABILITY FORM: See Motor Truck Cargo Policy
U
UMBRELLA
LIABILITY POLICY: A liability policy designed to provide liability
protection above and beyond that provided by standard liability contracts.
UNDER-INSURANCE:
A condition in which not enough insurance is carried to cover the insurable
value, and, especially, to satisfy a coinsurance clause.
UNDERWRITER:
(1) A person trained in evaluating risks and determining the rates and coverages
that will be used for them; (2) An agent, especially a life insurance agent,
who might qualify as a "field underwriter."
UNDERWRITING:
The process of examining, accepting, or rejecting insurance risks, and
classifying those selected in order to charge the proper premium for each.
UNINSURED
MOTORIST COVERAGE: Endorsement to a personal automobile policy that
covers an insured involved in a collision with a driver who does not have
liability insurance.
UNIVERSAL
LIFE INSURANCE: A flexible premium policy that combines protection
against premature death with a savings account that typically earns a money
market rate of interest.
V
VALUABLE
PAPERS AND RECORDS INSURANCE: An Inland Marine or burglary
insurance coverage providing for the replacement of valuable papers, records
and forms.
VOID
POLICY: One which is inadmissible as evidence in a court of law
(e.g. P.P.I. policy).
W
WAITING
PERIOD: A period of time between the beginning of a disability and
the date benefits begin.
WAIVE:
To forego; to refrain from insisting upon application of an insurance
deductible under specific conditions.
WAIVER
CLAUSE: A clause which entitles both Underwriter and Assured to
take measures to prevent or reduce loss without prejudice to the rights of either
party.
WARRANTY:
A statement made on an application for insurance that is warranted to be true
in all respects. If untrue in any respect, even though the untruth may not have
been known to the person giving the warranty, the contract may be voided whether
or not the untruth or inexactness is material to the risk.
WATERBORNE
AGREEMENT: A market understanding whereby Underwriters cover goods
against war risks only whilst they are on the overseas vessel. This rule is
relaxed only in the case of goods in a transshipping port for a short period
awaiting onward carriage.
WHOLE LIFE
INSURANCE: Life insurance payable to a beneficiary at the time of death
of the insured, whenever that occurs.
WITHOUT
BENEFIT OF SALVAGE: A term in a marine insurance policy, whereby
the Underwriters forgo their subrogation rights. A policy incorporating such a
term is deemed to be a gambling policy in law, and is therefore invalid in a
court of law.
WITHOUT
PREJUDICE: The claim is paid on this occasion, although the Underwriter
feels it does not attach to the policy, but this action must not be treated as
a precedent for future similar claims.
WORKERS
COMPENSATION: (1) A schedule of benefits payable to an employee for
injury, disability, dismemberment, or death as a result of occupational hazard.
The payments are a liability of an employer. (2) Insurance agreeing to pay the
Workers Compensation benefits required by law on behalf of the employer.