Claims and Adjusting

The effective date and time when insurance coverage begins for a policy.

Expediting expenses are extra costs incurred after a covered property loss to repair or replace damaged property faster than ordinary timing would allow.

An apportionment clause sets out how several insurers divide a common loss when the same property or liability is covered by more than one policy.

A person or entity that temporarily holds another person's property and is expected to care for it under the storage agreement.

The amount an insurer pays to beneficiaries when the insured dies, based on policy terms.

Dram shop liability insurance protects alcohol-serving businesses against covered claims that their service of alcohol contributed to injury or property damage.

A diagnosis identifies a condition from clinical evidence and is the primary trigger for treatment classification and claims coding.

A broad business liability form that covers many third-party bodily injury, property damage, and related defense exposures.

An employee dishonesty coverage form insures against direct loss of money, securities, or other property caused by dishonest acts of employees.

Situation in which the insurer creates and signs the policy document.

A source of additional exposure to an insured risk, often linked to but not always physically attached to the main insured property.

A divisible contract clause treats certain property insurance coverages as separately applied so a breach affecting one location or item does not automatically void all coverage.

A buy-back deductible lets the policyholder pay extra premium to remove or reduce deductible risk retention for a specific policy.

A health-related condition where care requirements or medical limitations limit an insured person to home or facility care.

Medical costs and services a health plan agrees to pay under its coverage terms.

Policy wording that removes a particular situation from coverage or, in some forms, restores coverage by carving something back into an exclusion.

The amount an insurer sets aside to pay claims that have occurred but are not yet fully settled.

Explosion, collapse, and underground damage, often called XCU, are hazardous construction exposures that liability insurers may exclude, restrict, or underwrite carefully.

The maximum total amount an insurer will pay for covered losses during a contract period.

The intentional and malicious setting of fire, with major implications for insurance fraud detection and non-payment defenses.

Business interruption insurance compensates for lost revenue and fixed costs caused by covered business shutdown.

An insurance sales practice where an existing policy is replaced mainly to generate commissions instead of improving coverage.

Funds set aside by insurers for uncertain but plausible future losses or obligations.

A backup policy beneficiary who receives benefits if the primary beneficiary cannot.

The right of an insurer that paid more than its fair share of a covered loss to recover the proper share from another insurer covering the same risk.

A legal doctrine that can bar or sharply limit recovery when the injured person also contributed to the loss.

The protection actually promised by a policy for specified risks, amounts, and conditions.

The scope of losses, people, and conditions an insurance policy is contractually set up to cover.

Insurance coverage for additional costs and business interruption caused by failures in critical data-processing systems.

A commercial crime form designed to cover specified losses from employee dishonesty, missing property, and related crime exposures.

Specialized insurance for property damage and related liability arising from an elevator's collision or violent contact event.

In health insurance, an encounter is a documented interaction in which a covered person receives services from a healthcare provider.

A fixed dollar amount the insured must absorb on each covered loss before the insurer pays.

Place of service identifies the care setting used on a health-insurance claim, such as an office, hospital, or outpatient facility.

A broad coverage form that combines multiple protected risks in one policy, subject to exclusions and limits.

Coverage for physical damage or liability losses arising from vehicle crashes, often tied to collision or comprehensive property protections.

An extra expense coverage form pays necessary additional costs a business incurs to keep operating or reduce a shutdown after covered property damage.

Rules that determine payment order when more than one insurance plan can cover the same healthcare expense.

A property insurance term for ground-shift events such as earthquake, landslide, mudflow, or earth sinking that are often excluded unless specifically covered.

Estoppel can prevent an insurer or policyholder from taking a position that conflicts with earlier words or conduct when the other side reasonably relied on it.

Acceleration life insurance allows part of the life benefit to be paid early when qualifying medical or terminal illness conditions are met.

Additional living expense reimburses temporary housing and essential life costs when a covered dwelling is uninhabitable.

Coverage that protects the insured vehicle itself from accidental, fire, theft, and other non-liability losses.

Conduct that creates legal liability to another person or property, commonly through negligence or contract breach.

A wrongful act that may create financial loss for policyholders and can be a covered peril only under specific insurance terms.

Sworn testimony recorded before a claim or legal proceeding, often used as evidence in disputes involving insurance coverage or claims.

The expected decline in value of property from wear, age, or obsolescence that affects insurance valuation.

Physical damage or financial damage caused immediately by a peril, before any secondary business effects occur.

Coverage structured to respond to losses discovered during the policy or treaty period, even if the underlying wrongful act occurred earlier, subject to the contract's terms.

An additional period after policy or bond termination during which covered losses from earlier acts may still be discovered and reported.

A dishonest act by an employee that causes direct financial loss to the employer.

An extended reporting period gives the insured extra time to report claims under a claims-made liability policy after the policy ends.

Uninsured motorists are drivers who carry no applicable auto liability coverage, creating a claim risk for people they injure.

A legal defense where a party knowingly accepts certain risks through voluntary participation.

A premises-liability doctrine where landowners can be liable for hazards that attract children.

An insurance clause that increases benefit payments on a schedule, helping long-term income protection keep pace with rising costs.

A disability-related benefit formula that pays based on an insured income average during an initial period.

A valuation standard used in insurance claims to determine actual cash value using all reliable, relevant loss evidence.

The cost an insurer incurs to investigate and administer a claim, separate from the payout itself.

The person or entity seeking payment under an insurance policy after a loss.

Compensatory damages are money awarded to make an injured party whole for actual loss caused by another party's wrongful conduct.

Two or more active insurance policies that respond to the same risk for the same loss.

The part of a health insurance claim that the insured pays through deductibles, co-pays, or coinsurance before and while the insurer pays.

Damages are monetary amounts intended to compensate for injury, loss, or financial harm in a legal or insurance claim.

A debris removal clause reimburses reasonable cleanup costs after an insured property loss.

The deductible clause defines how a deductible is applied in an insurance contract.

Depreciation insurance pays replacement value for damaged property without subtracting wear-and-tear depreciation.

A medically supervised process to treat substance withdrawal, often covered under specific health plan criteria.

A Difference in Conditions (DIC) endorsement extends coverage by adding protections not fully included in a primary property policy.

The process of arranging a patient's safe transition out of a hospital or facility, with important implications for health insurance authorization and claim payment.

Dwelling forms are property insurance forms used to insure residential dwellings outside the standard homeowners package, often with different peril and valuation structures.

A form of business interruption coverage designed to replace lost earnings after covered property damage, often written for smaller risks without a coinsurance clause.

The dishonest taking or misuse of money or property by someone who was entrusted with it, which matters in insurance because it can trigger crime or fidelity coverage issues.

A voluntary payment made by an insurer even though the policy may not legally require it.

A policy attachment that removes coverage for a specific condition, hazard, person, or category of loss.

Experimental procedures are treatments or services a health plan considers investigational, unproven, or not medically established enough for routine coverage.

The statement a health insurer sends showing how a claim was processed and what amount, if any, the patient may owe.

A health insurance provision that continues certain covered benefits after coverage would otherwise end, usually for members already hospitalized or disabled.

IBNR refers to claim costs from losses that have already happened but have not yet been reported to the insurer.

First-party auto coverage that pays medical expenses after an accident regardless of fault, up to the policy limit.

Premises burglary is theft from an insured location involving unlawful entry, typically covered under commercial crime forms when policy conditions are met.

A release document used in the recovery process when subrogation rights are preserved, settled, or impaired.

The insurance-law principle that parties must be honest and disclose material facts when forming and administering an insurance contract.

In insurance, a warranty is a statement or condition in the contract that must be strictly true or satisfied for coverage to apply.

Water damage legal liability coverage protects insureds against some claims made by neighbors or third parties for water-related losses that originate from the insured location.

The wear and tear exclusion removes coverage for losses caused by gradual deterioration, normal use, or aging of insured property.

An abandonment clause prevents policyholders from declaring total loss on property that still has recoverable salvage value.

A temporary life insurance payout to help a beneficiary cover ongoing expenses after the insured’s death.

A payout for minor cosmetic damage so the insured can keep damaged property or parts.

The allocation of a shared insurance loss across multiple coverages, policies, or insurers according to contract language and limits.

An appraisal clause lets either party request independent valuation when the parties disagree on the amount of a property loss.

An arbitration clause sets a private dispute process for claims disagreements, usually faster than court litigation.

Insurance that pays for third-party bodily injury and property damage when the insured driver is legally liable.

Events or conditions that must occur before a policy begins paying benefits.

Property coverage for bridges and bridge-related infrastructure that protects against loss, damage, and outage-related costs.

The unlawful entry into a building with intent to commit theft or related criminal damage, a key peril in property and business crime coverage.

A business risk exclusion removes coverage for losses caused by certain operational or product risks that are not considered insurable under the policy.

The insurer team that triages, investigates, and resolves claims under the policy terms.

The detailed file record used to document facts, damage, and documentation for a claims decision.

Protection against business losses from forged instruments, fake payment documents, and related fraudulent payment risks.