Claims and Adjusting

Coverage for losses from legal liabilities a business or professional assumes under written agreements.

A loss allocation method for distributing a shared property loss across overlapping insurance policies with nonidentical coverage.

Custodial care refers to non-medical daily living support paid under a care plan or policy benefit terms.

A formal statement of key policy facts, often shown on the declarations page of a policy.

Deep pockets liability describes a claim outcome where a more financially capable defendant pays more than its fair share of total damages.

A legal pleading asking the court to dismiss a claim as legally insufficient despite assumed facts.

A deductible structure that is reduced or eliminated when a covered loss exceeds a stated threshold or meets specified conditions.

An insurance arrangement in which two or more insurers each accept a stated share of the same risk.

Druggists' liability insurance covers pharmacy liability arising from dispensing errors, labeling mistakes, and other professional mistakes in pharmacy operations.

An electrical apparatus exemption clause limits property coverage for electrical damage unless the loss results in a covered ensuing fire.

Eligible expenses are the medical charges a health plan recognizes as covered or allowable under the policy.

In health insurance, an emergency is a sudden illness or injury requiring immediate medical attention to avoid serious harm.

A statement showing how a Medicare claim was processed and what amounts Medicare approved, paid, or left to the beneficiary.

An extra rider payment that increases what beneficiaries receive when the base death benefit settles.

The maximum amount an insurer will pay for all claims in a policy year for a class of coverage.

A clause that restores policy limits or values automatically after certain partial losses without waiting for a full underwriting restart.

The usual semi-private hospital room charge benchmark used in coverage calculations, usually based on region and provider data.

The wage rate used in many disability and workers compensation calculations to set benefit levels and duration.

A temporary transfer of possession of personal property without transferring ownership.

The owner or lawful possessor who entrusts personal property to a bailee.

Care, custody, and control identifies property for which the insured may not cover liability because it holds only temporary possession.

A choice no-fault plan lets certain drivers elect a no-fault auto-insurance option in which their own policy pays first-party injury benefits after an accident.

A formal request by an insured party for payment or benefits after a covered loss.

An insurer representative who manages claim intake, investigation support, and settlement support under policy authority.

The policy clause that sets out how claims are reported, documented, and resolved.

A legal rule that allocates fault among the parties to an accident and reduces damages according to each party's share of responsibility.

Completed operations insurance covers liability claims arising after a contractor's or business's work has been finished and put to its intended use.

Auto physical-damage coverage for losses other than collision, such as theft, fire, vandalism, weather, and falling objects.

A claim scenario where multiple causes combine to produce one loss event and trigger coverage questions.

A condition that can end coverage when it occurs after the policy has begun.

Secondary losses that follow a covered event, such as business interruption or spoilage from loss of use.

A reserve fund set for unexpected or unusual losses and stress events.

A potential obligation that depends on a future event, such as a lawsuit or contract outcome.

The policy event that starts coverage for a claim, such as when an injury occurs or when a claim is reported.

A loss or damage that meets a policy’s coverage terms and is payable by the insurer.

The date when care was actually provided to the patient.

The person who has died and whose death triggers certain insurance and legal processes.

A false statement that harms reputation and can create defense and coverage questions under insurance policies.

The party being sued and may be protected by insurance policy defense and indemnity terms.

A policy provision that limits or excludes coverage when claims involve delayed performance or timing-related loss events.

Diagnosis-related groups (DRGs) are classification groups used for standardized hospital payment and claims processing.

The stated maximum amount an insurance policy will pay for a particular coverage, class of property, or loss.

Employer's liability coverage protects an employer against certain employee injury claims that fall outside ordinary workers compensation benefits.

An endorsement extending the period of indemnity lengthens business interruption protection beyond physical reopening so the insured has more time to recover income.

The entire contract clause says the insurance policy and the documents attached to it are the full agreement between the insurer and the policyholder.

An evidence clause lets the insurer require reasonable proof needed to investigate, value, and decide a claim.

An extended period of indemnity continues business-income coverage after operations resume, while the insured's revenue is still recovering from a covered property loss.

A forgery or alteration coverage form protects a business against loss when checks, drafts, or similar instruments are forged or fraudulently altered.

In-area services are health care services received within a plan’s service area or network, typically covered at more favorable cost-sharing.

Removal coverage pays for covered property while it is being moved to protect it from an imminent covered peril, subject to time and location limits.

Liability coverage that pays when the insured is legally responsible for injury or damage suffered by someone else.

UB-92 is the standardized institutional claim form format used to bill hospital services, helping health insurers adjudicate claims consistently.

A commercial crime coverage form that insures certain property against robbery or forcible entry into a safe, subject to definitions and limits.

The level of prudence expected in a specific insurance context, usually measured by ordinary professional or reasonable standards.

A single deductible amount that can apply to multiple losses during one policy year.

A document that permits an insurer or related party to obtain, release, or use specified personal information for underwriting or claims purposes.

An occupational disease is an illness caused by workplace exposures or conditions, usually handled as a workers' compensation claim.

A single aggregate payment cap that applies to a group, block, or set of similar risks under one policy framework.

A broad medical expense coverage form that applies across many members or groups under common eligibility and benefit logic.

A capped maximum amount that applies to a specific group or block of similar exposures.

Physical injury to a person, which is a core trigger for many liability and personal injury coverage obligations.

The recorded value of an asset in the insurer or policyholder books, before market revaluation.

The non-cash value element in a claim or settlement transfer, often used when one side gives up an asset interest.