Insurance Terms and Related Concepts (The Adjuster School)

Accident

An unforeseen, unintended event; something unexpected.

Act of God

An event arising out of natural causes with no human intervention which could not have been prevented by reasonable care or foresight. Examples are floods, lightning, and earthquakes.

Actual Cash Value

The value of your property, based on the current cost to replace it minus depreciation.

Additional Living Expenses

Extra charges covered by homeowner's policies over and above the policyholder's customary living expenses due to damage by a covered perl that makes the home temporarily uninhabitable.

Adjuster

A person who investigates and settles insurance claims.

All Risk Insurance

The term "All-Risk Insurance" is used to mean insurance against loss of or damage to property arising from any cause except those that are specifically excluded.

Appraisal

The process in which there is a dispute between the insurer and the insured regarding the amount of the claim. Both parties hire an appraiser to represent them. The two appraisers attempt to settle the dispute. If they can not settle the dispute they hire

Bodily Injury

Physical injury to a person

Continuing Education Requirement

State-level requirement that insurance licensees periodically complete a minimum number of hours of insurance-related education in order to be eligible for license renewal.

Declarations Page

The declaration is the part of the written insurance policy that states all the policy's specifics, including the name of the policyholder, the type of property insured, the premiums, and the term limits for the coverage.

Deductible

The amount the insured must pay in a loss before any payment is due from the company.

Depreciation

The act of lowering an item's value due to use or wear and tear. Depreciation is based on Age, Condition, and Life Expectancy.

endorsement

An endorsement is a specific addition to a policy that alters the coverage and therefore the price of that policy. Endorsements can either add or remove specific types of coverages.

Exclusion

Provision in an insurance policy that indicates what is denied coverage. Examples of Exclusions are: Wear and Tear, Rust, Rot, Contamination, Mechanical Breakdown.

Expiration Date

The date on which an insurance policy expires.

First Party Loss

A situation involving only the insurer and insured

Fraud

Fraud is any intentional lying or misrepresentation by policyholders or claim adjusters in order to inflate a claims payment or receive a claims payment that would otherwise not be paid.

HO-A

A type of Homeowner's policy that provides coverage to both Coverage A (Structure) and Coverage B (Personal Property) on a Named Peril basis.

HO-B

A type of homeowner's policy that provides coverage to Coverage A (Structure) for All Risks of Physical Loss, unless specifically excluded and to Coverage B (Personal Property) on a Named Peril basis.

Incurred Expense

Expenses that have already been sustained and that have not yet been paid. Additional Living Expenses payments are a reimbursement of Incurred Expenses.

Insured

The party to an insurance arrangement whom the insurer agrees to indemnify for losses, provide benefits for, or render services.

Insurer

The insurance company.

Liability

Responsibility to another for one's negligence.

Loss History

Refers to an insured's history of losses (claims) with other companies, or the company they are currently with. A company will consider "loss history" when underwriting a new policy or considering a renewal of an existing policy. Companies view "loss hist

Loss Payee

The party to whom money or insurance proceeds is to paid in the event of loss, such as the lien holder or an automobile or the mortgagee on real property.

Material Misrepresentation

A significant misstatement in an application form. If a company had access to the correct information at the time of application, the company might not have agreed to accept the application.

Negligence

The failure to use that degree of care which an ordinary person of reasonable prudence would use under similar circumstances.

Non-Renewal

A decision by an insurance company not to renew a policy.

Notice of Loss

Notice required by insurance companies immediately after an accident or other loss. Part of the standard provisions defining a policyholder's responsibilities after a loss.

Occurrence

An event that results in an insured loss / damages.

Overhead & Profit

the amount of money dedicated to a general contractor's cost of doing business and earning a profit. Insurance industry standard is 10% and 10%.

Perils Insured Against

These are the specific causes of loss that are covered under the policy.

Policy Period

The period a policy is in force, from the beginning or effective date to the expiration date.

Premium

The amount paid by an insured to an insurance company to obtain or maintain an insurance policy.

Public Adjuster

A person hired by the insured to settle the claim with the insurance company on their behalf.

Replacement Cost

The cost associated with replacing property at current market prices

Reserves

A company's best estimate of what it will pay for claims. the amount representing actual or potential liabilities kept by an insurer to cover debts to policyholders.

Severity

Size of a loss, The extent of damages

Staff Adjuster

Employee of the insurance company's claim department.

Subrogation

The legal process by which an insurance company, after paying a loss, seeks to recover the amount of the loss from another party who is legally liable.

Third Party Loss

A situation involving a person other than the insurer and insured; i.e., a person making a liability claim against the insured.

Umpire

For Property coverage, if a company and a claimant fail to agree on the amount of loss, each may appoint an appraiser, and these in turn select an umpire. A decision by an two of the three is binding.

Underwriting

The process an insurance company uses to decide whether to accept or reject an application for a policy.

Accident

An unforeseen, unintended event; something unexpected.

Act of God

An event arising out of natural causes with no human intervention which could not have been prevented by reasonable care or foresight. Examples are floods, lightning, and earthquakes.

Actual Cash Value

The value of your property, based on the current cost to replace it minus depreciation.

Additional Living Expenses

Extra charges covered by homeowner's policies over and above the policyholder's customary living expenses due to damage by a covered perl that makes the home temporarily uninhabitable.

Adjuster

A person who investigates and settles insurance claims.

All Risk Insurance

The term "All-Risk Insurance" is used to mean insurance against loss of or damage to property arising from any cause except those that are specifically excluded.

Appraisal

The process in which there is a dispute between the insurer and the insured regarding the amount of the claim. Both parties hire an appraiser to represent them. The two appraisers attempt to settle the dispute. If they can not settle the dispute they hire

Bodily Injury

Physical injury to a person

Continuing Education Requirement

State-level requirement that insurance licensees periodically complete a minimum number of hours of insurance-related education in order to be eligible for license renewal.

Declarations Page

The declaration is the part of the written insurance policy that states all the policy's specifics, including the name of the policyholder, the type of property insured, the premiums, and the term limits for the coverage.

Deductible

The amount the insured must pay in a loss before any payment is due from the company.

Depreciation

The act of lowering an item's value due to use or wear and tear. Depreciation is based on Age, Condition, and Life Expectancy.

endorsement

An endorsement is a specific addition to a policy that alters the coverage and therefore the price of that policy. Endorsements can either add or remove specific types of coverages.

Exclusion

Provision in an insurance policy that indicates what is denied coverage. Examples of Exclusions are: Wear and Tear, Rust, Rot, Contamination, Mechanical Breakdown.

Expiration Date

The date on which an insurance policy expires.

First Party Loss

A situation involving only the insurer and insured

Fraud

Fraud is any intentional lying or misrepresentation by policyholders or claim adjusters in order to inflate a claims payment or receive a claims payment that would otherwise not be paid.

HO-A

A type of Homeowner's policy that provides coverage to both Coverage A (Structure) and Coverage B (Personal Property) on a Named Peril basis.

HO-B

A type of homeowner's policy that provides coverage to Coverage A (Structure) for All Risks of Physical Loss, unless specifically excluded and to Coverage B (Personal Property) on a Named Peril basis.

Incurred Expense

Expenses that have already been sustained and that have not yet been paid. Additional Living Expenses payments are a reimbursement of Incurred Expenses.

Insured

The party to an insurance arrangement whom the insurer agrees to indemnify for losses, provide benefits for, or render services.

Insurer

The insurance company.

Liability

Responsibility to another for one's negligence.

Loss History

Refers to an insured's history of losses (claims) with other companies, or the company they are currently with. A company will consider "loss history" when underwriting a new policy or considering a renewal of an existing policy. Companies view "loss hist

Loss Payee

The party to whom money or insurance proceeds is to paid in the event of loss, such as the lien holder or an automobile or the mortgagee on real property.

Material Misrepresentation

A significant misstatement in an application form. If a company had access to the correct information at the time of application, the company might not have agreed to accept the application.

Negligence

The failure to use that degree of care which an ordinary person of reasonable prudence would use under similar circumstances.

Non-Renewal

A decision by an insurance company not to renew a policy.

Notice of Loss

Notice required by insurance companies immediately after an accident or other loss. Part of the standard provisions defining a policyholder's responsibilities after a loss.

Occurrence

An event that results in an insured loss / damages.

Overhead & Profit

the amount of money dedicated to a general contractor's cost of doing business and earning a profit. Insurance industry standard is 10% and 10%.

Perils Insured Against

These are the specific causes of loss that are covered under the policy.

Policy Period

The period a policy is in force, from the beginning or effective date to the expiration date.

Premium

The amount paid by an insured to an insurance company to obtain or maintain an insurance policy.

Public Adjuster

A person hired by the insured to settle the claim with the insurance company on their behalf.

Replacement Cost

The cost associated with replacing property at current market prices

Reserves

A company's best estimate of what it will pay for claims. the amount representing actual or potential liabilities kept by an insurer to cover debts to policyholders.

Severity

Size of a loss, The extent of damages

Staff Adjuster

Employee of the insurance company's claim department.

Subrogation

The legal process by which an insurance company, after paying a loss, seeks to recover the amount of the loss from another party who is legally liable.

Third Party Loss

A situation involving a person other than the insurer and insured; i.e., a person making a liability claim against the insured.

Umpire

For Property coverage, if a company and a claimant fail to agree on the amount of loss, each may appoint an appraiser, and these in turn select an umpire. A decision by an two of the three is binding.

Underwriting

The process an insurance company uses to decide whether to accept or reject an application for a policy.