Insurance Terms Glossary

 

Actual Cash Value (ACV)

In property and auto physical damage insurance, one of several possible methods of establishing the value of insured property to determine the amount the insurer will pay in the event of loss. ACV is typically calculated one of three ways: (1) the cost to repair or replace the damaged property, minus depreciation; (2) the damaged property’s “fair market value”; or (3) using the “broad evidence rule,” which calls for considering all relevant evidence of the value of the damaged property.

Additional Insured

A person or organization not automatically included as an insured under an insurance policy of another but for whom the named insured desires or is required to provide a certain degree of protection under its insurance policy. A named insured’s impetus for providing additional insured status to others may be a desire to protect the other party because of a close relationship with that party (e.g., wanting to protect church members performing services for the insured church) or to comply with a contractual agreement requiring the named insured to do so (e.g., project owners, customers, or owners of property leased by the named insured). Additional insured status is commonly used in conjunction with an indemnity agreement between the named insured (the indemnitor) and the party requesting additional insured status (the indemnitee). Having the rights of an insured under its indemnitor’s commercial general liability (CGL) policy is viewed by most indemnities as a way of backing up the promise of indemnification. If the indemnity agreement proves unenforceable for some reason, the indemnitee may still be able to obtain coverage for its liability by making a claim directly as an additional insured under the indemnitor’s CGL policy.

Additional Living Expense

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, ALE insurance would cover an insured’s motel bill while fire damage to the home is being repaired or replaced or until the insured moves to a permanent residence. ALE coverage is subject to a limit equal to 30 percent of the dwelling limit under forms homeowners (HO) 2, HO 3, and HO 5. For form HO 8, ALE is 10 percent of the dwelling limit. Under the tenants policy (HO 4), ALE is 30 percent of the personal property limit, while under the condominium unit owners policy (HO 6), the limit of ALE is 50 percent of the personal property limit.

Advertising Injury

A general liability coverage, combined in standard commercial general liability (CGL) policies with personal injury (PI) coverage that insures the following offenses in connection with the insured’s advertising of its goods or services: libel, slander, invasion of privacy, copyright infringement, and misappropriation of advertising ideas.

Aggregate

(1) A limit in an insurance policy stipulating the most it will pay for all covered losses sustained during a specified period of time, usually a year. Aggregate limits are commonly included in liability policies. While not often used in property insurance, aggregates are sometimes included with respect to certain catastrophic exposures—for example, earthquake and flood. (2) The dollar amount of reinsurance coverage during one specified period, usually 12 months, for all reinsurance losses sustained under a treaty during such period.

Agreed Amount

A commercial property insurance provision that suspends the coinsurance clause until a specified expiration date. Insurers usually require a statement of property values signed by the insured as a condition of activating or including an agreed value provision in a commercial property policy. Previously referred to as an agreed amount clause.

Audit

A survey of the financial records of a person or organization conducted annually (in most cases) to determine exposures, limits, premiums, etc.

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.

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.

Bodily Injury (BI)

Liability insurance term that includes bodily harm, sickness, or disease, including resulting death.

Business Income

Insurance covering loss of income suffered by a business when damage to its premises by a covered cause of loss causes a slowdown or suspension of its operations during the time required to repair or replace the damaged property. There are two Insurance Services Office, Inc. (ISO), business income coverage forms: the business income and extra expense coverage form (CP 00 30) or the business income coverage form without extra expense (CP 00 32). Previously referred to as business interruption coverage.

Cancellation

(1) The termination of an insurance policy or bond, before its expiration, by either the insured or the insurer. Insurance policy cancellation provisions require insurers to notify insureds in advance (usually 30 days) of canceling a policy and stipulate the manner in which any unearned premium will be returned. (2) Runoff basis means that the liability of a reinsurer under policies, which became effective under a treaty prior to the cancellation date of such treaty, shall continue until the expiration date of each policy. (3) Cutoff basis means that the liability of a reinsurer under policies, which became effective under the treaty, prior to the cancellation date of such treaty, shall cease with respect to losses resulting from accidents taking place on and after said cancellation date.

Care, Custody & 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. Coverage for this exposure is available under other, more specific forms of insurance, such as motor truck cargo and garage keepers insurance. 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.

Certificate Holder

An entity that is provided with an insurance certificate as evidence of the insurance maintained by another entity.

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.

Coinsurance

A property insurance provision that penalizes the insured’s loss recovery if the limit of insurance purchased by the insured is not at least equal to a specified percentage (commonly 80 percent) of the value of the insured property. A business income coverage coinsurance provision penalizes the insured’s loss recovery if the business income limit of insurance is not at least equal to a specified percentage of the business income that would have been earned during the 12-month policy period. The coinsurance provision specifies that the insured will recover no more than the following: the amount of the loss multiplied by the ratio of the amount of insurance purchased (the limit of insurance) to the amount of insurance required (the value of the property on the date of loss multiplied by the coinsurance percentage), less the deductible.

Collision Insurance

A form of automobile insurance that provides for reimbursement for loss to a covered automobile due to its colliding with another vehicle or object or the overturn of the automobile. This covers only damage to the automobile itself as “auto” is defined in the policy.

Comprehensive Insurance

Coverage under an automobile physical damage policy insuring against loss or damage resulting from any cause, except those specifically precluded. It covers losses such as fire, theft, windstorm, flood, and vandalism, but not loss by collision or upset.

Cyberspace Liability

A term used to describe the liability exposures encountered when communicating or conducting business online. Potential liabilities include the Internet and e-mail. Online communication tools could result in claims alleging breaches of privacy rights, infringement or misappropriation of intellectual property, employment discrimination, violations of obscenity laws, the spreading of computer viruses, and defamation. Media liability policies are available to cover these exposures.

Damage to Premises Rented by You

One of the limits of liability prescribed by the standard commercial general liability (CGL) policy; it applies to damage by fire to premises rented to the insured and to damage regardless of cause to premises (including contents) occupied by the insured for 7 days or less. The basic limit is $100,000.

Deductible

An amount the insurer will deduct from the loss before paying up to its policy limits. Most property insurance policies contain a per-occurrence deductible provision that stipulates that the deductible amount specified in the policy declarations will be subtracted from each covered loss in determining the amount of the insured’s loss recovery. Usually, the amount of the deductible is not subtracted from policy limits.

Depreciation

The decrease in the value of property over a period of time, usually as result of age, wear and tear from use, or economic obsolescence. Actual physical depreciation (wear and tear from use) is subtracted from the replacement cost of insured property in determining its actual cash value (ACV); courts in some jurisdictions have allowed insurers to deduct depreciation due to economic obsolescence as well.

Endorsement

An insurance policy form that either changes or adds to the provisions included in one or more other forms used to construct the policy, such as the declarations page or the coverage form. Insurance policy endorsements may serve any number of functions, including broadening the scope of coverage, limiting or restricting the scope of coverage, clarifying the application of coverage to some unique loss exposure, adding other parties as insureds, or adding locations to the policy. They often effect these changes by modifying the existing insuring agreement, policy definitions, exclusions, or conditions in the coverage form or adding additional information, such as insured locations, to the declarations page.

Expense Constant

A fixed, flat expense charge applied to every workers compensation policy in states using advisory rates. The charge applies in addition to the premium developed for that policy and recognizes that some of the administrative costs associated with writing a workers compensation policy do not vary with the amount of premium and should, therefore, not be included in the factors that are used to develop rates.

Extra Expense Coverage

Time element property insurance that pays for expenses in excess of normal operating expenses that an organization incurs to continue operations while its property is being repaired or replaced after having been damaged by a covered cause of loss. Extra expense coverage can be purchased in addition to or instead of business income coverage, depending on the needs of the organization.

Federal Emergency Management Agency (FEMA)

An agency of the U.S. Department of Homeland Security that provides a single point of accountability for all federal emergency preparedness, mitigation, and response activities. FEMA’s primary purpose is to coordinate the response to a disaster that overwhelms the resources of state and local governments. It works closely with these governmental bodies by funding emergency programs and offering technical guidance and training. In addition, FEMA administers the National Flood Insurance Program (NFIP) and advises communities on building codes, emergency response, and floodplain management.

Garage Liability Insurance

Insurance covering the legal liability of franchised and non-franchised automobile, truck, truck-tractor, motorcycle, recreational vehicle, and trailer dealers for claims of bodily injury (BI) and property damage (PD) arising out of business operations. It includes two separate insuring agreements, “who is an insured” provisions, and “limit of insurance” provisions—one dealing with garage operations involving the ownership, maintenance, or use of autos and the other dealing with all other garage operations.

General Aggregate Limit

The maximum limit of insurance payable during any given annual policy period for all losses other than those arising from specified exposures. Under the standard commercial general liability (CGL) policy, the general aggregate limit applies to all covered bodily injury (BI) and property damage (PD) (except for injury or damage arising out of the products-completed operations hazard) and all covered personal and advertising injury. When paid losses in these categories reach the specified aggregate limit, that limit is exhausted and no more losses in any of those categories will be paid under the policy. In other words, once the general aggregate limit is paid out, the only coverage remaining under the policy will be for products-completed operations claims—which are paid out of a separate aggregate.

Hired Automobile

Term used (“hired autos”) in the Insurance Services Office, Inc. (ISO), business auto, garage, and motor carrier coverage forms to denote a particular type of auto included as a covered auto under the policy. With certain exceptions, the term refers to autos the named insured leases, hires, rents, or borrows. As respects both the business auto and the garage policy, the term does not include any auto the named insured leases, hires, rents, or borrows from any of its employees, partners, limited liability members, or members of their households. As respects the motor carrier, the exception applies as respects private passenger type autos only.

Hold Harmless Agreement

A provision in a contract that requires one contracting party to respond to certain legal liabilities of the other party. For example, construction contracts typically require the contractor to indemnify the owner with respect to the owner’s liability to members of the public who are injured or whose property is damaged during the course of the contractor’s operations. There are a number of types of hold harmless clauses, differentiated by the extent of the liabilities they transfer. The most commonly used types of clauses are the “broad,” “intermediate,” and “limited” form hold harmless clauses.
Limited form—Where Party A holds Party B harmless for suits arising out of Party A’s sole negligence. Party B is thus protected when it is held vicariously responsible for the actions of Party A.
Intermediate form—Where Party A holds Party B harmless for suits alleging sole negligence of Party A or negligence of both parties.
Broad form—Where Party A holds Party B harmless for suits against Party B based on the sole negligence of A, joint negligence of A and B, or the sole negligence of B. Broad form hold harmless agreements are unenforceable in a number of states.

Host Liquor Liability

Liability for bodily injury (BI) or property damage (PD) arising out of the serving or distribution of alcoholic beverages by a party not engaged in this activity as a business enterprise. Host liquor liability exposures are insurable under standard general liability policies.

Identity Theft Coverage

Optional endorsement available under the homeowners policy to insure a criminal event in which an imposter obtains key pieces of personal information, such as Social Security or driver’s license numbers, in order to impersonate the insured. The information can be used to obtain credit, merchandise, and services in the name of the victim, or to provide the thief with false credentials. This endorsement provides first-party coverage for expenses incurred by an insured as a direct result of any one identity theft first discovered during the policy period.

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.

License & Permit Bond

Required by a municipality or other public body as a condition to granting a license or permit to engage in a specified activity, this bond guarantees that the party seeking the license or permit (the obligor) will comply with applicable laws or regulations. These bonds can also be structured to provide indemnity guarantees to third parties who sustain injury or damage as a result of the obligor’s activities as described in the license or permit when such a guarantee is required. For example, businesses that hang signs over public sidewalks may be required to provide indemnity guarantees for injuries to pedestrians.

Loss of Income Coverage

A type of business interruption coverage that does not include a coinsurance clause but limits recovery to loss incurred during a specified period (typically 120 days) after the direct damage loss. Approximated by the “maximum period of indemnity coverage option” of the Insurance Services Office, Inc. (ISO), business income coverage forms.

Lost Policy Release

A statement signed by the named insured releasing the insurer from all liability under a lost or mislaid contract of insurance in cases in which the insured wishes to cancel the policy. At one time, many insurance policies required that the original policy be returned to the insurer to effect cancellation, and a lost policy release served in place of the original policy.

Medical Payments (Auto)

Optional coverage under an auto policy to pay for medical expenses for an insured who sustains bodily injury (BI) caused by an auto accident, without regard to fault. Coverage for persons other than the named insured and his or her family members is typically restricted to circumstances when they are occupants of the insured auto.

Medical Payments (GL)

A general liability coverage that reimburses others, without regard to the insured’s liability, for medical or funeral expenses incurred by such persons as a result of bodily injury (BI) or death sustained by accident under the conditions specified in the policy.

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.

Mobile Equipment

A term that is defined in both the commercial general liability (CGL) and commercial auto policies. It refers to equipment such as earthmovers, tractors, diggers, farm machinery, forklifts, etc., that, even when self-propelled, are not considered automobiles for insurance purposes (unless they are subject to a compulsory or financial responsibility law or other motor vehicle insurance law). Liability arising from mobile equipment is covered in the general liability policy. Physical damage coverage is usually provided by an “equipment floater.”

Non-owned Automobile

Described in commercial auto policies as an auto that is used in connection with the named insured’s business but that is not owned, leased, hired, rented, or borrowed by the named insured. As used in the business auto policy (BAP), the term specifically applies to vehicles owned by employees and used for company business; as used in the truckers and motor carrier policies, it applies only if such autos are private passenger type autos. (Autos other than private passenger type owned by employees are classified as hired autos in the truckers and motor carrier policies.)

Occurrence

In a commercial general liability (CGL) coverage form, an accident, including continuous or repeated exposure to substantially the same general harmful conditions. General liability policies insure liability for bodily injury (BI) or property damage (PD) that is caused by an occurrence. This is also a common homeowners provision.

Ordinance or Law

Coverage for loss caused by enforcement of ordinances or laws regulating construction and repair of damaged buildings. Older structures that are damaged may need upgraded electrical; heating, ventilating, and air-conditioning (HVAC); and plumbing units based on city codes. Many communities have a building ordinance(s) requiring that a building that has been damaged to a specified extent (typically 50 percent) must be demolished and rebuilt in accordance with current building codes rather than simply repaired. Unendorsed, standard commercial property insurance forms do not cover the loss of the undamaged portion of the building, the cost of demolishing that undamaged portion of the building, or the increased cost of rebuilding the entire structure in accordance with current building codes. However, coverage for these loss exposures is widely available by endorsement. Standard homeowners policies include a provision granting a limited amount of building ordinance coverage; this amount can be increased by endorsement.

Owners Contractor Protective Liability Coverage (OCP)

A stand-alone policy that covers the named insured’s liability for bodily injury (BI) and property damage (PD) caused, in whole or in part, by an independent contractor’s work for the insured. The contractor purchases the policy to provide coverage for vicarious liability the client (project owner) incurs as a result of the contractor’s acts or omissions on the project. The OCP policy also responds to liability arising out of the insured’s own acts or omissions in connection with its general supervision of the contractor’s operations.

Personal Article Floater

A personal lines inland marine policy that is used to cover scheduled personal property on an all risks basis. The policy is particularly appropriate for property that receives limited coverage under the homeowners forms, such as furs, jewelry, fine arts, silverware, cameras, musical instruments, stamp and coin collections, and similar property. Standard forms have been developed by both Insurance Services Office, Inc. (ISO), and American Association of Insurance Services, Inc. (AAIS). Coverage is also sometimes afforded in homeowners policies by endorsement.

Personal Injury Protection (PIP)

A type of auto insurance coverage mandated by statute in some jurisdictions. The statutes typically require insurers to provide or offer to provide first-party benefits for medical expenses, loss of income, funeral expenses, and similar expenses without regard to fault. Coverages, limits, and each party’s responsibilities vary from state to state, as provided by law.

Pollution

The contamination of an environment by substances regarded as pollutants. Liability from pollution is normally excluded to some degree by the general, auto, and umbrella liability policies. In recent years, insurers have attempted to introduce strict exclusionary language into these policies, making it necessary for insureds to seek coverage under separate “environmental impairment liability” policies.

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.

Property Damage

As defined in the general liability policy, physical injury to tangible property including resulting loss of use and loss of use of tangible property that has not been physically injured. Also addressed in the homeowners and personal auto policies.

Replacement Cost Coverage

A property insurance term that refers to one of the two valuation methods for establishing the value of most of the insured property for purposes of determining the amount the insurer will pay in the event of loss. It is usually defined in the policy as the cost to replace the damaged property with materials of like kind and quality, without any deduction for depreciation.

Reserve

An amount of money earmarked for a specific purpose. Insurers establish unearned premium reserves and loss reserves indicated on their balance sheets. Unearned premium reserves show the aggregate amount of premiums that would be returned to policyholders if all policies were canceled on the date the balance sheet was prepared. Loss reserves are estimates of outstanding losses, loss adjustment expenses (LAEs), and other related items. Self-insured organizations also maintain loss reserves.

Retention

(1) Assumption of risk of loss by means of noninsurance, self-insurance, or deductibles. Retention can be intentional or, when exposures are not identified, unintentional. (2) In reinsurance, the net amount of risk the ceding company keeps for its own account.

Rider

A form that is attached to a surety or fidelity bond that alters the provisions of the bond form in some manner. A rider is the surety and fidelity equivalent of an insurance policy endorsement, and though not common, insurance endorsements are sometimes called riders.

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.

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.

Subrogation

The assignment to an insurer by terms of the policy or by law, after payment of a loss, of the rights of the insured to recover the amount of the loss from one legally liable for it.

Subrogation Waiver

An agreement between two parties in which one party agrees to waive subrogation rights against another in the event of a loss. Generally, insurance policies do not bar coverage if an insured waives subrogation against a third party before a loss. However, coverage is excluded from many policies if subrogation is waived after a loss because to do so would violate the principle of indemnity.

Terrorism Coverage

Insurance covering loss due to acts of terrorism. Unless endorsed to exclude loss due to terrorism, commercial insurance policies issued in the United States (for example, commercial property policies, commercial general liability (CGL) policies, and commercial auto policies) generally provide terrorism insurance coverage. Terrorism insurance also may be written on a stand-alone terrorism policy.

Theft, Disappearance and Destruction of Money and Securities Coverage form C- Insurance Services Office, Inc. (ISO), crime form (CR 00 04)

Insures against loss by theft, disappearance, or destruction of the insured’s money and securities inside the insured’s premises (or insured’s bank’s premises) as well as outside the insured’s premises while in the custody of a messenger.

Third Party Liability Coverage

In general, any type of insurance covering the legal liability of one party to another party. For example, commercial general, business auto, and errors and omissions (E&O) liability policies all provide third-party liability coverage. In the context of employment practices liability (EPL) insurance, a so-called third-party liability coverage option is sometimes available to address claims made by nonemployees (e.g., customers, vendors, clients) against the insured company that arise from acts committed by employees. Most often, third-party claims allege some form of either discrimination or harassment. The majority of EPL policies do not explicitly cover third-party claims, although most insurers will provide such coverage by endorsement.

Time Element Loss

Loss resulting from inability to use a property. Examples are business interruption, extra expense, rental income, etc.

Trip Transit Insurance

Insurance written to cover a specific individual shipment, as distinguished from transit insurance written to cover any and all shipments that may occur during the policy term.

Uninsured Motorist Coverage (UM)

Coverage for bodily injury (BI) and, in some states, property damage (PD) incurred by an insured when an accident is caused by a motorist who is not insured. This coverage allows an insured to collect from his or her insurer as if it provided liability coverage for the negligent third party.

Waiver of Subrogation

The relinquishment by an insurer of the right to collect from another party for damages paid on behalf of the insured. The waiver of subrogation condition in current standard policies is referred to as “transfer of rights of recovery”.