Glossary of Insurance Terms
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- Absolute Liability:
Liability for damages even though fault or
negligence cannot be proven.
- Accident: An event or
occurrence which is unforeseen and
unintended.
- Accident and Health Insurance: A
type of coverage that pays
benefits, sometimes including
reimbursement for loss of income, in case of
sickness, accidental injury, or accidental
death.
- Accident Insurance: A form of
health insurance against loss by accidental
bodily injury.
- Accidental Bodily Injury: Injury to
the body as the result of an accident.
- Accidental Death Benefit: A benefit
in addition to the face amount of a life
insurance policy, payable if the insured dies
as the result of an accident. Sometimes
referred to as
double indemnity.
- Accounting: The process of
recording, summarizing, and allocating all
items of income and expense of the company and
analyzing, verifying, and reporting the
results.
- Accumulation period: (1) The time
between the first premium payment and the
first benefit payout under a deferred annuity;
(2) A specified period of time, such as 90
days, during which the insured person must
incur eligible medical expenses at least equal
to the deductible amount in order to establish
a benefit period under a
major medical expense or
comprehensive medical expense policy.
- Accumulation units: The mechanism
used to account for the insured's
deposits in a variable annuity contract
during the premium paying period. The number
of units purchased depends upon the current
valuation of a unit in dollars.
- Acquisition Costs: The insurer's
cost of putting new business in force,
including the agent's commission, the cost of
clerical work, fees for medical examinations
and inspection reports, sales promotion
expense, etc.
- Activities of Daily Living: A list
of activities, normally including mobility,
dressing, bathing, toileting, transferring,
and eating which are used to assess degree of
impairment and determine eligibility for some
types of insurance benefits.
- Acts of War, Confiscation, Detainment,
Revolution (Free of Capture, Seizure Clause):
Exclusion in most marine cargo policies, which
states that coverage is not provided when due
to capture, seizure, arrest, detainment,
confiscation, preemption, requisition or
nationalization, whether in time of peace or
war. This clause also excludes from coverage
loss due to hostilities or warlike operations
(including atom bombs), embargoes or other
interferences with the free flow of trade.
Coverage for these hazards can be obtained
through the
Cargo War Risk Policy.
- Actual Cash Value (ACV): The
replacement cost of property damaged or
destroyed at the time of loss, with deduction
for
depreciation. Actual cash value cannot
exceed the applicable limit of liability shown
in the declarations of the policy, nor the
amount it would cost to repair or replace such
property with material of like kind and
quality within a reasonable amount of time
after a loss.
- Actuarial Cost Method: One of
several systems for determining either the
contributions to be made under a retirement
plan, or level of benefits when the
contributions are fixed. In addition to
forecasts of
mortality, interest and expenses, some of
the methods involve estimates of future labor
turnover, salary scales and retirement rates.
- Actuarial Equivalent: If the
present values of two series of payments are
equal, taking into account a given interest
rate and
mortality according to a given table, the
two series are said to be actuarially
equivalent on this basis. For example, a
lifetime monthly benefit of $67.60 beginning
at age 60 (on a given set of actuarial
assumptions) can be said to be the actuarial
equivalent of $100 a month beginning at age
65. The actual benefit amounts are different
but the present value of the two benefits,
considering mortality and interest, is the
same.
- Actuarially Fair: The price for
insurance which exactly represents the
expected losses
- Actuary: A person professionally
trained in the technical aspects of
pensions,
insurance and related fields. The actuary
estimates how much money must be contributed
to an insurance or pension fund in order to
provide future benefits.
- Additional insured: An assured
party specifically named under an insurance
policy that is not automatically included as
an
insured under the policy of another, but
for whom the named insured's policy provides a
certain degree of protection. An
endorsement is typically required to
effect additional insured status. The 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., employees
or members of an insured club) or to comply
with a contractual agreement requiring the
named insured to do so (e.g., customers or
owners of property leased by the named
insured).
- Additional named insured: (1) An
individual or entity, other than the first
named insured, identified as an insured in the
policy
declarations or an addendum to the policy
declarations. (2) An individual or entity who
is added to a policy with the status of named
insured after the policy is written. Such an
individual or entity would have the same
rights and responsibilities as an individual
or entity named as an insured in the policy
declarations (other than those rights and
responsibilities reserved to the first named
insured). In this sense the term can be
contrasted with
additional insured, an individual or
entity added to a policy as an insured
but not as a named insured. The term
additional named insured has not acquired a
uniformly agreed-upon meaning within the
insurance industry, and use of the term in the
two different senses defined above often
produces confusion in requests for additional
insured status between contracting parties.
- Adhesion, Contract of: A contract
that is drafted by one party and accepted or
rejected by the other, with no opportunity to
bargain with respect to its terms.
- Adjustable Life Insurance: A type
of insurance that allows the
policyholder to change the plan of
insurance, raise or lower the face amount of
the policy, increase or decrease the premium
and lengthen or shorten the protection period.
- Adjusted gross estate:
Approximately the net worth of a deceased's
estate--the beginning point for the
computation of estate taxes. In addition to
the deceased's assets while alive, the value
will also generally include the proceeds of
life insurance.
- Adjuster: A person who investigates
and settles
losses for an insurance carrier.
- Adjusting: The process of
investigating and settling losses with or by
an insurance carrier.
- Adjustment Bureau: Organization for
adjusting insurance claims that is supported
by insurers using the bureau's services.
- Administrative Services Only (AS0)
Plan: An arrangement under which an
insurance carrier or an independent
organization will, for a fee, handle the
administration of claims, benefits and other
administrative functions for a self-insured
group.
- Advance Funding: Pension-funding
method in which the employer systematically
and periodically sets aside funds prior to the
employee's retirement.
- Advance Premium Mutual:
A mutual insurance company owned by the
policyowners that does not issue assessable
policies but charges premiums expected to be
sufficient to pay all claims and expenses.
- Adverse Selection: The tendency of
persons who present a poorer-than-average risk
to apply for, or continue, insurance to a
greater extent than do persons with average or
better-than-average expectations of loss.
- Advertising Injury: Injury rising
out of an offense committed in the course of
your advertising activities, if such injury
rises out of libel, slander, defamation,
violation of right of privacy, piracy, unfair
competition or infringement of copyright,
title or slogan.
- Age Limits: Stipulated minimum and
maximum ages below and above which the company
will not accept applications or may not renew
policies.
- Agent: An insurance company
representative licensed by the state who
solicits, negotiates or effects
contracts of insurance, and provides
service to the
policyholder for the
insurer.
- Aggregate Deductible: Deductible in
some property and health insurance contracts
in which all covered losses during a year are
added together and the insurer pays only when
the aggregate deductible amount is exceeded.
- Aggregate Indemnity: The maximum
dollar amount that may be collected for any
disability or period of disability under the
policy.
- Aggregate Limit: (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 one 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, e.g., 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 Endorsement: An
endorsement to a policy made by the insurance
company wherein it waives the coinsurance
clause on the specified property. As long as
this endorsement is in effect, there would be
no coinsurance penalty at the time of a claim.
By combining an Agreed Amount Endorsement with
a
Replacement Cost Endorsement you can
obtain an unusually high quality of insurance
coverage.
- AIDS: Acquired immune deficiency
syndrome. A fatal, incurable disease caused by
a virus that can damage the brain and destroy
the body's ability to fight off illness.
- Alien Insurer: An insurance company
domiciled in another country. Contrast
Foreign Insurer.
- Alienated Premises Exclusion: An
exclusion that eliminates coverage for
property damage liability to premises sold by
an entity. For example, a person owns a lot
and builds a house on it. After the house is
completed and sold, a subcontractor's faulty
wiring causes the house to burn. The buyer, or
his/her insurance company, sues for the cost
of repairing or rebuilding the house. There is
no coverage for this exposure under standard
liability policies.
- Allied Lines: A term for forms of
property insurance allied with
fire insurance, covering such perils as
windstorm, hail, explosion, and riot.
- Allocated Benefits: Benefits for
which the maximum amount payable for specific
services is itemized in the contract.
- All-risks Policy: Coverage by an
insurance contract that promises to cover all
losses except those losses specifically
excluded in the policy. To be covered for
damage or loss under a "basic " contract, the
damage or loss must be caused by a peril that
is "named" or listed in the contract.
Consequently, if damage or loss is caused by a
peril that is not named, there is no coverage.
In an all-risk policy, coverage is provided
unless specifically excluded. The contract's
exclusions must be considered in determining
coverage. See also
Named Perils and
Special Risk Insurance.
- Alternate Delivery Systems: Health
services provided in other than an in-patient,
acute-care hospital. Examples include skilled
and intermediary nursing facilities, hospice
programs, and home health care. Alternate
delivery systems are designed to provide
needed services in a more cost-effective
manner.
- Ambulatory Care: Medical services
that are provided on an outpatient (non-hospitalized)
basis. Services may include diagnosis,
treatment, and rehabilitation.
- Amendment: A formal document
changing the provisions of an insurance policy
signed jointly by the insurance company
officer and the policy holder or his
authorized representative.
- Amortization: Paying an
interest-bearing liability by gradual
reduction through a series of installments, as
opposed to one lump-sum payment.
- Annual Statement: The annual
report, as of December 31, of an insurer to a
state insurance department, showing assets and
liabilities, receipts and disbursements, and
other financial data, presented according to
Statutory Accounting Principles.
- Annuitant: The person during whose
life an annuity is payable, usually the person
to receive the annuity.
- Annuity: A contract that provides
an income for a specified period of time, such
as a number of years or for life.
- Annuity Certain: A contract that
provides an income for a specified number of
years, regardless of life or death.
- Annuity Consideration: The payment,
or one of the regular periodic payments, an
annuitant makes for an annuity.
- Antiselection: The tendency of
persons who present a poorer-than-average risk
to apply for, or continue, insurance to a
greater extent than do persons with average or
better-than-average expectations of loss.
- Application: A signed statement of
facts made by a person applying for life
insurance and then used by the insurance
company to decide whether or not to issue a
policy. The application becomes part of the
insurance contract when the policy is issued.
- Arbitration: A form of alternative
dispute resolution where an unbiased person or
panel renders an opinion as to responsibility
for or extent of a loss.
- Arson: The willful and malicious
burning of, or attempt to burn, any structure
or other property, often with criminal or
fraudulent intent.
- Assailing Thieves: Hazard generally
covered under a marine cargo policy, which
includes loss due to thievery when accompanied
by violence, but does not include petty
thievery.
- Assessment Association: An
insurer that does not charge a fixed
premium for insurance, but rather assesses its
members periodically to pay its losses.
Assessment insurers usually collect an advance
premium which is estimated to cover losses and
expenses, but reserve the right to make
additional assessments whenever the premium
collected is insufficient.
- Assessment Mutual: Mutual insurance
company that has the right to assess
policyowners for losses and expenses.
- Assets: All funds, property, goods,
securities, rights of action, or resources of
any kind owned by an insurance company.
Statutory accounting, however, excludes
non-admitted assets, such as deferred or
overdue premiums, that would be considered
assets under
generally accepted accounting principles (GAAP).
- Assigned Risk: See
Automobile Insurance Plan.
- Assignment: The legal transfer of
one person's interest in an insurance policy
to another person.
- Association Captive: Type of
captive insurer owned by members of a
sponsoring organization or group, such as a
trade association.
- Association Group: A group formed
from members of a trade or a professional
association for group insurance under one
master health insurance contract.
- Association Group Plan: Health
insurance plans designed for members of a
professional association or trade association.
Members may be protected under a group health
insurance policy or by individual franchise
policies.
- Assumption of Risk Doctrine:
Defense against a negligence claim that bars
recovery for damages if a person understands
and recognizes the danger inherent in a
particular activity or occupation.
- Assumptions: Conditions and rules
underlying the calculation of a pension
benefit, including expected interest,
mortality and turnover.
- Assurance: See
Insurance.
- Attractive Nuisance: Condition that
can attract and injure children. Owners or
occupants of land on which such a condition
exists are
liable for injuries to children.
- Audit, Insurance: Sometimes factors
that enter into determining appropriate
premiums for insurance coverage can't be known
in advance; therefore, accurate premiums for
the coverage provided can't be billed by the
insurance carrier. This often is true in the
case of
Worker's Compensation and
Product Liability insurance, where such
things as payroll and sales can't be
determined ahead of time. An audit serves as
an examination of the insured's records after
the fact to adjust the initial premium billed
to reflect the actual coverage.
- Automatic Premium Loan: Cash
borrowed from a life insurance policy's cash value
to pay an overdue premium after the grace
period for paying the premium has expired.
- Automatic Reinsurance: An agreement
that the insurer must cede and the reinsurer
must accept all risks within certain
explicitly defined limits. The reinsurer
undertakes in advance to grant reinsurance to
the extent specified in the agreement in every
case where the ceding company accepts the
application and retains its own limit. See
also,
Treaty Reinsurance.
- Automobile Insurance Plan: One of
several types of shared market mechanisms
where persons who are unable to obtain such
insurance in the voluntary market are assigned
to a particular company, usually at a higher
rate than the voluntary market. Formerly
called Assigned Risk. Compare
Automobile Reinsurance Facility,
Residual Market.
- Automobile Liability Insurance:
Coverage designed to provide protection for
the insured against financial loss because of
legal liability for car-related injuries to
others or damage to their property.
- Automobile Physical Damage Insurance:
Coverage to pay for damage to or loss of
an insured automobile resulting from
collision, fire, theft, or other
perils.
- Automobile Reinsurance Facility:
One of several types of shared market
mechanisms used to make automobile insurance
available to persons who are unable to obtain
such insurance in the regular market.
- Automobile Shared Market: A program
in which all automobile insurers in each state
and the District of Columbia participate to
make coverage available to car owners who are
unable to obtain auto insurance in the
voluntary market. Except in Maryland, which
operates a state-funded mechanism whose losses
are subsidized by private insurers, each state
uses one of three systems (an automobile
insurance plan, a joint underwriting
association, or a reinsurance facility) to
guarantee the availability of automobile
insurance.
- Aviation Insurance: Aircraft
insurance including coverage of aircraft or
their contents, the owner's liability, and
accident insurance on the passengers.
- Average Indexed Monthly Earnings (AIME):
Under the OASDI program, the person's actual
earnings are indexed to determine his or her
primary insurance amount (PIA).
- Avoidance: see
Loss Avoidance.
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