Claims Advice Glossary

Carrier
A party to the contract of insurance who assumes responsibility to indemnify in the event of covered losses; an insurance company.

Claim
A demand for payment made by the insured for payment of benefits as a result of a covered loss.

Claimant
A party that makes a claim.  Typically a claimant is an adverse party, or a third party.

Coverage
A specific scope of protection defined by an insurance policy.

Coverage Investigation
A process where an insurance adjuster analyzes the facts of an insurance claim to determine if that claim qualifies for coverage under the terms of the insurance policy.

Coverage-Liability-Damages
Three basic elements which must be considered in the investigation of liability claims.

Declarations Page
Specifies the name of the insurance carrier and the insured, coverages, policy limits, the premium amount, the risk and property covered, deductibles, and policy period.

Denial
A decision made by an insurance company to deny benefits.  Claim denials must be based on legitimate claim investigations.

Exclusion
A specific condition listed in the policy for which the insurer will not provide benefits.

Indemnify
To make whole again from a condition prior to a loss.

Insured
A person or entity who, in exchange for premiums, will be compensated for a covered loss.  The term insured relates not only to the "named insured", but also to anyone who is listed as insured under the policy.  Referred to as the first party.

Insurer
A party to the contract of insurance who assumes responsibility to indemnify in the event of specified losses; an insurance company.

Loss
A decrease or loss of value of an insured property; an amount sought in an insurance claim as a result of injury or damage.

Policyholder
The owner of an insurance policy.

Policy of Insurance
A contract between an insured and an insurer.  This contract defines the duties of the insured and the obligations of the insurer.  It defines all coverage, conditions of coverage and exclusions.  It is the basis upon which all further activity is based.

Policy Limits
The maximum amount of coverage purchased by an insured for a specific peril; the maximum amount the insurance company will pay for a covered loss.

Premium
An established price for insurance protection paid to an insurance company for specified risks during a specific period of time.

Rescission
A termination of the policy by the insurance company from the beginning of the policy, "as if it never existed".  A carrier can rescind the policy if it can prove misrepresentation on the part of the insured.

Reserves
Sums of actual or potential liabilities established and maintained by an insurer to cover claims payments.

Risk
Represents a danger of exposure to a particular event or set of events.  In exchange for premiums, the insurer assumes risk from the insured and agrees to indemnify the insured in the event of covered loss.

SIU
Special Investigations Unit.  A squad of insurance investigators whose primary purpose is to investigate suspected insurance fraud.

Whole Again
Basic indemnification, i.e., the requirement to bring the claimant or insured to the same state he enjoyed prior to his loss.  Not "better than".