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Insurance 101
GLOSSARY OF TERMS
ACTUAL CASH VALUE
An amount equivalent to the fair market value of the stolen or damaged property immediately preceding the loss. For real property, this amount can be based on a determination of the fair market value of the property before and after the loss. For vehicles, this amount can be determined by local area private party sales and dealer quotations for comparable vehicles.
ADMITTED COMPANY
An insurance company authorized to do business in California.
AGENT
A licensed person or organization authorized to sell insurance by or on behalf of an insurance company.
AIRCRAFT INSURANCE
Coverage for the insured in the event that the insured's negligent acts and/or omissions result in losses in connection with the use, ownership, or maintenance of aircraft.
AUTOMOBILE INSURANCE
Coverage on the risks associated with driving or owning an automobile. It can include collision, liability, comprehensive, medical, and uninsured motorist coverages.
BINDER
A temporary or preliminary agreement which provides coverage until a policy can be written or delivered.
BODILY INJURY
Any physical injury to a person. The purpose of liability insurance is to cover bodily injury to a third party resulting from the negligent or intentional acts of an insured.
BOILER AND MACHINERY INSURANCE
Covers losses resulting from the malfunction of boilers and machinery. This coverage is usually excluded from property insurance creating the need for this separate product.
BROKER
A licensed person or organization paid by you to look for insurance on your behalf.
BURGLARY
Coverage against loss as a result of forced entry into premises.
CANCELLATION
The termination of insurance coverage during the policy period. Flat cancellation is the cancellation of a policy as of its effective date, without any premium charge.
CLAIM
Notice to an insurer that under the terms of a policy, a loss maybe covered.
CLAIMANT
The first or third party. That is any person who asserts right of recovery.
COLLISION (AUTO)
Reimburses you for damage to YOUR automobile sustained in a collision with another car or with any other object, movable or fixed, (for example, you accidentally backed into another object while pulling out from a parking stall and causing damage to the bumper and fender of your covered automobile).
COLLISION DEDUCTIVE WAIVER
This coverage waves your collision deductible if you are hit by a negligent uninsured motorist. COMMON CARRIER LIABILITY Coverage for transportation firms that must carry any customer's goods so long as the customer is willing to pay. Examples include trucking companies, bus lines, and airlines.
COMPREHENSIVE (AUTO)
Provides coverage for any direct and accidental loss of, or damage to, YOUR covered automobile and its normal equipment, to include but not limited to fire, theft or malicious mischief.
COMPREHENSIVE GLASS INSURANCE
Coverage on an "all risks" basis for glass breakage, subject to exclusions of war and fire.
CREDIT LIFE INSURANCE
Insurance issued to a creditor (lender) to cover the life of a debtor (borrower) for an outstanding loan.
DECLINE
The company refuses to accept the request for insurance coverage.
DEDUCTIBLE
The amount of the loss which the insured is responsible to pay before benefits from the insurance company are payable. You may choose a higher deductible to lower your premium.
DEPRECIATION
A decrease in value due to age, wear and tear, etc.
DISABILITY INSURANCE
Health insurance that provides income payments to the insured wage earner when income is interrupted or terminated because of illness, sickness, or accident.
ENDORSEMENT
Amendment to the policy used to add or delete coverage. Also referred to as a "rider."
EXCLUSION
Certain causes and conditions, listed in the policy, which are not covered.
EXPIRATION DATE
The date on which the policy ends.
FACE AMOUNT
The dollar amount to be paid to the beneficiary when the insured dies. It does not include other amounts that may be paid from insurance purchased with dividends or any policy riders.
FINANCIAL GUARANTEE INSURANCE
A surety bond, insurance policy or, when issued by an insurer, an indemnity contract and any guaranty similar to the foregoing types, under which loss is payable upon proof of occurrence of financial loss to an insured claimant, obligee, or indemnitee.
FIRE INSURANCE
Coverage for loss of or damage to a building and/or contents due to fire.
GOOD DRIVER DISCOUNT
To be eligible for the Good Drivers Discount all operators of the insured vehicles must have been licensed for three or more year, have no more than a one (1) point charge on their driving record and has not been determined "at fault" in an accident resulting in bodily injury or death to any person.
GRACE PERIOD
A period (usually 31 days) after the premium due date, during which an overdue premium may be paid without penalty. The policy remains in force throughout this period.
GUARANTEED INSURABILITY
An option that permits the policy holder to buy additional stated amounts of life insurance at stated times in the future without evidence of insurability.
HEALTH INSURANCE
A policy that will pay specifies sums for medical expenses or treatments. Health policies can offer many options and vary in their approaches to coverage.
HOMEOWNER INSURANCE
An elective combination of coverages for the risks of owning a home. Can include losses due to fire, burglary, vandalism, earthquake, and other perils.
INCONTESTABLE CLAUSE
A policy provision in which the company agrees not to contest the validity of the contract after it has been in force for a certain period of time, usually two years.
INSURED
The policyholder - the person(s) protected in case of a loss or claim.
INSURER
The insurance company.
LEGAL INSURANCE
Prepaid legal insurance coverage plan sold on a group basis.
LIABILITY (AUTO)
This coverage will pay for BODILY INJURY and/or PROPERTY DAMAGE to the OTHER party for which you become legally responsible of an automobile accident.
LIABILITY INSURANCE
Coverage for all sums that the insured becomes legally obligated to pay because of bodily injury or property damage, and sometimes other wrongs, to which an insurance policy applies.
LIFE INSURANCE
A policy that will pay a specified sum to beneficiaries upon the death of the insured.
LIMIT
Maximum amount a policy will pay either overall or under a particular coverage.
LOAN VALUE
The amount which can be borrowed at a specified rate of interest from the issuing company by the policyholder, using the value of the policy as collateral. In the event the policyholder dies with the debt partially or fully unpaid, then the amount borrowed plus any interest is deducted from the amount payable.
MARINE INSURANCE
Coverage for goods in transit and the vehicles of transportation on waterways, land, and air.
MATERIAL MISREPRESENTATION
The policyholder / applicant makes a false statement of any material (important) fact on his/her application. For instance, the policyholder provides false information regarding the location where the vehicle is garaged.
MEDICAL PAYMENTS
Will pay reasonable expenses incurred for necessary medical and /or funeral services because of bodily injury caused by accident and sustained by YOU OR ANY OTHER PERSON WHILE OCCUPYING A COVERED AUTOMOBILE.
MORTGAGE INSURANCE
Life insurance that pays the balance of a mortgage if the mortgagor (insured) dies.
PERIL
The cause of a possible loss. For example, fire, theft, or hail.
POLICY
The written contract of insurance.
POLICY LIMIT
The maximum amount a policy will pay, either overall or under a particular coverage.
PREMIUM
The amount of money an insurance company charges for insurance coverage.
PREMIUM FINANCING
A policyholder contracts with a lender to pay the insurance premium on his/her behalf. The policyholder agrees to repay the lender for the cost of the premium, plus interest and fees.
PRO-RATA CANCELLATION
When the policy is terminated midterm by the insurance company, the earned premium is calculated only for the period coverage was provided. For example: an annual policy with premium of $1,000 is cancelled after 40 days of coverage at the company's election. The earned premium would be calculated as follows: 40/365 days X $1,000=.110 X $1,000=$110.
PROPERTY DAMAGE
Damage to another person's property. The purpose of liability insurance is to cover property damage to a third party resulting from the negligent or intentional acts of an insured.
QUOTE
An estimate of the cost of insurance, based on information supplied to the insurance company by the applicant.
REPLACEMENT COST
The cost to repair or replace an insured item. Some insurance only pays the actual cash or market value of the item at the time of the loss, not what it would cost to fix or replace it. If you have personal property replacement cost coverage, your insurance will pay the full cost to repair an item or buy a new one once the repairs or purchases have been made.
REPLACEMENT VALUE
The full cost to repair or replace the damaged property with no deduction for depreciation, subject to policy limits and contract provisions.
REINSTATEMENT
The restoring of a lapsed policy to full force and effect. The reinstatement may be effective after the cancellation date, creating a lapse of coverage. Some companies require evidence of insurability and payment of past due premiums plus interest.
RIDER
Usually known as an endorsement, a rider is an amendment to the policy used to add or delete coverage.
SHORT-RATE CANCELLATION
When the policy is terminated prior to the expiration date at the policyholder's request. Earned premium charged would be more than the pro-rata earned premium. Generally, the return premium would be approximately 90 percent of the pro-rata return premium. However, the company may also establish its own short-rate schedule.
SOLICITOR
A licensed employee of a fire and casualty agent or broker who may act for the agent or broker in some circumstances.
SPRINKLER INSURANCE
Coverage for property damage caused by untimely discharge from an automatic sprinkler system.
SURCHARGE
An extra charge applied by the insurer. For automobile insurance, a surcharge is usually for accidents or moving violations.
SURRENDER
To terminate or cancel a life insurance policy before the maturity date. In the case of a cash value policy, the policyholder may exercise one of the nonforfeiture options at the time of surrender.
TEAM AND VEHICLE INSURANCE
Includes insurance against loss through damage or legal liability for damage, to property caused by the use of teams or vehicles other than ships, boats, or railroad rolling stock, whether by accident or collision or by explosion of engine, tank, boiler, pipe, or tire of the vehicle, and insurance against the theft of the whole or part of such vehicle (California Insurance Code ?115).
TITLE INSURANCE
Coverage for losses if a land title is not free and clear of defects that were unknown when the title insurance was written.
UNDERWRITING
The process of selecting applicants for insurance and classifying them according to their degrees of insurability so that the appropriate premium rates may be charged. The process includes rejection of unacceptable risks.
UNINSURED MOTORIST BODILY INJURY
Will pay you and your passengers for BODILY INJURY cause by a negligent uninsured motorist, a hit-and-run driver, or by a driver whose insurer is insolvent.
UNINSURED MOTORIST PROPERTY DAMAGE
Will pay for damages to your automobile, set up to a limit, when caused by a negligent uninsured motorist.
WORKERS COMPENSATION INSURANCE
Coverage providing four types of benefits (medical care, death, disability, and rehabilitation) for employee job-related injuries or diseases as a matter of right (without regard to fault).
Disclaimer:
1. The informational sheet is for informational purposes only.
2. The actual terms of an insurance policy prevail over the information provided in the informational sheet.
3. In the case of a dispute, the insurance policy is controlling and a court will rely on the policy as it is written in English to resolve the dispute.
4. The policy is the sole source of rights and obligations of the insurer and the insured.
5. The information contained in the informational sheets does not create rights or obligations on the part of the insured, the insurer, the agent, the broker, or the state.
6. The informational sheet is not intended to be a substitute for the actual policy written in English.
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TIPS FOR FILING INSURANCE CLAIMS
State law requires insurance companies to assist you, the policyholder, in determining the amount the insurer owes you. This includes disclosing to you all benefits, coverages, time limits or other provisions of your insurance policy that may apply to your claim.
Upon receiving any communication from a claimant that reasonably suggests that a response is expected, every insurance company claims adjuster or agent must furnish the claimant with a complete response within 15 days?
State law requires every insurance company, upon receiving notice of claim, acknowledge receipt of such notice, provide you with necessary forms and assistance for proof of claim, and begin any necessary investigation within 15 days?
It is illegal for any insurer to discriminate in its claims settlement practices based on your race, gender, income, religion, language, sexual orientation, ancestry, national origin, or physical disability, or upon the territory of the property or person insured?
State law provides that upon receipt of proof of claim (separately defined in the Regulations) every insurer shall accept or deny the claim or give written notice regarding additional information that is needed?
State law requires that upon acceptance of a claim and, when necessary, a properly executed release, the insurer shall tender payment of the undisputed amount within 30 calendar days?
State law prohibits an insurer from delaying or denying the settlement of a claim with its policyholder on the basis that the responsibility for payment should be assumed by someone else?
Insurance companies are prohibited from requiring you to use non-original equipment in the repairs of your vehicle unless the parts are equal to the original equipment with respect to kind, quality, safety, fit, and performance and the insurance company warrants the same?
If non-original equipment is used in the repairs of your vehicle, such parts must carry permanent, non-removable identification so as to identify the manufacturer?
When paying for the repairs or replacement of your automobile insurance companies are required to justify any deductions for betterment, depreciation or salvage? All adjustments must be discernable, measurable, itemized and specified as to dollar amount.
If your homeowners policy provides for replacement cost:
1. any consequential physical damage incurred in making the repair or replacement, not otherwise excluded by your policy, must be included; and
2. the insurer must replace all items in the damaged area so as to conform to a reasonably uniform appearance?
[The information above is from the California Code of Regulations, Title 10, Chapter 5, Subchapter 7.5, entitled the Fair Claims Settlement Practices Regulations (Amendments filed 1/10/97)]
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