Glossary of Terms (wording)

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Adjuster

An adjuster is a representative of the insurer who seeks to determine the extent of the insured’s liability for loss when a claim is submitted.

Agent

An agent, or broker, represents one or more insurance companies in selling insurance.

Allowable expense

An allowable expense is an expense specified by an insurance plan to be eligible for payment either in part or whole.

Amendment

An amendment to an insurance policy changes the benefits, coverage, terms, or conditions.

Beneficiary

The beneficiary is the person named by the insured to whom the proceeds of a life or health insurance policy are payable.

Bodily Injury (BI) Liability Coverage

This coverage pays, up to the coverage limits, for damages due to injury or death of others in a vehicle accident for which you are legally responsible. It also pays your legal defense costs.

Case Management

Case management refers to a cost control method that directs the insured to the most appropriate duration and type of service. It can also refer to the monitoring of such outcomes.

Claim

A claim is a formal request to the insurance company for reimbursement for a loss, as set out in the plan.

Co-insurance

If the insured is required to pay any portion of the covered expenses, this is known as co-insurance.

Collision Coverage

This optional auto insurance coverage pays, up to the coverage limits, for damage to your vehicle caused by a collision with another vehicle or object. Select deductibles of $100, $250, $500, or $1000 to help offset the cost of this coverage. You can save money by selecting a $500 or $1000 deductible because the larger deductible lowers your insurance costs.

Comprehensive Physical Damage Coverage

Also optional, this coverage pays, up to the coverage limits, for damage to your vehicle resulting from glass damage, collision with an animal, theft, fire, vandalism, flooding, or hail. Select deductibles of $100, $250, $500, or $1000 to help offset the cost of this coverage. You can save money by selecting a $500 or $1000 deductible because the larger deductible lowers your insurance costs.

Covered Expense

Covered expenses are those eligible for medical care or supplies that will be paid by the insurance company.

Deductible

The deductible is the amount the insured pays each calendar year before benefits are paid.

Dependent

The insured’s dependents are the lawful spouse and unmarried children under a certain age who are eligible for coverage.

Effective Date

The date on which coverage under an insurance policy begins is called the effective date.

Exclusions

Exclusions are specified conditions that are not eligible for reimbursement under a policy or plan.

Medical Payments Coverage

In auto insurance, this coverage pays, up to the coverage limits, for reasonable and necessary doctor, hospital and funeral expenses for you and your passengers injured or killed in an accident, or as a pedestrian by another vehicle, regardless of who is at fault.

Pending Claim

When a claim has been reported, it’s considered a pending claim until final coverage determination has been made.

Premium

The premium is the cost for coverage during a specified period of time.

Property Damage (PD) Liability Coverage

This coverage pays, up to the coverage limits, for another individual’s vehicle or property that has been damaged in an accident for which you are legally responsible.

Rider

A rider is a provision that changes, adds, or excludes various coverage’s, terms or conditions in the policy.

Subrogation

Subrogation allows an insurance company to pursue a third party for claims paid that are the responsibility of that third party.

Underwriting

Underwriting is the process that assesses and classifies the potential degree of risk an applicant represents.

Uninsured/Underinsured Motorists (UM/UIM) Coverage

UM/UIM coverage pays up to the coverage limits for bodily injury to you or your family resulting from the negligence of a motorist whose liability insurance limits are insufficient.

Waiting Period

The waiting period is the time an employee must wait before insurance is effective or benefits are considered eligible.