Nonstandard, custom policies developed for one specific insured or for a small group of insureds, such as a business association, with unique coverage needs.
A statement in an insurance policy that the insurer will, under described circumstances, make a loss payment or provide a service.
Any provision that qualifies an otherwise enforceable promise made in the policy.
Specified causes of loss coverage
A named perils coverage that covers loss caused only by the specifically listed perils.
Special form coverage
Property insurance coverage covering all causes of loss not specifically excluded.
A reduction in property value resulting immediately and proximately from damage caused by a covered cause of loss.
A loss that arises as a result of damage to property, other than the direct loss to the property.
Compensation to claimants for their bodily injury or property damage.
A monetary award to compensate a victim for specific, out of pocket expenses incurred because of a loss, such as medical expenses, wage loss, funeral expenses, or repair bills.
A monetary award to compensate a victim for losses, such as pain and suffering, that do not involve specific measurable expenses.
A payment awarded by a court to punish a wrongdoer for a reckless, malicious, or deceitful act and to deter similar conduct.
The amount the insurer estimates and sets aside to pay on an existing claim that has not been settled.
Individual case method
A method of setting reserves based on the claim's circumstances and the claim representative's experience in handling similar claims.
A method of setting reserves by using the consensus of two or more claim personnel who have independently evaluated the claim file.
Average value method
A method of setting claim reserves by using a predetermined dollar amount that is set aside for a particular type of claim when it is reported.
A method of setting claim reserves by using a mathematical formula.
Expert system method
A method of setting reserves with a software application that estimates losses and loss adjustment expenses.
Loss ratio method
A method of setting reserves by establishing aggregate reserves for all claims within a type of insurance or a class of loss exposures.
The intentional or voluntary relinquishment of a known right.
A legal bar to asserting a certain contractual condition because of that party's previous actions or words to the contrary.
A signed agreement indicating that during the course of investigation, neither the insurer nor the insured waives rights under the policy.
Reservation of rights letter
An insurer's letter that specifies coverage issues and informs the insured that the insurer is handling a claim with the understanding that the insurer may later deny coverage should the facts warrant it.
An insurer's right to recover payment from a negligent third party who caused a property or liability loss that the insurer has paid to or on behalf of an insured.
Alternative dispute resolution (ADR)
Methods for settling disputes outside the traditional court system.
An alternative dispute resolution method by which disputing parties use a neutral outside party to examine the issues and develop a mutually agreeable settlement.
An alternative dispute resolution method by which the disputing parties use a neutral outside party to examine the issues and develop a settlement, which can be final and binding.
A policy condition that provides appraisal as a mechanism for resolving disputes between insurers and insureds over the amount owed on a covered loss.
An alternative dispute resolution method by which a case undergoes an abbreviated version of a trial before a panel or an advisor who poses questions and offers opinions on the outcome of a trial, based on the evidence presented.
Summary jury trial
An alternative dispute resolution method by which disputing parties participate in an abbreviated trial, presenting the evidence of a few witnesses to a panel of mock jurors who decide the case