Insurance Information
Lapse Insurance policy termination due to the insured's failure to make premium payments. Larceny Theft other than one involving a forcible entry (burglary) or an actual or threatened bodily harm (robbery). Many jurisdictions prefer the term theft. Last Clear Chance Rule The last reasonable opportunity to avoid an accident or injury. One who has the last clear chance to avoid an injury and fails to do so is usually held solely responsible, notwithstanding the injured person's own contributory negligence. Law of Large Numbers A principle that the larger the number of exposures considered, the more closely will reported losses equal the true probability of loss. This is the basis for the statistical expectation of loss, which determines premium rates. Legal Reserve Minimum reserves required by state law or regulation that life insurers must maintain to operate in that state. Liability An actual or potential legal obligation, duty, debt, or responsibility to another person; the obligation to compensate, in whole or part, a person harmed by one's acts or omissions. Liability insurance policies provide coverage for an insured's legal liability, excluding criminal acts, most intentional torts, and breach of contract. Liability Insurance Insurance that provides indemnity or compensation for a harm or wrong to a third party for which the insured is legally obligated to pay. Usually, the injury or damage is caused by the insured's negligent acts or omissions, but in some situations the law imposes strict liability without regard to negligence, and this may also be covered by liability insurance. Liability Limits The stipulated sum or sums beyond which an insurance company is not liable to protect the insured. License Legal authority granted by the state for a specified activity or business enterprise. State insurance departments grant licenses to insurance companies, agents, brokers, and other entities to transact insurance-related business within its borders. License Bond A bond guaranteeing that a person who has been issued a license will comply with the laws, regulations, and ordinances associated with the issuance of the license. Lienholder The financial institution that holds title of a vehicle until the loan is paid off. Life Expectancy The length of time a person of a given age can be expected to live, based on mortality tables. Limited Collision Physical damage protection for the insured's vehicle when damage results from impact with another object or upset. Paid ONLY if insured is LESS than 50% at fault. No deductible applies. Coverage only available in state of Michigan. Liquidation The conversion of an insolvent organization's assets into cash in order to pay creditors. An insurance department takes this action after it has determined that an insolvent insurer cannot be rehabilitated. Its business is wound up, and any remaining assets are used to pay policyholder claims and other creditors. Liquor Liability Law State or local statutes ("dram shop acts") that establish the liability of a business that sells or serves alcoholic beverages to customers for injuries caused by intoxicated customers to third parties. Laws sometimes also include people who serve alcohol to guests. Living Trust An ordinary trust established by a person while living to manage and distribute assets to other living persons. Long-Term Care Custodial care provided by a rehabilitation facility, nursing home or mental hospital on a continuum basis for chronically ill, disabled or retarded individuals. The care may be on an inpatient, outpatient, or at-home basis. Loss The happening of the event for which insurance pays. The amount the insurer is required to pay because of a happening against which it has insured. Loss Avoidance The elimination of a loss exposure by ceasing or never undertaking an activity that produces the exposure. In making this decision, the person or organization must weigh the potential value of the activity against the potential loss. Loss Control Prevention and reduction of losses. An insured, often in consultation with an underwriter or loss control specialist, takes measures to reduce the frequency of losses and to minimize the financial impact or severity of a loss. Loss Expense - Allocated An expense assigned to and recorded with a specific claim, including defense and investigation costs. Allocated claim expenses have more significance in liability insurance because of the legal costs involved in defending liability claims. Loss Expense - Unallocated An expense that cannot be assigned to and recorded with a specific claim. This includes claim department operating expenses such as rent, heat and electricity, and other overhead expenses. Loss of Use / Services Applies to a policyholder's exposure to financial loss if the part of the residence premises where the insured lives is damaged so badly that it is "not fit to live in". Loss Payable Clause A property insurance policy provision that authorizes the insurer to make a loss payment to a person (loss payee) other than the insured to the extent that the loss payee has an insurable interest in the property. Loss Prevention Measures designed to reduce the probability that a loss will occur. See also loss prevention services and loss reduction. Loss Prevention Services Survey, consultation, or loss control management services provided to policholders by an insurer to reduce the likelihood of accidents. Loss Ratio A formula used by insurers to relate loss expenses to income. Formula: (incurred losses + loss adjustment expenses) divided by earned premiums. See also accident year statistics, burning ratio, expected loss ratio, insured loss ratio. Loss Reduction A loss control measure designed to reduce the severity of loss occurrences. Loss Reserve An insurer's estimate of the amount an individual claim will ultimately cost. On an insurer's financial statement, it is the amount of estimated liabilities for known claims not yet paid and incurred but not reported claims.
Insurance Information
Mail Order Insurer Type of insurance company that sells policies through the mail or other mass media, eliminating need for agents. Manual Rate A loose-leaf manual, periodically updated or revised, that contains rules, rates and other information prepared by an insurance company or rating bureau to develop premiums for insurance policies. Hard-copy manuals have been supplemented or replaced by electronic data (CD-ROMs, computer disks, electronic networks). Manuscript Policy An insurance policy designed or tailored for a large commercial insured; a unique coverage written at the request of a broker or a risk manager. Marital deduction A reduction of an estate for estate tax purposes, which is available if the decedent is survived by his or her spouse, can be as large as the administrator or executor elects so long as it does not exceed the value of qualifying property passing to the surviving spouse. Market Price The price at which a security can be bought or sold at any particular time. Master Policy An original, complete insurance policy contract that is issued by an insurer with the understanding that certificates of insurance or underlying policies will be issued to others; for example, a master group health policy is issued to an employer while certificates are given to the employees. A master policy and underlying policies may be issued to a property owner to comply with requirements of a mortgage holder. Material Damage Insurance against damage to a vehicle itself. It includes automobile comprehensive, collision, fire and theft. Material damage and physical damage are terms that often are used inter- changeably. Maximum family benefit The largest amount in Social Security benefits that will be paid to any family unit. McCarran-Ferguson Act Federal legislation (U.S. Code Title 15, Chapter 20) enacted in 1945 to permit the states to continue regulating the insurance business after the Supreme Court, in U.S. v. South-Eastern Underwriters Association, overruled the decision in Paul v. Virginia, declaring insurance to be interstate commerce and therefore within Congress's constitutional authority to regulate. Under the Act, insurance is exempt from some federal antitrust statutes to the extent that it is regulated by the states. The exemption primarily applies to gathering data in concert for the purpose of ratemaking. Otherwise, antitrust laws prohibit insurers from boycotting, acting coercively, restraining trade, or violating the Sherman or Clayton Acts. Medicaid A state medical benefit program for persons, regardless of age, whose income and resources are insufficient to pay for health care. As of January 1, 1966, federal matching funds were provided to the states under Title XIX of the Social Security Act. Medical Examination The examination given by a qualified physician to determine to the insurability of an applicant. A medical examination may also be used to determine whether an insured claiming disability is actually disabled. Medical Payments Insurance A coverage, available in various liability insurance policies, in which their insurer agrees to reimburse the insured and others, without regard for the insured's liability, for medical or funeral expenses incurred as the result of bodily injury or death by accident under specified conditions. Medicare A federally administered program of hospital insurance (Part A) and supplementary medical insurance (Part B) primarily for people over 65, created by 1965 amendments to the Social Security Act. It also covers people of any age with permanent kidney failure and certain other disabilities. The Health Care Financing Administration in the U.S. Department of Health and Human Services reimburses hospitals and physicians for services to qualified patients. Part A (hospital insurance) coverage is automatic for all eligible people and is financed by a payroll tax on employers and employees. Part B (supplementary medical insurance) is a voluntary program of government-subsidized insurance requiring participants to make premium payments. Medigap Private insurance purchased by Medicare participants on a voluntary basis that is designed to fill the gaps in Medicare, such as coinsurance, deductibles and noncovered services (e.g., hospital stays beyond a certain length). Minimum Benefits A provision that a minimum amount of annuity will be paid if the regular benefit formula produces less. This minimum is usually payable only if certain service requirements are met at retirement. Minimum Group The minimum number of persons required to form a group insurance program under state law; the minimum number that an insurance company requires to issue a group policy. Miscellaneous Expenses Expenses involving hospital care other than room, board and doctors' fees, such as lab tests, drugs and radiology. Most hospital policies limit coverage for these expenses by scheduling the amounts covered or combining them for a an aggregate limit. Misrepresentation A false, incorrect, improper, or incomplete statement of a material fact, made in the application for a policy. Moral Hazard Circumstances of morals or habits that increase the probability of a loss from an insured peril. Example: An insured previously convicted of arson. Morbidity The frequency of the incidence of disease, illness or sickness. Morbidity Tables A table showing the number of individuals exposed to the risk of illness, sickness, and disease at each age, and the actual number of individuals who incurred an illness, sickness, and disease at each age. Mortality Table A table that indicates the number of individuals within a specified group of individuals (males, females, airline pilots, etc.), starting at a certain age, who are expected to be alive at succeeding ages. It is used to derive the "natural premium" for an individual life policy. Motor Vehicle Records The record maintained by a state motor vehicle department of a driver's accidents and traffic violations. Motor Vehicle Report Report that lists the moving violations and accidents that a driver has had in the past several years. Multi-Peril Policy A package policy which provides protection against a number of separate perils. Multi-peril policies are not necessarily multiple line policies, since the combined perils may be all within one insurance line. Multiple Employer Trust (MET) A legal trust formed by a health benefit plan sponsor to combine a number of small, unrelated employers for the purpose of providing group medical coverage on an insured or group self-insured basis. Mutual Insurance Company An insurance company that has no capital stock, but is owned by its policyholders, who elect a board of directors or trustees through whom business is conducted. Any earnings belong to the policyholders and may be distributed to them as policy dividends or educed premiums.
Insurance Information (cont'd)
Package Policy A combination of two or more individual polices or coverages into a single policy. A homeowners policy, for example, is a package combining property, liability and theft coverages for the homeowner. Paid-up Insurance Insurance on which all required premiums have been paid. The term is frequently used to mean the reduced paid-up insurance available as a nonforfeiture option. Paramedical Examination Physical examination of an applicant by a trained person other than a physician. Partial Disability A benefit sometimes found in disability income policies providing for the payment of reduced monthly income in the event the insured cannot work full time and/or is prevented from performing one or more important daily duties pertaining to his occupation. Participating Insurance Insurance issued by an insurance company providing participation in dividend distribution. Participating Policy A life insurance policy under which the company agrees to distribute to policyholders the part of its surplus which its Board of Directors determines is not needed at the end of the business year. Such a distribution serves to reduce the premium the policyholder had paid. (See also - Policy dividend; Nonparticipating policy) Pension Benefit Guaranty Corporation (PBGC) The Federal body responsible for administering the plan termination insurance program under ERISA. Pension Benefits A series of payments to be provided in accordance with the plan of benefits. Pension Plan A plan established and maintained by an employer, group of employers, union or any combination, primarily to provide for the payment of definitely determinable benefits to participants after retirement. Percentage Participation A provision in a health insurance contract that the insurer and insured will share covered losses in agreed proportions. Also see Coinsurance. Peril The cause of a possible loss, such as fire, windstorm, theft, explosion, or riot. Permanent Life Insurance A phrase used to cover any form of life insurance except term; generally insurance that accrues cash value, such as whole life or endowment. Persistency The degree to which policies stay in force through the continued payment of renewal premiums. Personal Articles Floater A form of coverage designed to meet the needs for insurance on property of a moveable nature. The coverage usually protects against all physical loss, subject to special exclusions and conditions. Examples of property covered include jewelry, furs, silverware, fine arts. Personal Injury Protection (PIP) First-party no-fault coverage in which an insurer pays, within the specified limits, the wage loss, medical, hospital and funeral expenses of the insured. Personal Lines Those types of insurance, such as auto or home insurance, for individuals or families rather than for businesses or organizations. Personal representative A person appointed through the will of a deceased or by a court to settle the estate of one who dies. Physical Damage Damage to or loss of the auto resulting from collision, fire, theft or other perils. Physician's Expense Insurance Coverage which provides benefits toward the cost of such services as doctor's fees for nonsurgical care in the hospital, at home or in a physician's office, and X-rays or laboratory tests performed outside the hospital. (Also called Regular Medical expense Insurance.) Plan Administrator The person or persons controlling the money or property contributed to the plan, usually designated in the plan agreement. Point-of-Service Plans Often known as open-ended HMOs or PPOs, these plans permit insureds to choose providers outside the plan yet are designed to encourage the use of network providers. Policy The legal document issued by the company to the policyholder, which outlines the conditions and terms of the insurance; also called the policy contract or the contract. Policy Dividend A refund of part of the premium on a participating life insurance policy reflecting the difference between the premium charged and actual experience. Policyholder A person who pays a premium to an insurance company in exchange for the insurance protection provided by a policy of insurance. Policyholders' Surplus Sum left after liabilities are deducted from assets. Sums such as paid-in capital and special voluntary reserves are also included in this term. This surplus is an additional financial protection to policyholders in the event a company suffers unexpected or catastrophic losses. In effect, it is the financial base that permits a company to sell insurance. Policy Loan A loan made by a life insurance company from its general funds to a policyholder on the security of the cash value of a policy. Policy Reserves The measure of the funds that a life insurance company holds specifically for fulfillment of its policy obligations. Reserves are required by law to be so calculated that, together with future premium payments and anticipated interest earnings, they will enable the company to pay all future claims. Policy Term That period for which an insurance policy provides coverage. Pollution Liability Exposure to lawsuits for injury or cleanup costs that result from pollution damage Pool An organization of insurers or reinsurers through which particular types of risk are underwritten and premiums, losses and expenses are shared in agreed-upon amounts. Portability The transfer of pension rights and credits when a worker changes jobs. Preadmission Certification Process in which a health care professional evaluates an attending physician's request for a patient's admission to a hospital by using established medical criteria. Preexisting Condition A physical and/or mental condition of an insured which first manifested itself prior to the issuance of his/her policy or which existed prior to issuance and for which treatment was received. Preexisting Condition A physical condition that existed before the effective date of coverage. Preferred Provider Organization (PPO) An arrangement whereby a third-party payer contracts with a group of medical care providers who furnish services at lower than usual fees in return for prompt payment and a certain volume of patients. Preferred Stock Evidence of ownership which entitles the owners to receive dividends from the corporation before the common stockholders and which usually also provides a prior claim to corporate assets if the corporation is dissolved. Premium The sum paid by a policyholder to keep an insurance policy in force. Premium finance allows the insured to pay part of the premium when coverage takes effect and pay the rest during the policy period. Premium Loan A policy loan made for the purpose of paying premiums. Premium Tax A tax, imposed by each state, on the premium income of insurers doing business in the state. Prepaid Group Practice Plan A plan under which specified health services are rendered by participating physicians to an enrolled group of persons, with a fixed periodic payment in advance made by or on behalf of each person or family. If a health insurance carrier is involved, a contract to pay in advance for the full range of health services to which the insured is entitled under the terms of the health insurance contract. Such a plan is one form of Health Maintenance Organization (HMO). Primary Insurance Insurance that pays compensation for a loss ahead of any other insurance coverages the policyholder may have. Principal Sum The amount payable in one sum in the event of accidental death and in, some cases, accidental dismemberment. When a contract provides benefits for both accidental death and accidental dismemberment, each dismemberment benefit is an amount equal to the principal sum or some fraction thereof. Probate The court-supervised process of validating or establishing a distribution for assets of a deceased including the payment of outstanding obligations. Probate Estate That portion of the assets and liabilities whose distribution is supervised by the courts in the probate process. Probationary Period A period from the policy date to a specified time, usually 15 to 30 days, during which no sickness coverage is effective. It is designed to eliminate a sickness actually contracted before the policy went into effect. Product Liability legal liability incurred by a manufacturer, merchant, or distributor because of injury or damage resulting from the use of its product. Product Liability Insurance Protection against financial loss arising out of the legal liability incurred by a manufacturer, merchant, or distributor because of injury or damage resulting from the use of a covered product. Professional Review Organization (PRO) An organization in which practicing physicians assume responsibility for reviewing the propriety and quality of health care services provided under Medicare and Medicaid. Proof of Loss Documentary evidence required by an insurer to prove a valid claim exists. It usually consists of a claim form completed by the insured and the insured's attending physician. For medical expense insurance itemized bills must also be included. Property Damage Coverage An agreement by an insurance carrier to protect an insured against legal liability for damage by an insured automobile to the property of another. Property Insurance Insurance providing financial protection against the loss of, or damage to, real and personal property caused by such perils as fire, theft, windstorm, hail, explosion, riot, aircraft, motor vehicles, vandalism, malicious mischief, riot and civil commotion, and smoke. Proration The adjustment of benefits paid because of a mistake in the amount of the premiums paid or the existence of other insurance covering the same accident or disability. Prospective Payment An advancement of payment for health care charges that are likely to occur. Prototype Plan A standardized plan, approved and qualified as to its concept by the Internal Revenue Service, which is made available by life insurance companies, banks and mutual funds for employers' use. Provision A part (clause, sentence, paragraph, etc.) of an insurance contract that describes or explains a feature, benefit, condition, requirement, etc. of the insurance protection afforded by the contract. Proximate Cause The dominating cause of loss or damage; an unbroken chain of events between the occurrence and damage. Punitive Damages a court-awarded amount that exceeds the economic losses and general damages of a defendant and is intended solely to punish the plaintiff. |
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