What is a suitable humidity level to prevent mold?

According to the EPA.gov,

“Sometimes, humidity or dampness (water vapor) in the air can supply enough moisture for mold growth. Indoor relative humidity (RH) should be kept below 60 percent — ideally between 30 percent and 50 percent, if possible. Low humidity may also discourage pests (such as cockroaches) and dust mites.

Humidity levels can rise in a building as a result of the use of:

  • Humidifiers
  • Steam radiators
  • Moisture-generating appliances such as dryers
  • Combustion appliances such as stoves

Cooking and showering also can add to indoor humidity.

HVAC System

One function of the building heating, ventilation and air conditioning (HVAC) system is to remove moisture from the air before the air is distributed throughout the building. If the HVAC system is turned off during or shortly after major cleaning efforts that involve a lot of water, such as mopping and carpet shampooing or cleaning, the humidity may rise greatly, and moisture or mold problems may develop.

Condensation

Condensation can be a sign of high humidity. When warm, humid air contacts a cold surface, condensation may form. (To see this, remove a cold bottle of water from a refrigerator and take it outside on a hot day. Typically, condensation will form on the outside of the bottle.) Humidity can be measured with a humidity gauge or meter; models that can monitor both temperature and humidity are generally available for less than $50 at hardware stores or on the Internet.”

Read more:

https://www.epa.gov/mold/mold-course-chapter-2


What are insurance endorsements?

An insurance endorsement is an amendment or addition to an existing insurance contract which changes or amends the terms or scope of the original policy. Endorsements are also be referred to as riders. An insurance endorsement may be used to add, delete, exclude or otherwise alter coverage.

My property damage claim was settled with my insurance company and I received check. However, now I am noticing more damage and I feel I was underpaid. Is it to late to hire a public adjuster?

It most cases it is never to late. It’s common to have supplemental damage claims that can be filed for things such as undiscovered water damage and mold damage, or damage behind walls once reconstruction starts. It’s always best to have a public adjuster on board from the beginning that will help to identify these common problem areas and adjust the claim accordingly. The only condition to this is when the policyholder signs a release. There is nothing you can do at this point. I would still suggest checking with an attorney to be sure.

What causes water damage?

Water damage can occur for a variety of reasons. Excess water in your home can come from pipes that burst or start to leak in your plumbing system, as well as from natural disasters such as hurricanes or flood. Household appliances can malfunction and cause water to accumulate in areas that might not be noticeable.

When gutters and roof drains get backed up, the excess water can begin to cause serious damage. Septic tanks can overflow and cause raw sewage to spew into your crawlspace or home. Bathtubs and showers that are poorly constructed or need the grout replaced can permit water to seep through onto the tile and create mold and other unwanted effects. Let’s not forget shower pans, and pipe leaks, and toilet bowl wax seals that go bad.

How can I prevent water damage?

Proper maintenance and care of your appliances can help ensure they don’t cause a water issue. Have a plumber come inspect your supply lines, drain lines, and overall plumbing to see if you have any at risk plumbing our outdated material. If you have a septic tank, monthly inspections can allow you to notice if anything looks amiss. You can also teach everyone who lives in your home where the water supply cutoff valve is, so they can turn it off in the event of an emergency.

Keep an eye on your water bill; a sudden increase one month may indicate a leaky pipe or something more severe. Also, if you notice any foul odors or black spots (mold) on the walls, you may want to call a mold hygienist. If you notice that you have damage it is always good to have a Public Adjuster come provide a free evaluation, so you can decide if an insurance claim is warranted. You may need to hire a Public Adjuster in most circumstances to get a fair settlement and to make sure your home is brought back to pre-loss condition. Call Experienced Public Adjusters for a free claim evaluation.

How do I know if I have enough coverage in case I suffer a water damage loss?

Review your policy with your insurance agent and make sure he goes over the coverages specific to water claims. Also, make sure he reviews with you any exclusions their may be in your policy. Do not forget to ask about what you have as a mold coverage cap. In almost every water loss if a remediation company is not onsite immediately you will start to have mold growth and this in most cases will be covered under a different part of your insurance policy. Last but not least, know how much the value of your home and your personal contents are worth to replace and repair.

How damaging and dangerous is mold?

Health-wise, mold has been known to be carcinogenic, and can cause flu-like symptoms such as diarrhea and infections, possible lung infections and sinusitis. Mold and mildew can cause many problems, both to your family’s health and to your home. It can destroy furniture, wood and drywall. It can offer a place where unwanted bacteria, mites, roaches and rodents can live.

What is a Civil Remedy Notice?

According to www.myfloridacfo.com, “The Civil Remedy Notice is intended for use by parties who are beginning the process of filing suit against an insurer, when a party feels they have been damaged by specific acts of the insurer. The Notice is intended to meet a portion of legal requirements set forth in Section 624.155, Florida Statutes, which requires a party to file Notice with both the insurer and the Department of Financial Services (DFS) at least 60 days prior to bringing an action against the insurer. The DFS does not involve itself in the pre-suit negotiations or communications related to Notices as such actions are not within the scope of its statutory authority.” Read more about a Civil Remedy Notice here: www.myfloridacfo.com

What are the elements of a bad faith insurance claim?

You can learn more about this by clicking on this link published by Find Law.

What is an insurance “Appraisal Clause” and how does it work?

An appraisal clause is a clause or paragraph found in most but not all insurance policies. It is designed to be a binding way of reaching a settlement when there is a dispute over the amount of a loss between you and your insurance company and can be invoked by either party or may require both parties to agree. It is not common for an insured to request appraisal when both parties are required to agree for the carrier to accept this request. However, when either party can invoke this can be a useful tool depending on your individual cl

How Does the Appraisal Process Work?

If a policyholder and insurance company can’t agree on the value of the loss, some Florida policies require both parties to agree to Appraisal. Other allow for either party to  demand that the damages be determined by appraisal. Here is how the process works:

  1. Both the policyholder and the insurer will hire an independent appraiser. It will usually state, ” In this event, each party will choose a competent appraiser within 20 days after receiving a written request from the other.”
  2. Together, the two appraisers will choose an umpire, who acts like an arbitrator (essentially the judge). The umpire will resolve any disagreements that arise between the appraisers. The Umpire only gets involved if the two appraiser cant reach a settlement. Most policies state,” If they cannot agree upon an umpire within 15 days, you or we may request that the choice be made by a judge of court of record in the state where the “residence premises” is located.
  3. The two appraisers will then examine the documents and estimations and try to reach an agreement on how much the repair or replacement should cost.
  4. If the appraisers can’t agree on specific items then they will submit their differences to the umpire. In this case the most policies in Florida will state, “If the appraisers submit a written report of an agreement to us, the amount agreed upon will be the amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will set the amount of loss.”
  5. Once two parties of the appraisal panel come to an agreement they will sign a binding appraisal award. The insurer will pay that amount to the policyholder.

How much does going to appraisal cost? 

Most Policies will state,

“Each party will:

A: Pay its own appraiser: and

B: Bear the expense of the appraisal and umpire equally.”

Umpire cost usually range from $2,000-$4,000 for a residential claim. Of course, the insured will only pay half of this cost. This is something an insured needs to consider this when making the decision to go to appraisal.

If you are considering going to appraisal or the carrier has demanded appraisal and you have to respond you should call a Public Adjuster for a free claim review. This is a binding decision and should not be taken lightly. This will require the guidance and expertise of an Experienced Public Adjuster. Please call us today for a free claim review at (407) 212-8669.


How long do I have to file A Hurricane Irma claim, supplement or reopen a claim in Florida?

Under Florida Law Statute, 627.70132 Notice of Windstorm or Hurricane Claim, you have 3 years to file a claim, supplemental claim, or reopened claim under an insurance policy that provides property insurance after the hurricane first made landfall or the windstorm caused the covered damage. Insurance companies are still overwhelmed or understaffed overwhelmed at this time, and it may be a while before they can get to you, but you do have time.

What is mediation for insurance policyholders?

Mediation is an informal, voluntary, non-binding process for conducting settlement negotiations between you and your insurance company. Mediation can be a fast and cheap way to resolve insurance claim and coverage disputes. However, the insurance carrier will usually not come with the authority to offer a settlement that brings you back to pre-loss condition. Be ready to walk away if they are unwilling to offer a fair settlement. Most likely once you walk away the next step would be to go to litigation.

Make sure you read your policy to see who will be responsible for paying for the mediator. There may be a payment provision covering claim adjustment expenses that you can use to get your insurer to pay for mediation fees.

Going to mediation is a very important decision for a policyholder. If you do not have an Appraisal clause going to mediation may be the last option offered by the carrier. Before exhausting all condition of the policy to reach a fair settlement it would be a good idea to consult a Public Adjuster. Call Experienced Public Adjusters today for a free claim review! (407)-212-8669

What is an Umpire when it comes to insurance claims?

A Property Insurance Umpire is a competent, disinterested, impartial individual who is charged with making a decision regarding the value of property or the amount of a property loss. The use of an Umpire is usually a requirement within an Appraisal clause when the insured appraiser and insurers appraiser are unable to reach a settlement.

My insurance company sent me a letter saying my claim has been closed. Does this mean I can’t go after additional money for damages?

No, that is a standard practice by insurance carriers to make you feel like the claim has been closed. You can have the claim reopened as long as you did not sign a “release” for the settlement offer provided. If you feel you were underpaid on your claim then you should call a Experienced Public Adjuster for a Free Claim Evaluation. (407) 212-8669

¿Qué es un Ajustador de Seguros Públicos?

Un ajustador público es un ajustador de reclamaciones manejador de reclamos profesional que aboga por el titular de la póliza en la evaluación y negociación de un reclamo de seguro del reclamante. Además de los abogados y el agente de registro, los ajustadores públicos con licencia de los departamentos estatales de seguros son el único tipo de ajustador de reclamos que puede representar legalmente los derechos de un asegurado durante un proceso de reclamo de seguro. Un ajustador público será más beneficioso cuando esté claro que el asegurador pagará el reclamo y el único problema es la identificación y valoración adecuada de la pérdida. La mayoría de los tasadores públicos cobran un porcentaje del acuerdo. Principalmente evalúan el daño, preparan un presupuesto y otra documentación de reclamo, leen la póliza de seguro para determinar la cobertura y negocian con el manejador de reclamaciones de la compañía de seguros.

Un ajustador público es un representante del titular de la póliza que asesora, administra y presenta un reclamo a la compañía de seguros del asegurado. ¡Llámenos hoy! (407) 212-8669

Beneficios de contratar a un Ajustador de Seguros Públicos?

Presentar un reclamo de seguro con su compañía de seguros podría ser una experiencia terrible por sí mismo. Un agente de seguros le hará algunas preguntas o incluso requerirá información que puede parecer irrelevante pero bastante esencial. Se requiere documentación detallada del daño o pérdida de su propiedad al presentar un reclamo, y eso significa que necesita todo tipo de investigación e investigación para determinar la condición de la propiedad antes de dicho daño.
Esta es solo una de las cosas que hacen los ajustadores públicos. Le ayudarán a entender incluso los detalles más pequeños de su póliza, por lo tanto, no tiene que lidiar con todo el proceso agotador solo para presentar una reclamación adecuada. Donde los desastres naturales son una ocurrencia común.

Aquí los principales beneficios de contratar un ajustador público:
Ahorra tiempo
Si necesita ayuda para comprender su política, puede llevarle mucho tiempo descifrarla antes de que pueda comenzar a documentar todo para su proceso de reclamo. Un ajustador público bien entrenado administrará y organizará estas cosas por usted, ayudándole a reducir el tiempo que tiene que gastar en ello.

Pericia
Las pólizas de seguro pueden ser bastante complicadas y difíciles de entender por su cuenta, por lo que contar con un experto a su lado que no solo esté familiarizado con las pólizas de seguros sino que también esté capacitado para explicarlas es de gran ayuda en su momento de necesidad. También lo guiarán a través de los procedimientos adecuados para presentar un reclamo de seguro.

Resolución rápida
Con la ventaja de contar con un ajustador público, usted entiende cómodamente su reclamo y es mucho más rápido procesar la documentación necesaria para presentar su reclamo de seguro. No tiene que lidiar con ir y venir y estresarse debido a la falta de comunicación con el representante de seguros. Cualquier tipo de reparación comenzará lo más rápido posible.

Protección de sus derechos
Un ajustador público como nuestro equipo de profesionales que comprende las técnicas de seguro por dentro y por fuera evitará la falta de comunicación entre usted y su compañía de seguros, y también le informará si sus derechos como asegurado están siendo descuidados. Ahora están ahí para cuidar su mejor interés, ya que usted es el cliente.

Valor justo para su reclamo
Según un estudio reciente, los tasadores públicos a menudo negocian hasta un 747% de acuerdos de seguro más grandes para reclamos de seguros por daños a la propiedad o incluso pérdidas que la compañía planea originalmente entregar al titular de la póliza.
Si observa el panorama general, usar los servicios de ajustadores públicos es una decisión inteligente y práctica, ya que obtiene mucho más de su reclamo de seguro y, al mismo tiempo, le impide gastar demasiado tiempo y energía en el proceso de reclamación. Por lo general, hay una tarifa por su servicio, pero si considera los beneficios que obtiene, bien vale la pena el gasto.

¡Llámenos hoy! (407) 212-8669

What is the difference between Actual Cash Value and Replacement Cost Value?

Replacement Cost Value– The term replacement cost or replacement value refers to the amount that an insurance carrier would have to pay to replace an asset at the present time, according to its current worth.

Actual Cash Value– Actual cash value is the amount equal to the replacement cost minus depreciation of a damaged or stolen property at the time of the loss. It is the actual value for which the property could be sold, which is always less than what it would cost to replace it.

How much does a public adjuster make in a year?

Well if you hire an Experienced Public Adjuster they will make a good living. Why you might ask? Because we only get paid if you get paid and we work on a contingency fee basis. So the more money we can get you the more we get paid. This is why its in your best interest to hire a Public Adjuster instead of an Attorney. We fight for every dollar owed. In Florida, Attorneys get paid by the carrier under Florida Statute if they collect just $1 dollar. So they have no incentive to work hard to maximize your settlement.

What is a Public Adjuster and what do they do?

A Public Adjuster is a professional claims handler who advocates for the policyholder in appraising and negotiating a claimant’s insurance claim.

What is a Public Adjuster in Florida?

A Public Insurance Adjuster in Florida is licensed by The Department of Financial Services and can be hired by a policyholder to represent their best interest in a property insurance claim.

Who pays for a Public Adjuster?

In most cases a Public Adjuster will charge a contingency fee as a percentage of only what they are able to settle from the insurance company. They are only allowed to take this percentage for new money they took part in adjusting and they can’t take a percentage out of the deductible.

What is a Staff Adjuster?

Staff Adjusters, typically work directly for the insurance carrier. They can work in the field or as a desk adjuster. But they usually do not have the homeowners or business owners best interest at heart. Only a Public Adjuster advocates and fights for your settlement. Once you have used a Public Adjuster in my opinion you will never think twice about filing a claim without one.

What is the role of a claims adjuster?

A claims adjuster represents the insurance carrier. They usually coordinate the appraisal, gather all documents and the facts and reports the details to the insured. What that mean is basic language is they may look for ways to underpay you or deny coverage. Remember, Insurance companies are privately owned or have shareholders. The goal of any business is to minimize costs and increase profits. That is why you need a Public Adjuster on your team from the start. Call an Experienced Public Adjuster Today at (407) 212-8669.

What is a POL or Proof of Loss?

A Proof of Loss is a policyholder’s statement of the amount of money being requested, signed to and sworn to by the policyholder with documentation to support the amount requested. If you receive a request for a Proof of Loss, please STOP and pick up the phone and call a Public Adjuster. The figure you submit can be a permanent one for the carrier. What if you have additional damages that you have not yet discovered. There are a lot of what ifs! Call a Public Adjuster for a free claim review immediately.

What is an EUO or Examination Under Oath?

An Examination under oath if requested may not be in your best interest. It can be one of the most powerful tools available to insurers when done correctly. It is a formal proceeding during which an insured under oath and in the presence of a court reporter , is questioned by an insurance company representative. You always have the right to have an Attorney or Public Adjuster present if this is requested by the carrier.

Do all insurance adjusters work for the insurance company?

The answer is sometimes, and yes indirectly! Most Florida insurance companies will outsource this task to an independent adjusting firm to go out and estimate the damages. Very few carriers have enough staff adjusters ready to deploy when a natural disaster strikes. Independent Adjuster and Staff Adjusters are usually thrown out into the field with little to no training and will most likely make mistakes that could lead to you being underpaid or even denied coverage. Remember they are both being paid by the carrier in the end. This is why you need an advocate to represent your best interest. A Public Adjuster is there for you to help you maximize your settlement and help you and your family be brought back to pre-loss condition.

How do you become a Public Adjuster?

There are requirements set forth that are constantly changing. You should always contact the Florida Department of Financial Services to help you answer this question. However, you will require a 6 month apprenticeship with a supervising Public Adjuster and you will have to be appointed by a firm. We are from time to time looking for an apprentice. Please feel free to contact us or email us your resume at info@experiencedpublicadjusters.com.

If I file a claim how long does the my insurance company have to pay or deny my claim?

Florida Statute 627.70131 states,”Insurer’s duty to acknowledge communications regarding claims; investigation.

(5)(a) Within 90 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer which reasonably prevent such payment. Any payment of an initial or supplemental claim or portion of such claim made 90 days after the insurer receives notice of the claim, or made more than 15 days after there are no longer factors beyond the control of the insurer which reasonably prevented such payment, whichever is later, bears interest at the rate set forth in s. 55.03. Interest begins to accrue from the date the insurer receives notice of the claim. The provisions of this subsection may not be waived, voided, or nullified by the terms of the insurance policy. If there is a right to prejudgment interest, the insured shall select whether to receive prejudgment interest or interest under this subsection. Interest is payable when the claim or portion of the claim is paid. Failure to comply with this subsection constitutes a violation of this code. However, failure to comply with this subsection does not form the sole basis for a private cause of action.”

Please click on the below link to learn more.

http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0600-0699/0627/Sections/0627.70131.html

How long does it take for an insurance adjuster to come out?

That’s a question that can’t be easily answered. Typically, you will be contacted within 1-3 days and they will come out to investigate the loss as soon as possible. After storms like Hurricane Irma people waited 1-2 months for a field adjuster to arrive. Not to mention they went through 4-5 different desk adjusters assigned to their claim.

This is why you need a Public Adjuster to advocate for your best interest. They manage the process and document everything and have to maintain the file for 5 years. This allows you the comfort to know that someone is doing everything they can within the Florida Statutes and the language of you policy to get you a fair settlement.

Do you have a Public Adjuster near me?

We have offices throughout the State of Florida. Please call us for a free phone consultation and insurance claim review. (407) 212-8669

Orlando Public Adjusters

Naples Public Adjusters

Merritt Island Public Adjusters

Boca Raton Public Adjusters


Do insurance adjusters work on the weekends?

Insurance carrier adjuster usually do not work on weekends. And Public Adjusters will usually make that determination based on how busy they are. At Experienced Public Adjuster we work 24 hours a day/ 7 days a week when warranted. Please call us at (407) 212-8669

Do you need a license to be a claims adjusters?

The answer in Florida is yes! Whether you work for an insurance company and an adjuster or as an independent adjuster you will require a license with The Department of Financial Services. A Public Adjuster also requires to be licensed with The Department of Financial Services. If you want to learn more please visit their website. www.myfloridacfo.com

You can also do a license search at the above website.

How do you become a Public Adjuster?

In order to become a Florida Public Adjuster you must read about the requirements. Click on this link to learn more!

Why should you put in your search engine “public adjuster near me?”

It’s important that you hire a local adjuster that knows about the local laws and ordinances and the required code upgrades that may be required. Of course this all depends on the coverage’s granted to you within your policy. You also do not want to hire someone that has to drive long distances to meet with insurance company adjusters, engineers, mold hygienists, appraisers, and more. Why? Because this could prolong you reaching a fair settlement in a timely fashion. Most out of the area Public Adjusters may only be in your area 1 or 2 days a month. A local Public Adjuster lives close and can schedule more appointments in a day in order to help you reach a fair settlement in a shorter amount of time. Call an Experienced Public Adjuster Today! (407) 212-8669


Can a Public Adjuster help with Auto Claims?

Yes, however we do not specialize in that field. We handle residential and commercial property damage claims only.

A Contractor told me that they can handle my insurance claim for me? Is that legal?

Industry Warning: Contractors-3rd Degree Felony For Attempting To Adjust a Claim!

Read The Florida Statutes by clicking this link:at www.myfloridacfo.com:

This page reads,

“If you are acting as a public adjuster in any manner by negotiating or effecting the settlement of an insurance claim on behalf of an insured and you are performing any of these services for money, commission or anything of value without being licensed as a public adjuster (Section 626.854, Florida Statutes), you could be subject to arrest and may be charged with a third-degree felony as provided by Section 626.8738, Florida Statutes.”

How much does a Public Adjuster make a year?

How much does a Public Adjuster make a year?

I see all kinds of numbers listed on the internet. The real answer is how good you are as an adjuster and the company you are with. The better the company and the adjuster the more clients they will have. The more clients they have and the size of the loss will help determine how much they make. They are paid a percentage of the contingency fee charged and the size of the settlement.

What is an insurance endorsement?

An insurance endorsement is an amendment or addition to an existing insurance contract which changes or amends the terms or scope of the original policy. Endorsements are also be referred to as riders. An insurance endorsement may be used to add, delete, exclude or otherwise alter coverage.

What is an insurance peril?

What is an insurance Peril. A specific risk or cause of loss covered by an insurance policy, such as a fire, windstorm, flood, hail, or theft. A named-peril policy covers the policyholder only for the risks named in the policy in contrast to an all-risk policy, which covers all causes of loss except those specifically excluded in the insurance policy.

I am buying a second home and I am going to rent it? Can I buy a regular homeowners policy?

No, you need a DP policy. Please consult with a Licensed Insurance Agent.

What is Xactomate and why do most insurance companies use it?

What is Xactomate and why do most insurance companies use it? Does it vary its estimates based on specific cities costs or contractor prices after a storm?


In 1986 Xactware opened for business with its new estimating system called Xactimate. Xactimate helped contractors and insurance adjusters estimate repairs much faster and more accurately than they ever could before and has become an industry standard for adjusters and contractors. This software does not account for inflated contractor pricing during and after a natural disaster. There is nothing wrong with getting a comparison estimate in your local market from a licensed general contractor. For example, it may be more expensive to hire a contractor in Naples, FL then it would be to hire a contractor to do the same work in Groveland, Florida.

I am frantic and a pipe burst so I called a plumber. Is there anything I need to know!

YES YES YES

  1. Keep the damaged pipe
  2. Take a before and after picture.
  3. Make sure he writes a detailed invoice of what was damaged and how he repaired it.
  4. I there is damage getting to it what do I do? Remember, you insurance policy does not cover the repair of the pipe or water leak but it does cover the resulting damages. That mean getting to the leak and repairing may require you to open a wall or pull up the flooring and break the concrete foundation to get to the pipe. So have your plumber separate the invoices. The repair will usually not be covered but the resulting damage will in most cases be covered.
  5. The plumber may also be a contractor or refer a restoration company. Do your own due diligence. Shut the water off at the source and take a deep breathe. Then you should call a Public Adjuster first to discuss your claim. Then make sure you hire the right remediation company to mitigate your damages. The wrong company could cost you 10’s of thousands of dollars. They provided time stamped pictures and they will moisture map your house if they are good. They will look for visible mold if the claim is a few days old.
  6. The restoration technician should be IICRC Certified.
  7. And if they work for the Insurance Carrier or are referred by the carrier they may not have your best interest at heart. Remember they may get 90% of their work from the carrier so they may cut corners to keep cost low for the carrier in order to maintain a healthy stream of business.
  8. Call and Experienced Public Adjuster as soon as the loss happens. We will guide you through the process and help make sure no mistakes are made. (407) 212-8669

What is Stachybotrys?

Stachybotrys is also known as “Toxic Black Mold”. It has the ability to produce mycotoxins which may cause a burning sensation in the mouth, throat, and nasal passages. Other symptoms stachybotrys may cause also include diarrhea, headaches, an memory loss. Stachybotrys forms on wet building materials .

What is the best way to test for mold?

You can purchase test kits that allow you to test your home for mold, but we recommend calling in an expert instead. Certified mold testers are trained to locate all traces of mold in a home and they can also tell you what strains of mold are present. Do-it-yourself mold tests aren’t always accurate and many require you to send samples to a lab to find out what strains of mold are present, at significant extra cost. Hiring a professional for the job simply provides better results.

Is mold in my house dangerous?

It can be dangerous. The degree of risk depends on numerous factors, including the type of mold (some strains are more hazardous to your health than others, although it’s not good for you to be inhaling any type of mold spores), the amount of mold, whether or not you’re allergic to mold, and the state of your health and the health of your family members. Health problems commonly associated with household mold include coughing, sneezing, sore throat, runny nose, headaches or migraines, sinus infections, pneumonia and asthma attacks. Infants, elderly people and those with respiratory disorders like asthma or emphysema are most susceptible to mold-related health problems, but even healthy young adults can be affected.

How do I know if there is mold in my home?

You might be able to see mold in your home, growing on walls, floors, carpet, ceilings or bathroom fixtures. However, mold often grows in places where it cannot be easily seen, like under carpets, inside walls and inside heating, ventilation and air conditioning ducts. You should suspect mold if your home has a musty smell. You should also know that mold is likely if you’ve had flooding or a water leak in your home. To find out for sure if there’s mold in your home, you need to call in a certified mold tester. Most certified mold testers are engineers and are trained to locate mold even in hard-to-see places. They can let you know if there is mold in your home and if so, what type of mold it is.

What is black mold?

Black mold is one of the most common types of mold that forms in homes. Other names for common black mold is stachybotrys chartarum, and toxic black mold. Black mold comes in many different species and classifications.

What are obvious signs of mold other than a musty odor?

Obvious signs of mold in your home include cracking paint, water stains (brown stains on the ceiling), rust, warped ceilings, walls, and dust.

How do I know if I have black mold?

You will SMELL it and/or SEE it.

Black mold can be gray, green and sometimes look dark blue. It forms in clusters and can sometimes look slimy, fluffy growing outward, and spotty.

It can sometimes and very frequently give off a musty and damp odor.

What are the benefits of having a professional conduct a mold test in your home?

  1. Most professionals that test for mold are engineers. They have extensive training and education in how to conduct and interpret the tests. A mold specialist will help you identify exactly what type(s) of mold you are dealing with, in order to determine the best clean-up techniques.
  2. They know how to find mold in hidden places, where homeowners frequently miss it. They will be able to find and identify mold that is hidden, such as inside walls or under flooring.
  3. They can tell you what strains of mold are present in your home (often there is more than one strain) and provide you with information about the health risks of exposure to those specific strains.
  4. They can advise you about the safety precautions that should be taken during the mold removal process. A specialist will help you understand each step involved in the cleanup process.
  5. It is also great documentation for a Public Adjuster to have in order to get your home back to Pre-Loss condition. Call and Experienced Public Adjuster today. (407) 212-8669

What are different types of mold categories? Category 1, 2, and 3

Category 1: Category 1 water originates from a sanitary water source and does not pose substantial risk from dermal, ingestion, or inhalation exposure.

Example: Sink overflow

Category 2: Category 2 water containing significant contamination and has the potential to cause discomfort or sickness if contacted or consumed by humans.

Example: Overflows from toilet bowls

Category 3: Category 3 water is grossly contaminated and can contain pathogenic, toxigenic, or other harmful agents. Its commonly called black water.

Example: Flooding from seawater

Places to watch for mold growth in your home!

  • Basements or cellars that have been flooded
  • Underneath kitchen sinks
  • Underneath or behind refrigerators
  • Bathroom shower or under sink
  • Behind walls that also house plumbing
  • Stacks of damp or wet newspaper or cardboard boxes
  • Around air-conditioning units
  • Wallboard or around windows that leak
  • Under carpeting that may have become wet
  • Attics & crawl spaces

Mold Prevention & Early Detection Tips

Mold Prevention & Early Detection Tips

MOISTURE


  • You can prevent damage to your home, and its contents, save money, and avoid potential health problems by controlling moisture and eliminating mold growth.
  • Condensation, humidity, leaks, and flooding are all moisture-related causes of mold growth.
  • Reminder: With any type of water damage in the home drying the affected areas within three days or less will help prevent the growth of toxic mold.
  • Black mold is a toxic species of mold that forms in moisture-rich areas.

MOLD


  • When dealing with a mold issue, calling a professional is your best bet in guaranteeing the issue is properly taken care of, and will not return.
  • Mold not only damages the materials it is found on, but also effects the air in your home, air conditioning unit, clothing, kitchenware, carpets, and your overall health.
  • Mold causes allergy-like symptoms in those who come in contact with mold spores.
  • Mold only needs a few things to grow including moisture, organic materials (nutrients), and temperature of 60-100 degrees.
  • Musty odors are a very common sign of mold growth.
  • Mold and mildew are two different forms of fungi. Mildew (surface mold) can easily be removed with soap and warm water.
  • Mold has a strong odor that typically smells like the following: Musty odor, wet leaves, dampness, aged wood, stuffy, stale and mildew.
  • November is the month where mold levels are the lowest due to lower humidity.
  • When ingested Activated Charcoal can help elevate mold poisoning.
  • Improving air flow in your home can prevent moisture build up and mold growth.
INDOOR AIR QUALITY


  • Plants help improve your indoor air quality. There are many kinds of indoor plants, but a specific few have the best affects on the indoor air. Read more here.
  • Furniture contains toxic chemicals that affect your indoor air quality.
  • Some candles contain harmful carcinogens that release toxins into the air when burned. Using soy candles or essential oils is a healthier and safer way to scent your home.
  • Make sure you have plenty of ventilation in your home. Use fans and open your windows often to allow fresh air into your space.
  • Use all natural cleaning products that don’t release harmful chemicals into the air. Bleach also gives off dangerous fumes that affect your respiratory system.
  • You can view your areas indoor air quality score by visiting the Earth Date Labs website.
  • Where you live can determine the air quality in your home based on air pollution.

ALLERGIES


  • Allergies effect many people and the cause could be something inside your home.
  • Common mold, dust, dust mites, cockroaches, furniture, cleaning products and more.
  • To find our ways to prevent allergy symtoms read our blog here.
  • Allergies sufferers are effected all year long, but July begins mold spore allergy season.

BLACK MOLD


  • Black mold is not actually just black. It can look gray and dark blue.
  • There are many different types of black mold, some are harmful and some are not.
  • Black mold is well known because it is the most common type of mold that forms in homes.
  • Black mold grows everywhere from on your food, in walls, and among vegetation including leaves.
  • One little known way to prevent mold growth in the shower is the use a squeegee.

MOLD AND PETS
  • Pets feel the negative effects of mold exposure more than people because their immune system is smaller and more sensitive than ours..
  • The best action to take when you find your pet is suffering from any of the above symptoms related to mold is to relocate them.
  • If you have an ill pet and have had water damage in your home, it’s best to let your veterinarian know if your home has been exposed to water damage whether it’s from a flood, roof leak, or a common household leak.
  • Take pets to the vet if you have mold to make sure they are not suffering from a mold-related illness and are continuing to be healthy.
  • mold and pets is very serious and for the sake of your little loved ones, should not be taken lightly.

What is water testing services?

Testing your water yearly is very important because water conditions frequently change and can cause long-term illnesses to those drinking and bathing in the water. Frequently, our water testing services are used to determine what is in homeowners’ water systems and if a treatment is necessary.


The two types of water testing services we offer are bacteria testing and well water testing. Our bacteria testing services guarantee results within 48 hours and well water testing results within 3-5 business days.


BACTERIA ANALYSIS TESTS FOR:

  • E Coli
  • Coliform

WELL WATER ANALYSIS TESTS FOR:

  • Metals
  • Minerals
  • Clarity
  • Bacteria
  • E Coli

MUST KNOW advice if your water comes from a well:

1. If your water passed testing when you moved in, you must get it checked again. Well water changes over time.
2. Just because no one has gotten sick, does not mean your water is safe. Bacterial illnesses develop over time and can be dangerous for you and your family.
3. Test your water YEARLY.
4. Even though your well water doesn’t smell, harmful contaminants could still be present. 

If you think you have a claim please contact Experienced Public Adjusters for a free evaluation. (407) 212-8669

What is Point of Origin Testing?

In areas where leak detection is not possible, we conduct a point of origin evaluation. Point of origin evaluation provides for a thorough assessment of the building envelop in order to locate the cause of water intrusion and or mold growth. Trained professionals will document all findings within a comprehensive report with photos. Inspectors are trained and certified in water & moisture intrusion, infra-red camera certified & licensed mold assessors through the Department of Business & Professional Regulation. Allow the best in the “test” industry to come evaluate your home or business to find the direct cause of your water or mold loss.

Do insurance companies and their field adjusters have to give you notice before arriving at your home?

Yes, Yes, Yes,  48 hours!!

  • The law states that company adjusters, independent adjusters, attorneys, investigators, or others acting on behalf of the insurer must give the insured, claimant, public adjuster or legal representative of the insured at least 48 hours notice that they need access to the damaged property. The insured or claimant can waive this notice.
  • https://www.myfloridacfo.com/division/agents/industry/news/pubadjregs.htm

How long does a carrier have to deny or pay my claim?

627.70131 Insurer’s duty to acknowledge communications regarding claims; investigation

(5)(a) Within 90 days after an insurer receives notice of an initial, reopened, or supplemental property insurance claim from a policyholder, the insurer shall pay or deny such claim or a portion of the claim unless the failure to pay is caused by factors beyond the control of the insurer which reasonably prevent such payment. Any payment of an initial or supplemental claim or portion of such claim made 90 days after the insurer receives notice of the claim, or made more than 15 days after there are no longer factors beyond the control of the insurer which reasonably prevented such payment, whichever is later, bears interest at the rate set forth in s. 55.03. Interest begins to accrue from the date the insurer receives notice of the claim. The provisions of this subsection may not be waived, voided, or nullified by the terms of the insurance policy. If there is a right to prejudgment interest, the insured shall select whether to receive prejudgment interest or interest under this subsection. Interest is payable when the claim or portion of the claim is paid. Failure to comply with this subsection constitutes a violation of this code. However, failure to comply with this subsection does not form the sole basis for a private cause of action.

If you want to read more please click on the link below:

http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0600-0699/0627/Sections/0627.70131.html

How long does my insurance company have to respond when they receive a communication about a claim?

The answer is 14 calendar days!

627.70131 Insurer’s duty to acknowledge communications regarding claims; investigation.

(1)(a) Upon an insurer’s receiving a communication with respect to a claim, the insurer shall, within 14 calendar days, review and acknowledge receipt of such communication unless payment is made within that period of time or unless the failure to acknowledge is caused by factors beyond the control of the insurer which reasonably prevent such acknowledgment. If the acknowledgment is not in writing, a notification indicating acknowledgment shall be made in the insurer’s claim file and dated. A communication made to or by an agent of an insurer with respect to a claim shall constitute communication to or by the insurer.

Does my insurance policy cover personal property in my home when there is smoke from a small fire?

A typical homeowner’s insurance policy will cover damage caused by wind, fire, and lightning. If your home is destroyed by a fire, then the insurance company needs to pay to build you a new home.

A typical insurance policy will also pay to replace or repair anything inside that home that may have been damaged by flames, smoke, soot, ash, and other byproducts of the fire.

Call Experienced Public Adjusters for a Free Claim Evaluation. (407) 212-8669

Why does the insurance company put my mortgage companies name on my settlement check for my home?

Because they have insurable interest in the home as well. Every bank has a different procedure to getting funds released. If you know you have a settlement check coming in you might want to call the back and see what documents you will need.

What is builders risk insurance?

Builder’s risk insurance is a special type of property insurance which protect the contractor (Insured) against damage to buildings while they are under construction.

Best Public Adjusters?

Since that is an opinion question I will provide my opinion. Experienced Public Adjusters has the best public adjusters in Florida.

Do we give a military discount?

YES!

We give a 5% discount off our contingency fee for active military and retired veterans. If you have a loss please contact us at (407) 212-8669

Water Intrusion?

Uncontrolled water intrusion into a building can stem from many sources. The most common sources include: Roof leaks and condensation forming above ceilings. Hurricane force winds breaking window seals and stucco, Pipe breaks (potable water, chilled water) … Moisture intrusion through the building envelope.

Public Adjusters in Florida?

How many Public Adjusters are there in Florida? This number has grown exponentially over the years. There is no data that could be located but I do know from my experience that when a Hurricane strikes there is not even close to the amount of Public Adjusters needed to help with insurance claims. Public Adjusters in Florida and local to your home is important. You do not want an out of state adjuster who may not know specific state statutes and codes. You also want one close so they dont delay your claim planning a full day to drive lets say for example from Georgia to Orlando, FL..Call Us Today (408-212-8669


Do most homeowners know what a Public Adjuster is?

I would say based on my experience the answer would be, “NO.”

I did a study to see what people would search for when someone must have mention they need to hire a public adjuster. These are some of the keywords they type into Google trying to find us.

  • Public Adjusters in Florida
  • Adjusters in Insurance
  • Fl Public Adjusters
  • Florida Public Adjusters
  • Adjusters
  • Public Adjusters Florida
  • Public Adjuster
  • Public Adjusters
  • Insurance Claim Adjuster
  • Independent  Insurance adjusters
  • Adjusters claims
  • Best public Adjusters
  • Independent Adjusters
  • Private Adjuster
  • licensed Public Adjuster
  • Private Adjusters
  • Licensed Public Adjusters
  • Experienced Public Adjusters (We like this one!)

If you ever suffer a loss and need an Experienced Public Adjuster give us a call today at (407) 212-8669

Florida Public Insurance Adjuster

What are the requirements to become a Florida Public Insurance Adjuster?

You can find all this information on the link below that will direct you to the Florida Department of Financial Services.

Click Here!

What does it mean to adjust a claim?

A Public Insurance Adjuster adjust a claim with and Insurance Company by negotiating an insurance claim and reaching a fair settlement that brings both parties to an agreement.

A Claims adjuster or Public Adjuster does not, and should not, engage in the practice of law.

Claims adjusters and Public Adjusters are to represent insured’s in first party insurance claims. A Public Adjuster or Claims Adjuster should never be involved in third party liability for property damage of others property and bodily injury.

What is Stachybotrys?

Stachybotrys is also known as “Toxic Black Mold”. It has the ability to produce mycotoxins which may cause a burning sensation in the mouth, throat, and nasal passages. Other symptoms stachybotrys may cause also include diarrhea, headaches, an memory loss. Stachybotrys forms on wet building materials .

When does the Atlantic Hurricane Season Start?

The Atlantic hurricane season starts June 1 and ends November 30.

When does the Pacific Hurricane Season Start?

The 2018 Pacific hurricane season is an ongoing event in the annual cycle of tropical cyclone formation. The season officially began on May 15 in the eastern Pacific, and on June 1 in the central Pacific; they will both end on November 30.

Hail Size Explained! What size hail will cause hail damage to your home or your business?

According to the National Oceanic and Atmospheric Administration, hail causes an average of $1 billion damage to crops and property each year; some years have exceeded more than $2 billion in damage.
Anyone whose property is struck by hail needs to have professionals check to make sure there is damage. Not all hail storms cause damage, Brennan says.  Pea sized hail (1/4 of an inch) or marble-sized hail (1/2 inch) might not cause damage. Anything larger, say a dime or a quarter (3/4 to one inch) can cause serious damage. Golf ball sized hail is 1 ¾ inches and softball-sized hail is 4 ½ inches according to NOAA.
Only a professional should evaluate the extent of the damage to your business or your home. Call an Experienced Public Adjuster for a free Hail Damage Claim evaluation. (407) 212-8669
Hail size explained

Pea = 1/4 inch diameterMarble/mothball = 1/2 inch diameter

Dime/Penny = 3/4 inch diameter – hail penny size or larger is considered severe

Nickel = 7/8 inch

Quarter = 1 inch

Ping-Pong Ball = 1 1/2 inch

Golf Ball = 1 3/4 inches

Tennis Ball = 2 1/2 inches

Baseball = 2 3/4 inches

Tea cup = 3 inches

Grapefruit = 4 inches

Softball = 4 1/2 inches

Source: National Oceanic and Atmospheric Administration

What does a Public Adjuster do?

public adjuster is a professional claims handler and claims adjuster who advocates for the policyholder or names insured’s in appraising and negotiating a claimant’s insurance claim. “Company Adjusters” or “Independent adjusters” can only legally represent the rights of an insurance company. A Public Adjuster is the only one who has the homeowner or business owners interest at heart. If you have suffered a loss call an Experienced Public Adjuster as soon as the you can. Call (407) 212-8669. We cover the entire State of Florida but we are headquartered in Orlando, Florida.

Is hiring a Public Adjuster a good idea?

It is always a good idea to have someone advocating for your best interest in an insurance claim. The more you are paid, the more the public adjuster will be paid.

What is an insurance rider?

An insurance endorsement is an amendment or addition to an existing insurance contract which changes or amends the terms or scope of the original policy. Endorsements are also be referred to as riders. An insurance endorsement may be used to add, delete, exclude or otherwise alter coverage.

How fast can mold grow from moisture or water damage?

According to a Fema mold brochure, “Mold growths, or colonies, can start to grow on a damp surface withing 24-48 hours!

Dealing With MOLD & MILDEW IN YOUR FLOOD DAMAGED HOME

The Problem with Mold
Mildew and molds are fungi – simple microscopic organisms that thrive anywhere there is a moist environment. Molds are a necessary part of the environment; without them, leaves would not decay and aspects of soil enrichment could not take place. It is their ability to destroy organic materials, however, that makes mold a problem for people – in our homes and in our bodies.
Mildew (mold in early stage) and molds grow on wood products, ceiling tiles, cardboard, wallpaper, carpets, drywall, fabric, plants, foods, insulation, decaying leaves and other organic materials. Mold growths, or colonies, can start to grow on a damp surface within 24 to 48 hours. They reproduce by spores – tiny, lightweight “seeds”- that travel through the air. Molds digest organic material, eventually destroying the material they grow on, and then spread to destroy adjacent organic material. In addition to the damage molds can cause in your home, they can also cause mild to severe health problems. See the HEALTH section to check for possible mold-related health problems.

Mold in Your home?
If your home has water damage due to –
flooding,
• sewage back-up from flooding in the area,
• plumbing or roof leaks,
• damp basement or crawl space,
• overflows from sinks or bathtub, or
• high humidity: steam cooking, dryer vents, humidifiers,
mildew and mold will develop within 24-48 hours of water exposure.
Even worse, it will continue to grow until steps are taken to eliminate the
source of moisture, and effectively deal with the mold problem.

https://www.fema.gov/pdf/rebuild/recover/fema_mold_brochure_english.pdf

If you notice mold its important to understand where the moisture is coming from in order to report a cause of loss when filing an insurance claim. If you have water damage or you notice mold it would be in your best interest to call a Experienced Public Adjuster for a free claim evaluation before filing a claim.

Contact us today! (407) 212-8669

Where Did Hurricane Irma Make Landfall?

Where Did Hurricane Irma Make Landfall?

On September 10th, 2017 Hurricane Irma first made landfall on Cudjoe Key in southern Florida early Sunday morning, bringing Category 4 winds that reached 130 miles per hour. Irma tore through south Florida before turning up the west coast of the state, with forecasters predicting the eye would hit the Naples-Fort Myers area.
Do you still need a Florida Public Adjuster? Call (407) 212-8669

What is a tropical cyclone?

A tropical cyclone is a rapidly rotating storm system characterized by a low-pressure center, a closed low-level atmospheric circulation, strong and high speed winds, and a spiral arrangement of thunderstorms that produce heavy rain. Depending on its strength and location, a tropical cyclone is referred to by different names, including hurricane, typhoon, tropical storm, tropical depression, cyclonic storm,  and simply cyclone. A hurricane is a tropical cyclone that occurs in the Atlantic Ocean and northeastern Pacific Ocean, and a typhoon occurs in the northwestern Pacific Ocean; while in the south Pacific or Indian Ocean, comparable storms are referred to simply as “tropical cyclones” or “severe cyclonic storms”.

What is insurance mediation?

Insurance mediation refers to the process of settling disputes arising from certain types of insurance claims. The dispute will be between the insured and the insurer. This is usually non-binding and if a settlement offer that is fair is not reached then usually the next step for the insured is litigation.

Have an professional advocate on your side. Contact us at Experienced Public Adjusters. (407) 212-8669

What is the most dangerous types of mold?

Black mold is the used as a name for the most harmful mold species, which happen to be appear black in appearance. However, even molds of a different color can be toxic and dangerous to the human body. … They are Cladosporium,, Fusarium, Aspergillus, Stachybotrys and Penicilium.

What Is A Mold Protocol For?

What Is A Mold Protocol?

Mold Protocol outlines the needed actions for any necessary mold remediation. Each plan is individually prepared based on the Indoor Mold Hygenists Mold Assessment of the property the size and area of the mold contamination.

Once the remediation is complete a Hygienist will do an addition test and provide a PRV clearance report. The Post Remediation Verification report will document the home is safe and clear from mold.

What Is An Insurance Endorsement?

An insurance endorsement is an amendment to an existing insurance contract which changes the terms or scope of the original policy.Endorsements may also be referred to as insurance policy riders. An insurance endorsement may be used to add, delete, exclude or otherwise alter coverage.

It important to review and endorsement listed when they send you a bill for your annual renewal. You may lose coverage and not know it.

If you don’t understand your policy it would be a good idea to have a review with your insurance agent. If your loss has already occurred you should call a Public Adjuster to review your coverage’s available for your loss.

Contact Us Today! Experience Public Adjusters (407) 212-8669

Is mold in my home dangerous?

It can be dangerous. The degree of risk depends on numerous factors, including the type of mold (some strains are more hazardous to your health than others, although it’s not good for you to be inhaling any type of mold spores), the amount of mold, whether or not you’re allergic to mold, and the state of your health and the health of your family members. Health problems commonly associated with household mold include coughing, sneezing, sore throat, runny nose, headaches or migraines, sinus infections, pneumonia and asthma attacks. Infants, elderly people and those with respiratory disorders like asthma or emphysema are most susceptible to mold-related health problems, but even healthy young adults can be affected.

What is the best way to test for mold?

You can purchase test kits that allow you to test your home for mold, but we recommend calling in an expert instead. Certified mold testers are trained to locate all traces of mold in a home and they can also tell you what strains of mold are present. Do-it-yourself mold tests aren’t always accurate and many require you to send samples to a lab to find out what strains of mold are present, at significant extra cost. Hiring a professional for the job simply provides better results.

How do I know if I have black mold?

You will SMELL it and/or SEE it.

Black mold can be gray, green and sometimes look dark blue. It forms in clusters and can sometimes look slimy, fluffy growing outward, and spotty.

It can sometimes and very frequently give off a musty and damp odor.

What are obvious signs of mold other than a musty odor?

Obvious signs of mold in your home include cracking paint, water stains (brown stains on the ceiling), rust, warped ceilings, walls, and dust.

What is black mold?

Black mold is one of the most common types of mold that forms in homes. Other names for common black mold is stachybotrys chartarum, and toxic black mold. Black mold comes in many different species and classifications.

What does an electrical engineer do?

Evaluates electrical systems, products, components, and applications by designing and conducting research programs; applying knowledge of electricity and materials. Confirms system’s and components’ capabilities by designing testing methods; testing properties.

When filing and insurance claim when can hiring one become important to win your claim?

Lightning Strike

Power Surges

Power Outage

Call a Public Adjuster for an evaluation and they will guide you through the process. They will usually know when you may require and electrical engineer.

What temperature and humidity grows mold?

Mold generally does not grow in cold environments. Warm, humid conditions are ideal for mold growth. Most molds need temperature of 70 degrees Fahrenheit or more to grow.

Will mold grow when humidity rises above 50%

Several mold species have been associated with asthma, including Alternaria, Cladosporium, Aspergillus and Penicillium.  Humidity levels above 55 percent can allow mold to grow, although levels of 70 percent are more ideal for mold growth. Keeping your house air conditioned in warm climates can help keep the humidity levels safe from mold. But not if you set your air conditioning at 90 degrees.

What is a 1st Party Claim?

first party insurance claim is one that you file with your own insurance company. A third party insurance claim is one that you file with the insurance company of another person or entity, such as a business. The type of claim you should file depends on who was at fault in your accident.

What is a 3rd Party Claim?

first party insurance claim is one that you file with your own insurance company. A third party insurance claim is one that you file with the insurance company of another person or entity, such as a business. The type of claim you should file depends on who was at fault in your accident.

How do you get insurance claim help?

You need an Orlando Public Adjuster or a Florida Public Adjuster to advocate for your best interests. You can compare it to going to court. You would not want to be accused of a crime without having an attorney represent you right? Or you would not want to file a lawsuit against someone without an attorney representing you? Why would you want to file a claim with a private insurance company that is responsible for profit for their owners or shareholders. They do not in most cases have your best interest at heart.

A public adjuster is a professional claims handler who advocates for the policyholder in appraising and negotiating a claimant’s insurance claim. Aside from attorneys and the broker of record, public adjusters licensed by The Florida Department of Financial Services are the only type of claims adjuster that can legally represent the rights of an insured during an insurance claim process. A public adjuster will be most beneficial when it is clear that the insurer will pay the claim and the only issue is the proper identification and valuation of the loss. Most public adjusters charge a percentage of the settlement. Primarily they appraise the damage, prepare an estimate and other claim documentation, read the policy of insurance to determine coverage’s, and negotiate with the insurance company’s claims handler.

A public adjuster is a representative of the policyholder who advises, manages, and submits a claim to the policyholder’s insurance company.

Orlando  Public Adjusters

Experienced Public Adjusters is a qualified and expert public adjusting company located in Orlando, which provides service to individuals homeowners and business property owners to resolve their insurance claims.

Corporate Headquarters

1215 Mt Vernon Street
Orlando, FL 32803
Phone: (407) 212-8669

Orlando is one of the largest city in Florida and resides in Orange County. There are over 500,000 households in Orange County alone. Public Adjusters in our Orlando Headquarters cover most of the Central Florida region. Our staff works in conjunction with engineers, accountants, lawyers and other experts to make sure to get you the maximum compensation for your damages. Our dedicated team of professionals is here to alleviate the burden associated with the insurance claim process. We enjoy working with our customers and look forward to meeting with you. We understand that time is a critical factor for all of us.

It’s vital to know what we do and how we’re unlike other insurance company adjusters. When you file a claim with your insurance provider, you must follow strict rules and regulations in order to get your claim approved. Insurance company adjusters work on behalf of the insurance provider and will do everything they can to make sure that they are working in the insurance company’s best interest. When you file a claim with an expert public adjuster, however, we work on your behalf. We understand the complex rules and regulations and are able to cut the Gordian knot to get most cases accepted and resolved quickly. We follow through on claims from start to finish, and have experience doing it. We’re easily available for your questions before and after you begin working with us.

While no one ever wants anything bad to happen to their home or business, it’s important to know what to expect and who you should contact first to make your home safe, secure, and repaired. We’re always available for you and handle the claim from start to finish. Because we understand the value of your home, we go above and beyond to settle your claims quickly and easily, so you can get back to feeling safe and secure with your loved ones. You can always count on us, when you need help.

About Us:

  • We Work with you from Start to Finish.
  • We Handle Most All Claims – Big or Small.
  • We Are Florida State Licensed, and Bonded and Insured.
  • We Work on Your Behalf – Not The Insurance Provider.
  • We Provide More Assistance in Your Time of Need

 Various Claim Types We Handle

Mission Statement

“Experienced Public Adjusters goal is to offer insurance adjusting services with the highest levels of customer service and satisfaction with ethics and integrity. We provide homeowner’s and business owners the ability to maximize and reach a fair settlement. We accomplish this by hiring the quality adjusters, providing high levels of training, and employing courteous and professional employee’s.”

Vision Statement

Experienced Public Adjusters will be the industry leader throughout the southeastern United States.

Core Values

  • Ethic
  • Integrity
  • Commitment to Clients
  • Communication
  • Honesty
  • Unselfishness
  • Self-Discipline
  • Self-Respect
  • Accountability
  • Dedication to Others
  • Strong Work Ethic

Contact Us Today! (407) 212-8669

How Do I Become A Florida Public Adjuster?

RESIDENT PUBLIC ADJUSTER LICENSE

TYPE AND CLASS:
3-20 Resident Public Adjuster License


Common Use(s) of License:

A “public adjuster” is any person, except a duly licensed attorney at law as exempted under s. 626.860, who, for money, commission, or any other thing of value, prepares, completes, or files an insurance claim form for an insured or third-party claimant or who, for money, commission, or any other thing of value, acts on behalf of, or aids an insured or third-party claimant in negotiating for or effecting the settlement of a claim or claims for loss or damage covered by an insurance contract or who advertises for employment as an adjuster of such claims. The term also includes any person who, for money, commission, or any other thing of value, solicits, investigates, or adjusts such claims on behalf of a public adjuster.


STEPS TO OBTAIN 3-20 RESIDENT PUBLIC ADJUSTER LICENSE:

Step 1 – You must be:

  • A natural person at least 18 years of age.
  • A resident of Florida or maintain a principle places of business in Florida.
  • A United States citizen or legal alien who possesses a work authorization from the United States Immigration and Naturalization Services. [Click here for more information]
  • Not hold a resident license in another state.

Step 2 – Must have the following prerequisite(s) before applying:

  • Has been licensed in this state as an all-lines adjuster, and has been appointed on a continual basis for the previous 6 months as a public adjuster apprentice under s. 626.8561, as an independent adjuster under s. 626.855, or as a company employee adjuster under s. 626.856.[Requires State Examination]
    AND
  • File an original fifty thousand-dollar ($50,000) surety bond, using a bond form provided by the Department. [Click here for Bond Form]

Mail original bond to:
Department of Financial Services
Bureau of Licensing, Room 419
200 East Gaines Street
Tallahassee, FL 32399-0319

Step 3 – Apply:

Step 4- Fingerprints:

Step 5- Examination:

  • Upon approval, an email will be sent to you directing you to check your messages in your MyProfile account. Messages are where you may view your notifications from the department, such as an authorization for an examination. Follow the message’s instructions to schedule the examination.
    [Click here for the Exam Information page]

Step 4- Status notification(s):

  • Once an application has been submitted, you may check your MyProfile account for the status of your application. Deficiencies will be listed under the pending license type.
  • Once all the above steps have been satisfied, the department will send your approval by email. You may then go to your MyProfile account and click the “Wallet” and/or “Letter” hyperlink(s), under the “Print Licenses” section, to generate a copy of your license for printing.
  • Note: If you are required to take an examination, you will not be able to print your license until the department has received a passing result from the testing vendor.

Special Note:

  • Attorneys at law duly licensed to practice law in the courts of this state, and in good standing with The Florida Bar are exempt from having to obtain a license per s. 626.860, Florida Statutes. Note: This does not exempt attorneys from the state examination if an adjuster license is applied for.
  • Upon licensure, a public adjuster must be appointed in his or her own name, or by a public adjuster or a public adjusting firm. A public adjuster can only have one appointment.
  • Cannot hold more than one adjuster license at a time.
  • Continuing Education (CE) Requirement: 24 hours due bi-annually by end of licensee’s birth month. When the CE requirement has been generated, the requirement can be viewed in licensee’s MyProfile account. Section 626.2815, Florida Statutes. Public adjuster level courses are designated as CE3-20 and CE5-320 only.  Additional information can be found on our Continuing Education page.
  • Appointment of License: This license requires an appointment to be active. Section 626.112(1)(a), Florida Statutes.  An adjuster can only hold one appointment at a time.
  • Expiration of License: This license will expire if unappointed for 48 months. Section 626.431(3), Florida Statutes.
  • Third party access must be authorized by the licensee through MyProfile in order for the third party to manage the licensing submissions and changes on behalf of the licensee.
  • Related Florida Statutes:  626.854, 626.865

https://www.myfloridacfo.com/division/agents/licensure/general/docs/3-series.htm

What Can A Public Adjuster Do For You?

What Can A Public Adjuster Do For You?

Most public adjusters charge a percentage of the settlement. Primarily they appraise the damage, read the policy of insurance to determine coverage’s, prepare an estimate and other claim documentation,  and negotiate with the insurance company’s claims handler.

What is an Assessor?

An Assessor is a person who calculates the value of something like a car, house, jewelry, etc…

What is comprehensive?

Comprehensive Insurance usually means all-inclusive; providing complete protection.

What is liability insurance?

Insurance protecting a person for anything for which a person is liable or responsible for causing a loss. This loss could be emotional, physical, financial, etc….

What is a Loss Adjuster?

Loss Adjuster

A Loss Adjuster is a person who assesses the amount of compensation arising from an insurance claim.

What is a policyholder?

Policyholder

A Policyholder is the person to whom an insurance policy is issued.

What is a premium?

A premium is your consideration a payment, usually monthly, yearly etc, for an insurance policy. Their consideration is the language and coverage’s offered in exchange for your premium.

What is reinsurance?

Reinsurance is the insuring of risk by one insurance company with another.

What Are Some Common Glossary Terms and Their Definitions?

GLOSSARY OF INSURANCE TERMS

This page provides a glossary of insurance terms and definitions that are commonly used in the insurance business. New terms will be added to the glossary over time.

The definitions in this glossary are developed by the NAIC Research and Actuarial Department staff based on various insurance references. These definitions represent a common or general use of the term. Some words and/or phrases may be defined differently by other entities, or used in a context such that the definition shown may not be applicable.

A

Accident – an unexpected event or circumstance without deliberate intent.

Accident Insurance – insurance for unforeseen bodily injury.

Accident Only – an insurance contract that provides coverage, singly or in combination, for death, dismemberment, disability, or hospital and medical care caused by or necessitated as a result of accident or specified kinds of accident.

Accident Only or AD&D – policies providing coverage, singly or in combination, for death, dismemberment, disability, or hospital and medical care caused by or necessitated as a result of accident or specified kinds of accidents. Types of coverage include student accident, sports accident, travel accident, blanket accident, specific accident or accidental death and dismemberment (AD&D).

Accidental Bodily Injury – unexpected injury to a person.

Accidental Death & Dismemberment – an insurance contract that pays a stated benefit in the event of death and/or dismemberment caused by accident or specified kinds of accidents.

Accumulation Period – period of time insured must incur eligible medical expenses at least equal to the deductible amount in order to establish a benefit period under a major medical expense or comprehensive medical expense policy.

Actual Cash Value – repayment value for indemnification due to loss or damage of property; in most cases it is replacement cost minus depreciation

Actuarial Report – (PC Insurance)a document or other presentation, prepared as a formal means of conveying to the state regulatory authority and the Board of Directors, or its equivalent, the actuary’s professional conclusions and recommendations, of recording and communicating the methods and procedures, of assuring that the parties addressed are aware of the significance of the actuary’s opinion or findings and that documents the analysis underlying the opinion. (In Life and Health) this document would be called an “Actuarial Memorandum.”

Actuary – business professional who analyzes probabilities of risk and risk management including calculation of premiums, dividends and other applicable insurance industry standards.

Adjuster – a person who investigates claims and recommends settlement options based on estimates of damage and insurance policies held.

Admission – hospital inpatient care for any medical condition.

Admitted Assets – insurer assets which can be valued and included on the balance sheet to determine financial viability of the company.

Admitted Company – an insurance company licensed to do business in a state(s), domiciled in an alternative state or country.

Advance Premiums – occur when a policy has been processed, and the premium has been paid prior to the effective date. These are a liability to the company and not included in written premium or the unearned premium reserve.

Adverse Selection – the social phenomenon whereby persons with a higher than average probability of loss seek greater insurance coverage than those with less risk.

Advisory Organization – a group supported by member companies whose function is to gather loss statistics and publish trended loss costs.

Affiliate – a person or entity that directly, or indirectly, through one or more other persons or entities, controls, is controlled by or is under common control with the insurer.

Agent – an individual who sells, services, or negotiates insurance policies either on behalf of a company or independently.

Aggregate – the maximum dollar amount or total amount of coverage payable for a single loss, or multiple losses, during a policy period, or on a single project.

Aggregate Cost Payments – method of reimbursement of a health plan with a corporate entity that directly provides care, where (1) the health plan is contractually required to pay the total operating costs of the corporate entity, less any income to the entity from other users of services, and (2) there are mutual unlimited guarantees of solvency between the entity and the health plan that put their respective capital and surplus at risk in guaranteeing each other.

Aircraft – coverage for aircraft (hull) and their contents; aircraft owners’ and aircraft manufacturers liability to passengers, airports and other third parties.

ALAE – an estimate of the claims settlement associated with a particular claim or claims.

Alien Company – an insurance company formed according to the laws of a foreign country. The company must conform to state regulatory standards to legally sell insurance products in that state.

Allied Lines – coverages which are generally written with property insurance, e.g., glass, tornado, windstorm and hail; sprinkler and water damage; explosion, riot, and civil commotion; growing crops; flood; rain; and damage from aircraft and vehicle, etc.

All-Risk – also known as open peril, this type of policy covers a broad range of losses. The policy covers risks not explicitly excluded in the policy contract.

Alternative Workers’ Compensation – other than standard workers’ compensation coverage, employer’s liability and excess workers’ compensation (e.g., large deductible, managed care).

Ambulatory Services – health services provided to members who are not confined to a health care institution. Ambulatory services are often referred to as “outpatient” services.

Annual Statement – an annual report required to be filed with each state in which an insurer does business. This report provides a snapshot of the financial condition of a company and significant events which occurred throughout the reporting year.

Annuitant – the beneficiary of an annuity payment, or person during whose life and annuity is payable.

Annuities – Immediate Non-variable – an annuity contract that provides for the fixed payment of the annuity at the end of the first interval of payment after purchase. The interval may vary, however the annuity payouts must begin within 13 months.

Annuity – a contract providing income for a specified period of time, or duration of life for a person or persons.

Appraisal – an estimate of value.

Arbitration – a binding dispute resolution tactic whereby a conciliator with no interest in the outcome intercedes.

Assessed Value – estimated value for real or personal property established by a taxing entity

Asset – probable future economic benefits obtained or controlled by a particular entity as a result of past transactions or events. An asset has three essential characteristics: It embodies a probable future benefit that involves a capacity, singly or in combination with other assets, to contribute directly or indirectly to future net cash inflows; A particular entity can obtain the benefit and control others’ access to it; and The transaction or other event-giving rise to the entity’s right to or control of the benefit has already occurred.

Asset Risk – in the risk-based capital formula, risk assigned to the company’s assets.

Assigned Risk – A governmental pool established to write business declined by carriers in the standard insurance market.

Assisted Living Care – a policy or rider that provides coverage only while a policyholder is confined to an assisted living facility and meets the policy requirements for coverage.

Assumed Reinsurance – the assumption of risk from another insurance entity within a reinsurance agreement or treaty.

Authorized Company – an insurer licensed or admitted to do business in a particular state.

Authorized Control Level Risk Based Capital – theoretical amount of capital plus surplus an insurance company should maintain.

Authorized Reinsurance – reinsurance placed with a reinsurer who is licensed or otherwise allowed to conduct reinsurance within a state.

Auto Liability – coverage that protects against financial loss because of legal liability for motor vehicle related injuries (bodily injury and medical payments) or damage to the property of others caused by accidents arising out of ownership, maintenance or use of a motor vehicle (including recreational vehicles such as motor homes). Commercial is defined as all motor vehicle policies that include vehicles that are used primarily in connection with business, commercial establishments, activity, employment, or activities carried on for gain or profit. No Fault is defined by the state concerned.

Auto Physical Damage – motor vehicle insurance coverage (including collision, vandalism, fire and theft) that insures against material damage to the insured’s vehicle. Commercial is defined as all motor vehicle policies that include vehicles that are used in connection with business, commercial establishments, activity, employment, or activities carried on for gain or profit.

Automobile Liability Insurance – coverage for bodily injury and property damage incurred through ownership or operation of a vehicle.

B

Balance Sheet – accounting statement showing the financial condition of a company at a particular date.

BCEGS – Building Code Effectiveness Grading Schedule – classification system for assessment of building codes per geographic region with special emphasis on mitigation of losses from natural disasters.

Beneficiary – an individual who may become eligible to receive payment due to will, life insurance policy, retirement plan, annuity, trust, or other contract.

Benefits (Medical & Hospital Expenses) – total expenditures for health care services paid to or on behalf of a member.

Blanket coverage – coverage for property and liability that extends to more than one location, class of property or employee.

Boatowners/Personal Watercraft – covers damage to pleasure boats, motors, trailers, boating equipment and personal watercraft as well as bodily injury and property damage liability to others.

Bodily Injury – physical injury including sickness or disease to a person.

Boiler & Machinery or Equipment Breakdown & Machinery – coverage for the failure of boilers, machinery and other electrical equipment. Benefits include (i) property of the insured, which has been directly damaged by the accident; (ii) costs of temporary repairs and expediting expenses; and (iii) liability for damage to the property of others. Coverage also includes inspection of the equipment.

Bonds – a form of debt security whereby the debt holder has a creditor stake in the company. Obligations issued by business units, governmental units and certain nonprofit units having a fixed schedule for one or more future payments of money; includes commercial paper, negotiable certificates of deposit, repurchase agreements and equipment trust certificates.

Book Value – original cost, including capitalized acquisition costs and accumulated depreciation, unamortized premium and discount, deferred origination and commitment fees, direct write-downs, and increase/decrease by adjustment.

Broker – an individual who receives commissions from the sale and service of insurance policies. These individuals work on behalf of the customer and are not restricted to selling policies for a specific company but commissions are paid by the company with which the sale was made.

Builders’ Risk Policies – typically written on a reporting or completed value form, this coverage insures against loss to buildings in the course of construction. The coverage also includes machinery and equipment used in the course of construction and to materials incidental to construction.

Burglary and Theft – coverage for property taken or destroyed by breaking and entering the insured’s premises, burglary or theft, forgery or counterfeiting, fraud, kidnap and ransom, and off-premises exposure.

Business Auto – coverage for motor vehicles, other than those in the garage business, engaged in commerce. Business auto filings include singularly or in any combination coverage such as the following: Auto Liability, PIP, MP, Uninsured Motorist and/or Underinsured Motorists (UM/UIM); Specified Causes of Loss, Comprehensive, and Collision.

Business Interruption – loss of income as a result of property damage to a business facility.

Business owners Policy – business insurance typically for property, liability and business interruption coverage.

C

Calendar Year Deductible – in health insurance, the amount that must be paid by the insured during a calendar year before the insurer becomes responsible for further loss costs.

Capital and Surplus – a company’s assets minus its liabilities.

Capital and Surplus Requirement – statutory requirement ordering companies to maintain their capital and surplus at an amount equal to or in excess of a specified amount to help assure the solvency of the company by providing a financial cushion against expected loss or misjudgments and generally measured as a company’s admitted assets minus its liabilities, determined on a statutory accounting basis.

Capital Gains (Loss) – excess (deficiency) of the sales price of an asset over its book value. Calculated on the basis of original cost adjusted, as appropriate, for accrual of discount or amortization of premium and for depreciation.

Capitation Arrangement – a compensation plan used in connection with some managed care contracts where a physician or other medical provider is paid a flat amount, usually on a monthly basis, for each subscriber who has elected to use that physician or medical provider. Capitated payments are sometimes expressed in terms of a “per member/per month” payment. The capitated provider is generally responsible, under the conditions of the contract, for delivering or arranging for the delivery of all contracted health services required by the covered person.

Captive Agent – an individual who sells or services insurance contracts for a specific insurer or fleet of insurers.

Captive Insurer – an insurance company established by a parent firm for the purpose of insuring the parent’s exposures.

Carrying Value (Amount) – the SAP book value plus accrued interest and reduced by any valuation allowance and any nonadmitted adjustment applied to the individual investment.

Cash – a medium of exchange.

Cash Equivalent – short-term, highly liquid investments that are both (a) readily convertible to known amounts of cash, and (b) so near their maturity that they present insignificant risk of changes in value because of changes in interest rates. Investments with original maturities of three months or less qualify under this definition.

Casualty Insurance – a form of liability insurance providing coverage for negligent acts and omissions such as workers compensation, errors and omissions, fidelity, crime, glass, boiler, and various malpractice coverages.

Catastrophe Bonds – Bonds issued by an insurance company with funding tied to the company’s losses from disasters, or acts of God. A loss exceeding a certain size triggers a reduction in the bond value or a change in the bond structure as loss payments are paid out of bond funds.

Catastrophe Loss – a large magnitude loss with little ability to forecast.

Ceded Premium – amount of premium (fees) used to purchase reinsurance.

Ceding Company – an insurance company that transfers risk by purchasing reinsurance.

Centers for Medicare & Medicaid Services (CMS) – U.S. governmental agency responsible for the licensing of federally qualified HMOs. This was formerly the Health Care Financing Administration.

Change in Valuation Basis – a change in the interest rate, mortality assumption or reserving method or other factors affecting the reserve computation of policies in force.

Chartered Life Underwriter (CLU) – a professional designation awarded by the American College to persons in the life insurance field who pass a series of exams in insurance, investment, taxation, employee benefit plans, estate planning, accounting, management, and economics.

Chartered Property Casualty Underwriter (CPCU) – a professional designation awarded by the American Institute of Property and Casualty Underwriters to persons in the property and liability insurance field who pass a series of exams in insurance, risk management, economics, finance, management, accounting, and law. Designates must also have at least three years experience in the insurance business or related field.

Claim – a request made by the insured for insurer remittance of payment due to loss incurred and covered under the policy agreement.

Claims Adjustment Expenses – costs expected to be incurred in connection with the adjustment and recording of accident and health, auto medical and workers’ compensation claims.

Claims-made Form – A type of liability insurance form that only pays if the both event that causes (triggers)the claim and the actual claim are submitted to the insurance company during the policy term

Class Rating – a method of determining rates for all applicants within a given set of characteristics such as personal demographic and geographic location.

Coinsurance – A clause contained in most property insurance policies to encourage policy holders to carry a reasonable amount of insurance. If the insured fails to maintain the amount specified in the clause (Usually at least 80%), the insured shares a higher proportion of the loss. In medical insurance a percentage of each claim that the insured will bear.

Collar – an agreement to receive payments as the buyer of an Option, Cap or Floor and to make payments as the seller of a different Option, Cap or Floor.

Collateral Loans – unconditional obligations for the payment of money secured by the pledge of an investment.

Collateralized Bond Obligations (CBOs) – an investment-grade bond backed by a pool of low-grade debt securities, such as junk bonds, separated into tranches based on various levels of credit risk.

Collateralized Mortgage Obligations (CMOs) – a type of mortgage-backed security (MBS) with separate pools of pass-through security mortgages that contain varying classes of holders and maturities (tranches) with the advantage of predictable cash flow patterns.

Combinations – a special form of package policy composed of personal automobile and homeowners insurance.

Combined Ratio – an indication of the profitability of an insurance company, calculated by adding the loss and expense ratios.

Commencement Date – date when the organization first became obligated for any insurance risk via the issuance of policies and/or entering into a reinsurance agreement. Same as “effective date” of coverage.

Commercial Auto – coverage for motor vehicles owned by a business engaged in commerce that protects the insured against financial loss because of legal liability for motor vehicle related injuries, or damage to the property of others caused by accidents arising out of the ownership, maintenance, use, or care-custody & control of a motor vehicle. This includes Commercial Auto Combinations of Business Auto, Garage, Truckers and/or Other Commercial Auto.

Commercial Earthquake – earthquake property coverage for commercial ventures.

Commercial Farm and Ranch – a commercial package policy for farming and ranching risks that includes both property and liability coverage. Coverage includes barns, stables, other farm structures and farm inland marine, such as mobile equipment and livestock.

Commercial Flood – separate flood insurance policy sold to commercial ventures.

Commercial General Liability – flexible & broad commercial liability coverage with two major sub-lines: premises/operations sub-line and products/completed operations sub-line.

Commercial Mortgage-Backed Securities – a type of mortgage-backed security that is secured by the loan on a commercial property.

Commercial Multiple Peril – policy that packages two or more insurance coverages protecting an enterprise from various property and liability risk exposures. Frequently includes fire, allied lines, various other coverages (e.g., difference in conditions) and liability coverage. Such coverages would be included in other annual statement lines, if written individually. Include under this type of insurance multi-peril policies (other than farmowners, homeowners and automobile policies) that include coverage for liability other than auto.

Commercial Package Policy – provides a broad package of property and liability coverages for commercial ventures other than those provided insurance through a business owners policy.

Commercial Property – property insurance coverage sold to commercial ventures.

Commission – a percentage of premium paid to agents by insurance companies for the sale of policies.

Community Rating – a rating system where standard rating is established and usually adjusted within specific guidelines for each group on the basis of anticipated utilization by the group’s employees.

Company Code – a five-digit identifying number assigned by NAIC, assigned to all insurance companies filing financial data with NAIC.

Completed Operations Liability – policies covering the liability of contractors, plumbers, electricians, repair shops, and similar firms to persons who have incurred bodily injury or property damage from defective work or operations completed or abandoned by or for the insured, away from the insured’s premises.

Comprehensive (Hospital and Medical) – line of business providing for medical coverages; includes hospital, surgical, major medical coverages; does not include Medicare Supplement, administrative services (ASC) contracts, administrative services only (ASO) contracts, federal employees health benefit plans (FEHBP), medical only programs, Medicare and Medicaid programs, vision only and dental only business.

Comprehensive General Liability (CGL) – coverage of all business liabilities unless specifically excluded in the policy contract.

Comprehensive Personal Liability – comprehensive liability coverage for exposures arising out of the residence premises and activities of individuals and family members. (Non-business liability exposure protection for individuals.)

Comprehensive/Major Medical – policies that provide fully insured indemnity, HMO, PPO, or Fee for Service coverage for hospital, medical, and surgical expenses. Coverage excludes Short-Term Medical Insurance, the Federal Employees Health Benefit Program and non-comprehensive coverage such as basic hospital only, medical only, hospital confinement indemnity, surgical, outpatient indemnity, specified disease, intensive care, and organ and tissue transplant coverage.

Concurrent Causation – property loss incurred from two or more perils in which only one loss is covered but both are paid by the insurer due to simultaneous incident.

Conditions – requirements specified in the insurance contract that must be upheld by the insured to qualify for indemnification.

Condos – homeowners insurance sold to condominium owners occupying the described property.

Construction and Alteration Liability – covering the liability of an insured to persons who have incurred bodily injury or property damage from alterations involving demolition, new construction or change in size of a structure on the insured’s premises.

Contingency Reserves – required by some jurisdictions as a hedge against adverse experience from operations, particularly adverse claim experience.

Contingent Liability – the liability of an insured to persons who have incurred bodily injury or property damage from work done by an independent contractor hired by the insured to perform work that was illegal, inherently dangerous, or directly supervised by the insured

Continuation of Care Requirement – statutory or contractual provision requiring providers to deliver care to an enrollee for some period following the date of a Health Plan Company’s insolvency.

Continuing Care Retirement Communities – senior housing arrangements that in addition to housing include some provision for skilled nursing care.

Contract Reserves – reserves set up when, due to the gross premium structure, the future benefits exceed the future net premium. Contract reserves are in addition to claim and premium reserves.

Contractual Liability – liability coverage of an insured who has assumed the legal liability of another party by written or oral contract. Includes a contractual liability policy providing coverage for all obligations and liabilities incurred by a service contract provider under the terms of service contracts issued by the provider.

Convertible Term Insurance Policy – an insurance policy that can be converted into permanent insurance without a medical assessment. The insurer is required to renew the policy regardless of the health of the insured subject to policy conditions.

Coordination of Benefits (COB) – provision to eliminate over insurance and establish a prompt and orderly claims payment system when a person is covered by more than one group insurance and/or group service plan.

Copay – a cost sharing mechanism in group insurance plans where the insured pays a specified dollar amount of incurred medical expenses and the insurer pays the remainder.

Corrective Order – commissioner’s directive of action to be completed by an insurer.

Covered Lives – The total number of lives insured, including dependents, under individual policies and group certificates.

Credit – individual or group policies that provide benefits to a debtor for full or partial repayment of debt associated with a specific loan or other credit transaction upon disability or involuntary unemployment of debtor, except in connection with first mortgage loans.

Credit – Assumption Agreement – an insurance certificate issued on an existing insurance contract indicating that another insurer has assumed all of the risk under the contract from the ceding insurance company.

Credit – Credit Default – coverage purchased by manufacturers, merchants, educational institutions, or other providers of goods and services extending credit, for indemnification of losses or damages resulting from the nonpayment of debts owed to them for goods or services provided in the normal course of their business.

Credit – Involuntary Unemployment – makes loan/credit transaction payments to the creditor when the debtor becomes involuntarily unemployed.

Credit Accident and Health (group and individual) – coverage provided to or offered to borrowers in connection with a consumer credit transaction where the proceeds are used to repay a debt or an installment loan in the event the consumer is disabled as the result of an accident, including business not exceeding 120 months duration.

Credit Disability – makes monthly loan/credit transaction payments to the creditor upon the disablement of an insured debtor.

Credit Health Insurance – policy assigning creditor as beneficiary for insurance on a debtor thereby remitting balance of payment to creditor should the debtor become disabled.

Credit Involuntary Unemployment – credit insurance that provides a monthly or lump sum benefit during an unpaid leave of absence from employment resulting from specified causes, such as layoff, business closure, strike, illness of a close relative and adoption or birth of a child. This insurance is sometimes referred to as Credit Family Leave.

Credit Life Insurance – policy assigning creditor as beneficiary for insurance on a debtor thereby remitting balance of payment to creditor upon death of debtor.

Credit Personal Property Insurance – insurance written in connection with a credit transaction where the collateral is not a motor vehicle, mobile home or real estate and that covers perils to the goods purchased through a credit transaction or used as collateral for a credit transaction and that concerns a creditor’s interest in the purchased goods or pledged collateral, either in whole or in part; or covers perils to goods purchased in connection with an open-end transaction.

Credit Placed Insurance – insurance that is purchased unilaterally by the creditor, who is the named insured, subsequent to the date of the credit transaction, providing coverage against loss, expense or damage to property as a result of fire, theft, collision or other risks of loss that would either impair a creditor’s interest or adversely affect the value of collateral. “Creditor Placed Home” means “Creditor Placed Insurance” on homes, mobile homes and other real estate. “Creditor Placed Auto” means insurance on automobiles, boats or other vehicles.

Credit Risk – part of the risk-based capital formula that addresses the collectability of a company’s receivables and the risk of losing a provider or intermediary that has received advance capitation payments.

Creditor-Placed Auto – single interest or dual interest credit insurance that is purchased unilaterally by the creditor, who is the named insured, subsequent to the date of the credit transaction, providing coverage against loss to property that would either impair a creditor’s interest or adversely affect the value of collateral on automobiles, boats, or other vehicles.

Creditor-Placed Home – single interest or dual interest credit insurance purchased unilaterally by the creditor, who is the named insured, subsequent to the date of the credit transaction, providing coverage against loss to property that would either impair a creditor’s interest or adversely affect the value of collateral on homes, mobile homes, and other real estate.

Crop – coverage protecting the insured against loss or damage to crops from a variety of perils, including but not limited to fire, lightening, loss of revenue, tornado, windstorm, hail, flood, rain, or damage by insects.

Crop-Hail Insurance – coverage for crop damage due to hail, fire or lightning.

D

Date of Issue – date when an insurance company issues a policy.

Declarations – policy statements regarding the applicant and property covered such as demographic and occupational information, property specifications and expected mileage per year .

Deductible – Portion of the insured loss (in dollars) paid by the policy holder

Deferred Annuity – annuity payment to be made as a single payment or a series of installments to begin at some future date, such as in a specified number of years or at a specified age.

Demutualization – conversion of a mutual insurance company to a capital stock company.

Dental Insurance – policies providing only dental treatment benefits such as routine dental examinations, preventive dental work, and dental procedures needed to treat tooth decay and diseases of the teeth and jaw.

Dental Only – line of business providing dental only coverage; coverage can be on a stand-alone basis or as a rider to a medical policy. If the coverage is as a rider, deductibles or out-of-pocket limits must be set separately from the medical coverage. Does not include self-insured business as well as FEHBP or Medicare and Medicaid programs.

Derivative – securities priced according to the value of other financial instruments such as commodity prices, interest rates, stock market prices, foreign or exchange rates.

Difference In Conditions (DIC) Insurance – special form of open-peril coverage written in conjunction with basic fire coverage and designed to provide protection against losses not reimbursed under the standard fire forms. Examples are flood and earthquake coverage.

Direct Incurred Loss – loss whereby the proximate cause is equivalent to the insured peril.

Direct Loss – Damage to covered real or personal property caused by a covered peril.

Direct Writer – an insurance company that sells policies to the insured through salaried representatives or exclusive agents only; reinsurance companies that deal directly with ceding companies instead of using brokers.

Direct Written Premium – total premiums received by an insurance company without any adjustments for the ceding of any portion of these premiums to the Reinsurer.

Directors & Officers Liability – liability coverage protecting directors or officers of a corporation from liability arising out of the performance of their professional duties on behalf of the corporation.

Disability Income – a policy designed to compensate insured individuals for a portion of the income they lose because of a disabling injury or illness.

Disability Income – Long-Term – policies that provide a weekly or monthly income benefit for more than five years for individual coverage and more than one year for group coverage for full or partial disability arising from accident and/or sickness.

Disability Income – Short-Term – policies that provide a weekly or monthly income benefit for up to five years for individual coverage and up to one year for group coverage for full or partial disability arising from accident and/or sickness.

Dividend – a refund of a portion of the premium paid by the insured from insurer surplus.

Domestic Insurer – an insurance company that is domiciled and licensed in the state in which it sells insurance.

Dual Interest – insurance that protects the creditor’s and the debtor’s interest in the collateral securing the debtor’s credit transaction. “Dual Interest” includes insurance commonly referred to as “Limited Dual Interest.”

Dwelling Property/Personal Liability – a special form of package policy composed of dwelling fire and/or allied lines, and personal liability insurance.

E

Early warning system – a system designed by insurance industry regulators of identifying practices and risk-related trends that contribute to systemic risk by measuring insurer’ financial stability.

Earned Premium – portion of insured’s prepaid premium allocated to the insurance company’s loss experience, expenses, and profit year- to -date.

Earthquake – property coverages for losses resulting from a sudden trembling or shaking of the earth, including that caused by volcanic eruption. Excluded are losses resulting from fire, explosion, flood or tidal wave following the covered event.

EBNR – Earned but not reported – premium amount insurer reasonably expects to receive for which contracts are not yet final and exact amounts are not definite.

EDP Policies – coverage to protect against losses arising out of damage to or destruction of electronic data processing equipment and its software.

Effective Date – date at which an insurance policy goes into force.

Elevators and Escalators Liability – liability coverage for bodily injury or property damage arising from the use of elevators or escalators operated, maintained or controlled by the insured.

Employee Benefit Liability – liability protection for an employer for claims arising from provisions in an employee benefit insurance plan provided for the economic and social welfare of employees. Examples of items covered are pension plans, group life insurance, group health insurance, group disability income insurance, and accidental death and dismemberment.

Employee Retirement Income Security Act of 1974 (ERISA) – a federal statute governing standards for private pension plans, including vesting requirements, funding mechanisms, and plan design.

Employers Liability – employers’ liability coverage for the legal liability of employers arising out of injuries to employees. This code should be used when coverage is issued as an endorsement, or as part of a statutory workers’ compensation policy.

Employment Practices Liability Coverage – liability insurance for employers providing coverage for wrongful termination, discrimination, or sexual harassment of the insured’s current or former employees.

Encumbrance – outstanding mortgages or other debt related to real estate and any unpaid accrued acquisition or construction costs.

Endorsement – an amendment or rider to a policy adjusting the coverages and taking precedence over the general contract.

Enrollment – The total number of plans, not the total number of covered lives, providing coverage to the enrollee and their dependents.

Environmental Impairment Liability (EIL) – coverage for negligence or omission resulting in pollution or environmental contamination.

Environmental Pollution Liability – liability coverage of an insured to persons who have incurred bodily injury or property damage from acids, fumes, smoke, toxic chemicals, waste materials or other pollutants.

Equity Indexed Annuity – a fixed annuity that earns interest or provides benefits that are linked to an external reference or equity index, subject to a minimum guarantee.

Errors and Omissions Liability | Professional Liability other than Medical – liability coverage of a professional or quasi professional insured to persons who have incurred bodily injury or property damage, or who have sustained any loss from omissions arising from the performance of services for others, errors in judgment, breaches of duty, or negligent or wrongful acts in business conduct.

Event Cancellation – coverage for financial loss because of the cancellation or postponement of a specific event due to weather or other unexpected cause beyond the control of the insured.

Excess and Umbrella Liability – liability coverage of an insured above a specific amount set forth in a basic policy issued by the primary insurer; or a self insurer for losses over a stated amount; or an insured or self insurer for known or unknown gaps in basic coverages or self insured retentions.

Excess of Loss Reinsurance – loss sharing mechanism where an insurer pays all claims up to a specified amount and a reinsurance company pays any claims in excess of stated amount.

Excess Workers’ Compensation – either specific and/or aggregate excess workers’ compensation insurance written above an attachment point or self-insured retention.

Expense Ratio – percentage of premium income used to attain and service policies. Derived by subtracting related expenses from incurred losses and dividing by written premiums.

Experience Rating – rating system where each group is rated entirely on the basis of its own expected claims in the coming period, with retrospective adjustments for prior periods. This method is prohibited under the conditions for federal qualification.

Exposure – risk of possible loss.

Extra Expense Insurance – a type of property insurance for extraordinary expenses related to business interruption such as a back-up generator in case of power failure.

F

Face Amount – the value of a policy to be provided upon maturity date or death.

Facultative Reinsurance – reinsurance for a specific policy for which terms can be negotiated by the original insurer and reinsurer.

FAIR Plan – Fair Access to Insurance Requirements – state pools designed to provide insurance to property owners who are unable to obtain property insurance through conventional means.

Fair Value – the amount at which an asset (or liability) could be bought (or incurred) or sold (or settled) in a current transaction between willing parties, that is, other than in a forced or liquidation sale. Quoted market prices in active markets are the best evidence of fair value and shall be used as the basis for the measurement, if available. If a quoted market price is available, the fair value is the product of the number of trading units times market price.

Farmowners Insurance – farmowners insurance sold for personal, family or household purposes. This package policy is similar to a homeowners policy, in that it has been developed for farms and ranches and includes both property and liability coverage for personal and business losses. Coverage includes farm dwellings and their contents, barns, stables, other farm structures and farm inland marine, such as mobile equipment and livestock.

Federal Flood Insurance – coverage for qualifying residents and businesses in flood prone regions through the National Flood Insurance Act, a federally subsidized flood insurance program enacted in 1968.

Federally Reinsured Crop – crop insurance coverage that is either wholly or in part reinsured by the Federal Crop Insurance Corporation (FCIC) under the Standard Reinsurance Agreement (SRA). This includes the following products: Multiple Peril Crop Insurance (MPCI); Catastrophic Insurance, Crop Revenue Coverage (CRC); Income Protection and Revenue Assurance.

Fees Payable – fees incurred but not yet paid.

FEMA – Federal Emergency Management Agency – an independent agency, tasked with responding to, planning for, mitigating and recovery efforts of natural disasters.

Fidelity – a bond or policy covering an employer’s loss resulting from an employee’s dishonest act (e.g., loss of cash, securities, valuables, etc.).

Financial Guaranty – a surety bond, insurance policy, or an indemnity contract (when issued by an insurer), or similar guaranty types under which loss is payable upon proof of occurrence of financial loss to an insured claimant, obligee or indemnitee as a result of failure to perform a financial obligation or any other permissible product that is defined as or determined to be financial guaranty insurance.

Financial Reporting – insurance companies are required to maintain records and file annual and quarterly financial statements with regulators in accordance with statutory accounting principles (SAP). Statutory rules also govern how insurers should establish reserves for invested assets and claims and the conditions under which they can claim credit for reinsurance ceded.

Financial Responsibility Law – a statute requiring motorists to show capacity to pay for automobile-related losses.

Financial Statement – balance sheet and profit and loss statement of an insurance company. This statement is used by the NAIC, and by State Insurance Commissioners to regulate an insurance company according to reserve requirements, assets, and other liabilities.

Fire – coverage protecting the insured against the loss to real or personal property from damage caused by the peril of fire or lightning, including business interruption, loss of rents, etc.

Fire Legal Liability – coverage for property loss liability as the result of separate negligent acts and/or omissions of the insured that allows a spreading fire to cause bodily injury or property damage of others. An example is a tenant who, while occupying another party’s property, through negligence causes fire damage to the property.

Flood – coverage protecting the insured against loss or damage to real or personal property from flood. (Note: If coverage for flood is offered as an additional peril on a property insurance policy, file it under the applicable property insurance filing code.)

Foreign Insurer – an insurance company selling policies in a state other than the state in which they are incorporated or domiciled.

Foreign Investment – an investment in a foreign jurisdiction, or an investment in a person, real estate or asset domiciled in a foreign jurisdiction. An investment shall not be deemed to be foreign if the issuing person, qualified primary credits source or qualified guarantor is a domestic jurisdiction or a person domiciled in a domestic jurisdiction, unless: a) The issuing person is a shell business entity; and b) The investment is not assumed, accepted, guaranteed or insured or otherwise backed by a domestic jurisdiction or a person, that is not a shell business entity, domiciled in a domestic jurisdiction.

Foreign jurisdiction – a jurisdiction outside of the United States, Canada or any province or political subdivision of the foregoing.

Fraternal Insurance – a form of group coverage or disability insurance available to members of a fraternal organization.

Fronting – an arrangement in which a primary insurer acts as the insurer of record by issuing a policy, but then passes the entire risk to a reinsurer in exchange for a commission. Often, the fronting insurer is licensed to do business in a state or country where the risk is located, but the reinsurer is not.

G

Generally Accepted Accounting Principles (GAAP) – an aggregate of the accounting standards, principles and best practices for the preparation of financial statements allowing for consistency in reporting.

Gramm-Leach Bliley Act (GLBA) – act, repealing Glass-Steagal Act of 1933, allows consolidation of commercial banks, investment institutions and insurance companies. Established a framework of responsibilities of federal and state regulators for these financial industries. It permits financial services companies to merge and engage in a variety of new business activities, including insurance, while attempting to address the regulatory issues raised by such combinations.

Goodwill – the difference between the cost of acquiring the entity and the reporting entity’s share of the book value of the acquired entity.

Gross Paid-in and Contributed Surplus – amount of capital received in excess of the par value of the stock issued.

Gross Premium – the net premium for insurance plus commissions, operating and miscellaneous commissions. For life insurance, this is the premium including dividends.

Group Accident and Health – coverage written on a group basis (e.g., employees of a single employer and their dependents) that pays scheduled benefits or medical expenses caused by disease, accidental injury or accidental death. Excludes amounts attributable to uninsured accidents and health plans and the uninsured portion of partially insured accident and health plans.

Group Annuities – Deferred Non- Variable and Variable – an annuity contract that provides an accumulation based on both (1) funds that accumulate based on a guaranteed crediting interest rates or additional interest rate applied to designated considerations, and (2) funds where the accumulation vary in accordance with the rate of return of the underlying investment portfolio selected by the policyholder. The contract provides for the initiation of payments at some designated future date.

Group Annuities – Deferred Variable – an annuity contract that provides an accumulation based fund where the accumulation varies in accordance with the rate of return of the underlying investment portfolio selected by the policyholder. Must include at least one option to have the accumulation vary in accordance with the rate of return of the underlying investment portfolio selected by the policyholder and may include at least one option to have the series of payments vary in accordance with the rate of return of the underlying investment portfolio selected by the policyholder. This annuity contract provides for the initiation of payments at some designated future date.

Group Annuities – Immediate Non-Variable and Variable – an annuity contract that provides an accumulation based on both (1) funds that accumulate based on a guaranteed crediting interest rates or additional interest rate applied to designated considerations, and (2) funds where the accumulation vary in accordance with the rate of return of the underlying investment portfolio selected by the policyholder. The contract provides for the initiation of payments at some interval that may vary, however the annuity payouts must begin within 13 months.

Group Annuities – Immediate Variable – an annuity contract that provides for the first payment of the annuity at the end of the fixed interval of payment after purchase. The interval may vary, however the annuity payouts must begin within 13 months. The amount varies with the value of equities (separate account) purchased as investments by the insurance companies.

Group Annuities – Unallocated – annuity contracts or portions thereof where the Insurer purchases an annuity for the retirees.

Group Annuity – a contract providing income for a specified period of time, or duration of life for a person or persons established to benefit a group of employees.

Group Health – health insurance issued to employers, associations, trusts, or other groups covering employees or members and/or their dependents, to whom a certificate of coverage may be provided.

Group Code – a unique three to five digit number assigned by the NAIC to identify those companies that are part of a larger group of insurance companies.

Group Credit – Life – contracts sold in connection with loan/credit transactions or other credit transactions, which do not exceed a stated duration and/or amount and provide insurance protection against death.

Group Health Organizations – Health Maintenance (HMO) – a plan under which an enrollee pays a membership fixed fee in advance in return for a wide range of comprehensive health care services with the HMO’s approved providers in a designated service area.

Guaranty Fund – funding mechanism employed by states to provide funds to cover policyholder obligations of insolvent reporting entities.

H

Hard Market – a market characterized by high demand and low supply.

Hazard – circumstance which tends to increase the probability or severity of a loss.

Health – Excess/Stop Loss – this type of insurance may be extended to either a health plan or a self-insured employer plan. Its purpose is to insure against the risk that any one claim will exceed a specific dollar amount or that an entire plan’s losses will exceed a specific amount.

Health Insurance – a generic term applying to all types of insurance indemnifying or reimbursing for losses caused by bodily injury or illness including related medical expenses.

Health Maintenance Organization (HMO) – a medical group plan that provides physician, hospital, and clinical services to participating members in exchange for a periodic flat fee.

Health Plan – written promise of coverage given to an individual, family, or group of covered individuals, where a beneficiary is entitled to receive a defined set of health care benefits in exchange for a defined consideration, such as a premium.

Hold-Harmless Agreement – A risk transfer mechanism whereby one party assumes the liability of another party by contract

Homeowners Insurance – a package policy combining real and personal property coverage with personal liability coverage. Coverage applicable to the dwelling, appurtenant structures, unscheduled personal property and additional living expense are typical. Includes mobile homes at a fixed location.

Hospital Indemnity Coverage – coverage that provides a pre-determined, fixed benefit or daily indemnity for contingencies based on a stay at a hospital or intensive care facility.

Hull Insurance – coverage for damage to a vessel or aircraft and affixed items.

I

Incontestability Provision – a life insurance and annuity provision limiting the time within which the insurer has the legal right to void the contract on grounds of material misrepresentation in the policy application.

Incurred But Not Reported (IBNR) – (Pure IBNR) claims that have occurred but the insurer has not been notified of them at the reporting date. Estimates are established to book these claims. May include losses that have been reported to the reporting entity but have not yet been entered into the claims system or bulk provisions. Bulk provisions are reserves included with other IBNR reserves to reflect deficiencies in known case reserves. IBNR can sometimes include estimates of incurred but Not Enough Reported (IBNER)

Incurred Claims – paid claims plus amounts held in reserve for those that have been incurred but not yet paid.

Incurred Losses – sustained losses, paid or not, during a specified time period. Incurred losses are typically found by combining losses paid during the period plus unpaid losses sustained during the time period minus outstanding losses at the beginning of the period incurred in the previous period.

Indemnity, Principle of – a general legal principle related to insurance that holds that the individual recovering under an insurance policy should be restored to the approximate financial position he or she was in prior to the loss. Legal principle limiting compensation for damages be equivalent to the losses incurred.

Independent Adjuster – freelance contractor paid a fee for adjusting losses on behalf of companies.

Independent Agent – a representative of multiple insurance companies who sells and services policies for records which they own and operate under the American Agency System.

Independent Contractor – an individual who is not employed for a company but instead works for themselves providing goods or services to clients for a fee.

Index Annuity – an interest bearing fixed annuity tied to an equity index, such as the Dow Jones Industrial Average or S & P 500.

Individual Annuities – Deferred Variable – an annuity contract that provides an accumulation based fund where the accumulation varies in accordance with the rate of return of the underlying investment portfolio selected by the policyholder. Must include at least one option to have the accumulation vary in accordance with the rate of return of the underlying investment portfolio selected by the policyholder and may include at least one option to have the series of payments vary in accordance with the rate of return of the underlying investment portfolio selected by the policyholder. This annuity contract provides for the initiation of payments at some designated future date.

Individual Annuities – Immediate Variable – an annuity contract that provides for the first payment of the annuity at the end of the fixed interval of payment after purchase. The interval may vary, however the annuity payouts must begin within 13 months. The amount varies with the value of equities (separate account) purchased as investments by the insurance companies.

Individual Annuities – Special – contracts with certain noteworthy attributes.

Individual Annuities- Deferred Non-Variable and Variable – an annuity contract that provides an accumulation based on both (1) funds that accumulate based on a guaranteed crediting interest rates or additional interest rate applied to designated considerations, and (2) funds where the accumulation vary in accordance with the rate of return of the underlying investment portfolio selected by the policyholder. The contract provides for the initiation of payments at some designated future date.

Individual Annuities- Deferred Non-Variable – an annuity contract that provides an accumulation based on funds that accumulate based on a guaranteed crediting interest rate or additional interest rate. This annuity contract provides for the initiation of payments at some designated future date.

Individual Annuities- Immediate Non-Variable – an annuity contract that provides for the fixed payment of the annuity at the end of the first interval of payment after purchase. The interval may vary, however the annuity payouts must begin within 13 months.

Individual Annuities- Immediate Non-Variable and Variable – an annuity contract that provides an accumulation based on both (1) funds that accumulate based on a guaranteed crediting interest rates or additional interest rate applied to designated considerations, and (2) funds where the accumulation vary in accordance with the rate of return of the underlying investment portfolio selected by the policyholder. The contract provides for the initiation of payments at some interval that may vary, however the annuity payouts must begin within 13 months.

Individual Health – health insurance where the policy is issued to an individual covering the individual and/or their dependents in the individual market. This includes conversions from group policies.

Individual Credit – Credit Disability – makes monthly loan/credit transaction payments to the creditor upon the disablement of an insured debtor.

Individual Credit – Life – contracts sold in connection with loan/credit transactions or other credit transactions, which do not exceed a stated duration and/or amount and provide insurance protection against death.

Industrial Life – Industrial life insurance, also called “debit” insurance, is insurance under which premiums are paid monthly or more often, the face amount of the policy does not exceed a stated amount, and the words “industrial policy” are printed in prominent type on the face of the policy.

Inland Marine – coverage for property that may be in transit, held by a bailee, at a fixed location, a movable good that is often at different locations (e.g., off road constructions equipment), or scheduled property (e.g., Homeowners Personal Property Floater) including items such as live animals, property with antique or collector’s value, etc. This line also includes instrumentalities of transportation and communication, such as bridges, tunnels, piers, wharves, docks, pipelines, power and phone lines, and radio and television towers.

Insurable Interest – A right or relationship in regard to the subject matter of the insured contract such that the insured can suffer a financial loss from damage, loss or destruction to it. (Bickelhaupt and Magee )

Insurance – an economic device transferring risk from an individual to a company and reducing the uncertainty of risk via pooling.

Insurance Holding Company System – consists of two or more affiliated persons, one or more of which is an insurer.

Insurance Regulatory Information System (IRIS) – a baseline solvency screening system for the National Association of Insurance Commissioners (NAIC) and state insurance regulators established in the mid-1970s.

Insurance to Value – Amount of insurance purchased vs. the actual replacement cost of the insured property expressed as a ratio.

Insured – party(ies) covered by an insurance policy.

Insurer – an insurer or reinsurer authorized to write property and/or casualty insurance under the laws of any state.

Intermediary – a person, corporation or other business entity (not licensed as a medical provider) that arranges, by contracts with physicians and other licensed medical providers, to deliver health services for a health insurer and its enrollees via a separate contract between the intermediary and the insurer.

International – includes all business transacted outside the U.S. and its territories and possessions where the appropriate line of business is not determinable.

Internet Liability Insurance/Cyber Insurance – coverage for cyber commerce including copyright infringement, libel, and violation of privacy.

Investment grade – the obligation has been determined to be in one of the top four generic lettered rating classifications by a securities rating agency acceptable to the commissioner, that the obligation has been identified in writing by such a rating agency to be of investment grade quality, or, if the obligation has not been submitted to any such rating agency, that the obligation has been determined to be investment grade (Class 1 and Class 2) by the Securities Valuation Office of the National Association of Insurance Commissioners.

Investment Income Accrued – investment income earned as of the reporting date but not legally due to be paid to the reporting entity until subsequent to the reporting date.

Investment Income Due – investment income earned and legally due to be paid to the reporting entity as of the reporting date.

Investment Income Gross – shall be recorded as earned and shall include investment income collected during the period, the change in investment income due and accrued, the change in unearned investment income plus any amortization (e.g., discounts or premiums on bonds, origination fees on mortgage loans, etc.)

Irrevocable Beneficiary – a life insurance policy beneficiary who has a vested interest in the policy proceeds even during the insured’s lifetime because the policy owner has the right to change the beneficiary designation only after obtaining the beneficiary’s consent.

J

Joint and Last Survivor Annuity – retirement plan that continues to payout so long as at least one, of two or more, annuitants is alive.

Joint Underwriting Association (JUA) – a loss-sharing mechanism combining several insurance companies to provide extra capacity due to type or size of exposure.

Joint-Life Annuity – an annuity contract that ceases upon the death of the first of two or more annuitants.

K

Key-Persons Insurance – a policy purchased by, for the benefit of, a business insuring the life or lives of personnel integral to the business operations.

Kidnap/Ransom Insurance – coverage for ransom or extortion costs and related expenses.

L

Lapse – termination of a policy due to failure to pay the required renewal premium.

Level Premium Insurance – life insurance policy for which the cost is equally distributed over the term of the premium period, remaining constant throughout.

Liability – a certain or probable future sacrifice of economic benefits arising from present obligations of a particular entity to transfer assets or to provide services to other entities in the future as a result of a past transactions(s) or event(s). three essential characteristics: a)    It embodies a present duty or responsibility to one or more other entities that entails settlement by probable future transfer or use of assets at a specified or determinable date, on occurrence of a specified event, or on demand; b)    The duty or responsibility obligates a particular entity, leaving it little or no discretion to avoid the future sacrifice; and c)    The transaction or other event obligating the entity has already happened.

Life – Endowment – insurance that pays the same benefit amount should the insured die during the term of the contract, or if the insured survives to the end of the specified coverage term or age.

Life – Flexible Premium Adjustable Life – a group life insurance that provides a face amount that is adjustable to the certificate holder and allows the certificate holder to vary the modal premium that is paid or to skip a payment so long as the certificate value is sufficient to keep the certificate in force, and under which separately identified interest credits (other than in connection with dividend accumulation, premium deposit funds or other supplementary accounts) and mortality and expense charges are made to individual certificates while providing minimum guaranteed values.

Life Settlements – a contract or agreement in which a policyholder agrees to sell or transfer ownership in all or part of a life insurance policy to a third party for compensation that is less than the expected death benefit of a policy.

Lifetime Disability Benefit – a provision in some disability income policies to recoup lost wages for the term of disability or remainder of insured’s life in case of permanent disability.

Limited Benefit – policies that provide coverage for vision, prescription drug, and/or any other single service plan or program. Also include short-term care policies that provide coverage for less than one year for medical and other services provided in a setting other than an acute care unit of the hospital.

Limited Payment Life Insurance – a form of whole-life insurance with a pre-defined number of premiums to be paid.

Limited Policies – health insurance coverage for a certain ailment, such as cancer.

Limits – maximum value to be derived from a policy.

Line of Business – classification of business written by insurers.

Liquor Liability – coverage for the liability of an entity involved in the retail or wholesale sales of alcoholic beverages, or the serving of alcoholic beverages, to persons who have incurred bodily injury or property damage arising from an intoxicated person.

Living benefits rider – a rider attached to a life insurance policy providing long term care for the terminally ill.

Lloyd’s of London – association offering membership in various syndicates of wealthy individuals organized for the purpose of writing insurance for a particular hazard.

Loan-backed Securities – pass-through certificates, collateralized mortgage obligations (CMOs), and other securitized loans not included in structured securities where payment of interest and/or principal is directly proportional to the interest and/or principal received by the issuer from the mortgage pool or other underlying securities.

Long Duration Contracts – contracts, excluding financial guaranty contracts, mortgage guaranty contracts and surety contracts, that fulfill both of the following conditions: (1) the contract term is greater than or equal to thirteen months and (2) the insurer can neither cancel nor increase the premium during the contract term.

Long-Term Care – policies that provide coverage for not less than one year for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services provided in a setting other than an acute care unit of a hospital, including policies that provide benefits for cognitive impairment or loss of functional capacity. This includes policies providing only nursing home care, home health care, community based care, or any combination. The policy does not include coverage provided under comprehensive/major medical policies, Medicare Advantage, or for accelerated heath benefit-type products.

Long-Term Disability Income Insurance – policy providing monthly income payments for insureds who become disabled for an extensive length of time, typically two years or longer.

Loss – physical damage to property or bodily injury, Including loss of use or loss of income

Loss Adjustment Expense (LAE) – expected payments for costs to be incurred in connection with the adjustment and recording of losses. Can be classified into two broad categories: Defense and Cost Containment (DCC) and Adjusting and Other (AO). Can also be separated into (Allocated Loss Adjustment Expense) and (Unallocated Loss Adjustment Expense for ratemaking purposes.

Loss Frequency – incidence of claims on a policy during a premium period.

Loss of Use Insurance – policy providing protection against loss of use due to damage or destruction of property.

Loss Payable Clause – coverage for third party mortgagee in case of default on insured property, secured by a loan, that has been lost or damaged.

Loss Ratio – the percentage of incurred losses to earned premiums.

Loss Reserve – the amount that insurers set aside to cover claims incurred but not yet paid.

Loss Reserves – an estimate of liability or provision in an insurer’s financial statement, indicating the amount the insurer expects to pay for losses incurred but not yet reported or reported claims that haven’t been paid.

Losses Incurred – Includes claims that have been paid and/or have amounts held in reserve for future payment

Losses Incurred But Not Reported (IBNR) – An estimated amount set aside by the insurance company to pay claims that may have occurred, but for some reason have not yet been reported to the insurance company.

M

Major Medical – a hospital/surgical/medical expense contract that provides comprehensive benefits as defined in the state in which the contract will be delivered.

Malpractice – alleged misconduct or negligence in a professional act resulting in loss or injury.

Managed Care – system of health care delivery that attempts to influence the utilization, quality, and cost of services provided.

Mandated benefits – insurance required by state or federal law.

Manufacturers Output Policies – provides broad form coverage of personal property of an insured manufacturer including raw material, goods in process, finished goods and goods shipped to customers.

Margin Premium – a deposit that an organization is required to maintain with a broker with respect to the Futures Contracts purchased or sold.

Market Value – fair value or the price that could be derived from current sale of an asset.

Mechanical Breakdown Insurance – premiums attributable to policies covering repair or replacement service, or indemnification for that service, for the operational or structural failure of property due to defects in materials or workmanship, or normal wear and tear. (May cover motor vehicles, mobile equipment, boats, appliances, electronics, residual structures, etc.)

Medicaid – policies issued in association with the Federal/State entitlement program created by Title XIX of the Social Security Act of 1965 that pays for medical assistance for certain individuals and families with low incomes and resources.

Medical & Hospital Expenses (Benefits or Claims) – total expenditures for health care services paid to or on behalf of members.

Medical Malpractice – insurance coverage protecting a licensed health care provider or health care facility against legal liability resulting from the death or injury of any person due to the insured’s misconduct, negligence, or incompetence, in rendering or failure to render professional services.

Medical Only – line of business that provides medical only benefits without hospital coverage. An example would be provider-sponsored organizations where there is no coverage for other than provider (non-hospital) services. Does not include self-insured business, FEHBP, Medicare and Medicaid programs, or dental only business.

Medical Professional Liability – insurance coverage protecting a licensed health care provider or health care facility against legal liability resulting from the death or injury of any person due to the insured’s misconduct, negligence, or incompetence in rendering professional services. Medical Professional Liability is also known as Medical Malpractice.

Medicare – a state assistance program, passed under Title XVIII of the Social Security Amendments of 1965, to provide hospital and medical expense insurance to those over 65 years of age.

Medicare + Choice – a major initiative in the Balanced Budget Act of 1997 (also called Medicare Part C), under which Medicare beneficiaries may select from among several managed care options or a Medicare system.

Medicare Advantage Plan – an HMO, PPO, or Private Fee-For Service Plan that contracts with Medicare Advantage Prescription Drug Plan also includes drug benefits. The plan may provide extra coverage such as vision, hearing, dental, and/or health and wellness programs. Medicare pays a fixed amount for insured’s care every month to the companies offering Medicare Advantage plans.

Medicare Cost – contract with Center for Medicare and Medicaid Services (CMS) for Medicare coverage. These contracts with CMS provide reimbursement through pre-determined monthly amount per member based on a total estimated budget. The beneficiary may use providers outside the provider network. Does not include stand alone Medicare Part D Plans.

Medicare Part D – Stand-Alone – stand-alone Part D coverage written through individual contracts; stand-alone Part D coverage written through group contracts and certificates; and Part D coverage written on employer groups where the reporting entity is responsible for reporting claims to the Centers for Medicare & Medicaid Services (CMS).

Medicare Supplement – Insurance coverage sold on an individual or group basis to help fill the “gaps” in the protections granted by the federal Medicare program. This is strictly supplemental coverage and cannot duplicate any benefits provided by Medicare. It is structured to pay part or all of Medicare’s deductibles and co-payments. It may also cover some services and expenses not covered by Medicare. Also known as Medigap” insurance.

Medigap – supplementary private health insurance products to Medicare insurance benefits.

Minimum Premium Plan – an arrangement under which an insurance carrier will, for a fee, handle the administration of claims and insure against large claims for a self-insured group. The employer self-funds a fixed percentage (e.g. 90%) of the estimated monthly claims, and the insurer covers the remainder.

Mobile Homes – Homeowners – homeowners insurance sold to owners occupying the described mobile home.

Mobile Homes under Transport – coverage for mobile homes while under transport for personal or commercial use.

Modified Guaranteed – an annuity that contains a provision that adjusts the value of withdrawn funds based on a formula in the contract. The formula reflects market value adjustments.

Member – A person who has enrolled as a subscriber or an eligible dependent of a subscriber and for whom the health organization has accepted the responsibility for the provision of health services as may be contracted for.

Moral Hazard – personality characteristics that increase probability of losses. For example not taking proper care to protect insured property because the insured knows the insurance company will replace it if it is damaged or stolen.

Morale Hazard – negligence or disregard on the part of the insured which could lead to probable loss.

Morbidity – the frequency or severity of disease or illness within a subset of the population.

Morbidity Risk – the potential for a person to experience illness, injury, or other physical or psychological impairment, whether temporary or permanent. Morbidity risk excludes the potential for an individual’s death, but includes the potential for an illness or injury that results in death.

Morbidity Table – a statistical record of the rate of illness among the defined age groups.

Mortality Table – chart that shows the death rates of a particular population at each age displayed as the number of deaths per thousand.

Mortgage – a note used to secure a loan for real property.

Mortgage Guaranty – insurance that indemnifies a lender for loss upon foreclosure if a borrower fails to meet required mortgage payments.

Mortgage Insurance – a form of life insurance coverage payable to a third party lender/mortgagee upon the death of the insured/mortgagor for loss of loan payments.

Mortgage-Backed Securities – a type of asset-backed security that is secured by a mortgage or collection of mortgages. These securities must also be grouped in one of the top two ratings as determined by an accredited credit rating agency, and usually pay periodic payments that are similar to coupon payments. Furthermore, the mortgage must have originated from a regulated and authorized financial institution.

Multi-Peril Insurance – personal and business property coverage combining several types of property insurance in one policy.

Municipal Bond Guarantee Insurance – coverage sold to municipalities to guarantee the principle payment on bonds issued.

Municipal Liability – liability coverage for the acts of a municipality.

Municipal obligation bond – any security, or other instrument, including a state lease but not a lease of any other governmental entity, under which a payment obligation is created, issued by or on behalf of a governmental unit to finance a project servicing a substantial public purpose, and 1) Payable from tax revenues, but not tax allocations, within the jurisdiction of such governmental unit; 2) Payable or guaranteed by the United States of America or any agency, department or instrumentality thereof, or by a state housing agency; 3) Payable from rates or charges (but not tolls) levied or collected in respect of a non-nuclear utility project, public transportation facility (other than an airport facility) or public higher education facility; or 4) With respect to lease obligations, payable from future appropriations.

Mutual Insurance Company – a privately held insurer owned by its policyholders, operated as a non-profit that may or may not be incorporated.

Mutual Insurance Holding Company – a company organized as a mutual and owning a capital stock insurer or insurers for the benefit of pooling risk for many people, typically those in the same industry.

N

Named Insured – the individual defined as the insured in the policy contract. .

Named Peril Coverage – insurance for losses explicitly defined in the policy contract.

National Association of Insurance Commissioners (NAIC) – the U.S. standard-setting and regulatory support organization created and governed by the chief insurance regulators from the 50 states, the District of Columbia and five U.S. territories. Through the NAIC, state insurance regulators establish standards and best practices, conduct peer review, and coordinate their regulatory oversight. NAIC staff supports these efforts and represents the collective views of state regulators domestically and internationally. NAIC members, together with the central resources of the NAIC, form the national system of state-based insurance regulation in the U.S.

Negligence – failure to exercise reasonable consideration resulting in loss or damage to oneself or others.

Net Admitted Assets – total of assets whose values are permitted by state law to be included in the annual statement of the insurer.

Net Income – total revenues from an insurer’s operations less total expenses and income taxes

Net Premiums Earned – premiums on property/casualty or health policies that will not have to be returned to the policyholder if the policy is cancelled.

NFIP – National Flood Insurance Program – flood insurance and floodplain management for personal and business property administered under the National Flood Act of 1968. Encourages participation by private insurers through a flood insurance pool .

Nonadmitted Assets – assets having economic value other than those which can be used to fulfill policyholder obligations, or those assets which are unavailable due to encumbrances or other third party interests and should not be recognized on the balance sheet.

Nonadmitted Insurer – insurance company not licensed to do business within a given state.

Non-controlled stock insurers – insurers in which a parent company has: 1) a financial interest represented by the direct or indirect ownership of less than 50% of voting shares, and 2) does not have the ability to exercise control over the insurer, e.g., through voting stock or management contract

Non-proportional Reinsurance – reinsurance that is not secured on individual lives for specific individual amount of reinsurance, but rather reinsurance that protects the ceding company’s overall experience on its entire portfolio of business, or at least a broad segment of it. The most common forms of non-proportional reinsurance are stop loss and catastrophe.

Notional Value – the principal value upon which future payments are based in a derivative transaction as at a specific period in time (the “as of” reporting date) in the reporting currency.

Nationally Recognized Statistical Rating Organization (NRSRO) – refers to rating organizations so designated by the SEC whose status has been confirmed by the Securities Valuation Office. Examples are: Moody’s Investors Service, Inc., Standard & Poor’s (S&P), A.M. Best Company (A.M. Best) and Fitch Ratings and Dominion Bond Rating Service (DBRS).

Nuclear Energy Liability – coverage for bodily injury and property damage liability resulting from the nuclear energy material (whether or not radioactive) on the insured business’s premises or in transit.

O

Occurrence – an accident , including injurious exposure to conditions, which results, during the policy period in bodily injury or property damage neither expected or intended from the standpoint of the insured. (Bickelhaupt and Magee)

Ocean Marine – coverage for ocean and inland water transportation exposures; goods or cargoes; ships or hulls; earnings; and liability.

Officer – a president, vice-president, treasurer, actuary, secretary, controller and any other person who performs for the company functions corresponding to those performed by the foregoing officers.

Option – an agreement giving the buyer the right to buy or receive, sell or deliver, enter into, extend or terminate, or effect a cash settlement based on the actual or expected price, level, performance or value of one or more Underlying Interests.

Other Accident and Health – accident and health coverages not otherwise properly classified as Group Accident and Health or Credit Accident and Health (e.g., collectively renewable and individual non-cancelable, guaranteed renewable, non-renewable for stated reasons only, etc.). Include all Medicare Part D Prescription Drug Coverage, whether sold on a stand-alone basis or through a Medicare Advantage product and whether sold directly to an individual or through a group.

Other Considerations – Unallocated annuity considerations and other unallocated deposits that incorporate any mortality or morbidity risk and are not reported as direct premiums, direct annuity considerations or deposit-type contract funds.

Other Liability – coverage protecting the insured against legal liability resulting from negligence, carelessness, or a failure to act resulting in property damage or personal injury to others.

Other Underwriting Expenses – allocable expenses other than loss adjustment expenses and investment expenses.

Owner Occupied – homeowners insurance sold to owners occupying the described property.

P

Package Policy – two or more distinct policies combined into a single contract.

Par Value – the nominal or face value of a stock or bond.

Peril – the cause of property damage or personal injury, origin of desire for insurance. “Cause of Loss”

Permanent Life Insurance – policy that remains active for the life of the insured.

Personal Auto Policy – coverage designed to insure private passenger automobiles and certain types of trucks owned by an individual or husband and wife.

Personal Earthquake – earthquake property coverage for personal, family or household purposes.

Personal Flood – separate flood insurance policy sold for personal, family or household purposes.

Personal GAP Insurance – credit insurance that insures the excess of the outstanding indebtedness over the primary property insurance benefits in the event of a total loss to a collateral asset.

Personal Injury Liability – liability coverage for those who have been discriminated against, falsely arrested, illegally detained, libeled, maliciously prosecuted, slandered, suffered from identity theft, mental anguish or alienation of affections, or have had their right of privacy violated.

Personal Injury Protection Coverage/PIP – automobile coverage available in states that have enacted no-fault laws or other auto reparation reform laws for treatment of injuries to the insured and passengers of the insured.

Personal Property – single interest or dual interest credit insurance (where collateral is not a motor vehicle, mobile home, or real estate) that covers perils to goods purchased or used as collateral and that concerns a creditor’s interest in the purchased goods or pledged collateral either in whole or in part; or covers perils to goods purchased in connection with an open-end credit transaction.

Pet Insurance Plans – veterinary care plan insurance policy providing care for a pet animal (e.g., dog or cat) of the insured owner in the event of its illness or accident.

Policy – a written contract ratifying the legality of an insurance agreement.

Policy Dividend – a refund of part of the premium on a participating life insurance policy. Amount of payment is determined by subtracting the actual premium expense from the premium charged. The payment can be taken as cash, applied to a purchase an increment of paid-up insurance, left on deposit with the insurance company or applied to purchase term insurance for one year.

Policy Period – time period during which insurance coverage is in effect.

Policy Reserve – the amount of money allocated specifically for the fulfillment of policy obligations by a life insurance company; reserves are in place to safeguard that the company is able to pay all future claims.

Policyholders Surplus – assets in excess of the liabilities of a company or net income above any monies indebted to legal obligation.

Pollution – environmental contamination.

Pool – an association organized for the purpose of absorbing losses through a risk-sharing mechanism thereby limiting individual exposures.

Preferred Provider Organization (PPO) – arrangement, insured or uninsured, where contracts are established by Health Plan Companies (typically, commercial insurers, and, in some circumstances, by self-insured employers) with health care providers. The Health Plans involved will often designate these contracted providers as “preferred” and will provide an incentive, usually in the form of lower deductibles or co-payments, to encourage covered individuals to use these providers. Members are allowed benefits for non-participating provider services on an indemnity basis with significant copayments and providers are often, but not always, paid on a discounted fee for service basis.

Preferred Risk – insured, or applicant for insurance, who presents likelihood of risk lower than that of the standard applicant.

Premises and Operations – policies covering the liability of an insured to persons who have incurred bodily injury or property damage on an insured’s premises during normal operations or routine maintenance, or from an insured’s business operations either on or off of the insured’s premises.

Premium – Money charged for the insurance coverage reflecting expectation of loss.

Premiums Earned – the portion of premium for which the policy protection or coverage has already been given during the now-expired portion of the policy term.

Premiums Net – is the amount calculated on the basis of the interest and mortality table used to calculate the reporting entity’s statutory policy reserves.

Premiums Written – total premiums generated from all policies (contracts) written by an insurer within a given period of time.

Primary Insurance – coverage that takes precedence when more than one policy covers the same loss.

Prior Approval Law – a state regulatory requirement for pre-approval of all insurance rates and forms.

Private Passenger Auto (PPA) – filings that include singularly or in any combination coverage such as the following: Auto Liability, Personal Injury Protection (PIP), Medical Payments (MP), Uninsured/Underinsured (UM/UIM); Specified Causes of Loss, Comprehensive, and Collision.

Producer – an individual who sells, services, or negotiates insurance policies either on behalf of a company or independently.

Product Liability – insurance coverage protecting the manufacturer, distributor, seller, or lessor of a product against legal liability resulting from a defective condition causing personal injury, or damage, to any individual or entity, associated with the use of the product.

Professional Errors and Omissions Liability – coverage available to pay for liability arising out of the performance of professional or business related duties, with coverage being tailored to the needs of the specific profession. Examples include abstracters, accountants, insurance adjusters, architects, engineers, insurance agents and brokers, lawyers, real estate agents, stockbrokers.

Property – coverage protecting the insured against loss or damage to real or personal property from a variety of perils, including but not limited to fire, lightening, business interruption, loss of rents, glass breakage, tornado, windstorm, hail, water damage, explosion, riot, civil commotion, rain, or damage from aircraft or vehicles.

Pro-rata (proportional) Reinsurance – portion of the losses and premium reinsurer shares with the ceding entity.

Protected Cell – an insurance-linked security retained within the insurance or reinsurance company and is used to insulate the proceeds of the securities offering from the general business risks of the insurer, granting an additional comfort level for investors of the securitized instrument.

Protection and Indemnity (P&I) Insurance – a broad form of marine legal liability insurance coverage.

Provider Sponsored Network (PSN) – formal affiliations of providers, sometimes called “integrated delivery systems”, organized and operated to provide an integrated network of health care providers with which third parties, such as insurance companies, HMOs, or other Health Plan Companies, may contract for health care services to covered individuals. Some models of integration include Physician Hospital Organizations, Management Service Organizations, Group Practices Without Walls, Medical Foundations, and Health Provider Cooperatives.

Provisions – contingencies outlined in an insurance policy.

Proximate Cause – event covered under insured’s policy agreement.

Public Adjuster – independent claims adjuster representing policyholders instead of insurance companies.

Pure Premium – that portion of the premium equal to expected losses void of insurance company expenses, premium taxes, contingencies, or profit margin.

Pure Risk – circumstance including possibility of loss or no loss but no possibility of gain.

Q

Qualified Actuary – a person who meets the basic education, experience and continuing education requirements (these differ by line of business) of the Specific Qualification Standard for Statements of Actuarial Opinion, NAIC Property and Casualty Annual Statement, as set forth in the Qualification Standards for Actuaries Issuing Statements of Actuarial Opinion in the United States, promulgated by the American Academy of Actuaries, and is in good standing of the American Academy of Actuaries who has been approved as qualified for signing casualty loss reserve opinions by the Casualty Practice Council of the American Academy of Actuaries.

R

Rate – value of insured losses expressed as a cost per unit of insurance.

Risk Based Capital (RBC) Ratio – ratio used to identify insurance companies that are poorly capitalized. Calculated by dividing the company’s capital by the minimum amount of capital regulatory authorities have deemed necessary to support the insurance operations.

Rebate – a refund of part or all of a premium payment.

Reinsurance – a transaction between a primary insurer and another licensed (re) insurer where the reinsurer agrees to cover all or part of the losses and/or loss adjustment expenses of the primary insurer. The assumption is in exchange for a premium. Indemnification is on a proportional or non-proportional basis.

Reinsurer – company assuming reinsurance risk.

Renewable Term Insurance – insurance that is renewable for a limited number of successive terms by the policyholder and is not contingent upon medical examination.

Renters Insurance – liability coverage for contents within a renter’s residence. Coverage does not include the structure but does include any affixed items provided or changed by the renter.

Replacement Cost – the cost of replacing property without a reduction for depreciation due to normal wear and tear.

Reported Losses – Includes both expected payments for losses relating to insured events that have occurred and have been reported to the insurance company, but not yet paid.

Reserve – A portion of the premium retained to pay future claims

Reserve Credit – reduction of reserve amounts for reinsurance ceded. Reductions may include the claim reserve and/or the unearned premium reserve.

Residence – the domicile location of a member as shown by his or her determination as a resident.

Residual Market Plan – method devised for coverage of greater than average risk individuals who cannot obtain insurance through normal market channels.

Retention – a mechanism of internal fund allocation for loss exposure used in place of or as a supplement to risk transfer to an insurance company.

Retention Limit – maximum amount of medical and hospital expense an insurer will carry on its own. The limit can be for an individual claim and/or for the insurers total claims, depending upon the terms of the reinsurance contract.

Retrocession – the portion of risk that a reinsurance company cedes or amount of insurance the company chooses not to retain.

Retrospective Rating – the process of determining the cost of an insurance policy based on the actual loss experience determined as an adjustment to the initial premium payment.

Rider – an amendment to a policy agreement.

Risk – Uncertainty concerning the possibility of loss by a peril for which insurance is pursued.

Risk Retention Act – a 1986 federal statute amending portions of the Product Liability Risk Retention Act of 1981 and enacted to make organization of Risk Retention Groups and Purchasing Groups more efficient.

Risk Retention Group – group-owned insurer organized for the purpose of assuming and spreading the liability risks to its members.

S

Salvage – value recoverable after a loss.

Statutory Accounting Principles (SAP) – a set of accounting principles set forth by the National Association of Insurance Commissioners used to prepare statutory financial statements for insurance companies.

Securitization of Insurance Risk – a method for insurance companies to access capital and hedge risks by converting policies into securities that can be sold in financial markets.

Security – a share, participation, or other interest in property or in an enterprise of the issuer or an obligation of the issuer.

Self-Insurance – type of insurance often used for high frequency low severity risks where risk is not transferred to an insurance company but retained and accounted for internally.

Separate Account – segregated funds held and invested independently of other assets by an insurer for the purpose of a group retirement fund.

Short-term Disability – a company standard defining a period of time employees are eligible for short-term disability coverage, typically for 2 years or less.

Short-Term Medical – policies that provide major medical coverage for a short period of time, typically 30 to 180 days. These policies may be renewable for multiple periods.

Situs of Contract – the jurisdiction in which the contract is issued or delivered as stated in the contract.

Social Insurance – compulsory insurance plan administered by a federal or state government agency with the primary emphasis on social adequacy.

Soft Market – a buyer’s market characterized by abundant supply of insurance driving premiums down.

Special revenue bond – any security, or other instrument under which a payment obligation is created, issued by or on behalf of a governmental unit to finance a project serving a substantial public purpose and not payable from the sources in connection with the payment of municipal obligation bonds.

Specified Disease Coverage – coverage that provides primarily pre-determined benefits for expenses of the care of cancer and/or other specified diseases.

Specified/Named Disease – policies that provide benefits only for the diagnosis and/or treatment of a specifically named disease or diseases. Benefits can be paid as expense incurred, per diem or as a principal sum.

Standard Risk – a person who, according to a company’s underwriting standards, is considered a normal risk and insurable at standard rates. High or low risk candidates may qualify for extra or discounted rates based on their deviation from the standard.

State Children’s Health Insurance Program – policies issued in association with the Federal/State partnership created by title XXI of the Social Security Act.

State of Domicile – the state where a company’s home office is located.

State Page – Exhibit of Premiums and Losses for each state a company is licensed. The state of domicile receives a schedule for each jurisdiction the company wrote direct business, or has amounts paid, incurred or unpaid.

Statement Type – refers to the primary business type under which the company files its annual and quarterly statement, such as Life, Property, Health, Fraternal, Title.

Statement Value – the Statutory Accounting Principle book value reduced by any valuation allowance and non-admitted adjustment applied to an individual investment or a similar group of investments, e.g., bonds, mortgage loans, common stock.

Statutory Accounting – method of accounting standards and principles used by state regulatory authorities to measure the financial condition of regulated companies and other insurance enterprises. This method tends to be more conservative than the Generally Accepted Accounting Principles used by most businesses. Compliance with solvency and other standards is determined using financial documents prepared in accordance with Statutory Accounting Principles.

Stock Insurance Company – business owned by stockholders.

Stop Loss/Excess Loss – individual or group policies providing coverage to a health plan, a self-insured employer plan, or a medical provider providing coverage to insure against the risk that any one claim or an entire plan’s losses will exceed a specified dollar amount.

Structured Securities – loan-backed securities that have been divided into two or more classes of investors where the payment of interest and/or principal of any class of securities has been allocated in a manner that is not proportional to interest and/or principal received by the issuer from the mortgage pool or other underlying securities.

Structured Settlements – periodic fixed payments to a claimant for a determinable period, or for life, for the settlement of a claim.

Subrogation – situation where an insurer, on behalf of the insured, has a legal right to bring a liability suit against a third party who caused losses to the insured. Insurer maintains the right to seek reimbursement for losses incurred by insurer at the fault of a third party.

Subrogation Clause – section of insurance policies giving an insurer the right to take legal action against a third party responsible for a loss to an insured for which a claim has been paid.

Subsequent Event – events or transactions that occur subsequent to the balance sheet date, but before the issuance of the statutory financial statements and before the date the audited financial statements are issued, or available to be issued.

Substandard Risk – (impaired risk) risks deemed undesirable due to medical condition or hazardous occupation requiring the use of a waiver, a special policy form, or a higher premium charge.

Superfund – federal act mandating retroactive liability for environmental pollution where responsible party maintains accountability for environmental clean-up regardless of length of time since polluting event occurred.

Surety Bond – a three-party agreement whereby a guarantor (insurer) assumes an obligation or responsibility to pay a second party (obligee) should the principal debtor (obligor) become in default.

Surplus – insurance term referring to retained earnings.

Surplus Line – specialized property or liability coverage available via nonadmitted insurers where coverage is not available through an admitted insurer, licensed to sell that particular coverage in the state.

Swap – an agreement to exchange or net payments as the buyer of an Option, Cap or Floor and to make payments as the seller of a different Option, Cap or Floor.

T

Tenants – homeowners insurance sold to tenants occupying the described property.

Term – period of time for which policy is in effect.

Term Insurance – life insurance payable only if death of insured occurs within a specified time, such as 5 or 10 years, or before a specified age.

Third Party – person other than the insured or insurer who has incurred losses or is entitled to receive payment due to acts or omissions of the insured.

Title Insurance – coverage that guarantees the validity of a title to real and personal property. Buyers of real and personal property and mortgage lenders rely upon the coverage to protect them against losses from undiscovered defects in existence when the policy is issued.

Total Liabilities – total money owed or expected to be owed by the insurance company.

Total Revenue – premiums, revenue, investment income, and income from other sources.

Travel Coverage – covers financial loss due to trip cancellation/interruption; lost or damaged baggage; trip or baggage delays; missed connections and/or changes in itinerary; and casualty losses due to rental vehicle damage.

Treaty – a reinsurance agreement between the ceding company and reinsurer.

U

Unallocated Loss Adjustment Expense (ULAE) – loss adjustment expenses that cannot be specifically tied to a claim.

Umbrella and Excess (Commercial) – coverage for the liability of a commercial venture above a specific amount set forth in a basic policy issued by the primary insurer; or a self-insurer for losses over a stated amount; or an insured or self-insurer for known or unknown gaps in basic coverages or self-insured retentions.

Umbrella and Excess (Personal) – non-business liability protection for individuals above a specific amount set forth in a basic policy issued by the primary insurer; or a self-insurer for losses over a stated amount; or an insured or self-insurer for known or unknown gaps in basic coverages or self-insured retentions.

Unauthorized Reinsurance – reinsurance placed with a company not authorized in the reporting company’s state of domicile.

Underinsured Motorist Coverage – policy option for bodily injury or property losses caused by a motorist with coverage insufficient to cover total dollar amount of losses. Compensation for the injured party is equal to the difference between the losses incurred and the liability covered by the motorist at fault.

Underlying Interest – the asset(s), liability(ies) or other interest(s) underlying a derivative instrument, including, but not limited to, any one or more securities, currencies, rates indices, commodities, derivative instruments, or other financial market instruments.

Underwriter – person who identifies, examines and classifies the degree of risk represented by a proposed insured in order to determine whether or not coverage should be provided and, if so, at what rate.

Underwriting – the process by which an insurance company examines risk and determines whether the insurer will accept the risk or not, classifies those accepted and determines the appropriate rate for coverage provided.

Underwriting Risk – section of the risk-based capital formula calculating requirements for reserves and premiums.

Unearned Premium – amount of premium for which payment has been made by the policyholder but coverage has not yet been provided.

Unearned Premium Reserve – all premiums (fees) received for coverage extending beyond the statement date; appears as a liability on the balance sheet.

Universal Life Insurance – adjustable life insurance under which premiums and coverage are adjustable, company expenses are not specifically disclosed to the insured but a financial report is provided to policyholder’s annually.

Unpaid Losses – claims that are in the course of settlement. The term may also include claims that have been incurred but not reported.

V

Valued Policy – an insurance contract for which the value is agreed upon in advance and is not related to the amount of the insured loss.

Valued Policy Law – state legislation which specifies that the insured shall receive the face amount of the policy in the event of a total loss to a dwelling rather than the actual cash value regardless of the principle of indemnity.

Variable Annuity – an annuity contract under which the premium payments are used to purchase stock and the value of each unit is relative to the value of the investment portfolio.

Variable Life Insurance – life insurance whose face value and/or duration varies depending upon the value of underlying securities.

Variable Universal Life – combines the flexible premium features of universal life with the component of variable life in which excess credited to the cash value of the account depends on investment results of separate accounts. The policyholder selects the accounts into which the premium payments are to be made.

Viatical Settlements – contracts or agreements in which a buyer agrees to purchase all or a part of a life insurance policy.

Vision – limited benefit expense policies. Provides benefits for eye care and eye care accessories. Generally provides a stated dollar amount per annual eye examination. Benefits often include a stated dollar amount for glasses and contacts. May include surgical benefits for injury or sickness associated with the eye.

Back to the Top

W

Warrant – an agreement that gives the holder the right to purchase an underlying financial instrument at a given price and time or at a series of prices and times according to a schedule or warrant agreement.

Warranty – coverage that protects against manufacturer’s defects past the normal warranty period and for repair after breakdown to return a product to its originally intended use. Warranty insurance generally protects consumers from financial loss caused by the seller’s failure to rectify or compensate for defective or incomplete work and cost of parts and labor necessary to restore a product’s usefulness. Includes but is not limited to coverage for all obligations and liabilities incurred by a service contract provider, mechanical breakdown insurance and service contracts written by insurers.

Whole Life – life insurance that may be kept in force for a person’s entire life and that pays a benefit upon the person’s death, whenever that may be.

Whole Life Insurance – life insurance that may be kept in force for the duration of a person’s life and pays a benefit upon the person’s death. Premiums are made for same time period.

Workers’ Compensation – insurance that covers an employer’s liability for injuries, disability or death to persons in their employment, without regard to fault, as prescribed by state or federal workers’ compensation laws and other statutes.

Written Premium – the contractually determined amount charged by the reporting entity to the policyholder for the effective period of the contract based on the expectation of risk, policy benefits, and expenses associated with the coverage provided by the terms of the insurance contract.

X

Y

Z

https://www.naic.org/consumer_glossary.htm

Do You Have To Be A US Citizen To Be A Florida Public Adjuster

The answer is NO!

STEPS TO OBTAIN 3-20 RESIDENT PUBLIC ADJUSTER LICENSE:

Step 1 – You must be:

  • A natural person at least 18 years of age.
  • A resident of Florida or maintain a principle places of business in Florida.
  • A United States citizen or legal alien who possesses a work authorization from the United States Immigration and Naturalization Services. [Click here for more information]
  • Not holdhttps://www.myfloridacfo.com/division/agents/licensure/general/docs/3-series.htm a resident license in another state.

What is an Insurance Alien Company?

Alien Company – an insurance company formed according to the laws of a foreign country. The company must conform to state regulatory standards to legally sell insurance products in that state.

What is blanket coverage?

Blanket coverage – coverage for property and liability that extends to more than one location, class of property or employee.

Builders Risk Policies?

Builders’ Risk Policies – typically written on a reporting or completed value form, this coverage insures against loss to buildings in the course of construction. The coverage also includes machinery and equipment used in the course of construction and to materials incidental to construction.

What is business interruption?

Business Interruption – loss of income as a result of property damage to a business facility.

What is Coinsurance?

Coinsurance – A clause contained in most property insurance policies to encourage policy holders to carry a reasonable amount of insurance. If the insured fails to maintain the amount specified in the clause (Usually at least 80%), the insured shares a higher proportion of the loss. In medical insurance a percentage of each claim that the insured will bear.

Commercial Multiple Peril?

Commercial Multiple Peril – policy that packages two or more insurance coverages protecting an enterprise from various property and liability risk exposures. Frequently includes fire, allied lines, various other coverages (e.g., difference in conditions) and liability coverage. Such coverages would be included in other annual statement lines, if written individually. Include under this type of insurance multi-peril policies (other than farmowners, homeowners and automobile policies) that include coverage for liability other than auto.

Domestic Insurer?

Domestic Insurer – an insurance company that is domiciled and licensed in the state in which it sells insurance.

Federal Flood Insurance?

Federal Flood Insurance – coverage for qualifying residents and businesses in flood prone regions through the National Flood Insurance Act, a federally subsidized flood insurance program enacted in 1968.

Farmers Insurance?

Farmowners Insurance – farmowners insurance sold for personal, family or household purposes. This package policy is similar to a homeowners policy, in that it has been developed for farms and ranches and includes both property and liability coverage for personal and business losses. Coverage includes farm dwellings and their contents, barns, stables, other farm structures and farm inland marine, such as mobile equipment and livestock.

What is a Foreign Insurer?

Foreign Insurer – an insurance company selling policies in a state other than the state in which they are incorporated or domiciled.

What is an incurred loss?

Incurred Losses – sustained losses, paid or not, during a specified time period. Incurred losses are typically found by combining losses paid during the period plus unpaid losses sustained during the time period minus outstanding losses at the beginning of the period incurred in the previous period.

Lloyd’s of London

Lloyd’s of London – association offering membership in various syndicates of wealthy individuals organized for the purpose of writing insurance for a particular hazard.

Glossary of Insurance Terms

GLOSSARY OF KEY INSURANCE TERMS

This page provides a glossary of insurance terms and definitions that are commonly used in the insurance business. New terms will be added to the glossary over time.

The definitions in this glossary are developed by the NAIC Research and Actuarial Department staff based on various insurance references. These definitions represent a common or general use of the term. Some words and/or phrases may be defined differently by other entities, or used in a context such that the definition shown may not be applicable.

A

Accident – an unexpected event or circumstance without deliberate intent.

Accident Insurance – insurance for unforeseen bodily injury.

Accident Only – an insurance contract that provides coverage, singly or in combination, for death, dismemberment, disability, or hospital and medical care caused by or necessitated as a result of accident or specified kinds of accident.

Accident Only or AD&D – policies providing coverage, singly or in combination, for death, dismemberment, disability, or hospital and medical care caused by or necessitated as a result of accident or specified kinds of accidents. Types of coverage include student accident, sports accident, travel accident, blanket accident, specific accident or accidental death and dismemberment (AD&D).

Accidental Bodily Injury – unexpected injury to a person.

Accidental Death & Dismemberment – an insurance contract that pays a stated benefit in the event of death and/or dismemberment caused by accident or specified kinds of accidents.

Accumulation Period – period of time insured must incur eligible medical expenses at least equal to the deductible amount in order to establish a benefit period under a major medical expense or comprehensive medical expense policy.

Actual Cash Value – repayment value for indemnification due to loss or damage of property; in most cases it is replacement cost minus depreciation

Actuarial Report – (PC Insurance)a document or other presentation, prepared as a formal means of conveying to the state regulatory authority and the Board of Directors, or its equivalent, the actuary’s professional conclusions and recommendations, of recording and communicating the methods and procedures, of assuring that the parties addressed are aware of the significance of the actuary’s opinion or findings and that documents the analysis underlying the opinion. (In Life and Health) this document would be called an “Actuarial Memorandum.”

Actuary – business professional who analyzes probabilities of risk and risk management including calculation of premiums, dividends and other applicable insurance industry standards.

Adjuster – a person who investigates claims and recommends settlement options based on estimates of damage and insurance policies held.

Admission – hospital inpatient care for any medical condition.

Admitted Assets – insurer assets which can be valued and included on the balance sheet to determine financial viability of the company.

Admitted Company – an insurance company licensed to do business in a state(s), domiciled in an alternative state or country.

Advance Premiums – occur when a policy has been processed, and the premium has been paid prior to the effective date. These are a liability to the company and not included in written premium or the unearned premium reserve.

Adverse Selection – the social phenomenon whereby persons with a higher than average probability of loss seek greater insurance coverage than those with less risk.

Advisory Organization – a group supported by member companies whose function is to gather loss statistics and publish trended loss costs.

Affiliate – a person or entity that directly, or indirectly, through one or more other persons or entities, controls, is controlled by or is under common control with the insurer.

Agent – an individual who sells, services, or negotiates insurance policies either on behalf of a company or independently.

Aggregate – the maximum dollar amount or total amount of coverage payable for a single loss, or multiple losses, during a policy period, or on a single project.

Aggregate Cost Payments – method of reimbursement of a health plan with a corporate entity that directly provides care, where (1) the health plan is contractually required to pay the total operating costs of the corporate entity, less any income to the entity from other users of services, and (2) there are mutual unlimited guarantees of solvency between the entity and the health plan that put their respective capital and surplus at risk in guaranteeing each other.

Aircraft – coverage for aircraft (hull) and their contents; aircraft owners’ and aircraft manufacturers liability to passengers, airports and other third parties.

ALAE – an estimate of the claims settlement associated with a particular claim or claims.

Alien Company – an insurance company formed according to the laws of a foreign country. The company must conform to state regulatory standards to legally sell insurance products in that state.

Allied Lines – coverages which are generally written with property insurance, e.g., glass, tornado, windstorm and hail; sprinkler and water damage; explosion, riot, and civil commotion; growing crops; flood; rain; and damage from aircraft and vehicle, etc.

All-Risk – also known as open peril, this type of policy covers a broad range of losses. The policy covers risks not explicitly excluded in the policy contract.

Alternative Workers’ Compensation – other than standard workers’ compensation coverage, employer’s liability and excess workers’ compensation (e.g., large deductible, managed care).

Ambulatory Services – health services provided to members who are not confined to a health care institution. Ambulatory services are often referred to as “outpatient” services.

Annual Statement – an annual report required to be filed with each state in which an insurer does business. This report provides a snapshot of the financial condition of a company and significant events which occurred throughout the reporting year.

Annuitant – the beneficiary of an annuity payment, or person during whose life and annuity is payable.

Annuities – Immediate Non-variable – an annuity contract that provides for the fixed payment of the annuity at the end of the first interval of payment after purchase. The interval may vary, however the annuity payouts must begin within 13 months.

Annuity – a contract providing income for a specified period of time, or duration of life for a person or persons.

Appraisal – an estimate of value.

Arbitration – a binding dispute resolution tactic whereby a conciliator with no interest in the outcome intercedes.

Assessed Value – estimated value for real or personal property established by a taxing entity

Asset – probable future economic benefits obtained or controlled by a particular entity as a result of past transactions or events. An asset has three essential characteristics: It embodies a probable future benefit that involves a capacity, singly or in combination with other assets, to contribute directly or indirectly to future net cash inflows; A particular entity can obtain the benefit and control others’ access to it; and The transaction or other event-giving rise to the entity’s right to or control of the benefit has already occurred.

Asset Risk – in the risk-based capital formula, risk assigned to the company’s assets.

Assigned Risk – A governmental pool established to write business declined by carriers in the standard insurance market.

Assisted Living Care – a policy or rider that provides coverage only while a policyholder is confined to an assisted living facility and meets the policy requirements for coverage.

Assumed Reinsurance – the assumption of risk from another insurance entity within a reinsurance agreement or treaty.

Authorized Company – an insurer licensed or admitted to do business in a particular state.

Authorized Control Level Risk Based Capital – theoretical amount of capital plus surplus an insurance company should maintain.

Authorized Reinsurance – reinsurance placed with a reinsurer who is licensed or otherwise allowed to conduct reinsurance within a state.

Auto Liability – coverage that protects against financial loss because of legal liability for motor vehicle related injuries (bodily injury and medical payments) or damage to the property of others caused by accidents arising out of ownership, maintenance or use of a motor vehicle (including recreational vehicles such as motor homes). Commercial is defined as all motor vehicle policies that include vehicles that are used primarily in connection with business, commercial establishments, activity, employment, or activities carried on for gain or profit. No Fault is defined by the state concerned.

Auto Physical Damage – motor vehicle insurance coverage (including collision, vandalism, fire and theft) that insures against material damage to the insured’s vehicle. Commercial is defined as all motor vehicle policies that include vehicles that are used in connection with business, commercial establishments, activity, employment, or activities carried on for gain or profit.

Automobile Liability Insurance – coverage for bodily injury and property damage incurred through ownership or operation of a vehicle.

B

Balance Sheet – accounting statement showing the financial condition of a company at a particular date.

BCEGS – Building Code Effectiveness Grading Schedule – classification system for assessment of building codes per geographic region with special emphasis on mitigation of losses from natural disasters.

Beneficiary – an individual who may become eligible to receive payment due to will, life insurance policy, retirement plan, annuity, trust, or other contract.

Benefits (Medical & Hospital Expenses) – total expenditures for health care services paid to or on behalf of a member.

Blanket coverage – coverage for property and liability that extends to more than one location, class of property or employee.

Boatowners/Personal Watercraft – covers damage to pleasure boats, motors, trailers, boating equipment and personal watercraft as well as bodily injury and property damage liability to others.

Bodily Injury – physical injury including sickness or disease to a person.

Boiler & Machinery or Equipment Breakdown & Machinery – coverage for the failure of boilers, machinery and other electrical equipment. Benefits include (i) property of the insured, which has been directly damaged by the accident; (ii) costs of temporary repairs and expediting expenses; and (iii) liability for damage to the property of others. Coverage also includes inspection of the equipment.

Bonds – a form of debt security whereby the debt holder has a creditor stake in the company. Obligations issued by business units, governmental units and certain nonprofit units having a fixed schedule for one or more future payments of money; includes commercial paper, negotiable certificates of deposit, repurchase agreements and equipment trust certificates.

Book Value – original cost, including capitalized acquisition costs and accumulated depreciation, unamortized premium and discount, deferred origination and commitment fees, direct write-downs, and increase/decrease by adjustment.

Broker – an individual who receives commissions from the sale and service of insurance policies. These individuals work on behalf of the customer and are not restricted to selling policies for a specific company but commissions are paid by the company with which the sale was made.

Builders’ Risk Policies – typically written on a reporting or completed value form, this coverage insures against loss to buildings in the course of construction. The coverage also includes machinery and equipment used in the course of construction and to materials incidental to construction.

Burglary and Theft – coverage for property taken or destroyed by breaking and entering the insured’s premises, burglary or theft, forgery or counterfeiting, fraud, kidnap and ransom, and off-premises exposure.

Business Auto – coverage for motor vehicles, other than those in the garage business, engaged in commerce. Business auto filings include singularly or in any combination coverage such as the following: Auto Liability, PIP, MP, Uninsured Motorist and/or Underinsured Motorists (UM/UIM); Specified Causes of Loss, Comprehensive, and Collision.

Business Interruption – loss of income as a result of property damage to a business facility.

Business owners Policy – business insurance typically for property, liability and business interruption coverage.

C

Calendar Year Deductible – in health insurance, the amount that must be paid by the insured during a calendar year before the insurer becomes responsible for further loss costs.

Capital and Surplus – a company’s assets minus its liabilities.

Capital and Surplus Requirement – statutory requirement ordering companies to maintain their capital and surplus at an amount equal to or in excess of a specified amount to help assure the solvency of the company by providing a financial cushion against expected loss or misjudgments and generally measured as a company’s admitted assets minus its liabilities, determined on a statutory accounting basis.

Capital Gains (Loss) – excess (deficiency) of the sales price of an asset over its book value. Calculated on the basis of original cost adjusted, as appropriate, for accrual of discount or amortization of premium and for depreciation.

Capitation Arrangement – a compensation plan used in connection with some managed care contracts where a physician or other medical provider is paid a flat amount, usually on a monthly basis, for each subscriber who has elected to use that physician or medical provider. Capitated payments are sometimes expressed in terms of a “per member/per month” payment. The capitated provider is generally responsible, under the conditions of the contract, for delivering or arranging for the delivery of all contracted health services required by the covered person.

Captive Agent – an individual who sells or services insurance contracts for a specific insurer or fleet of insurers.

Captive Insurer – an insurance company established by a parent firm for the purpose of insuring the parent’s exposures.

Carrying Value (Amount) – the SAP book value plus accrued interest and reduced by any valuation allowance and any nonadmitted adjustment applied to the individual investment.

Cash – a medium of exchange.

Cash Equivalent – short-term, highly liquid investments that are both (a) readily convertible to known amounts of cash, and (b) so near their maturity that they present insignificant risk of changes in value because of changes in interest rates. Investments with original maturities of three months or less qualify under this definition.

Casualty Insurance – a form of liability insurance providing coverage for negligent acts and omissions such as workers compensation, errors and omissions, fidelity, crime, glass, boiler, and various malpractice coverages.

Catastrophe Bonds – Bonds issued by an insurance company with funding tied to the company’s losses from disasters, or acts of God. A loss exceeding a certain size triggers a reduction in the bond value or a change in the bond structure as loss payments are paid out of bond funds.

Catastrophe Loss – a large magnitude loss with little ability to forecast.

Ceded Premium – amount of premium (fees) used to purchase reinsurance.

Ceding Company – an insurance company that transfers risk by purchasing reinsurance.

Centers for Medicare & Medicaid Services (CMS) – U.S. governmental agency responsible for the licensing of federally qualified HMOs. This was formerly the Health Care Financing Administration.

Change in Valuation Basis – a change in the interest rate, mortality assumption or reserving method or other factors affecting the reserve computation of policies in force.

Chartered Life Underwriter (CLU) – a professional designation awarded by the American College to persons in the life insurance field who pass a series of exams in insurance, investment, taxation, employee benefit plans, estate planning, accounting, management, and economics.

Chartered Property Casualty Underwriter (CPCU) – a professional designation awarded by the American Institute of Property and Casualty Underwriters to persons in the property and liability insurance field who pass a series of exams in insurance, risk management, economics, finance, management, accounting, and law. Designates must also have at least three years experience in the insurance business or related field.

Claim – a request made by the insured for insurer remittance of payment due to loss incurred and covered under the policy agreement.

Claims Adjustment Expenses – costs expected to be incurred in connection with the adjustment and recording of accident and health, auto medical and workers’ compensation claims.

Claims-made Form – A type of liability insurance form that only pays if the both event that causes (triggers)the claim and the actual claim are submitted to the insurance company during the policy term

Class Rating – a method of determining rates for all applicants within a given set of characteristics such as personal demographic and geographic location.

Coinsurance – A clause contained in most property insurance policies to encourage policy holders to carry a reasonable amount of insurance. If the insured fails to maintain the amount specified in the clause (Usually at least 80%), the insured shares a higher proportion of the loss. In medical insurance a percentage of each claim that the insured will bear.

Collar – an agreement to receive payments as the buyer of an Option, Cap or Floor and to make payments as the seller of a different Option, Cap or Floor.

Collateral Loans – unconditional obligations for the payment of money secured by the pledge of an investment.

Collateralized Bond Obligations (CBOs) – an investment-grade bond backed by a pool of low-grade debt securities, such as junk bonds, separated into tranches based on various levels of credit risk.

Collateralized Mortgage Obligations (CMOs) – a type of mortgage-backed security (MBS) with separate pools of pass-through security mortgages that contain varying classes of holders and maturities (tranches) with the advantage of predictable cash flow patterns.

Combinations – a special form of package policy composed of personal automobile and homeowners insurance.

Combined Ratio – an indication of the profitability of an insurance company, calculated by adding the loss and expense ratios.

Commencement Date – date when the organization first became obligated for any insurance risk via the issuance of policies and/or entering into a reinsurance agreement. Same as “effective date” of coverage.

Commercial Auto – coverage for motor vehicles owned by a business engaged in commerce that protects the insured against financial loss because of legal liability for motor vehicle related injuries, or damage to the property of others caused by accidents arising out of the ownership, maintenance, use, or care-custody & control of a motor vehicle. This includes Commercial Auto Combinations of Business Auto, Garage, Truckers and/or Other Commercial Auto.

Commercial Earthquake – earthquake property coverage for commercial ventures.

Commercial Farm and Ranch – a commercial package policy for farming and ranching risks that includes both property and liability coverage. Coverage includes barns, stables, other farm structures and farm inland marine, such as mobile equipment and livestock.

Commercial Flood – separate flood insurance policy sold to commercial ventures.

Commercial General Liability – flexible & broad commercial liability coverage with two major sub-lines: premises/operations sub-line and products/completed operations sub-line.

Commercial Mortgage-Backed Securities – a type of mortgage-backed security that is secured by the loan on a commercial property.

Commercial Multiple Peril – policy that packages two or more insurance coverages protecting an enterprise from various property and liability risk exposures. Frequently includes fire, allied lines, various other coverages (e.g., difference in conditions) and liability coverage. Such coverages would be included in other annual statement lines, if written individually. Include under this type of insurance multi-peril policies (other than farmowners, homeowners and automobile policies) that include coverage for liability other than auto.

Commercial Package Policy – provides a broad package of property and liability coverages for commercial ventures other than those provided insurance through a business owners policy.

Commercial Property – property insurance coverage sold to commercial ventures.

Commission – a percentage of premium paid to agents by insurance companies for the sale of policies.

Community Rating – a rating system where standard rating is established and usually adjusted within specific guidelines for each group on the basis of anticipated utilization by the group’s employees.

Company Code – a five-digit identifying number assigned by NAIC, assigned to all insurance companies filing financial data with NAIC.

Completed Operations Liability – policies covering the liability of contractors, plumbers, electricians, repair shops, and similar firms to persons who have incurred bodily injury or property damage from defective work or operations completed or abandoned by or for the insured, away from the insured’s premises.

Comprehensive (Hospital and Medical) – line of business providing for medical coverages; includes hospital, surgical, major medical coverages; does not include Medicare Supplement, administrative services (ASC) contracts, administrative services only (ASO) contracts, federal employees health benefit plans (FEHBP), medical only programs, Medicare and Medicaid programs, vision only and dental only business.

Comprehensive General Liability (CGL) – coverage of all business liabilities unless specifically excluded in the policy contract.

Comprehensive Personal Liability – comprehensive liability coverage for exposures arising out of the residence premises and activities of individuals and family members. (Non-business liability exposure protection for individuals.)

Comprehensive/Major Medical – policies that provide fully insured indemnity, HMO, PPO, or Fee for Service coverage for hospital, medical, and surgical expenses. Coverage excludes Short-Term Medical Insurance, the Federal Employees Health Benefit Program and non-comprehensive coverage such as basic hospital only, medical only, hospital confinement indemnity, surgical, outpatient indemnity, specified disease, intensive care, and organ and tissue transplant coverage.

Concurrent Causation – property loss incurred from two or more perils in which only one loss is covered but both are paid by the insurer due to simultaneous incident.

Conditions – requirements specified in the insurance contract that must be upheld by the insured to qualify for indemnification.

Condos – homeowners insurance sold to condominium owners occupying the described property.

Construction and Alteration Liability – covering the liability of an insured to persons who have incurred bodily injury or property damage from alterations involving demolition, new construction or change in size of a structure on the insured’s premises.

Contingency Reserves – required by some jurisdictions as a hedge against adverse experience from operations, particularly adverse claim experience.

Contingent Liability – the liability of an insured to persons who have incurred bodily injury or property damage from work done by an independent contractor hired by the insured to perform work that was illegal, inherently dangerous, or directly supervised by the insured

Continuation of Care Requirement – statutory or contractual provision requiring providers to deliver care to an enrollee for some period following the date of a Health Plan Company’s insolvency.

Continuing Care Retirement Communities – senior housing arrangements that in addition to housing include some provision for skilled nursing care.

Contract Reserves – reserves set up when, due to the gross premium structure, the future benefits exceed the future net premium. Contract reserves are in addition to claim and premium reserves.

Contractual Liability – liability coverage of an insured who has assumed the legal liability of another party by written or oral contract. Includes a contractual liability policy providing coverage for all obligations and liabilities incurred by a service contract provider under the terms of service contracts issued by the provider.

Convertible Term Insurance Policy – an insurance policy that can be converted into permanent insurance without a medical assessment. The insurer is required to renew the policy regardless of the health of the insured subject to policy conditions.

Coordination of Benefits (COB) – provision to eliminate over insurance and establish a prompt and orderly claims payment system when a person is covered by more than one group insurance and/or group service plan.

Copay – a cost sharing mechanism in group insurance plans where the insured pays a specified dollar amount of incurred medical expenses and the insurer pays the remainder.

Corrective Order – commissioner’s directive of action to be completed by an insurer.

Covered Lives – The total number of lives insured, including dependents, under individual policies and group certificates.

Credit – individual or group policies that provide benefits to a debtor for full or partial repayment of debt associated with a specific loan or other credit transaction upon disability or involuntary unemployment of debtor, except in connection with first mortgage loans.

Credit – Assumption Agreement – an insurance certificate issued on an existing insurance contract indicating that another insurer has assumed all of the risk under the contract from the ceding insurance company.

Credit – Credit Default – coverage purchased by manufacturers, merchants, educational institutions, or other providers of goods and services extending credit, for indemnification of losses or damages resulting from the nonpayment of debts owed to them for goods or services provided in the normal course of their business.

Credit – Involuntary Unemployment – makes loan/credit transaction payments to the creditor when the debtor becomes involuntarily unemployed.

Credit Accident and Health (group and individual) – coverage provided to or offered to borrowers in connection with a consumer credit transaction where the proceeds are used to repay a debt or an installment loan in the event the consumer is disabled as the result of an accident, including business not exceeding 120 months duration.

Credit Disability – makes monthly loan/credit transaction payments to the creditor upon the disablement of an insured debtor.

Credit Health Insurance – policy assigning creditor as beneficiary for insurance on a debtor thereby remitting balance of payment to creditor should the debtor become disabled.

Credit Involuntary Unemployment – credit insurance that provides a monthly or lump sum benefit during an unpaid leave of absence from employment resulting from specified causes, such as layoff, business closure, strike, illness of a close relative and adoption or birth of a child. This insurance is sometimes referred to as Credit Family Leave.

Credit Life Insurance – policy assigning creditor as beneficiary for insurance on a debtor thereby remitting balance of payment to creditor upon death of debtor.

Credit Personal Property Insurance – insurance written in connection with a credit transaction where the collateral is not a motor vehicle, mobile home or real estate and that covers perils to the goods purchased through a credit transaction or used as collateral for a credit transaction and that concerns a creditor’s interest in the purchased goods or pledged collateral, either in whole or in part; or covers perils to goods purchased in connection with an open-end transaction.

Credit Placed Insurance – insurance that is purchased unilaterally by the creditor, who is the named insured, subsequent to the date of the credit transaction, providing coverage against loss, expense or damage to property as a result of fire, theft, collision or other risks of loss that would either impair a creditor’s interest or adversely affect the value of collateral. “Creditor Placed Home” means “Creditor Placed Insurance” on homes, mobile homes and other real estate. “Creditor Placed Auto” means insurance on automobiles, boats or other vehicles.

Credit Risk – part of the risk-based capital formula that addresses the collectability of a company’s receivables and the risk of losing a provider or intermediary that has received advance capitation payments.

Creditor-Placed Auto – single interest or dual interest credit insurance that is purchased unilaterally by the creditor, who is the named insured, subsequent to the date of the credit transaction, providing coverage against loss to property that would either impair a creditor’s interest or adversely affect the value of collateral on automobiles, boats, or other vehicles.

Creditor-Placed Home – single interest or dual interest credit insurance purchased unilaterally by the creditor, who is the named insured, subsequent to the date of the credit transaction, providing coverage against loss to property that would either impair a creditor’s interest or adversely affect the value of collateral on homes, mobile homes, and other real estate.

Crop – coverage protecting the insured against loss or damage to crops from a variety of perils, including but not limited to fire, lightening, loss of revenue, tornado, windstorm, hail, flood, rain, or damage by insects.

Crop-Hail Insurance – coverage for crop damage due to hail, fire or lightning.

D

Date of Issue – date when an insurance company issues a policy.

Declarations – policy statements regarding the applicant and property covered such as demographic and occupational information, property specifications and expected mileage per year .

Deductible – Portion of the insured loss (in dollars) paid by the policy holder

Deferred Annuity – annuity payment to be made as a single payment or a series of installments to begin at some future date, such as in a specified number of years or at a specified age.

Demutualization – conversion of a mutual insurance company to a capital stock company.

Dental Insurance – policies providing only dental treatment benefits such as routine dental examinations, preventive dental work, and dental procedures needed to treat tooth decay and diseases of the teeth and jaw.

Dental Only – line of business providing dental only coverage; coverage can be on a stand-alone basis or as a rider to a medical policy. If the coverage is as a rider, deductibles or out-of-pocket limits must be set separately from the medical coverage. Does not include self-insured business as well as FEHBP or Medicare and Medicaid programs.

Derivative – securities priced according to the value of other financial instruments such as commodity prices, interest rates, stock market prices, foreign or exchange rates.

Difference In Conditions (DIC) Insurance – special form of open-peril coverage written in conjunction with basic fire coverage and designed to provide protection against losses not reimbursed under the standard fire forms. Examples are flood and earthquake coverage.

Direct Incurred Loss – loss whereby the proximate cause is equivalent to the insured peril.

Direct Loss – Damage to covered real or personal property caused by a covered peril.

Direct Writer – an insurance company that sells policies to the insured through salaried representatives or exclusive agents only; reinsurance companies that deal directly with ceding companies instead of using brokers.

Direct Written Premium – total premiums received by an insurance company without any adjustments for the ceding of any portion of these premiums to the Reinsurer.

Directors & Officers Liability – liability coverage protecting directors or officers of a corporation from liability arising out of the performance of their professional duties on behalf of the corporation.

Disability Income – a policy designed to compensate insured individuals for a portion of the income they lose because of a disabling injury or illness.

Disability Income – Long-Term – policies that provide a weekly or monthly income benefit for more than five years for individual coverage and more than one year for group coverage for full or partial disability arising from accident and/or sickness.

Disability Income – Short-Term – policies that provide a weekly or monthly income benefit for up to five years for individual coverage and up to one year for group coverage for full or partial disability arising from accident and/or sickness.

Dividend – a refund of a portion of the premium paid by the insured from insurer surplus.

Domestic Insurer – an insurance company that is domiciled and licensed in the state in which it sells insurance.

Dual Interest – insurance that protects the creditor’s and the debtor’s interest in the collateral securing the debtor’s credit transaction. “Dual Interest” includes insurance commonly referred to as “Limited Dual Interest.”

Dwelling Property/Personal Liability – a special form of package policy composed of dwelling fire and/or allied lines, and personal liability insurance.

E

Early warning system – a system designed by insurance industry regulators of identifying practices and risk-related trends that contribute to systemic risk by measuring insurer’ financial stability.

Earned Premium – portion of insured’s prepaid premium allocated to the insurance company’s loss experience, expenses, and profit year- to -date.

Earthquake – property coverages for losses resulting from a sudden trembling or shaking of the earth, including that caused by volcanic eruption. Excluded are losses resulting from fire, explosion, flood or tidal wave following the covered event.

EBNR – Earned but not reported – premium amount insurer reasonably expects to receive for which contracts are not yet final and exact amounts are not definite.

EDP Policies – coverage to protect against losses arising out of damage to or destruction of electronic data processing equipment and its software.

Effective Date – date at which an insurance policy goes into force.

Elevators and Escalators Liability – liability coverage for bodily injury or property damage arising from the use of elevators or escalators operated, maintained or controlled by the insured.

Employee Benefit Liability – liability protection for an employer for claims arising from provisions in an employee benefit insurance plan provided for the economic and social welfare of employees. Examples of items covered are pension plans, group life insurance, group health insurance, group disability income insurance, and accidental death and dismemberment.

Employee Retirement Income Security Act of 1974 (ERISA) – a federal statute governing standards for private pension plans, including vesting requirements, funding mechanisms, and plan design.

Employers Liability – employers’ liability coverage for the legal liability of employers arising out of injuries to employees. This code should be used when coverage is issued as an endorsement, or as part of a statutory workers’ compensation policy.

Employment Practices Liability Coverage – liability insurance for employers providing coverage for wrongful termination, discrimination, or sexual harassment of the insured’s current or former employees.

Encumbrance – outstanding mortgages or other debt related to real estate and any unpaid accrued acquisition or construction costs.

Endorsement – an amendment or rider to a policy adjusting the coverages and taking precedence over the general contract.

Enrollment – The total number of plans, not the total number of covered lives, providing coverage to the enrollee and their dependents.

Environmental Impairment Liability (EIL) – coverage for negligence or omission resulting in pollution or environmental contamination.

Environmental Pollution Liability – liability coverage of an insured to persons who have incurred bodily injury or property damage from acids, fumes, smoke, toxic chemicals, waste materials or other pollutants.

Equity Indexed Annuity – a fixed annuity that earns interest or provides benefits that are linked to an external reference or equity index, subject to a minimum guarantee.

Errors and Omissions Liability | Professional Liability other than Medical – liability coverage of a professional or quasi professional insured to persons who have incurred bodily injury or property damage, or who have sustained any loss from omissions arising from the performance of services for others, errors in judgment, breaches of duty, or negligent or wrongful acts in business conduct.

Event Cancellation – coverage for financial loss because of the cancellation or postponement of a specific event due to weather or other unexpected cause beyond the control of the insured.

Excess and Umbrella Liability – liability coverage of an insured above a specific amount set forth in a basic policy issued by the primary insurer; or a self insurer for losses over a stated amount; or an insured or self insurer for known or unknown gaps in basic coverages or self insured retentions.

Excess of Loss Reinsurance – loss sharing mechanism where an insurer pays all claims up to a specified amount and a reinsurance company pays any claims in excess of stated amount.

Excess Workers’ Compensation – either specific and/or aggregate excess workers’ compensation insurance written above an attachment point or self-insured retention.

Expense Ratio – percentage of premium income used to attain and service policies. Derived by subtracting related expenses from incurred losses and dividing by written premiums.

Experience Rating – rating system where each group is rated entirely on the basis of its own expected claims in the coming period, with retrospective adjustments for prior periods. This method is prohibited under the conditions for federal qualification.

Exposure – risk of possible loss.

Extra Expense Insurance – a type of property insurance for extraordinary expenses related to business interruption such as a back-up generator in case of power failure.

F

Face Amount – the value of a policy to be provided upon maturity date or death.

Facultative Reinsurance – reinsurance for a specific policy for which terms can be negotiated by the original insurer and reinsurer.

FAIR Plan – Fair Access to Insurance Requirements – state pools designed to provide insurance to property owners who are unable to obtain property insurance through conventional means.

Fair Value – the amount at which an asset (or liability) could be bought (or incurred) or sold (or settled) in a current transaction between willing parties, that is, other than in a forced or liquidation sale. Quoted market prices in active markets are the best evidence of fair value and shall be used as the basis for the measurement, if available. If a quoted market price is available, the fair value is the product of the number of trading units times market price.

Farmowners Insurance – farmowners insurance sold for personal, family or household purposes. This package policy is similar to a homeowners policy, in that it has been developed for farms and ranches and includes both property and liability coverage for personal and business losses. Coverage includes farm dwellings and their contents, barns, stables, other farm structures and farm inland marine, such as mobile equipment and livestock.

Federal Flood Insurance – coverage for qualifying residents and businesses in flood prone regions through the National Flood Insurance Act, a federally subsidized flood insurance program enacted in 1968.

Federally Reinsured Crop – crop insurance coverage that is either wholly or in part reinsured by the Federal Crop Insurance Corporation (FCIC) under the Standard Reinsurance Agreement (SRA). This includes the following products: Multiple Peril Crop Insurance (MPCI); Catastrophic Insurance, Crop Revenue Coverage (CRC); Income Protection and Revenue Assurance.

Fees Payable – fees incurred but not yet paid.

FEMA – Federal Emergency Management Agency – an independent agency, tasked with responding to, planning for, mitigating and recovery efforts of natural disasters.

Fidelity – a bond or policy covering an employer’s loss resulting from an employee’s dishonest act (e.g., loss of cash, securities, valuables, etc.).

Financial Guaranty – a surety bond, insurance policy, or an indemnity contract (when issued by an insurer), or similar guaranty types under which loss is payable upon proof of occurrence of financial loss to an insured claimant, obligee or indemnitee as a result of failure to perform a financial obligation or any other permissible product that is defined as or determined to be financial guaranty insurance.

Financial Reporting – insurance companies are required to maintain records and file annual and quarterly financial statements with regulators in accordance with statutory accounting principles (SAP). Statutory rules also govern how insurers should establish reserves for invested assets and claims and the conditions under which they can claim credit for reinsurance ceded.

Financial Responsibility Law – a statute requiring motorists to show capacity to pay for automobile-related losses.

Financial Statement – balance sheet and profit and loss statement of an insurance company. This statement is used by the NAIC, and by State Insurance Commissioners to regulate an insurance company according to reserve requirements, assets, and other liabilities.

Fire – coverage protecting the insured against the loss to real or personal property from damage caused by the peril of fire or lightning, including business interruption, loss of rents, etc.

Fire Legal Liability – coverage for property loss liability as the result of separate negligent acts and/or omissions of the insured that allows a spreading fire to cause bodily injury or property damage of others. An example is a tenant who, while occupying another party’s property, through negligence causes fire damage to the property.

Flood – coverage protecting the insured against loss or damage to real or personal property from flood. (Note: If coverage for flood is offered as an additional peril on a property insurance policy, file it under the applicable property insurance filing code.)

Foreign Insurer – an insurance company selling policies in a state other than the state in which they are incorporated or domiciled.

Foreign Investment – an investment in a foreign jurisdiction, or an investment in a person, real estate or asset domiciled in a foreign jurisdiction. An investment shall not be deemed to be foreign if the issuing person, qualified primary credits source or qualified guarantor is a domestic jurisdiction or a person domiciled in a domestic jurisdiction, unless: a) The issuing person is a shell business entity; and b) The investment is not assumed, accepted, guaranteed or insured or otherwise backed by a domestic jurisdiction or a person, that is not a shell business entity, domiciled in a domestic jurisdiction.

Foreign jurisdiction – a jurisdiction outside of the United States, Canada or any province or political subdivision of the foregoing.

Fraternal Insurance – a form of group coverage or disability insurance available to members of a fraternal organization.

Fronting – an arrangement in which a primary insurer acts as the insurer of record by issuing a policy, but then passes the entire risk to a reinsurer in exchange for a commission. Often, the fronting insurer is licensed to do business in a state or country where the risk is located, but the reinsurer is not.

G

Generally Accepted Accounting Principles (GAAP) – an aggregate of the accounting standards, principles and best practices for the preparation of financial statements allowing for consistency in reporting.

Gramm-Leach Bliley Act (GLBA) – act, repealing Glass-Steagal Act of 1933, allows consolidation of commercial banks, investment institutions and insurance companies. Established a framework of responsibilities of federal and state regulators for these financial industries. It permits financial services companies to merge and engage in a variety of new business activities, including insurance, while attempting to address the regulatory issues raised by such combinations.

Goodwill – the difference between the cost of acquiring the entity and the reporting entity’s share of the book value of the acquired entity.

Gross Paid-in and Contributed Surplus – amount of capital received in excess of the par value of the stock issued.

Gross Premium – the net premium for insurance plus commissions, operating and miscellaneous commissions. For life insurance, this is the premium including dividends.

Group Accident and Health – coverage written on a group basis (e.g., employees of a single employer and their dependents) that pays scheduled benefits or medical expenses caused by disease, accidental injury or accidental death. Excludes amounts attributable to uninsured accidents and health plans and the uninsured portion of partially insured accident and health plans.

Group Annuities – Deferred Non- Variable and Variable – an annuity contract that provides an accumulation based on both (1) funds that accumulate based on a guaranteed crediting interest rates or additional interest rate applied to designated considerations, and (2) funds where the accumulation vary in accordance with the rate of return of the underlying investment portfolio selected by the policyholder. The contract provides for the initiation of payments at some designated future date.

Group Annuities – Deferred Variable – an annuity contract that provides an accumulation based fund where the accumulation varies in accordance with the rate of return of the underlying investment portfolio selected by the policyholder. Must include at least one option to have the accumulation vary in accordance with the rate of return of the underlying investment portfolio selected by the policyholder and may include at least one option to have the series of payments vary in accordance with the rate of return of the underlying investment portfolio selected by the policyholder. This annuity contract provides for the initiation of payments at some designated future date.

Group Annuities – Immediate Non-Variable and Variable – an annuity contract that provides an accumulation based on both (1) funds that accumulate based on a guaranteed crediting interest rates or additional interest rate applied to designated considerations, and (2) funds where the accumulation vary in accordance with the rate of return of the underlying investment portfolio selected by the policyholder. The contract provides for the initiation of payments at some interval that may vary, however the annuity payouts must begin within 13 months.

Group Annuities – Immediate Variable – an annuity contract that provides for the first payment of the annuity at the end of the fixed interval of payment after purchase. The interval may vary, however the annuity payouts must begin within 13 months. The amount varies with the value of equities (separate account) purchased as investments by the insurance companies.

Group Annuities – Unallocated – annuity contracts or portions thereof where the Insurer purchases an annuity for the retirees.

Group Annuity – a contract providing income for a specified period of time, or duration of life for a person or persons established to benefit a group of employees.

Group Health – health insurance issued to employers, associations, trusts, or other groups covering employees or members and/or their dependents, to whom a certificate of coverage may be provided.

Group Code – a unique three to five digit number assigned by the NAIC to identify those companies that are part of a larger group of insurance companies.

Group Credit – Life – contracts sold in connection with loan/credit transactions or other credit transactions, which do not exceed a stated duration and/or amount and provide insurance protection against death.

Group Health Organizations – Health Maintenance (HMO) – a plan under which an enrollee pays a membership fixed fee in advance in return for a wide range of comprehensive health care services with the HMO’s approved providers in a designated service area.

Guaranty Fund – funding mechanism employed by states to provide funds to cover policyholder obligations of insolvent reporting entities.

H

Hard Market – a market characterized by high demand and low supply.

Hazard – circumstance which tends to increase the probability or severity of a loss.

Health – Excess/Stop Loss – this type of insurance may be extended to either a health plan or a self-insured employer plan. Its purpose is to insure against the risk that any one claim will exceed a specific dollar amount or that an entire plan’s losses will exceed a specific amount.

Health Insurance – a generic term applying to all types of insurance indemnifying or reimbursing for losses caused by bodily injury or illness including related medical expenses.

Health Maintenance Organization (HMO) – a medical group plan that provides physician, hospital, and clinical services to participating members in exchange for a periodic flat fee.

Health Plan – written promise of coverage given to an individual, family, or group of covered individuals, where a beneficiary is entitled to receive a defined set of health care benefits in exchange for a defined consideration, such as a premium.

Hold-Harmless Agreement – A risk transfer mechanism whereby one party assumes the liability of another party by contract

Homeowners Insurance – a package policy combining real and personal property coverage with personal liability coverage. Coverage applicable to the dwelling, appurtenant structures, unscheduled personal property and additional living expense are typical. Includes mobile homes at a fixed location.

Hospital Indemnity Coverage – coverage that provides a pre-determined, fixed benefit or daily indemnity for contingencies based on a stay at a hospital or intensive care facility.

Hull Insurance – coverage for damage to a vessel or aircraft and affixed items.

I

Incontestability Provision – a life insurance and annuity provision limiting the time within which the insurer has the legal right to void the contract on grounds of material misrepresentation in the policy application.

Incurred But Not Reported (IBNR) – (Pure IBNR) claims that have occurred but the insurer has not been notified of them at the reporting date. Estimates are established to book these claims. May include losses that have been reported to the reporting entity but have not yet been entered into the claims system or bulk provisions. Bulk provisions are reserves included with other IBNR reserves to reflect deficiencies in known case reserves. IBNR can sometimes include estimates of incurred but Not Enough Reported (IBNER)

Incurred Claims – paid claims plus amounts held in reserve for those that have been incurred but not yet paid.

Incurred Losses – sustained losses, paid or not, during a specified time period. Incurred losses are typically found by combining losses paid during the period plus unpaid losses sustained during the time period minus outstanding losses at the beginning of the period incurred in the previous period.

Indemnity, Principle of – a general legal principle related to insurance that holds that the individual recovering under an insurance policy should be restored to the approximate financial position he or she was in prior to the loss. Legal principle limiting compensation for damages be equivalent to the losses incurred.

Independent Adjuster – freelance contractor paid a fee for adjusting losses on behalf of companies.

Independent Agent – a representative of multiple insurance companies who sells and services policies for records which they own and operate under the American Agency System.

Independent Contractor – an individual who is not employed for a company but instead works for themselves providing goods or services to clients for a fee.

Index Annuity – an interest bearing fixed annuity tied to an equity index, such as the Dow Jones Industrial Average or S & P 500.

Individual Annuities – Deferred Variable – an annuity contract that provides an accumulation based fund where the accumulation varies in accordance with the rate of return of the underlying investment portfolio selected by the policyholder. Must include at least one option to have the accumulation vary in accordance with the rate of return of the underlying investment portfolio selected by the policyholder and may include at least one option to have the series of payments vary in accordance with the rate of return of the underlying investment portfolio selected by the policyholder. This annuity contract provides for the initiation of payments at some designated future date.

Individual Annuities – Immediate Variable – an annuity contract that provides for the first payment of the annuity at the end of the fixed interval of payment after purchase. The interval may vary, however the annuity payouts must begin within 13 months. The amount varies with the value of equities (separate account) purchased as investments by the insurance companies.

Individual Annuities – Special – contracts with certain noteworthy attributes.

Individual Annuities- Deferred Non-Variable and Variable – an annuity contract that provides an accumulation based on both (1) funds that accumulate based on a guaranteed crediting interest rates or additional interest rate applied to designated considerations, and (2) funds where the accumulation vary in accordance with the rate of return of the underlying investment portfolio selected by the policyholder. The contract provides for the initiation of payments at some designated future date.

Individual Annuities- Deferred Non-Variable – an annuity contract that provides an accumulation based on funds that accumulate based on a guaranteed crediting interest rate or additional interest rate. This annuity contract provides for the initiation of payments at some designated future date.

Individual Annuities- Immediate Non-Variable – an annuity contract that provides for the fixed payment of the annuity at the end of the first interval of payment after purchase. The interval may vary, however the annuity payouts must begin within 13 months.

Individual Annuities- Immediate Non-Variable and Variable – an annuity contract that provides an accumulation based on both (1) funds that accumulate based on a guaranteed crediting interest rates or additional interest rate applied to designated considerations, and (2) funds where the accumulation vary in accordance with the rate of return of the underlying investment portfolio selected by the policyholder. The contract provides for the initiation of payments at some interval that may vary, however the annuity payouts must begin within 13 months.

Individual Health – health insurance where the policy is issued to an individual covering the individual and/or their dependents in the individual market. This includes conversions from group policies.

Individual Credit – Credit Disability – makes monthly loan/credit transaction payments to the creditor upon the disablement of an insured debtor.

Individual Credit – Life – contracts sold in connection with loan/credit transactions or other credit transactions, which do not exceed a stated duration and/or amount and provide insurance protection against death.

Industrial Life – Industrial life insurance, also called “debit” insurance, is insurance under which premiums are paid monthly or more often, the face amount of the policy does not exceed a stated amount, and the words “industrial policy” are printed in prominent type on the face of the policy.

Inland Marine – coverage for property that may be in transit, held by a bailee, at a fixed location, a movable good that is often at different locations (e.g., off road constructions equipment), or scheduled property (e.g., Homeowners Personal Property Floater) including items such as live animals, property with antique or collector’s value, etc. This line also includes instrumentalities of transportation and communication, such as bridges, tunnels, piers, wharves, docks, pipelines, power and phone lines, and radio and television towers.

Insurable Interest – A right or relationship in regard to the subject matter of the insured contract such that the insured can suffer a financial loss from damage, loss or destruction to it. (Bickelhaupt and Magee )

Insurance – an economic device transferring risk from an individual to a company and reducing the uncertainty of risk via pooling.

Insurance Holding Company System – consists of two or more affiliated persons, one or more of which is an insurer.

Insurance Regulatory Information System (IRIS) – a baseline solvency screening system for the National Association of Insurance Commissioners (NAIC) and state insurance regulators established in the mid-1970s.

Insurance to Value – Amount of insurance purchased vs. the actual replacement cost of the insured property expressed as a ratio.

Insured – party(ies) covered by an insurance policy.

Insurer – an insurer or reinsurer authorized to write property and/or casualty insurance under the laws of any state.

Intermediary – a person, corporation or other business entity (not licensed as a medical provider) that arranges, by contracts with physicians and other licensed medical providers, to deliver health services for a health insurer and its enrollees via a separate contract between the intermediary and the insurer.

International – includes all business transacted outside the U.S. and its territories and possessions where the appropriate line of business is not determinable.

Internet Liability Insurance/Cyber Insurance – coverage for cyber commerce including copyright infringement, libel, and violation of privacy.

Investment grade – the obligation has been determined to be in one of the top four generic lettered rating classifications by a securities rating agency acceptable to the commissioner, that the obligation has been identified in writing by such a rating agency to be of investment grade quality, or, if the obligation has not been submitted to any such rating agency, that the obligation has been determined to be investment grade (Class 1 and Class 2) by the Securities Valuation Office of the National Association of Insurance Commissioners.

Investment Income Accrued – investment income earned as of the reporting date but not legally due to be paid to the reporting entity until subsequent to the reporting date.

Investment Income Due – investment income earned and legally due to be paid to the reporting entity as of the reporting date.

Investment Income Gross – shall be recorded as earned and shall include investment income collected during the period, the change in investment income due and accrued, the change in unearned investment income plus any amortization (e.g., discounts or premiums on bonds, origination fees on mortgage loans, etc.)

Irrevocable Beneficiary – a life insurance policy beneficiary who has a vested interest in the policy proceeds even during the insured’s lifetime because the policy owner has the right to change the beneficiary designation only after obtaining the beneficiary’s consent.

J

Joint and Last Survivor Annuity – retirement plan that continues to payout so long as at least one, of two or more, annuitants is alive.

Joint Underwriting Association (JUA) – a loss-sharing mechanism combining several insurance companies to provide extra capacity due to type or size of exposure.

Joint-Life Annuity – an annuity contract that ceases upon the death of the first of two or more annuitants.

K

Key-Persons Insurance – a policy purchased by, for the benefit of, a business insuring the life or lives of personnel integral to the business operations.

Kidnap/Ransom Insurance – coverage for ransom or extortion costs and related expenses.

L

Lapse – termination of a policy due to failure to pay the required renewal premium.

Level Premium Insurance – life insurance policy for which the cost is equally distributed over the term of the premium period, remaining constant throughout.

Liability – a certain or probable future sacrifice of economic benefits arising from present obligations of a particular entity to transfer assets or to provide services to other entities in the future as a result of a past transactions(s) or event(s). three essential characteristics: a)    It embodies a present duty or responsibility to one or more other entities that entails settlement by probable future transfer or use of assets at a specified or determinable date, on occurrence of a specified event, or on demand; b)    The duty or responsibility obligates a particular entity, leaving it little or no discretion to avoid the future sacrifice; and c)    The transaction or other event obligating the entity has already happened.

Life – Endowment – insurance that pays the same benefit amount should the insured die during the term of the contract, or if the insured survives to the end of the specified coverage term or age.

Life – Flexible Premium Adjustable Life – a group life insurance that provides a face amount that is adjustable to the certificate holder and allows the certificate holder to vary the modal premium that is paid or to skip a payment so long as the certificate value is sufficient to keep the certificate in force, and under which separately identified interest credits (other than in connection with dividend accumulation, premium deposit funds or other supplementary accounts) and mortality and expense charges are made to individual certificates while providing minimum guaranteed values.

Life Settlements – a contract or agreement in which a policyholder agrees to sell or transfer ownership in all or part of a life insurance policy to a third party for compensation that is less than the expected death benefit of a policy.

Lifetime Disability Benefit – a provision in some disability income policies to recoup lost wages for the term of disability or remainder of insured’s life in case of permanent disability.

Limited Benefit – policies that provide coverage for vision, prescription drug, and/or any other single service plan or program. Also include short-term care policies that provide coverage for less than one year for medical and other services provided in a setting other than an acute care unit of the hospital.

Limited Payment Life Insurance – a form of whole-life insurance with a pre-defined number of premiums to be paid.

Limited Policies – health insurance coverage for a certain ailment, such as cancer.

Limits – maximum value to be derived from a policy.

Line of Business – classification of business written by insurers.

Liquor Liability – coverage for the liability of an entity involved in the retail or wholesale sales of alcoholic beverages, or the serving of alcoholic beverages, to persons who have incurred bodily injury or property damage arising from an intoxicated person.

Living benefits rider – a rider attached to a life insurance policy providing long term care for the terminally ill.

Lloyd’s of London – association offering membership in various syndicates of wealthy individuals organized for the purpose of writing insurance for a particular hazard.

Loan-backed Securities – pass-through certificates, collateralized mortgage obligations (CMOs), and other securitized loans not included in structured securities where payment of interest and/or principal is directly proportional to the interest and/or principal received by the issuer from the mortgage pool or other underlying securities.

Long Duration Contracts – contracts, excluding financial guaranty contracts, mortgage guaranty contracts and surety contracts, that fulfill both of the following conditions: (1) the contract term is greater than or equal to thirteen months and (2) the insurer can neither cancel nor increase the premium during the contract term.

Long-Term Care – policies that provide coverage for not less than one year for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services provided in a setting other than an acute care unit of a hospital, including policies that provide benefits for cognitive impairment or loss of functional capacity. This includes policies providing only nursing home care, home health care, community based care, or any combination. The policy does not include coverage provided under comprehensive/major medical policies, Medicare Advantage, or for accelerated heath benefit-type products.

Long-Term Disability Income Insurance – policy providing monthly income payments for insureds who become disabled for an extensive length of time, typically two years or longer.

Loss – physical damage to property or bodily injury, Including loss of use or loss of income

Loss Adjustment Expense (LAE) – expected payments for costs to be incurred in connection with the adjustment and recording of losses. Can be classified into two broad categories: Defense and Cost Containment (DCC) and Adjusting and Other (AO). Can also be separated into (Allocated Loss Adjustment Expense) and (Unallocated Loss Adjustment Expense for ratemaking purposes.

Loss Frequency – incidence of claims on a policy during a premium period.

Loss of Use Insurance – policy providing protection against loss of use due to damage or destruction of property.

Loss Payable Clause – coverage for third party mortgagee in case of default on insured property, secured by a loan, that has been lost or damaged.

Loss Ratio – the percentage of incurred losses to earned premiums.

Loss Reserve – the amount that insurers set aside to cover claims incurred but not yet paid.

Loss Reserves – an estimate of liability or provision in an insurer’s financial statement, indicating the amount the insurer expects to pay for losses incurred but not yet reported or reported claims that haven’t been paid.

Losses Incurred – Includes claims that have been paid and/or have amounts held in reserve for future payment

Losses Incurred But Not Reported (IBNR) – An estimated amount set aside by the insurance company to pay claims that may have occurred, but for some reason have not yet been reported to the insurance company.

M

Major Medical – a hospital/surgical/medical expense contract that provides comprehensive benefits as defined in the state in which the contract will be delivered.

Malpractice – alleged misconduct or negligence in a professional act resulting in loss or injury.

Managed Care – system of health care delivery that attempts to influence the utilization, quality, and cost of services provided.

Mandated benefits – insurance required by state or federal law.

Manufacturers Output Policies – provides broad form coverage of personal property of an insured manufacturer including raw material, goods in process, finished goods and goods shipped to customers.

Margin Premium – a deposit that an organization is required to maintain with a broker with respect to the Futures Contracts purchased or sold.

Market Value – fair value or the price that could be derived from current sale of an asset.

Mechanical Breakdown Insurance – premiums attributable to policies covering repair or replacement service, or indemnification for that service, for the operational or structural failure of property due to defects in materials or workmanship, or normal wear and tear. (May cover motor vehicles, mobile equipment, boats, appliances, electronics, residual structures, etc.)

Medicaid – policies issued in association with the Federal/State entitlement program created by Title XIX of the Social Security Act of 1965 that pays for medical assistance for certain individuals and families with low incomes and resources.

Medical & Hospital Expenses (Benefits or Claims) – total expenditures for health care services paid to or on behalf of members.

Medical Malpractice – insurance coverage protecting a licensed health care provider or health care facility against legal liability resulting from the death or injury of any person due to the insured’s misconduct, negligence, or incompetence, in rendering or failure to render professional services.

Medical Only – line of business that provides medical only benefits without hospital coverage. An example would be provider-sponsored organizations where there is no coverage for other than provider (non-hospital) services. Does not include self-insured business, FEHBP, Medicare and Medicaid programs, or dental only business.

Medical Professional Liability – insurance coverage protecting a licensed health care provider or health care facility against legal liability resulting from the death or injury of any person due to the insured’s misconduct, negligence, or incompetence in rendering professional services. Medical Professional Liability is also known as Medical Malpractice.

Medicare – a state assistance program, passed under Title XVIII of the Social Security Amendments of 1965, to provide hospital and medical expense insurance to those over 65 years of age.

Medicare + Choice – a major initiative in the Balanced Budget Act of 1997 (also called Medicare Part C), under which Medicare beneficiaries may select from among several managed care options or a Medicare system.

Medicare Advantage Plan – an HMO, PPO, or Private Fee-For Service Plan that contracts with Medicare Advantage Prescription Drug Plan also includes drug benefits. The plan may provide extra coverage such as vision, hearing, dental, and/or health and wellness programs. Medicare pays a fixed amount for insured’s care every month to the companies offering Medicare Advantage plans.

Medicare Cost – contract with Center for Medicare and Medicaid Services (CMS) for Medicare coverage. These contracts with CMS provide reimbursement through pre-determined monthly amount per member based on a total estimated budget. The beneficiary may use providers outside the provider network. Does not include stand alone Medicare Part D Plans.

Medicare Part D – Stand-Alone – stand-alone Part D coverage written through individual contracts; stand-alone Part D coverage written through group contracts and certificates; and Part D coverage written on employer groups where the reporting entity is responsible for reporting claims to the Centers for Medicare & Medicaid Services (CMS).

Medicare Supplement – Insurance coverage sold on an individual or group basis to help fill the “gaps” in the protections granted by the federal Medicare program. This is strictly supplemental coverage and cannot duplicate any benefits provided by Medicare. It is structured to pay part or all of Medicare’s deductibles and co-payments. It may also cover some services and expenses not covered by Medicare. Also known as Medigap” insurance.

Medigap – supplementary private health insurance products to Medicare insurance benefits.

Minimum Premium Plan – an arrangement under which an insurance carrier will, for a fee, handle the administration of claims and insure against large claims for a self-insured group. The employer self-funds a fixed percentage (e.g. 90%) of the estimated monthly claims, and the insurer covers the remainder.

Mobile Homes – Homeowners – homeowners insurance sold to owners occupying the described mobile home.

Mobile Homes under Transport – coverage for mobile homes while under transport for personal or commercial use.

Modified Guaranteed – an annuity that contains a provision that adjusts the value of withdrawn funds based on a formula in the contract. The formula reflects market value adjustments.

Member – A person who has enrolled as a subscriber or an eligible dependent of a subscriber and for whom the health organization has accepted the responsibility for the provision of health services as may be contracted for.

Moral Hazard – personality characteristics that increase probability of losses. For example not taking proper care to protect insured property because the insured knows the insurance company will replace it if it is damaged or stolen.

Morale Hazard – negligence or disregard on the part of the insured which could lead to probable loss.

Morbidity – the frequency or severity of disease or illness within a subset of the population.

Morbidity Risk – the potential for a person to experience illness, injury, or other physical or psychological impairment, whether temporary or permanent. Morbidity risk excludes the potential for an individual’s death, but includes the potential for an illness or injury that results in death.

Morbidity Table – a statistical record of the rate of illness among the defined age groups.

Mortality Table – chart that shows the death rates of a particular population at each age displayed as the number of deaths per thousand.

Mortgage – a note used to secure a loan for real property.

Mortgage Guaranty – insurance that indemnifies a lender for loss upon foreclosure if a borrower fails to meet required mortgage payments.

Mortgage Insurance – a form of life insurance coverage payable to a third party lender/mortgagee upon the death of the insured/mortgagor for loss of loan payments.

Mortgage-Backed Securities – a type of asset-backed security that is secured by a mortgage or collection of mortgages. These securities must also be grouped in one of the top two ratings as determined by an accredited credit rating agency, and usually pay periodic payments that are similar to coupon payments. Furthermore, the mortgage must have originated from a regulated and authorized financial institution.

Multi-Peril Insurance – personal and business property coverage combining several types of property insurance in one policy.

Municipal Bond Guarantee Insurance – coverage sold to municipalities to guarantee the principle payment on bonds issued.

Municipal Liability – liability coverage for the acts of a municipality.

Municipal obligation bond – any security, or other instrument, including a state lease but not a lease of any other governmental entity, under which a payment obligation is created, issued by or on behalf of a governmental unit to finance a project servicing a substantial public purpose, and 1) Payable from tax revenues, but not tax allocations, within the jurisdiction of such governmental unit; 2) Payable or guaranteed by the United States of America or any agency, department or instrumentality thereof, or by a state housing agency; 3) Payable from rates or charges (but not tolls) levied or collected in respect of a non-nuclear utility project, public transportation facility (other than an airport facility) or public higher education facility; or 4) With respect to lease obligations, payable from future appropriations.

Mutual Insurance Company – a privately held insurer owned by its policyholders, operated as a non-profit that may or may not be incorporated.

Mutual Insurance Holding Company – a company organized as a mutual and owning a capital stock insurer or insurers for the benefit of pooling risk for many people, typically those in the same industry.

N

Named Insured – the individual defined as the insured in the policy contract. .

Named Peril Coverage – insurance for losses explicitly defined in the policy contract.

National Association of Insurance Commissioners (NAIC) – the U.S. standard-setting and regulatory support organization created and governed by the chief insurance regulators from the 50 states, the District of Columbia and five U.S. territories. Through the NAIC, state insurance regulators establish standards and best practices, conduct peer review, and coordinate their regulatory oversight. NAIC staff supports these efforts and represents the collective views of state regulators domestically and internationally. NAIC members, together with the central resources of the NAIC, form the national system of state-based insurance regulation in the U.S.

Negligence – failure to exercise reasonable consideration resulting in loss or damage to oneself or others.

Net Admitted Assets – total of assets whose values are permitted by state law to be included in the annual statement of the insurer.

Net Income – total revenues from an insurer’s operations less total expenses and income taxes

Net Premiums Earned – premiums on property/casualty or health policies that will not have to be returned to the policyholder if the policy is cancelled.

NFIP – National Flood Insurance Program – flood insurance and floodplain management for personal and business property administered under the National Flood Act of 1968. Encourages participation by private insurers through a flood insurance pool .

Nonadmitted Assets – assets having economic value other than those which can be used to fulfill policyholder obligations, or those assets which are unavailable due to encumbrances or other third party interests and should not be recognized on the balance sheet.

Nonadmitted Insurer – insurance company not licensed to do business within a given state.

Non-controlled stock insurers – insurers in which a parent company has: 1) a financial interest represented by the direct or indirect ownership of less than 50% of voting shares, and 2) does not have the ability to exercise control over the insurer, e.g., through voting stock or management contract

Non-proportional Reinsurance – reinsurance that is not secured on individual lives for specific individual amount of reinsurance, but rather reinsurance that protects the ceding company’s overall experience on its entire portfolio of business, or at least a broad segment of it. The most common forms of non-proportional reinsurance are stop loss and catastrophe.

Notional Value – the principal value upon which future payments are based in a derivative transaction as at a specific period in time (the “as of” reporting date) in the reporting currency.

Nationally Recognized Statistical Rating Organization (NRSRO) – refers to rating organizations so designated by the SEC whose status has been confirmed by the Securities Valuation Office. Examples are: Moody’s Investors Service, Inc., Standard & Poor’s (S&P), A.M. Best Company (A.M. Best) and Fitch Ratings and Dominion Bond Rating Service (DBRS).

Nuclear Energy Liability – coverage for bodily injury and property damage liability resulting from the nuclear energy material (whether or not radioactive) on the insured business’s premises or in transit.

O

Occurrence – an accident , including injurious exposure to conditions, which results, during the policy period in bodily injury or property damage neither expected or intended from the standpoint of the insured. (Bickelhaupt and Magee)

Ocean Marine – coverage for ocean and inland water transportation exposures; goods or cargoes; ships or hulls; earnings; and liability.

Officer – a president, vice-president, treasurer, actuary, secretary, controller and any other person who performs for the company functions corresponding to those performed by the foregoing officers.

Option – an agreement giving the buyer the right to buy or receive, sell or deliver, enter into, extend or terminate, or effect a cash settlement based on the actual or expected price, level, performance or value of one or more Underlying Interests.

Other Accident and Health – accident and health coverages not otherwise properly classified as Group Accident and Health or Credit Accident and Health (e.g., collectively renewable and individual non-cancelable, guaranteed renewable, non-renewable for stated reasons only, etc.). Include all Medicare Part D Prescription Drug Coverage, whether sold on a stand-alone basis or through a Medicare Advantage product and whether sold directly to an individual or through a group.

Other Considerations – Unallocated annuity considerations and other unallocated deposits that incorporate any mortality or morbidity risk and are not reported as direct premiums, direct annuity considerations or deposit-type contract funds.

Other Liability – coverage protecting the insured against legal liability resulting from negligence, carelessness, or a failure to act resulting in property damage or personal injury to others.

Other Underwriting Expenses – allocable expenses other than loss adjustment expenses and investment expenses.

Owner Occupied – homeowners insurance sold to owners occupying the described property.

P

Package Policy – two or more distinct policies combined into a single contract.

Par Value – the nominal or face value of a stock or bond.

Peril – the cause of property damage or personal injury, origin of desire for insurance. “Cause of Loss”

Permanent Life Insurance – policy that remains active for the life of the insured.

Personal Auto Policy – coverage designed to insure private passenger automobiles and certain types of trucks owned by an individual or husband and wife.

Personal Earthquake – earthquake property coverage for personal, family or household purposes.

Personal Flood – separate flood insurance policy sold for personal, family or household purposes.

Personal GAP Insurance – credit insurance that insures the excess of the outstanding indebtedness over the primary property insurance benefits in the event of a total loss to a collateral asset.

Personal Injury Liability – liability coverage for those who have been discriminated against, falsely arrested, illegally detained, libeled, maliciously prosecuted, slandered, suffered from identity theft, mental anguish or alienation of affections, or have had their right of privacy violated.

Personal Injury Protection Coverage/PIP – automobile coverage available in states that have enacted no-fault laws or other auto reparation reform laws for treatment of injuries to the insured and passengers of the insured.

Personal Property – single interest or dual interest credit insurance (where collateral is not a motor vehicle, mobile home, or real estate) that covers perils to goods purchased or used as collateral and that concerns a creditor’s interest in the purchased goods or pledged collateral either in whole or in part; or covers perils to goods purchased in connection with an open-end credit transaction.

Pet Insurance Plans – veterinary care plan insurance policy providing care for a pet animal (e.g., dog or cat) of the insured owner in the event of its illness or accident.

Policy – a written contract ratifying the legality of an insurance agreement.

Policy Dividend – a refund of part of the premium on a participating life insurance policy. Amount of payment is determined by subtracting the actual premium expense from the premium charged. The payment can be taken as cash, applied to a purchase an increment of paid-up insurance, left on deposit with the insurance company or applied to purchase term insurance for one year.

Policy Period – time period during which insurance coverage is in effect.

Policy Reserve – the amount of money allocated specifically for the fulfillment of policy obligations by a life insurance company; reserves are in place to safeguard that the company is able to pay all future claims.

Policyholders Surplus – assets in excess of the liabilities of a company or net income above any monies indebted to legal obligation.

Pollution – environmental contamination.

Pool – an association organized for the purpose of absorbing losses through a risk-sharing mechanism thereby limiting individual exposures.

Preferred Provider Organization (PPO) – arrangement, insured or uninsured, where contracts are established by Health Plan Companies (typically, commercial insurers, and, in some circumstances, by self-insured employers) with health care providers. The Health Plans involved will often designate these contracted providers as “preferred” and will provide an incentive, usually in the form of lower deductibles or co-payments, to encourage covered individuals to use these providers. Members are allowed benefits for non-participating provider services on an indemnity basis with significant copayments and providers are often, but not always, paid on a discounted fee for service basis.

Preferred Risk – insured, or applicant for insurance, who presents likelihood of risk lower than that of the standard applicant.

Premises and Operations – policies covering the liability of an insured to persons who have incurred bodily injury or property damage on an insured’s premises during normal operations or routine maintenance, or from an insured’s business operations either on or off of the insured’s premises.

Premium – Money charged for the insurance coverage reflecting expectation of loss.

Premiums Earned – the portion of premium for which the policy protection or coverage has already been given during the now-expired portion of the policy term.

Premiums Net – is the amount calculated on the basis of the interest and mortality table used to calculate the reporting entity’s statutory policy reserves.

Premiums Written – total premiums generated from all policies (contracts) written by an insurer within a given period of time.

Primary Insurance – coverage that takes precedence when more than one policy covers the same loss.

Prior Approval Law – a state regulatory requirement for pre-approval of all insurance rates and forms.

Private Passenger Auto (PPA) – filings that include singularly or in any combination coverage such as the following: Auto Liability, Personal Injury Protection (PIP), Medical Payments (MP), Uninsured/Underinsured (UM/UIM); Specified Causes of Loss, Comprehensive, and Collision.

Producer – an individual who sells, services, or negotiates insurance policies either on behalf of a company or independently.

Product Liability – insurance coverage protecting the manufacturer, distributor, seller, or lessor of a product against legal liability resulting from a defective condition causing personal injury, or damage, to any individual or entity, associated with the use of the product.

Professional Errors and Omissions Liability – coverage available to pay for liability arising out of the performance of professional or business related duties, with coverage being tailored to the needs of the specific profession. Examples include abstracters, accountants, insurance adjusters, architects, engineers, insurance agents and brokers, lawyers, real estate agents, stockbrokers.

Property – coverage protecting the insured against loss or damage to real or personal property from a variety of perils, including but not limited to fire, lightening, business interruption, loss of rents, glass breakage, tornado, windstorm, hail, water damage, explosion, riot, civil commotion, rain, or damage from aircraft or vehicles.

Pro-rata (proportional) Reinsurance – portion of the losses and premium reinsurer shares with the ceding entity.

Protected Cell – an insurance-linked security retained within the insurance or reinsurance company and is used to insulate the proceeds of the securities offering from the general business risks of the insurer, granting an additional comfort level for investors of the securitized instrument.

Protection and Indemnity (P&I) Insurance – a broad form of marine legal liability insurance coverage.

Provider Sponsored Network (PSN) – formal affiliations of providers, sometimes called “integrated delivery systems”, organized and operated to provide an integrated network of health care providers with which third parties, such as insurance companies, HMOs, or other Health Plan Companies, may contract for health care services to covered individuals. Some models of integration include Physician Hospital Organizations, Management Service Organizations, Group Practices Without Walls, Medical Foundations, and Health Provider Cooperatives.

Provisions – contingencies outlined in an insurance policy.

Proximate Cause – event covered under insured’s policy agreement.

Public Adjuster – independent claims adjuster representing policyholders instead of insurance companies.

Pure Premium – that portion of the premium equal to expected losses void of insurance company expenses, premium taxes, contingencies, or profit margin.

Pure Risk – circumstance including possibility of loss or no loss but no possibility of gain.

Q

Qualified Actuary – a person who meets the basic education, experience and continuing education requirements (these differ by line of business) of the Specific Qualification Standard for Statements of Actuarial Opinion, NAIC Property and Casualty Annual Statement, as set forth in the Qualification Standards for Actuaries Issuing Statements of Actuarial Opinion in the United States, promulgated by the American Academy of Actuaries, and is in good standing of the American Academy of Actuaries who has been approved as qualified for signing casualty loss reserve opinions by the Casualty Practice Council of the American Academy of Actuaries.

R

Rate – value of insured losses expressed as a cost per unit of insurance.

Risk Based Capital (RBC) Ratio – ratio used to identify insurance companies that are poorly capitalized. Calculated by dividing the company’s capital by the minimum amount of capital regulatory authorities have deemed necessary to support the insurance operations.

Rebate – a refund of part or all of a premium payment.

Reinsurance – a transaction between a primary insurer and another licensed (re) insurer where the reinsurer agrees to cover all or part of the losses and/or loss adjustment expenses of the primary insurer. The assumption is in exchange for a premium. Indemnification is on a proportional or non-proportional basis.

Reinsurer – company assuming reinsurance risk.

Renewable Term Insurance – insurance that is renewable for a limited number of successive terms by the policyholder and is not contingent upon medical examination.

Renters Insurance – liability coverage for contents within a renter’s residence. Coverage does not include the structure but does include any affixed items provided or changed by the renter.

Replacement Cost – the cost of replacing property without a reduction for depreciation due to normal wear and tear.

Reported Losses – Includes both expected payments for losses relating to insured events that have occurred and have been reported to the insurance company, but not yet paid.

Reserve – A portion of the premium retained to pay future claims

Reserve Credit – reduction of reserve amounts for reinsurance ceded. Reductions may include the claim reserve and/or the unearned premium reserve.

Residence – the domicile location of a member as shown by his or her determination as a resident.

Residual Market Plan – method devised for coverage of greater than average risk individuals who cannot obtain insurance through normal market channels.

Retention – a mechanism of internal fund allocation for loss exposure used in place of or as a supplement to risk transfer to an insurance company.

Retention Limit – maximum amount of medical and hospital expense an insurer will carry on its own. The limit can be for an individual claim and/or for the insurers total claims, depending upon the terms of the reinsurance contract.

Retrocession – the portion of risk that a reinsurance company cedes or amount of insurance the company chooses not to retain.

Retrospective Rating – the process of determining the cost of an insurance policy based on the actual loss experience determined as an adjustment to the initial premium payment.

Rider – an amendment to a policy agreement.

Risk – Uncertainty concerning the possibility of loss by a peril for which insurance is pursued.

Risk Retention Act – a 1986 federal statute amending portions of the Product Liability Risk Retention Act of 1981 and enacted to make organization of Risk Retention Groups and Purchasing Groups more efficient.

Risk Retention Group – group-owned insurer organized for the purpose of assuming and spreading the liability risks to its members.

S

Salvage – value recoverable after a loss.

Statutory Accounting Principles (SAP) – a set of accounting principles set forth by the National Association of Insurance Commissioners used to prepare statutory financial statements for insurance companies.

Securitization of Insurance Risk – a method for insurance companies to access capital and hedge risks by converting policies into securities that can be sold in financial markets.

Security – a share, participation, or other interest in property or in an enterprise of the issuer or an obligation of the issuer.

Self-Insurance – type of insurance often used for high frequency low severity risks where risk is not transferred to an insurance company but retained and accounted for internally.

Separate Account – segregated funds held and invested independently of other assets by an insurer for the purpose of a group retirement fund.

Short-term Disability – a company standard defining a period of time employees are eligible for short-term disability coverage, typically for 2 years or less.

Short-Term Medical – policies that provide major medical coverage for a short period of time, typically 30 to 180 days. These policies may be renewable for multiple periods.

Situs of Contract – the jurisdiction in which the contract is issued or delivered as stated in the contract.

Social Insurance – compulsory insurance plan administered by a federal or state government agency with the primary emphasis on social adequacy.

Soft Market – a buyer’s market characterized by abundant supply of insurance driving premiums down.

Special revenue bond – any security, or other instrument under which a payment obligation is created, issued by or on behalf of a governmental unit to finance a project serving a substantial public purpose and not payable from the sources in connection with the payment of municipal obligation bonds.

Specified Disease Coverage – coverage that provides primarily pre-determined benefits for expenses of the care of cancer and/or other specified diseases.

Specified/Named Disease – policies that provide benefits only for the diagnosis and/or treatment of a specifically named disease or diseases. Benefits can be paid as expense incurred, per diem or as a principal sum.

Standard Risk – a person who, according to a company’s underwriting standards, is considered a normal risk and insurable at standard rates. High or low risk candidates may qualify for extra or discounted rates based on their deviation from the standard.

State Children’s Health Insurance Program – policies issued in association with the Federal/State partnership created by title XXI of the Social Security Act.

State of Domicile – the state where a company’s home office is located.

State Page – Exhibit of Premiums and Losses for each state a company is licensed. The state of domicile receives a schedule for each jurisdiction the company wrote direct business, or has amounts paid, incurred or unpaid.

Statement Type – refers to the primary business type under which the company files its annual and quarterly statement, such as Life, Property, Health, Fraternal, Title.

Statement Value – the Statutory Accounting Principle book value reduced by any valuation allowance and non-admitted adjustment applied to an individual investment or a similar group of investments, e.g., bonds, mortgage loans, common stock.

Statutory Accounting – method of accounting standards and principles used by state regulatory authorities to measure the financial condition of regulated companies and other insurance enterprises. This method tends to be more conservative than the Generally Accepted Accounting Principles used by most businesses. Compliance with solvency and other standards is determined using financial documents prepared in accordance with Statutory Accounting Principles.

Stock Insurance Company – business owned by stockholders.

Stop Loss/Excess Loss – individual or group policies providing coverage to a health plan, a self-insured employer plan, or a medical provider providing coverage to insure against the risk that any one claim or an entire plan’s losses will exceed a specified dollar amount.

Structured Securities – loan-backed securities that have been divided into two or more classes of investors where the payment of interest and/or principal of any class of securities has been allocated in a manner that is not proportional to interest and/or principal received by the issuer from the mortgage pool or other underlying securities.

Structured Settlements – periodic fixed payments to a claimant for a determinable period, or for life, for the settlement of a claim.

Subrogation – situation where an insurer, on behalf of the insured, has a legal right to bring a liability suit against a third party who caused losses to the insured. Insurer maintains the right to seek reimbursement for losses incurred by insurer at the fault of a third party.

Subrogation Clause – section of insurance policies giving an insurer the right to take legal action against a third party responsible for a loss to an insured for which a claim has been paid.

Subsequent Event – events or transactions that occur subsequent to the balance sheet date, but before the issuance of the statutory financial statements and before the date the audited financial statements are issued, or available to be issued.

Substandard Risk – (impaired risk) risks deemed undesirable due to medical condition or hazardous occupation requiring the use of a waiver, a special policy form, or a higher premium charge.

Superfund – federal act mandating retroactive liability for environmental pollution where responsible party maintains accountability for environmental clean-up regardless of length of time since polluting event occurred.

Surety Bond – a three-party agreement whereby a guarantor (insurer) assumes an obligation or responsibility to pay a second party (obligee) should the principal debtor (obligor) become in default.

Surplus – insurance term referring to retained earnings.

Surplus Line – specialized property or liability coverage available via nonadmitted insurers where coverage is not available through an admitted insurer, licensed to sell that particular coverage in the state.

Swap – an agreement to exchange or net payments as the buyer of an Option, Cap or Floor and to make payments as the seller of a different Option, Cap or Floor.

T

Tenants – homeowners insurance sold to tenants occupying the described property.

Term – period of time for which policy is in effect.

Term Insurance – life insurance payable only if death of insured occurs within a specified time, such as 5 or 10 years, or before a specified age.

Third Party – person other than the insured or insurer who has incurred losses or is entitled to receive payment due to acts or omissions of the insured.

Title Insurance – coverage that guarantees the validity of a title to real and personal property. Buyers of real and personal property and mortgage lenders rely upon the coverage to protect them against losses from undiscovered defects in existence when the policy is issued.

Total Liabilities – total money owed or expected to be owed by the insurance company.

Total Revenue – premiums, revenue, investment income, and income from other sources.

Travel Coverage – covers financial loss due to trip cancellation/interruption; lost or damaged baggage; trip or baggage delays; missed connections and/or changes in itinerary; and casualty losses due to rental vehicle damage.

Treaty – a reinsurance agreement between the ceding company and reinsurer.

U

Unallocated Loss Adjustment Expense (ULAE) – loss adjustment expenses that cannot be specifically tied to a claim.

Umbrella and Excess (Commercial) – coverage for the liability of a commercial venture above a specific amount set forth in a basic policy issued by the primary insurer; or a self-insurer for losses over a stated amount; or an insured or self-insurer for known or unknown gaps in basic coverages or self-insured retentions.

Umbrella and Excess (Personal) – non-business liability protection for individuals above a specific amount set forth in a basic policy issued by the primary insurer; or a self-insurer for losses over a stated amount; or an insured or self-insurer for known or unknown gaps in basic coverages or self-insured retentions.

Unauthorized Reinsurance – reinsurance placed with a company not authorized in the reporting company’s state of domicile.

Underinsured Motorist Coverage – policy option for bodily injury or property losses caused by a motorist with coverage insufficient to cover total dollar amount of losses. Compensation for the injured party is equal to the difference between the losses incurred and the liability covered by the motorist at fault.

Underlying Interest – the asset(s), liability(ies) or other interest(s) underlying a derivative instrument, including, but not limited to, any one or more securities, currencies, rates indices, commodities, derivative instruments, or other financial market instruments.

Underwriter – person who identifies, examines and classifies the degree of risk represented by a proposed insured in order to determine whether or not coverage should be provided and, if so, at what rate.

Underwriting – the process by which an insurance company examines risk and determines whether the insurer will accept the risk or not, classifies those accepted and determines the appropriate rate for coverage provided.

Underwriting Risk – section of the risk-based capital formula calculating requirements for reserves and premiums.

Unearned Premium – amount of premium for which payment has been made by the policyholder but coverage has not yet been provided.

Unearned Premium Reserve – all premiums (fees) received for coverage extending beyond the statement date; appears as a liability on the balance sheet.

Universal Life Insurance – adjustable life insurance under which premiums and coverage are adjustable, company expenses are not specifically disclosed to the insured but a financial report is provided to policyholder’s annually.

Unpaid Losses – claims that are in the course of settlement. The term may also include claims that have been incurred but not reported.

V

Valued Policy – an insurance contract for which the value is agreed upon in advance and is not related to the amount of the insured loss.

Valued Policy Law – state legislation which specifies that the insured shall receive the face amount of the policy in the event of a total loss to a dwelling rather than the actual cash value regardless of the principle of indemnity.

Variable Annuity – an annuity contract under which the premium payments are used to purchase stock and the value of each unit is relative to the value of the investment portfolio.

Variable Life Insurance – life insurance whose face value and/or duration varies depending upon the value of underlying securities.

Variable Universal Life – combines the flexible premium features of universal life with the component of variable life in which excess credited to the cash value of the account depends on investment results of separate accounts. The policyholder selects the accounts into which the premium payments are to be made.

Viatical Settlements – contracts or agreements in which a buyer agrees to purchase all or a part of a life insurance policy.

Vision – limited benefit expense policies. Provides benefits for eye care and eye care accessories. Generally provides a stated dollar amount per annual eye examination. Benefits often include a stated dollar amount for glasses and contacts. May include surgical benefits for injury or sickness associated with the eye.

Back to the Top

W

Warrant – an agreement that gives the holder the right to purchase an underlying financial instrument at a given price and time or at a series of prices and times according to a schedule or warrant agreement.

Warranty – coverage that protects against manufacturer’s defects past the normal warranty period and for repair after breakdown to return a product to its originally intended use. Warranty insurance generally protects consumers from financial loss caused by the seller’s failure to rectify or compensate for defective or incomplete work and cost of parts and labor necessary to restore a product’s usefulness. Includes but is not limited to coverage for all obligations and liabilities incurred by a service contract provider, mechanical breakdown insurance and service contracts written by insurers.

Whole Life – life insurance that may be kept in force for a person’s entire life and that pays a benefit upon the person’s death, whenever that may be.

Whole Life Insurance – life insurance that may be kept in force for the duration of a person’s life and pays a benefit upon the person’s death. Premiums are made for same time period.

Workers’ Compensation – insurance that covers an employer’s liability for injuries, disability or death to persons in their employment, without regard to fault, as prescribed by state or federal workers’ compensation laws and other statutes.

Written Premium – the contractually determined amount charged by the reporting entity to the policyholder for the effective period of the contract based on the expectation of risk, policy benefits, and expenses associated with the coverage provided by the terms of the insurance contract.

X

Y

Z

https://www.naic.org/consumer_glossary.htm

My insurance company has assigned an adjuster to handle my claim. Why should I not just use them?

A public adjuster is a professional claims handler claims adjuster who advocates for the policyholder in appraising and negotiating a claimant’s insurance claim. Aside from attorneys and the broker of record, public adjusters licensed by state departments of insurance are the only type of claims adjuster that can legally represent the rights of an insured during an insurance claim process. A Public Adjuster is your advocate and will guide you through the process. Help you understand your insurance policy deductible, coverages, exclusions, help you appraise and write and estimate for the the true value of your loss. They are experts at what they do. Once they prepare an estimate and other claim documentation they negotiate with the insurance company’s claims handler to help you receive the maximum settlement you deserve.

After a large disaster is there more of a reason why I should not trust the insurance carrier’s adjuster?

After a widespread disaster, insurance companies will bring in company adjusters from out of state who aren’t familiar with local costs. Adjusters from outside your area will not have a handle on how much tradespeople such as electricians or plumbers charge, or how much it costs to rebuild a house. They are also not familiar with required code upgrades and can be very inexperienced and hired and trained just for the disaster.

When should an insurance carrier provide me housing?

Your home insurance covers your “additional living expenses” if there’s a mandatory evacuation, including hotels and food — even additional transportation costs. They are also required to provide you additional living expenses and housing when the damage is so severe that the home is not suitable for you to live in. This could be as simple as you having no bathroom use or no kitchen or severe mold that could be a health concern.

After a hurricane or a fire should I start removing things or throwing things out that are damaged?

The clear answer to this is NO! You need to have a professional like a Public Adjuster advise you on what to do in this situation. There are professionals who will come and document, inventory, and photograph all the inventory. The Public Adjuster will also take photographs and document all the damages. You are also required under most policies to allow the insurance carrier the right to inspect the damages. If you take this right away from them you may not be reimbursed.

What is the first thing I should do when buying insurance for my house or my business?

Make sure you sit down with your insurance agent and ask him to go over the full policy including all the exclusions. Most agents will just go over the declaration pages of your policy limits. You should have him thoroughly explain every detail of the policy before purchasing it. That way there are no surprises when you suffer a loss. A Public Adjuster can only help you recover what is available to you within the policy.

Should I use the company recommended by the insurance company to do my water restoration or remediation?

My answer would be the same as would you trust your insurance adjuster to act in your best interest and pay you fairly? It is always your decision on who to hire as a contractor unless your policy dictates otherwise. I would advise you to call a few contractors who do not work with insurance companies and let them explain why they will pay more attention to detail, document all of the damages, and make sure the job is done right. Remember they are not contracted regularly by the insurance carriers and are not well in most people’s opinion trying to keep the costs contained for the insurance company to help them minimize their losses. This is an opinion. My advice is to meet with a few private contractors and the carriers and then make your own informed decision.

What is the first thing I should do when I suffer a loss to my home or business?

Safety is first. If you are not sure if you are safe then my answer is call a Public Adjuster to come evaluate your home. But please do not stay in the home or business waiting for anyone including the Public Adjuster until you know its safe to reside in the structure.

What do I do when I a pipe breaks in my home and there is water everyplace?

There are professionals to handle this and document the damages. Please do not take it upon yourself to start doing the work of a professional restoration company. You are required to do what you can to stop the leak. If you know how to shut the water off to the home then do so, but if not call a plumber immediately. Then I would advise you to call a Public Adjuster to come out and provide you a free evaluation of your loss and then you can make an informed decision on how to move forward with a claim.

Many condo owners have no idea that they need their own home insurance policies and if they do the normally do not know what is covered.

They think that the condo association’s policy covers their property. However, the association’s policy covers only common areas, typically up to the walls of your condo. You usually own from the flooring up and the paint and texture in. The COA is responsible for the structure.  If you want your own space and belongings protected, you need a home insurance policy. Otherwise, all your belongings, furniture, appliances and cabinets are uninsured.

Without your own policy you may have no liability protection if you’re sued for something that happens within your condo, like a slip-and-fall injury.