Glossary
There are many insurance terms consumers face when investigating and purchasing insurance. We have have put together this simple glossary to assist you. Please note that while every effort has been made to ensure the accuracy of these terms and references, neither NIBA nor the glossary compilers can be held responsible for any innacuary, exclusion or incorrect definition.
A - B - C - D - E - F - G - H- I- J- K- L- M- N- O- P- Q- R- S- T- U- V- W- X- Y- Z
A
Accident
Any injury inflicted as a result of unintentional, unexpected actions or events. This excludes accidental illness, surgical procedures, pregnancy, injury or illnesses induced by alcohol or drug dependence and aggravation of a pre-existing condition.
Accidental death cover
The optional benefit payable on the death of the insured as a result of an accident. The amount of the benefit is shown in the policy schedule together with any increases as a result of automatic indexation of benefits.
Accidental loss or damage policy
Different from a Defined Events policy, this provides additional cover for accidental loss or damage unless the policy specifically excludes it. The list of exclusions is usually longer than for a defined events policy, and this kind of policy usually costs more.
Act of terrorism
An act, including but not limited to the use of force or violence and/or threat thereof, of any person, whether acting alone, or on behalf of, or in connection with any organisation(s) or government(s) which from its nature or context is done for, or in connection with
- political
- religious
- ideological
- ethnic
or similar purposes or reasons, including the intention to influence any government and/or to put the public, or any section of the public, in fear.
Actuary
A person professionally trained in mathematical and statistical methods who analyses the financial consequences of risk.
Adverse outcome
A result from medical treatment contrary to the expectation of the patient and/or the practitioner.
Agreed value
Applies normally to vehicle insurance (also see market value). The insured and the insurer agree on how much will be paid in the event of the vehicle being written off. The amount is reviewed by the insurer each year on renewal of the policy.
All Risks
Insurance that covers each and every loss except for those specifically excluded. If the insurance company does not specifically exclude a particular loss, it is automatically covered. This is the broadest type of property policy that can be purchased.
Annual Premium
Is specified in the Policy Schedule and includes the premiums for the benefits attached to the policy and the policy fee.
APRA
The Australian Prudential Regulation Authority, a statutory authority established in July 1998. APRA is responsible for the prudential regulation of the financial sector. APRA took over the roles of the previous insurance regulator, the Insurance & Superannuation Commission (ISC). APRA administers the Insurance Act and is responsible for the authorising of insurers.
ASIC
The Australian Securities and Investments Commission, a statutory authority established in July 1998. ASIC is responsible for consumer protection legislation and administers the Insurance Contracts Act, the Financial Services Reform Act and such things as the industry codes of practice. The consumer protection provisions of Part V of the Trade Practices Act have to a large extent been replicated in the ASIC Act and it is ASIC, rather than the Australian Competition and Consumer Commission, that monitors compliance by insurers with trade practices legalisation. ASIC is responsible for the registration of insurance brokers.
Assessor
A person appointed by the insurer to inspect damage following a claim, and assess what will be required to meet the claim under the terms of the insurance contract. An assessor may be a computer technician or qualified builder. (see loss adjuster)
Audit
A survey of processes, files and data to ensure compliance with protocols, policies and procedures.
Averaging
See "co-insured".
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B
Benefit
Financial reimbursement and other services provided to insureds by insurers under the terms of an insurance contract.
Body corporate
A group consisting of the owners of each strata property, formed to maintain the common areas of flats or units and to take out insurance for the common areas.
Broker
A representative of the insurance buyer who arranges insurance with insurance companies on the buyer's behalf. Brokers are paid either through commission from the insurer, or through a service fee.
Builders
Contractors who build houses or commercial buildings.
Building
The residence owned by the individual at the insured address. It includes structural improvements of a domestic nature, like:
- garages or domestic outbuildings;
- carports, verandahs and pergolas;
- walls, paths, driveways and paved terraces;
- gates, masts, aerials and clothes lines;
- fences (but in the case of a dividing or shared fence only the amount the law would require you to pay for the fence);
- fixtures providing services, either above or below ground, which have been connected to the residence;
- fixed apparatus and equipment connected to the gas, plumbing, drainage, sewerage or electrical systems;
- permanently fixed swimming pools, saunas and spas, including their fixed accessories;
- exterior blinds and awnings.
The residence or improvement must comply with local government regulations, or the requirements of any other statutory authority at the time it was built, renovated, or installed. It also includes fixtures owned by you which are attached to the residence, like:
- stoves, dishwashers, room heaters, air conditioners, fans, light fittings or hot water services;
- built-in furniture;
- fixed floor, wall and ceiling coverings other than carpets.
It does not normally include:
- a residence or improvement which comprises a structure containing residential flats or that is part of a shared scheme;
- a residence or improvement which is in the course of construction;
- trees, shrubs, hedges or other plant life;
- landscaping;
- swimming pools that are free standing, or which can be moved from the insured address;
- temporary or mobile structures, including caravans and motor vehicles;
- loose floor, wall or ceiling coverings which are not fixed;
- fixed carpets;
- any fixtures, fittings or structural improvements which are not owned by you;
- items defined as Contents.
Business interruption
A break in commercial activities following damage or loss.
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C
Calendar Year and Membership Year
Most important for health insurance. A calendar year means January 1 to December 31. Membership year commences on the date that the member joined a specific health fund.
Captive Insurer
An insurance company that is wholly owned by one or more entities, the main purpose of which is to insure the risks of the parent company.
Cede
To transfer risk from an insurer to a reinsurer. A "cession" is a particular reinsurance transaction. (also see "retrocession")
Certificate of Currency
Documentary evidence that an insurance contract is current. Brief details of the extent of cover and the parties to the contract are provided. Usually requested by banks and finance companies to confirm that their interests are noted, and that the policy is current.
Certificate of Insurance
Same as certificate of currency.
Claim
A formal request for payment or rectification under the terms of the insurance policy to make up for, or compensate for, a loss.
Claimant
The party or representative of the party making a claim.
Claims incurred
A policy term that provides access to indemnity as long as the claimant was insured at the time an incident giving rise to a claim occurred. Should a claim arise years later related to the period the policyholder was insured, the policyholder can still claim.
Claims made
Provides access to indemnity for claims arising from incidents which occur while the person or organisation is insured. Once reported, it is not necessary to still be insured against the risk when the claim is settled or finalised.
Claims professionals
A person qualified to handle claims for or on behalf of the insurer. Also see loss adjuster.
Class of Insurance
Term used to group related lines of business. For example "Private Motor" is a class of insurance. This class is made up of several products or lines of business, such as comprehensive motor, third party property damage and third party fire and theft.
Co-insurance
Usually applied to property policies, this is a measure which allows the insurer to lower the amount it will pay for a claim on an underinsured property. For example, take a house which is valued at $200,000 but is only insured for $150,000, If it is damaged and the repairs will cost, say, $20,000, the insurer may have the right to reduce the value of the claim by the amount the house is underinsured. The insured in this example might only receive a payment that is $5000 short of the actual claim figure. This is called "averaging" or "co-insurance".
Commercial lines
Any type of insurance that provides coverage for a business.
Commission
The fee paid to an insurance salesperson as a percentage of the premium generated by a sold insurance policy.
Compensation
The money or medical care provided to an accident victim. Usually associated with workers' compensation or personal injury claims.
Complaints Services
The general and life insurance industries, as well as insurance brokers, maintain Government-approved independent complaints and claims dispute resolution services.
Comprehensive insurance
The top-of-the-line form of cover (and the most expensive) for vehicle-owners. It covers loss or damage to the vehicle no matter how it is caused. Some comprehensive policies also carry additional benefits like towing charge payments and legal costs. Some even pay for property stolen from the vehicle.
Compulsory insurance
Also known as statutory insurance. Insurance required for compliance with statutory requirements, run by state and territory governments. eg. workers compensation, compulsory third party insurance.
Consumer credit insurance
This policy pays the insured's loan repayments for the period he or she is not able to do so through illness or other reasons.
Contents
Items of property owned by the insured which are not fixtures but belong at the insured address. It generally includes:
* furniture and household goods;
* carpets (fixed or loose), and other loose floor coverings;
* internal blinds, curtains and soft furnishings;
* portable domestic appliances that are not built in;
* indoor plants and trees or shrubs growing in pots or tubs inside the building;
* specified contents items;
* lawn mowing and garden maintenance equipment;
* swimming pools, saunas or spas and their accessories which are pre-fabricated or above-ground, or which are free-standing;
* swimming pool accessories which are not permanently fixed, pool liners and removable covers but only while at the insured address.
It does not normally include:
* any item which is not owned by the insured;
* clothing, footwear and personal effects;
* jewellery, unset precious and semi-precious stones;
* money or other negotiable instruments, or documents of any kind any compact discs, records or tapes registered or licensed firearms, or firearms where the owner is required to be licensed;
* curios, gold or silver, or antiques (other than antique furniture);
* items of common property;
* stock or plant used for business purposes, or any tools of trade motor vehicles or motor cycles, and accessories, components or spare parts, regardless of whether or not they are registered for use on public roads, or whether they are intended for "off-road" use only;
* any other motorised self-propelled vehicle, and its accessories, components or spare parts (other than lawn mowing or garden maintenance equipment);
* caravans or trailers, or their equipment or accessories;
* aircraft, watercraft (powered or not) or their accessories, components or spare parts;
* birds, animals or fish;
* trees, shrubs and outdoor plants;
* building materials.
Where the building is a strata title property, fixtures and fittings (including built-in furniture and fixed wall, floor or ceiling coverings) which are owned by you and are not otherwise insured by the Body Corporate, are also considered to be contents.
Contents Insurance
1. In personal property insurance, coverage is for personal property items that are movable, that is, not attached to the building's structure (the home), such as television sets, radios, clothes, household goods. Not included under the coverage are animals, vehicles and boats but bicycles are usually covered. 2. In commercial property insurance, coverage is for the business' personal property items that are coverable - that is, not attached to the building's structure such as inventory, machinery, equipment, furniture and fixtures. Not included under the coverage are animals, vehicles, boats and crops.
Co-payment
A health insurance term. You agree to pay a certain amount per day for hospital accommodation. The amount of this "co-payment" depends on what type of cover you select and with which health fund. Normal excess provisions will apply per admission where applicable.
Cover
The scope of the protection provided by an insurance contract.
Cover Note
Special short-term cover which generally lasts for two weeks to give the insured time to finalise paperwork and other details. A cover note can often be organised over the phone. The cover note is still a legal contract binding the insured to full disclosure, etc. If you decide not to take out a policy, the insurer has the right to charge you for the period the cover note was in effect.
Crop
Coverage for crops in the event of loss or damage by insured perils including hail, fire, and lightning.
CTP or Compulsory Third Party insurance
Prescribed as compulsory insurance under State and Territory legislation, CTP insurance covers liability for bodily injury to third parties arising out of the use of a motor vehicle.
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D
Damages
Monetary compensation which may be recovered in the courts or through agreed settlement, by any person or entity who has suffered loss or alleges loss through the omission or negligence of another.
Deed of release
A deed of settlement between the plaintiff and defendant or his/her insurer. The deed precludes the plaintiff from claiming again from the defendant for the alleged damage suffered and for which the settlement monies have been paid.
Deferred Annuities
Annuity that can be paid either with a single premium or series of instalments in life insurance.
Defined event
The agreed events that the insurance policy covers the insured against.
Denial
A claim may be denied for a variety of reasons. For example, a stolen vehicle left with the keys in the ignition; or a claim in which the insured lied about the facts; or for using the insured property outside the terms of the policy.
Direct Underwriter
An insurer who sells insurance directly to insureds without the involvement of an insurance intermediary (agent or broker). Most personal lines insurance is direct insurance.
D & O of Directors' and Officers' insurance
Coverage for when a director or officer of a company commits a negligent act or omission, or misstatement, or misleading statement, as a successful libel suit is brought against the company as a result.
Disability Benefit
Income paid under a disability policy that is not covered under workers' compensation benefits.
Disclosure
The legal duty of a policyholder to disclose all relevant matters to an insurer which are known by the applicant to be relevant, or that a reasonable person in the circumstances would know to be relevant to the insurer.
Domiciliary Care
Non-medical treatment such as personal assistance, showering and dressing which is not covered under home nursing.
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E
Endorsement
Written agreement attached to a policy to add or subtract insurance coverage. Once attached the endorsement takes precedence over the original provisions of the policy.
Endowment policy
A form of life insurance. The insured is paid once he or she reaches an agreed age or dies - whichever comes first.
Environmental
Surroundings and circumstances affecting one's life
Estimate
An estimation of the total costs which may be incurred in respect of a claim, including damages and legal costs.
Excess
Many types of policies carry an excess, which is the amount the insured will have to pay before the insurer pays the rest. This allows the insurer to increase the excess for young and/or inexperienced drivers who are more accident-prone, as well as to deter small claims.
Exclusions
Those events and happenings for which cover is specifically not included or provided for in the policy.
Ex Gratia Payment
"from favour" payment by an insurance company to the insured even though the company has no legal liability. The insurer usually makes such a payment for "goodwill" purposes.
Exposure
The measurement of the extent of a risk assumed by an insurer or indemnifier.
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F
Family Income Policy
A contract combining whole life and decreasing term insurance. A monthly income is paid to a beneficiary if an insured dies during a specific period. At the end of that period the full-face amount of the policy is also paid to the beneficiary. If an insured dies after the specified period, only the face amount of the policy is paid.
Farm
The property and buildings used for growing crops and rearing animals.
Financial Services Reform Act 2001
An Act passed by Parliament on 23 August 2001, which establishes a single licensing regime for the provision of financial services. The regime involves organisations that deal in financial products, provide financial product advice or make a market for a financial product.
Fire Services Levy
Amounts payable by insurance companies to The New South Wales, Victorian and Tasmanian governments to pay most capital and operating expenses. Insurers recoup the levy through a surcharge on property insurance policies. Most states now fund their fire services through property taxes.
Flood
The overflowing or influx of water on normally dry land. Property policies do not usually cover flood through an exclusion.
Fraud
In insurance terms, the action whereby an insured tries to "inflate" a claim in order to collect something he or she is not entitled to.
Fully Funded
Having reserves that are greater than both known (reported) claims and the assessed Incurred but not reported liabilities.
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G
General insurance
Insurance business transacted by insurers authorised under the Insurance Act 1973, as opposed to insurance transacted by insurers authorised under the Life Insurance Act 1995. General insurance mainly operates in the areas of property, injury and liability.
General insurance broker
Professional who usually acts for the insurance buyer, finding the best available cover. The broker also assists in claims management and may also provide risk management advisory services.
General Insurance Reform Act 2001
Passed in September 2001, this empowers APRA to issue prudential standards from time to time. See Insurance Act 1973.
General insurer
Organisation that underwrites general insurance companies.
Group Life
Life insurance that usually does not require medical examinations on a group of people under a master policy. It is typically issued to an employer for the benefit of employees, or to members of an association; for example, a professional membership group. The individual members of the group hold certificates as evidence of their insurance.
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H
Heavy vehicle
Gross vehicle mass (GVM) of greater than 4.5 tonnes.
High-risk occupation
A job in which there is a higher than normal risk of injury or liability.
Home
The private residence of the insured. It includes structural improvements of a domestic nature, such as:
* garages or domestic outbuildings;
* carports, verandahs and pergolas;
* walls, paths, driveways and paved terraces;
* gates, masts, aerials and clothes lines;
* fences (but in the case of a dividing or shared fence only the amount the law would require you to pay for the fence);
* fixtures providing services, either above or below ground, which have been connected to the home;
* fixed apparatus and equipment connected to the gas, plumbing, drainage, sewerage or electrical systems;
* permanently fixed swimming pools, saunas and spas, including their fixed accessories;
* exterior blinds and awnings.
The home or improvement must comply with local government regulations, or the requirements of any other statutory authority, at the time it was built, renovated, or installed.
It also includes fixtures and fittings attached to the residence, like:
* stoves, dishwashers, room heaters, air conditioners, fans, light fittings or hot water services;
* built-in furniture;
* fixed floor, wall and ceiling coverings other than carpets.
It does not include:
* a strata titled unit;
* a building which comprises flats;
* a building in the course of construction;
* contents within the home which are not fixed;
* trees, shrubs, hedges or other plant life;
* landscaping;
* swimming pools that are free standing, or which can be moved from the insured address;
* temporary or mobile structures, including caravans;
* loose floor, wall or ceiling coverings which are not fixed;
* fixed carpets.
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I
Incident
An event which involves loss or injury which may result in a claim being made.
Incurred but not reported losses (IBNR)
These usually apply to "long tail" classes of business like medical indemnity. It occurs when an act which may be negligent or make the policyholder liable is not immediately reported to the insurer.
Indemnity
An agreement protecting an individual or business against damages pursued by another party. In the case of professional indemnity cover, the insurer agrees to compensate third parties who suffer damages or losses through the actions of the policyholder.
Insolvency
When an insured business is bankrupt, the circumstance doesn't relieve the insurance company of its legal obligations under a contract.
Insurance
A contractual relationship whereby one party (the insurer) agrees to indemnify another party (the insured) against specified damage, loss or liability in exchange for a set premium.
Insurance agent
Representative of an insurance company who solicits business on its behalf.
Insurance Contracts Act (1984)
The Act focuses on consumer protection and aims to ensure policyholders' contractual rights are respected.
Insurance Council of Australia (ICA)
The representative body for general insurers in Australia.
Insurance Council of New Zealand
The representative body for general insurers in New Zealand.
Insurance Ombudsman Service (IOS)
An independent complaints and dispute-resolution body which mediates and settles disputed insurance claims. Financed by the insurance industry, IOS has an independent board of directors which includes industry and consumer representation.
Insurance policy
A legally binding written contract between a policyholder and an insurer stating the obligations and responsibilities of each party.
Insured
An individual, business or structure that has entered a contractual agreement with an insurance company.
Insurer
The company offering to provide cover in return for a premium. In Australia, insurers must be licensed.
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K
Key person (keyman) insurance
Insurance covering losses to a business when the "key" or most vital person within the business is unable to provide his/her services through death or disability.
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L
Level premium
A rating structure under which the premium level remains the same throughout the life of the policy.
Liability
A condition meaning an individual may be legally bound or obligated to something.
Life brokers
An insurance broker who arranges life insurance cover on behalf of consumers.
Long tail business
A risk or class of business that may be exposed to claims long after the policy expires. \
Loss adjuster
A qualified individual who is usually used by insurers to assess the value of a claim and may supervise reinstatement. Most belong to the Australasian Institute of Chartered Loss Adjusters (AICLA).
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M
Marine insurance
Coverage for goods in transit and the vehicles of transportation on waterways, like barges and ships.
Market value
The actual value of a possession if it was to be replaced with an exact replica.
Mediation
An alternative to litigation designed to assist the parties to settle a dispute by structured negotiation.
Medical malpractice
Negligent or criminal professional conduct in the medical field.
Mortgage indemnity insurance
Additional to home and contents policies, this protects the mortgagee if the property is damaged or destroyed while the mortgage is still active.
Motor Insurance
Cover for motorised vehicles. They vary in the level of cover they provide.
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N
Negligence
A breach of the duty against a person or business. The act must cause injury, loss or damage to the victim.
New for old
When an insurer offers to replace lost/damaged/stolen goods with new items of similar value.
No claim bonus
An arrangement whereby the insurer offers discounts to policyholders who don't make a claim in a set period of time.
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O
Occupational heath and safety
Guidelines to protect employees from workplace accidents and injuries.
Out of pocket expenses
Incidental costs arising following an accident or loss.
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P
Personal lines
Insurance for personal assets such as a vehicle or house. It doesn't extend to businesses, which are classified under "commercial lines" risks.
Policy
Document prepared by an insurer or a broker as evidence of the existence of an insurance contract. Section 11(1) of the Insurance Contracts Act 1984 defines "policy" as also including a document known as a cover note.
Policyholder
Individual or other entity who owns an insurance policy.
Premium
The price of the policy.
Prepayment
A payment made to the insured by the insurer before the settlement date.
Professional indemnity insurance
Provides indemnity to professionals against claims made against them resulting from legal liability to others for loss or damage arising out of professional negligence on the part of the professional.
Property damage
The term used for loss or destruction of a policyholder's property.
Prudential regulations
Scrutiny and supervision of the financial and business affairs of organisations by statutory authorities. In the case of the insurance industry prudential regulation is the responsibility of the Australian Prudential Regulation Authority (APRA), through its administration of the Insurance Act 1973.
Public liability
A broad term for insurance covering liability exposures for individuals, organisations and businesses.
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R
Rate
Cost per unit of insurance
Reinsurance
A contract taken out by the original insurer with a reinsurer (ceding) to cover it for some or all of its liability under the original contract of insurance. The reinsurer transfers adverse consequence of holding the risk to retrocessionaires.
Reinsurance brokers
Individuals or companies which represent a ceding insurance company in placing its business with a reinsurer.
Reinsurer
Specialist company which provides reinsurance cover.
Renewal notice
A form showing notification that an insurance policy has been renewed with the same clauses, provisions and benefits of the previous policy.
Reserve
Funds set aside for the purpose of meeting obligations as they fall due.
Risk
The chance of something occurring which is measured in terms of consequence and likelihood.
Risk management
The systematic application of management policies, practices and procedures to analyse assess treat, monitor and communicate risk.
Risk manager
Individual who assesses risks to minimise the adverse effect of a possible loss. This role involves identifying potential sources of loss, measuring the financial consequences and implementing controls to eliminate losses, reduce their impact or minimise their financial consequences.
Risk transfer
The process whereby a party exposed to loss, damage or liability arising from risk transfers the exposure to another party, usually an insurer. The insurer is now also a party at risk and transfers adverse consequence to its reinsurers by way of a reinsurance contract. The reinsurers transfer adverse consequence to their retrocessionaires.
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S
Schedule Fee
The Federal Government's recommended charges for each medical consultation, service or procedure. The schedule fee is used as the basis for calculating Medicare rebates. Medicare pays 75% of the schedule fee for in-patient hospital services, with health funds covering the remaining 25% and, where applicable, agreed gap benefits. Medicare also pays 85% of the schedule fee for outpatient medical services.
Security measures
Devices or systems that reduced the risk of burglary or damage.
Settlement
An agreement, resolution or payment which concludes legal proceedings or threatened legal proceedings.
Shared scheme
A property that is part of a legislative scheme (such as a Strata Title) which provides for the subdivision, management and occupation of buildings and land with shared property.
Short tail business
Business where the general claims settlement pattern is relatively quick, and is sometimes applied to those classes of business that takes no more than three years to run off.
Solvency margin
Assets of a general insurer must at all times exceed liabilities by statutory amounts set out by APRA.
Storm
Usually a violent wind, sometimes combined with thunder, heavy falls of rain, hail or snow.
Strike cover
Coverage to protect employers from losses due to labour disruptions.
Subrogation
The statutory or legal right of an insurer to recover from a third party who is wholly or partially responsible for a loss paid by the insurer.
Sum insured
The amount for which a property is covered.
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T
Terminal bonus
An additional policy dividend paid to a life insurance policyholder when a policy terminates.
Term policy
A contract of insurance that covers the insured for only a certain period of time (term), not for his or her entire life. The policy pays death benefits only if the insured dies during the term.
Third party
An individual other than the insured or insurer who has incurred a loss or is entitled to receive a payment as a result of the acts or omissions of the insured.
Travel Insurance
Usually includes cover against medical, property loss and other defined costs incurred while travelling. The Federal Government recommends that Australians travelling overseas always have the best possible insurance cover.
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U
Underfunding
Having insufficient reserves for both known (reported) claims and actuarially assessed IBNR liabilities.
Underinsurance
The amount outstanding when the full value of the policy is compared against the full cost of the loss. This is a particular problem with home and contents policies, because whole rebuilding and replacement costs rise, policyholders' assessments of the full cost of reinstatement are often understated. Also see Coinsurance.
Underwriting
The process of selecting applicants for insurance and classifying them according to their degrees of insurability so that the appropriate premium rates may be charged. The process includes rejection of unacceptable risks.
Underwriting agent
Company which designs, sells and services insurance policies to brokers for specific types of specialised risks. An underwriting agent usually works with one or two insurance companies.
Uninsurable risk
Risks that fail to meet the underwriter's guidelines which define an insurable risk.
Unoccupied
Either no-one is living in the home, or someone is living in the home but without the insured's consent. Insurers usually place limits on the period of time a property can remain unoccupied.
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W
Waiver of premium
In life insurance, action by an insurance company cancelling premium payments by an insured who has been disabled for at least six months. The policy remains in force and continues to build cash values and pay dividends, just as if the insured was still making premium payments.
Warranty
Pledge by an insured in writing, and a part of the actual contract, that a particular condition exists or does not exist.
Whole of life policy
A plan of insurance for life, with premiums payable for a person's entire life.
Write-off
Property so damaged as not to be worth repair, and therefore acknowledged by the insurer as a total loss.
© Copyright NIBA 2006.
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