INSURANCE CLAIM
 
 Terms 

A Consumers Guide To Filing A Homeowners Insurance Claim

 

       WHERE TO BEGIN   WHAT TO LOOKOUT FOR   WHEN TO SETTLE   PROTECTING YOUR RIGHTS

 

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FORMS

LOG
STATEMENT OF LOSS
PHOTOGRAPHS
WITNESS STATEMENT
EMERGENCY WORK CHARGE
PERSONAL PROPERTY SUMMARY
DEPRECIATION SCHEDULE
1. ENTRANCE HALL
2. LIVING ROOM
3. DINING ROOM
4. KITCHEN
5. HALLWAY/STAIRWELL
6. DEN
7. BEDROOM 1
8. BEDROOM 2
9. BEDROOM 3
10. BEDROOM 4
11. BEDROOM 5
12. BATHROOM 1
13. BATHROOM 2
14. BATHROOM 3
RECREATION ROOM
LAUNDRY/BASEMENT
PORCH/PATIO
GARAGE
ATTIC
MEN'S CLOTHING
WOMEN'S CLOTHING
CHILDREN'S CLOTHING
LINENS
ELECTRICAL APPLIANCES
FLOOR COVERING
CABINETS
WALLPAPER
SPORTING EQUIPMENT
JEWELRY
MISCELLANEOUS
MISCELLANEOUS
MISCELLANEOUS
HOMEOWNERS STRUCTURE LIST
CONTRACTOR BID
DEBRIS REMOVAL
TRESS,SHRUBS, OTHER PLANTS
LOSS OF USE
RESTORATION SERVICE CONTRACT
CHANGE ORDER
LIEN WAIVER
EXTRA
EXTRA
EXTRA

Your Homeowners Insurance Claim Guide

Terms
A H O V
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C J Q X
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Disclaimer   The information, forms, and techniques herein represent the author's opinions only and is not legal advice. Any and all advise given herein is not legal advise. The information and forms provide general educational information only. If legal or other expert advice is required by the reader, the services of a competent attorney, accountant, insurance agent, or other professional should be sought. The information, forms, etc. come without warranty of any kind, either express or implied, including but not limited to implied warrantes for quality, performance, merchantability, or fitness for any purpose. The author shall not be liable to the user or any other person or entity with respect to any liability, loss, or damage caused or alleged to be caused directly or indirectly by this information, forms, etc.

 

Copyright © 1992 Michael L. Smith,  Revised 1998, 2000 All rights reserved. No part of this publication (except forms) may be reproduced or transmitted in any form or by any means, electronic or mechanical, without permission in writing from the author. The forms may be printed out for private, one time, use only. Any and all commercial use of this site, without prior agreement, is strictly prohibited. All copyright infringements may result in severe penalties.

 

 

 

Actual Cash Value      A dollar value placed on damaged property equal to replacement cost less depreciation. Actual cash value is derived by fixing a new price for the same or similar item and deducting for wear and tear and obsolescence.

Additional Living Expenses
  Any additional expenses incurred for food, lodging, transportation, and other daily needs, resulting from an insured loss.

Adhesion contract  Standardized contract form offered to consumers on a take it or leave it basis. A contract that, by its nature, prevents the weaker party from having any say regarding its terms.
Adjuster One who represents the insurer or homeowner in arranging settlement of a claim. See claims representative, independent adjusters, public adjuster.

Agent   One who solicits insurance business on behalf of the insurer. An employee of the insurance company for the sale and service of insurance contracts.
Appraisal     A valuation of property by disinterested persons of suitable qualifications.
Appurtenance  Something belonging or incidental to a principal thing, such as a garage to a house, an outboard motor to a boat, or a protective case to a violin.
Appurtenant Structures   Something belonging or incidental to a principal structure. An appurtenant structure to a home may be a garage, barn, playhouse, storage shed, etc. Structures on the property that are not attached to the home.
Arbitration A method of resolving disputes through the assistance of an impartial (third) party. The parties to the dispute agree on the arbitrator to be used and to abide by the arbitrator's decision. Insurance arbitration is binding on both parties

Arbitration clause
   Provision in the homeowner's policy which outlines the method of resolving a dispute through arbitration. If parties decide to use arbitration before filing an action in court, and a binding decision is made by the arbitrator, it will be ruled as a binding agreement in a subsequent court case. The clause provides that the policyholder and the insurance company agree to one person to act as arbitrator. If such agreement cannot be made, then each party chooses his own representative and each representative then chooses an umpire to decide on the issue. The arbitrator's decision is binding and final on both parties. If the policyholder or the insurance company cannot agree to the provisions then the matter must go to the courts.
Average Clause see coinsurance clause

Bad faith
  An act of willful deception in furtherance of a sinister or dishonest motive.

Betterment   An improvement to property which increases its value. The improvement is characterized by increasing the value more than would mere replacement, repair or maintenance.
Bid   Promise to perform work for a certain price. An offer to provide services which become legally binding upon acceptance.

Board up  
Emergency repairs to secure property from further damages or loss.

Boilerplate
   Standardized language in a contract that is identical throughout the industry.
Broker   One who solicits insurance on behalf of several insurers. See Agent.
Claim   Notification of loss and extent of damages suffered. Includes information relating to coverage, type of peril, what was lost, value of loss, and evidence of loss.
Claims Representative    Employee of insurance company, who negotiates settlement on behalf of his employer.
Coinsurance clause   Provision in policy that specifies a minimum 80% replacement coverage in order to be protected fully for any size loss up to the policy limit.
Coinsurer   Homeowner who shares the risk of loss by not carrying enough insurance to comply with the coinsurance clause in the policy.

Concealment
  The intentional withholding of information that one has a duty to reveal. Such information being necessary for the determination of coverage but withheld for purposes of benefiting either; from something not entitled to under the policy, or something entitled to in the policy but not known to the insured.
Condition  A provision in an insurance policy which sets out the rights and duties of the parties involved, or describes the events under which protection is granted.
Contribution Clause  See coinsurance clause

Coverage
 
The amount and extent of protection under an insurance contract.

Damages
 
The dollar amount awarded to an injured party for losses suffered at the hands of an others unlawful acts, omissions or negligence. Damages are for compensating injured party for their loss (Compensatory) and in some cases for punishing the wrongdoer (Punitive).
Deductible   An amount, usually $100 or $250, which is subtracted from the claim before homeowner is entitled to compensation.
Depreciation   A reduction of worth arising from age, use or obsolescence.
Endorsement   Provisions that add nonstandard coverage's to a homeowner's policy.
Estimate  A rough approximation of restoration costs having no promise to perform.
Exclusion   Provisions in the policy which state certain circumstances that bar coverage.
Fiduciary   Business relations between parties, in which one party has practically full control over terms of contract, and is thereby held to the highest degree of trust, confidence, fairness and good faith to the other.
Floater   Policy endorsement, which covers items that have no fixed location such as jewelry or personal property while traveling. The terms floater policy and floating policy are often used in place of endorsement.
Fraud  A deceptive representation, whether by word, conduct, concealment or implication, which another relies on to his detriment. See Bad faith.
Guaranty   A pledge or promise that materials and workmanship meet accepted standards, and in the event of a discovered defect or default, the primrose will replace or repair.
Homeowner    The owner-occupier of an insured dwelling.
Homeowners policy   A multi-peril insurance policy covering such hazards as fire, water, burglary, liability, etc.
Hidden Damage   Damages which are not discoverable under reasonable inspection.
Independent Adjuster   A person or firm who holds himself or itself out for the employment of claims adjustment to more than one insurance company.
Illusory promise   A promise which appears to provide something of substance but on closer examination has little or no redeeming value.
Indemnify   To make good, to restore a victim of a loss, by payment, repair or replacement.
Inflation protection clause   Provision which adjusts the coverage due to inflation. The premium is adjusted accordingly.
Insured   The buyer of an insurance policy, the homeowner.
Insured loss   Damages or loss covered by homeowner's policy.
Insurer   The insurance company or underwriter.
Joint and several liability   Liability where each of several joint wrong-doers are responsible either; on a combined, undivided basis, or on an individual basis, for the full amount of damages for which the several wrong-doers are all responsible.
Knowledge   A clear understanding of the truth. A firm belief of things to be correct or incorrect.
Liability insurance   Insurance protection that covers injuries to others.
Lien Release   A waiver of lien rights, signed by subcontractors, so that the general contractor can receive a progress payment for work completed.
Limits   The maximum amount an insurance company will pay on a particular loss.
Line Item Bid   A detailed bid for restoration work listing each area of restoration and its cost.
Loss   Injury or damage sustained by policyholder which is the basis for filing a claim.
Loss department   That part of an insurance company responsible for the settlement of claims. Also referred as Claims Department.
Loss of Use   Additional expenses incurred as a result of the homeowner's loss of property. See Additional Living Expenses.
Loss Payable Clause   Provision in homeowner's policy which authorizes payment to others (mortgage company, deed of trust, etc.) having legal interest in the property.
Mediator   One who intermediates between disputants to affect a mutual understanding and agreement.
Mediation   A voluntary, legally non-binding, method of resolving a dispute with the assistance of a neutral party.
McCarran Act   United States Congressional Act of 1945, which exempts insurance companies from federal antitrust laws and permits each state to regulate and tax insurers from within and without the state.
Mortgage Clause   Clause in an insurance policy which protects the mortgagee's rights. See Loss payable clause.
Mortgage Inspector   A representative of a mortgage holder who verifies work progress of restorations to an insured dwelling, in order to release some or all funds for payment.
Mortgagee   The person or company who loans money to the homeowner for the purchase of a house and uses the value of the house as collateral for the loan.
Mortgagor   The homeowner who conveys his property as collateral on a loan.
Mysterious Disappearance   The vanishing or disappearance of property that cannot be explained. A form of theft coverage that insures not only for theft, but also for loss due to any disappearance under unknown, puzzling or baffling circumstances.
Negligence   Failure to use a reasonable amount of care. Falling below that standard of care used by a reasonably prudent and careful person under similar circumstances.
Other Insurance Clause   Clause in the insurance policy that identifies any and all other insurance companies which insure the same property as described in the policy, and apportions any claim amount accordingly.
Outbuilding   Something used in conjunction with a main building. An appurtenant structure such as a storage shed, garage, etc.
Peril   The hazard insured against, the cause of the loss such as fire, flood, bursting pipe.
Precedent   A course of conduct or decision making based on prior decisions. In case law, legal decisions based on prior decisions of analogous issues.
Premium   The amount of money a homeowner pays for insurance, the cost of coverage.
Proof of Loss   A claimant's formal statement to the insurer which is used to determine the insurer's extent of liability.
Puffing   An undue or exaggerated opinion regarding quality or performance and not considered a legally binding promise.
Quasi Contract   Situation imposed by law to prevent unjust enrichment or injustice and not dependent on agreement of the parties to the contract.
Replacement Cost   An amount equal to the price of a new item without deduction for depreciation.
Rider   An addition or amendment to a policy which is attached to and incorporated into the terms of the policy. See endorsement
Scope of damages   A contractor's list of structural damages, combined with an explanation of the method of repair and their cost.
Serviceability   That degree of restoration made to older homes under the homeowner's (HO-8) policy. Replacement of structure using methods and materials which are inferior in quality, simpler in design and without the aesthetic value of the original.
Subrogation   The transference of legal rights from the homeowner to the insurance company in order to recover from a third party. For example, an insurance company pays you on a claim and then sues a third party to recover the claim amount. The claim you have against the third party is transferred, or subrogated, to the insurer.
Subsidence   The sinking, upheaval or movement of land and the damages attributed to such. For example, cracks in foundation caused by settling is a form of subsidence.
Sudden and Accidental   An unexpected, unforeseen casualty or loss, as opposed to something that results from a continuous action. A requirement for recovery in a homeowner's claim.
Supplemental   An addition to the original claim for newly discovered hidden damages.
Tenant   One who has temporary use and occupation of another's real property (land and/or dwelling) for a fixed period of time as agreed to under the terms of a lease.
Tort   A civil wrong committed, independent of a contract, which is a breach of a legal duty owed to another and causes harm or injury.
Umpire   A third person appointed to decide an arbitration.
Underinsurance   An amount of coverage which is less than the value of the property, or less than the minimum amount required to prevent the coinsurance clause from taking effect.
Verify   To establish the truth by means of demonstration or use of reliable evidence.
Void   Having no legal force as in an unenforceable contract.
Warranty   The statement by the insured, the truth of which becomes a condition of the validity of the policy. Statement in a policy as to the existence of a fact or a condition of the subject of the insurance, which, if untrue, will void the policy.
X-Bracing    Cross bracing in a partition to provide rigidity.
Youthful Insured   An insured (male or female) under the age of 25.
Zoning Ordinance   Exercise of police power of a municipality in regulating and controlling the character and use of property.

Disclaimer   The information, forms, and techniques herein represent the author's opinions only and is not legal advice. Any and all advise given herein is not legal advise. The information and forms provide general educational information only. If legal or other expert advice is required by the reader, the services of a competent attorney, accountant, insurance agent, or other professional should be sought. The information, forms, etc. come without warranty of any kind, either express or implied, including but not limited to implied warrantes for quality, performance, merchantability, or fitness for any purpose. The author shall not be liable to the user or any other person or entity with respect to any liability, loss, or damage caused or alleged to be caused directly or indirectly by this information, forms, etc.

Copyright © 1992 Michael L. Smith,  Revised 1998, 2000 All rights reserved. No part of this publication (except forms) may be reproduced or transmitted in any form or by any means, electronic or mechanical, without permission in writing from the author. The forms may be printed out for private, one time, use only. Any and all commercial use of this site, without prior agreement, is strictly prohibited. All copyright infringements may result in severe penalties.