Claims Made Easy - Insurance Terms Explained

The person who investigates and assesses claims on behalf of insurers (123.ie/RSA) (claims adjuster or loss adjuster).

All Risks cover is an add-on to your standard Contents insurance policy.  It is an optional extra provided by most insurers on a home policy to cover personal effects or valuable jewellery for loss / damage / theft when you are in and out of the home (anywhere in Republic or Ireland, Northern Ireland, Great Britain, the Channel Islands and the Isle of Man).All Risks will also cover the items when you are abroad on holidays anywhere else in the world for no more than 60 days in any period of insurance.
 All Risks is divided into Specified All Risks and Unspecified All Risks.
 

The Buildings are  the Home built with brick, stone or concrete and roofed substantially with slates, tiles or other incombustible materials including fixtures and fittings therein and thereon (the Home)
The domestic outbuildings, garages, swimming pools (but not outdoor spas or hot tubs) and tennis courts including fixtures and fittings therein or thereon
The fuel storage tanks and their contents and the terraces, patios, driveways, footpaths, walls, gates. fences, lawns, hedges, trees, shrubs and plants all situated at the Home.
Exclusions:
Buildings cover does not include outdoor spas or hot tubs.
 

This is the insured's claims history. It will outline the details of any previous claims including, type of claim, date of loss, amount paid out & the current status. They need inform their insurer fully of any previous claims before purchasing a new policy or adding a new driver.

Household Goods and Personal Effects in Your Home or its domestic outbuildings or garages belonging to You (or for which you are legally responsible) or belonging to members of Your Household or to a domestic employee permanently residing with You.
The maximum amount payable in respect of any one article or item is 10% of the Contents sum insured.  This is known as the Single Article Limit.
 
The maximum amount payable in respect of the total of all high value items at the Home is 50% of the Contents sum insured. Home office equipment, being personal computers, printers, facsimile machines, telephone answering machines and the like, is included in the Contents sum insured and limited to a maximum of €4,000 in respect of any one claim.
 

Contents does not include property otherwise insured, property primarily held for professional or business purposes other than as specified above, motor vehicles (other than mechanically propelled lawn mowers), marine craft, caravans and trailers, aircraft or parts, keys or accessories of, on or in any of them, animals and livestock, bonds, securities for money, manuscripts, certificates, bills of exchange, promissory note and documents of every kind unless specifically mentioned as being insured or any part of the structure of Your Home or any landlord's fixtures and fittings.
 

An endorsement is a written document attached to an insurance policy that changes the cover provided by the policy.  An endorsement can be used to increase or reduce cover for acts or things that are not written in the original policy. They can be added at the start of the policy or mid-year if new information is given. 

An Excess is the amount that is deducted from each claim or can be paid up-front by the insured. Check your policy schedule for the excess you selected & the policy booklet.

A specific item or circumstance that is not covered by an insurance policy. It usually applies to a certain circumstance that will not be covered. (i.e. you have theft cover but under theft cover, loss that occurs when the car is left unlocked is specifically excluded.)

Payment of a claim made by an insurer, when there is no requirement for them to pay. This is usually done as a gesture of good will.

A claim is seen to be fraudulent when the person claiming intentionally leaves out, misrepresents, alters or hides vital information relating to the claim in order to get a payment under the policy that they would not otherwise be entitled to. This can be in the form of exaggerating the amount of loss up as far as creating a completely false version of events. 

If someone suspects an individual of making a fraudulent claim they can report it by contacting Insurance Confidential on 1890 333 333.  
 

Any item, set or collection of:

1. jewellery or precious metals

2. pictures, paintings, books or other works of art

3. furs

4. antiques

5. fine wine

6. stamps or coins

The inception date is the date that the policy starts or becomes operative.   

Financial compensation sufficient to place the insured in the same financial position after a loss as he/she enjoyed immediately before the loss has occurred.

In order to insure a car or a home you must have “insurable interest”. This means that you must have a legal & financial interest in the thing to be insured in order to benefit from an insurance policy for that thing. 
For example, to insure a car you must be the legal & registered owner of the car. Frank cannot insure his neighbour Paul’s car as he does not own it, nor would he be out of pocket should that car be damaged. Paul’s ownership of the car, in that he bought it, creates an insurable interest or relationship.

This is where there are two or more people insured or named under one policy and whose interests are noted under the same policy.  Our Household polices can be in joint names.

The maximum amount the insurance company would pay for an insured circumstance or insured item. The insurer may give the maximum limit within a specific time also. (E.g. The maximum payable under personal accident benefit is €5000 total in any one year.)

Another term for a claim.

The person who investigates and assesses claims on behalf of insurers. (123.ie/RSA) (claims adjuster or loss adjuster).

A loss assessor is appointed by the insured to assess and investigate a claim.

A material fact is an occurrence, event, or information that is sufficiently significant to influence an individual into acting in a certain way, such as entering into an insurance contract. Leaving out information that is seen to be material fact, could result in a claim under a policy not being paid or in the insurance policy being invalid. All material facts need to be provided to an insurance company before entering into an insurance policy so that the insurance company can decide on the proper premium or cover, if they agree to accept the policy. 

A moral hazard arises from the attitude and conduct of people.   

Negligence is not to do something we should have done, or to do something we should not have done.

The failure by the insured or his broker to provide relevant information (see material facts) to the insurance company that relates to the insurance policy before accepting the insurance policy or amendments to the insurance policy. 

A peril can defined as that which gives rise to a loss / the cause of a loss.    

Articles normally worn or carried on the person excluding contact lenses, hearing aids and dentures.

The person in whose name the policy is issued. 

The amount paid to the insurance company for a contract of insurance for the specified period of insurance. 

A proposal form is the form completed by the proposer when applying for insurance.  123.ie proposal forms are completed online or through an agent over the telephone.

The cause that sets in motion a train of events which brings about a result, without the intervention of any force started and working actively from a new and independent source.

Making good. Where insured property is damaged, it is usual for settlement to be arranged by cash/cheque payment, but a policy may give either the insured or insurer the option to restore or rebuild instead.

Risk can mean 2 different things in insurance. The insured risk can be the item that is to be insured, the car or the house. (i.e. The Risk Address.) It can also mean the circumstance the person taking out insurance is to be insured against. (i.e. Theft Risk, Fire Risk.) 

The part of an insurance contract that sets out the details specific to the policy.

Personal items valued at over €1,000 individually must be specified with a description of the item and its value.

The following items must be specified in order to be covered under All Risks:

• Sports Equipment including those used for water or winter sports
• Personal Computers and Laptops, including accessories
• Personal Electronic Entertainment Devices, such as Sony Playstation, Microsoft X-Box, Nintendo Wii, I-Pods
• Hearing Aids, Dentures and Contact Lenses
• Bicycles
• Guns
• Musical Instruments
• Mobile Phones, including accessories

An alternative to a completed proposal form. A statement provided by the insurer clarifying the basis on which insurance is accepted and what conditions apply.

A person who accepts business on behalf of an insurer.

Not adequately furnished or equipped for normal living purposes.

Not lived in by a member of Your Household or any other person authorised by You for more than 45 consecutive days. 

This applies to any non-specific or miscellaneous personal effects that you may wish to cover.   The maximum that will be paid out for any one item under Unspecified All Risks is €1,000.
The maximum that will be paid out for Money under Unspecified All Risks is €400.
The excess will be applied to any claims made other than claims for Money.
 

Utmost Good Faith is the positive duty to voluntarily disclose, accurately and fully, all facts material to the risk being proposed whether requested or not.