Insurance Claim Glossary

Actual cash value roof coverage is an endorsement (ISO HO 04 93 or a carrier equivalent) under which losses to roof surfacing from windstorm or hail are settled at actual cash value, meaning…

Replacement cost value (RCV) is what it costs to repair or replace damaged property with new materials of like kind and quality today.

Additional living expense (ALE), the main part of a homeowners policy's Coverage D (Loss of Use), pays the necessary increase in living expenses you incur so your household can maintain its normal…

An anti-concurrent causation (ACC) clause is the sentence at the top of a policy's exclusions that says the excluded loss is excluded "regardless of any other cause or event contributing concurrently…

The appraisal clause is a provision in most property policies that lets either the policyholder or the insurer demand appraisal when they disagree on the amount of a covered loss.

An assignment of benefits (AOB) is a contract in which the policyholder transfers the right to the insurance claim payment, and the right to pursue the claim, to a contractor (typically a water…

Bad faith is an insurer's failure to settle a claim when, under all the circumstances, it could and should have done so had it acted fairly and honestly toward its policyholder.

A calendar-year deductible is a deductible that is satisfied once for all covered losses of that type in the same calendar year.

Civil authority coverage is the part of Loss of Use (homeowners) or Business Income (commercial) that pays when a civil authority prohibits you from using your property because of direct physical…

Coinsurance, on a property policy, is a condition that requires the building to be insured for at least a stated percentage of its value (commonly 80%, sometimes 90% or 100%).

Contents coverage, Coverage C on a homeowners policy, pays for personal property (furniture, clothing, electronics, tools, kitchenware, everything that is not part of the building) damaged by a named…

The date of loss (DOL) is the date the damage occurred, which is the date the covered event happened, not the date you discovered it or reported it.

An ensuing loss provision is the exception inside an exclusion that says "any ensuing loss not excluded is covered." The excluded event (faulty workmanship, wear and tear, a corroded pipe, a…

An examination under oath (EUO) is a formal, sworn question-and-answer session that most property policies entitle the insurer to require as a condition of the claim.

A hurricane deductible is a separate, usually percentage-based deductible that replaces your regular deductible when a loss is caused by a named hurricane.

On a property policy, windstorm is the peril: damage caused by wind of any origin, covered under the standard deductible.

Insurance claim mediation in Florida is a non-binding, state-run conference under §627.7015 where the policyholder and the insurer meet with a Department of Financial Services-approved mediator to…

A limited water damage endorsement caps the policy's payment for water damage from plumbing, appliances, HVAC and water heaters (non-weather water) at a stated amount, most often $10,000, in exchange…

The matching rule is the principle that when a covered loss requires replacing part of a roof, floor, siding or other continuous surface, and the new material will not match the undamaged remainder…

The mortgagee clause (standard mortgage clause) is the policy provision that names your lender as a mortgagee and gives it an independent right to the insurance proceeds up to the loan balance.

Ordinance or law coverage pays the increased cost of repairing or rebuilding damaged property to comply with current building codes, including demolition of undamaged portions that code requires you…

Overhead and profit (O&P) is the general contractor's charge for running the job: overhead is the cost of doing business (office, insurance, supervision, permits), and profit is the margin.

A policy exclusion is a provision that takes a cause of loss, a type of property, or a situation out of coverage that the insuring agreement would otherwise provide.

A proof of loss is a sworn, signed statement from the policyholder setting out the date and cause of the loss, the property involved, the interest of the insured and others, other insurance, and the…

Three kinds of adjusters can show up on a property claim, and only one works for you.

Recoverable depreciation is the money your insurer withholds from a replacement-cost claim payment until you repair or replace the damaged property.

A reservation of rights (ROR) letter is written notice from the insurer that it is investigating or adjusting the claim while reserving the right to deny or limit coverage later based on specific…

A roof payment schedule (roof surfacing payment schedule) is a policy endorsement that pays a roof loss at a percentage of replacement cost set by the roof's age and material, instead of full…

Florida law splits ground-movement losses into two coverages.

A supplemental claim is a claim for additional loss or damage from the same peril the insurer has already adjusted, or for costs incurred while repairing under an open claim.

A vacancy clause limits or removes coverage when the insured building has been vacant for more than a stated period, usually 60 consecutive days, before the loss.

The IICRC S500 Standard for Professional Water Damage Restoration sorts a water loss two ways.

The wear and tear exclusion removes coverage for damage that happens gradually through age, use and exposure: worn shingles, deteriorated seals, rust, rot, corrosion, settling.