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Definition
| A demand by an insured person or organization seeking to recover from its insurer for a loss that its insurance policy may cover. |
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| A demand against an insured by a person or organization other than the insured or the insurer, seeking to recover damages that may be payable by the insured’s liability insurance. |
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| A party that makes a claim and that can be either a first-party claim- ant or a third-party claimant. |
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Definition
| A person responsible for investigating, evaluating, and settling claims. |
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| Third-party administrator (TPA) |
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Definition
| An organization that provides administrative services associated with risk financing and insurance. |
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Definition
| An independent claim representative who handles claims for insurers for a fee. |
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| An outside organization or person hired by an insured to represent the insured in a claim in exchange for a fee. |
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Definition
| A signed agreement indicating that during the course of investigation, neither the insurer nor the insured waives rights under the policy. |
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Term
| Reservation of rights letter |
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Definition
| An insurer’s letter that specifies coverage issues and informs the insured that the insurer is handling a claim with the understanding that the insurer may later deny coverage should the facts warrant it. |
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Definition
| The process by which an insurer can, after it has paid a loss under the policy, recover the amount paid from any party (other than the insured) who caused the loss or is otherwise legally liable for the loss. |
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Definition
| An alternative dispute resolution (ADR) method by which disputing parties use a neutral outside party to examine the issues and develop a mutually agreeable settlement. |
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Term
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Definition
| An alternative dispute resolution (ADR) method by which disputing parties use a neutral outside party to examine the issues and develop a settlement, which can be final and binding. |
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Term
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Definition
| A method of resolving disputes between insurers and insureds over the amount owed on a covered loss. |
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Term
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Definition
| An alternative dispute resolution method by which a case undergoes an abbreviated version of a trial before a panel or an adviser who poses questions and offers opinions on the outcome of a trial, based on the evidence presented. |
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Term
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Definition
| An alternative dispute resolution method by which disputing parties participate in an abbreviated trial, presenting the evidence of a few witnesses to a panel of mock jurors who decide the case. |
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Term
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Definition
| An interest in the subject of an insurance policy that is not unduly remote and that would cause the interested party to suffer financial loss if an insured event occurred. |
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Definition
| Cost to replace property with new property of like kind and quality less depreciation. |
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Term
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Definition
| The reduction in value caused by the physical wear and tear or technological or economic obsolescence of property. |
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Definition
| The cost to repair or replace property using new materials of like kind and quality with no deduction for depreciation. |
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Term
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Definition
| A method of valuing property in which the insurer and the insured agree, at the time the policy is written, on the maximum amount that will be paid in the event of a total loss. |
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Definition
| The insurer’s rights to recover and sell or otherwise dispose of insured property on which the insurer has paid a total loss or a constructive total loss. |
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Definition
| A loss that occurs when the cost to repair damaged property plus its remaining salvage value equals or exceeds the property’s pre-loss value. |
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Definition
| Money claimed by, or a monetary award to, a party who has suffered bodily injury or property damage for which another party is legally responsible. |
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| A payment awarded by a court to reimburse a victim for actual harm. |
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Definition
| A form of compensatory damages that awards a sum of money for specific, identifiable expenses associated with the injured person’s loss, such as medical expenses or lost wages. |
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Term
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Definition
| A monetary award to compensate a victim for losses, such as pain and suffering, that do not involve specific measurable expenses. |
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