Glossary of selected terms
Additional insured
Insureds can be added to a liability insurance policy, not by paying the premium, but from a contractual relationship. Typically, one party (Named Insured) undertakes activities that may expose another to liability (Additional Insured).
Adjuster
Adjusters are retained by insurance companies to recommend how a given policy should respond to a claim. They do not make legal conclusions, nor do they advocate on behalf of the insured.
Aggregate limit
This is the most a policy will pay for any and all claims. It's like that famous line from that movie, 'insurance is like a box of chocolates, you only get so much'.
All Risks policy
A type of insurance policy that names what's not covered, as distinguished from a Named Perils policy that specifies what is covered.
Bad faith
Not a poor rendition of a George Michael song. Rather, this is a breach of the good faith standard to which insurers are held. In egregious cases, this can give rise to punitive damages.
Captive
This is a sophisticated form of self insurance whereby the insurance company is owned/controlled by the insured.
Claims made and reported policy
As distinct from an 'Occurrence' policy, this type of policy only responds to claims of liability arising, and reported, during the policy. A common feature of E&O policies.
Deductible
This the predetermined amount paid by the insured as part of the insurer accepting their claim and agreeing to fund it. Fun fact: even if it is specifically listed in the policy, an insurer's ability to insist on the payment of a deductible can be controlled by statute.
Endorsement
Have you noticed that the body of insurance policies occasionally say "we cover/don't cover ___ unless otherwise stated"? Endorsements are the "otherwise stated" and modify the underlying wording.
Eroding limits policy
AKA: Burning limits or "defence within limits" policy. E&O and D&O policies are often characterized by eroding limits. So the costs paid to defend you in a claim erode the limits available to settle or fund the liability.
First Party coverage
This is coverage for the insured/policyholder's own loss. This is in contrast to third party coverage that covers liabilities to others.
Indemnity
This is generally what policyholders think of when they buy insurance: Payment for the actual loss itself (rather than lawyers to fight about liability for the loss).
Insurance
A risk transfer mechanism that protects against a potential loss, usually defence costs or indemnity, in which the insured has an insurable interest.
Insurance defence
A type of legal practice in which insurer-appointed lawyers defend policyholders/insureds under liability policies.
Insured vs Insured exclusion
This is an important exclusion in which insureds listed as such on the same policy may not recover for claims between each other.
LEG (1/2/3)
In Builders Risk policies, endorsements can be added that improve coverage. For 20+ years, the London Engineering Group ("LEG") has provided standard form wordings that enhance coverage for losses resulting from faulty workmanship.
Loss payee
Of the parties that may benefit from an insurance policy, loss payees are arguably the most important category (which gets lost in the debate around categories of insured): The funds are disbursed to them, even if an insured (that is not a loss payee) proves the claim is meritorious. One of many ways a contract and insurance policy may lack coordination.
Moral hazard
You probably won't find this term in any insurance policy, but "moral hazards" are a primary driver for what insurance will cover. In short, it is an increase in risk taking behaviour due to a decrease in (or protection from) negative consequences. Kind of like if sports gambling losses were tax deductible. Or if insurance policies did not have deductibles.
Notice-only notification
A form of notice to an insurer that preserves the insured's entitlement to pursue the policy for recovery without formally opening a claim.
Occurrence
An occurrence is an insurable event that (typically) dictates how many deductibles apply.
Occurrence policy
This is a policy triggered by unintended (insured) events/loss that transpire while the policy is active.
Other Insurance provision
Often times, multiple insurance policies can technically respond to an insurable loss. This is the part of the policy that helps determine how that policy responds when multiple policies are in the mix.
Policyholder
This is the person or entity in whose name an insurance policy is held.
Proof of Loss
A formal attestation of a first party loss. An insurer must respond to a proof of loss after a specified time period with a formal disposition of the claim (approved or denied).
Reinsurance
Did you know that insurers buy their own insurance? Enter reinsurers! Policyholders are generally none the wiser; but reinsurers can have a significant impact on claim administration.
Reservation of Rights
This is a formal position (letter) from an insurer that allows the insurer to fulfill certain time-sensitive obligations without waiving their right to investigate and potentially avoid coverage. It helps spare a delay or stalemate.
Self insured retention
While some (including courts) use this term interchangeably with "deductible"— strictly speaking, they are different. A self-insured retention functions more like a primary layer of insurance, which the insured has to exhaust before the insurer will participate. See Loblaw Companies Limited v. Royal & Sun Alliance Insurance Company of Canada, 2024 ONCA 145 at para 131.
Subrogation
For first party claims, this is a legal right that passes to the insurer once they have paid an insured's claim: They may now recover their losses, stepping into the shoes of the insured, from the liable party.
TPA (Third Party Administrator)
Intermediaries that facilitate insurance operations, including investigating claims.
Wrap Up policy
This is a popular method (particularly in construction) for pooling liability coverage on a project specific basis rather than having every entity provide separate General Liability coverage.
