Important terms in Insurance claims
Taking out insurance for business of personal reasons typically comes with a lot of paperwork and signatures. Here are a few of the most used terms when dealing with insurance matters.
- Indemnity:
This is the basis of most insurance policies. It is the benefit you receive that places you, as far as possible, in the same financial position that you were in before the loss occurred. The insurer has an option to repair, re-instate, replace or to pay cash. Different policies will have different cover options to indemnify you for your loss and the basis on which your insurer will indemnify you.
- Exclusions:
Exclusions are specific items, losses or events that are not covered in terms of your policy. These will be specified in your policy wording and it is important that you read your policy carefully. Exclusions may also sometimes be referred to as “exceptions”.
- Liability:
This is the legal responsibility one person (natural or juristic) has to another, that is enforceable by law.
- “Held liable”:
You are held liable (responsible) when someone proves that you caused him/her injury, loss or damage unlawfully, whether deliberately or accidentally (negligently).
- Reject (see also Repudiate):
If an insurer rejects a claim, the insurer has refused to pay the claim or any part of the claim, in terms of the policy.
- Repudiate (also see Reject):
If an insurer repudiates a claim, the insurer has rejected the claim, which could be for various reasons. It has the same meaning as the definition of Reject.
- Terms and Conditions (“Ts and Cs”):
The terms and conditions in a policy set out the general and special arrangements, provisions, requirements, legal rules, specifications, and standards that form an integral part of the agreement or contract between you and the insurer. Your policy document is a very important document and you must read and understand it.
- Clauses:
Clauses are sentences and paragraphs describing the responsibilities of both you and your insurer and other terms and conditions that may apply to your policy.
- Schedule:
A schedule is a document that summarises all your specific insurance information. It can also be referred to as a “certificate of insurance”. It forms part of your insurance policy document. It sets out the type of insurance you have bought, the premium amount you have to pay, information about excesses and/or exclusions, start date, period of insurance, renewal date and other details specific to your policy.
- Conditions:
These are detailed conditions in your policy and are requirements that must be in place or complied with by you so that you can enjoy the benefits of the policy.
- Policy term:
Policy term is a term or clause in a contract. There are different classes of terms in a policy, such as conditions, warranties, exceptions and exclusions, extensions, clauses and provisions. (In long-term insurance [life insurance], the policy term may refer to the period during which the contract may be in force i.e. its period of insurance.)
- Provision:
A policy provision is a term which may require certain things to be done or not done. If you do not comply with a provision, it may affect your cover, premium or a claim
Need advice on your insurance matter?
If you need assistance with an insurance matter, where a claim has been denied, rejected or repudiated feel free to contact us at Paul du Plessis Attorneys on 012 809 1588 or send an e-mail to paul@pauldup.co.za