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Access The availability of medical care to a patient. This can be determined by location, transportation, type of medical services in the area, etc.
Accident An accident or occurence which is unintended, unforeseen, and unexpect; something which could not be consider as a foreseeable occurrence and consquence of an undertaking; a casualty or mishap.
Accident An event or occurrence which is unintended, unforeseen, and unexpected; something which could not be considered as a foreseeable occurrence and consequence of an undertaking; a casualty or mishap.
Accident & Sickness Insurance A broad term describing protection from loss because of illness or injury which may result in loss of life, loss of earnings, or expenses incurred. Whithin the broad area of health insurance, there are several major coverages which focus on more specific needs.
Accident Insurance Insurance covering death, dismemberment, loss of sight, loss of income, and medical expenses caused by accidental injury.
Accident Report Either the report that is used to document the time, cause, results, injuries, parties, and other pertinent facts of an accident for insurance purposes or a similar type of report prepared by law enforcement persons as a result of an accident
Accidental Bodily Injury Bodily injury to a person or persons that has been caused accidentally and with unforeseen results
Accidental Death Any death that results from causes other than natural causes or homicide.
Accidental Death and Dismemberment A policy or a provision in a Disability Income policy which pays either a specified amount or a multiple of the weekly disability benefit if the insured dies, loses his or her sight, or loses two limbs as the result of an accident. A lesser amount is payable for the loss of one eye, arm, leg, hand, or foot.
Accidental Death Insurance A life insurance policy that pays a benefit only in the event that death was accidental.
Account Executive A person whose duty is to specifically service an account or group of accounts for an agency or brokerage firm.
Accounts Receivable Insurance Coverage which protects businesses against their inability to collect their accounts receivable because of the loss of supporting records.
Accrete A Medicare term which means the process of adding new members to a health plan.
Act of God An event beyond human origin or control. Lightning, windstorms, and earthquakes are examples, the damage from which would not be the responsibility of an insured, although the insured might be responsible for many other calamities. Acts of God are excluded by the usual bill of lading, as well as by some insurance policies, unless specifically included.
Actively-at-work Most group health insurance policies state that if an employee is not actively at work on the day the policy goes into effect, the coverage will not begin until the employee does return to work.
Activities of Daily Living (ADL) Everyday living functions and activities performed by individuals without assistance. These functions would include mobility, dressing, personal hygiene and eating.
Activities of Daily Living (ADL) Standards Used to assess the ability of an individual to live independently, measured by the ability to perform unaided such activities as eating, bathing, toiletry, dressing, and walking. ADL standards are sometimes discussed as a way to measure or define eligibility for long term care.
Actual Cash Value The basis of loss settlement in property insurance policies, which takes into consideration factors such as replacement value less depreciation, market value, rental value, the use of the building, the area in which it is located, obsolescence, assessed valuation, and any other factor which would have an effect upon the value. A working rule-of-thumb definition, however, is "replacement cost new at the time of loss, less depreciation." (See Replacement Cost Insurance.)
Actual Charge The actual amount charged by a physician for medical services rendered.
Actual Total Loss When insured property is so badly damaged by a covered cause of loss that it is not repairable or recoverable or when there is so little remaining of the salvageable or repairable nature that it no longer has any value, it is considered an actual total loss. This usually signifies the maximum settlement possible under the terms of the policy.
Actuary A social mathematician who uses mathematical skills to define, analyze and solve complex business and social problems involving insurance and employee benefit programs. The work of actuaries involves the various contingencies which face human beings: birth, marriage, sickness, accident, loss of property, legal liability, retirement, and death, and the financial effects which these and other contingencies have on various insurance and and benefit programs. Many of these programs involve long-range financial obligations, for which actuarial forecasts are fundamental in maintaining a sound financial basis: rate-making, premium and loss reserving, investment valuation, pension benefits, and insurance statistics, among others.
Acute Care A group program for functionally impaired adults, designed to meet health, social and functional needs in a setting away from the adult's home.
Ad Valorem A legal term meaning according to value. Often used with respect to a value bill of lading. A value bill of lading is the receipt issued by the transportation company for goods being shipped and which describes the specifics of carriage, including freight and value of goods.
Additional Death Benefit Life insurance benefits offered should death occur during a specific time period or as a result of specific causes. (See Death Benefit and Double Indemnity.)
Additional Insured A person, other than the named insured, who is protected by the terms of the policy. Usually a specified individual such as a spouse or a member of the insured's family but sometimes, as in automobile insurance, any person, provided that person is driving the insured vehicle with the insured's permission.
Additional Premium When a policy has been issued subject to rate, subject to audit, subject to inspection, is assessable, or when the policy is endorsed, the additional premium is the extra amount due, over and above the initial premium stated in the Declarations, because of the increased exposures, higher rates, retrospective rate calculations, additional coverage, or premium audit.
Adhesion Contract A type of contract in which the standard provisions offered are not subject to negotiation, but are on a "take it or leave it" basis. Most insurance policies are contracts of adhesion since the terms and conditions of the contract are drawn or written by the insurer with no input from the insured who must adhere to the terms and conditions as set forth, and who has little recourse to negotiate for better benefits or terms. If there is any ambiguity when a contract of adhesion has been written, court decisions and rulings will be in favor of the party who did not have control of the wording of the provisions; in this case the insured.
Adjustable Policy A policy in which the exposure basis is a variable (such as sales or payroll), which can only be determined at the end of the policy term. (See Audit Policy)
Adjustable Premium Policies issued by an insurer that do not guarantee the premium upon renewal. At each subsequent renewal the policy may be re-rated and bear premiums that may or may not be substantially different than the previous period premium.
Adjuster One who determines the amount of loss suffered. A "company" adjuster represents the company. A "public" adjuster represents the policyholder. An "independent" adjuster may be hired by either.
Admiralty Liability The liability posed by the combination of both common and statutory law, as it relates to maritime operations and activities.
Admitted Assets Those assets, or portions thereof, of an insurance company which under state insurance laws may be taken into account in establishing the financial condition of the insurance company, e.g., agents' balances or uncollected premiums under 90 days old.
Admitted Company A foreign or alien insurance company which has been licensed by the insurance department of the state in question, and which thereby is authorized to conduct business within that state to the extent licensed. Also called an admitted market or admitted insurer.
Admitted Insurer A foreign or alien insurance company which has been licensed by the insurance department of the state in question, and which thereby is authorized to conduct business within that state to the extent licensed. Also called an admitted market or admitted company.
Admitted Liability An aviation specific coverage for passengers or guests aboard aircraft, which precludes the need for those guests or passengers to prove the liability of the insured owner or operator of the aircraft, in order to recover for damages suffered in an accident. This coverage is normally written with a meximum limit per seat, and the passenger or guest can recover up to that amount.
Admitted Market A foreign or alien insurance company which has been licensed by the insurance department of the state in question and which, thereby, is authorized to conduct business within that state to the extent licensed. Also called an admitted company or admitted insurer.
Adult Day Care A group program for functionally impaired adults, designed to meet health, social and functional needs in a setting away from the adult's home.
Advance Premium A provisional or deposit premium charged at the start of a policy term, with the final premium determined after the policy has expired.
Adventure With respect to ocean marine insurance, any type of commercial venture which exposes a maritime vessel (including cargo) to potential losses by perils of the sea.
Adventure Clause With respect to ocean marine insurance, the clause within the insurance coverage that requires the insured to provide the insurer with an accurate and detailed description of the voyage, which in turn will become attached to and part of the Declarations of the policy and which will be used as the basis for the coverage, underwriting, and pricing of the insurance policy.
Advertisers Liability Insurance Covers an insured against claims for libel, slander, defamation, infringement of copyright, invasion of privacy, etc., arising out of its advertising program. Also available for radio and television stations and advertising agencies.
Advertising Injury Damages or injury sustained by a claimant in the course of the advertising activities of the insured which included such injury as libel, slander, violation of the right to privacy, misappropriation of advertising ideas, or the infringement of copyright.
Aftercare Individualized patient services required after hospitalization or rehabilitation.
Agency A business office whose function is the sales of insurance and insurance products. An agency may be owned or run by a general agent, manager, independent agent, or company manager. The principal is responsible for the statements and actions of agents performing within the scope of authorization specified in the agency agreement. (See General Agent and Independent Agent.)
Agent One who has the authority to act for another. In inurance language, an agent is the person who sells insurance by contacting the policyholder. By contract and by law, the agent is endowed with many of the powers of the company itself. There are various types of agents, based upon the contractual relationship with the insurer they represent.
Agent of Record The agent who has been recognized by the insured or customer as their authorized representative for handling the specified insurance transactions.
Aggregate Benefits The maximum amount an insured is able to collect under a single policy regardless of the number of claims, injuries, accidents, or number of insureds.
Aggregate Excess Insurance Coverage developed for operations that prefer to self-insure a portion of their losses, capping at a specified amount. When the accumulation of losses exceeds the threshold amount during any annual period, the remainder of losses up to the policy limit, are covered by this type of insurance.
Aggregate Limit In a policy providing such an aggregate limit, the maximum amount the insurer will pay during the policy period, irrespective of the policy's limit of liability.
Agreed Amount The amount of coverage which the insurer and insured have mutually agreed to be the value of the property at the time the insurance is purchased.

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