Claim Glossary


Claims Terms and Definitions

A

Accident

Event or occurrence that is unforeseen and unintended.

Actual cash value

Current value of property. This is often calculated by subtracting depreciation from the replacement cost. Replacement cost – depreciation = actual cash value.

Additional living expenses

Any costs above your typical living expenses if you’re unable to live in your home due to a covered loss.

Adjuster

Person who investigates and settles losses for an insurance company.

Adverse carrier

The other person’s insurance company.

Aftermarket parts

Car parts that are manufactured by a company other than the Original Equipment Manufacturer (OEM).

Appraiser

Person who estimates property damage and value.

Appreciation

Increase in the value of a property due to changes in market conditions or other contributing factors.

Arbitration

When two parties disagree about who is responsible for a loss, an unbiased person or panel provides an opinion on liability or damages. Certain types of arbitration results are binding, meaning they cannot be appealed.

At-fault accident

Car accident where you, the insured, are responsible for the loss.

At-fault party

Party or parties legally responsible for the damages.

Auto appraisal

Written estimate that outlines the value of a vehicle, factoring in any damage that may have occurred.

B

Bodily injury

Certain types of injuries, including physical, mental/emotional, sickness, disease or death. Coverage for bodily injury is subject to any definitions, limitations or exclusions in the policy.

Building code

Regulations based on safety and health standards that designate permitted designs, construction and materials used in construction.

C

Catastrophe

Natural disaster that causes extensive damage.

Claim

Request for payment from an insurance company for a loss.

Claimant

Individual who submits a request for payment of a loss.

Collision coverage

Coverage for physical damage to your auto caused by a collision with another vehicle or object.

Collision damage waiver (CDW)

Optional damage coverage that can be purchased, typically from a rental vehicle company. This protects your rental vehicle in case of an accident. Your Amica policy will not reimburse you for purchasing this coverage.

Comprehensive coverage (also known as other than collision or OTC)

Coverage for physical damage to your auto (including glass or windshield) caused by such things as fire, theft or vandalism.

Conditions

Part of the insurance contract which describes the duties and responsibilities of both the policyholder and the insurance company.

Coverage

Protection against a loss as provided by an insurance contract.

Customized vehicle

A vehicle that has been substantially modified.

D

Damage

Destruction of or loss of use of tangible property that results from an accident or occurrence.

Damages

Money that one party is legally obligated to pay another as compensation for an injury or loss.

Dealer glass

Replacement glass that is sourced from the same distributor as the auto’s original manufacturer.

Declarations page (also known as dec page)

Section of an insurance policy that includes basic information about the policyholder, the insured property and coverages.

Deductible

Amount of money the policyholder is responsible for paying as part of the claim.

Depreciation

Decrease in value of an item due to age, wear and tear, or other contributing factors.

Direction to pay

Form that allows Amica to issue payment directly to a vendor or provider, such as a contractor or body shop, on your behalf.

Dwelling

Place of residence.

E

Effective date

Date on which the insurance coverage under a policy begins.

EFT (electronic funds transfer)

Transfer of funds from one bank account to another for the purpose of premium or claim payments.

Endorsement

Amendment to the basic insurance policy.

Ensuing loss

Loss caused by an earlier or related event.

Estimate

Approximate calculation of value.

Exclusions

Certain policy restrictions that limit or exclude coverage. Exclusions may vary by policy type and state.

Expiration date

Date when the insurance policy’s coverage ends.

F

First party

Person who qualifies as an insured, or the types of coverages the insured is entitled to.

Fraud

Intentional deception made by a person or entity.

G

GAP (Guaranteed Asset Protection) insurance

Optional insurance that may pay the difference between the vehicle’s value and the auto loan balance in the event of a total loss.

H

I

Indemnity

Compensation from an insurance contract that restores an individual to his or her estimated financial position prior to loss.

Independent adjusters

Individuals contracted by an insurance company to investigate and settle losses.

Insurance

Financial protection for unexpected events that may cause loss.

Insurance ID card

Card containing basic information as proof of insurance.

Insured

A person, organization or any other parties protected by an insurance policy.

Insurer

Person or company that writes a policy for an insurance risk.

J

K

L

Liability coverage

Coverage for bodily injury and/or property damage to others when you are legally responsible as a result of an accident involving your vehicle.

Liability limit(s) (also known as policy limits)

Maximum amount provided by policy coverage(s) for a loss.

Lienholder/Loss payee

Party who has a financial interest in a covered property, such as a bank that has financed your vehicle or home.

Litigation

Legal process involving a plaintiff and a defendant, such as legal proceedings to determine fault.

Loss

Occurrence of damage and/or injury that an insurance company may pay for.

Loss of use coverage

Compensation for additional expenses while damaged property is not available for use.

M

Malicious mischief

Intentional destruction of another person’s personal property.

Medical payments coverage

Coverage for reasonable medical expenses for you, your family and your passengers when injured in an accident, regardless of whom is at fault.

Misrepresentation

Giving false or misleading information.

N

Named insured

Individual to whom the policy is issued. This person is listed on the policy declarations page.

Negligence

Failure to take the level of care that a reasonable and prudent person would take in the same or similar situation.

No-fault insurance coverage

Type of auto insurance that requires drivers to carry insurance for their own protection, while limiting their ability to sue others for certain types of damage.

Non-owned auto

Borrowed or rented vehicle.

O

Occurrence

Exposure to conditions that causes injury or damage.

Original Equipment Manufacturer (OEM) parts

Equipment, accessories and replacement parts (including glass) produced by the original manufacturer.

Other than collision (OTC) coverage (also known as comprehensive)

Coverage for physical damage to your auto (including glass and windshield) caused by such things as fire, theft and vandalism.

Out-of-pocket expenses

Claim-related expenses not covered by your insurance policy. In some instances, the person who was at fault may pay for these expenses.

P

Payment recovery (also known as subrogation)

To recover funds paid out to you from a responsible party.

Peril

Possible cause of loss. Examples include fire, windstorm, hail, etc.

Personal injury protection (PIP) coverage

Auto insurance coverage for medical expenses and, in some cases, lost wages and other damages. PIP compensates covered individuals regardless of who is at fault and is mandatory in some states.

Personal property

Generally includes personal belongings, such as furniture, appliances or jewelry. It does not include land or property connected to land (such as a house, garage or shed).

Policy

Formal written contract of insurance that lists policyholders, coverages and effective dates.

Policyholder

Person who owns and is listed in the policy.

Proof of loss

Formal statement made by an insured demonstrating that a loss occurred.

Property damage coverage

Coverage for destruction to another person’s property as a result of an accident for which you are responsible.

Punitive/Exemplary damages

Damages awarded by the courts that are intended to punish the wrongdoer. This form of damages is generally not covered by a liability policy, and the wrongdoer is typically financially responsible.

Q

R

Real property

Anything permanently attached to or part of the land, such as buildings or trees.

Reinspection

Repeat inspection to view repairs to a vehicle or home.

Rental reimbursement coverage

Helps to pay the cost of a rental vehicle if your car is out of service due to a covered loss.

Repair Assistance Program (RAP)

An optional program for our customers who would like to use our pre-screened, high-quality participating repair shops.

Replacement cost

Total cost to repair or replace an insured item.

Replacement cost coverage

Additional coverage you can purchase for a home insurance policy that pays for the full cost to repair an item or to buy a new one.

S

Salvage

Damaged property that an insurance company obtains as part of a loss settlement.

Scheduled item

Items specifically listed on a policy that have individual insurance limits. These items are usually highly valued items, such as jewelry, furs, etc.

Special limits

Specified limit of coverage for an item or group of items. This usually applies to jewelry, cash, computers or silver.

Subrogation (also known as payment recovery)

Process of seeking financial reimbursement from the responsible party for a loss.

Summons and complaint

Lawsuit documents that inform an individual(s) that he or she is being sued and outlines the allegations and the damages being sought.

Supplement

Estimate or payment for additional damages.

T

Third party

Individual who is not listed or covered on a policy.

Tort

Wrongful act, whether intentional or accidental, that results in an injury to another.

Tort feasor

Person who commits a wrongful act leading to legal liability.

Total loss

Damaged property that cannot be repaired safely or the cost to repair the property exceeds its value.

Towing and Labor

Optional coverage for reimbursement of a tow due to mechanical breakdown.

U

Umbrella policy

Extra layer of insurance protection that covers you beyond the limits of your auto, home and marine policies.

Uninsured/Underinsured motorist coverage

Coverage for injury-related expenses that you are legally entitled to recover from the owner or operator of an uninsured or underinsured motor vehicle.

V

Vandalism

Act of deliberately causing damage or destruction to public or private property.

Vehicle Identification Number (VIN)

17-digit alphanumeric code used to identify vehicles manufactured in the United States.

Vehicle recall

Occurs when a manufacturer determines that a specific vehicle model has a safety-related defect.

W

Waiver

Document signed by a business or person that relinquishes rights or responsibility.

Warranty

Written guarantee by a manufacturer.

X

Y

Z