Glossary of Terms

Claim

A Claim is a suit or proceedings served upon or issued against the Insured or oral or written allegation communicated to the Insured.              

Claims-Made Policy

A policy that, covers claims that are made against an insured and reported to the insurer during the policy period for coverage to apply subject to the retroactive date.

Cancellation

The provision contained in the Policy that allows the insured to cancel on a short rate basis (table normally contained within the policy), and the insurer to cancel on a pro rata basis. A certain amounts of days notice is required.

Consent of the Insured

A policy provision that requires and insured’s consent before the insurer is allowed to settle a claim. Since a settlement can effect the reputation and earning ability of the insured, this type of clause is an important consideration in selecting a policy

Contractual Cover

A policy that contains the terms, conditions, exclusions, limits of liability and premium.

Discretionary Cover

Cover that does not necessarily have terms and conditions and cover will be granted by a committee.

Excess

An amount the Insured must pay prior to insurers paying out for a claim. Insurers are not liable for this excess. The excess is stated on the Schedule of the Policy.

Extended reporting Coverage

Good Samaritan Act

Treatment administered at the scene of a medical emergency, accident or disaster by an Insured when present either by chance or in response to an emergency call following an accident or a disaster.

Insurer

An insurance carrier that is rated and licensed and authorised to do business.

Insuring Clause

The portion of the insurance policy in which the insurer promises to make payment to or on behalf of the Insured. The insuring agreement is normally contained  in a coverage form from which a policy is constructed. Often, insuring agreements outline a broad scope of coverages, which is then narrowed by definitions and exclusions.

Limit of Liability

An insurance contract provision limiting the maximum liability of the insurer in a given time period – if limited to 12 months it is normally described  as the annual aggregate.

Law and Jurisdiction

This limits which law will govern the policy and is normally stated in the Schedule of the policy.

Medical Malpractice

A term used that outlines the type of professional coverage afforded within the Insuring Clause. It covers the Insured’s liability for death, bodily injury, mental injury, illness or disease of or to any patient of the Insured caused by any act, error or omission committed by the Insured which is or is alleged to be negligent and which arises from the provision of Professional Services on or after the Retroactive Date

Mutual

Not an insurance carrier therefore not financial rated nor is it governed by the FCA

Occurrence

A policy that covers an event from the moment treatment occurs, regardless of when an eventual claim is made.

Policy

The contract between, an insurer and its insured. The policy defines what the company agrees to cover for what period of time and describes the obligations and responsibilities of the insured.

Policy Period

This limits the timeframe of the Policy and is found on the Schedule. Typically this is 12 months.

Premium

The amount of money the insured pays for the policy.

Professional Services

The definition within the policy, that reflects the bona fide practice declared by the insured in the proposal for insurance.

Retroactive Coverage (Prior Acts)

Under a claim made policy, the coverage provides insurance for claims arising from incidents that occurred while a previous claim made policy or policies were in effect, but were not known or reported by the insured until that policy had expired.

Retroactive Date

It is a specified date that is found on the schedule of the policy that eliminates coverage for any work undertaken prior to this date by the insured from which any incident or claim arises post this date.

Schedule

The front page of a policy, that specifies the name of the insured, business, policy period, policy limit of liability and other key information that varies from insured to insured.

Territorial Limits

This will limit the cover as to where the insured can work in the world as is normally specified in the Schedule of the Policy.