21+ Useful Insurance Terms You Should Know

INSURED - A person or a corporation who contracts for an insurance policy that indemnifies (protects) him against loss or damage to property or, in the case of a liability policy, defend him against a claim from a third party.

NAMED INSURED - Any person, firm or corporation specifically designated by name as an insured(s) in a policy as distinguished from others who, though unnamed, are protected under some circumstances. For example, a common application of this latter principle is in auto liability policies wherein by a definition of "insured", coverage is extended to other drivers using the car with the permission of the named insured. Other parties can also be afforded protection of an insurance policy by being named an "additional insured" in the policy or endorsement.

ADDITIONAL INSURED - An individual or entity that is not automatically included as an insured under the policy of another, but for whom the named insureds policy provides a certain degree of protection. An endorsement is typically required to effect additional insured status. The named insureds impetus for providing additional insured status to others may be a desire to protect the other party because of a close relationship with that party (e.g., employees or members of an insured club) or to comply with a contractual agreement requiring the named insured to do so (e.g., customers or owners of property leased by the named insured).

CO-INSURANCE - The sharing of one insurance policy or risk between two or more insurance companies. This usually entails each insurer paying directly to the insured their respective share of the loss. Co-insurance can also be the arrangement by which the insured, in consideration of a reduced rate, agrees to carry an amount of insurance equal to a percentage of the total value of the property insured. An example is if you have guaranteed to carry insurance up to 80% or 90% of the value of your building and/or contents, whatever the case may be. If you don't, the company pays claims only in proportion to the amount of coverage you do carry.

The following equation is used to determine what amount may be collected for partial loss:

Amount of Insurance Carried x Loss

Amount of Insurance that = Payment

Should be Carried

Example A Mr. Right has an 80% co-insurance clause and the following situation:

$100,000 building value

$ 80,000 insurance carried

$ 10,000 building loss

By applying the equation for determining payment for partial loss, the following amount may be collected:

$80,000 x $10,000 = $10,000

$80,000

Mr. Right recovers the full amount of his loss because he carried the coverage specified in his co-insurance clause.

Example B Mr. Wrong has an 80% co-insurance clause and the following situation:

$100,000 building value

$ 70,000 insurance carried

$ 10,000 building loss

By applying the equation for determining payment for partial loss, the following amount may be collected:

$70,000 x $10,000 = $8,750

$80,000

Mr. Wrong's loss of $10,000 is greater than the company's limit of liability under his co-insurance clause. Therefore, Mr. Wrong becomes a self-insurer for the balance of the loss-- $1,250.

PREMIUM - The amount of money paid by an insured to an insurer for insurance coverage.

DEDUCTIBLE - The first dollar amount of a loss for which the insured is responsible before benefits are paid by the insurer; similar to a self-insured retention (SIR). The insurer's liability begins when the deductible is exhausted.

SELF INSURED RETENTION - Acts the same way as a deductible but the insured is responsible for all legal fees incurred in relation to the amount of the SIR.

POLICY LIMIT - The maximum monetary amount an insurance company is responsible for to the insured under its policy of insurance.

FIRST PARTY INSURANCE - Insurance that applies to coverage for an insureds own property or a person. Traditionally it covers damage to insureds property from whatever causes are covered in the policy. It is property insurance coverage. An example of first party insurance is BUILDERS RISK INSURANCE which is insurance against loss to the rigs or vessels in the course of their construction. It only involves the insurance company and the owner of the rig and/or the contractor who has a financial interest in the rig.

THIRD PARTY INSURANCE - Liability insurance covering the negligent acts of the insured against claims from a third party (i.e., not the insured or the insurance company - a third party to the insurance policy). An example of this insurance would be SHIP REPAIRER'S LEGAL LIABILITY (SRLL) - provides protection for contractors repairing or altering a customer's vessel at their shipyard, other locations or at sea; also covers the insured while the customer's property is under the "Care, Custody and Control" of the insured. A Commercial General Liability policy is needed for other coverages, such as slip-and-fall situations.

INSURABLE INTEREST - Any interest in something that is the subject of an insurance policy or any legal relationship to that subject that will trigger a certain event causing monetary loss to the insured. Example of insurable interest - ownership of a piece of property or an interest in that piece of property, e.g., a shipyard constructing a rig or vessel. (See BUILDERS RISK above)

LIABILITY INSURANCE - Insurance coverage that protects an insured against claims made by third parties for damage to their property or person. These losses usually come about as a result of negligence of the insured. In marine construction this policy is referred to an MGL, marine general liability policy. In non marine circumstances the policy is referred to as a CGL, commercial general liability policy. Insurance policies can be divided into two broad categories:

    First party insurance covers the property of the person who purchases the insurance policy. For example, a home owner's policy promising to pay for fire damage to the home owner's home is a first party policy. Liability insurance, sometimes called third party insurance, covers the policy holder's liability to other people. For example, a homeowners' policy might cover liability if someone trips and falls on the home owner's property. Sometimes one policy, such as in these examples, may have both first and third party coverage.
    Liability insurance provides two separate benefits. First, the policy will cover the damage incurred by the third party. Sometimes this is called providing "indemnity" for the loss. Second, most liability policies provide a duty to defend. The duty to defend requires the insurance company to pay for lawyers, expert witnesses, and court costs to defend the third party's claim. These costs can sometimes be substantial and should not be ignored when facing a liability claim.

UMBRELLA LIABILITY COVERAGE - This type of liability insurance provides excess liability protection. Your business needs this coverage for the following three reasons:

    It provides excess coverage over the "underlying" liability insurance you carry.
    It provides coverage for all other liability exposures, excepting a few specifically excluded exposures. This subject to a large deductible of about $10,000 to $25,000.
    It provides automatic replacement coverage for underlying policies that have been reduced or exhausted by loss.

NEGLIGENCE - The failure to use reasonable care. The doing of something which a reasonably prudent person would not do, or the failure to do something which a reasonably prudent person would do under like circumstances. Negligence is a 'legal cause' of damage if it directly and in natural and continuous sequence produces or contributes substantially to producing such damage, so it can reasonably be said that if not for the negligence, the loss, injury or damage would not have occurred.

GROSS NEGLIGENCE - A carelessness and reckless disregard for the safety or lives of others, which is so great it appears to be almost a conscious violation of other people's rights to safety. It is more than simple negligence, but it is just short of being willful misconduct. If gross negligence is found by the trier of fact (judge or jury), it can result in the award of punitive damages on top of general and special damages, in certain jurisdictions.

WILLFUL MISCONDUCT - An intentional action with knowledge of its potential to cause serious injury or with a reckless disregard for the consequences of such act.

PRODUCT LIABILITY - Liability which results when a product is negligently manufactured and sent into the stream of commence. A liability that arises from the failure of a manufacturer to properly manufacture, test or warn about a manufactured object.

MANUFACTURING DEFECTS - When the product departs from its intended design, even if all possible care was exercised.

DESIGN DEFECTS - When the foreseeable risks of harm posed by the product could have been reduced or avoided by the adoption of a reasonable alternative design, and failure to use the alternative design renders the product not reasonably safe.

INADEQUATE INSTRUCTIONS OR WARNINGS DEFECTS - When the foreseeable risks of harm posed by the product could have been reduced or avoided by reasonable instructions or warnings, and their omission renders the product not reasonably safe.

PROFESSIONAL LIABILITY INSURANCE - Liability insurance to indemnify professionals, (doctors, lawyers, architects, engineers, etc.,) for loss or expense which the insured professional shall become legally obliged to pay as damages arising out of any professional negligent act, error or omission in rendering or failing to render professional services by the insured. Same as malpractice insurance.

Professional Liability has expanded over the years to include those occupations in which special knowledge, skills and close client relationships are paramount. More and more occupations are considered professional occupations, as the trend in business continues to grow from a manufacturing-based economy to a service-oriented economy. Coupled with the litigious nature of our society, the companies and staff in the service economy are subject to greater exposure to malpractice claims than ever before.

ERRORS AND OMISSIONS - Same as malpractice or professional liability insurance.

HOLD HARMLESS AGREEMENT - A contractual arrangement whereby one party assumes the liability inherent in the situation, thereby relieving the other party of responsibility. For example, a lease of premises may provide that the lessee must "hold harmless" the lessor for any liability from accidents arising out of the premises.

INDEMNIFY - To restore the victim of a loss, in whole or in part, by payment, repair, or replacement.

INDEMNITY AGREEMENTS - Contract clauses that identify who is to be responsible if liabilities arise and often transfer one party's liability for his or her wrongful acts to the other party.

WARRANTY - An agreement between a buyer and a seller of goods or services detailing the conditions under which the seller will make repairs or fix problems without cost to the buyer.

Warranties can be either expressed or implied. An EXPRESS WARRANTY is a guarantee made by the seller of the goods which expressly states one of the conditions attached to the sale e.g.,"This item is guaranteed against defects in construction for one year".

An IMPLIED WARRANTY is usual in common law jurisdictions and attached to the sale of goods by operation of law made on behalf of the manufacturer. These warranties are not usually in writing. Common implied warranties are a warranty of fitness for use (implied by law that if a seller knows the particular purpose for which the item is purchased certain guarantees are implied) and a warranty of merchantability (a warranty implied by law that the goods are reasonably fit for the general purpose for which they are sold).

DAMAGES OR LOSS - The monetary consequence which results from injury to a thing or a person.

CONSEQUENTIAL DAMAGES - As opposed to direct loss or damage -- is indirect loss or damage resulting from loss or damage caused by a covered peril, such as fire or windstorm. In the case of loss caused where windstorm is a covered peril, if a tree is blown down and cuts electricity used to power a freezer and the food in the freezer spoils, if the insurance policy extends coverage for consequential loss or damage then the food spoilage would be a covered loss. Business Interruption insurance, extends consequential loss or damage coverage for such items as extra expenses, rental value, profits and commissions, etc.

LIQUIDATED DAMAGES - Are a payment agreed to by the parties of a contract to satisfy portions of the agreement which were not performed. In some cases liquidated damages may be the forfeiture of a deposit or a down payment, or liquidated damages may be a percentage of the value of the contract, based on the percentage of work uncompleted. Liquidated damages are often paid in lieu of a lawsuit, although court action may be required in many cases where liquidated damages are sought. Liquidated damages, as opposed to a penalty, are sometimes paid when there is uncertainty as to the actual monetary loss involved. The payment of liquidated damages relieves the party in breech of a contract of the obligation to perform the balance of the contract.

SUBROGATION - "To stand in the place of" Usually found in property policies (first party) when an insurance company pays a loss to an insured or damaged to the insureds property, the insurer stands in the shoes of the insured and may pursue any third party who might be responsible for the loss. For example, if a defective component is sold to a manufacturer to be used in his product and that product is damaged due to the defective component. The insurance company who pays the loss to the manufacturer of the product may sue the manufacturer of the defective component.

Subrogation has a number of sub-principles namely:

•     The insurer cannot be subrogated to the insureds right of action until it has paid the insured and made good the loss.
•     The insurer can be subrogated only to actions which the insured would have brought himself.
•     The insured must not prejudice the insurer's right of subrogation. Thus, the insured may not compromise or renounce any right of action he has against the third party if by doing so he could diminish the insurer's right of recovery.
•     Subrogation against the insurer. Just as the insured cannot profit from his loss the insurer may not make a profit from the subrogation rights. The insurer is only entitled to recover the exact amount they paid as indemnity, and nothing more. If they recover more, the balance should be given to the insured.
•     Subrogation gives the insurer the right of salvage.

In its history of providing insurance services to its clients for over thirty years, Nausch Hogan & Murray has provided coverage for all areas of liability - both on land and at sea.

Over the years Nausch Hogan & Murray [http://www.nhmurray.com/home.html] has found it helpful to draft a glossary of useful insurance terms that come up time and again in discussions with an insured concerning their coverage needs. We hope these help you as well.



By: Carmen A. Russo

How Some Life Insurance Policies Fail and Leave Grieving Families to Struggle Financially

Many people own life insurance, but let's face it. It's probably not a purchase that most people brag about to their friends like they might if they had just purchased a new Corvette, but they made the purchase anyway because they love their families and want their family to carry on living their current lifestyle in the event of the primary breadwinner's untimely death. While this article doesn't apply to people who own term insurance, those who bought permanent life insurance, which is life insurance with an additional savings component, will find this information very important.

To understand the problem, I will first give you a brief primer on life insurance, and then explain how something that seems like a sure bet can go so wrong. Life insurance can be separated in to two basic types, term and permanent life insurance. With term insurance a person pays a certain amount of money, called a premium, for a period of time, from one year up to 30 years. During the specified period of time, as long as the insured person is paying the premium, the insurance company is obligated to pay a certain amount of money, called a death benefit, to the insured person's beneficiary in the event the insured person dies during that time period. If the person does not die in that time period the insurance company keeps the money as well as the earnings on that money. While there are different types of term insurance nowadays, including "return of premium" term which returns the insureds premium dollars at the end of the term(but not the earnings on the money), the general jist of term insurance is that a person is covered during a certain period of time. If they want coverage beyond that time period they have to buy another policy. Term insurance is really not the focus of this article so if that's what you have you can stop reading now if you wish, and rest assured that as long as you pay the premium, and the insurance company remains financially solvent, your family will be paid in the event of your untimely death.

The other type insurance is called permanent insurance. Permanent insurance is insurance that has a death benefit to it, similar to term, but also contains a savings "sidecar", this gives the policy a value called cash value. The premiums are paid on the policy, a portion is pulled to pay for the insurance and the remainder goes into the savings sidecar. There are three primary types of permanent insurance that vary depending on what is done with the savings component. The first type of permanent insurance is Whole Life Insurance. The savings component of Whole Life Insurance is invested in the general fund of the insurance company where it earns interest. The amount of interest apportioned to a particular individual is depended on how much of the money in the general fund belongs to that individual. Some policies if they are are "participating" policies also earn dividends. Generally speaking whole life policies are not a lapse danger as the amounts that it earns are guaranteed by the insurance company. As long as the insurance company remains solvent it will pay out a death benefit. The only problems a person who owns a Whole Life policy typically runs into is overpaying for insurance, and the death benefit not keeping pace with inflation.

The second type of permanent insurance is called Universal Life Insurance. With Universal Life Insurance the savings sidecar is a separate account, as opposed to Whole Life where the savings sidecar is invested into the general fund of the insurance company. Universal Life Insurance's main advantage is it's flexibility. For example, if you are a landscaper in the northeastern part of the country and basically have your winter months off, you could buy a Universal Life policy, fund it heavily during the spring, summer, and fall when you're raking in the big bucks, and then not pay anything during the winter months. As long as there is a certain amount of money in the savings sidecar (based on insurance company formulas), nothing needs to be done. Also, if you need additional insurance because you just had a child, you don't need to buy another policy. As long as you are insurable you can increase the death benefit on your current Universal Life Insurance policy and pay the extra premium. The money in the savings sidecar of a Universal Life Insurance policy is typically invested in ten year bonds. The Universal Life policy has a guaranteed interest rate to it, as well as a current rate. The money in the sidecar typically earns the slightly higher current rate, but the policy owner is only guranateed the guaranteed amount. Keep this last thought in your mind because after I describe Variable Insurance in the next paragraph, I'm going to tie these two together in the following paragraph and that final concept is the thing that's going wrong

The final type of permanent life insurance is Variable Life Insurance. It can be either straight Variable Life Insurance, or Variable Universal Life Insurance, which combines the versatility of Universal with Variable Life Insurance. Variable Insurance came about due to the awesome bull market in stocks that ran basically uninterrupted from 1982 through 2000. People wanted to invest as much as possible in the stock market and the thought of investing money in an insurance policy that invested in lower yielding bonds was quite distasteful to many. So the Variable Insurance Policy was built. With Variable Life the savings sidecar can be invested in insurance "sub-accounts" which are basically mutual funds within a Variable Life, or Variable Annuity. In fact, many sub-accounts exactly mirror a particular mutual fund, some mutual fund managers manage both their respective fund as well as its sub-account "sister." So with the Variable Life policy buying insurance no longer meant leaving the high flying stock market, you could have the best of both worlds by protecting your family AND investing in the stock market. As long as the savings in the sidecar was at an adequate level things were fine. Again, remember this last line because I'm about to show you how the whole thing goes to pot.

In the heyday of Universal Life Insurance and Variable Life Insurance interest rates were high and so was the stock market, and the insurance industry had two products that were custom designed to take advantage of the times. The problem came about when the agents designing these policies for the public assumed that the high interest rates and high flying stock market would never end. You see, whenever these products are sold, several assumptions have to be made outside of the guaranteed aspect of the policies which is typically about 3-5%, depending on the insurance company. The current values are paid out based on the prevailing rates or returns of the time, and that's exactly how the policies were designed. I can still remember when I began in the insurance industry back in 1994, when the experienced agents in my office were were writing Universal Life with a hypothetical 10-15% interest rate. Variable Universal would be written anywhere between 10-20%. Happy days were here to stay. Or were they? Unfortunately, those interest rates started heading south about the mid-1990s, and as we all know, except for a couple of years, the stock market didn't do so swell after the 2000 tech bubble, maybe two or three "up" years out of eight and possibly nine. This is a real problem because many families' futures were riding on the assumptions that were made in these policies. Many policyowners were told to pay during their working years and then to quit when they retired and the policy would be fine, the returns earned on the savings sidecar would keep the policy in force. There are countless Universal and Variable Life policies in bank and corporate trust accounts, as well as in dresser drawers and fire proof safes that were bought and assumed that as long as the premiums were paid, things were good to go. Many of these policies are sick or dying as we speak. Some people, or trustees will get a notice letting them know that they need to add more money or the policy will lapse, of course by this time "red line" has already been reached. The people who get this notice may even ignore it because hey, the agent said that all would be well, "pay for 20 years and the family will be taken care of when I meet my maker." So the policy will lapse and nobody will know it till it comes time for the family to collect their money, only to find out that they will meet the same fate as Old Mother Hubbard's Dog. If anybody reading this can picture the litigation attorneys licking their chops, waiting to let insurance agents and trustees have it with both barrels for negligence, don't worry that onslaught has already begun. But if you have one of these policies, don't count on the 50/50 prospect of winning a court case, do something about it!

One of the first things I do when I get a new client that has an existing permanent life insurance policy is do an "audit" of that policy. Just like the IRS does an audit to find out where the money went, I do an audit to find out where the premiums went. The way this is done is by ordering what is called an "In Force Ledger" on the policy from the insurance company. The In Force Ledger will show the status of the policy now under current conditions, as well as several other scenarios paying more or less money. It will also show if the policy is lapsed or will lapse in the future. By doing this audit the policyholder may get something that they didn't have before, OPTIONS!

For example, take a 50 year old policyowner, who is also the insured on the policy, and the In Force Ledger showed that the policy, under current condtions is going to lapse when the policyowner is 63 assuming premium payments were going to be kept the same, and stock market conditions were going to stay the same (this was in early 2007 and this policy was a Variable Universal Life, it probably would not have lasted till 63, given what has happened in the stock market.) Since the policyowner is the family breadwinner, they have a 16 year old daughter, and their savings could not sustain the wife and daughter in the event of an early death of the breadwinner, whether or not to keep the life insurance is not even a question, life insurance is absolutely needed in this case. Now the next question is, does he keep on paying on a policy that is going to lapse or write a new one? For that I go to some business associates at an insurance brokerage I work with, and find out how we can get a new policy without a huge increase in premium, in some cases the it is possible to get an increase in death benefit and a decrease in premium. How can this be done since the policyholder is older than when the policy is written? Easy. With the advances in medicine between 1980 and 2000 (the years the mortality tables used were written), people are living longer, conditions that used to cause death such as cancer, people are surviving and even live normal lives after the cancer is eliminated. It used to be you either smoked or you didn't. Now allowances are made for heavy smokers, social smokers, snuff users, cigar smokers etc. One company will even allow mild cannabis use. So in some cases your policy may not be lapsing, but a person may be overpaying even though they are older. Maybe they smoked socially then, but quit 5 years ago, but their policy still has them listed as a smoker paying the same premium as someone that smoked like a chimney. What happens if the solution that makes the most sense is a new policy? We do what is called a 1035 Exchange into a new policy, that allows the cash value of the current policy to be transferred to the new one without being taxed. What if the insured doesn't want another life insurance policy but wants to get out of the one they are currently in and not pay taxes? Then we do a 1035 Exchange to an annuity, either variable or fixed. I'm currently using a no-load annuity that works great and the expenses are low. Is a 1035 Exchange right in every situation? Absolutely NOT! Many things must be explored before making the exchange, especially on a policy written before 1988 when the tax law on insurance policies changed for the worse, in the above example it proved to be the correct move, but in the end it's up to the policyowner and family as to what direction to go.

In conclusion, if you have a permanent life insurance policy that is 5 years old or older, make sure you have it audited. The cost (nothing), versus the benefit (a family that doesn't have financial worries in their time of grief) makes this decision a no-brainer.



As usual, if you have any questions about the matters discussed in this paper, feel free to write me at chalas@venn.us.


Christian Halas is owner and wealth manager with Halas Consulting located in Pittsburgh, PA. Halas Consulting prides itself in providing unique and objective solutions to various insurance, investment, banking, tax, and estate issues faced by individuals and small businesses. Investment services provided in conjuction with Venn Wealth and Benefit Services, a PA Registered Investment Advisor. Christian can be reached via email at chalas@venn.us with any questions or comments on this article



By: Christian Halas