Glossary of Insurance Terms
To help you better understand the many terms you will find in our professional liability insurance policies, documents and resources, below is a glossary of insurance terms every healthcare professional should know.
Advertising Injury: Injury arising out of oral or written publication of material that slanders or libels an entity or disparages an entity's goods, products, or services; violates an entity's right of privacy; misappropriation of advertising ideas or style of doing business; and infringement of copyright, title, or slogan.
Aggregate: An aggregate is a total. The total amount of liability for all claims in one policy year shall not exceed the limit of liability as stated on your certificate of insurance.
A.M. Best: A.M. Best Co., The Insurance Information Source, offers comprehensive data to insurance professionals. Founded in 1899 by Alfred M. Best, A.M. Best is the world's oldest and most authoritative source of insurance company ratings and information. Its Best's Ratings are the industry's standard measure of insurer financial performance.
Assault: Any willful attempt to inflict physical harm on you by another which results in injury or damage.
Cancer: A disease manifested by the presence of a malignant tumor. This tumor must be characterized by the uncontrolled growth and spread of malignant cells, the invasion of tissue, or leukemia.
Claim: A demand for money or services; also the filing of a suit or the starting of arbitration proceedings naming you and alleging injury or damage.
Claim Expenses: Fees charged by an attorney we designate; all other fees, costs, and expenses, including interest on that part of any judgment that does not exceed the limit of your coverage, which result from the investigation, adjustment, defense and appeal of a claim.
Claims-Made Policy: Policy type that covers the named insured for claims made and reported to the insurance company while the policy remains in force.
Complaint: Official documentation required by an entity responsible for regulating your professional conduct to trigger an investigation of you for a medical incident covered by this policy.
Covered Expenses: Only expenses for travel, food, lodging, and wage loss incurred by you for your required attendance at a disciplinary hearing or proceeding.
Damage: Physical injury to tangible property, including all resulting loss of use of that property; or loss of use of tangible property that is not physically injured.
Dependent: Lawful spouse, and/or Unmarried children whom you support and who are:
- At least 15 days of age, but under age 19; or
- Full-time students between the ages of 19 and 25.
- Loss of Sight means total loss of sight which cannot be restored by surgical or other means.
- Loss of Hand means that a hand is permanently severed at or above the wrist.
- Loss of Foot means that a foot is permanently severed at or above the ankle.
Eligible Survivor: Your lawful spouse if living on the date a benefit payment is due. If the spouse is not living, the term means your dependent children.
Illness Period: Starts when you incur covered expenses while the Policy is in force. If you go 45 days without incurring such expenses, we will consider treatment after that date as starting a new Illness Period.
Injury: Bodily injury, sickness, disease, mental or emotional distress sustained by a person, or death resulting from such injury.
Liability Risk: Liability loss or exposure where negligent acts may occur for which an individual or organization may be held responsible. The act must be injury to or property damage of Others. This coverage is also known as "third party insurance".
Limits of Liability: The maximum amount of coverage agreed upon in the insurance contract that the company would pay in the event of a loss.
Locum Tenens: A healthcare provider who is serving as a temporary relief or substitute.
Medical Incident: Any act, error or omission in your providing or failure to provide professional services, including your responsibility for anyone acting under your direction or control.
Negligence: The failure to exercise the proper degree of care required by a prudent person.
Occurrence Policy: Type of policy which will cover the named insured for bodily injury or property damage to others which occurs during the policy period, regardless of when the claim is actually reported as long as the policy was in force at the time of the bodily injury or property damage.
Personal Injury: Injury arising out of testimony given at or arising out of inquests; malicious prosecution; false arrest, detention, imprisonment, wrongful entry or eviction or other invasion of the right of private occupancy; libel, slander or other disparaging materials; a violation of an individual's right to privacy; assault, battery, mental anguish, mental shock or humiliation; advertising injury.
Personal Property: Property other than buildings and their appurtenances, consisting of furniture, fixtures, machinery and equipment not permanently installed, all other personal property owned by you and used in your practice, and merchandise held in storage for sale, raw materials and in process or finished goods, including supplies used in their packing or shipping.
Premises: The location described on the certificate of insurance; any additional premises used for professional purposes, for which you have given notice to us, not less than 30 days after such premises is to become insured under the policy.
Professional Services: Those services for which you are licensed, trained, and qualified to perform in your capacity as a healthcare provider in the professions shown on the Certificate of Insurance. Also, your services while acting as a member of a formal accreditation, standards of review, or similar professional board or committee, including the directives of such board or committee.
Terminal Illness: A medical condition which is expected to result in the insured person's death within 6 months; and from which the insured person is not expected to recover.
Total Disability (as defined by U.S. Life's Income Protection Plan administered by Healthcare Providers Service Organization): During the waiting period and the next 24 months, the complete inability of the person to perform the material duties of his regular occupation; "his regular occupation" is that which the person was performing on the day before total disability began.
Underwriting: The selection and classification of profitable insureds through a clearly stated company policy consistent with company objectives.
Waiting Period: A period of consecutive days of total disability for which no benefit is payable. The duration of the waiting period is shown in the Schedule of Benefits. The waiting period begins on the first day of the total disability occurring after the effective date of a person's insurance.
Workplace: Any location used for professional purposes.