A Ab initio A term used to describe avoidance of a contract from its inception or its beginning. The Insurance Contracts Act allows an insurer to avoid a policy ab initio in situations where an insured fraudulently non-disclosed or fraudulently misrepresented information when applying for insurance.
Accident An unplanned and unexpected event which occurs suddenly and at a definite place.
Accident cover Provides benefits in the event of an accident occurring during the period of cover. Usually refers to insurance covering injury or death arising out of violent, accidental, external and visible means.
Act of God An event or occurrence due to natural causes which occurs independently of human intervention and either could not be foreseen, or if foreseen, could not be reasonably guarded against. (e.g. storm, flood, earthquake, cyclone)
Actual total loss Where the property insured is completely destroyed or so badly damaged that it ceases to be a thing of the kind insured, or where the insured is irretrievably deprived of it. Also called “constructive total loss”.
Adjuster Also known as an assessor is a representative of the insurer who seeks to determine the extent of the company’s liability for loss when a claim is submitted.
Advice (in relation to Financial Services) A statement made which influences, or is intended to influence, a person to purchase a particular financial product or service. Advice can be personal or general:
Personal advice is advice which takes one or more of a person’s individual circumstances into account.
General advice is advice which is not personal—i.e. does not fulfil this individual circumstances test.
Agent A person holding an agency agreement with an insurer and who, for reward, carries on the business of arranging contracts of insurance as agent for one or more insurers. Such an agent is referred to as an Authorised Representative.
Aggrieved party A party who has been wronged. A person who is a victim is said to be aggrieved.
Agreed Value (Usually associated with motor vehicle insurance) A car’s agreed value is set at the beginning of each period of cover. It is based on the fair value given then for the cars make and model in the motor trade’s most commonly accepted price handbook. The value doesn’t change for the period of cover.
Amount covered The current amount covered is shown on the most recent of the insurance schedule and the renewal notice. It is the most the insurer will pay, less any excess, for a claim that is covered by the policy. The amount covered includes GST.
Arbitration A system of deciding legal disputes between an insured and an insurer by use of a private tribunal outside of the court system.
Arson Any unlawful setting fire to property.
Australian Financial Services Licensee A person who holds an Australian Financial Services licence.
B Binder An authority given by an insurer to an intermediary to enter into, as agent for the insurer, contracts of insurance on behalf of the insurer. Some binders give an intermediary authority to deal with and settle claims against the insurer, as agent for the insurer.
Broadform A form of liability wording that extends the cover for personal injury beyond physical injury, disease or death to include other causes including mental injury or anguish, fright, false arrest, malicious prosecution, libel, slander, defamation, wrongful entry, eviction or other invasion of the right of private property, assault and battery which occurs during the period of the policy.
Broker An intermediary, who acts on behalf of a person who is applying for insurance. They earn a commission from the insurer; however, they have a responsibility to obtain cover appropriate to the needs of the insured. In certain circumstances a broker can also act as an agent for the insurer in terms of issuing a policy or collecting a premium.
Burglary Theft following forcible and violent entry to the premises. Note: this term may not apply for some states of Australia.
Business pack A number of policies typically required by a business are combined into one policy or package—e.g. fire damage to property, burglary, liability, etc. Business packs are sometimes tailored to cover the risks of a particular industry or business—e.g. motor dealers, builders, etc.
C Cancellation The termination of a policy before the expiry date.
Captive insurance company An insurance company that is wholly owned by one or more entities, the main purpose of which is to insure the risks of its parent companies. Several large Australian companies and organisations have their own captive insurers.
Catastrophe reinsurance A form of reinsurance whereby the reinsured is protected against an accumulation of losses from the same event—e.g. a cyclone.
Caveat emptor Let the buyer beware. Insurance contracts are NOT Caveat emptor (buyer beware) contracts. They are Uberrima Fidei Utmost Good Faith) contracts.
Cedant An insurer who transfers all or part of a risk to a reinsurer.
Cede To transfer risk from an insurer to a reinsurer. A ‘cession’ is a particular reinsurance transaction. Normally, this refers to the proportional insurance of a risk.
Ceding insurer The original insurer. It is the company which deals with the client, and reinsures part or all of the risk.
Certificate of Insurance A certificate that acts as proof that a policy has been issued.
Cession The portion of the sum insured of a risk ceded to a reinsurer. A Cession is a particular reinsurance transaction.
Claim Notification by or on behalf of a claimant that an event likely to be covered by a policy has occurred, or is likely to occur, and giving formal notice to the insurer accordingly. Usually a claim will be accompanied by a request for indemnification under the policy.
Claimant The party asserting a right of recovery under a contract of insurance.
Claims history The history of losses suffered by an insured which have been covered by insurance. Some claims histories also record events notified to the insurer which did not result in actual claims pay-outs—e.g. events below the policy excess.
Claims Ratio The ratio of the cost of claims to earned premiums.
Closing The document sent by a broker to an insurer confirming and finalising an insurance cover arranged by the broker.
Code Of Practice (General) The Insurance Council of Australia, as a response to the needs of the insurance industry and with the assistance of the Insurance Enquiries and Complaints Ltd. (IEC), developed the General Insurance Code of Practice (“the Code”). The Code is a self-regulatory form of regulation, that is, the insurance industry, not the government, is responsible for making it work. The overall aim of the Code is to raise service standards across the general insurance industry. It applies across the insurance industry to insurance companies, their employees, agents, investigators, assessors, loss adjusters and collection agents.
Co-insurance (average) An insured who has a sum insured which does not represent the full value of the insured property may be their own co-insurer and, therefore, sharing in the risk with the insurer. This can result in a reduced claim.
Collection or Set A group of items of sufficiently common type, appearance or nature that they reasonably belong together and that is devalued if one or more of the group is lost or damaged.
Commission A fee charged by a broker or agent for services in the sale of an insurance contract.
Common Law The principles of law arising from court decisions.
Comprehensive Insurance (Usually associated with motor vehicle insurance) Provides specified cover for damage to insured car as well as damage the insured car may cause to the property of others.
Compulsory insurance Insurance arranged in order to comply with the law—e.g. workers compensation insurance or compulsory third party insurance. Also referred to as Statutory Insurance.
Condition precedent to liability Conditions which must be fulfilled if the insured’s claim is to be accepted. For example, a claims co-operation condition may require an insured to make its books of account available for inspection should a loss occur.
Conditions precedent to policy Conditions which must be fulfilled in order for a policy to be valid— e.g. the Duty of Disclosure.
Conditions subsequent to policy Conditions which must be fulfilled in order for a policy to continue. An insured may be required to meet certain conditions while the policy is in force—e.g. pay the premium, maintain the premises, have the burglar alarm regularly serviced, etc.
Consequential Loss A loss of property may also result in a “loss of profits” and/or additional expenses. This is a loss which is a consequence of the property loss. Consequential loss insurance is usually referred to as business interruption’ insurance. It is available as an addition to a property policy.
Consideration A simple contract requires consideration to be given by the parties to the contract. The consideration must be worth something. It may be in the form of money, goods or services.
Contra Proferentum Rule The legal rule by which the words of an author are to be construed against the author. Therefore, any ambiguity in an insurer’s proposal form or policy wording will be construed against the insurer. Note that this rule will only be applied where there is a real ambiguity.
Contract An agreement between two or more parties which is enforceable by law.
Contribution Where an insured has two or more insurance policies which are covering the same interest against the same peril, the insured can make his/her claim in full against one or other of the insurers. The chosen insurer can then require the other insurers to make a proportional contribution towards that loss. (Given that the insurance policies are subject to the rule of indemnity, the insured is prevented from recovering from all the insurers and therefore making a profit from his/her claims).
Cooling off period A period of not less than 14 days which must be provided to Retail Clients on Retail products. During this period a client may return the policy and receive a full refund of premium unless a claim has been made.
Cover and covers Means the protection provided by the policy.
Cover note A contract of insurance intended by the insurer to provide temporary insurance cover and which is to be replaced by another contract of insurance. Cover notes are usually issued where further particulars are to be ascertained or where the insured has been requested to comply with additional risk acceptance conditions before a more permanent insurance contract is entered into. Also called an Interim Contract of Insurance under Section 38 of the Insurance Contracts Act.
Coverage The scope of the protection provided under a contract of insurance.
CTP Insurance Compulsory Third Party insurance (CTP Green slip in NSW) is the insurance that is needed when registering a vehicle. CTP insurance is intended for the situation where another person is injured or killed in an accident, which is caused by the driver of the insured vehicle.

Loss or injury suffered by a person, normally calculated in monetary terms.

D Damage Damages Compensation for loss suffered, which is awarded by courts and endeavours to place a person in the position where they would have been had the loss not been suffered.
Decline To refuse. For example, the insurer may decide not to accept a proposal for insurance or perhaps decline to accept a claim.
Deductible The amount of loss that is to be born by the insured prior to being able to claim under a policy. Sometimes called an “excess”.
Defendant Person or entity being sued by the plaintiff.
Deposit premium Amount paid by a client as an initial premium under a policy. The deposit premium is subject to adjustment at the end of the policy period based on, for example, claims experience. After adjustment, the insured receives a refund or is required to pay extra premium, as the case may be.
Depreciation A decrease in the value of any type of property over a period of time resulting from use, wear and tear, or obsolescence.
Direct insurer Is an insurer which deals direct with the consumer rather than through an intermediary or agent.
Direct policy The parties to a direct insurance contract are the insurer and the original insured. The term is used to differentiate the direct policy contract from any reinsurance contract that may be arranged as a result of the direct policy contract.
Disaster A disaster is said to have occurred when the normal community and organisational arrangements cannot cope with a hazard impact.
Disclaimer A person may make a statement to the effect that they will not accept any responsibility for certain things which may (or may not) happen. For example, disclaimers are used to try and avoid or limit a person’s liability for breach of duty of care.
Dispute Resolution Process A system for resolving complaints which an AFS Licence holder is required to have in place as part of their compliance with the Financial Services Reform Act (FSRA)—the FSRA is now part of the Corporations Act. The process consists of an Internal Dispute Resolution system and an External Dispute Resolution system.
Doctrine Of Precedent Reliance by judges on previous judicial decisions when deciding similar cases before them.
Due date The date a policy is in force to and by when a renewal premium must be paid.
Duty of disclosure A requirement under Section 21 of the Insurance Contract Act. The insured has a duty to disclose every matter known to be relevant to the insurer, or that a reasonable person in the circumstances could be expected to know to be relevant to the insurer. The duty applies up until a contract is entered into, and when it is renewed, varied, reinstated or extended. An intending insured must be advised of their duty to disclose material facts.
E Earned Premium Insurance policies usually run for a period of 12 months. An insured can cancel a policy at any time and request a refund of premium. Therefore, insurers must only take into the books of account that portion of premium which corresponds to actual elapsed time on risk. That portion of premium which can be taken up in the accounts is called earned premium. That portion of premium yet to expire is termed unearned premium.
Effective date The date on which the cover of an insurance policy commences.
Eighths system A method of calculating unearned premium, usually under a proportional reinsurance treaty where premium details are provided quarterly. Risks are assumed to attach on average on the middle day of each quarter. Therefore, at the end of a calendar year, 7/8ths of premiums on policies accepted in the first quarter are assumed to be earned, with 1/8th unearned, and so on.
Endorsement Any writing appearing on a policy, or additional documentation attaching to a policy, whereby the printed terms of the policy, the parties to it, or other particulars, are varied.
Event An incident or situation, which occurs in a particular place during a particular interval of time.
Ex gratia payment A payment made by an insurer to a claimant as an act of grace, where no contractual entitlement to the claim exists. The insurer will make an ex gratia payment in order to maintain good will, public relations, or as a matter of social justice or some other non-contractual reason.
Excess An excess on a policy is the first amount that must be contributed by the insured towards each claim. When one or more excesses apply to a policy, they will be shown on the insurance schedule.
Expiry date The date upon which a policy ends. Conventionally, 4.00 pm is the normal time of expiry, although this varies by type of policy and by insurer.
F Facultative reinsurance Reinsurance negotiated and placed on a case-by-case basis, as opposed to the automatic protection provided under a reinsurance treaty. Each facultative reinsurance arrangement is subject to a process of offer and acceptance between the parties.
Fidelity insurance An insurance policy which covers the misappropriation of goods or money by employees.
Financial Ombudsman Service Any policyholder who is dissatisfied with the outcome of his or her dealings with the insurer can contact the Financial Ombudsman Service on 1300 780 808.
Financial Services Guide (FSG) This is a statement that must be given to a Retail Client when, or before, a Financial Service or Financial Product is provided. It contains information about the service provider, who he/she is working on behalf of, remuneration, dispute resolution and other information required by the Financial Services Reform Act (FSRA)—now in the Corporations Act.
First party The first and second parties are simply the parties to an insurance contract. A third party is not a party to the contract but a party who seeks to be compensated for some injury or loss caused by the insured. A first party policy may also refer to insurance for the policyholder’s own property or person.
Flood Means the inundation or covering of normally dry land by water which: escapes or overflows from, or cannot enter, because it is full or has overflowed, or is prevented from entering, because other water has already escaped or been released from it, the normal confines of any watercourse or lake, including any that may have been modified by human intervention, or reservoir, canal, dam or storm water channel. Flood does not mean storm water run off from areas surrounding the site or water escaping from any water main, pipe, street gutter, guttering or surface.
Fortuitous loss An unforseen loss is termed a fortuitous loss. Insurers will only insure fortuitous losses. Whilst an insurer knows that there will be motor accidents, it cannot predict which insureds will suffer a loss.
Franchise A type of excess whereby claims under a certain amount are not paid. However, claims over the franchise amount are paid in full.
Fraud The term “fraud or dishonesty” encompasses all those risks of loss that might arise through dishonest acts or omissions.
Fronting Arrangement The issuance of a policy by one insurer on behalf of a second insurer because the second insurer is not licensed or admitted in the state of jurisdiction for the line of business being written. The first insurer actually issues the policy to the insured and retains legal responsibility for meeting claim payments under it, but is reinsures 100% of its exposure to the second insurer.
G General average (marine During a marine venture, certain cargo may be deliberately sacrificed so that the rest of the cargo may be saved. All those with cargo on board must share in the loss of those whose cargo was sacrificed.
Gross Premium The net premium plus operating expenses, commissions and other expenses.
H Hazard A situation that increases the probability of the happening of loss arising from a peril, or that may influence the extent of the loss. For example, accident, fire, flood, liability, burglary, and explosion are perils. Slippery floors, flammable liquids, unsanitary conditions, unlocked and unguarded premises and poor roads are hazards.
Housekeeping An important risk assessment issue for underwriters, housekeeping concerns an objective assessment of the extent to which an insured maintains the general cleanliness, appearance, utility and up-keep of premises. Poor housekeeping would be evidenced by excessive rubbish, congestion in work areas, deferred maintenance of machines, and general untidiness.
I IBNR Incurred but not reported the liability that an insurer has for losses that have happened but not yet reported as claims.
Implied condition This is a condition that the law reads into a contract but which does not appear in the policy document—e.g. it is implied that the subject matter of the insurance does exist. The duty of utmost good faith is an implied term in all contracts of insurance.
Indemnity insurance Type of insurance that restores the individual as close as possible to the financial position that they enjoyed before the loss.
Indemnity period (applies to Business Interruption Insurance) A term used in Business Interruption insurance. It means the period beginning with the occurrence of damage and ending not later than the number of months specified in the policy schedule during which the results of the business are affected in sequence of the damage. For example, assume damage has occurred on the very last day of the period of insurance. The indemnity period starts from that date and runs until the business is no longer affected, subject of course to the number of months the client selected. If the client selects too short an indemnity period, then the consequences are similar to under-insuring a building. If the business continues to be adversely affected after the nominated indemnity period, the insured will have to carry the losses, as the policy cover has ceased.
Insolvency A situation where a person is unable to pay debts as and when they fall due for payment.
Insolvent A company may not be able to settle debts in full because its assets are worth less than the liabilities that must be paid off.
Insurable interest In order to make a claim under a general insurance contract the claimant must demonstrate that at the time of loss the claimant suffered a pecuniary or economic loss. ‘Pecuniary’ means money. ‘Economic’ is a broader term and includes loss of use. This is what we now mean by an insurable interest. The claimant stands, in relation to the subject matter of insurance, to benefit by its safety or suffer some prejudice by its loss. The interest the claimant has does not need to be an interest recognised in law or in equity.
Insurance A device for transferring specified risks of individual persons to an insurer. The insurer agrees, for consideration (usually payment of a premium), to assume, to a specified extent, certain losses that may be suffered by the insured.
Insurance schedule Sets out the information given to an insurer upon which the decision to offer cover is made. It also displays the individual details of a policy.
Insured The party to an insurance arrangement to whom the insurer agrees to provide cover against specified losses, or to render services, subject to the terms of the insurance contract.
Insured event Occurrences which cause loss and damage which are listed in the relevant policy.
Insurer The party to an insurance arrangement who undertakes to provide cover or to render services, on the happening of specified events.
Interim cover A temporary contract of insurance (usually issued for 14–30 days) to be replaced by a Contract of Insurance (a policy) Refer to section 38 of the Insurance Contracts Act.
Intermediary An agent or broker who assists the public in proposing for insurance.
J Jurisdiction The power given to courts, either by statute or constitutionally, to hear particular matters.
Jurisdiction Clause A clause in a treaty wording defining the laws under which any dispute shall be resolved.
K Knock-for-knock agreement An arrangement between motor insurers whereby each agrees to pay for its own repair costs and will forego subrogation recovery action against the other signatories, irrespective of questions of fault.
L Lapsed policy A policy which has been allowed to expire because of non payment of premiums.
Leading underwriter The insurer who determines the terms and rating applicable to large insurance placements involving participation by several insurers. The lead usually takes the largest share of a risk, with other insurers following the lead.
Letter of Credit A financial instrument obtained from a bank guaranteeing the availability of funds to be collected in the future under a reinsurance contract. Often required in overseas markets where currency restrictions or concerns about reinsurer solvency exist.
Liability Insurance A form of general insurance that provides cover in regard to the insured’s legal obligation for loss or damage to another person.
Limited liability companies Companies that are owned by their shareholders. The liability of its shareholders is limited to the fully paid up value of the shares.
Line A line is the amount an insurer retains on a risk under a proportional treaty. It is also used to refer to the amount a reinsurer will accept on a piece of business.
Local insurer Transacts business only within the country where it is registered.
London Market This refers to the international insurance and reinsurance business written in London. It consists of the following segments: international reinsurance; marine and aviation; US excess and surplus lines business; and direct overseas business written in the UK
Long tail business A term used to describe a risk or class of business that may have claims notified or settled long after risks have expired. The financial outcome for these classes will not be known with certainty for several years. Liability insurance is long tail.
Loss Generally refers to the amount of reduction in the value of an insured’s property caused by an insured peril. In an insurance sense it usually does not mean “misplacing” an item.
Loss history The history of losses suffered by an insured or intending insured. This includes losses which were not covered by insurance.
Loss Occurrence Insurance arranged on a “per occurrence” basis permits all losses arising out of one event to be aggregated together. In casualty business, the term “occurrence” is broadly defined as a sudden happening resulting in bodily injury or damage and which is neither expected nor intended. In property reinsurance, the term ‘occurrence’ is usually defined as all losses from a single event arising during a specified period of time.
Loss Ratio The percentage that incurred losses bear to earned premiums.
Loss Reserve An amount set aside to provide for outstanding claims.
M Market value The fair price for which something can be sold in its current condition.
Material facts Facts which are relevant to the situation. For example, speeding fines would be relevant to a motor vehicle proposal but probably would not be relevant to a house insurance application. The Insurance Contracts Act requires a proposer to reveal facts which a “reasonable person” would think are relevant.
Maximum probable loss (MPL) A term used in property insurance. It represents an estimate of the likely loss to be experienced in a “worst case” scenario, excluding catastrophe events. Some definitions assume that all fire fighting equipment, structural fire protection (e.g. fire doors) and alarms for a particular risk will fail. Other definitions assume that these items will function normally. Insurers use MPL definitions in order to arrange their reinsurance and decide how much of a risk they can retain. It also applies in reinsurance. Companies calculate estimates of the maximum probable loss they could get out of a disaster—e.g. bushfire, storm, earthquake—and buy an appropriate amount of reinsurance.
Misrepresentation Misrepresentation occurs when the insured has provided information to an insurer but that information is incorrect. Fraudulent misrepresentation will allow an insurer to avoid a contract from its inception. Innocent misrepresentation does not allow an insurer to avoid a contract but the insurer can cancel the contract, and may reduce any claim by the extent of the prejudice suffered by the insurer.
Moral hazard There may be certain risks regarding the basic honesty and integrity of a person who is seeking insurance. For example, a person who has been convicted of theft may be more likely to lodge a fraudulent claim.
Morale hazard Morale hazards involve the attitudes of individuals—e.g. are they careless, lacking interest, discouraged?
N Negligence Failure to use a degree of care which an ordinary reasonable person would use under the given or similar circumstances. A person may be negligent by acts of omission or commission or both.
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