Reference

Insurance Claim Terms Glossary

40 words and phrases you’ll meet in policies, estimates and appraisal awards, defined in plain English. Type to filter.

Actual cash value (ACV)
The replacement cost of damaged property minus depreciation. Many policies pay ACV first and the rest after repairs.
Additional living expenses (ALE)
Coverage for the extra cost of living elsewhere while your home is unlivable after a covered loss. It sits under Coverage D, the loss-of-use section of a homeowners policy.
Amount of loss
The dollar value of a covered loss under the policy. It is the main question an appraisal panel decides.
Appraisal award
The written decision signed by at least two of the three panel members that sets the amount of loss.
Appraisal clause
The policy paragraph that lets either side resolve a disagreement over the amount of loss through appraisers and an umpire.
Appraisal demand
The written notice from one party to the other invoking the appraisal clause and starting the process.
Bad faith
A general term for unreasonable claim handling by an insurer. Oklahoma courts recognize a duty of good faith and fair dealing, and an attorney can explain whether it applies to your facts.
Betterment
An improvement beyond the condition before the loss, which a carrier may argue it should not pay for.
Class 4 shingles
Shingles rated to the highest impact-resistance class under the UL 2218 test. Many carriers offer premium discounts for them.
Code upgrade (ordinance or law)
Coverage that pays for work required by current building codes during repair, subject to its own limit.
Competent and disinterested
The standard many policies set for appraisers: qualified to value the loss and free of a stake that compromises independence.
Cosmetic damage exclusion
An endorsement that removes coverage for hail dents or marks that change appearance but not function, often on metal roofs.
Coverage A
The dwelling coverage on a homeowners policy, covering the house and attached structures.
Coverage B
Other structures coverage for detached items such as fences, sheds and detached garages.
Coverage C
Personal property coverage for contents such as furniture, clothing and electronics.
Declarations page
The summary page of your policy listing the insured, the property, coverage limits, deductibles and endorsements.
Depreciation
The reduction in value for age, wear and condition that a carrier subtracts from replacement cost.
Earthquake endorsement
Optional coverage added to a property policy for earth movement from earthquakes, usually with its own percentage deductible.
Functional damage
Damage that impairs how a material performs, such as a fractured shingle mat or a punctured panel.
Hail mat / test square
A marked area on a roof slope, often ten feet by ten feet, where hits are counted to judge whether the slope needs replacement.
Holdback
The portion of a replacement-cost claim, usually recoverable depreciation, withheld until repairs are completed.
Line item
One priced entry in an estimate, such as a square of shingle removal or a linear foot of drip edge.
Matching
The question of whether repaired areas must reasonably match undamaged areas in color, style or texture.
Mitigation
Reasonable steps to prevent further damage after a loss, such as tarping a roof or drying out a wet room.
Named insured
The person or entity listed on the declarations page as holding the policy.
Overhead and profit (O&P)
A general contractor’s markup for managing a job with several trades, often figured as a percentage of the estimate.
Policy period
The dates the policy is in force. Losses must generally occur within this window to be covered.
Proof of loss
A sworn statement of the amount claimed that some policies require when the carrier asks for it.
Public adjuster
A licensed professional who represents a policyholder in presenting and negotiating a claim, separate from an appraiser.
Recoverable depreciation
Depreciation the carrier pays back once repairs are finished under a replacement-cost policy.
Replacement cost value (RCV)
The cost to repair or replace damaged property with like kind and quality at current prices, without subtracting depreciation.
Reservation of rights
A letter in which the carrier keeps handling a claim while reserving the right to deny coverage later.
Roof payment schedule
An endorsement that pays roof losses at a percentage that drops as the roof ages, rather than full replacement cost.
Scope of loss
The full list of damaged items and the repair work each needs, before pricing.
Squares
The roofing unit of measure. One square equals 100 square feet of roof surface.
Steep charge
An added labor allowance for working on roofs with a steep pitch, commonly 7/12 and above.
Suit limitation
A policy clause setting the time within which a lawsuit over the claim must be filed.
Umpire
The neutral third member of an appraisal panel who decides items the two appraisers cannot agree on.
Wind/hail deductible
A separate deductible for wind and hail losses, often a percentage of the dwelling limit.
Xactimate
Estimating software widely used by carriers and contractors, with regional price lists for labor and materials.
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