CII IF7 key terms

A formal request by a policyholder or third party for payment or another remedy under an insurance contract, following a loss, injury or event that the policy is said to cover.

The first communication by which an insured or claimant tells the insurer that a loss has occurred, starting the claims process and triggering duties of good faith on both sides.

The specific occurrence, circumstance or trigger described in the policy wording that must happen before cover responds, such as fire, theft or bodily injury.

The scope of protection an insurer agrees to provide under a policy, defined by the insuring clause, conditions, limits and exclusions, and assessed against the facts of each claim.

A clause that removes specified losses, causes, persons or circumstances from the cover otherwise granted, shifting the resulting cost back to the policyholder.

The maximum amount an insurer will pay for a defined category of claim under the policy, which may apply per claim, per event or in aggregate across the policy period.

The amount stated in the schedule as representing the value of the insured property or the maximum payable, used as the basis for premium and for assessing adequacy of cover.

A separate, lower maximum that caps payment for a particular type of loss or item within the overall policy limit, such as a cap on valuables or temporary accommodation costs.

The first amount of each loss that the insured must bear before the insurer pays, deducted from the settlement or collected from the claimant depending on the wording.

A sum the insured agrees to contribute toward each loss, often used interchangeably with excess but sometimes calculated differently, for example as a percentage of the loss.

A financial or legal relationship to the subject matter of insurance such that the insured benefits from its preservation and suffers loss from its damage or destruction.

The principle that insurance should restore the insured financially to the position held before the loss, neither better nor worse off, subject to policy limits and excesses.

An improvement in the insured's position arising from repairs or replacement with new items for old, which may be deducted from a settlement to preserve the indemnity principle.

The reduction in an asset's value caused by age, wear, use or obsolescence, used in claims assessment to calculate the pre-loss value of damaged property.

The mutual duty of insurer and insured to act honestly and disclose material facts relevant to the risk, breach of which may allow the other party to avoid the contract.

Information that would influence a prudent insurer's decision on whether to accept a risk, or on the terms and premium charged, and which the proposer should disclose.

Failure by a proposer or insured to reveal a material fact to the insurer, which may entitle the insurer to remedies ranging from additional premium to avoidance of the policy.

A false or misleading statement of fact made to an insurer, whether innocent, negligent or deliberate, that induces the insurer to enter the contract on terms it would not otherwise accept.

A policy term that must be complied with exactly, where breach may discharge the insurer's liability for losses occurring while the breach continues, subject to applicable statute.

A term of the policy that sets out obligations or procedures, such as notifying claims promptly or maintaining security, which the insured must satisfy for cover to respond.

A policy condition dealing specifically with how claims must be handled, including notice periods, cooperation duties, proof requirements and the consequences of non-compliance.

A policy term making the insurer liable only if a specified requirement is met, so failure to comply can defeat the claim entirely rather than merely giving a remedy for breach.

The initial assessment by which a notified claim is categorised by type, severity, coverage questions and fraud indicators, determining who handles it and what action follows.

The person within an insurer or third-party administrator who receives, investigates, evaluates and settles claims, acting as the main point of contact for the claimant.

An independent specialist appointed to investigate the cause and extent of a loss, verify the claim and recommend a settlement figure to the insurer.

A professional engaged by the policyholder to prepare, present and negotiate a claim, acting in the insured's interest rather than the insurer's.

A person or organisation making a claim under a policy, whether the insured themselves or a third party with a legal right to pursue the insurer.

A demand made against the insured by someone who has suffered loss or injury, which the insurer may handle and pay under a liability policy.

The process of estimating and recording the expected ultimate cost of a claim, including payments already made and future costs, so the insurer can report accurate liabilities.

Claims that have occurred within a policy period but have not yet been notified to the insurer by the end of the reporting date, requiring estimation in reserves.

The maximum amount a named claims handler may pay or commit without referring the decision to a more senior colleague or committee.

The insurer's right, after paying a claim, to step into the insured's shoes and recover the loss from the party legally responsible for causing it.

The right of an insurer that has paid a claim to recover a proportionate share from other insurers covering the same loss, preventing double recovery by the insured.

Property saved from a loss that retains value, which the insurer may sell or retain, with proceeds usually credited against the claim to reduce the net payment.

A policy provision that reduces the claim payment in proportion to underinsurance, applied where the sum insured is less than the value of the property at risk.

A situation where the sum insured is lower than the true value of the insured subject matter, so a partial loss may not be fully met from the policy.

An arrangement where two or more insurers share a risk, or where the insured bears an agreed percentage of each loss alongside the insurer.

The obligation on a party to establish the facts it relies on, so a claimant must usually show that a loss falls within the cover before the insurer must prove an exclusion applies.

The remedy by which an insurer treats a policy as never having existed, typically for serious non-disclosure or misrepresentation, returning premiums and refusing claims.

A claim that is knowingly exaggerated, fabricated or supported by false evidence in order to obtain a payment to which the claimant is not entitled.

The end-to-end process of receiving, assessing, negotiating and settling claims, including cost control, data recording, complaint handling and learning from outcomes.