Insurance Claims Tips

How to read an insurance policy :

Reading an insurance policy is difficult, even for many insurance professionals.  It seems as if everything is excluded and nothing is covered.  How and where do you look to figure out if you actually have any protection?  Hopefully this page will help!

First off, this document is NOT meant in any way to replace the coverage you may or may not have. Do not take this page to a lawyer and say that we told you something was covered! Instead, use this page as a tool to help you get through the insurance language to a point where you can ask your agent, “paragraph K says this is excluded, but I need this covered” and you will be just fine.

First off, insurance forms are designed like what a machinist would call a “blank”. This means that a majority of insurance companies use what is called an “ISO Form” and then modify it through a series of endorsements to tailor coverage the way they want. Think of it as going to Men’s Warehouse and buying a suit off the rack. Although the suit may be roughly the right size, it then must be tailored.

If you think you have a claim, the adjuster, will usually follows these steps in order:

  1. Are you an insured under the policy? (you or your business name for example)
  2. Was there damage or injury? (according to the definitions of your policy)
  3. Are all the elements required for triggering coverage satisfied? (this includes definitions)
  4. Is the reported damage or injury specially excluded?
  5. Are there any policy limits left to pay the claim?
  6. Did you meet the policy conditions (reporting it quickly etc.)?