Claims Terms and Definitions
Accident
Event or occurrence that is unforeseen and unintended.
Actual cash value
Current value of property. This is often calculated by subtracting depreciation from the replacement cost. Replacement cost – depreciation = actual cash value.
Additional living expenses
Any costs above your typical living expenses if you’re unable to live in your home due to a covered loss.
Adjuster
Person who investigates and settles losses for an insurance company.
Adverse carrier
The other person’s insurance company.
Aftermarket parts
Car parts that are manufactured by a company other than the Original Equipment Manufacturer (OEM).
Appraiser
Person who estimates property damage and value.
Appreciation
Increase in the value of a property due to changes in market conditions or other contributing factors.
Arbitration
When two parties disagree about who is responsible for a loss, an unbiased person or panel provides an opinion on liability or damages. Certain types of arbitration results are binding, meaning they cannot be appealed.
At-fault accident
Car accident where you, the insured, are responsible for the loss.
At-fault party
Party or parties legally responsible for the damages.
Auto appraisal
Written estimate that outlines the value of a vehicle, factoring in any damage that may have occurred.
Bodily injury
Certain types of injuries, including physical, mental/emotional, sickness, disease or death. Coverage for bodily injury is subject to any definitions, limitations or exclusions in the policy.
Building code
Regulations based on safety and health standards that designate permitted designs, construction and materials used in construction.
Catastrophe
Natural disaster that causes extensive damage.
Claim
Request for payment from an insurance company for a loss.
Claimant
Individual who submits a request for payment of a loss.
Collision coverage
Coverage for physical damage to your auto caused by a collision with another vehicle or object.
Collision damage waiver (CDW)
Optional damage coverage that can be purchased, typically from a rental vehicle company. This protects your rental vehicle in case of an accident. Your Amica policy will not reimburse you for purchasing this coverage.
Comprehensive coverage (also known as other than collision or OTC)
Coverage for physical damage to your auto (including glass or windshield) caused by such things as fire, theft or vandalism.
Conditions
Part of the insurance contract which describes the duties and responsibilities of both the policyholder and the insurance company.
Coverage
Protection against a loss as provided by an insurance contract.
Customized vehicle
A vehicle that has been substantially modified.
Damage
Destruction of or loss of use of tangible property that results from an accident or occurrence.
Damages
Money that one party is legally obligated to pay another as compensation for an injury or loss.
Dealer glass
Replacement glass that is sourced from the same distributor as the auto’s original manufacturer.
Declarations page (also known as dec page)
Section of an insurance policy that includes basic information about the policyholder, the insured property and coverages.
Deductible
Amount of money the policyholder is responsible for paying as part of the claim.
Depreciation
Decrease in value of an item due to age, wear and tear, or other contributing factors.
Direction to pay
Form that allows Amica to issue payment directly to a vendor or provider, such as a contractor or body shop, on your behalf.
Effective date
Date on which the insurance coverage under a policy begins.
EFT (electronic funds transfer)
Transfer of funds from one bank account to another for the purpose of premium or claim payments.
Endorsement
Amendment to the basic insurance policy.
Ensuing loss
Loss caused by an earlier or related event.
Estimate
Approximate calculation of value.
Exclusions
Certain policy restrictions that limit or exclude coverage. Exclusions may vary by policy type and state.
Expiration date
Date when the insurance policy’s coverage ends.
First party
Person who qualifies as an insured, or the types of coverages the insured is entitled to.
Fraud
Intentional deception made by a person or entity.
GAP (Guaranteed Asset Protection) insurance
Optional insurance that may pay the difference between the vehicle’s value and the auto loan balance in the event of a total loss.
Indemnity
Compensation from an insurance contract that restores an individual to his or her estimated financial position prior to loss.
Independent adjusters
Individuals contracted by an insurance company to investigate and settle losses.
Insurance
Financial protection for unexpected events that may cause loss.
Insurance ID card
Card containing basic information as proof of insurance.
Insured
A person, organization or any other parties protected by an insurance policy.
Insurer
Person or company that writes a policy for an insurance risk.
Liability coverage
Coverage for bodily injury and/or property damage to others when you are legally responsible as a result of an accident involving your vehicle.
Liability limit(s) (also known as policy limits)
Maximum amount provided by policy coverage(s) for a loss.
Lienholder/Loss payee
Party who has a financial interest in a covered property, such as a bank that has financed your vehicle or home.
Litigation
Legal process involving a plaintiff and a defendant, such as legal proceedings to determine fault.
Loss
Occurrence of damage and/or injury that an insurance company may pay for.
Loss of use coverage
Compensation for additional expenses while damaged property is not available for use.
Malicious mischief
Intentional destruction of another person’s personal property.
Medical payments coverage
Coverage for reasonable medical expenses for you, your family and your passengers when injured in an accident, regardless of whom is at fault.
Misrepresentation
Giving false or misleading information.
Named insured
Individual to whom the policy is issued. This person is listed on the policy declarations page.
Negligence
Failure to take the level of care that a reasonable and prudent person would take in the same or similar situation.
No-fault insurance coverage
Type of auto insurance that requires drivers to carry insurance for their own protection, while limiting their ability to sue others for certain types of damage.
Non-owned auto
Borrowed or rented vehicle.
Occurrence
Exposure to conditions that causes injury or damage.
Original Equipment Manufacturer (OEM) parts
Equipment, accessories and replacement parts (including glass) produced by the original manufacturer.
Other than collision (OTC) coverage (also known as comprehensive)
Coverage for physical damage to your auto (including glass and windshield) caused by such things as fire, theft and vandalism.
Out-of-pocket expenses
Claim-related expenses not covered by your insurance policy. In some instances, the person who was at fault may pay for these expenses.
Payment recovery (also known as subrogation)
To recover funds paid out to you from a responsible party.
Peril
Possible cause of loss. Examples include fire, windstorm, hail, etc.
Personal injury protection (PIP) coverage
Auto insurance coverage for medical expenses and, in some cases, lost wages and other damages. PIP compensates covered individuals regardless of who is at fault and is mandatory in some states.
Personal property
Generally includes personal belongings, such as furniture, appliances or jewelry. It does not include land or property connected to land (such as a house, garage or shed).
Policy
Formal written contract of insurance that lists policyholders, coverages and effective dates.
Policyholder
Person who owns and is listed in the policy.
Proof of loss
Formal statement made by an insured demonstrating that a loss occurred.
Property damage coverage
Coverage for destruction to another person’s property as a result of an accident for which you are responsible.
Punitive/Exemplary damages
Damages awarded by the courts that are intended to punish the wrongdoer. This form of damages is generally not covered by a liability policy, and the wrongdoer is typically financially responsible.
Real property
Anything permanently attached to or part of the land, such as buildings or trees.
Reinspection
Repeat inspection to view repairs to a vehicle or home.
Rental reimbursement coverage
Helps to pay the cost of a rental vehicle if your car is out of service due to a covered loss.
Repair Assistance Program (RAP)
An optional program for our customers who would like to use our pre-screened, high-quality participating repair shops.
Replacement cost
Total cost to repair or replace an insured item.
Replacement cost coverage
Additional coverage you can purchase for a home insurance policy that pays for the full cost to repair an item or to buy a new one.
Salvage
Damaged property that an insurance company obtains as part of a loss settlement.
Scheduled item
Items specifically listed on a policy that have individual insurance limits. These items are usually highly valued items, such as jewelry, furs, etc.
Special limits
Specified limit of coverage for an item or group of items. This usually applies to jewelry, cash, computers or silver.
Subrogation (also known as payment recovery)
Process of seeking financial reimbursement from the responsible party for a loss.
Summons and complaint
Lawsuit documents that inform an individual(s) that he or she is being sued and outlines the allegations and the damages being sought.
Supplement
Estimate or payment for additional damages.
Third party
Individual who is not listed or covered on a policy.
Tort
Wrongful act, whether intentional or accidental, that results in an injury to another.
Tort feasor
Person who commits a wrongful act leading to legal liability.
Total loss
Damaged property that cannot be repaired safely or the cost to repair the property exceeds its value.
Towing and Labor
Optional coverage for reimbursement of a tow due to mechanical breakdown.
Umbrella policy
Extra layer of insurance protection that covers you beyond the limits of your auto, home and marine policies.
Uninsured/Underinsured motorist coverage
Coverage for injury-related expenses that you are legally entitled to recover from the owner or operator of an uninsured or underinsured motor vehicle.
Vandalism
Act of deliberately causing damage or destruction to public or private property.
Vehicle Identification Number (VIN)
17-digit alphanumeric code used to identify vehicles manufactured in the United States.
Vehicle recall
Occurs when a manufacturer determines that a specific vehicle model has a safety-related defect.
Waiver
Document signed by a business or person that relinquishes rights or responsibility.