Claims Management Glossary and Jargon Buster

A

Accidental Damage

Harm or loss caused unexpectedly and unintentionally.

Actual Claim Cost

The real final cost of handling a claim.

Adjuster

A professional who investigates insurance claims to determine what happened, whether the policy covers the loss and how much should be paid. They often inspect damage, gather evidence, and recommend settlement amounts.

API (Application Programming Interface)

A way for different software systems to “talk” to each other. For instance, the Claimable API lets Claimable connect with other tools (like accounting or policy systems) to share data automatically, reduce manual work, and streamline processes.

Appointed Supplier

A preferred supplier chosen to carry out work on a claim, such as repairs, replacements, legal advice or other services. An appointed supplier can be a lawyer, a surveyor, a repairer, etc.

Appraiser

An appraiser is an independent expert, hired during the claims process, who assesses the value of damages or losses after an incident and provides an objective estimate of repair, replacement or compensation costs.

Assigned To

The team member responsible for handling a claim or specific task within a claim management system.

B

Beneficiary

A beneficiary is the person or organisation that receives money or benefits from an insurance claim.

Bordereau

Another word for 'Report' that usually shows itemised lists or tabular data. It is often in spreadsheet form and contains information about claims, losses and policies. Insurers and reinsurers request bordereaux from brokers, MGAs, or third-party administrators to monitor exposure, claims paid, reserves, and recoveries.

Broker

A broker is an independent professional or company that helps people or businesses arrange insurance and supports them when making a claim.

C

Case

A case is a record of a claim, a dispute or a legal matter that needs to be managed and resolved. The term is sometimes used interchangeably with 'claim'.

Claim

A formal request by a policyholder or third party for compensation under the terms of an insurance policy.

Claimant

The person or business making the claim.

Claim History

The number of claims a contact or a company is involved in, independent of the capacity in which they are involved. Claimable allows you to keep track of the claim history for all contacts and companies.

Claim Type

A claim type is a way of categorising different kinds of claims within a claims management system. Examples include motor claims, property claims, liability claims and workers' compensation claims. Defining claim types helps categorise and manage claims more effectively. In Claimable, you can customise claim types to match the way your organisation identifies and processes claims.

Compliance

Compliance means following the laws, regulations and industry standards that apply to insurance and claims handling, such as GDPR, SOC 2 or financial conduct rules. Claimable aligns with GDPR and SOC 2 requirements.

Contact

A contact is any person or organisation involved in a claim, such as a policyholder, claimant, witness, third party or a supplier.

Cover

Cover is the protection provided by an insurance policy against specific risks, such as property damage, accidents or liability.

D

Damage

The loss or harm sustained by an insured party or a claimant. It can refer to physical damage to property or persons, as well as financial loss.

Date of Loss

The specific date when an incident resulting in a claim occurred (such as collision, theft or natural disaster). In Claimable we refer to Date of Loss as Incident Date.

Dispute

A disagreement between two parties, such us the claimant and the insurer, regarding the coverage, liability or settlement amount of a claim.

E

Effective Date

The date on which an insurance policy or coverage comes into force. Claims are only covered if they occurred after the effective date.

Eligibility

The conditions or requirements a person or company must meet to qualify for insurance coverage or benefits under a policy.

Estimate

An assessment of the expected cost of repairing or replacing damaged items, often prepared by an adjuster, contractor, or independent surveyor.

Excess

Excess refers to a fixed amount that the policyholder must pay towards the cost of a claim before the insurer covers the rest.

F

FNOL (First Notice of Loss)

The First Notice of Loss (FNOL) is the first report made after an incident occurs. It marks the official start of the claims process and usually includes details like the time, date, location and description of the loss.

Full Coverage

A term used to describe an insurance policy that includes both liability and physical damage coverage. In claims, this means broader protection but not necessarily “everything is covered.”

G

General Insurance

General insurance provides financial protection for common risks such as property damage, accidents, theft or liability. Unlike life insurance, it covers non-life risks and usually renews annually.

Gross Premium

The gross premium is the full price the policyholder pays for insurance.

I

Incident

An event or occurrence that may result in a claim under an insurance policy. Not all incidents result in claims but they should be reported if they fall within the policy's coverage scope.

Incident Date

The specific date when the event that led to the claim happened.

Incident Location

The physical place where the incident occurred. Recording the location of an incident is a key step in claims management to support the investigation, liability determination and assesment of the loss.

Incident Type

A classification of the kind of event that led to a claim. Examples include: accident, theft, fire, flood, collision, vandalism, etc.

Independent Adjuster

An independent adjuster is a professional who investigates and manages insurance claims but is not employed directly by the insurer.

Insured Party

The individual, business or entity covered by an insurance policy.

Insurer

The insurance company or provider that issues the policy and assumes the financial risk of potential losses in exchange for the payment of a premium.

J

Jettison

The voluntary act of throwing cargo or goods overboard from a ship in order to safeguard the vessel, crew or remaining cargo during an emergency.

Joint Liability

A legal principle under which two or more parties share responsibility for a loss, injury or obligation. In claims and insurance contexts, this means each liable party can be held accountable for the entire amount of damages, regardless of their individual share of fault.

K

Knock-for-Knock Agreement

In motor insurance claims, a knock-for-knock agreement is an arrangement between insurers by which each pays for the cost of repairs or damages to its own policyholder's vehicle, regardless of who was at fault in the accident. This type of agreement helps insurers speed up claims settlement, reduce disputes over liability and simplify the claims process for drivers.

L

Letter of Acknowledgement

A formal letter issued to acknowledge the receipt of a claim.

Letter of Subrogation

A letter issued to notify a third party that the insurer has taken over the insured's right to recover damages.

Letters

Formal written communications exchanged during the claims process. Claimable allows you to create unlimited letters automatically populated with data from within the claim.

Liability

A legal or contractual obligation to compensate another party for loss, injury or damage caused.

Loss Adjuster

A professional appointed by an insurance company to investigate, assess and manage claims on its behalf.

Loss Event

An occurrence that can result in multiple claims. A loss event can be a natural disaster such as a flood or a earthquake or a product recall case.

M

Material Damage

It refers to physical loss of or damage to tangible property caused by an insured event, such as fire, flood, storm, explosion, or accidental damage.

Mitigation of Loss

The duty of the insured to take reasonable steps to minimise the extent of loss or damage after an incident.

Malpractice

Professional negligence leading to a claim, often occurring in healthcare or legal services.

Medical-Only Claim

A worker's compensation claim that covers only medical expenses, without lost wages or disability benefits.

Mileage Reimbursement

Compensation for travel expenses related to medical appointments in the context of a workplace injury claim.

N

Named Driver

A person specifically listed on a motor insurance policy who is permitted to drive the insured vehicle.

Non-Occupational Injury

An injury or illness not related to work and therefore not covered under worker's compensation.

Notes

Qualitative information about a claim. Notes can be summary of a phone call or a meeting or comments left by the team regarding the claim process. Claimable allows you to add unlimited notes for every claim you manage.

Notice of Injury

A formal notification by an employee to their employer or insurer that a work-related injury or illness has occurred, typically required within a statutory timeframe to initiate a workers' compensation claim.

Notice Period

The time within which a claim or an incident must be reported after it has occurred.

O

Occupational Injury

Any injury sustained while performing work duties, typically covered by worker's compensation policies.

Ongoing Benefits

Continuous payments for medical care or wage replacement following a successful claim.

OSHA (Occupational Safety and Health Administration)

OSHA is a U.S. regulatory body that sets and enforces workplace safety standards. It is often referenced in worker's compensation cases.

Out-of-Court Settlement

Resolution of a dispute without going to trial, common in liability or legal claims.

Original Equipment Manufacturer (OEM) Parts

Genuine parts used in repairs after damage caused by an accident or incident.

P

Policy Holder

The individual or company that owns an insurance policy and has the rights and responsibilities under it.

Policy Number

The unique reference number assigned to an insurance policy, used to identify the policy and related claims.

PPI (Payment Protection Insurance)

In claims management, PPI refers to Payment Protection Insurance, a type of insurance designed to cover loan or credit repayments if a borrower becomes unable to pay due to certain circumstances. PPI became significant because of widespread mis-selling scandals, where customers were sold policies they either did not need or were not eligible for or aware of.

Product Liability

A type of insurance coverage that protects a business against claims for injuries or damages caused by products it has manufactured or supplied.

Professional Indemnity

A type of insurance that covers professionals against claims of negligence, mistakes or omissions in the services they provide.

Q

Qualified Claim

A claim that meets the policy requirements and therefore it is eligible for payment or settlement.

Quote

An estimate of the premium and coverage terms offered by an insurer or a broker before a policy is issued.

R

Remediation

Remediation in claims management is the process of correcting past errors or unfair treatment in insurance claims. It involves reviewing claims, compensating affected policyholders and improving processes to ensure compliance and fairness.

Replacement Vehicle

A replacement vehicle is a temporary vehicle provided to the insured party or the claimant while their own vehicle is unavailable due to a covered loss (e.g. accident, theft, or repair following damage)

Reserves

Reserves are the funds set aside to pay for a claim's obligations. They represent the best estimate of the costs of settling a claim.

Residual Disability

In workers' compensation claims, residual disability occurs when an employee has not fully recovered from a work injury and can only perform limited or modified duties.

Risk

In insurance and claims management, a risk refers to the possibility that a covered event (like an accident, fire, or injury) will occur, leading to a claim. A risk can also be used to refer to an insurance policy.

Risk Management

Strategies and processes used to reduce the likelihood and severity of claims.

Road Traffic Accident

A collision or incident on the road involving vehicles, often leading to motor claims.

S

Salvage

In claims management, salvage refers to the remaining value of damaged property after a total loss. Once the insurer pays the claim, they may take ownership of the damaged property and sell it (for example, a wrecked car sold for parts) to recover some of the payout.

Settlement

Settlement is the process of concluding a claim, either by payment to the insured/claimant or by other resolutions such as repair, replacement or denial. It represents the insurer's fulfillment of their obligations under the policy terms.

Subrogation

Subrogation is the process by which an insurance company, having paid a claim to its policyholder, acquires the right to recover those costs from the party legally responsible for the loss.

Surveyor

A surveyor is a professional appointed to assess the cause, circumstances and extent of loss or damage, often in marine or property claims. They provide reports that help insurers decide on liability and claim settlement.

T

Third Party

A person or organisation that is not the policyholder (the first party) but is involved in a claim and affected by the loss. For example, someone injured in a car accident caused by the policyholder is considered a third party.

Third-Party Administrator (TPA)

An external organisation that manages claims on behalf of an insurer or an employer.

Third Party Liability

Insurance that covers the policyholder's legal responsibility for injury or damage to others.

Total Loss

A total loss is when insured property is damaged or destroyed to the extent that it cannot be repaired, or when the repair cost would exceed the property's insured value. In the cases where the claim is covered, insurers usually settle by compensating the policyholder for the asset's assessed value instead of covering repairs.

U

Underwriter

The insurance professional or company that evaluates risks and decides the terms, conditions, and pricing of coverage.

Unearned Premium

The portion of a premium that applies to the remaining period of coverage and may be refunded if the policy is cancelled.

V

Valuation

The process of determining the value of property, vehicles, or losses for claim settlement.

Vendor's Liability

A type of insurance that covers a seller's responsibility for injury or damage caused by products they sell.

VIN (Vehicle Identification Number)

A unique code assigned to each vehicle, often used to track motor claims and repairs.

W

Waiver

The voluntary giving up of a known right, such as an insurer waiving a policy exclusion.

Warranty

A condition or promise in an insurance policy that the policyholder must follow. If a warranty is breached (for example, not maintaining a security system in a property policy), the insurer may reduce or deny cover for a related claim.

Warranty Claim

A request made by a policyholder, customer, or insured party to repair, replace, or receive compensation for a product or service that has failed within the terms of its warranty.

Wear and Tear

Gradual deterioration from normal use of a property or vehicle. In insurance claims, wear and tear is typically excluded from coverage, meaning a claim cannot be made for damage that arises naturally over time rather than from a sudden, unforeseen event.

Without Prejudice

A legal term used in claim negotiations, meaning discussions or offers can't be used as evidence if the matter goes to court.

Workers' Compensation Claim

A request for benefits made by an employee who has been injured or become ill as a result of their job. These claims typically cover medical expenses, rehabilitation costs and wage replacement while the employee is unable to work.

X

XOL (Excess of Loss)

XOL (Excess of Loss) is a type of backup cover that helps insurance companies handle very large claims. When claims go over a certain amount, another company (the reinsurer) steps in to pay the extra. This safety net protects insurers from big or unexpected losses, so they can stay financially secure and continue paying claims reliably.

Y

Yield Loss

In agricultural or crop insurance, this refers to losses in claims related to reduced yield due to insured perils such like drought or pests.

Z

Zone Rating

In the context of claims, it refers to assigning a risk level to a specific area based on factors like geographic location, political instability or exposure to natural disasters. This is used to calculate premiums and it is often relevant in auto, property, and workers' comp. policies.