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Complaints and Disputes terms
Complaints and Disputes in Homeowners Insurance: the news, the names and what changed.
Anti-concurrent causation clauseExclusion wording that denies a loss whenever an excluded cause contributes, even if a covered cause also played a part or came first.Appraisal clauseA policy condition that lets either side demand a neutral panel to set the dollar amount of a loss when you and the insurer cannot agree on its value.Concurrent causationThe question of how to decide coverage when a covered cause and an excluded cause combine to produce one loss, such as wind and storm surge in a hurricane.Efficient proximate causeA legal test that decides coverage by asking which cause set the others in motion and dominated the loss when covered and excluded causes combine.Examination under oathA formal, recorded question-and-answer session under oath that an insurer can require of a claimant, usually led by the insurer's attorney.NAIC complaint indexA ratio comparing an insurer's share of confirmed consumer complaints with its share of premium, where 1.00 means complaints in line with its size.Public adjusterA licensed claims professional hired by the policyholder, not the insurer, who documents and negotiates the claim for a fee, usually a share of the payout.Reservation of rightsA written notice that an insurer is investigating or paying a claim but keeps the option to deny coverage or limit payment later if the facts warrant it.UmpireThe neutral third person who breaks the tie when the two appraisers in a claim appraisal cannot agree on the amount of a loss.