# Claims Glossary

> 48 terms from the Insurance book's Claims part, each defined in a line and linked to the chapter that explains it.

- **Advance charges:** towing, storage and impound fees a salvage auction pays to release a total loss vehicle and recovers from the sale ([Subrogation, Salvage & Recovery](https://www.syntaqx.com/books/insurance/subrogation-and-salvage#salvage)).
- **Anti-subrogation rule:** an insurer may not subrogate against a person insured under the same policy ([Subrogation, Salvage & Recovery](https://www.syntaqx.com/books/insurance/subrogation-and-salvage#subrogation-rights)).
- **A&O (adjusting and other):** loss adjustment expense not tied to a specific claim's defense, chiefly the cost of the claims operation ([Exposures, Reserves & Payments](https://www.syntaqx.com/books/insurance/reserves-and-payments#case-reserves-by-cost-type)).
- **Appraisal clause:** the policy provision under which each side names an appraiser, the appraisers pick an umpire, and a written award by any two fixes the amount of loss ([Property Claims](https://www.syntaqx.com/books/insurance/property-claims#appraisal)).
- **Assignment of benefits (AOB):** a policyholder signing insurance proceeds over to a contractor; Florida voided it for policies issued on or after January 1, 2023 ([Property Claims](https://www.syntaqx.com/books/insurance/property-claims#assignment-of-benefits-and-florida-s-ban)).
- **Case reserve (case outstanding):** the adjuster's estimate of what remains to be paid on a known claim, by exposure and cost type ([Exposures, Reserves & Payments](https://www.syntaqx.com/books/insurance/reserves-and-payments#case-reserves-by-cost-type)).
- **Civil remedy notice:** Florida's 60-day presuit notice of an insurer's alleged bad faith, which the insurer can cure ([Bad Faith & Litigation](https://www.syntaqx.com/books/insurance/bad-faith-and-litigation#statutory-remedies)).
- **Claim diary:** the claim's tasks with due dates, generated from cited claim clock rules and the events that trigger them ([Claim Handling Law & Clocks](https://www.syntaqx.com/books/insurance/claim-handling-law#the-diary-as-a-rules-engine)).
- **Comparable vehicle:** a vehicle of the same make, same or newer year, similar body, options and mileage, available locally within 90 days, used to value a total loss ([Auto Claims & Total Loss](https://www.syntaqx.com/books/insurance/auto-claims-and-total-loss#valuation-rules)).
- **Coverage position:** the insurer's recorded stance on a coverage issue for an exposure (covered, reserved, partially denied, denied), with its deadline and the letter that carried it ([First Notice, Coverage & Triage](https://www.syntaqx.com/books/insurance/first-notice-and-triage#coverage-positions-reservations-of-rights-and-denials)).
- **Credible referral:** in California, an SIU referral with at least one red flag, which the SIU must investigate ([Fraud & SIU](https://www.syntaqx.com/books/insurance/insurance-fraud#detection)).
- **DCC (defense and cost containment):** loss adjustment expense tied to specific claims, such as defense counsel and experts ([Exposures, Reserves & Payments](https://www.syntaqx.com/books/insurance/reserves-and-payments#case-reserves-by-cost-type)).
- **Deductible recovery:** the insured's share of a subrogation recovery, shared proportionately under the model regulation ([Subrogation, Salvage & Recovery](https://www.syntaqx.com/books/insurance/subrogation-and-salvage#deductible-recovery)).
- **Direct repair program (DRP):** a network of repair shops that accept an insurer's rates and guidelines in exchange for referrals; the claimant still chooses the shop ([Auto Claims & Total Loss](https://www.syntaqx.com/books/insurance/auto-claims-and-total-loss#estimating-and-repair)).
- **Excess exposure:** the risk that a liability verdict exceeds the policy limits, which makes a demand within limits a bad faith decision point ([Bad Faith & Litigation](https://www.syntaqx.com/books/insurance/bad-faith-and-litigation#first-party-and-third-party-bad-faith)).
- **Exposure (claims):** one claimant against one coverage on a claim, the unit reserves and payments attach to ([Exposures, Reserves & Payments](https://www.syntaqx.com/books/insurance/reserves-and-payments#exposures)).
- **First notice of loss (FNOL):** the first report of a claim to the insurer or its agent, which starts the claim clocks ([First Notice, Coverage & Triage](https://www.syntaqx.com/books/insurance/first-notice-and-triage#first-notice-channels-and-data)).
- **First-party bad faith:** an insurer's unreasonable denial or delay of its own insured's claim, a tort in California and Texas ([Bad Faith & Litigation](https://www.syntaqx.com/books/insurance/bad-faith-and-litigation#first-party-and-third-party-bad-faith)).
- **General business practice:** the frequency standard under which repeated claim handling failures become an unfair claims practice ([Claim Handling Law & Clocks](https://www.syntaqx.com/books/insurance/claim-handling-law#the-unfair-claims-settlement-practices-act)).
- **Incident:** what was damaged or hurt on a claim (a vehicle, a property, an injury), to which exposures attach ([First Notice, Coverage & Triage](https://www.syntaqx.com/books/insurance/first-notice-and-triage#the-claim-file-opened)).
- **Independent adjuster (IA):** a licensed adjuster from an outside firm retained by an insurer, paid as adjusting expense ([First Notice, Coverage & Triage](https://www.syntaqx.com/books/insurance/first-notice-and-triage#segmentation-and-assignment)).
- **Inter-company arbitration:** resolution of subrogation disputes between insurers through Arbitration Forums programs instead of court ([Subrogation, Salvage & Recovery](https://www.syntaqx.com/books/insurance/subrogation-and-salvage#demands-and-inter-company-arbitration)).
- **LAE (loss adjustment expense):** the cost of investigating, defending and settling claims, split into DCC and A&O ([Exposures, Reserves & Payments](https://www.syntaqx.com/books/insurance/reserves-and-payments#case-reserves-by-cost-type)).
- **LEDES:** the Legal Electronic Data Exchange Standard formats for invoices, budgets and timekeeper data, maintained by the LEDES Oversight Committee; insurers take them from defense counsel ([Bad Faith & Litigation](https://www.syntaqx.com/books/insurance/bad-faith-and-litigation#litigation-management)).
- **Matching:** the rule extending a repair to undamaged items so replacements conform to a reasonably uniform appearance ([Property Claims](https://www.syntaqx.com/books/insurance/property-claims#matching)).
- **Model 900 (Unfair Claims Settlement Practices Act):** NAIC's 1990 model listing fourteen unfair claims practices, enforced against flagrant violations or a general business practice ([Claim Handling Law & Clocks](https://www.syntaqx.com/books/insurance/claim-handling-law#the-unfair-claims-settlement-practices-act)).
- **Model 902:** NAIC's property and casualty claims model regulation setting 15, 21, 30 and 45-day clocks, total loss valuation and deductible sharing ([Claim Handling Law & Clocks](https://www.syntaqx.com/books/insurance/claim-handling-law#the-model-regulation-s-clocks)).
- **Proof of loss:** the insured's documentation of a claim, often sworn, from which many decision clocks run ([Claim Handling Law & Clocks](https://www.syntaqx.com/books/insurance/claim-handling-law#the-rules-at-a-glance)).
- **Public adjuster:** a licensed adjuster hired by the policyholder for a fee, capped at 10% in Texas and after declared emergencies in Florida ([Property Claims](https://www.syntaqx.com/books/insurance/property-claims#public-adjusters)).
- **Recovery allocation:** the split of a recovery among insurer, insured, reinsurers and fees, summing to the amount received ([Subrogation, Salvage & Recovery](https://www.syntaqx.com/books/insurance/subrogation-and-salvage#recovery-accounting)).
- **Red flag:** a written, line-specific indicator of possible fraud that supports an SIU referral ([Fraud & SIU](https://www.syntaqx.com/books/insurance/insurance-fraud#detection)).
- **Reopened claim:** a closed claim reopened for more costs on a loss already disclosed; in Florida noticed within one year of the loss ([Exposures, Reserves & Payments](https://www.syntaqx.com/books/insurance/reserves-and-payments#closing-and-reopening)).
- **Reported claims (case incurred):** cumulative paid plus case outstanding at a date ([Exposures, Reserves & Payments](https://www.syntaqx.com/books/insurance/reserves-and-payments#case-reserves-by-cost-type)).
- **Reservation of rights:** a letter telling the insured the insurer is investigating or defending while reserving the right to deny on stated grounds; in Florida due within 30 days of learning the defense ([First Notice, Coverage & Triage](https://www.syntaqx.com/books/insurance/first-notice-and-triage#coverage-positions-reservations-of-rights-and-denials)).
- **Right of recourse:** the insured's 35-day window to show a comparable can't be bought for the total loss value, which reopens the valuation ([Auto Claims & Total Loss](https://www.syntaqx.com/books/insurance/auto-claims-and-total-loss#valuation-rules)).
- **Safe harbor (Florida bad faith):** no third-party bad faith action if the insurer tenders the lesser of limits or the demand within 90 days of notice ([Bad Faith & Litigation](https://www.syntaqx.com/books/insurance/bad-faith-and-litigation#florida-s-2023-changes)).
- **Salvage:** the damaged property an insurer takes and sells after paying a total loss; its net proceeds reduce the loss ([Subrogation, Salvage & Recovery](https://www.syntaqx.com/books/insurance/subrogation-and-salvage#salvage)).
- **Salvage title:** a title brand for a vehicle damaged beyond a state's threshold or paid as a total loss ([Auto Claims & Total Loss](https://www.syntaqx.com/books/insurance/auto-claims-and-total-loss#when-a-car-is-a-total-loss)).
- **Segmentation:** sorting a claim or exposure into a handling path (fast track, injury, total loss, complex, catastrophe, suspicious) at submission ([First Notice, Coverage & Triage](https://www.syntaqx.com/books/insurance/first-notice-and-triage#segmentation-and-assignment)).
- **Social inflation:** claim costs rising faster than economic inflation because of larger verdicts, more litigation and litigation funding, as insurers' filings describe it ([Bad Faith & Litigation](https://www.syntaqx.com/books/insurance/bad-faith-and-litigation#legal-spend-and-social-inflation-in-the-filings)).
- **Special investigations unit (SIU):** an insurer's unit, in-house or contracted, that investigates suspected fraud and reports it to the state ([Fraud & SIU](https://www.syntaqx.com/books/insurance/insurance-fraud#state-requirements)).
- **Subrogation:** the insurer's right, after paying its insured, to recover from the party responsible for the loss ([Subrogation, Salvage & Recovery](https://www.syntaqx.com/books/insurance/subrogation-and-salvage#subrogation-rights)).
- **Supplemental claim:** a claim for additional loss from the same peril already adjusted; in Florida noticed within 18 months of the loss ([Exposures, Reserves & Payments](https://www.syntaqx.com/books/insurance/reserves-and-payments#closing-and-reopening)).
- **Third-party bad faith:** a liability insurer's failure to settle within limits when a prudent insurer would have, exposing it to the excess verdict ([Bad Faith & Litigation](https://www.syntaqx.com/books/insurance/bad-faith-and-litigation#first-party-and-third-party-bad-faith)).
- **Time-limited demand:** an offer to settle a liability claim, usually for the limits, if accepted by a deadline; regulated in California and Georgia ([Bad Faith & Litigation](https://www.syntaqx.com/books/insurance/bad-faith-and-litigation#time-limited-demands)).
- **Total loss:** a vehicle whose repair cost plus salvage exceeds its value, or that a state's title rule brands; settled at actual cash value with taxes and fees ([Auto Claims & Total Loss](https://www.syntaqx.com/books/insurance/auto-claims-and-total-loss#when-a-car-is-a-total-loss)).
- **UTBMS:** the Uniform Task-Based Management System of task, activity and expense codes used on legal invoices ([Bad Faith & Litigation](https://www.syntaqx.com/books/insurance/bad-faith-and-litigation#litigation-management)).
- **Verified policy:** a policy resolved from the policy system at FNOL, as against an unverified one captured from the reporter, which typically can't be paid on ([First Notice, Coverage & Triage](https://www.syntaqx.com/books/insurance/first-notice-and-triage#verifying-coverage)).

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