Claims & Adjusting Glossary

A professional who investigates insurance claims, assesses damage, and determines the amount the insurer should pay.

The automated processing and settlement of insurance claims using rule-based systems or AI, typically applied to simple, low-value claims that meet predefined criteria.

A formal written document prepared by an insurance adjuster summarizing the findings of a claim investigation, including damage assessment, coverage analysis, and recommended settlement.

A formal request by a policyholder to an insurance company for payment or compensation for a covered loss or policy event.

An estimated amount of money set aside by an insurance company to cover an expected claim payment, established when a claim is first reported and adjusted as more information becomes available.

The process of resolving an insurance claim, ending with the insurer making a payment to the policyholder or a denial of the claim based on policy terms and investigation findings.

The decision by an insurer to reject a claim based on policy exclusions, non-disclosure, breach of conditions, or determination that the loss is not covered under the policy terms.

The outright rejection of a claim by the insurer, often due to fundamental policy breaches such as non-disclosure, fraud, or failure to meet condition precedents.

The formal notification of a claim to the insurer, used primarily in Indian insurance markets. Timely intimation is often a condition precedent under IRDAI guidelines.

The systematic process of gathering facts, evidence, and documentation to verify the legitimacy and extent of an insurance claim before settlement.

The specific event, peril, or circumstance that directly caused the damage or destruction leading to an insurance claim, which determines whether the loss is covered.

A situation where the cost to repair or recover damaged property exceeds a specified percentage of its insured value, making it economically impractical to repair.

An adjuster who specializes in handling claims during large-scale disaster events such as hurricanes, earthquakes, or wildfires, often deployed to affected areas for weeks at a time.

The organized mobilization of adjusters, surveyors, and claims support staff to a disaster-affected area to handle the surge in claims volume following a catastrophic event.

An organization hired by an insurance company to manage all or part of the claims handling process, including intake, investigation, documentation, and settlement.

An insurance professional who manages and processes claims from initial receipt through to settlement or denial, coordinating between policyholders, adjusters, and other parties.

The complete collection of all documents, correspondence, reports, photographs, and records related to a specific insurance claim, maintained by the insurer or adjusting firm.

The systematic evaluation and documentation of the type, extent, and severity of damage to insured property following a loss event.

A claims professional who handles claims remotely from an office without visiting the loss site, typically managing smaller or less complex claims via phone, email, and documentation review.

A claim made by the policyholder against their own insurance policy for a covered loss, as opposed to a third-party claim filed by someone outside the policy.

A detailed itemized list of all damaged property or components identified during a survey inspection, including descriptions, quantities, measurements, and estimated repair or replacement costs.

The initial report made by a policyholder to the insurance company notifying them that a loss or damage event has occurred, triggering the claims process.

A simplified claims handling process for low-value or straightforward claims that meet predetermined criteria, allowing quicker settlement with reduced documentation requirements.

A third-party claims professional who contracts with insurance companies to investigate and settle claims, not employed by any single carrier.

The total cost of claims during a specific period, including both paid claims and reserves set aside for claims that have been reported but not yet settled.

A professional appointed by the insurer to investigate large or complex insurance claims, assess the loss amount, and recommend settlement. The term is used primarily in UK, India, and international markets.

A professional who acts on behalf of the policyholder to prepare, present, and negotiate insurance claims, similar to a public adjuster in the US market.

The ratio of claims paid (including adjustment expenses) to premiums earned, expressed as a percentage. A key metric used to evaluate the profitability of an insurance portfolio.

A large volume of insurance claims arising from a single catastrophic event or series of related events, requiring coordinated response and often exceeding normal claims handling capacity.

The actions taken to reduce or prevent further damage after an insured loss event, such as boarding up broken windows, tarping a damaged roof, or extracting standing water.

A discount on the renewal premium offered to policyholders who have not made any claims during the previous policy period, commonly used in motor insurance.

Claims that have been reported and acknowledged by the insurer but have not yet been settled or paid, for which reserves have been established.

A licensed claims professional who represents the policyholder (not the insurance company) in the claims process, typically paid a percentage of the settlement amount.

A loss where only a portion of the insured property is damaged or destroyed, and the cost of repair is less than the full insured value.

The detailed calculation and valuation of the total loss amount in an insurance claim, including itemized costs, depreciation, salvage deductions, and policy deductibles.

The amount of money an insurer recovers from third parties, salvage sales, or other sources after paying a claim, reducing the net cost of the claim.

The calculated projection of the ultimate cost of an insurance claim, set by claims professionals based on available information and adjusted as new facts emerge during the investigation.

A claims professional employed directly by an insurance company to handle claims on behalf of that carrier within an assigned territory.

A licensed professional in the Indian insurance market who inspects damaged property, assesses the extent of loss, and submits a detailed survey report to the insurance company for claim settlement.

The remaining value of damaged property after a loss, which the insurer may recover by selling the damaged items to offset the claim payment.

The estimated monetary value of damaged property or materials that can be recovered or sold after an insured loss event.

The professional fee paid to a licensed surveyor or loss adjuster for conducting a survey, inspecting the damage, and preparing the survey report for an insurance claim.

A situation where the insured property is completely destroyed, cannot be repaired, or where repair costs exceed the insured value, resulting in the insurer paying the full sum insured.

A claim made against the insured by a person or entity who is not a party to the insurance contract, seeking compensation for loss, injury, or damage caused by the insured.

A declaration that damaged property (especially vehicles) is beyond economical repair, meaning the cost to fix it exceeds its pre-accident market value.