Legal & Dispute Glossary

A method of dispute resolution where an independent arbitrator (or panel) hears both sides and makes a binding decision, commonly used in insurance policy disputes as an alternative to court litigation.

A dispute resolution process specified in many property insurance policies where each party selects an independent appraiser, and a neutral umpire resolves disagreements about the value or amount of loss.

The criminal act of deliberately setting fire to property, often investigated in insurance claims where fire origin or motive is suspicious and the insured may benefit from the destruction.

The obligation to provide sufficient evidence to support a claim or defense in an insurance dispute. The policyholder typically bears the burden to prove a covered loss occurred, while the insurer bears the burden to prove an exclusion applies.

A legal principle used in insurance disputes stating that any ambiguous language in a policy should be interpreted against the party that drafted it (the insurer), in favor of the policyholder.

The various methods used to resolve disagreements between insurers and policyholders, including negotiation, mediation, arbitration, appraisal, and litigation.

A written communication from the insurer to the policyholder formally declining to pay a claim, stating the specific policy provisions and reasons for the denial.

A formal letter from the policyholder or their representative to the insurer requesting payment of a specific claim amount, often preceding formal legal action if the demand is not met.

A qualified professional who provides specialized opinions and testimony in insurance disputes based on their expertise in areas such as engineering, fire investigation, construction, or financial analysis.

A detailed scientific investigation into the cause and origin of a loss, using specialized techniques such as fire forensics, structural analysis, or financial auditing to determine facts for insurance claims.

The deliberate act of deceiving an insurance company to obtain an illegitimate payment, including fabricated claims, staged accidents, inflated damages, and concealment of material facts.

A contractual arrangement where one party agrees to compensate another for specific losses or damages, commonly used in insurance-related contracts to allocate financial responsibility.

The process of resolving insurance disputes through the court system, involving formal legal proceedings, discovery, trial, and judgment by a judge or jury.

The legal protection of communications between a party and their legal advisor from disclosure in court proceedings, relevant in insurance when claim investigations involve legal counsel.

A voluntary dispute resolution process where a neutral mediator helps the insurer and policyholder reach a mutually acceptable settlement, without the mediator imposing a binding decision.

The voiding of an insurance policy from its inception as though it never existed, typically due to material misrepresentation or fraud by the policyholder during the application process.

A formal notice from an insurer to the policyholder stating that while the claim is being investigated, the insurer reserves the right to later deny coverage based on specific policy provisions.

The legally prescribed time period within which an insurance claim or lawsuit must be filed. Failure to act within this period results in the permanent loss of the right to pursue the claim.

A neutral third party selected during the appraisal process who makes binding decisions when the two appointed appraisers cannot agree on the value or amount of loss.

An endorsement or agreement where the insurer gives up its right to pursue recovery from a third party after paying a claim, often required in lease agreements and construction contracts.

Legal doctrines that can prevent an insurer from denying coverage when its actions have led the policyholder to reasonably believe coverage exists, even if the policy terms might otherwise allow denial.