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Educating you on insurance jargon!

So often the general public are unsure of what exactly the various terms and phrases are all about. Here we try to simplify and explain more for you.

INSURANCE QUESTIONS

What is insurance?

Insurance is a means of compensation should any misfortune happen to the object or item insured. The reason why people find it necessary or even essential to insure is because the loss or damage could spell disaster for the owner. To the businessman, a loss or near catastrophe could upset years of planning and budgeting.

What is a risk?

Risk is the chance of a loss and/or risk is the possibility of an unfortunate accident. The use of the word risk in insurance refers also to the subject matter of the insurance, such as a house, factory or office block.

What is the difference between insurance and assurance?

Much confusion exists as to the use of these two words. Assurance refers to life and pensions business, and insurance refers to the short term classes such as contents, motor, fire and accident.

What is insurable?

Any risk can be insured against if :

its occurrence would result in a loss to the person taking out the insurance, the loss is entirely accidental as far as the insured is concerned, and a reasonable premium can be assessed.

Note the following important principles of insurance :

  1. A person may only insure against a risk which would cause him a direct personal loss. He cannot for instance, insure his neighbor’s car or a friend’s life. He must have what is called an “insurable interest” in the subject matter of the insurance.
  2. A person may not receive more than the amount of any loss that he suffers. The purpose of insurance is to put the individual back, as near as possible, in the same financial position as he held before the occurrence. He may not enjoy a profit as the result of the loss!
  3. The amount of the loss or damage, such as the cost of replacing or repairing an item stolen or damaged by fire, should be measurable.
  4. The loss or damage should be entirely accidental so far as the insured is concerned. Insurance is not there to compensate a person who has deliberately burnt down his own factory or house.
  5. Remembering the concept of the insurance pool, the risk must be one that is frequently encountered so that the underwriter has some experience and statistics on which to judge what a fair premium should be!

What are the advantages of insurance?

The benefits of insurance to YOU as a whole are numerous. Compensation and peace of mind have already been mentioned but there are others less obvious :

  1. Once relieved of the worry of accidental loss or damage, the businessman can concentrate his efforts on running his affairs and making money;
  2. Gone is the need to accumulate large reserves to pay for possible losses.
  3. The businessman will take decisions involving speculative ventures which he would not have done without insurance. Such ventures include opening new factories, launching export drives and experimenting with new products.
  4. Insurance companies employ specialists to advise clients on ways of reducing risks and at the same time paying lower premiums. For example, these specialists include fire surveyors who advise on how to reduce fire hazards, theft surveyors to recommend the most effective intruder protection and alarm systems, etc.
  5. Premiums collected by insurance companies are invested in many areas which benefit the community at large. Not to mention the numerous sponsorships.

What is average?

This refers to a practice used to combat under-insurance. It has been defined as “a condition whereby the insurer is liable only for the same proportion of a loss as the sum insured bears to the actual value of the property at the time of the loss”.

In other words, should you suffer any loss or damage and if at the time of such loss the property is insured for less than its true value, your insurers will only pay a rateable proportion of the loss eg.

Insured for : R150 000
Actual : R250 000
Amount of claim : R 20 000
Insurers pay (R150 000 x R20 000)/R250 000 : R 12 000
You pay : R 8 000

Where under-insurance exists, the whole principle of insurance is being undermined, in the sense that the insured is not paying a fair premium into the pool for the risk presented. Thus, for full compensation to be paid in the event of a loss would be unfair on other contributors to the same pool.

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GLOSSARY OF TERMS

Betterment = the value of the improvement in an insured property when it has been repaired or rebuilt following loss or damage

Claim Free Group = the term used in motor insurance to indicate into which of the rating groups a policyholder will fall according to his claims’ record

Comprehensive = a policy covering a wide variety of perils

Declaration = the statement on a proposal form signed by the insured certifying the truthfulness and accuracy of the information supplied

Deductible = similar in meaning to an excess and being the first portion of a loss payable by the insured

Disclosure = the duty of the parties to a contract of insurance to reveal all material facts to each other before it is concluded and prior to each renewal

Endorsement = documentary evidence of some alteration to a policy of insurance

Excess = that part of a loss for which the insured is liable

First Amount = the amount payable by an insured in the event of a claim under a Payable motor policy

Hazard = a physical or moral feature that impacts on the likelihood of a loss occurring or has an influence on the size of the loss

Indemnity = the placing of the insured in the same financial position after a loss as he was in immediately prior to the occurrence. Not applicable to life insurance

Insurance = a person who investigates and adjudicates on differences
Ombudsman between insured and insurers

Insurance Policy = a document which is evidence of a contract of insurance

Insurer = a company or society transacting insurance business

Intermediary = a person who arranges insurance on behalf of another

Knock for Knock = an agreement between motor insurers whereby following an Agreement collision, each pays the cost of repairs to its own policyholder’s vehicle, regardless of fault, provided that the vehicles involved are all insured for accidental damage

Lapse = the termination of an insurance through the non-payment of the premium or by the insurer’s decision not to invite renewal

Limit of Liability = the maximum amount that an insurer will pay for one loss in terms of a liability policy

Loading = those elements added to a premium to allow for insurer’s expenses; also the extra premium required for sub-standard risks

Loss Adjuster = an independent qualified person who assesses the size or value of Assessor a loss on behalf of an insurer, but who may also be employed by an insured to look after his interests in a loss settlement

Loss ratio = the ratio of claims to premiums

Material Fact = anything which would affect the judgement of a prudent underwriter in accepting or deciding terms for a risk

Negligence = failing to act in what the law considers to be a reasonable manner

New for Old = insurance where the replacement value of property which has been lost or damaged is payable without deduction for depreciation

No Claim Discount = a discount granted on a renewal premium after a period free of claims

Policy = written evidence of the terms of an insurance contract

Policyholder = the insured person

Preamble Clause = the clause in a policy which sets out the essential elements of the contract

Premium = the money paid by the insured to the insurer for cover as
provided in the policy

Premium rate = the price per unit of insurance

Pro rata Premium = the premium based on the length of time for which the insurer was actually on risk

Proposal Form = an application for insurance which seeks to obtain from the proposer all the information relating to the risk

Proposer = the individual or organisation seeking insurance

Proximate Clause = the direct cause of a loss uninterrupted by any other event

Reinstatement = the making good of damaged property; the restoration of the sum insured after settlement of a loss on payment of an additional premium

Reinsurance = the placing by an insurer of part of a risk with another insurer or a re-insurer

Renewal Notice = the notice issued by a short term insurer to remind a policyholder that his contract will shortly terminate; in life insurance, a notice that a premium is due

Replacement Cost = the value of property as indicated by the current purchase price of a similar article

Salvage = whatever is recovered of an insured item or part of it, on which a claim has been paid

Self Insurance = insurance which a business organisation finances internally by establishing a fund to meet losses

Short Term = insurance that operates on a year to year basis and which may Insurance be terminated by the insurer or the insured

Special Perils = extra risks added to a policy not originally designed to cover these perils

Stop Loss = a form of reinsurance used as a means of limiting aggregate net Reinsurance losses on a particular class of business in any one year of account

Sum Insured = the monetary limit of the insurer’s liability under a policy

Third Party = any person or organisation other than the insurer (being the second party) against whom the insured (the first party) may have a claim. A third party may have similar rights against the insured

Third Party = motor insurance cover providing compensation for injury to
Insurance (motor) third parties and damage to their property

Third Party Fire & = third party insurance plus cover for fire damage to and the Theft Insurance (motor) theft of the insured’s own vehicle

Under Insurance = insurance for a sum insured less than the value at risk

Underwriter = an insurer; a person who makes decisions on whether or not to accept insurance business

Utmost Good Faith = the duty of utmost good faith imposed on both parties to an insurance contract to disclose all material facts.

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ORGANISATIONS COMMONLY KNOWN BY THEIR INITIALS

FIA Financial Intermediaries Association of South Africa

IISA Insurance Institute of South Africa

ILASA Institute of Loss Adjusters of South Africa

LOA Life Offices Association of South Africa

LUA Lloyd’s Underwriters’ Association

LUASA Life Underwriters Association of South Africa

NOSA National Occupational Safety Association

NRSO National Road Safety Organisation

SAIA South African Insurance Association

SARBA South African Reinsurance Brokers Association

SASRIA South African Special Risks Insurance Association

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