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A-B-C-D-E-F-G-H-I-J-K-L-M Accidental Death Insurance Insurance that provides coverage in the event of death due to accidental injuries, but not illness. In the event of death, payment is made to the insured's beneficiary. If bodily injury occurs (e.g., the loss of a limb), the insured receives a sum specified by the contract. This coverage is usually used in combination with dismemberment insurance. Top COBRA (Consolidated Omnibus Budget Reconciliation) Regulations requiring an employer who employs more than 20 people to offer continued group insurance coverage to former employees for up to 18 months. If the employee dies, the employer must offer continued group health insurance coverage to widowed spouses and dependent children for up to 36 months. Co-payment A type of cost sharing where insured persons pay a specific flat amount per incident of service or a percent of the amount allowed as reimbursement for a covered service. Co-insurance A cost-sharing requirement under a health insurance policy in which the insured party pays a share of the costs of covered services. Top Deductible An amount the insured person must pay before insurance payments for covered services begin. For example, an insurance plan might require the insured to pay the first $250 of covered expenses during a calendar year. There may be other, separate deductibles that apply to certain types of services. Dependant A legal spouse if not legally separated or unmarried child under the age of 19 and not eligible for personal coverage or is a full-time student at an accredited school Disability Insurance Also known as disability income insurance, this type of policy provides income benefits to the insured if he or she becomes ill or is injured and can no longer work Top Elective A health care procedure that is not an emergency and that the patient and doctor plan in advance. Elimination period Period of time (beginning with the first day of illness or injury) during which no benefits are payable under a disability insurance policy. Benefits are paid only for costs incurred after the end of the elimination period. Exclusions Conditions, situations, and services not covered by the health care plan. Top Health Care Provider A doctor, hospital, laboratory, nurse, or anyone who delivers medical or health-related care. Top Indemnity A type of insurance plan under which you pay 100% of all medical bills up to an annual deductible. The insurance company then pays a percentage of all covered charges. In-Network A group of doctors, hospital and other health care providers contracting with a health plan, usually to provide care at special rates and to handle paperwork with the health plan. Top Lifetime Maximum The maximum dollar amount paid for all covered sickness and injuries for each insured person. Top Medicare A national health insurance program created in 1965 for people aged 65 and over, and for people who have been eligible for social security disability payments for more than two years. Funding for Medicare comes from payroll taxes and the premiums of beneficiaries. Medicare consists of two separate programs: A and B. Medicare Part A, which is automatic at age 65, covers hospital costs and is financed largely by employer payroll taxes. Medicare Part B covers outpatient care and is financed through taxes and individual payments toward a premium. Multiple Employer Trust (MET) A group of small employers brought together by a plan sponsor to provide group health coverage to their employees either through insurance or self-funding. Top Open Enrollment Period A period of time, often once or twice a year, during which individuals are permitted to enroll in group insurance plans. Out-Of-Network Health care services received outside the HMO, POS or PPO network. Out-Of-Pocket Expense Any medical care costs not covered by insurance, which must be paid by the insured. Top PPO (Preferred Provider Organization) A delivery system where providers are under contract to an insurance company or health plan to provide care at a discount or negotiated rate. There is freedom of choice among In-Network providers, including specialists. When In-Network providers are used, out-of-pocket expenses are lower and no claim forms are required. Pre-existing Conditions A condition for which medical advice, diagnosis, care or treatment, including use of prescription drugs, was recommended or received from a licensed health practitioner during a specified period of time immediately preceding the effective date of coverage. Top Short-term Disability Insurance A disability insurance policy that pays benefits only for a limited period of time (e.g., 26 weeks or one year Top Term Life Insurance A form of life insurance which provides coverage for a specified period of time and does not build cash value. Third Party Administrator (TPA) Organization that processes health plan claims without bearing any insurance risk. Top Utilization Management A method of managing medical care costs by controlling the fees charged by providers for various medical treatments, as well as the appropriateness of the treatment. Utilization management controls the component of appropriateness for medical care by using established criteria to review the care patients receive and make sure it is necessary and appropriate. Top |
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A-B-C-D-E-F-G-H-I-J-K-L-M ADA (Americans with Disabilities Act ) The Americans with Disabilities Act ("ADA") prohibits discrimination against otherwise qualified individuals with mental or physical disabilities. The Act requires employers to provide "reasonable accommodation" to such workers. The Act applies to all employers with 15 or more employees. An employee must exhaust his/her administrative remedies before the EEOC first, prior to bringing a civil court action. Compensatory damages are available if the defendant acted intentionally. Punitive damages are available if the defendant acted intentionally with malice or reckless indifference to the plaintiff's rights. ADEA (Age Discrimination in Employment Act) The Age Discrimination in Employment Act ("ADEA") prohibits discrimination in employment of persons 40 years of age or over. The Act applies to most employers with 20 or more employees. Requires exhaustion of administrative (EEOC) procedures first. Allocation Allocation is the degree of coverage which must be determined between two opposite opinions / sides / points of view. Under Directors and Officers Liability three types may apply: 1. Between covered individuals and uncovered individuals (example: Directors and Officers vs. employees). 2. Between Covered Acts vs. Excluded (uncovered) Acts (example: When an exclusion applies). 3. Between Directors and Officers and the corporate entity (example: Because the corporate entity is not covered under the Directors and Officers policy). Under Employment Practices Liability Policies two types may apply: 1. Between covered parties and uncovered parties (example: employees vs. independent contractors). 2. Between Covered Acts and Excluded (uncovered) Acts (example: When an exclusion applies). Unlike Directors and Officers Liability policies that may not provide coverage for the entity, Employment Practices policies generally do insure the entity. Therefore, no allocation need be made between the insured individuals and entities. In addition, Employment Practices Liability policies are frequently duty-to-defend policies which, based on many state's laws, do not permit allocation of defense costs between covered and uncovered allegations. Top Binder The document that outlines and "binds" the purchase agreement between the client, the broker, and the carrier while the insurance contract in being issued. Top Capacity The amount of insurance that is available either by an individual insurance company or the entire insurance industry. The major Directors and Officers Liability and Employment Practices Liability insurance companies typically have between $25mm and $50mm in capacity. Carrier Any Insurance Carrier or Insurance Company that provides insurance contracts for a premium. Change of Control Event Ann event that changes the control of the Board of Directors or changes the ownership of a majority (over 50%) of the voting securities. Typical Change of Control events occur include when a corporation is acquired or merged into another organization, or following a bankruptcy proceeding. "Claims Made" Policy "Claims Made" policies cover only claims that are filed during the policy period for Wrongful Act(s) committed before or during the policy period. Co-Insurance Co-insurance is a provision that obligates the Insured to absorb a specified percentage of Loss that otherwise would be paid by the insurance company. Co-Insurance in the Employment Practices Liability context is often used as an alternative to a "Hammer Clause" discussed below. Concurrent Liability "Concurrent Liability" means "damages, settlements and ‘Costs’, ‘Charges’ and ‘Expenses’ incurred jointly by both the Company and the Directors or Officers." Continuity Continuous insurance coverage without any interruption or gaps in coverage terms, conditions, and endorsements. Continuity Dates are often used in Directors and Officers Liability and Employment Practices Liability policies to either identify how far back in time the policy will respond to litigation or to identify the last warranty statement completed by the Insured. Also known as Pending or Prior Litigation Date. Corporate Reimbursement (Coverage B) Coverage B is the corporate reimbursement portion of a Directors and Officers liability policy. The policy will pay on behalf of (or will reimburse to) the corporation the amount the corporation is required (or permitted) to pay as indemnification to the directors and/or officers. Top Deductible/Retention Amount The portion of a claim that the Insured is required to fund. Also known as "Self-Insurance." Defendant The individual or entity charged with wrongdoing in a legal suit. Derivative Action When a claim is brought by the company against is own directors and/or officers. DIC (Difference in Conditions ) This will apply to an excess wording that does not follow form to the primary wording. Where the different conditions apply, this excess policy may drop down to become primary. Directors and Officers Liability (Coverage A) Coverage A pays on behalf of the directors and officers for any alleged wrongful act in their capacity as directors and officers. This coverage does not apply if the individual insureds are indemnified or entitled to indemnification by the corporation. Coverage would then fall under Coverage B (Corporate Reimbursement). "Directors and Officers Liability"(Directors and Officers) Policy Terms A company, through its by-laws can indemnify directors and officers for most situations. Because a company can indemnify for most things, when a claim comes along it is necessary to determine which agreement the claim would fall under. Directors and Officers Liability Policies have two insuring agreements:
Discovery Period / Extended Reporting Period / Run-Off Coverage EEOC (Equal Employment Opportunity Commission) The U.S. Equal Employment Opportunity Commission (EEOC) is an administrative body of the federal government. The EEOC was established by Title VII of the Civil Rights Act of 1964. The EEOC enforces the principal federal statutes prohibiting employment discrimination, including:
In most cases an employee is required under the federal statutory scheme to bring a charge or complaint before the EEOC prior to filing a federal civil court action under alleging violations of any of the above statutes. Fidelity As mandated by the 1974 ERISA (Employee Retirement Income Security Act), all fiduciaries must have a fidelity bond on the pension plan itself. Fidelity Bond guards against theft, dishonesty, fraud, misappropriation or mysterious disappearance of money, securities and other property. Fiduciary For Fiduciary Liability Insurance purposes, a fiduciary is any person or personal entity who has discretionary authority over plan assets. A fiduciary is held to a higher standard than other individuals because a third party relies upon the integrity and expertise of that fiduciary. Exposure arises for a fiduciary from decisions made. This is very similar to the exposures faced by directors and officers of companies. FLSA (Fair Labor Standards Act of 1938) The Fair Labor Standards Act of 1938, as amended, ("FLSA") sets standards requiring employers to pay a minimum wage, overtime pay, equal pay for equal work and governs child labor standards. FMLA (Family and Medical Leave Act of 1993) The Family and Medical Leave Act of 1993 ("FMLA") allows employees up to twelve (12) weeks of job protected leave in any 12 month period for (i) birth of a child (ii) the placement of a child for adoption or foster care; or (iii) the serious health condition of an employee or immediate family member. To be eligible for protection, an employee must have been employed at least 12 months and worked at least 1250 hours in the 12 months prior to leave. Top Hammer Clause This language of many insurance policies states that if the Insured refuses to accept a settlement offer from the claimant/plaintiff that is acceptable to the Insurer, then the Insurer's liability for damages and defense costs is limited to amount of the proposed settlement and defense cost incurred up to the point of the settlement offer. Top Indemnification When the directors and officers are paid by the company for their expenses resulting from claims, investigations, etc. Independent Contractor An Independent Contractor is a person who contracts with another person or entity to do something for them. The Independent Contractor is not controlled by the other person/entity. In particular, the other person/entity does not have the right to control the Independent Contractor's physical conduct in the performance of the undertaking. Indication The insurance carrier's offer of insurance coverage for the client. An indication outlines the terms of the offer including limit of liability, retention, premium and policy terms, conditions and endorsements. Insured(s) Any Insured Person (example: Directors and Officers) or Insured Organization (example: the Corporation or its Subsidiaries) who is afforded coverage under the terms of the contract. Top Limit of Liability The maximum amount of insurance available to pay for claims under a policy. Directors and Officers Liability and Employment Practices Liability carriers typically offer an aggregate limit of liability. This means that one amount is the maximum available for all claims made during the policy period. (For example: If you purchase a $1mm Limit of Liability and your first claim made during the policy period utilizes the full $1mm, there will be no Limit of Liability left for any subsequent claims that may be made during the remainder of the policy period.) Top Non-Monetary Relief When used in Employment Practices Liability policies, this term generally refers to equitable style relief such as injunctive relief, declaratory relief, or specific performance granted by a court or agreed to in a settlement. Examples include a court ordering an employer to build a ramp in a disability discrimination case, a court order an employer to implement a sexual harassment or discrimination sensitivity training program for all employees, or forced implementation of a specific plan for increased minority participation in management. Generally, such relief is not covered under Employment Practices Liability policies. NLRA (National Labor Relations Act) The National Labor Relations Act ("NLRA") is a comprehensive federal employment law regulating private sector employers and unions. It establishes the National Labor Relations Board ("NLRB") to administer the law and resolve disputes that arise under the law. The Act prohibits discrimination based on union membership or non-membership, participation in union activities or filing or testifying as part of an unfair labor practice. Top OFCCP (Office of Federal Contract Compliance Programs) The Office of Federal Contract Compliance Programs (OFCCP) is part of the U.S. Department of Labor's Employment Standards Administration. The Office of Federal Contract Compliance Programs enforces various statutes largely through conducting compliance reviews and complaint investigations of federal contractors and subcontractors personnel policies and procedures. OSHA (Occupational Safety and Health Act) The Occupational Safety and Health Act ("OSHA") provides a means of reducing incidents of illness and injuries caused by substandard safety and health conditions in the workplace. OSHA prohibits retaliation against workers reporting unsafe conditions. Top Pending or Prior Litigation Litigation that exists as of the effective date of the policy. The litigation can be both open (currently active and working) or closed (resolved). Typically, administrative actions such as EEOC actions are included as prior and pending litigation under Employment Practices Liability policies. Plaintiff The individual or entity who brings a legal suit against any other party. Policy Period The period of time from the inception date or effective date of the policy to the expiration date or cancellation of the policy. Prior Acts/Prior Acts Date (Retroactive Date) Actions or Wrongful Acts that occur prior to a date in time. Policies may have "Prior Acts Dates" or "Retroactive Dates." Carriers will not pick up litigation that arises out of actions that occur prior to these dates. Top Retaliation When used in Employment Practices Liability policies, this term generally means an adverse employment decision allegedly taken in response the following: 1. An employee's actual or attempted exercise of a right that such employee has under law 2. An actual or threatened disclosure by an employee of an act by the employer or a fellow employee that is allegedly in violation of the law Examples include firing, demoting or refusing to promote an employee for filing a worker's compensation claim, for reporting a toxic spill to the government or for filing a claim under the Federal False Claims Act. Generally, retaliation is a covered wrongful act under most Employment Practices Liability policies. Retention -- see Deductible Retroactive Date -- see Prior Acts Date Run-Off Coverage -- see Discovery Period Top Subrogation The substitution of one person in the place of another with reference to a lawful claim, demand or right, so that he who is substituted succeeds to the rights of the other in relation to the debt or claim, and its rights, remedies, or securities. Insurance companies generally have the right to step into the shoes of the party whom they compensate and sue any party whom the compensated party could have sued. Surplus Lines Tax (SLT) Surplus Lines is specialized property or liability coverage provided by a non-admitted insurer in instances where it is unavailable from insurers licensed by the state. Examples of surplus lines are coverage for some environmental impairment liability risks or liability coverage for directors and officers of certain companies. Top Third Party Claims In the context of Employment Practices Liability, Third Party Claims usually refers to claims of discrimination or harassment brought by clients, customers, vendors or other non-employees of an entity. Title VII of the Federal Civil Rights Act of 1964 Title VII of the Federal Civil Rights Act of 1964 ("Title VII") prohibits discrimination in employment on the basis of race, color, religion, sex or national origin. Title VII applies to all employers with 15 or more employees. An employee must exhaust administrative remedies (EEOC) first. The Act permits recovery of back pay and front pay with discretion to award fees to successful plaintiff. Compensatory and punitive damages are available in cases of intentional violations of Title VII. Available equitable relief includes hiring, reinstatement or promotion. Top WARN (Worker Readjustment and Retraining Notification Act) The Worker Readjustment and Retraining Notification Act ("WARN") requires employers to give notice to employees and other interested individuals and parties prior to implementing a wide range of work force reductions. Warranty A question in an application form which asks if the directors and officers are aware of any issues which are not currently claims, but have the potential to become claims in the future. Underwriters will not want to provide coverage for any such issues. Worker's Compensation Each state has a worker's compensation statute. Generally, the worker's compensation system requires an employer to provide compensation and pay for medical expenses incurred by injured employees, regardless of fault, when they suffer work-related injuries or illness. In exchange, the employer is given immunity from common law tort suits brought by the employees for work-related injuries. Wrongful Act (Directors and Officers) Any actual or alleged act, error, omission, misstatement, misleading statement or breach of duty by an insured person in his or her capacity as a director or officer of the company. Wrongful Act This definition usually lists the defined perils covered by the policy. Among other things, this definition in most Employment Practices Liability policies includes discrimination, harassment, retaliation, and wrongful termination as those terms are defined under the policies. Top
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