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HomeCar Insurance ResourcesWhat are the different types of insurance clauses?

In Canada, as in many countries, insurance contracts (or policies) include various clauses that set out the terms, conditions, and stipulations under which the contract operates. These clauses detail the rights, obligations, and limits of both the insured and the insurer. While there are numerous specific clauses that might appear in any given insurance policy, the following is a general overview of some common types:

  1. Deductible Clause: Specifies the amount the policyholder must pay out-of-pocket before the insurer will cover the rest of the claim. Deductibles can vary depending on the type of policy and coverage.
  2. Exclusion Clause: Lists specific situations, conditions, or property that are not covered by the insurance policy.
  3. Co-insurance Clause: Specifies that the policyholder and the insurance company will share the costs of a claim. This is common in health insurance.
  4. Subrogation Clause: Allows the insurance company to take action against a third party responsible for a loss to recover the amount of a claim paid to an insured.
  5. Pro Rata Cancellation Clause: If either the insured or the insurer wants to cancel the policy, the insurer will return the unearned premium on a pro-rata basis.
  6. Misrepresentation Clause: Specifies that if the policyholder intentionally provides false information, the insurance company can void the policy.
  7. Incontestability Clause: Often found in life insurance, this states that after the policy has been in effect for a certain period, the insurer cannot dispute its validity based on statements made in the application.
  8. Grace Period Clause: Found in policies that require regular premium payments, it provides a set period after the due date for the insured to make payment without the policy lapsing.
  9. Assignment Clause: Details under what conditions and how the policy benefits may be transferred to another party.
  10. Beneficiary Clause: Common in life insurance, it designates who will receive the policy benefits upon the insured’s death.
  11. Free Look Period Clause: Allows a policyholder to cancel a new policy within a specific period (e.g., 10 days) after purchase for a full refund.
  12. Appraisal Clause: Used when the insured and the insurer disagree on the value of a claim. It allows for an independent appraiser to be involved.
  13. Arbitration Clause: Specifies that any disputes between the insured and the insurer will be resolved through arbitration rather than through the court system.
  14. Rider or Endorsement Clause: Adds, modifies, or excludes coverage. It essentially changes the base terms of the policy.
  15. Conditions Clause: Lays out the responsibilities of both the policyholder and the insurance company.
  16. Territorial Limits Clause: Specifies the geographical area within which the policy coverage is effective. For instance, an auto insurance policy might limit coverage to Canada and the U.S.
  17. Renewal Clause: Describes the terms under which a policy can be renewed once it expires. Some policies might be automatically renewed, while others may require a new application.
  18. Non-renewal Clause: Specifies the conditions under which the insurer can decide not to renew a policy at the end of its term.
  19. Notice of Claim Clause: Outlines the procedures and timelines the insured must follow to report a claim to the insurer.
  20. Coinsurance Penalty Clause: In property insurance, if a policyholder insures an asset for less than its actual value and suffers a loss, they might receive less than the full amount of the loss because of this clause.
  21. War Exclusion Clause: Often found in life and property insurance policies, this clause excludes coverage for losses caused by war or acts of war.
  22. Other Insurance Clause: Specifies how the policy will respond if other insurance policies also cover the loss. This helps prevent double recovery for the same loss.
  23. Reinstatement Clause: If a policy lapses due to non-payment of premiums, this clause outlines the terms under which the policy can be revived or reinstated.
  24. Change of Risk Clause: Specifies that the policyholder must notify the insurer of any significant change in risk. For instance, if you start a home business, you might need to inform your home insurance provider.
  25. Loss Payable Clause: Found in property insurance, this designates who receives the payment in the event of a claim. For example, if there’s a mortgage on a property, the lender might be listed as the loss payee.
  26. No-Fault Insurance Clause: Pertinent to some auto insurance policies in certain provinces, it means that each insurer pays for the damages to their insured’s vehicle regardless of fault in the accident.
  27. Actual Cash Value (ACV) Clause: Specifies that, in the event of a loss, the insurer will pay the cost to replace the damaged property minus depreciation.
  28. Replacement Cost Clause: Unlike ACV, this means the insurer will pay the full cost to repair or replace the damaged property without accounting for depreciation.
  29. Occurrence Limit Clause: Sets a maximum limit on the amount the insurer will pay for all claims resulting from a single occurrence or event.
  30. Aggregate Limit Clause: Specifies a maximum amount the insurer will pay for all claims over a specified period, usually a policy term.
  31. Umbrella Policy Clause: This typically provides additional liability coverage above the limits of homeowners, auto, and boat insurance policies. It can also provide coverage for claims excluded by primary policies.
  32. Nuclear Exclusion Clause: Common in many insurance policies, this clause excludes coverage for damages caused by nuclear reactions, radiation, or contamination.
  33. Pair and Set Clause: Found in property insurance, this states that if part of a set (like earrings or a set of china) is damaged or lost, the insurer will not pay for the replacement of the entire set, only the lost or damaged item.
  34. Cancellation Clause: Specifies the conditions under which the policy can be canceled either by the insurer or the insured before its expiration date.
  35. Non-concurrency Clause: Refers to a situation where an insured has multiple policies that don’t provide the same levels of coverage, causing potential gaps in the case of a claim.
  36. Binding Arbitration Clause: A stipulation that requires both parties (insurer and insured) to resolve disputes through arbitration rather than litigation.
  37. Mortgagee Clause: Protects the interests of a mortgagee (like a bank) in a property insurance policy, ensuring that the mortgagee will be compensated if a claim is filed.
  38. Liberalization Clause: If the insurer introduces an improved coverage condition or term without a premium charge, this clause ensures that the improvement applies to existing policies.
  39. Cross Liability Clause: Often found in liability insurance for businesses or organizations with multiple named insureds. It treats each insured as if they have their own policy, allowing one party to make a claim against another.
  40. Valued Policy Clause: In the event of a total loss, this clause pays the full face value of a policy, regardless of the actual cash value of the lost property.
  41. Time Limit on Certain Defenses Clause: Typically found in health or life insurance, it restricts the insurer’s ability to deny a claim or void a policy after it has been in force for a certain period, except in cases of fraud.
  42. Automatic Premium Loan Clause: Common in whole life insurance policies, it allows for unpaid premiums to be automatically borrowed from the policy’s cash value if the policyholder doesn’t pay them.
  43. Primary and Non-contributory Clause: Designates one policy as the primary coverage, meaning it pays out first in the event of a claim. Other policies won’t contribute until the primary policy’s limit is exhausted.
  44. Terrorism Exclusion Clause: Excludes coverage for damages caused by acts of terrorism. In some jurisdictions or situations, separate terrorism coverage can be purchased.
  45. Hostile Fire Exception: Although many policies exclude damage from war or hostilities, a ‘hostile fire’ – a fire that becomes uncontrollable or breaks out from where it was intended to be – might still be covered.

When dealing with insurance, it’s crucial to remember that specific clauses and their interpretations can vary based on the insurer, the type of insurance, and provincial regulations. As always, reading the policy document thoroughly and consulting with an insurance professional can provide clarity on any uncertainties.

About the Author: Valerie D. Hahn

Valerie is an insurance editor, journalist, and business professional at RateLab. She has more than 15 years of experience in personal financial products. She strives to educate readers and ensure that they are properly protected.

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