As part of a larger discussion with public adjusters addressing fresh perspectives on claim presentation a few weeks ago, my colleague Mike Poli revealed a perfect tool to make certain policy provisions remain understood: D.I.C.E. (Declarations Page. Insuring Agreement. Conditions. Exclusions).

For those not involved in the discussion, here are some points Mike tackled regarding using D.I.C.E. to prepare your client’s claim.

DECLARATIONS PAGE

While we must read the entire policy to make certain we know all provisions, we start with the Declarations Page. We’ll find important provisions summarized there, along with highlights to review in the policy itself. The Declaration Page is usually the first part of an insurance policy. It identifies who is an insured, what risks or property are covered, the policy limits, and the policy period (i.e., time the policy is in force).

INSURING AGREEMENT

The Insuring Agreement summarizes the carrier’s major promises. The insuring agreement also states what is covered. In the insuring agreement, the carrier agrees to do certain things (such as paying losses for covered perils and providing certain services). Two basic forms of an insuring agreement exist:

  • Named-perils coverage, under which only those perils specifically listed in the policy are covered. If the peril is not listed, it is not covered.
  • All-risk coverage, under which all losses are covered except those losses specifically excluded. If the loss is not excluded, then it is covered.

CONDITIONS

Conditions comes next (policy conditions, that is). The Conditions are provisions inserted in the policy that qualify limit the carrier’s promise to pay or perform. If the policy conditions are not met, the carrier can deny the claim. Typical policy conditions include the requirement to file a proof of loss with the carrier, to protect property after a loss, and to cooperate during the carrier’s investigation or defense of a liability lawsuit.

EXCLUSIONS

As the name implies, Exclusions take coverage away from the Insuring Agreement. The three major types of Exclusions are:

  • Excluded perils or causes of loss
  • Excluded losses
  • Excluded property

Typical exclusions under a homeowners or commercial property policy include flood, earthquake, and nuclear radiation. Excluded property under these policies include personal property such as an automobile, pet, or airplane.

WHAT DOES THIS MEAN FOR ME?

In our world, we have no claim without an insurance policy. We hope this tool helps our diligence in understanding each one. As we mentioned during the larger discussion: we are not saying anything you do not already know. Sometimes, though, having points re-emphasized in plain language reminds us to cover all the steps along the way.

MOTIVATIONAL POSTER OF THE DAY