For Consumers

Coverage descriptions

Company complaints type of coverage descriptions

The Office of the Insurance Commissioner's agent, agency and company lookup tool displays complaints against an insurance company by types of insurance coverage. Definitions used for types of coverage in the tool include:

Note: All but "Miscellaneous” have subcategories that describe a more specific area of coverage within a primary category. The subcategories are divided into two categories:

  • First level coverage type: Sub-types of the major category. 

  • Second level coverage type: Detailed descriptions of the type of coverage. 

Auto

First level

Individual private passenger: Personal automobile coverage for liability, physical damage and other exposures for automobiles owned or leased by individuals or families.

Commercial: Provides coverage for liability, physical damage and other exposures for automobiles owned or leased by businesses, partnerships or organizations.

Motorcycle: Individual coverage for any two-wheel automotive vehicle having one or more saddles and sometimes a sidecar with a third supporting wheel.

Motorhome/recreational vehicles: Individual coverage for an automotive vehicle built on a truck or bus chassis and equipped as a self-contained traveling home.

Rental: Automobile insurance coverage for rented vehicles.

Other: All other automobile coverage.

Second level

Liability: Policyholder's legal liability resulting from injuries to other persons or damage to their property.

Physical damage: Provides coverage to vehicles owned, leased or operated by a covered person due to collision or under comprehensive coverage and non-collision hazards, such as fire, theft or falling objects.

Collision: Provides protection against an automobile’s physical contact with an inanimate object, resulting in damage to the insured’s’ vehicle.

Comprehensive: Protection in case of physical damage suffered by the insured’s car, other than collision or theft. Examples: Fire, flood.

Medical payments: Coverage, available in various liability insurance policies, in which the insurer agrees to reimburse the insured and others, without regard to the insured's liability, for medical or funeral expenses as the result of bodily injury or death by accident under specified conditions.

Uninsured motorist and/or underinsured motorist

  • Uninsured motorist:Protection covers the policyholder, family members and passengers if injured by a hit-and-run motorist or a driver who carries no liability insurance.
  • Underinsured motorist:Protection covers the policyholder and family members if injured by a motorist who carries liability limits less than his/her proportionate share of the total liability. Also provides coverage if the other driver's insurance is with a financially irresponsible insurer.

No-fault/personal injury protection (PIP)

  • No-fault:Forms of insurance by which a person's financial losses resulting from an automobile accident are paid by their own insurers, regardless of who was at fault.
  • Personal injury protection (PIP): A form of insurance issued in some states with minimum coverage limits, or thresholds, set by state law. Injured parties cannot sue the responsible party until the specific threshold of expenses are met.

Personal effects coverage (PEC): Coverage that protects personal effects of the renter while in the rental car.

Policy proof of interest (PPI): Insurance covering peculiar conditions of risk concerning anticipated freight. Example: If a company picks up freight which is destroyed, they suffer losses such as shipping fees.

Rental reimbursement: Automobile coverage that pays the cost of a vehicle rental during a period the insured vehicle requires covered repair.

Surplus lines: Coverage obtained in an unlicensed insurance company because of its unavailability in the licensed market.

Towing: An endorsement to an automobile policy that pays specified amounts for towing and related labor costs.

Other: Other second-level coverage types that don’t clearly fit into any specific category in the secondary level.

Fire, allied lines and commercial

First level

Fire, allied lines: Insurance covering the peril of fire damage to property, as well as extended coverage, which includes perils other than fire, such as windstorm, hail, explosion, riot, etc., along with resultant damage caused by smoke and water. Allied lines provide further coverage against perils such as sprinkler leakage, rain and non-fire-related water damage, and earthquake.

Crop/hail: Policies may cover one or more of the perils that affect growing crops: bad weather, hail, fire, flood, insects, and disease.  Coverage is reduced proportionally as harvesting progresses, and terminates when the harvest is complete.

Commercial MP (multi-peril coverage): Commercial package policies which include liability, fire and allied lines coverage.

Credit property: Insurance against loss of or damage to personal property, covering a creditor's security interest in the property, when the insurance is written as part of a loan or other credit transaction. Can include GAP insurance as it relates to the difference between loss payments and loan indebtedness.

Dwelling fire: Covers buildings and the personal property inside. Designed to insure one- to four-family dwellings, whether owner-occupied or tenant-occupied, and can be used to insure mobile homes. Policies do not include theft, liability or medical-payments coverage.

Builder’s risk: Provides direct damage coverage on buildings or structures while they are under construction. It also covers foundations, fixtures, machinery and equipment used to service the building and materials and supplies used during construction.

Other: Lines of property and casualty insurance that don’t clearly fit in any other category at this level.

Second level

Liability: The portion of insurance that covers the insured for negligence against another person or another person's property.

Theft: Covers theft of the insured's property.

Windstorm: Covers windstorms, including hurricanes, cyclones and high winds, which are perils not normally covered under standard homeowner policies.

Fire - real property: Coverage of insured's real estate property against the peril of fire.

Personal property: Coverage for property not attached to real property, property other than real estate, property that is movable or separable from real estate for property insurance purposes and tangible property. Personal property may be used for business purposes and, therefore, may be covered by a commercial policy, while personal property not used for business purposes is generally covered only by personal lines policies (such as homeowner or renter insurance).

Surplus lines: Coverage obtained with an unlicensed insurance company because of its unavailability in the licensed market.

Other: Other types that don’t fit clearly into any specific category in the second level.

Homeowner

First level

Homeowner: Coverage for homes, including dwelling coverage. Protects owners and tenants against losses or damage to their residential property and provides protection against liability claims by others suffering injury or damages while on such property.

Group homeowner: Homeowner insurance containing a benefit package policy that combines property and liability coverage of property and individuals. Coverage obtained by a group member/enrollee/certificate-holder through a master contract issued to the association/group in which the individual or family belongs.

Farm owner/ranch owner: A contract which combines personal and business multiple-line insurance. Coverage for the entire farm and ranch operations may include the dwelling.

Mobile homeowner: Coverage for mobile homes, which are classified as portable units that are built to be towed on their own chassis with frame and wheels but are permanently affixed to the real estate and designed for year-round living.

Condo/townhouse: Coverage protecting the insured’s personal property and loss of use. Coverage may include protection against: fire, lightning, vandalism, malicious mischief, wind, hail, explosion, riot, civil commotion, vehicles, aircraft, smoke, falling objects, weight of ice/sleet/snow and volcanic eruption.

Renters/tenants: Coverage for the contents of a renter’s home/apartment and liability. Tenant policies reflect homeowner insurance but they do not cover the structure. It covers inside structure changes such as carpeting, kitchen appliances and built-in bookshelves.

Other: Does not clearly fit in any other category in this level.

Second level

Liability: The portion of insurance that covers the insured for negligence against another person or another person's property.

Theft: Covers theft of the insured's property.

Earthquake: Covers direct damage resulting from earthquake or volcanic eruptions. Excluded are losses resulting from fire, explosion, flood or tsunami.

Flood: Coverage made available to residents of a community on a subsidized and non-subsidized premium rate basis once the governing body of the community qualifies that community for coverage.

Fire - real property: Coverage of insured's real estate property against the peril of fire.

Single-interest: Insurance protecting the interest of only one of the parties having an insurable interest in certain property, such as that protecting a mortgagee but not the mortgagor, or protecting the seller but not the buyer of merchandise.

Medical payments: Coverage provided under the homeowner policy. The insurance includes medical expenses of persons who sustain bodily injury at an insured's premises without regard to negligence. Medical expenses include first aid, surgery, X-rays, dental services, prosthetic devices and transportation by ambulance and funeral services.

In-home business/incidental business: Provides comprehensive coverage for business personal property and business general liability exposures, reducing the risk of operating a small service or retail business from home.

Personal property: Property not attached to real property, property other than real estate, property that is movable or separable from real estate for property insurance purposes and tangible property. Personal property may be used for business purposes and therefore may be covered by a commercial policy, while personal property not used for business purposes is generally covered only by personal lines policies (such as homeowner or renter insurance).

Replacement cost: Sum needed to replace an insured’s damaged or destroyed property with one of a like kind and quality, equivalent to actual cash value, minus physical depreciation (fair wear and tear) and obsolescence.

Loss of use: If your home is destroyed by an insured peril or it becomes uninhabitable because of an insured peril, your standard homeowner policy provides you coverage for setting up a temporary living situation. Loss of use covers any additional expenses if you have to move out of your home.

Windstorm: Covers windstorms, including hurricanes, cyclones and high winds, which are not normally covered under standard homeowner policies.

Surplus lines: Coverage obtained from an unlicensed insurance company because of its unavailability in the licensed market.

Other: Other types that don’t fit clearly into any specific category in the second level.

Life and annuities

First level

Individual life: Covers the life of an individual, with the face value usually payable at the death of the insured.

Group life: Coverage obtained by a group member/enrollee/ certificate-holder through a master contract issued to the association/group to which the individual belongs, usually paying face value benefits upon the death of the covered individual.

Individual annuities: The policy pays a benefit at regular intervals for the life of the annuitant or for a specified period, usually beginning at retirement.

Group annuities: Annuities purchased by a group member/enrollee/ certificate-holder through a master contract issued to the association/group to which the individual belongs. These annuities pay a benefit at regular intervals for the life of the annuitant or for a specified period, usually beginning at retirement.

Credit life: A type of decreasing term insurance usually issued to a creditor to cover the life of a debtor for an outstanding loan.

Accelerated benefits: Prepayment of a specified percentage of life insurance death benefits prior to death to cover the cost of treatment for a life-threatening disease or confinement to a nursing home. Generally used in case of a terminal illness. Also known as “living benefits.”

Other life and annuity: Doesn’t clearly fit in any other category in this level.

Second level

Accidental death and dismemberment: A form of accident insurance, which indemnifies or pays a stated benefit to the insured or his/her beneficiary in the event of an accidental bodily injury or death (not due to natural causes).

Association: The pool (association or syndicate) is an organization of insurers or reinsurer through whom life insurance and annuities are written/purchased with the premiums, losses, and expenses shared in agreed amounts among the insurers belonging to the pool.

Equity indexed: Equity index futures typically have dividend rates lower than money market returns, and futures prices tend to be higher than spot index values.

Fixed: Guarantees a specific payment amount in the future.

Premium wavier: An agreement attached to a policy which exempts from coverage certain disabilities or injuries that otherwise would be covered by policy.

Single premium: A single premium contract is paid at the inception of the policy and the policy becomes fully paid.

Term: Life insurance in effect for a specified limited period. If an insured dies within that period, the beneficiary receives payment. If the insured survives the specified limited period, the beneficiary receives nothing.

Universal: Adjustable life insurance, under which premiums flex, protection adjusts, and the insurance company discloses expenses and other charges to the purchaser.

Variable: A policy allowing premium payments to vary within certain limits at the option of the policyholder.

Whole life: A policy remaining in full force and effect for the life of the insured with premium payments being made for the specified period. Also known as “ordinary life.”

Other: Other secondary level types that do not fit clearly into any specific category in the secondary level.

Accident and health

First level

Individual: Coverage against sickness or injury. This includes all major medical insurance coverage, which after the limits of coverage have been exhausted under a basic plan, medical expenses relating to room and board, physician fees, miscellaneous expenses such as bandages, operating room expenses, drugs, X-ray and fluoroscopy are then met under a major medical plan.

Group: Insurance that is issued against sickness or injury where the group is the policyholder and the individual insured is the certificate holder.

Credit accident and health: Usually issued to a creditor to provide indemnity for payments or debt becoming due on a specific loan or other credit transaction if the debtor becomes disabled.

Other: Doesn’t clearly fit in any other category in this level.

Second level

Accident-only: Health insurance pertaining to only accident coverage.

Disability income: Provides benefits in case of the insured's inability to perform all or part of their occupational duties because of an accident or illness.

Health-only: Insurance covering sickness only. This can include an HMO (health maintenance organization) that provides basic health care services to enrollees on a prepaid basis except for enrollees' responsibility for co-payments, deductible and a PPO (preferred provider organization).

Medicare Supplement (policies or certificates): Provides accident and health expenses not covered under Medicare. The policy type identifies which of the standard Medicare Supplement policies is involved in the complaint. 

Medicare Select (policies or certificates): The Medicare HMO operates similar to HMOs and PPOs (preferred provider organization) in arranging services for covered persons through designated providers. 

Long-term care: Designed to provide coverage for no less than 12 consecutive months for necessary medical services provided in a setting other than an acute care unit of a hospital.

Home health care: Health care provided in the home of the patient, usually by a private nurse or a state-licensed home health care agency. Services are usually limited to part-time or intermittent nursing care and physical or occupational rehabilitation.

Mental health: Coverage for professional mental health services, including psychologists, crisis centers, rehabilitative therapy, etc. 

Dental: Dental service plans provide services from participating dentists or other health care personnel.

Limited benefits: A life insurance policy with limited benefit payments (all benefits are paid to the beneficiary).

Chiropractic: Covers care provided by a chiropractor. Normally, not seen as regular health maintenance, but as a term recovery plan.

Hospital indemnity: Provides a predetermined flat benefit for each day of hospitalization, regardless of expenses incurred.

Vision: Health insurance coverage for eye examinations and eyeglass or contact lens prescriptions.

Health Insurance Portability and Accountability Act (HIPAA): Guarantees that employers are not able to impose pre-existing condition limitations in the insurance they offer to new employees who had insurance coverage for at least 12 months with their previous employer.

Pre-existing condition: An illness or disability that existed before the effective date of a health or life insurance policy. Such a condition can result in cancellation of a policy or exclusion from coverage.

Cancer/dread disease: A policy that covers only medical expenses for specific catastrophic illnesses, such as cancer.

Self-funded/Employee Retirement Income Security Act (ERISA) of 1974

  • Self-funded:Financial preparations in advance to meet estimated losses.
  • Employee Retirement Income Security Act (ERISA) of 1974
    A United States federal law establishing (a) the rights of pension plan participants, (b) standards for the investment of pension plan assets, and (c) requirements for the disclosure of plan provisions and funding.

Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985: Requires that employers sponsoring group health plans offer continuation of coverage under the group plan to employees and their dependents who have lost coverage because of the occurrence of a "qualifying event." Qualifying events include reduction in work hours, many types of termination of employment, death and divorce.

Health maintenance organization (HMO): An organization that provides comprehensive health care services for subscribing members in a particular geographic area. 

Preferred provider organization (PPO): A health benefit plan with contracts between the sponsor and health care providers to treat plan members. A PPO can be a group of health care providers who contract with an insurer to treat policyholders according to a predetermined fee schedule. 

Other: Other types that don’t fit clearly into any specific category in the second level.

Liability

First level

General: Coverage that mostly pertains to claims arising out of the insured's liability for injuries or damage caused by ownership of property, manufacturing operations, contracting operations, sale or distribution of products, the operation of machinery and professional services. Covers all types of liability insurance other than employers, automobile or product liability.

Products: Covers liability of an insurer due to personal injury, death, emotional harm, consequential economic damage or property damage arising from the use or operation of a product manufactured and/or sold by the insured.

Professional/errors and omissions (EO): Coverage pertaining to claims arising from the insured's liability for injuries or damage caused by acts or errors and ommissions of the insured while performing the duties of his/her profession.

Umbrella: Excess liability coverage above the limits of basic liability insurance policy, such as the owners, landlords and tenants liability policy. The umbrella policy fills gaps in coverage under basic liability policies.

Directors and officers: Reimburses for loss because of wrongful acts by directors and/or officers while acting in their respective capacities. It covers defense costs, charges and expenses, as well as the actual settlements from litigation.

Other: Other types of liability coverage which don’t clearly fit in any other category in this level.

Second level

Medical malpractice:

  • Occurrence:Protects the insured for claims stemming from alleged incidents that take place during the policy period, even if the policy has expired or been canceled. Occurrence coverage is the most comprehensive kind of malpractice insurance.
  • Claims-made:Coverage is limited to claims or incidents which take place on or after the retroactive date designated in the policy and are first reported by the insured during the policy period. An alleged incident before the retroactive date is not covered regardless when the claim is made. It may also be necessary to secure "tail coverage" for protection against claims submitted after the coverage has expired.

Pollution: Coverage for liability to third parties arising from contamination of air, water or land due to the sudden and accidental release of hazardous materials from the insured site. The policy usually covers the costs of cleanup and may include coverage for releases from underground storage tanks. Intentional acts are specifically excluded.

Surplus lines: Coverage obtained in an unlicensed insurance company because of its unavailability in the licensed market.

Other: Other types that don’t fit clearly into any specific category in the second level.

Miscellaneous

First level

Fidelity and surety:

  • Fidelity:Insurance guaranteeing the honesty of persons holding positions of public or private trusts. The insurer accepts the responsibility of the employee to the employer for faithful performance of the duties of employment.
  • Surety:Insurance guaranteeing the performance of contracts, other than insurance policies, or guaranteeing and executing all bonds, undertakings and contracts of surety ship. One party becomes responsible to a third party for the act or negligence of a second party.

Ocean marine: Insurance for sea-going vessels and their cargoes, including liabilities connected with them. This covers ships and hulls, goods and cargoes, earnings (e.g. passage money, commissions, profit), and liability incurred by the owner or by any party interested in or responsible for insurable property for reasons of maritime perils while in transport.

Inland marine: A broad form of insurance, generally covering articles in transit as well as bridges, tunnels and other means of transportation and communication. Besides goods in transit (generally excepting trans-ocean), it includes numerous floater policies, such as those covering personal effects, personal property, jewelry, furs, fine arts and other items of value.

Title: Insurance against the loss of the title or against expenses due to a defective title, damage suffered by reasons of liens, encumbrances upon, defects in or the unmarketability of a title to such real property. Coverage may extend to heirs in case of death or to the insurers of a corporate owner of property.

In-home business/incidental business: Reduces the risk of operating a small service or retail business from home. Provides comprehensive coverage for business personal property and business general liability exposures.

Boiler machinery: Coverage for loss arising out of the operation of pressure, mechanical and electrical equipment. It covers loss of the boiler and machinery itself, damages to other property, legal fees and business interruption losses. The insurance covers business property, other property involved and legal fees.

Private mortgage insurance (PMI): Insurance written by a private company protecting the mortgage lender against loss due to a mortgage default.

Surplus lines: Coverage obtained in an unlicensed insurance company because of the coverage’s unavailability in the licensed market.

Watercraft: Coverage for damages resulting from the operation of motor boats too large to qualify for insurance under ordinary homeowner and small business policies. Coverage exists whether the boats are leased or owned by another party who operates them in the benefit of the business exposing them to liability. This covers the actual boat, engine, propellers and permanently attached equipment in and out of water while boating, launching, towing and storing.

Aircraft: Coverage on an all-risk basis whether the airplane is on the ground or in the air. Air cargo covers legal liability for damage destruction or other loss of a customer’s property while being shipped.

Extended warranty and service contracts: Repair or replacement service or indemnification for services such as the operational failure of covered property. Examples: Homeowner warranty, electronic devices warranty, etc.

Federal programs: Programs provided or administered by the federal government including Medicare, Medicaid and the National Flood Insurance Program.

Federal crop: Protection against natural disasters which may strike crops. 

Federal flood: Coverage made available to residents of a community on a subsidized and non-subsidized premium rate basis once the governing body of the community qualifies that community for coverage under the National Flood Insurance Act. Resident includes business and non-business operation with coverage written on structures and their contents.

Other: Doesn’t clearly fit in any other category in this level.

Second level

No second-level insurance types exist for this category.