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Case Manager A person, usually an experienced professional, who coordinates the services necessary under the case management approach.
Cash Surrender Value In a life insurance policy, if the insured wishes to surrender the policy in order to collect the cash value of the policy, the cash surrender value is the amount the insured is entitled to, as stated in the policy, based upon time in the policy,limits and payments. The amount of cash the insured will receive may be reduced by a surrender fee, any outstanding loans, and applicable interest.
Cash Value The amount that a life insurance policy will pay the insured if the Policy is terminated or canceled prior to maturity. The cash value is the amount the insured is entitled to, as stated in the policy, based upon time in the policy, limits and payments. The amount of cash the insured will receive may be reduced by a surrender fee, any outstanding loans, and applicable interest.
Casualty Insurance Insurance concerned with legal liability for personal injuries or damage to property of others, including many other types of insurance, such as workers compensation, plate glass, burglary, boiler and machinery, aviation, etc. "Casualty" is generally accepted to cover all classes outside the definition of "property insurance," so that a property and casualty company would tend to handle all forms of insurance other than life.
Catastrophe Policy This is an older name for Major Medical. See Major Medical.
Cause of Loss Previously called "peril," this is the actual type of event that causes the loss. Examples are: theft, collision, earthquake, flood, fire, or mischief.
CCRCs See Continuing Care Retirement Communities (CCRCs).
Certificate Booklet The plan agreement. A printed description of the benefits and coverage provisions intended to explain the contractual arrangement between the carrier and the insured group or individual. May also be referred to as a policy booklet
Certificate of Authority (COA) Issued by the state, it licenses the operation of an HMO (Health Maintenance Organization).
Certificate of Insurance A short-form documentation of an insurance policy.
Certificate of Need (CON) Issued by a governmental body. It certifies that the proposed facility will meet the needs of those for whom it is intended. Such need might involve constructing a new health facility, offering a new or different health service, or acquiring new medical equipment.
CGL - Commercial General Liability Policy The commercial general liability policy provides comprehensive general liability coverage for commercial risks covering all liability exposures for all locations and causes of loss except those specifically excluded or limited either within the coverage form or by endorsement. Protection may be provided on either an occurrence type of policy or on a claims-made-basis.
Charters Liability Insurance Liability coverage for parties or individuals who lease a vessel from another party.
Chemical Dependency Services The services required in the treatment and diagnosis of chemical dependency, alcoholism, and drug dependency.
Chemical Equivalents Drugs which contain identical amounts of the same ingredients.
Chop Shop Slang term for illegitimate enterprises which offer parts from dismantled stolen vehicles for sale.
Christian Science Organization A religious organization which is certified by the First Church of Christian Scientists. The organization may also be Medicare certified as a hospital or skilled nursing facility.
Civil Authority Clause A provision in a policy requiring the payment of the loss suffered by the policyholder if the insured property is destroyed by the city, or other civil authority, in an effort to prevent the spread of fire.
Civil Commotion A disturbance among, or a popular uprising of a large number of people.
Civil Commotion Exclusion A property policy exclusion that specifies that there is no coverage for property damage suffered as a result of any type civil commotion or riot.
Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) Part of the Uniformed Services Health Benefits Program which supplements the medical care available for families of active, deceased, and retired military personnel.
Claim An amount requested of an insurer, by a policyholder or a claimant, for an insured loss.
Claimant One who presents a claim, or one who has suffered a collectible loss.
Claims Reserve An estimate of the amount an insurance company expects to pay for reported and estimated claims. This may include amounts for loss adjustment expenses. In an insurance company's financial statement, it includes losses incurred but not reported, losses due but not yet paid, and amount not yet due.
Claims-Made A liability insurance method covering losses from claims asserted against the insured during the policy period, regardless of whether the liability-imposing causes occurred during or prior to the policy period. (However, may underwriters may not cover liability-imposing causes occurring prior to the policy period.) The coverage trigger is based on the retroactive date stated in the Declarations.
Claims-Made Trigger In order to trigger coverage in a claims-made liability policy, a claim must be made against the insured during the policy period and the injury or damage alleged in the claim must not have occurred prior to the retroactive date specified in the policy Declarations.
Class Rate Rates developed for a line of property/casualty business based on the concept of what is average for that particular class. For example; the class rate for fire on a frame grocery store would be based on the average statistics for all frame grocery stores and would be applied to all frame grocery stores unless otherwise specifically rated. Rates are then deviated for other factors such as the public protection class and, when applicable, individual risk characteristics.
Classification The systematic arranging of properties, persons or business operations into groups or categories according to certain criteria. The purposes of such classification in insurance are to create bases for establishing statistical experience and determining rates, and to avoid unfair discrimination. The essential concept of establishing classifications is that each risk should bear its fair share of the overall cost of expenses and loses in relation to its own relevant expenses and hazards. It is unfair discrimination to charge different rates for similar risks,and it is equally wrong to treat in the same manner risks which have differenct costs and expenses.
Clause Language in a policy which describes, limits or modifies coverage granted.
Clean-Up Costs Costs that a party incurs to clean pollutants from the ground, water or air after the occurrence of a pollution incident. These costs are usually mandated or assessed in response to a confirmed incident by the Environmental Protection Agency (EPA).
Closed Access A situation where covered insureds must select one primary care physician. That physician is the only one allowed to refer the patient to other health care providers within the plan. Also called Closed Panel or Gatekeeper model.
Closed Panel See Closed Access.
Co-insurance The percentage of covered expenses an insured individual shares with the carrier. (i.e., for an 80/20 plan, the health plan member's co-insurance is 20%.) If applicable, co-insurance applies after the insured pays the deductible and is only required up to the plan's stop loss amount. (see "stop loss.")
Co-pay/Co-payment The amount an insured individual must pay toward the cost of a particular benefit. For example, a plan might require a $10 co-pay for each doctor's office visit.
Co-Payment A flat, pre-set fee paid by an insured for office visits, drugs, and other medical services as member of an HMO or preferred provider service. These co-payments are normally a small fraction of the overall cost and act much like a service charge or handling fee.
Coastal Waters For the insurance of yachts and outboard motor boats, the waters of bays and inlets, as well as of the sea along the coast. Also referred to as contiguous waters.
COB Coordination of Benefits. See Nonduplication of Benefits.
COBRA See Consolidated Omnibus Budget Reconciliation Act of 1986.
COBRA (Consolidated Omnibus Budget Reconciliation Act) Federal legislation that requires group health plans to provide health plan members the opportunity to purchase continued coverage in the event their insurance is terminated. Applies only to employer groups with 20 or more employees.
Cognitive Impairment A deficiency in the ability to think, perceive, treason or remember resulting in loss of the ability to take care of one's daily living needs.
Coinsurance The provisions in insurance coverages in which the insured and the insurer agree to share in the covered losses in the proportion specified in policy terms and conditions.
Coinsurance Clause 1) In property insurance, a clause requiring the insured to maintain insurance at least equal to stipulated percentage of value in order to collect partial losses in full. If the insurance is less than the minimum required, that portion of the loss will be paid which the amount of insurance carried bears to the amount which should have been carried. Symbolically: Insurance Carried x Loss = Payment Insurance Required (subject to policy Limit) 2) In major medical insurance, the clause which specifies the percentage of a loss which the company will pay and the percentage which the insured will bear (e.g., 80-20, 75-25).
Coinsurance Clause A provision stating that the insured and the insurer will share all losses covered by the policy in a proportion agreed upon in advance, i.e., 80-20 would mean that the insurer would pay 80% and the insured would pay 20% of all losses. See also Percentage Participation.
Collision Damage Waiver When renting an automobile or other vehicle from a rental agency, the rental agreement between renter and rental agency may contain an option allowing the renter to pay an additional fee in exchange for the agreement by the rental agency to waive their rights to collect any collsion losses to the vehicle from tne renter.
Combined Ratio The addition of the ratio of losses incurred to earned premiums, and the ratio fo underwriting expenses to written premiums.
Commercial Multiple Peril A general term, sometimes shortened to commercial multi-peril, relating to that class of package policies which provides coverage for more than one peril or cause of loss in one contract. Not the same as a commercial package policy, which contains more than one line of business.
Commercial Policy - Health In Health Insurance, this term originally applied to policy forms intended for sale to individuals in commerce, as contrasted with industrial workers. Currently the term is loosely used to mean all policies that do not guarantee renewability
Common Area Most often used in reference to the property and liability coverages for apartments, condominiums, townhouses, cooperatives, and other related risks. Common areas are those areas not specifically owned by a tenant or individual property owner, but are owned either by the landlord or all the occupant-owners, or are under the control of the landlord or association. Common areas are open to all. The most common examples are hallways, parking areas, and recreational facilities.
Community Rating Under this rating system, the charge for insurance to all insureds depends on the medical and hospital costs in the community or area to be covered. Individual characteristics of the insureds are not considered at all.
Commutation Clause A clause in a reinsurance agreement which provides for discharge of all obligations (past, present and future) between the parties for reinsurance losses incurred. This clause is usually optional but may be mandatory.

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