Charges that generate insurance premiums that are enough to cover incurred claims, operational costs, risk charges, and contingency reserve funds.
Insurance Encyclopedia
ADFM
Abbreviation in the TRICARE program that means active duty family members.
Adhesion
A legal principle stating that any ambiguities or uncertainties in the wording of an insurance agreement will be construed against the insurer.
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MEDICAL: Band of scar tissue of two adjacent structures that are usually separate from each other. This condition may occur as the result of surgery, infection, or injury.
Adhesion contract
A standardized set of agreements offered by one (usually the stronger) party to another on a take it or leave it basis. An insurance policy is an example of such a contract. The insurer offers a personal auto policy, for example, that an individual may adhere to (or not) but in any case the individual may not change any of its terms. Because it has the stronger position, the insurance company has the burden to spell out its terms precisely. Such contracts are interpreted strictly against the author of the contract. Not to be confused with aleatory contract.
Adhesion insurance contract
A contract offered on a “take-it-or-leave-it” basis.
Adhesive Contract
An adhesive contract is one that is written and issued by one party to the contract and does not require the signature of the other party to the contract to be valid. Insurance contracts are adhesive contracts since the contract is written and issued by the insurance company and the insured is not required to sign the policy. If a dispute arises concerning the terms of the contract, courts will generally interpret the contract conditions in favor of the party that did not write the contract -in this case, the insured. (See Unilateral Contract).
Adhikari Suraksha Kavach (Executives All Risks/Businessman’s All Risks)
A personal package policy designed for executives and/or businessman. Policy covers (I) Laptop/portable computer due to any unforeseen loss or damage due to any cause whilst anywhere in the world, subject to an excess. (II) Cellular Phone: Loss and/or damage including theft, burglary, malicious or accidental damage (III) Loss of Cash: Loss of cash due to accident or misfortune when the insured is on official duty or on outstation tour subject to a maximum per event limit (IV) Baggage Insurance: Loss or damage to baggage due to accident or misfortune whilst on journey anywhere in the world (V) All Risks for Jewellery and Valuables (VI) Personal Accident (VII) Health Insurance (VIII) Personal Liability.
Adjacent
Living near to, but not in actual contact with nearby property. Some Insurance policies cover adjoining but not adjacent property. Refer “Adjoining.”
Adjoining
In physical contact with, rather than next to, but not touching. One building is adjacent to another when it is so located that it touches the other building. Contrast with “Adjacent.”
Adjudicate
Processing of an insurance claim by an insurance company through a series of edits for determination of coverage (benefits) and issue of payment to the provider or patient.