Claims paid by the original Insurer for which he has no legal liability. See Also: “Claims, types of ex-gratia payments.
Tag: RAW
Ex-turpi causa non oritur actio
‘An action does not arise from a base cause. The rule prevents a criminal from recovering under a liability policy for injury or damage that otherwise would be within the policy. However, in Hardy v. Motor Insurers Bureau (1964), the claimant, through a right conferred by the Road Traffic Act, had a direct right of action against the insurer. Recoveries can also be made for mere acts of negligence even though criminal.
Ex-works
A shipment term. When goods are shipped ex-works it is the duty of the seller to place the goods at the disposal of the buyer at the time and place specified in the contract (usually the premises of the seller) and to bear all costs involved in doing so.
Examination
An evaluation conducted by the state insurance department of an insurance company.
examination (Ex)
1. See physical examination (PE or PX) . 2. Audit of an insurer’s records, transactions, methods, and assets by a state insurance department or by internal or external auditors or accountants.
Examination under oath
Found in the conditions section of many insurance policies, the insurer’s right to examine an insured under oath following a loss. It is taken from an insured under oath and in the presence of a court reporter. The carrier asks questions pertinent to the claim involved, and the examination helps a carrier determine what happened in the loss and whether or not there is a claim that needs to be paid. Often referred to as EUO.
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A sworn statement in question and answer form usually taken before a notary and a certified shorthand reporter. It can be taken by any person appointed by the insurer but should be taken by an attorney experienced in first party property insurance matters (Third party liability policies do not have examination under oath provisions). It is taken for the purpose of allowing the insurer to cross-examine the proof of loss submitted by the insured. It is one of the most valuable tools an insurer has against fraud.
Examiner
Representative of a state department of insurance who performs official audits and investigates the compliance of insurance companies to regulations.
Examiner (General Insurance Terms/Health Insurance/Life Insurance)
A general term for a state insurance department employee who is sent to audit an insurer. In health insurance or life insurance, an examiner is a doctor assigned by an insurance company to examine prospective policyholders.
Exception
A peril or contingency specifically excluded from the insurance cover.
Exception (Health Insurance)
A clause in the policy contract that voids or removes the obligation for coverage.