Insurance & Claims Terminology Glossary (A–Z) | Spanish-English
A Professional Gift to the Interpreting Community from Samuel Arcelay
Insurance & Claims
The Language of Liability and Loss. Insurance is the safety net of the modern economy, and inevitably, that net often ends up in a tangle of litigation. Whether interpreting for a car accident, property damage, or workers' compensation, these terms define who pays, how much, and why.
"Vocabulary shifts depending on the relationship. A first-party claimant worries about deductibles and exclusions. A third-party claimant worries about liability limits and bad faith."
Misinterpreting terms like reservation of rights or indemnification can lead to a denial of coverage, making precision essential for the legal interpreter.
A
Accident ReportInforme del accidente
Definition: Official documentation of an incident by police or employer.
Notes: Essential evidence in injury claims.
Notes: Essential evidence in injury claims.
Act of GodActo de Dios / Fuerza mayor
Definition: An event caused by natural forces beyond human control, such as a tornado.
Actual Cash Value (ACV)Valor en efectivo real
Definition: Cost to replace an item minus depreciation.
Additional InsuredAsegurado adicional
Definition: Person or entity added to a policy to share liability protection.
Additional Living Expenses (ALE)Gastos de vida adicionales
Definition: Coverage for temporary housing and related costs after a loss.
Adjuster (Claims Adjuster)Ajustador de reclamaciones
Definition: Insurance representative who investigates, evaluates, and negotiates claims.
Adverse SelectionSelección adversa
Definition: The tendency of those in high-risk categories to purchase insurance disproportionately.
Agent (Insurance Agent)Agente de seguros
Definition: A professional who sells insurance policies on behalf of a company.
Aggregate LimitLímite agregado
Definition: Maximum amount an insurer will pay for all losses during a policy period.
All-Risk PolicyPóliza de todo riesgo
Definition: Coverage that protects against all risks unless specifically excluded.
Appraisal ClauseCláusula de tasación
Definition: Provision allowing independent appraisal if parties disagree on the value of a loss.
Arbitration ClauseCláusula de arbitraje (seguro)
Definition: Policy provision requiring disputes to be resolved outside of court.
Assignment of Benefits (AOB)Cesión de beneficios
Definition: Transfer of claim payment rights from insured to a service provider.
B
Bad Faith (Insurance)Mala fe del seguro
Definition: When an insurer unreasonably denies, delays, or underpays a valid claim.
Benefit DeterminationDeterminación de beneficios
Definition: Insurer’s official decision on what is covered and how much is paid.
Benefit PeriodPeríodo de beneficios (seguro por discapacidad)
Definition: Length of time disability payments will be made for a covered claim.
Binder (Insurance Binder)Cobertura provisional / póliza provisional
Definition: Temporary insurance contract until full policy is issued.
Bodily Injury Liability CoverageCobertura de responsabilidad por lesiones corporales
Definition: Pays for injuries the insured causes to others.
Broker (Insurance Broker)Corredor de seguros
Definition: Licensed intermediary who represents the insured in finding coverage.
Burden of Proof (Insurance)Carga de la prueba (reclamaciones de seguro)
Definition: Claimant must show that the loss occurred and is covered.
Business Interruption CoverageCobertura por interrupción de negocios
Definition: Insurance replacing lost income when business is suspended due to covered peril.
C
Cancellation NoticeAviso de cancelación
Definition: Formal notification that a policy will be terminated before expiration.
Captive AgentAgente cautivo / agente exclusivo
Definition: An agent who represents only one insurance company.
Catastrophic LossPérdida catastrófica
Definition: Extremely large loss affecting many policyholders at once (e.g. hurricane).
Certificate of Insurance (COI)Certificado de seguro
Definition: Document providing evidence that insurance coverage exists.
Claim (Insurance Claim)Reclamación de seguro
Definition: Formal request for payment or coverage after a loss.
Claim DenialNegación de la reclamación
Definition: Insurer rejects a claim due to lack of coverage or evidence.
Claim FileExpediente de la reclamación
Definition: Complete record kept by insurer including reports and statements.
Claims-Made PolicyPóliza de reclamaciones presentadas
Definition: Policy covering claims made during the period, regardless of when incident occurred.
Co-Insurance ClauseCláusula de coaseguro
Definition: Requirement for insured to carry a specific percentage of insurance to value.
Co-Pay (Health)Coseguro / copago
Definition: Fixed fee paid by insured for medical services.
Collision CoverageCobertura por colisión
Definition: Pays for damage to insured vehicle from a crash.
Comprehensive CoverageCobertura contra daños no causados por colisión
Definition: Covers theft, vandalism, weather, or falling objects.
Conditions (Policy)Condiciones de la póliza
Definition: Section setting forth the rights and duties of both parties.
Coordination of Benefits (COB)Coordinación de beneficios
Definition: Rules determining primary payer when covered by multiple policies.
Coverage LimitsLímites de cobertura
Definition: Maximum amount an insurer will pay for a covered loss.
D
Date of Loss (DOL)Fecha de la pérdida
Definition: Calendar date on which the damage or event occurred.
Declaration Page (Dec Page)Página de declaraciones
Definition: Key section summarizing coverage, limits, and premiums.
DeductibleDeducible
Definition: Amount paid out of pocket before insurance coverage begins.
Denied Claim AppealApelación de reclamación denegada
Definition: Formal request for reconsideration of a denial.
Depreciation (Insurance)Depreciación
Definition: Reduction in value due to age or wear.
Directors and Officers Liability (D&O)Responsabilidad de directores y funcionarios
Definition: Protection for corporate leaders against lawsuits regarding management decisions.
Disability BenefitsBeneficios por discapacidad
Definition: Payments for inability to work due to injury or illness.
Duty to DefendDeber de defensa
Definition: Insurer’s obligation to provide legal defense to the insured.
E
Earned PremiumPrima devengada
Definition: Portion of premium corresponding to time coverage has already been provided.
Effective DateFecha de vigencia
Definition: The date on which insurance coverage begins.
Endorsement (Rider)Endoso / anexo de póliza
Definition: Addition or modification to existing policy coverage.
Errors and Omissions (E&O)Seguro de errores y omisiones
Definition: Liability insurance protecting against claims of inadequate professional work.
Estimating SoftwareSoftware de estimación de daños
Definition: Programs used to calculate repair costs (Xactimate, etc.).
Evidence of InsurabilityPrueba de asegurabilidad
Definition: Medical/personal info required before granting certain coverage.
Excess Endorsement (X-Endorsement)Endoso de exceso (X-endorsement)
Definition: Additional coverage layer beyond standard limits.
Excess Liability Coverage (Umbrella)Cobertura de responsabilidad civil adicional (umbrella)
Definition: Additional layer of insurance above main policy limits.
Exclusion (Policy)Exclusión de póliza
Definition: Specific situations or losses not covered by a policy.
Experience RatingTarificación por experiencia
Definition: Method of setting premiums based on past loss history.
F
Fault DeterminationDeterminación de culpa
Definition: Insurer’s assessment of who caused the loss or accident.
Fidelity BondFianza de fidelidad
Definition: Protection against losses caused by employee dishonesty.
First-Party ClaimReclamación de primera parte
Definition: Claim filed by insured against their own policy.
Flood InsuranceSeguro contra inundaciones
Definition: Policy covering direct physical loss caused by flooding.
Formally Reserved Rights (ROR)Carta de reserva de derechos
Definition: Notification of potential coverage issues while investigating.
Fraudulent ClaimReclamación fraudulenta
Definition: False or exaggerated claim submitted for benefits.
Full Coverage (Informal)Cobertura completa
Definition: Term typically used to describe liability, collision, and comprehensive.
G
Gap InsuranceSeguro de brecha (GAP)
Definition: Covers the difference between car loan balance and ACV.
General Liability CoverageCobertura de responsabilidad civil general
Definition: Covers injury or damage caused by insured’s negligence.
Good Faith (Insurance Duty)Buena fe (deber de buena fe del seguro)
Definition: Legal obligation to act honestly and fairly toward policyholders.
Grace PeriodPeríodo de gracia
Definition: Time allowed after premium due date before policy lapses.
Guaranteed Replacement CostCosto de reemplazo garantizado
Definition: Pays full rebuild cost even if it exceeds policy limits.
H
Hazard (Insurance)Riesgo / peligro asegurado
Definition: Condition increasing the chance of loss (e.g. faulty wiring).
Hazard Insurance (Housing)Seguro contra riesgos (vivienda)
Definition: Portion of homeowners policy covering structure damage.
Health Insurance ExchangeIntercambio de seguros de salud
Definition: Marketplace for purchasing health plans (ACA).
Hold Harmless AgreementAcuerdo de exención de responsabilidad
Definition: Contract releasing a party from liability for certain losses.
Home Inventory ReportInventario del hogar
Definition: List of personal property used to support claims.
Household ExclusionExclusión del hogar
Definition: Clause preventing liability claims by family members.
I
Indemnification (Indemnity)Indemnización / resarcimiento
Definition: Compensation for loss intended to make the insured whole.
Independent AdjusterAjustador independiente
Definition: Adjuster working as independent contractor for multiple firms.
Independent Medical Examination (IME)Examen médico independiente (IME)
Definition: Doctor chosen by insurer evaluates injury severity.
Inflation Guard EndorsementEndoso de protección contra la inflación
Definition: Automatically increases limits to keep pace with inflation.
Initial Claim EvaluationEvaluación inicial de la reclamación
Definition: Preliminary assessment of coverage and liability.
Inland Marine InsuranceSeguro de transporte terrestre
Definition: Coverage for goods in transit and mobile equipment.
Insurance Carrier / InsurerAseguradora / compañía de seguros
Definition: Company that issues policies and pays claims.
Insurance Fraud InvestigationInvestigación de fraude de seguros
Definition: Inquiry into potential false statements or staged losses.
Insurable InterestInterés asegurable
Definition: Requirement that insured have a financial stake in the object insured.
Insuring AgreementCláusula de seguro / acuerdo de aseguramiento
Definition: Core section describing covered risks and conditions.
Incontestability ClauseCláusula de incontestabilidad
Definition: Limits insurer's ability to void a policy after a set period.
J
Joint Liability (Insurance)Responsabilidad conjunta
Definition: Multiple insured parties share financial responsibility for a loss.
Joint-and-Several LiabilityResponsabilidad solidaria
Definition: Doctrine allowing recovery of full damages from any one liable party.
Judgment Proof ClaimantDemandado insolvente / sin bienes para responder
Definition: Defendant lacking assets or insurance to pay a judgment.
Jurisdiction Clause (Policy)Cláusula de jurisdicción
Definition: Provision specifying which courts handle disputes.
K
Key Person InsuranceSeguro para persona clave
Definition: Policy protecting a business from loss due to a critical employee's death/disability.
Kidnap and Ransom InsuranceSeguro contra secuestro y rescate
Definition: Specialized coverage protecting against kidnapping and extortion.
Known Loss RuleRegla de pérdida conocida
Definition: Prohibition against insuring a loss that has already happened.
L
LapseCaducidad / lapso
Definition: Termination of policy due to non-payment.
Lapsed PolicyPóliza caducada
Definition: Coverage terminated for nonpayment.
Liability CoverageCobertura de responsabilidad civil
Definition: Pays damages for harm the insured causes to others.
Liability Limits (Split)Límites de responsabilidad (límites divididos)
Definition: Separate maximums (e.g. 25/50/25) for injury and property.
Long-Term Care InsuranceSeguro de cuidado a largo plazo
Definition: Policy covering nursing home or in-home chronic care.
Loss of Use CoverageCobertura por pérdida de uso
Definition: Reimburses rental car or housing while property is repaired.
Loss PayeeBeneficiario de la pérdida / acreedor prendario
Definition: Party (like a lender) entitled to receive claim payments.
Loss RatioÍndice de pérdidas
Definition: Comparison of claims paid versus premiums collected.
Loss ReserveReserva para pérdidas
Definition: Estimated value of a claim not yet paid.
M
Material MisrepresentationFalsa declaración material
Definition: False info provided that affects underwriting decisions.
Medical Payments (MedPay)Cobertura de pagos médicos (MedPay)
Definition: Pays medical bills for insured regardless of fault.
Mitigation of Damages (Insurance)Mitigación de daños (deber del asegurado)
Definition: Insured's duty to prevent additional damage after a loss.
Moral HazardRiesgo moral
Definition: Increased risk because the insured is less careful when protected.
Mortgagee ClauseCláusula hipotecaria
Definition: Protects lender's interest in the insured property.
Multi-Policy DiscountDescuento por pólizas múltiples
Definition: Premium reduction for bundling (e.g. auto + home).
N
Named InsuredAsegurado nominal / asegurado designado
Definition: Primary individual or entity listed on the policy.
Named Peril PolicyPóliza de peligros nombrados
Definition: Covers losses only from specific listed causes.
Network ProviderProveedor dentro de la red
Definition: Health provider contracted for discounted rates.
No-Fault InsuranceSeguro sin culpa
Definition: Each insurer pays their own insured's injuries regardless of fault.
Non-Renewal NoticeAviso de no renovación
Definition: Written notice that a policy will not be renewed at term end.
Notice of Loss (FNOL)Aviso de pérdida (primer aviso de pérdida)
Definition: First report notifying insurer of a loss or accident.
O
Occurrence vs. Claims-MadeCobertura por ocurrencia vs. por reclamaciones presentadas
Definition: comparison between policy triggers (event time vs report time).
Occurrence-Based PolicyPóliza basada en ocurrencias
Definition: Covers incidents during the period regardless of when filed.
Other Insurance ClauseCláusula de otros seguros
Definition: Policy provision explaining handling when multiple policies apply.
Out-of-Network ProviderProveedor fuera de la red
Definition: Provider not contracted; usually higher cost for insured.
Overlapping CoverageCobertura superpuesta
Definition: When more than one policy may cover the same loss.
P
Peril (Covered Peril)Peligro cubierto
Definition: Specific cause of loss such as fire or theft.
Personal Injury Protection (PIP)Protección contra lesiones personales (PIP)
Definition: No-fault medical coverage for drivers/passengers.
Point of ImpactPunto de impacto
Definition: Area where vehicles initially collide.
Policy ExclusionsExclusiones de la póliza
Definition: List of risks or situations specifically not covered.
Policy PeriodPeríodo de la póliza
Definition: Time span during which coverage is in effect.
PolicyholderTitular de la póliza
Definition: Person or entity that owns the policy.
PremiumPrima
Definition: Payment made by the insured to maintain coverage.
Primary vs. Excess CoverageCobertura primaria vs. excedente
Definition: Primary pays first; excess after exhaustion.
Product Liability InsuranceSeguro de responsabilidad civil por productos
Definition: Coverage against claims of injury caused by products.
Professional Liability InsuranceSeguro de responsabilidad profesional
Definition: Coverage for professionals (doctors, etc.) against negligence.
Proof of LossPrueba de pérdida / formulario de prueba de pérdida
Definition: Sworn statement describing the amount/details of a claim.
Q
Qualifying Event (Health)Evento calificativo
Definition: Life change allowing policy changes outside open enrollment.
Quota Share ReinsuranceReaseguro de cuota parte
Definition: Reinsurer assumes a fixed percentage of every policy written.
Quote (Insurance Quote)Cotización / presupuesto de seguro
Definition: Estimated premium cost based on risk profile.
R
ReinstatementReinstalación de póliza
Definition: Restoring a lapsed policy after missed premiums.
ReinsuranceReaseguro
Definition: Insurance purchased by one company from another to share risk.
Replacement Cost Value (RCV)Valor de reemplazo (RCV)
Definition: Cost to replace damaged property without depreciation.
Reservation of Rights (ROR)Reserva de derechos
Definition: Notification that coverage may not apply while still investigating.
Retroactive Date (Claims-Made)Fecha retroactiva (póliza de reclamaciones presentadas)
Definition: Earliest date on which an incident can occur and be covered.
Risk AssessmentEvaluación de riesgos
Definition: Process of analyzing likelihood and severity of potential losses.
S
Salvage RightsDerechos de salvamento
Definition: Insurer ownership interest in property after paying total loss.
Schedule of BenefitsTabla de beneficios
Definition: Breakdown of coverage types, limits, and costs.
Self-Insured Retention (SIR)Retención autoasegurada (SIR)
Definition: Amount the insured pays before excess insurer responds.
Statute of Limitations (Claim)Plazo de prescripción (reclamación de seguro)
Definition: Legal time limit for filing a lawsuit related to insured loss.
Stop-Loss CoverageCobertura de alto costo / stop-loss
Definition: Reimburses self-insured employers when claims exceed set amount.
SubrogationSubrogación
Definition: Insurer’s right to pursue a third party responsible for a loss.
Supplemental ClaimReclamación suplementaria
Definition: Additional request for payment after new damages discovered.
T
Terminate CoverageTerminar la cobertura / cancelar la póliza
Definition: Ending insurance policy by either party with notice.
Third-Party Administrator (TPA)Administrador externo de siniestros (TPA)
Definition: Outsourced claims handling firm that does not bear risk.
Third-Party ClaimReclamación de terceros
Definition: Claim filed by someone harmed by the insured (liability).
Time Limit to SuePlazo contractual para demandar
Definition: Policy provision shortening the period to file suit against insurer.
Tortfeasor (Insurance Context)Autor del hecho ilícito
Definition: Party responsible for causing damages.
Total LossPérdida total
Definition: Repair costs exceed the value of the property or vehicle.
U
Umbrella PolicyPóliza sombrilla
Definition: high-limit liability coverage above primary policies.
Underinsured Motorist (UIM)Cobertura contra conductor con seguro insuficiente (UIM)
Definition: Pays when at-fault driver’s limits are too low.
Underpayment of ClaimPago insuficiente de la reclamación
Definition: When insurer pays less than the full covered amount.
UnderwritingSuscripción de seguros
Definition: Process of evaluating risk to determine terms and premiums.
Unearned PremiumPrima no devengada
Definition: Premium paid for coverage not yet provided; refundable.
Uninsurable RiskRiesgo no asegurable
Definition: Condition insurers refuse to cover due to extreme likelihood of loss.
Uninsured Motorist (UM)Cobertura contra conductor sin seguro (UM)
Definition: Pays for damages caused by a driver with no insurance.
V
Variable Life InsuranceSeguro de vida variable
Definition: Life policy with investment component where value fluctuates.
Vehicle AppraisalTasación del vehículo
Definition: Expert valuation of car damage or market worth.
Verification of LossVerificación de pérdida
Definition: Documentation confirming damages (photos, receipts).
Void PolicyPóliza anulada
Definition: Policy invalid from start due to fraud or misrepresentation.
W
Waiting Period (Elimination Period)Período de espera / período de carencia
Definition: Time that must pass before benefits are payable.
Waiver (Insurance)Renuncia / exención
Definition: Voluntary relinquishment of a known policy right.
Waiver of PremiumExención de prima
Definition: Insurer waives payments under specific circumstances (disability).
Wind/Hail Damage ClaimReclamación por daños de viento/granizo
Definition: Claim for property damage caused by specific storm perils.
Workers’ Compensation ClaimReclamación de compensación laboral
Definition: Claim for workplace injuries under a no-fault system.
Y
Yearly Renewable Term (YRT)Seguro renovable anualmente (YRT)
Definition: Life policy renewed each year with increasing premiums.
Z
Zero-Depreciation CoverageCobertura sin depreciación
Definition: Pays full replacement cost without deducting for wear.
Zone RatingClasificación por zonas de riesgo
Definition: Risk factor based on geographic location (flood/fire zones).
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