Insurance policy

In insurance, the insurance policy is a contract (generally a standard form contract) between the insurer and the insured, known as the policyholder, which determines the claims which the insurer is legally required to pay. In exchange for an initial payment, known as the premium, the insurer promises to pay for loss caused by perils covered under the policy language.

Insurance contracts are designed to meet specific needs and thus have many features not found in many other types of contracts. Since insurance policies are standard forms, they feature boilerplate language which is similar across a wide variety of different types of insurance policies.

The insurance policy is generally an integrated contract, meaning that it includes all forms associated with the agreement between the insured and insurer.[1]:10 In some cases, however, supplementary writings such as letters sent after the final agreement can make the insurance policy a non-integrated contract.[1]:11 One insurance textbook states that generally "courts consider all prior negotiations or agreements ... every contractual term in the policy at the time of delivery, as well as those written afterwards as policy riders and endorsements ... with both parties' consent, are part of written policy".[2] The textbook also states that the policy must refer to all papers which are part of the policy.[2] Oral agreements are subject to the parol evidence rule, and may not be considered part of the policy if the contract appears to be whole. Advertising materials and circulars are typically not part of a policy.[2] Oral contracts pending the issuance of a written policy can occur.[2]

General features

The insurance contract or agreement is a contract whereby the insurer will pay the insured (the person whom benefits would be paid to, or on behalf of), if certain defined events occur. Subject to the "fortuity principle", the event must be uncertain. The uncertainty can be either as to when the event will happen (e.g. in a life insurance policy, the time of the insured's death is uncertain) or as to if it will happen at all (e.g. in a fire insurance policy, whether or not a fire will occur at all).


Insurance contracts were traditionally written on the basis of every single type of risk (where risks were defined extremely narrowly), and a separate premium was calculated and charged for each. This system of "specific risk" or "named perils" coverage proved to be unsustainable in the context of the Second Industrial Revolution, in that a typical large conglomerate might have dozens of types of risks to insure against. For example, in 1926, an insurance industry spokesman noted that a bakery would have to buy a separate policy for each of the following risks: manufacturing operations, elevators, teamsters, product liability, contractual liability (for a spur track connecting the bakery to a nearby railroad), premises liability (for a retail store), and owners' protective liability (for negligence of contractors hired to make any building modifications).[7]

In 1941, the insurance industry began to shift to the current system where covered risks are initially defined broadly in an "all risk" or "all sums" insuring agreement on a general policy form (e.g., "We will pay all sums that the insured becomes legally obligated to pay as damages..."), then narrowed down by subsequent exclusion clauses (e.g., "This insurance does not apply to...").[8] If the insured desires coverage for a risk taken out by an exclusion on the standard form, the insured can sometimes pay an additional premium for an endorsement to the policy that overrides the exclusion.

Insurers have been criticized in some quarters for the development of complex policies with layers of interactions between coverage clauses, conditions, exclusions, and exceptions to exclusions. In a case interpreting one ancestor of the modern "products-completed operations hazard" clause,[9] the Supreme Court of California complained:

The instant case presents yet another illustration of the dangers of the present complex structuring of insurance policies. Unfortunately the insurance industry has become addicted to the practice of building into policies one condition or exception upon another in the shape of a linguistic Tower of Babel. We join other courts in decrying a trend which both plunges the insured into a state of uncertainty and burdens the judiciary with the task of resolving it. We reiterate our plea for clarity and simplicity in policies that fulfill so important a public service.[10]

Parts of an insurance contract

Industry standard forms

In the United States, property and casualty insurers typically use similar or even identical language in their standard insurance policies, which are drafted by advisory organizations such as the Insurance Services Office and the American Association of Insurance Services.[12] This reduces the regulatory burden for insurers as policy forms must be approved by states; it also allows consumers to more readily compare policies, albeit at the expense of consumer choice.[12] In addition, as policy forms are reviewed by courts, the interpretations become more predictable as courts elaborate upon the interpretation of the same clauses in the same policy forms, rather than different policies from different insurers.[13]

In recent years, however, insurers have increasingly modified the standard forms in company-specific ways or declined to adopt changes[14] to standard forms. For example, a review of home insurance policies found substantial differences in various provisions.[15] In some areas such as directors and officers liability insurance[16] and personal umbrella insurance[17] there is little industry-wide standardization.

Manuscript policies and endorsements

For the vast majority of insurance policies, the only page that is heavily custom-written to the insured's needs is the declarations page. All other pages are standard forms that refer back to terms defined in the declarations as needed.

However, certain types of insurance, such as media insurance, are written as manuscript policies, which are either custom-drafted from scratch or written from a mix of standard and nonstandard forms.[18] By analogy, policy endorsements which are not written on standard forms or whose language is custom-written to fit the insured's particular circumstances are known as manuscript endorsements.


  1. 1 2 3 Wollner KS. (1999). How to Draft and Interpret Insurance Policies. Casualty Risk Publishing LLC.
  2. 1 2 3 4 Porter K. (2007). The Legal Environment of Insurance, §5.17. AICPCU.
  3. Rahdert MC. (1998). Reasonable Expectations Revisited. Conn. Ins. Law Journal.
  4. Hadland v. NN Investors Life Ins. Co., 24 Cal. App. 4th 1578 (1994).
  5. St. Paul Fire & Marine Insurance Co. v. Albany County School District No. 1, 763 P.2d 1255 (Wyo. 1988).
  6. Standard Venetian Blind Co. v. American Empire Ins. Co., 503 Pa. 300, 469 A.2d 563 (1983).
  7. Anderson, Eugene R.; Stanzler, Jordan S.; Masters, Lorelie S. (2013). Insurance Coverage Litigation (2nd ed.). New York: Wolters Kluwer. pp. 1–31. ISBN 9780735511736. Retrieved 10 April 2016.
  8. Stempel, Jeffrey W. (2007). Stempel on Insurance Contracts (3rd ed.). New York: Aspen Publishers. pp. 2–113—2–116. ISBN 0735554366.
  9. Baker v. National Interstate Ins. Co. 180 Cal. App. 4th 1319 (2009). This case explains how the modern clause more clearly excludes both the "products" and "completed operations" hazards as separate things (i.e., each hazard is separately excluded), as opposed to the prior version which was held to apply only when both hazards were present.
  10. Insurance Co. of North America v. Electronic Purification Co., 67 Cal. 2d 679, 691-692 (1967).
  11. "Pricing Medical Expense Insurance," in Medical Expense Insurance, (Washington: The Health Insurance Association of America, 1997), 89.
  12. 1 2 Impact of the Abolition of McCarran-Ferguson Antitrust Exemption for the “Business of Insurance”. CRS.
  13. Boardman M. (2006). Contra Proferentem: The Allure of Ambiguous Boilerplate. Michigan Law Review.
  14. Policy Issues: ISO Program Revisions. PropertyCasualty360.
  15. Schwarzc D. (2011). Reevaluating Standardized Insurance Policies. The University of Chicago Law Review. See also: Not All Homeowners’ Policies Are Alike. New York Times.
  16. E&O Insights: Directors & Officers Liability Is Not Your Normal Insurance Product. Insurance Journal.
  17. Time To Standardize Personal Umbrella Insurance Policies. IRMI.
  18. Dart Industries, Inc. v. Commercial Union Insurance Co., 28 Cal.4th 1059 (2002).
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