保险专业术语解释

2005年7月3日21年前

Liability - Provides coverage for you or other insured persons if someone else is killed or injured or their property is damaged in an automobile incident. It will pay for legitimate claims against you or other insured persons up to the limit of your coverage, and the cost of settling claims.

Accident Benefits - Your insurance company is obligated to explain details of Accident Benefits coverage to you. Provides benefits that you and other insured persons are entitled to receive if injured or killed in an automobile accident. These benefits include: income replacement for persons who have lost income; payments to non-earners who suffer complete inability to carry on a normal life; payment of care expenses to persons who cannot continue to act as a primary caregiver for a member of their household; payment of medical, rehabilitation and attendant care expenses; payment of certain other expenses; payment of funeral expenses; and payments to survivors of a person who is killed. You may also purchase optional benefits to
increase the basic level of benefits provided in your policy.

The optional benefits your insurance company must offer are:
Increased Income Replacement C the basic level of income replacement provided in the policy ($400 per week maximum) can be increased by purchasing optional coverage so that the weekly limit is up to $600, $800 or $1,000. All income replacement benefits are based on 80% of your net weekly income.

Increased Caregiver and Dependant Care C the basic level of caregiver benefits for care expenses of persons who are not employed but care for dependants (up to $250 per week for the first person needing care, and $50 per week for every additional person) can be increased by purchasing optional coverage so that the weekly limit is up to $325 for the first person and $75 for additional persons. There is no basic benefit for persons who are employed and care for dependants, but if you purchase this optional coverage you can receive a benefit to cover additional weekly dependant care expenses of $75 for the first dependant, and $25 for each additional dependant, up to $150 per week.

Increased Medical, Rehabilitation and Attendant Care C the basic benefit pays up to $100,000 for medical and rehabilitation expenses, with a 10 year time limit in most cases, and up to $72,000 for attendant care expenses. If catastrophically impaired, the basic benefit pays up to $1,000,000 for medical and rehabilitation expenses and up to $1,000,000 for attendant care expenses. You can purchase optional coverage of $1,000,000 above the basic coverage, and that provides no limitation on the time for which these expenses are paid.

Increased Death and Funeral C the basic level of death benefits paid to the surviving spouse or surviving same-sex partner and dependant of a person who is killed ($25,000 to surviving spouse or surviving same-sex partner; $10,000 to surviving dependant) can be doubled by purchasing this optional coverage. This coverage also increases the basic funeral expense benefit from $6,000 to $8,000.

Indexation Benefit C this optional coverage will ensure that certain weekly benefit payments and monetary limits will increase on an annual basis to reflect changes in the cost of living.

Uninsured Automobile
Provides coverage if you or other insured persons are injured or killed by an uninsured motorist or by a hit-and-run driver. It covers damage to your automobile and its contents caused by an identified, uninsured motorist, subject to a $300 deductible.

Direct Compensation C Property Damage Provides coverage in Ontario, under certain conditions, for damage to your automobile and to property it is carrying, when another motorist is responsible. It is called Direct mpensation because you will collect from us, your insurance company, even though you are not at fault for the accident. There may be a deductible amount, and this amount is either paid by you toward the cost of repairs or is deducted from the loss settlement. Higher deductibles may reduce your premium.

Loss or Damage
Provides a selection of optional coverages for your own automobile. Payments cover direct and accidental loss of, or damage
to, a described automobile and its equipment. There is usually a deductible amount indicated for each coverage and this
amount is either paid by you toward the cost of repairs or is deducted from the loss settlement. Higher deductibles may
reduce your premium. There are four types of coverages:
Specified Perils: Covers the described automobile against loss or damage caused by certain specific perils. They are fire;
theft or attempted theft; lightning, windstorm, hail or rising water; earthquake; explosion; riot or civil disturbance; falling or
forced landing of aircraft or parts of aircraft; or the stranding, sinking, burning, derailment or collision of any kind of transport
in, or upon which, the described automobile is being transported.
Comprehensive: Covers a described automobile against loss or damage other than those covered by Collision or Upset,
including perils listed under Specified Perils, falling or flying objects, missiles and vandalism.

Collision or Upset: Covers damage when a described automobile is involved in a collision with another object or tips over.
All Perils: Combines the Collision or Upset and Comprehensive coverages.

此外：

单保：（适用于二手旧车或价值比较低的车，比如几千块钱以下）

Section A: Third Party Liability
叫第三方责任保险，在加拿大，法律规定最低为$200,000/每辆车。但一般大家都选择 $500,000 或 $1,000,000/每辆车。保护范围是由司机开车给其他人或事物所造成的一切损失，保险公司为投保人所承担的责任上限。保额越高，保费越高。与车无关。

Section B: Accident Benifits
大概应该翻译成‘事故补偿’吧，保护范围是：1，司机的受伤或死亡；2，车上乘客的受伤或死亡；3，动用你的车子的一部分的人的受伤或死亡；4，被你的车伤害的行人的受伤或死亡。赔偿钱数和方法政府又专门规定，这里就不详述了。这个保护范围不管是谁的错误。这个条款对保费没有影响。

SEF 44 Family Protection Endorsement
这是第44号备忘录，意思是如果发生车祸，是对方的责任，而对方的保额又不能满足你的索赔要求时，你的保险公司补剩下的余额。这个条款虽然不是强制的，但是在99.9%的保单上，都会附上这个备忘录。$20-40/年左右。

这就是单保的全部内容。其中A 和 B 是法律强制的。每辆上公路的车必须买。

全保的内容为：Section A + Section B + Section C + Endorsements

其中 Section A + Section B 在上面单保的内容中已经说过了。Section C 保护的范围是如果是在自己的责任的事故中，对自己的车和自己的财物损失的补偿。内容包括：

C1:All Perils, 意思是所有的风险。保险公司要赔偿任何情况下你的车所受到的损失。赔偿额是：实际的损失-保单可扣减的部分（Deductible,俗称垫底费）。垫底费越高，保费越便宜。

C2:Collision & Upset, 意思是由于自己的过失而造成的撞车和翻车而对自己的车的损坏，保险公司所作的赔偿。赔偿额的计算和对保费的影响同 C1。

C3:Comprehensive, 意思是对除了撞车和翻车以外的其它的原因对自己的车的损失的赔偿。大多数属于没有肇事方的天灾人祸，例如，火灾，雷电，偷盗，蓄意破坏，风暴和冰雹，暴乱，搁浅，烟熏，和动物相撞... ...。赔偿额的计算和对保费的影响同 C1。但是如果是由于火灾，雷电和偷盗而引起的车的完全的损失，则垫底费不再起作用，也就是说保险公司要赔偿全部的损失。

C4:Special Perils, 意思是特殊的风险，由保险公司和顾客商定的只对某些特定的风险进行保护。赔偿额的计算和对保费的影响同 C1。这个选择很少被人选用。

大家的保单中最常见的是 C2 和 C3。

关于 Endorsement，我不知道怎么翻译这个单词才合适，叫‘背书’，‘批单’，还是叫‘备忘录’。反正，在保险单里，它的作用就是减少，增加，或修改一个标准保单的内容的附加文件。

在人寿保险里，一般称为 Rider。
在普通保险里，一般称为 Endorsement，作用是一样的。房屋保险或者叫财产保险，也有许多 Endorsement。这里我们先不说这个问题。在这里我们只说汽车保险里的 Endorsement。

在汽车保险里，大概有几十个近一百个 Endorsement。我不可能在这里一一述说，那样就太累了。今天只说说常见的几个就足够了。(SEF=Standard Endorsement Form)

SEF44--Family Protection Endorsement，

这个Endorsement的意思是，如果你和第三方车辆发生交通事故，第三方负全部责任，你想他提出索赔，例如50万，而它的保单里第三方责任只有20 万，那么它的保险公司只能替他想你赔偿最高20万。而你仍需要30万才能得到完全的补偿，这个时候，你自己的保险公司可以根据这个 Endorsement 替那个第三方向你补偿剩下的余额。

SEF20--Loss of Use，

这个Endorsement的意思是，如果你的车被偷，或是在车祸中被损坏了，在得到新车以前，想租一辆车作日常用，不超过30天，而又想让保险公司付租车费，就需要加上这个 Endorsement。