Insurance Claim Dictionary | ACV, Umpire, Snow Load & More

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Actual cash value (ACV): The value of damaged property at the time of loss, usually figured as replacement cost minus depreciation. Some policies define it differently, so check your own policy’s wording.
Additional living expense (ALE): Coverage for the increased cost of living away from home, such as lodging, extra mileage and restaurant meals, while a covered loss makes the home uninhabitable.
Amount of loss: The dollar value of a covered loss. Appraisal decides this figure; it generally does not decide whether the loss is covered in the first place.
Appraisal clause: The policy provision that lets either party demand appraisal when they disagree on the amount of loss. It sets out how appraisers and the umpire are chosen and how the award works.
Award: The written decision of an appraisal panel stating the amount of loss. An award signed by any two of the three panel members is generally binding on the amount.
Class 4 shingle: A shingle that earned the highest impact-resistance rating under the UL 2218 test. Some insurers offer premium discounts for Class 4 roofs, though the shingles are not hail-proof.
Collapse: A policy term for a building, or part of one, falling down or, under some policies, being in imminent danger of falling. Definitions vary widely, so read the exact wording.
Competent and disinterested: The standard many appraisal clauses set for appraisers: able to evaluate and price the loss, and without a financial or personal stake in the outcome beyond a reasonable fee.
Contents (personal property): Belongings such as furniture, clothing, tools and electronics, usually insured under Coverage C. Some categories, like jewelry or firearms, carry special lower limits for theft.
Cosmetic damage exclusion: An endorsement in some policies that limits or excludes payment for damage that affects only appearance, such as hail dents on metal roofing, without affecting how the roof performs.
Debris removal: Coverage for the cost of removing debris from damaged property after a covered loss. Some policies pay it within the coverage limit and add a modest extra amount.
Declarations page: The summary page of a policy listing the named insured, the property, coverage limits, deductibles, the policy period and attached endorsements. Often called the dec page.
Deductible: The amount you bear toward a covered loss before the insurer pays. It is subtracted from the claim payment rather than paid to the carrier separately.
Dwelling (Coverage A): The coverage for the house itself and structures attached to it, such as an attached garage, porch or deck, along with built-in fixtures.
Endorsement: A form attached to a policy that adds, removes or changes coverage. Endorsements can change deductibles, valuation, roof coverage or even the appraisal clause itself.
Holdback: The amount a carrier withholds, usually recoverable depreciation, until repairs are finished. It is released once you document completion, subject to any time limit in the policy.
Ice dam: A ridge of ice that forms at a roof’s edge and traps melting snow behind it. The water backs up under roofing and can leak into ceilings, walls and insulation.
Line of sight: A concept used in matching disputes: whether repaired and undamaged areas can be seen together. Areas in a continuous line of sight are more likely to raise matching issues.
Loss of use: The coverage section, often Coverage D, that includes additional living expense and fair rental value when a covered loss makes the property unusable.
Matching: The question of whether replacement materials must reasonably match undamaged areas in color, texture and size. How it is handled depends on policy wording and the facts.
Mitigation: Reasonable steps taken to prevent further damage after a loss, such as tarping a roof, shutting off water or drying out a building. Most policies require it.
Montana CSI: The Office of the Montana Commissioner of Securities and Insurance, part of the State Auditor’s office. It regulates insurers, takes consumer complaints and publishes consumer guidance.
Mortgagee clause: A policy provision protecting the lender’s interest in the property. It usually means the lender is named as a payee on dwelling claim payments.
NFIP: The National Flood Insurance Program, a federal program that offers flood insurance. Most homeowners policies exclude flood, so flood coverage usually requires a separate NFIP or private policy.
Ordinance or law coverage: Coverage for the added cost of meeting current building codes when repairing or rebuilding, such as required ice and water shield or structural upgrades. Limits are often a percentage of dwelling coverage.
Other structures (Coverage B): Coverage for detached structures on the property, such as fences, sheds, detached garages, pole barns and corrals, usually limited to a percentage of the dwelling limit.
Overhead and profit (O&P): A contractor’s charges for business overhead and profit, often figured as a percentage added to an estimate. Disputes often center on whether a general contractor is reasonably needed.
Percentage deductible: A deductible figured as a percentage of a coverage limit, usually the dwelling limit, instead of a flat dollar amount. It grows as the coverage limit grows.
Pitch: The slope of a roof, expressed as inches of rise per 12 inches of horizontal run, such as 6/12. Steeper pitches add labor, safety and equipment costs.
Proof of loss: A sworn statement of the amount claimed and the facts of the loss. Some policies require one within a set time or when the carrier asks for it.
Recoverable depreciation: The portion of depreciation a replacement cost policy will pay once repairs or replacement are completed, usually after you submit proof of the finished work.
Replacement cost value (RCV): The cost to repair or replace damaged property with materials of like kind and quality, without any deduction for depreciation.
Reservation of rights: A letter in which an insurer says it is investigating or paying a claim while reserving the right to deny coverage later, often citing specific policy provisions.
Roof payment schedule: An endorsement that pays a declining percentage of roof replacement cost based on the roof’s age and material, regardless of its condition before the loss.
Scope of loss: The list of damaged items and the repairs needed to restore them. Many appraisal disputes turn on scope rather than on unit pricing.
Snow load: The weight of accumulated snow and ice on a roof. Local building codes set design snow loads, which are considerably higher in many Montana mountain towns.
Square (roofing): A unit of roof area equal to 100 square feet. Roofing estimates are priced per square, with an added allowance for cutting waste.
Supplement: A request for additional payment for items missed in the original estimate or found during repairs, supported by photos, invoices or a revised estimate.
Surplus lines insurer: A non-admitted insurer allowed to write hard-to-place risks in Montana through licensed surplus-lines brokers. Its policy forms can differ more from standard forms.
Symbility: Property claims estimating software used by some insurers and adjusters as an alternative to Xactimate, with its own pricing data and report format.
Umpire: A neutral third person chosen by the two appraisers, or appointed by a court if they can’t agree, who decides the items the appraisers can’t resolve.
Unfair claim settlement practices: Claim-handling conduct that Montana’s Unfair Trade Practices Act, in Title 33, Chapter 18 of the Montana Code Annotated, lists as prohibited. Talk to a licensed Montana attorney about specific situations.
Wildland-urban interface (WUI): Areas where homes and other development meet or mix with forest, grassland or other wildland fuels. Many western Montana homes sit in the WUI.
Wind/hail deductible: A separate deductible that applies only to wind or hail losses. On some Montana policies it is a percentage of the dwelling limit and can exceed the all-peril deductible.
Xactimate: Estimating software widely used by insurers, adjusters, appraisers and contractors to price property repairs from regional price lists for labor and materials.

Montana Claim Dictionary: Insurance Terms in Plain English