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Exclusions: There Is a Reason It’s Not Covered

Exclusions: There Is a Reason It's Not Covered

Every insurance policy has a section popularly known as “the fine print,” though its actual title is “Exclusions.” Exclusions are provisions in an insurance policy describing losses that the policy will not cover. For example, a homeowner’s policy does not cover losses caused by the use of cars, and a business auto policy does not cover injuries caused by a bulldozer on a construction site. While it may appear at first glance that the insurance company includes these provisions to get out of paying claims, the reasons are more complex and less insidious than that. There are very sensible reasons why no insurance policy covers everything.

First, not every person or business has the same exposures to loss. Most homeowners do not own a dump truck used in a business; the owner of the dump truck might not have employees to insure for jobsite injuries; the employer with a dozen employees might not own the building it occupies. Imagine if there were one insurance policy that covered all of these exposures — it would be hundreds of pages long and very complex. Therefore, over time insurance companies have developed different policies for different exposures — auto, home, business liability, and so on. The homeowner’s policy excludes losses that the auto policy should cover, personal policies exclude losses that business policies should cover, and vice versa.

Related to this are the issues of cost and choice. Standard insurance policies contain coverages that apply to large groups of households and businesses, but they do not cover every possibility. Those with additional needs have coverage options to choose from. For example, homeowner’s policies do not cover damage caused by water backing up from an overflowing sump or drain, but households that have basements with sumps or drains have the option of buying this coverage. Households without a basement do not have to buy it. This affords the buyer choices but does not force coverage on those who do not need or want it.

Furthermore, exclusions reduce the cost of the insurance policy. Every coverage comes with an associated cost — the company must factor in the costs of potential claims, expenses and profit for that coverage.

The more coverages a policy provides, the higher its premium will be. Without exclusions, people and businesses would be forced to pay for coverages they do not need. Exclusions help keep the premium affordable.

Finally, certain types of losses are uninsurable. Insurance companies cannot accurately predict when certain types of losses will happen, and the potential loss amounts are too large for them to absorb. For example, almost all policies exclude losses suffered as the result of a war or a nuclear accident. These events would cause massive losses beyond the abilities of insurance companies to pay. Other losses are not insurable as a matter of common sense. Because the purpose of insurance is to pay for losses from accidents, it will not cover most losses that a person intentionally causes.

Because every household or business’s circumstances are different, standard policies might not provide all the coverage necessary for proper protection. Properties in flood-prone areas, businesses that have a lot of contracts with other businesses, and individuals who post to online message boards may all lack important coverage. Consultation with a professional insurance agent will help determine whether more coverage is needed, whether it is available, and how much it will cost. The time to find out the availability and cost of coverage is before the loss occurs.

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