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The insurance guide

The insurance guide

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  • Claims adjuster: Any individual authorized by an insurance company to draw up an amicable report on a car accident that has occurred with the agreement of all involved parties. This report is only conducted when the accident results in only property damage.
  • Border insurance: Liability insurance purchased by drivers of vehicles registered in a foreign country that is not a member of an international system for managing motor third-party liability insurance. It is usually issued at border posts for a limited period of time.
  • Accessory: For a vehicle, these are the parts or equipment added to the vehicle after its first date of registration. International Automobile Insurance Card: It is the "identity card" of the vehicle in a way. This document includes the vehicle's chassis number, type of vehicle, the owner's name, address and of course, the license plate number. If there has been more than one owner, you will also find the date of the first registration.
  • Pink Card: An insurance card that covers the liability of automobiles in international circulation, issued by the national bureau of a member and valid in each of the other countries adhering to the system.
    Insurance certification and attestation: a document provided when subscribing to auto-insurance, and after each deadline, serving as an attestation of insurance. It constitutes a presumption of insurance (without being an absolute proof of coverage) and can be consulted by the police during a road check.
  • Driver:
    Insurers distinguish several types of drivers:
    - Main or regular driver: person who most frequently drives the insured vehicle.
    - Exclusive driver: declared as the only and unique driver of the insured vehicle.
    - Occasional driver: any person other than the main driver, who occasionally drives the insured vehicle.
    - Authorized or unauthorized driver: any person who has authorized or unauthorized custody or control of the insured vehicle.
  • Amicable agreement: It is a document to be filled out with the person with whom you had a strictly material automobile accident. The advantage of this document is to gather on a single page all the useful information for your compensation (location of the accident, date, time, circumstances...), its disadvantage is its irrevocable nature once it is signed by both parties present.
  • Wreck: (wrecked vehicle): When the cost of repairs following a covered automobile accident exceeds the vehicle's value on the day of the accident, the vehicle is declared a wreck (VEI = Economically Irreparable Vehicle) by the expert who limits the assessment to the expert declaration value.
  • Auto insurance or butterfly sticker: It is a detachable document that serves as proof of insurance but is not an absolute proof. The sticker is a document that allows the police or other control services to quickly check for insurance even when the owner is not present or when the vehicle is parked. It is therefore mandatory to place the sticker on the vehicle's windshield, as failure to do so may result in a fine.
  • Transported person: The concept of persons transported free of charge is important in automobile insurance. Indeed, if it turns out that at the time of an accident, the transported person had paid to be transported, the compensation will be removed. On the other hand, a distinction is made between occasional participation in road expenses (such as gas) and true paid transportation invoiced by an individual.
  • Information statement: This is the insured's "resume" as an automobile policyholder. It is a document that traces their history as a policyholder including information on accidents, their bonus/malus rating, and goes back a variable number of years depending on the insurance company (between 2 and 5 years). The insurer is required to issue an information statement containing the following information: designated regular driver(s), recorded accidents, their number, nature, degree of responsibility, and identity of the responsible driver, and the reduction/increase coefficient.
  • Motorized land vehicle: Any motorized land vehicle is subject to mandatory insurance. Therefore, it is essential to know its definition: it is "any machine intended for the transport of people or things circulating on the ground propelled by any motor force". Note that the notion of registration has no impact on this obligation. Therefore, be aware that case law considers as a motorized land vehicle (and therefore subject to mandatory third-party liability insurance): a self-propelled lawn mower, a battery-powered model car on which children ride.
  • Replacement value: It is the amount, possibly adjusted for the evolution rate of the model, that is necessary for the purchase of a vehicle of the same characteristics (on the day of the incident).
  • Market value: This is the price at which the owner could have sold the vehicle if the accident had not occurred. It is the new value minus depreciation.
  • Layout: Installations that cannot be detached without being damaged or without damaging the buildings. These are buildings by destination, like an elevator or a central heating system.
  • Building: This refers to structures and their accessories (building by nature) but does not include the land. The term building may also refer to the body of a ship or aircraft.
  • Constructor: Architect, contractor, technician or any other person connected to the project owner through a contract for work and services. A person who sells a completed construction that they have built or had built; A person who, even though acting as an agent for the owner of the project, performs a mission that is comparable to that of an independent contractor.
  • Builder: Damage insurance covers the owner of the construction against damages that occur within 10 years after the site is received. It is mandatory for both professionals and individuals.
  • Ten-year guarantee or Construction Defects Insurance (CDI):The CDI covers the owner of the construction against damages occurring to the building within 10 years after the reception of the site. It is mandatory for professionals and individuals.
  • Embellishment: These refer to paintings, mirrors fixed to the walls, woodwork, paneling, false ceilings, fitted kitchens and bathrooms, and all glued coverings except for tiles and parquet flooring. Owner: This refers to a natural person or legal entity on whose behalf the execution of works or the supply of equipment is carried out.
  • Structure: A result of various civil engineering works that may involve construction, reconstruction, demolition, repair, or renovation operations.
  • Decennial civil liability: The owner who must have work done is not always able to appreciate the perfect completion of the same work, and whether the construction is correctly executed. It is therefore necessary for a certain amount of time to pass so that the new building has time to "work" and settle on its foundations. The legislator has therefore deemed it necessary to impose a ten (10) year warranty period on architects and contractors. This decennial guarantee is the obligation to guarantee, for ten (10) years, the proper execution and good solidity of the work. Therefore, when you have work done, make sure that your contractor has fulfilled their obligation of decennial insurance (they must provide you with a certificate).
  • Usufuct: According to Article 578 of the Civil Code, "usufuct is the right to enjoy things that someone else owns, as the owner would, but with the obligation to preserve their substance." In other words, the usufuctuary can use and benefit from a property's income, such as by renting it out. Usufuct is temporary because it cannot exceed the lifetime of its holder. Insurers typically create a single contract to cover an entire residence, which can be jointly subscribed to by the bare owner and usufuctuary or by just one of them. In the event of a claim, the indemnity will be paid to both parties.
  • Agreed value: This is the value of a property contractually determined by an expert. In the context of a homeowner's insurance policy, and for belongings above a certain value, it is beneficial for the insured individual to have an appraisal conducted by an expert approved by their insurance company. In the event of a loss, the amount owed will be determined according to the terms of the contract and with the support of the appraisal. This is unlike a traditional homeowner's policy, where the insured value is subject to depreciation.
  • Life insurance: Life insurance is a branch that includes investment, retirement, and insurance contracts, and generally encompasses all contracts related to personal protection.
  • Life insurance: An insurance policy that guarantees the payment of a lump sum or annuity to the beneficiary in the event of the insured's death before the end of the policy.
  • Life insurance policy: An insurance contract aimed at generating savings that may be paid out in the form of either a annuity or a sum of money (provided the insured is still alive at the end of the contract).
  • Temporary death benefit: Insurance guaranteeing the payment of a lump sum or annuity in the event of the death of the insured provided that the death occurs before a specified date in the contract. If the insured survives until that date, no benefit is payable by the insurer and the premiums are retained.
  • Beneficiary: In life insurance, an individual or legal entity for whose benefit the insurance policy was taken out, and who receives the capital or annuity payment from the insurer. The beneficiary can be specifically named in the policy's special provisions or can be referred to in the general conditions as the surviving spouse, rightful heirs, or even a born or unborn heir. The beneficiary receives the compensation from the insurer in the event of the insured risk materializing.
  • Life insurance policy: Agreement in which, in exchange for one-time or periodic payments, the insurer guarantees benefits whose execution depends on the survival or death of the insured.
  • Health insurance supplement: An insurance contract that allows for the reimbursement of medical and surgical expenses in addition to the compensation received from the mandatory health insurance plan.
  • Capitalization contract: An insurance agreement where the probability of death or survival does not affect the determination of the benefit in that, in exchange for single or periodic premiums, the beneficiary receives the capital formed by the payments made, increased by interest and profit-sharing.
  • Total and Irreversible Loss of Autonomy: This refers to the physical, mental, or social loss of autonomy of a person that no longer allows them to perform daily activities without assistance. Dependence insurance is an insurance contract that pays a lump sum or annuity to beneficiaries to support and cover expenses related to the situation of dependence.
  • Inability: State of a person who, due to illness or accident, is temporarily or permanently (if permanent = disability) unable to work and/or perform certain basic actions. In common law, compensation means that the victim must be returned to the situation they were in before the accident. In case of temporary incapacity, we distinguish between Total Temporary Incapacity for Work (TTI) and Partial Temporary Incapacity for Work (PTI). In case of permanent incapacity, we speak of Partial Permanent Incapacity (PPI) and Total Permanent Incapacity (TPI) also known as disability. We also speak of functional incapacity in case of a decrease in the ability of a person, victim of a bodily accident, to perform certain basic actions: getting up, lying down, walking, running and/or manipulating objects...
  • Temporary incapacity (TI): State of the injured person during illness or trauma, ranging from the accident to the consolidation. It corresponds to the period of unavailability during which the insured person can no longer carry out his or her usual professional activity or regular activities if he or she does not practice a professional activity.
  • Total Temporary Disability (TD): A medically verified state of complete physical or mental inability to perform any activity temporarily.
  • Daily Allowance (D.A): In case of temporary total work incapacity, the insurer will provide the insured with a fixed daily allowance during the period of work stoppage. A deductible is often applied for illness-related incapacities.
  • Total Permanent Disability (TPD): The insured is recognized as definitively unable to engage in any professional activity that generates gain or profit, and whose rate of functional disability is equal to or greater than 80%.
  • Whole Life Insurance: Whole life insurance guarantees the beneficiaries of a life insurance policy a lump-sum payment upon the insured's death, regardless of when the event occurs. The Whole Life option allows for an increase in the amount transmitted to the designated beneficiaries in the event of the insured's death.
  • Member: Refers to one or more individuals covered by an insurance contract. In the context of a group contract, the insured is the employee. They may cover family members, who will be the beneficiaries (dependents) of the insured.
  • APERITOR: In the division of large risks, the "apériteur" is a single point of contact for the policyholder, designated by the co-insurance companies, to manage an insurance contract. Their mission is to conclude the contract with the policyholder, establish the policy, collect premiums, distribute them among the co-insurers, and settle insurance claims. They also incur civil liability; in the event of any wrongdoing, towards the policyholder.
  • Entitled persons: Entitled persons are family members (spouse, children, dependent ascendants, etc.) who are not covered by social insurance on a personal basis. They benefit from the maternity health insurance services due to the coverage of the insured person. They also have the right to the capital provided in death insurance policies in case of the death of the insured person when no specific beneficiary has been designated.
  • Amendment: It is a complementary document to the contract which attests to the modifications made to it. The insurance company establishes an amendment in the following cases:
    - If the insured requests an extension of coverage;
    - If they request a modification of the amounts specified in the contract; if they change address;
    - Etc…
    It also occurs when the initial conditions of the contract are reviewed: moving, changing vehicles... your insurer issues an amendment (a replacement) in order to validate your new situation and coverage. The amendment, like the initial contract, must be signed by the insured and the insurer, as the amendment represents proof of the contract's modification. It avoids the complete drafting of a new contract.
  • Terms and Conditions: These are the general rules that govern the operation of a contract. They apply to all contracts of the same type and comprehensively explain the operation and all proposed guarantees. This document also describes all the rights and obligations of the insured during the contract period. It may contain general information about guarantees that are not subscribed to. To know the guarantees they benefit from, the insured must refer to the Specific Conditions.
  • Broker: The broker is the agent of their client, which is to say the insured party for whom they independently search for the best insurance company to guarantee the client's interests on a case-by-case basis. The broker has the legal status of a merchant.
  • Damage claim: The act by which the insured declares to their insurer any damages they have caused or suffered. The declaration must be made within deadlines that vary depending on the nature of the damages (in case of non-compliance with these deadlines, except in cases of unforeseeable circumstances or force majeure, the insurer has the right to refuse to cover the damages): Nature of the damages.
  • Degradation: Penalty taken by the insurer against its policyholder for actions taken after the claim. Examples of reasons for forfeiture include false declarations and the conviction of the policyholder for driving under the influence. All cases of forfeiture must be specified in your insurance policy, and are not enforceable against the victim, who must be compensated for their damages. The insurer will pursue reimbursement from its policyholder for the amounts paid.
  • Material Damage: Material damage refers to harm caused to a victim's property. This means it relates to any property or economic interests of a person. For example, in the case of a traffic accident, material damage insurance can cover the vehicle or its accessories. Material damage is damage that represents harm to a thing, property, or animal. Material damage can be insured through contracts for property damage, liability, or personal insurance.
  • Non-material damages: Consequences of the loss or destruction of an object such as:
    - The deprivation of enjoyment or loss of a right. For example, the inability for the occupant of a burned apartment to live in it.
    - The interruption of a rendered service. Such as not being able to use one's car due to an accident.
    Financial loss. Such as the obligation of a merchant to close their store due to water damage from a neighboring apartment.
  • Exclusions of Guarantees: An exclusion of guarantee is a contractual clause that releases the insurer from paying compensation under certain specified circumstances. These exclusions, written in apparent characters, must be specified in the insurance contract. The insured has various means of challenging an exclusion imposed by the insurer, and this may involve a restriction of the insured's rights or responsibilities. This can also be due to the particular nature of the realization of the insured risks. To be valid, the exclusions must be explicit, limited in number and clearly mentioned in the contract, to allow the insured to easily understand them.
  • Areas of Expertise: Pre-loss
    Assessment of the value of assets to be insured, such as a preliminary appraisal.
    Post-loss
    Estimation of the amount of damages, possibly determining the causes of the loss.
    Amicable expertise
    An expert designated by the insurer assesses the amount of damages, which allows for proposing compensation to the insured. The insured is not bound by the expert's conclusions.
    Contradictory expertise
    The insurance company designates an expert; the insured chooses another, often with the advice of their insurance broker. In case of disagreement, they appoint a third expert: the three experts jointly resume their operations, and decisions are made by majority vote.
    Judicial expertise
    A mission that the court entrusts to a specialist if the matter goes to court.
  • IARD: Fire, Accidents, Various Risks: this abbreviation is commonly used on documents sent to policyholders. It refers to a branch, a category of property damage insurance.
  • Insurance policy: A document that represents the insurance contract. It specifies the general and specific terms and conditions of the policy, and any amendments that may have been made.
  • Risks: Event feared by the insured and which constitutes the object of the contract.
  • Sinister: Occurrence of the event specified in the insurance contract.
  • Proportional: The insurance code provides for a reduction in compensation in the event of a loss if there is a deficiency in the insured capital (proportional rule of capital), or if the declarations made at the time of subscription are not in conformity with the reality of the risk (proportional rule of premium).
  • Mathematical Reserves: In order to be able to fulfill their commitments, insurance companies must maintain a certain liquidity ratio, known as mathematical reserves. These reserves are mandatory and must remain available at all times. Therefore, in case of need, they can immediately release funds in favor of their subscribers (insureds). Mathematical reserves are made up of the net premiums received by insurers. The financial revenues generated by their investments are added to this amount, and their management expenses are deducted from it.
  • Technical reserves: Technical reserves are recorded in the liabilities section of an insurance company's balance sheet. They correspond to: Charges expected to cover claims that have not yet been reported but are foreseeable under current policies. For example, in the case of a reported car accident, the amounts that will likely be paid to the beneficiaries; Anticipation of future benefits that the insurer will have to provide when a commitment takes effect. For example, anticipating future annuities in the case of a retirement contract.
  • Civil liability: The legal basis for civil liability is the provisions of articles 258, 259, 260 of the Congolese Civil Code LIII. A natural or legal person (for example, a company) is civilly responsible and obliged to compensate all or part of the damage they caused to a third party or that the person they are responsible for caused to a third party. In the Democratic Republic of Congo, civil liability is mandatory for 7 types of insurance products.
  • Equipment: The equipment used to control a ship, including cables, yards, and sails.
  • Apparels: Machines installed on ships dedicated to handling operations or maneuvers. An amount of money due or to be paid periodically to the beneficiary, as a pension or annuity.
  • Faculties insurance: Insurance for goods and/or cargo.
  • General average: In maritime law, general average is the legal situation in which both the ship and the shipper are involved when, upon the captain's order, it was necessary to throw goods or packages overboard and incur extraordinary expenses to save the equipment, the ship, and the remaining cargo.
  • General average: loss or expenses voluntarily incurred by the captain to save the ship and its cargo. General average can be caused, for example, by jettisoning part of the cargo, usually the heaviest goods, to prevent the ship from sinking.
  • Particular average: damage occurring by accident to the vessel or its cargo. A particular average may occur during the sea transport of the cargo or during loading, unloading, stowage operations, etc.
  • Food declaration: An insurance order given by an insured person to an insurer that provides coverage for frequent shipments of goods at sea, either as part of a floating policy or an advance subscription for a specific period of time.
  • Maritime bill of lading: The bill of lading is a document issued by a shipping company that attests to having received goods and commits to delivering them to a designated place and person (the recipient or his agent). This written acknowledgment serves as both a receipt of goods, a transport contract, and a commitment to deliver to the recipient. The bill of lading constitutes, in the hands of the regular bearer, the title of ownership of the transported goods. The bill of lading is the document that the shipping company hands to the shipper in recognition of the goods that their ship is transporting. It is an endorsable document that allows, while the goods are in transit, the seller to transfer ownership to buyers, and allows the latter to virtually hand over the goods to a banker to create a pledge to secure a credit that has been granted for their purchase.
  • Work accident: An accident that occurs in the workplace or during the commute between the workplace and home (and vice versa).
  • Property and Casualty Insurance (Fire, Accident, and Miscellaneous Risks): This term generally refers to all types of property insurance. For individuals, the main types of property and casualty insurance are auto insurance, homeowners insurance, and liability insurance. For professionals, in addition to insurance, there is professional liability insurance and business insurance. Insurance premium: The amount paid by the insured as a premium in exchange for an insurance policy from a mutual insurance company.
  • Abandonment: Transfer of ownership of the insured item to the insurer in the event of a claim, in exchange for payment of the full insured amount to the insured.
  • Business Interruption Insurance: In a commercial multi-risk insurance policy, following a loss caused by an insured event, the insurance coverage pays for the reconstruction of the business premises and the replacement of inventory. However, during the time of reconstruction, the company's revenue may decline due to the difficult operating conditions. The fixed expenses of the business such as rent, taxes, loans, etc. will remain the same. Business Interruption Insurance is designed to replace the income that would have been earned if the loss had not occurred, and to help the business return to its pre-loss financial position.
  • Indirect losses: Following an incident, the policyholder may face various additional expenses (transport, dining, postage, etc.). The purpose of this coverage is to compensate you for certain exceptional expenses resulting from an incident covered by the insurer.
  • Civil Liability: The legal basis for civil liability is found in Articles 258, 259, and 260 of the Congolese Civil Code LIII. A person or entity, such as a company, is civilly responsible for partially or wholly repairing any damage caused to a third party, or that was caused by a person for whom they are responsible. In the Democratic Republic of the Congo, civil liability insurance is mandatory for seven types of insurance products. Third party payer: An organization serving as a third-party payer in matters of civil liability, providing benefits to victims of bodily injury caused by an event of any kind, and later seeking reimbursement from the person held liable for the injury.

Incident Report Form

IDENTIFICATION
DECLARATION OF DISASTER