Insurance Exclusions Explained (2024)

An exclusion is an event (peril, accident, incident, or accusation) that an insurance policy will not cover. A standard insurance policy will typically include some exclusions.

While insurance policies help small businesses mitigate risk, they don’t cover everything. That’s why it’s important to read through your insurance coverage carefully and purchase additional coverage if there are any gaps.

Before buying a policy, learn about common insurance exclusions and why insurers may omit them from a policy. Grab your notepad!

What are insurance exclusions?

Insurance exclusions are policy provisions that waive coverage for certain types of risks or events.

Policy exclusions create a balance between coverage for fortuitous losses (losses you couldn’t have reasonably prepared for) and the need to remain solvent in order to pay those claims.

For example, a homeowners insurance policy doesn’t include flood insurance. Homeowners must purchase a separate policy to get coverage for property damage due to flooding. Next, learn about other exclusions you may encounter.

Common insurance exclusion categories

Policy exclusions vary based on several factors and are ultimately up to the insurance provider’s discretion. Note that some of the exclusions in commercial property, homeowners, personal auto, and general liability insurance policies will be the same, but others will be unique to that specific type of policy.

However, there are a few common types of exclusions that you should be aware of when reviewing your insurance policies. We’ll examine each in detail:

  • Catastrophic
  • Intentional actions
  • Covered elsewhere
  • Illegal actions
  • Maintenance issues
  • Easy to control

Catastrophic

Catastrophic risks may negatively impact a large number of policyholders simultaneously, which can affect the insurer’s ability to pay out claims. For example, many insurance policies exclude “hostile acts” such as war. In fact, catastrophic exclusions are sometimes simply referred to as “war exclusions,” and protect insurers from having to pay for losses caused by low-probability, high-cost widespread events.

In addition to war, this term can also apply to unexpected natural disasters like floods, tornados, earthquakes, or other “acts of God.” Although you generally won’t be able to purchase war coverage, you may be able to obtain coverage for natural disasters by purchasing a separate catastrophic insurance policy.

Intentional actions

The purpose of insurance is to protect an individual or business from misfortune and circ*mstances that are beyond their control. On the other hand, if you intentionally cause the damage, most policies won’t pay for the losses.

For example, if a driver experiences road rage and purposefully drives their car into another vehicle, their auto insurance policy will most likely not cover damages to the insured’s car, even if they had a comprehensive auto policy. Similarly, if a contractor purposefully damages a client’s property because they haven’t been paid, the malicious damage wouldn’t be covered by the provider.

Covered elsewhere

Many risks are excluded from one type of policy because that coverage is included in another type of policy. For example, a general liability policy won’t cover vehicle liability claims, since that is what commercial auto policies do.

Illegal actions

Most insurance policies feature exclusions that void the insurance contract if the insured is attempting to recoup losses resulting from lawless behavior or criminal actions.

One of the first steps an insurance company will take when evaluating a claim is to decide whether the act that caused the loss can be reasonably counted as an “occurrence” per the policy. In most cases, if there is an underlying crime, a claim won’t be counted as an occurrence.

Maintenance issues

While insurance policies can help protect you from a wide variety of risks, not every risk can be insured, especially since many of them occur naturally over time.

For example, most insurance policies won’t cover damage caused by wear-and-tear to a vehicle or a home. Not only are these risks that can be controlled by taking proper precautions and through continued maintenance, but they’re also an unavoidable aspect of owning the asset in question.

Easy to control

There are some risks that insurers exclude because they can be easily mitigated or significantly reduced if the insured takes the proper precautions or actions.

For instance, if your roof were to cave in because of snow buildup over several days, the insurer could claim that there were actions you could have reasonably taken to remove the snow and prevent the damage. Now that you know what to look for — where in the world do you find exclusions? (Hint: They’re in your policy.)

Where to look for exclusions in your policy

You should read your policy documents thoroughly in order to make a note of any exclusions. Exclusions are typically listed after the coverage section of your policy, but sometimes they are a part of each coverage description.

If you’re unsure about what is excluded from your policy, you should get in touch with your insurer in order to double-check the details. In some cases, it may be a good idea to purchase an additional insurance policy in order to fill in the gaps caused by an insurance exclusion. Other times, a “rider” (add-on coverage to your policy) can be a workaround for exclusions.

For example, general liability policies generally exclude product liability coverage for bodily injury or property damage caused by goods you make or sell. However, Thimble does not exclude product liability coverage in our Crafters Insurance policies. If you have any questions about your policy’s exclusions, read your policy carefully and speak with your provider if you have questions.

Straightforward liability coverage

There’s a lot of complex terminology in the insurance industry, but insurance doesn’t have to be complicated. Enter Thimble: We offer simple, flexible insurance for small businesses, with as little confusing jargon as possible.

We’re the first insurance service provider that puts customers in control: small businesses of any size can get a policy by the job, month, or year and modify, pause, or cancel anytime. Download the Thimble mobile app or click “select a quote.” In under 60 seconds, you get the coverage you need, only when you need it.

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Insurance Exclusions Explained (2024)

FAQs

How do insurance exclusions work? ›

An exclusion is a provision within an insurance policy that eliminates coverage for certain acts, property, types of damage or locations. Things that are excluded are not covered by the plan, and excluded costs don't count towards the plan's total out-of-pocket maximum.

What are two of the most common exclusions used by underwriters? ›

Risky activity: Any death due to risky activities, such as skydiving or rock climbing, are usually counted as an exclusion. Substance abuse: If a policyholder's death is the result of drug or alcohol abuse, it may be excluded from their policy.

Who has the burden of proof for insurance exclusions? ›

The burden is on the insurer to show an exclusion applies. In ERISA cases, the principle is well settled that the plan has the burden to show the applicability of an exclusion once the claimant has presented a prima facie case that she is covered and thus entitled to benefits under the plan terms.

What are the major types of exclusions typically found in insurance contracts? ›

Typical examples of excluded perils under a homeowners policy are flood, earthquake, and nuclear radiation. A typical example of an excluded loss under an automobile policy is damage due to wear and tear.

What is an example of an insurance exclusion? ›

For example, homeowners policies typically exclude coverage for flood damage, but this protection is available through a separate flood policy. Many insurance policies exclude wear and tear, since that kind of damage isn't accidental.

What is a list of exclusions? ›

The Office of the Inspector General's (OIG) List of Excluded Individuals/Entities (LEIE) provides information to the health care industry, patients and the public regarding individuals and entities currently excluded from participation in Medicare, Medicaid and all other Federal health care programs.

What voids life insurance payout? ›

Some of the top reasons for a claim to be denied include fraud, high-risk activities, suicide clauses, policy expiration and the possibility of beneficiaries' involvement in the insured's death.

What is the difference between exclusion and exception in insurance? ›

Exclusions are specific situations or circ*mstances which are not covered by a particular policy, while exceptions are specific situations which are covered by a policy, even if they would normally be excluded.

What kind of exclusions might be included in a car insurance policy? ›

Death, injury, or damage sustained by nuclear accidents, war, or other catastrophic events are not covered by car insurance.

How do you determine who has the burden of proof? ›

The burden of proof determines which party is responsible for putting forth evidence and the level of evidence they must provide in order to prevail. In most cases, the plaintiff (the party bringing the claim) has the burden of proof. As an initial matter, they must meet the burden of production.

What is the exclusion clause in insurance law? ›

An exclusion clause cannot conflict with the main purpose of the contract and the party relying on such clause should not have committed any act of fraud, coercion or misrepresentation particularly when the contract along with the exclusion clause is introduced by it.

Who is making a claim always has the burden of proving that claim? ›

Most of the time, the party bringing the claim—called the plaintiff—has the burden of proof. Evidence is typically in the form of objects, documents, and witness testimonies. During a trial, the judge assigns the burden of proof to different parties.

What is severability of all exclusions? ›

Severability of exclusions is a term stating that although an exclusion applies to one or more insured(s) under a policy, the exclusion does not necessarily apply and preclude coverage for the other insureds.

What are four major exclusions found in homeowners insurance policies pertaining to real property? ›

Important: Read exclusions in your insurance contract.

Earthquake, flood, mold, earth movement, and “wear and tear” are some of the perils that are usually excluded. When an insurer writes your homeowners coverage, the insurer is legally obligated to offer you earthquake coverage for an additional premium.

What are pre existing conditions exclusions? ›

Pre-existing Condition Exclusion. A limitation or exclusion of benefits for a condition based on the fact that you had the condition before your enrollment date in the group health plan.

What does being excluded from insurance mean? ›

An excluded driver is a person in your household who has been explicitly excluded from coverage under your car insurance policy. Their name will show as "excluded" on your policy, and they won't be insured to drive any vehicles on your policy.

How long can an insurer exclude? ›

The time period during which a health plan won't pay for care relating to a pre-existing condition. Under a job-based plan, this cannot exceed 12 months for a regular enrollee or 18 months for a late-enrollee.

How to avoid pre-existing condition exclusion? ›

If your health plan is fully compliant with the ACA and obtained in either the individual/family market or the employer-sponsored market, you no longer need to worry about pre-existing condition exclusion periods.

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