Losses are settled according to the loss or valuation provisions listed in a policy. P&C policies provide coverage “up to specified limits” stated in the policy. For example, if a home is insured for $300,000, the insurer’s limit of liability for loss to the home resulting from a covered peril is $300,000. “Limits of liability” may also be referred to as coverage limits, stated limits, coverage amounts, policy limits or indemnity limits.
Market Value is the price a willing buyer would pay and a willing seller would accept in the open market. It may be higher or lower than ACV and is rarely used in standard policies.
Valued Policy establishes an agreed amount payable for a total loss. It is often used for unique items like fine art and may also refer to state “Valued Policy Laws,” which require insurers to pay the full policy limit for a total dwelling loss due to fire or another covered peril (e.g., FL, TX, LA).
Agreed Value is a valuation method where the insurer and insured agree on the value of the property before a loss. It replaces the need for coinsurance and locks in the settlement amount for covered total losses.
Stated Amount, is commonly used for classic or antique vehicles. The insured declares a stated value, and insurance is written for that amount. The insurer generally pays the stated amount or the cost to repair or replace the property, whichever is less, unless fraud or material misrepresentation is proven
Functional replacement cost is used when property is repaired or replaced with less costly or modern materials that perform the same function, often in historic or older structures where original materials are unavailable or impractical.
The doctrine of actual cash value prevents an insured from profiting or collecting the coverage amount regardless of the amount of the loss. If Jean owns a $100,000 dwelling but insures it for $200,000, she will not be able to collect the $200,000 if a total loss occurs. ACV is the method of loss valuation most often utilized in property and liability policies. It is typically calculated as replacement cost minus depreciation, or by using the “broad evidence rule,” depending on the jurisdiction.
Replacement cost is the amount needed today to replace damaged or destroyed property covered under the policy. Some policies will pay a loss based on the replacement cost of the damaged property if stipulated in the contract, which generally has a higher premium. Replacement-cost coverage pays to repair or replace property with materials of like kind and quality, without deduction for depreciation, but only up to the policy limit. This does not violate the principle of indemnity because the insured cannot recover more than the amount of insurance purchased. Some optional “guaranteed replacement cost” endorsements extend coverage beyond limits, but these are clearly disclosed and not standard.
This coverage form includes a coinsurance clause. This principle encourages an insured to carry an insurance amount that is a specific percentage (i.e., 80 %) of its value. If the insured complies, the insurer will pay the full amount of a covered partial loss (up to the policy limit) less any deductible. Coinsurance applies only to partial losses, not total losses.
The coinsurance clause states that the insured must carry insurance which is at least 80% of the property’s value. If not, a formula will be applied to determine what the insurer will pay.
Under a coinsurance clause, the insured must carry insurance equal to at least the specified percentage (usually 80%) of the property’s value. If this requirement is not met, the insurer applies a formula to determine the payment amount, which penalizes underinsurance.
The formula is as follows:
For example, let’s assume that Behunin’s Hardware buys a building and personal property coverage form with an 80% coinsurance requirement. The policy includes a $250 deductible, and Behunin’s Hardware carries $120,000 of coverage. The building is valued at $200,000. A fire ensues, and the damage is $6,000. How much will the insurer pay?
Answer: $4,250
Let’s pull out the key information from the example:
And now, we can put this into an equation and solve it.
Claim settlements are based on the valuation provisions stated in the policy. Property and Casualty (P&C) contracts provide coverage “up to specified limits,” which define the insurer’s maximum liability. The following terms describe common methods of determining coverage and settlement values:
Market Value: The selling price of property in the open market, which may differ from its Actual Cash Value (ACV).
Valued Policy: Used for unique or irreplaceable property such as artwork, or under state Valued Policy Laws that require full payment of the policy limit in a total dwelling loss.
Agreed Value: The insurer and insured agree in advance on the property’s value, replacing the need for coinsurance.
Stated Amount: Common for classic cars or antiques; the insured declares a value, and the insurer will pay the stated amount or the cost to repair or replace, whichever is less.
Functional Replacement Cost: Replaces damaged property with modern, functionally equivalent materials that cost less than the original.
Actual Cash Value (ACV) ensures that an insured does not profit from a loss exceeding the property’s value. Replacement Cost is the current cost of replacing the property. Policies may pay based on replacement cost if stipulated, often with a higher premium. The coinsurance clause ensures the insured maintains coverage at a specified percentage of the property’s value, or the formula will determine the claim payment.
For example, suppose Behunin’s Hardware carries $120,000 of coverage on a $200,000 building and sustains a $6,000 fire loss. In that case, the insurer applies the coinsurance formula and subtracts the deductible to determine payment — resulting in a $4,250 settlement due to underinsurance.
Sign up for free to take 9 quiz questions on this topic