What Is Exclusion?
A specific condition or circumstance listed in a policy that is not covered by the insurance contract. Exclusions define what the insurer will not pay for under the policy.
Exclusion across 7 exams
Exclusion appears on the following exams. Each defines it in the context candidates are tested on:
- Property & Casualty
- A specific condition or circumstance listed in a policy that is not covered by the insurance contract. Exclusions define what the insurer will not pay for under the policy.
- Health Insurance
- A specific condition, treatment, service, or person that is not covered by a health insurance policy. Common exclusions include cosmetic procedures, experimental treatments, and services not ordered by a licensed provider.
- ServSafe Food Handler
- Keeping a food handler away from working with food because of illness. Handlers must not work with food when they have vomiting, diarrhea, or jaundice, or when diagnosed with Salmonella, Shigella, E. coli, Hepatitis A, or Norovirus.
- All-Lines Adjuster
- A provision in an insurance policy that explicitly eliminates coverage for specific perils, property, or circumstances. Common exclusions include acts of war, wear and tear, and intentional loss. Adjuster must verify whether a loss falls under an exclusion to properly deny or approve a claim.
- Personal Lines
- A provision that identifies losses, perils, property, or circumstances the policy does not cover. Common personal-lines exclusions include flood, earthquake, and intentional acts.
- Public Adjuster
- A specific condition, cause of loss, or type of property that a policy explicitly does not cover. Understanding exclusions is essential for adjusters to determine claim eligibility and to identify coverage gaps that may affect settlement amounts.
- Health-Only Insurance
- A specific condition, treatment, or circumstance that is not covered by the insurance policy. Examples include cosmetic procedures or self-inflicted injuries that are explicitly excluded from coverage.