How do I read my Insurance Contract? – by Loïc Di Stefano
By Loïc DI STEFANO, Expert Bordeaux My Business – Insurance
Far from being the ancillary part of the insurance contract, exclusions are at the heart of it.
Unless you have a contract notified in “everything except”, which is a very readable principle but often reserved for contracts written on the Anglo-Saxon model, the most important lines to read in its insurance contract are those of exclusions.
Indeed, on the basis that what allows allows less than what excludes, if I allow such activity, is that de facto I exclude all others, whereas if I exclude such activity, it is that de facto I admit all the others.
The guaranteed activity signals the field of activity, but the exclusions delineate precisely this area.
Let’s take the example of a massage therapist. His warranty will signal his activity, but the exclusions will specify to what limits he will be able to exercise. Masso-kinesitherapy, which every insurer has in its nomenclature, is manipulation formalized by an intensity, pressure and velocity of precise technical gestures. Of course, and ethics also exist. But how are massage therapists who work with a patient of professional sportsmen and women guaranteed when the exclusions from the contract prohibit this possibility?
Thus, the guarantee can even be very precise and detailed: “sport massage therapist”, if the exclusions block the guarantee outside the office or on a particular patient (professional sportsmen, or particular sport), then the details of the guarantee will relate only to the techniques accepted in the practices covered but will not be in any way an authorization to exercise his art as is often believed on the stadiums or with such an athlete.
If your professional practice is noted in exclusions, then there is no guarantee. So you think you’re covered, you’re not. Of course, it is up to your insurance board to take into account the particularities of your activity in order to advise you best on the guarantees to be adopted, or to draw your attention to the points not covered.
However, more often than not, contractual clauses can be defined upstream by the company, and your insurer may have little latitude over their content. Therefore, it is very important on the one hand to explain to his board the reality of his activity, and on the other hand, to pay particular attention to exclusions.
This verification of exclusions is important for all contracts, both personal and industrial, because it allows to adapt very precisely its guarantee to the reality of its professional activity, and to its personal way of exercising. It is also the insurer’s relied upon to not pay the claim if it is allowed. And the insurer does not take you as a traitor, who notes in his contracts the exclusions in bold and not in mini-characters as the legend wants!
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