Insurance Law

What are "exclusions" and "limitations" in an insurance policy and how do they affect my insurance coverage?

An "exclusion" is a statement in an insurance policy which describes a condition or type of loss that is not covered by the policy. An exclusion is an exception to the general statement of coverage contained in the policy. For example, an auto liability policy typically states that it will pay damages for bodily injury or property damage for which an insured becomes legally responsible because of an auto accident. The same policy typically would have "exclusions" that provide, for example, that there is no coverage if the injury is caused intentionally or if the injury is caused by a person who uses an insured vehicle without permission.

A provision found in some policies which is similar to an exclusion is called a "limitation." A limitation also is an exception to the general statement of coverage but is applicable only under certain circumstances or for a specified period of time. For example, a health insurance policy often contains a "preexisting conditions" limitation, which states that the coverage does not apply to an illness or other medical condition that has been treated or diagnosed within a certain period of time (e.g., six months) prior to the beginning of the policy. However, after the policy has been in effect for a specified period of time (often six months to one year), the limitation will no longer apply and subsequent treatment for the preexisting illness or condition will be covered.

Since exclusions and limitations "take away" some of the coverage of the policy, the law requires that they be clearly written and very specific. In the event of a reasonable difference of opinion over how to interpret the meaning of an exclusion or limitation, a court generally will resolve the dispute in favor of the policyholder by adopting the narrowest or most restrictive interpretation.