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Benefits Payable Exclusion

Benefits Payable Exclusion

What Is a Benefits Payable Exclusion?

A benefits payable exclusion is a clause in insurance policy contracts that eliminates the insurer's responsibility for paying claims connected with employee benefits. In particular, the clause shields the insurer from paying for benefits that could somehow be paid from an alternative source, for example, the employer's pension plan.

How Benefits Payable Exclusions Work

Organizations frequently purchase insurance to shield themselves from rare however possibly [catastrophic losses](/calamity misfortune file), like those brought about by extreme climate events or costly legal settlements. Most insurers, nonetheless, won't safeguard against risks that are an ordinary or unsurprising part of the company's business practices, for example, the risk of losses due to rising costs or wages.

These types of risks are all in all known as "business risks," and they incorporate the risk that employees could make claims against the company for certain benefits owed to them because of their employment. A common model is employee retirement pension benefits, which can be expensive to the employer. Since these costs can be seen as an anticipated part of business activities, most insurers would see such benefits payments as a business risk. Likewise, they would prohibit themselves from being required to cover those payments by adding a benefits payable exclusion clause to their insurance contracts.

It is important to note, notwithstanding, that at times a court might require an insurer to cover benefits-related costs even assuming a benefits payable exclusion was remembered for their contract. This could happen assuming the company being referred to had played it safe to service the actual claim, yet were in any case unfit to do as such. For example, on the off chance that a company's benefits plan becomes insolvent in spite of the company having made standard and reasonable contributions into the plan, a court could choose to hold the insurer responsible for covering any setbacks. According to the insurer's point of view, this potential legal risk must be thought about while concluding what level of premiums to charge to safeguard against this risk.

Real World Example of a Benefits Payable Exclusion

Emma is the owner of a mid-size company with several dozen employees. Throughout the long term, she has taken active efforts to increase the wages and retirement benefits of her staff, consistently adding to her company's employee retirement pension plan.

Sadly, a significant number of Emma's more established employees arrived at retirement in no time before a major financial crisis. Subsequently, the pension funds that had been invested in stocks and other financial assets saw a sudden and emotional decline. In spite of her best efforts to fund the plan enough, Emma currently found herself unfit to give the retirement benefits expected by her as of late retired employees, some of whom then, at that point, sued the company.

In court, Emma's insurer contended that due to the benefits payable exclusion clause of their contract, they were not responsible to cover the unpaid benefits payments. To Emma's surprise, notwithstanding, the court disallowed her insurer, contending that in light of the fact that the company's retirement plan had become ruined in spite of the reasonable efforts of the company's management, the insurer would be required to respect the unfunded portion of the claims made by Emma's employees.


  • In practice, courts will in some cases expect insurers to cover such claims even on the off chance that a benefits payable exclusion clause is in place.
  • A benefits payable exclusion is a legal clause reimbursing an insurer against claims connecting with employee benefits.
  • These types of claims are viewed as a uninsurable business risk.