48 CFR 1352.271-79 - Liability and insurance.

Code of Federal Regulations, 2011 CFR

2011-10-01

... AND FORMS SOLICITATION PROVISIONS AND CONTRACT CLAUSES Text of Provisions and Clauses 1352.271-79... against all suits, actions, claims, costs or demands (including without limitation, suits, actions, claims.... Such indemnity shall include, without limitation, suits, actions, claims, costs or demands of any kind...

48 CFR 1352.271-79 - Liability and insurance.

Code of Federal Regulations, 2012 CFR

2012-10-01

... AND FORMS SOLICITATION PROVISIONS AND CONTRACT CLAUSES Text of Provisions and Clauses 1352.271-79... against all suits, actions, claims, costs or demands (including without limitation, suits, actions, claims.... Such indemnity shall include, without limitation, suits, actions, claims, costs or demands of any kind...

48 CFR 1352.271-79 - Liability and insurance.

Code of Federal Regulations, 2013 CFR

2013-10-01

... AND FORMS SOLICITATION PROVISIONS AND CONTRACT CLAUSES Text of Provisions and Clauses 1352.271-79... against all suits, actions, claims, costs or demands (including without limitation, suits, actions, claims.... Such indemnity shall include, without limitation, suits, actions, claims, costs or demands of any kind...

48 CFR 3052.217-95 - Liability and insurance (USCG).

Code of Federal Regulations, 2013 CFR

2013-10-01

... SECURITY, HOMELAND SECURITY ACQUISITION REGULATION (HSAR) CLAUSES AND FORMS SOLICITATION PROVISIONS AND... insurance against any form of loss or damage to the vessel(s) or to the materials or equipment to which the... limitation, suits, actions, claims, costs, or demands of any kind, resulting from death, personal injury, or...

20 CFR 335.2 - Manner of claiming sickness benefits.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 1 2014-04-01 2012-04-01 true Manner of claiming sickness benefits. 335.2 Section 335.2 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT SICKNESS BENEFITS § 335.2 Manner of claiming sickness benefits. (a) Forms required for...

20 CFR 335.2 - Manner of claiming sickness benefits.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false Manner of claiming sickness benefits. 335.2 Section 335.2 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT SICKNESS BENEFITS § 335.2 Manner of claiming sickness benefits. (a) Forms required for...

20 CFR 335.2 - Manner of claiming sickness benefits.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 1 2013-04-01 2012-04-01 true Manner of claiming sickness benefits. 335.2 Section 335.2 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT SICKNESS BENEFITS § 335.2 Manner of claiming sickness benefits. (a) Forms required for...

20 CFR 335.2 - Manner of claiming sickness benefits.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 1 2012-04-01 2012-04-01 false Manner of claiming sickness benefits. 335.2 Section 335.2 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT SICKNESS BENEFITS § 335.2 Manner of claiming sickness benefits. (a) Forms required for...

Billing third party payers for pharmaceutical care services.

PubMed

Poirier, S; Buffington, D E; Memoli, G A

1999-01-01

To describe the steps pharmacists must complete when seeking compensation from third party payers for pharmaceutical care services. Government publications; professional publications, including manuals and newsletters; authors' personal experience. Pharmacists in increasing numbers are meeting with success in getting reimbursed by third party payers for patient care activities. However, many pharmacists remain reluctant to seek compensation because they do not understand the steps involved. Preparatory steps include obtaining a provider/supplier number, procuring appropriate claim forms, developing data collection and documentation systems, establishing professional fees, creating a marketing plan, and developing an accounting system. To bill for specific patient care services, pharmacists need to collect the patient's insurance information, obtain a statement of medical necessity from the patient's physician, complete the appropriate claim form accurately, and submit the claim with supporting documentation to the insurer. Although many claims from pharmacists are rejected initially, pharmacists who work with third party payers to understand the reasons for denial of payment often receive compensation when claims are resubmitted. Pharmacists who follow these guidelines for billing third party payers for pharmaceutical care services should notice an increase in the number of paid claims.

44 CFR 62.21 - Claims adjustment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program SALE OF INSURANCE AND ADJUSTMENT OF CLAIMS Claims Adjustment, Claims Appeals, and Judicial Review § 62.21 Claims adjustment. (a) In...

76 FR 39118 - Notice of Proposed Information Collection: Comment Request; Multifamily Insurance Benefits Claims...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-05

... Information Collection: Comment Request; Multifamily Insurance Benefits Claims Package AGENCY: Office of the..., Multifamily Insurance Operations Division, Multifamily Claims Branch, Department of Housing and Urban... also lists the following information: Title of Proposal: Multifamily Insurance Benefits Claims Package...

29 CFR 15.102 - May an insurance company file an FTCA administrative claim on behalf of a claimant?

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 1 2014-07-01 2013-07-01 true May an insurance company file an FTCA administrative claim... the Federal Tort Claims Act § 15.102 May an insurance company file an FTCA administrative claim on behalf of a claimant? (a) A claim for loss wholly compensated by an insurance company may be presented by...

29 CFR 15.102 - May an insurance company file an FTCA administrative claim on behalf of a claimant?

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 1 2013-07-01 2013-07-01 false May an insurance company file an FTCA administrative claim... the Federal Tort Claims Act § 15.102 May an insurance company file an FTCA administrative claim on behalf of a claimant? (a) A claim for loss wholly compensated by an insurance company may be presented by...

78 FR 59767 - Proposed Information Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-27

.... Current Actions: There are no changes being made to the form at this time. Type of Review: Extension of a... Burden Hours: 1,540,000. Title: Affordable Care Act Internal Claims and Appeals and External review... issuers of group health insurance coverage, in connection with internal appeals of claims denials, to...

75 FR 36154 - Proposed Information Collection (Request to Employer for Employment Information in Connection...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-24

... (Request to Employer for Employment Information in Connection With Claim for Disability Benefits) Activity...: Request to Employer for Employment Information in Connection With Claim for Disability Benefits, VA Form... solicits comments for information needed to determine a claimant's eligibility for disability insurance...

48 CFR 252.247-7007 - Liability and insurance.

Code of Federal Regulations, 2011 CFR

2011-10-01

... REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE CLAUSES AND FORMS SOLICITATION PROVISIONS AND CONTRACT CLAUSES Text... suits, demands, claims, or actions, in which the United States might be named as a co-defendant of the... without regard to whether such suit, demand, claim, or action was the result of the Contractor's...

48 CFR 252.247-7007 - Liability and insurance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE CLAUSES AND FORMS SOLICITATION PROVISIONS AND CONTRACT CLAUSES Text... suits, demands, claims, or actions, in which the United States might be named as a co-defendant of the... without regard to whether such suit, demand, claim, or action was the result of the Contractor's...

48 CFR 252.247-7007 - Liability and insurance.

Code of Federal Regulations, 2014 CFR

2014-10-01

... REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE CLAUSES AND FORMS SOLICITATION PROVISIONS AND CONTRACT CLAUSES Text... suits, demands, claims, or actions, in which the United States might be named as a co-defendant of the... without regard to whether such suit, demand, claim, or action was the result of the Contractor's...

48 CFR 252.247-7007 - Liability and insurance.

Code of Federal Regulations, 2013 CFR

2013-10-01

... REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE CLAUSES AND FORMS SOLICITATION PROVISIONS AND CONTRACT CLAUSES Text... suits, demands, claims, or actions, in which the United States might be named as a co-defendant of the... without regard to whether such suit, demand, claim, or action was the result of the Contractor's...

Disability insurance and the physician practice: a primer for physicians and office managers.

PubMed

Newfield, Jason; Frankel, Justin

2009-01-01

While your office may be familiar with all of the ins and outs of health insurance, disability insurance claims are complex and difficult to navigate, often deliberately so. When the unthinkable occurs and a claim must be filed, physicians are all too frequently stymied by the response of the insurance company to their claim. This article will provide fundamental information for the physician who needs to file a claim as well the practitioner who comes across a long-term disability insurance claim in his or her practice.

14 CFR 1274.941 - Insurance and indemnification.

Code of Federal Regulations, 2013 CFR

2013-01-01

... notify the Agreement Officer of any third party claim or suit against the Recipient, one of its related... damages resulting from covered activities; (2) Furnish evidence or proof of any such claim, suit or damages, in the form required by NASA; and (3) Immediately furnish to NASA, or its designee, copies of all...

14 CFR § 1274.941 - Insurance and indemnification.

Code of Federal Regulations, 2014 CFR

2014-01-01

... notify the Agreement Officer of any third party claim or suit against the Recipient, one of its related... damages resulting from covered activities; (2) Furnish evidence or proof of any such claim, suit or damages, in the form required by NASA; and (3) Immediately furnish to NASA, or its designee, copies of all...

14 CFR 1274.941 - Insurance and indemnification.

Code of Federal Regulations, 2010 CFR

2010-01-01

... notify the Agreement Officer of any third party claim or suit against the Recipient, one of its related... damages resulting from covered activities; (2) Furnish evidence or proof of any such claim, suit or damages, in the form required by NASA; and (3) Immediately furnish to NASA, or its designee, copies of all...

14 CFR 1274.941 - Insurance and indemnification.

Code of Federal Regulations, 2012 CFR

2012-01-01

... notify the Agreement Officer of any third party claim or suit against the Recipient, one of its related... damages resulting from covered activities; (2) Furnish evidence or proof of any such claim, suit or damages, in the form required by NASA; and (3) Immediately furnish to NASA, or its designee, copies of all...

20 CFR 321.2 - Filing claims for benefits electronically.

Code of Federal Regulations, 2010 CFR

2010-04-01

... UNEMPLOYMENT INSURANCE ACT ELECTRONIC FILING OF APPLICATIONS AND CLAIMS FOR BENEFITS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT § 321.2 Filing claims for benefits electronically. (a) Electronic filing. A claim for benefits under the Railroad Unemployment Insurance Act may be filed electronically through the...

20 CFR 321.2 - Filing claims for benefits electronically.

Code of Federal Regulations, 2013 CFR

2013-04-01

... UNEMPLOYMENT INSURANCE ACT ELECTRONIC FILING OF APPLICATIONS AND CLAIMS FOR BENEFITS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT § 321.2 Filing claims for benefits electronically. (a) Electronic filing. A claim for benefits under the Railroad Unemployment Insurance Act may be filed electronically through the...

20 CFR 321.2 - Filing claims for benefits electronically.

Code of Federal Regulations, 2011 CFR

2011-04-01

... UNEMPLOYMENT INSURANCE ACT ELECTRONIC FILING OF APPLICATIONS AND CLAIMS FOR BENEFITS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT § 321.2 Filing claims for benefits electronically. (a) Electronic filing. A claim for benefits under the Railroad Unemployment Insurance Act may be filed electronically through the...

20 CFR 321.2 - Filing claims for benefits electronically.

Code of Federal Regulations, 2014 CFR

2014-04-01

... UNEMPLOYMENT INSURANCE ACT ELECTRONIC FILING OF APPLICATIONS AND CLAIMS FOR BENEFITS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT § 321.2 Filing claims for benefits electronically. (a) Electronic filing. A claim for benefits under the Railroad Unemployment Insurance Act may be filed electronically through the...

20 CFR 321.2 - Filing claims for benefits electronically.

Code of Federal Regulations, 2012 CFR

2012-04-01

... UNEMPLOYMENT INSURANCE ACT ELECTRONIC FILING OF APPLICATIONS AND CLAIMS FOR BENEFITS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT § 321.2 Filing claims for benefits electronically. (a) Electronic filing. A claim for benefits under the Railroad Unemployment Insurance Act may be filed electronically through the...

26 CFR 31.3406(g)-1 - Exception for payments to certain payees and certain other payments.

Code of Federal Regulations, 2014 CFR

2014-04-01

... form prescribed under section 3406 for claiming exempt status. (c) Prepaid or advance premium life..., 1996, on prepaid or advance premium life-insurance contracts to a payee who is the owner for tax purposes of the prepaid or advance premium life-insurance contract. For purposes of this exception from...

Dental claims in the Swedish Patient Insurance Scheme.

PubMed

René, N; Owall, B; Cronström, R

1991-06-01

The Swedish Patient Insurance Scheme covers treatment injuries and guarantees the replacement of failed removable prostheses for 1 year and fixed prostheses for 2 years after fitting. In this paper, 573 dental cases are analysed for a 3-month period in 1986, during which crowns and bridges formed the vast majority of failed treatments that were reported.

20 CFR 200.2 - The general course and method by which the Board's functions are channeled and determined.

Code of Federal Regulations, 2011 CFR

2011-04-01

... to the nearest field office of the Board. That office inspects the applications to detect errors and..., the claimant executes a registration and claim for unemployment insurance benefits (Form UI-3). In... openings, detecting errors and omissions, and noting items requiring investigation. The claim is then...

24 CFR 17.46 - Claims involving carriers or insurers.

Code of Federal Regulations, 2010 CFR

2010-04-01

... service is insured in whole or in part, the claimant must make demand in writing against the insurer for... claim against the Government. (c) Failure to make a demand on a carrier or insurer or to make all... claimant's service preclude reasonable filing of such a claim or diligent prosecution, or the evidence...

76 FR 44491 - Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-26

... 37208) entitled, ``Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims..., ``Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals and... external review processes for group health plans and health insurance issuers offering coverage in the...

78 FR 41339 - Federal Housing Administration (FHA) Multifamily Mortgage Insurance; Capturing Excess Claim Proceeds

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-10

...-AJ16 Federal Housing Administration (FHA) Multifamily Mortgage Insurance; Capturing Excess Claim... reimbursement to FHA of excess claim proceeds. When a mortgagee finances mortgages through the issuance and sale of bonds or through bond anticipation notes, the mortgagee uses the FHA insurance claim funds to pay...

44 CFR 62.20 - Claims appeals.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Claims appeals. 62.20 Section... OF CLAIMS Claims Adjustment, Claims Appeals, and Judicial Review § 62.20 Claims appeals. (a.... Decision means the insurer's final claim determination, which is the insurer's written denial, in whole or...

44 CFR 62.20 - Claims appeals.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Claims appeals. 62.20 Section... OF CLAIMS Claims Adjustment, Claims Appeals, and Judicial Review § 62.20 Claims appeals. (a.... Decision means the insurer's final claim determination, which is the insurer's written denial, in whole or...

44 CFR 62.20 - Claims appeals.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Claims appeals. 62.20 Section... OF CLAIMS Claims Adjustment, Claims Appeals, and Judicial Review § 62.20 Claims appeals. (a.... Decision means the insurer's final claim determination, which is the insurer's written denial, in whole or...

Reserving by detailed conditioning on individual claim

NASA Astrophysics Data System (ADS)

Kartikasari, Mujiati Dwi; Effendie, Adhitya Ronnie; Wilandari, Yuciana

2017-03-01

The estimation of claim reserves is an important activity in insurance companies to fulfill their liabilities. Recently, reserving method of individual claim have attracted a lot of interest in the actuarial science, which overcome some deficiency of aggregated claim method. This paper explores the Reserving by Detailed Conditioning (RDC) method using all of claim information for reserving with individual claim of liability insurance from an Indonesian general insurance company. Furthermore, we compare it to Chain Ladder and Bornhuetter-Ferguson method.

Model estimation of claim risk and premium for motor vehicle insurance by using Bayesian method

NASA Astrophysics Data System (ADS)

Sukono; Riaman; Lesmana, E.; Wulandari, R.; Napitupulu, H.; Supian, S.

2018-01-01

Risk models need to be estimated by the insurance company in order to predict the magnitude of the claim and determine the premiums charged to the insured. This is intended to prevent losses in the future. In this paper, we discuss the estimation of risk model claims and motor vehicle insurance premiums using Bayesian methods approach. It is assumed that the frequency of claims follow a Poisson distribution, while a number of claims assumed to follow a Gamma distribution. The estimation of parameters of the distribution of the frequency and amount of claims are made by using Bayesian methods. Furthermore, the estimator distribution of frequency and amount of claims are used to estimate the aggregate risk models as well as the value of the mean and variance. The mean and variance estimator that aggregate risk, was used to predict the premium eligible to be charged to the insured. Based on the analysis results, it is shown that the frequency of claims follow a Poisson distribution with parameter values λ is 5.827. While a number of claims follow the Gamma distribution with parameter values p is 7.922 and θ is 1.414. Therefore, the obtained values of the mean and variance of the aggregate claims respectively are IDR 32,667,489.88 and IDR 38,453,900,000,000.00. In this paper the prediction of the pure premium eligible charged to the insured is obtained, which amounting to IDR 2,722,290.82. The prediction of the claims and premiums aggregate can be used as a reference for the insurance company’s decision-making in management of reserves and premiums of motor vehicle insurance.

75 FR 5079 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-01

... ``Forms Related to Processing Deposit Insurance Claims'' information (OMB No. 3064-0143). No comments were... the proposed revised Forms 7200/05 and 7200/09, and proposed new Form 7200/18 can be obtained at the... is requesting OMB approval to make minor revisions to simplify and clarify three of the forms, and...

44 CFR 62.22 - Judicial review.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Judicial review. 62.22... HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program SALE OF INSURANCE AND ADJUSTMENT OF CLAIMS Claims Adjustment, Claims Appeals, and Judicial Review § 62.22 Judicial review. (a) Upon...

Characteristics of, and insurance payments for, injuries to cyclists in Tasmania, 1990-2010.

PubMed

Hitchens, P L; Palmer, A J

2012-11-01

To describe the characteristics and costs of injuries to cyclists resulting in a 3rd party insurance claim in Tasmania. Data on injuries to cyclists were obtained from the Motor Accident Insurance Board (MAIB) for the period 1990-2010. Frequency and insurance costs of injuries to cyclists were compared to injuries incurred by other road users. Descriptive analyses of cycling injuries and insurance costs by year, age and sex of claimant, and type and location of injury are presented. Annual costs of insurance claims by cyclists averaged AUD 3.9 million. There was a significant decrease in the frequency of claims made by all road users combined over the study period, but not for cyclists. Cycling injuries made up 2.0% of claims but accounted for 3.4% of the total costs and were among the road user groups with the highest mean costs per claim. Fractures (20.7%) were the most common cycling injury. Brain injuries led to the highest mean claim costs (AUD 1,559,032), and accounted for 66.8% of claim costs made by cyclists. Mean costs per claim for cycling injuries are high compared to those made by most other road users. The costs of these injuries impose a substantial burden on insurance payers. The high costs and severity of claims by cyclists compared to other road users demonstrates the high vulnerability of cyclists, and lends support to increasing separation of cyclists from motor vehicles. Copyright © 2012 Elsevier Ltd. All rights reserved.

75 FR 39051 - Allstate Insurance Company, Altoona Express Market Claim Office, Including On-Site Leased Workers...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-07

... former workers of Allstate Insurance Company, Altoona Express Market Claim Office, including on- site... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-73,536] Allstate Insurance Company, Altoona Express Market Claim Office, Including On-Site Leased Workers From Kelly Services...

The role of insurance claims databases in drug therapy outcomes research.

PubMed

Lewis, N J; Patwell, J T; Briesacher, B A

1993-11-01

The use of insurance claims databases in drug therapy outcomes research holds great promise as a cost-effective alternative to post-marketing clinical trials. Claims databases uniquely capture information about episodes of care across healthcare services and settings. They also facilitate the examination of drug therapy effects on cohorts of patients and specific patient subpopulations. However, there are limitations to the use of insurance claims databases including incomplete diagnostic and provider identification data. The characteristics of the population included in the insurance plan, the plan benefit design, and the variables of the database itself can influence the research results. Given the current concerns regarding the completeness of insurance claims databases, and the validity of their data, outcomes research usually requires original data to validate claims data or to obtain additional information. Improvements to claims databases such as standardisation of claims information reporting, addition of pertinent clinical and economic variables, and inclusion of information relative to patient severity of illness, quality of life, and satisfaction with provided care will enhance the benefit of such databases for outcomes research.

An Audit of Indian Health Insurance Claims for Mental Illness from Pooled Insurance Information Bureau's Macroindicator Data.

PubMed

Mohandoss, Anusa Arunachalam; Thavarajah, Rooban

2017-01-01

Information on the social and voluntary insurance coverage of mental illness in India is scarce. We attempted to address this lacuna, utilizing a secondary macrodata approach for 3 years. Mental illness per se is not covered by most of existing Indian health insurance policies. Publicly available de-identified claim macrodata for all health (nonlife) insurance for Indian financial year from 2011-2012 to 2013-2014 were collected. The age group, gender, amount of claims, proportion of claims, and details of number of days of hospitalization were collected and analyzed. Descriptive statistics, Chi-square test, and Wilcoxon tests were used appropriately. P ≤ 0.05 was considered statistically significant. In 2011-2012, there were 2864 claims from the registered 2,591,781 members citing mental illness (0.11%) which decreased to 0.03% in 2012-2013 and marginally rose to 0.07% of all claims. The total amount of claims paid for mental illness was Rs. 51.7 millions in 2011-2012, Rs. 97.2 million in 2012-2013, and Rs. 150 million in 2013-2014. Statistically significant difference emerged in terms of age group, gender, amount and proportion of claim, and number of days of hospitalization. The penetration of health insurance is low and claim for mental illness remains low. The difference in patterns of age, gender, amount of claims, and number of days for mental illness provides detailed relevant information to formulate future policies.

Hip Arthroplasty Malpractice Claims in the Netherlands: Closed Claim Study 2000-2012.

PubMed

Zengerink, Imme; Reijman, Max; Mathijssen, Nina M C; Eikens-Jansen, Manon P; Bos, P Koen

2016-09-01

A total hip arthroplasty (THA) is a successful and reliable operation with few complications. These complications however, do form a potential source for compensation claims. In the Netherlands, there are no studies available concerning filed claims after THA. The aim of this study was to determine the incidence of claims related to THAs in the Netherlands and the reasons to claim, which claims lead to compensation, the costs involved for the insurer, and the demographics of the claimants. In this observational study, we analyzed all closed claims from 2000 to 2012 from the national largest insurer of medical liability and compared it to data from our national implant registry in the Netherlands. With the intention to contribute to prevention, we have identified the demographics of the claimant, the reasons for filing claims, and the outcome of claims. Overall, 516 claims were expressed in 280 closed claim files after THA. Claims were most often related to sciatic nerve injury (19.6%). Most claimants were women (71.6%) with an average age of 63.1 years. The median cost per compensated claim is €5.921. The claimant is more likely to be female and to be younger than the average patient receiving a THA. The incidence of a claim after a THA is 0.14%-0.30%. Nerve damage is the most common reason to file for compensation. The distribution in reasons to claim does not resemble the complication rate in literature after a THA. The outcome of this study can be used to improve patient care, safety, and costs. Copyright © 2016 Elsevier Inc. All rights reserved.

Retention for Stoploss reinsurance to minimize VaR in compound Poisson-Lognormal distribution

NASA Astrophysics Data System (ADS)

Soleh, Achmad Zanbar; Noviyanti, Lienda; Nurrahmawati, Irma

2015-12-01

Automobile insurance is one of the emerging general insurance's product in Indonesia. Fluctuation in total premium revenues and total claim expenses leads to a risk that insurance company can not be able to pay consumer's claims, thus reinsurance is needeed. Reinsurance is a risk transfer mechanism from the insurance company to another company called reinsurer, one of the reinsurance type is Stoploss. Because reinsurer charges premium to the insurance company, it is important to determine the retention or the total claims to be retain solely by the insurance company. Thus, retention is determined using Value at Risk (VaR) which minimize the total risk of the insurance company in the presence of Stoploss reinsurance. Retention depends only on the distribution of total claims and reinsurance loading factor. We use the compound Poisson distribution and the Log-Normal Distribution to illustrate the retention value in a collective risk model.

44 CFR 63.9 - Sale while claim pending.

Code of Federal Regulations, 2014 CFR

2014-10-01

... OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program IMPLEMENTATION OF SECTION 1306(c) OF THE NATIONAL FLOOD INSURANCE ACT OF 1968 General § 63.9 Sale while claim...

44 CFR 63.9 - Sale while claim pending.

Code of Federal Regulations, 2011 CFR

2011-10-01

... OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program IMPLEMENTATION OF SECTION 1306(c) OF THE NATIONAL FLOOD INSURANCE ACT OF 1968 General § 63.9 Sale while claim...

44 CFR 63.9 - Sale while claim pending.

Code of Federal Regulations, 2013 CFR

2013-10-01

... OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program IMPLEMENTATION OF SECTION 1306(c) OF THE NATIONAL FLOOD INSURANCE ACT OF 1968 General § 63.9 Sale while claim...

Medical research using governments' health claims databases: with or without patients' consent?

PubMed

Tsai, Feng-Jen; Junod, Valérie

2018-03-01

Taking advantage of its single-payer, universal insurance system, Taiwan has leveraged its exhaustive database of health claims data for research purposes. Researchers can apply to receive access to pseudonymized (coded) medical data about insured patients, notably their diagnoses, health status and treatments. In view of the strict safeguards implemented, the Taiwanese government considers that this research use does not require patients' consent (either in the form of an opt-in or in the form of an opt-out). A group of non-governmental organizations has challenged this view in the Taiwanese Courts, but to no avail. The present article reviews the arguments both against and in favor of patients' consent for re-use of their data in research. It concludes that offering patients an opt-out would be appropriate as it would best balance the important interests at issue.

Index for Predicting Insurance Claims from Wind Storms with an Application in France.

PubMed

Mornet, Alexandre; Opitz, Thomas; Luzi, Michel; Loisel, Stéphane

2015-11-01

For insurance companies, wind storms represent a main source of volatility, leading to potentially huge aggregated claim amounts. In this article, we compare different constructions of a storm index allowing us to assess the economic impact of storms on an insurance portfolio by exploiting information from historical wind speed data. Contrary to historical insurance portfolio data, meteorological variables show fewer nonstationarities between years and are easily available with long observation records; hence, they represent a valuable source of additional information for insurers if the relation between observations of claims and wind speeds can be revealed. Since standard correlation measures between raw wind speeds and insurance claims are weak, a storm index focusing on high wind speeds can afford better information. A storm index approach has been applied to yearly aggregated claim amounts in Germany with promising results. Using historical meteorological and insurance data, we assess the consistency of the proposed index constructions with respect to various parameters and weights. Moreover, we are able to place the major insurance events since 1998 on a broader horizon beyond 40 years. Our approach provides a meteorological justification for calculating the return periods of extreme-storm-related insurance events whose magnitude has rarely been reached. © 2015 Society for Risk Analysis.

44 CFR 63.9 - Sale while claim pending.

Code of Federal Regulations, 2012 CFR

2012-10-01

... HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program IMPLEMENTATION OF SECTION 1306(c) OF THE NATIONAL FLOOD INSURANCE ACT OF 1968 General § 63.9 Sale while claim pending. If a...

76 FR 37037 - Requirements for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-24

... Requirements for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and... interim final regulations published July 23, 2010 with respect to group health plans and health insurance..., group health plans, and health insurance issuers providing group health insurance coverage. The text of...

46 CFR 308.515 - Payment in event of loss.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Open Policy War Risk Cargo Insurance § 308.515 Payment in event of loss. All... claims must be supported by the customary documents required in connection with war risk insurance claims...

Risk Adjustment, Reinsurance Improved Financial Outcomes For Individual Market Insurers With The Highest Claims.

PubMed

Jacobs, Paul D; Cohen, Michael L; Keenan, Patricia

2017-04-01

The Affordable Care Act (ACA) reformed the individual health insurance market. Because insurers can no longer vary their offers of coverage based on applicants' health status, the ACA established a risk adjustment program to equalize health-related cost differences across plans. The ACA also established a temporary reinsurance program to subsidize high-cost claims. To assess the impact of these programs, we compared revenues to claims costs for insurers in the individual market during the first two years of ACA implementation (2014 and 2015), before and after the inclusion of risk adjustment and reinsurance payments. Before these payments were included, for the 30 percent of insurers with the highest claims costs, claims (not including administrative expenses) exceeded premium revenues by $90-$397 per enrollee per month. The effect was reversed after these payments were included, with revenues exceeding claims costs by $0-$49 per month. The risk adjustment and reinsurance programs were relatively well targeted in the first two years. While there is ongoing discussion regarding the future of the ACA, our findings can shed light on how risk-sharing programs can address risk selection among insurers-a pervasive issue in all health insurance markets. Project HOPE—The People-to-People Health Foundation, Inc.

48 CFR 352.228-7 - Insurance-liability to third persons.

Code of Federal Regulations, 2014 CFR

2014-10-01

... SERVICES CLAUSES AND FORMS SOLICITATION PROVISIONS AND CONTRACT CLAUSES Texts of Provisions and Clauses 352... paragraph shall be in form and amount and for those periods as the Contracting Officer may require or... Cost and Payment clause of this contract. (g) If any suit or action is filed or any claim is made...

48 CFR 352.228-7 - Insurance-liability to third persons.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SERVICES CLAUSES AND FORMS SOLICITATION PROVISIONS AND CONTRACT CLAUSES Texts of Provisions and Clauses 352... paragraph shall be in form and amount and for those periods as the Contracting Officer may require or... Cost and Payment clause of this contract. (g) If any suit or action is filed or any claim is made...

Bundled automobile insurance coverage and accidents.

PubMed

Li, Chu-Shiu; Liu, Chwen-Chi; Peng, Sheng-Chang

2013-01-01

This paper investigates the characteristics of automobile accidents by taking into account two types of automobile insurance coverage: comprehensive vehicle physical damage insurance and voluntary third-party liability insurance. By using a unique data set in the Taiwanese automobile insurance market, we explore the bundled automobile insurance coverage and the occurrence of claims. It is shown that vehicle physical damage insurance is the major automobile coverage and affects the decision to purchase voluntary liability insurance coverage as a complement. Moreover, policyholders with high vehicle physical damage insurance coverage have a significantly higher probability of filing vehicle damage claims, and if they additionally purchase low voluntary liability insurance coverage, their accident claims probability is higher than those who purchase high voluntary liability insurance coverage. Our empirical results reveal that additional automobile insurance coverage information can capture more driver characteristics and driving behaviors to provide useful information for insurers' underwriting policies and to help analyze the occurrence of automobile accidents. Copyright © 2012 Elsevier Ltd. All rights reserved.

46 CFR 308.515 - Payment in event of loss.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Ii-Open Policy War Risk Cargo Insurance § 308.515 Payment in event of loss. All... claims must be supported by the customary documents required in connection with war risk insurance claims...

46 CFR 308.515 - Payment in event of loss.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Ii-Open Policy War Risk Cargo Insurance § 308.515 Payment in event of loss. All... claims must be supported by the customary documents required in connection with war risk insurance claims...

Validation of 2D flood models with insurance claims

NASA Astrophysics Data System (ADS)

Zischg, Andreas Paul; Mosimann, Markus; Bernet, Daniel Benjamin; Röthlisberger, Veronika

2018-02-01

Flood impact modelling requires reliable models for the simulation of flood processes. In recent years, flood inundation models have been remarkably improved and widely used for flood hazard simulation, flood exposure and loss analyses. In this study, we validate a 2D inundation model for the purpose of flood exposure analysis at the river reach scale. We validate the BASEMENT simulation model with insurance claims using conventional validation metrics. The flood model is established on the basis of available topographic data in a high spatial resolution for four test cases. The validation metrics were calculated with two different datasets; a dataset of event documentations reporting flooded areas and a dataset of insurance claims. The model fit relating to insurance claims is in three out of four test cases slightly lower than the model fit computed on the basis of the observed inundation areas. This comparison between two independent validation data sets suggests that validation metrics using insurance claims can be compared to conventional validation data, such as the flooded area. However, a validation on the basis of insurance claims might be more conservative in cases where model errors are more pronounced in areas with a high density of values at risk.

16 CFR Appendix A to Part 313 - Model Privacy Form

Code of Federal Regulations, 2010 CFR

2010-01-01

... scores; insurance claim history; medical information; overdraft history; purchase history; account...; retirement assets; checking account information; employment information; wire transfer instructions. (c... account; enter into an investment advisory contract; give us your income information; provide employment...

Flood damage claims reveal insights about surface runoff in Switzerland

NASA Astrophysics Data System (ADS)

Bernet, D. B.; Prasuhn, V.; Weingartner, R.

2015-12-01

A few case studies in Switzerland exemplify that not only overtopping water bodies frequently cause damages to buildings. Reportedly, a large share of the total loss due to flooding in Switzerland goes back to surface runoff that is formed and is propagating outside of regular watercourses. Nevertheless, little is known about when, where and why such surface runoff occurs. The described process encompasses surface runoff formation, followed by unchannelised overland flow until a water body is reached. It is understood as a type of flash flood, has short response times and occurs diffusely in the landscape. Thus, the process is difficult to observe and study directly. A promising source indicating surface runoff indirectly are houseowners' damage claims recorded by Swiss Public Insurance Companies for Buildings (PICB). In most of Switzerland, PICB hold a monopoly position and insure (almost) every building. Consequently, PICB generally register all damages to buildings caused by an insured natural hazard (including surface runoff) within the respective zones. We have gathered gapless flood related claim records of most of all Swiss PICB covering more than the last two decades on average. Based on a subset, we have developed a methodology to differentiate claims related to surface runoff from other causes. This allows us to assess the number of claims as well as total loss related to surface runoff and compare these to the numbers of overtopping watercourses. Furthermore, with the good data coverage, we are able to analyze surface runoff related claims in space and time, from which we can infer spatial and temporal characteristics of surface runoff. Although the delivered data of PICB are heterogeneous and, consequently, time-consuming to harmonize, our first results show that exploiting these damage claim records is feasible and worthwhile to learn more about surface runoff in Switzerland.

[AIDS and life insurance in Germany. 10 years successful risk management].

PubMed

Akermann, S

1998-06-01

The introduction of AIDS specific measures by the German life assurance industry in 1988 was an important step towards prevention of adverse selection by the well known risk groups. In retrospect one can state that in the eighties there was a tendency of risk groups for inappropriately high insurance coverage. This could be curtailed with the introduction of a question as to a positive HIV test in each proposal form and a mandatory HIV test for every policy exceeding DM 250,000. These tendencies could very nicely be demonstrated by studies of own AIDS cases. The claims for death and disability benefits because of AIDS are as of now compared to the total claims of minor importance.

24 CFR 235.1208 - Eligible mortgagors.

Code of Federal Regulations, 2010 CFR

2010-04-01

... submitting of consent forms by mortgagors and cooperative members for the obtaining of wage and claim information from State Wage Information Collection Agencies, see part 200, subpart V, of this chapter... MORTGAGE INSURANCE AND ASSISTANCE PAYMENTS FOR HOME OWNERSHIP AND PROJECT REHABILITATION Eligibility...

Development of an electronic claim system based on an integrated electronic health record platform to guarantee interoperability.

PubMed

Kim, Hwa Sun; Cho, Hune; Lee, In Keun

2011-06-01

We design and develop an electronic claim system based on an integrated electronic health record (EHR) platform. This system is designed to be used for ambulatory care by office-based physicians in the United States. This is achieved by integrating various medical standard technologies for interoperability between heterogeneous information systems. The developed system serves as a simple clinical data repository, it automatically fills out the Centers for Medicare and Medicaid Services (CMS)-1500 form based on information regarding the patients and physicians' clinical activities. It supports electronic insurance claims by creating reimbursement charges. It also contains an HL7 interface engine to exchange clinical messages between heterogeneous devices. The system partially prevents physician malpractice by suggesting proper treatments according to patient diagnoses and supports physicians by easily preparing documents for reimbursement and submitting claim documents to insurance organizations electronically, without additional effort by the user. To show the usability of the developed system, we performed an experiment that compares the time spent filling out the CMS-1500 form directly and time required create electronic claim data using the developed system. From the experimental results, we conclude that the system could save considerable time for physicians in making claim documents. The developed system might be particularly useful for those who need a reimbursement-specialized EHR system, even though the proposed system does not completely satisfy all criteria requested by the CMS and Office of the National Coordinator for Health Information Technology (ONC). This is because the criteria are not sufficient but necessary condition for the implementation of EHR systems. The system will be upgraded continuously to implement the criteria and to offer more stable and transparent transmission of electronic claim data.

Comparison of Musculoskeletal Disorder Health Claims Between Construction Floor Layers and a General Working Population

PubMed Central

Dale, Ann Marie; Ryan, Daniel; Welch, Laura; Olsen, Margaret A.; Buchholz, Bryan; Evanoff, Bradley

2014-01-01

Objectives Compare rates of medical insurance claims for musculoskeletal disorders (MSD) between workers in a construction trade and a general worker population to determine if higher physical exposures in construction lead to higher rates of claims on personal medical insurance. Methods Health insurance claims between 2006 and 2010 from floor layers were frequency matched by age, gender, eligibility time, and geographic location to claims from insured workers in general industry obtained from MarketScan. We extracted MSD claims and dates of service from six regions of the body: neck, low back, knee, lower extremity, shoulder, and distal arm, and evaluated differences in claim rates. Results Fifty-one percent of floor layers (n=1,475) experienced musculoskeletal claims compared to 39% of MarketScan members (p<0.001). Claim rates were higher for floor layers across all body regions with nearly double the rate ratios for the knee and neck regions (RR: 2.10 and 2.07). The excess risk was greatest for the neck and low back regions; younger workers had disproportionately higher rates in the knee, neck, low back, and distal arm. A larger proportion of floor layers (22%) filed MSD claims in more than one body region compared to general workers (10%; p<0.001). Conclusions Floor layers have markedly higher rates of MSD claims compared to a general worker population, suggesting shifting of medical costs for work-related MSD to personal health insurance. The occurrence of disorders in multiple body regions and among the youngest workers highlights the need for improved work methods and tools for construction workers. PMID:25224720

Dental treatment injuries in the Finnish Patient Insurance Centre in 2000-2011.

PubMed

Karhunen, Sini; Virtanen, Jorma I

2016-01-01

Objective The Patient Insurance Centre in Finland reimburses patients who sustained injuries associated with medical and dental care without having to demonstrate malpractice. The aim was to analyse all dental injuries claimed through the Patient Insurance Centre over a 12-year period in order to identify factors affecting reimbursement of claims. Methods This study investigated all dental patient insurance claims in Finland during 2000-2011. The injury cases were grouped as (K00-K08) according to the International Classification of Diseases (ICD-10). Calendar year, claimant's age and gender, dental disease group and health service sector were the explanatory factors and the outcome was the decision of a claim. Multiple logistic regression modelling was used in the statistical analyses. Results The total number of decisions related to dental claims at the PIC in 2000-2011 was 7662, of which women claimed a clear majority (72%). Diseases of the pulp and periapical tissues (K04) and dental caries (K02) were the major disease groups (both 29%). Of the claims 40% were eligible for reimbursement, 27% were classified as insignificant or unavoidable injuries and 32% were rejected for other reasons. The proportion of reimbursed claims declined during the period. Patients from the private sector were more likely to be eligible for compensation than were those from the public sector (OR = 1.89, 95% CI = 1.71-2.10). Conclusions The number of dental patient insurance claims in Finland clearly rose, while the proportion of reimbursed claims declined. More claims received compensation in the private sector than in the public sector.

75 FR 43109 - Requirements for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-23

... Requirements for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and... the Office of Consumer Information and Insurance Oversight of the U.S. Department of Health and Human... health insurance coverage offered in connection with a group health plan under the Employee Retirement...

46 CFR 308.205 - Reporting casualties and filing claims.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 308.205 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.205 Reporting casualties and filing claims. All... documents filed with the Office of Subsidy and Insurance, Maritime Administration, Department of...

46 CFR 308.205 - Reporting casualties and filing claims.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 308.205 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.205 Reporting casualties and filing claims. All... documents filed with “Office of Marine Insurance, Maritime Administration, Department of Transportation.” ...

46 CFR 308.205 - Reporting casualties and filing claims.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 308.205 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.205 Reporting casualties and filing claims. All... documents filed with the Office of Subsidy and Insurance, Maritime Administration, Department of...

46 CFR 308.205 - Reporting casualties and filing claims.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 308.205 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.205 Reporting casualties and filing claims. All... documents filed with the Office of Subsidy and Insurance, Maritime Administration, Department of...

46 CFR 308.205 - Reporting casualties and filing claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 308.205 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.205 Reporting casualties and filing claims. All... documents filed with the Office of Subsidy and Insurance, Maritime Administration, Department of...

Assistance provided abroad to insured travellers from Australia following the 2004 Asian tsunami.

PubMed

Leggat, Peter A; Leggat, Frances W

2007-01-01

On 26 December 2004, the Asian tsunami hit countries around the Indian Ocean rim, particularly around its earthquake-associated epicentre off Indonesia. A number of popular tourist destinations for Australian travellers are located in this region. This study was designed to investigate travel insurance claims reported by travellers from Australia following the Asian tsunami and to examine the role of travel insurance and emergency assistance companies. In December 2005, all claims reported, following the Asian tsunami on 26 December 2004, to a major Australian travel insurance company were examined for those claims associated with the Asian tsunami. Twenty-two tsunami-related claims were submitted of which nine travellers (40.9%) used the travel insurance company's emergency assistance service. Four travellers (18.2%) cancelled their trip to Asia, mainly to Thailand. Five travellers (27.3%), who were already abroad, also curtailed their trip as a result of the tsunami. Half of travellers (50.0%) were claiming loss of personal belongings. Of those using the emergency assistance service, five travellers (22.7%) sought policy and claiming advice, two (9.1%) sought assistance with flight rearrangements, and one (4.5%) sought situation advice. There was also assistance provided following the death of one insured traveller as a direct consequence of the tsunami, which included a lump sum payment to the deceased estate. The mean refund, where a travel insurance claim was paid, was Australian dollars (AUD)2234 (SD=AUD5755). This study highlights the importance of travellers taking out appropriate travel insurance, which provides for emergency assistance. Travel insurance agencies do play some role after emergencies, such as the Asian tsunami. This assistance predominantly involves dealing with cancellation of travellers' intended visits to the affected area, but does also involve some assistance to travellers affected by the crisis. Travellers should be advised to seek travel health advice well before departure overseas and to ensure that they are aware of travel advisories for their destination.

Modeling the Malaysian motor insurance claim using artificial neural network and adaptive NeuroFuzzy inference system

NASA Astrophysics Data System (ADS)

Mohd Yunos, Zuriahati; Shamsuddin, Siti Mariyam; Ismail, Noriszura; Sallehuddin, Roselina

2013-04-01

Artificial neural network (ANN) with back propagation algorithm (BP) and ANFIS was chosen as an alternative technique in modeling motor insurance claims. In particular, an ANN and ANFIS technique is applied to model and forecast the Malaysian motor insurance data which is categorized into four claim types; third party property damage (TPPD), third party bodily injury (TPBI), own damage (OD) and theft. This study is to determine whether an ANN and ANFIS model is capable of accurately predicting motor insurance claim. There were changes made to the network structure as the number of input nodes, number of hidden nodes and pre-processing techniques are also examined and a cross-validation technique is used to improve the generalization ability of ANN and ANFIS models. Based on the empirical studies, the prediction performance of the ANN and ANFIS model is improved by using different number of input nodes and hidden nodes; and also various sizes of data. The experimental results reveal that the ANFIS model has outperformed the ANN model. Both models are capable of producing a reliable prediction for the Malaysian motor insurance claims and hence, the proposed method can be applied as an alternative to predict claim frequency and claim severity.

The effectiveness of insurer-supported safety and health engineering controls in reducing workers' compensation claims and costs.

PubMed

Wurzelbacher, Steven J; Bertke, Stephen J; Lampl, Michael P; Bushnell, P Timothy; Meyers, Alysha R; Robins, David C; Al-Tarawneh, Ibraheem S

2014-12-01

This study evaluated the effectiveness of a program in which a workers' compensation (WC) insurer provided matching funds to insured employers to implement safety/health engineering controls. Pre- and post-intervention WC metrics were compiled for the employees designated as affected by the interventions within 468 employers for interventions occurring from 2003 to 2009. Poisson, two-part, and linear regression models with repeated measures were used to evaluate differences in pre- and post-data, controlling for time trends independent of the interventions. For affected employees, total WC claim frequency rates (both medical-only and lost-time claims) decreased 66%, lost-time WC claim frequency rates decreased 78%, WC paid cost per employee decreased 81%, and WC geometric mean paid claim cost decreased 30% post-intervention. Reductions varied by employer size, specific industry, and intervention type. The insurer-supported safety/health engineering control program was effective in reducing WC claims and costs for affected employees. © 2014 Wiley Periodicals, Inc.

The Effectiveness of Insurer-Supported Safety and Health Engineering Controls in Reducing Workers’ Compensation Claims and Costs

PubMed Central

Wurzelbacher, Steven J.; Bertke, Stephen J.; Lampl, Michael P.; Bushnell, P. Timothy; Meyers, Alysha R.; Robins, David C.; Al-Tarawneh, Ibraheem S.

2015-01-01

Background This study evaluated the effectiveness of a program in which a workers’ compensation (WC) insurer provided matching funds to insured employers to implement safety/health engineering controls. Methods Pre- and post-intervention WC metrics were compiled for the employees designated as affected by the interventions within 468 employers for interventions occurring from 2003 to 2009. Poisson, two-part, and linear regression models with repeated measures were used to evaluate differences in pre- and post-data, controlling for time trends independent of the interventions. Results For affected employees, total WC claim frequency rates (both medical-only and lost-time claims) decreased 66%, lost-time WC claim frequency rates decreased 78%, WC paid cost per employee decreased 81%, and WC geometric mean paid claim cost decreased 30% post-intervention. Reductions varied by employer size, specific industry, and intervention type. Conclusions The insurer-supported safety/health engineering control program was effective in reducing WC claims and costs for affected employees. PMID:25223846

Estimation model of life insurance claims risk for cancer patients by using Bayesian method

NASA Astrophysics Data System (ADS)

Sukono; Suyudi, M.; Islamiyati, F.; Supian, S.

2017-01-01

This paper discussed the estimation model of the risk of life insurance claims for cancer patients using Bayesian method. To estimate the risk of the claim, the insurance participant data is grouped into two: the number of policies issued and the number of claims incurred. Model estimation is done using a Bayesian approach method. Further, the estimator model was used to estimate the risk value of life insurance claims each age group for each sex. The estimation results indicate that a large risk premium for insured males aged less than 30 years is 0.85; for ages 30 to 40 years is 3:58; for ages 41 to 50 years is 1.71; for ages 51 to 60 years is 2.96; and for those aged over 60 years is 7.82. Meanwhile, for insured women aged less than 30 years was 0:56; for ages 30 to 40 years is 3:21; for ages 41 to 50 years is 0.65; for ages 51 to 60 years is 3:12; and for those aged over 60 years is 9.99. This study is useful in determining the risk premium in homogeneous groups based on gender and age.

Medical malpractice lawsuits and the value of skilled and diverse legal counsel.

PubMed

Lapuyade, Keith D; Sorkin, Alison C

2013-12-01

Medical malpractice claims against dermatologists and dermapathologists arise mostly out of claims for negligence--when a patient claims a provider owed a duty to a patient, breached that duty, and caused damages to the patient. When a health care provider files a claim with his or her insurance company, the insurance company will usually retain and pay an attorney for the health care provider. It is important to understand the role the attorney retained by the insurance company plays to evaluate whether a health care provider should seek the advice of independent or "personal" counsel.

24 CFR 266.515 - Record retention.

Code of Federal Regulations, 2010 CFR

2010-04-01

... FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS Project Management... insurance remains in force. (b) Defaults and claims. Records pertaining to a mortgage default and claim must be retained from the date of default through final settlement of the claim for a period of no less...

46 CFR 308.105 - Reporting casualties and filing claims.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 8 2014-10-01 2014-10-01 false Reporting casualties and filing claims. 308.105 Section 308.105 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.105 Reporting casualties and filing claims. All...

46 CFR 308.410 - Reporting casualties and filing claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 8 2010-10-01 2010-10-01 false Reporting casualties and filing claims. 308.410 Section 308.410 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Builder's Risk Insurance § 308.410 Reporting casualties and filing claims. Casualties...

46 CFR 308.105 - Reporting casualties and filing claims.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 8 2012-10-01 2012-10-01 false Reporting casualties and filing claims. 308.105 Section 308.105 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.105 Reporting casualties and filing claims. All...

46 CFR 308.304 - Reporting casualties and filing claims.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 8 2014-10-01 2014-10-01 false Reporting casualties and filing claims. 308.304 Section 308.304 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Second Seamen's War Risk Insurance § 308.304 Reporting casualties and filing claims. All...

46 CFR 308.304 - Reporting casualties and filing claims.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 8 2011-10-01 2011-10-01 false Reporting casualties and filing claims. 308.304 Section 308.304 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Second Seamen's War Risk Insurance § 308.304 Reporting casualties and filing claims. All...

46 CFR 308.410 - Reporting casualties and filing claims.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 8 2011-10-01 2011-10-01 false Reporting casualties and filing claims. 308.410 Section 308.410 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Builder's Risk Insurance § 308.410 Reporting casualties and filing claims. Casualties...

46 CFR 308.304 - Reporting casualties and filing claims.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 8 2013-10-01 2013-10-01 false Reporting casualties and filing claims. 308.304 Section 308.304 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Second Seamen's War Risk Insurance § 308.304 Reporting casualties and filing claims. All...

46 CFR 308.304 - Reporting casualties and filing claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 8 2010-10-01 2010-10-01 false Reporting casualties and filing claims. 308.304 Section 308.304 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Second Seamen's War Risk Insurance § 308.304 Reporting casualties and filing claims. All...

46 CFR 308.105 - Reporting casualties and filing claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 8 2010-10-01 2010-10-01 false Reporting casualties and filing claims. 308.105 Section 308.105 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.105 Reporting casualties and filing claims. All...

46 CFR 308.105 - Reporting casualties and filing claims.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 8 2011-10-01 2011-10-01 false Reporting casualties and filing claims. 308.105 Section 308.105 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.105 Reporting casualties and filing claims. All...

46 CFR 308.105 - Reporting casualties and filing claims.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 8 2013-10-01 2013-10-01 false Reporting casualties and filing claims. 308.105 Section 308.105 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.105 Reporting casualties and filing claims. All...

46 CFR 308.410 - Reporting casualties and filing claims.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 8 2013-10-01 2013-10-01 false Reporting casualties and filing claims. 308.410 Section 308.410 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Builder's Risk Insurance § 308.410 Reporting casualties and filing claims. Casualties...

46 CFR 308.410 - Reporting casualties and filing claims.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 8 2012-10-01 2012-10-01 false Reporting casualties and filing claims. 308.410 Section 308.410 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Builder's Risk Insurance § 308.410 Reporting casualties and filing claims. Casualties...

46 CFR 308.304 - Reporting casualties and filing claims.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 8 2012-10-01 2012-10-01 false Reporting casualties and filing claims. 308.304 Section 308.304 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Second Seamen's War Risk Insurance § 308.304 Reporting casualties and filing claims. All...

46 CFR 308.410 - Reporting casualties and filing claims.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 8 2014-10-01 2014-10-01 false Reporting casualties and filing claims. 308.410 Section 308.410 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Builder's Risk Insurance § 308.410 Reporting casualties and filing claims. Casualties...

Comparison of musculoskeletal disorder health claims between construction floor layers and a general working population.

PubMed

Dale, Ann Marie; Ryan, Daniel; Welch, Laura; Olsen, Margaret A; Buchholz, Bryan; Evanoff, Bradley

2015-01-01

Compare rates of medical insurance claims for musculoskeletal disorders (MSD) between workers in a construction trade and a general worker population to determine if higher physical exposures in construction lead to higher rates of claims on personal medical insurance. Health insurance claims between 2006 and 2010 from floor layers were frequency matched by age, gender, eligibility time and geographic location to claims from insured workers in general industry obtained from MarketScan. We extracted MSD claims and dates of service from six regions of the body: neck, low back, knee, lower extremity, shoulder and distal arm, and evaluated differences in claim rates. Fifty-one per cent of floor layers (n=1475) experienced musculoskeletal claims compared with 39% of MarketScan members (p<0.001). Claim rates were higher for floor layers across all body regions with nearly double the rate ratios for the knee and neck regions (RR 2.10 and 2.07). The excess risk was greatest for the neck and low back regions; younger workers had disproportionately higher rates in the knee, neck, low back and distal arm. A larger proportion of floor layers (22%) filed MSD claims in more than one body region compared with general workers (10%; p<0.001). Floor layers have markedly higher rates of MSD claims compared with a general worker population, suggesting a shifting of medical costs for work-related MSD to personal health insurance. The occurrence of disorders in multiple body regions and among the youngest workers highlights the need for improved work methods and tools for construction workers. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

24 CFR 201.55 - Calculation of insurance claim payment.

Code of Federal Regulations, 2010 CFR

2010-04-01

... insurance coverage reserve account established by the Secretary under § 201.32, if the insurance claim is... (net unpaid principal and the uncollected interest earned to the date of default, calculated according... (net unpaid principal and the uncollected interest earned to the date of default, calculated according...

A study on the effect of exclusion period on the suicidal risk among the insured.

PubMed

Yip, Paul S F; Chen, Feng

2014-06-01

An exclusion period (usually from 12 months to 2 years) is usually found in life insurance policies as a precautionary measure to prohibit people from insuring their lives with the intent to kill themselves shortly thereafter. Several studies have been conducted to investigate the effect of exclusion periods on the risk of suicide among the insured in the US and Australia. However, while Hong Kong has experienced an increase in the number of suicides among the insured, little is known about the dynamic between the exclusion period and suicide in Asia. Here we make use of death claims data from one of the major life insurance companies in Hong Kong to ascertain the impact of a 12-month exclusion period on suicide risk. We also use utility functions derived from economic theory to better understand individual choices regarding suicide among the insured. More specifically, we sought to determine whether there is a greater risk of suicide immediately following the 12-month exclusion period. We also examined whether the risk of suicide claims was higher than that of other non-suicidal claims. The study period for this investigation was from January 1, 1997 to December 31, 2011, during which time there were 1935 claims based on 1243 deaths. Of these, 197 were suicide-related claims for 106 suicide deaths. The mean number of life policies held by suicidal claimants and non-suicidal claimants was 1.6 and 1.4, respectively. The average/median size of the claims (total payment made on all policies held by the insured life) was HK$665,800/426,600 and HK$497,700/276,200 for suicidal and non-suicidal deaths, respectively. The policy lifetime of the claims, or the number of days from policy issuance to suicide occurrence, ranged from 38 to 7561 days, with a mean of 2209 days, a median of 1941 days, and a standard deviation of 1544 days. The peak density of suicide claims occurred on day 1039 of the policy. Our results revealed that suicide claims tend to occur earlier than other claims and that there is a greater risk of suicide observed following the 12-month exclusion period. Some suggestions are made in terms of extending the exclusion period, which is anticipated to significantly reduce suicide at the global level. Copyright © 2014 Elsevier Ltd. All rights reserved.

76 FR 5374 - Agency Information Collection Activities: Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-31

... Request. Form Title: Notice of Claim and Proof of Loss, Working Capital Guarantee. SUMMARY: The Export..., guarantees, insurance and working capital credits. By neutralizing the effect of export credit support.... Under the Working Capital Guarantee Program, Ex-Im Bank provides repayment guarantees to lenders on...

78 FR 11645 - Agency Information Collection Activities: Final Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-19

... EXPORT-IMPORT BANK OF THE UNITED STATES [Public Notice 2013-0115] Agency Information Collection Activities: Final Collection; Comment Request AGENCY: Export-Import Bank of the United States. ACTION...-Im Bank approved insurance claims. Affected Public: This form affects entities involved in the export...

The proportion of uncoded diagnoses in computerized health insurance claims in Japan in May 2010 according to ICD-10 disease categories.

PubMed

Tanihara, Shinichi

2014-01-01

Uncoded diagnoses in computerized health insurance claims are excluded from statistical summaries of health-related risks and other factors. The effects of these uncoded diagnoses, coded according to ICD-10 disease categories, have not been investigated to date in Japan. I obtained all computerized health insurance claims (outpatient medical care, inpatient medical care, and diagnosis procedure-combination per-diem payment system [DPC/PDPS] claims) submitted to the National Health Insurance Organization of Kumamoto Prefecture in May 2010. These were classified according to the disease categories of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). I used accompanying text documentation related to the uncoded diagnoses to classify these diagnoses. Using these classifications, I calculated the proportion of uncoded diagnoses by ICD-10 category. The number of analyzed diagnoses was 3,804,246, with uncoded diagnoses accounting for 9.6% of the total. The proportion of uncoded diagnoses in claims for outpatient medical care, inpatient medical care, and DPC/PDPS were 9.3%, 10.9%, and 14.2%, respectively. Among the diagnoses, Congenital malformations, deformations, and chromosomal abnormalities had the highest proportion of uncoded diagnoses (19.3%), and Diseases of the respiratory system had the lowest proportion of uncoded diagnoses (4.7%). The proportion of uncoded diagnoses differed by the type of health insurance claim and disease category. These findings indicate that Japanese health statistics computed using computerized health insurance claims might be biased by the exclusion of uncoded diagnoses.

45 CFR 34.3 - Filing procedures and time limits.

Code of Federal Regulations, 2010 CFR

2010-10-01

... not limited to type, design, model number, date acquired, value when acquired, value when lost, and... insured, insurance information, such as insurance carrier, type of coverage, deductible, and whether claim... the date of the incident. (2) If the claim accrues in the time of war or in the time of armed conflict...

78 FR 45936 - Agency Information Collection Activities: Proposed Collection; Comment Request; National Flood...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-30

... establish by regulation an additional process for the appeal of decisions of flood insurance claims issued... informal process to handle appeals regarding decisions related to coverage, or claims under the NFIP... to the flood insurance claims process. DATES: Comments must be submitted on or before September 30...

Development of methods for using workers' compensation data for surveillance and prevention of occupational injuries among State-insured private employers in Ohio.

PubMed

Wurzelbacher, Steven J; Al-Tarawneh, Ibraheem S; Meyers, Alysha R; Bushnell, P Timothy; Lampl, Michael P; Robins, David C; Tseng, Chih-Yu; Wei, Chia; Bertke, Stephen J; Raudabaugh, Jill A; Haviland, Thomas M; Schnorr, Teresa M

2016-12-01

Workers' compensation (WC) claims data may be useful for identifying high-risk industries and developing prevention strategies. WC claims data from private-industry employers insured by the Ohio state-based workers' compensation carrier from 2001 to 2011 were linked with the state's unemployment insurance (UI) data on the employer's industry and number of employees. National Labor Productivity and Costs survey data were used to adjust UI data and estimate full-time equivalents (FTE). Rates of WC claims per 100 FTE were computed and Poisson regression was used to evaluate differences in rates. Most industries showed substantial claim count and rate reductions from 2001 to 2008, followed by a leveling or slight increase in claim count and rate from 2009 to 2011. Despite reductions, there were industry groups that had consistently higher rates. WC claims data linked to employment data could be used to prioritize industries for injury research and prevention activities among State-insured private employers. Am. J. Ind. Med. 59:1087-1104, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Evidence of Adverse Selection in Iranian Supplementary Health Insurance Market

PubMed Central

Mahdavi, Gh; Izadi, Z

2012-01-01

Background: Existence or non-existence of adverse selection in insurance market is one of the important cases that have always been considered by insurers. Adverse selection is one of the consequences of asymmetric information. Theory of adverse selection states that high-risk individuals demand the insurance service more than low risk individuals do. Methods: The presence of adverse selection in Iran’s supplementary health insurance market is tested in this paper. The study group consists of 420 practitioner individuals aged 20 to 59. We estimate two logistic regression models in order to determine the effect of individual’s characteristics on decision to purchase health insurance coverage and loss occurrence. Using the correlation between claim occurrence and decision to purchase health insurance, the adverse selection problem in Iranian supplementary health insurance market is examined. Results: Individuals with higher level of education and income level purchase less supplementary health insurance and make fewer claims than others make and there is positive correlation between claim occurrence and decision to purchase supplementary health insurance. Conclusion: Our findings prove the evidence of the presence of adverse selection in Iranian supplementary health insurance market. PMID:23113209

Valganciclovir Use Among Commercially and Medicaid-insured Infants With Congenital CMV Infection in the United States, 2009-2015.

PubMed

Leung, Jessica; Dollard, Sheila C; Grosse, Scott D; Chung, Winnie; Do, ThuyQuynh; Patel, Manisha; Lanzieri, Tatiana M

2018-03-01

The aim of this study was to assess the clinical characteristics and trends in valganciclovir use among infants diagnosed with congenital cytomegalovirus (CMV) disease in the United States. We analyzed data from medical claims dated 2009-2015 from the Truven Health MarketScan ® Commercial Claims and Encounters and Medicaid databases. We identified infants with a live birth code in the first claim who were continuously enrolled for at least 45 days. Among infants diagnosed with congenital CMV disease, identified by an ICD-9-CM or ICD-10-CM code for congenital CMV infection or CMV disease within 45 days of birth, we assessed data from claims containing codes for any CMV-associated clinical condition within the same period, and data from claims for hearing loss and/or valganciclovir within the first 180 days of life. In the commercial and Medicaid databases, we identified 257 (2.5/10,000) and 445 (3.3/10,000) infants, respectively, diagnosed with congenital CMV disease, among whom 135 (53%) and 282 (63%) had ≥1 CMV-associated condition, 30 (12%) and 32 (7%) had hearing loss, and 41 (16%) and 78 (18%) had a claim for valganciclovir. Among infants with congenital CMV disease who had a claim for valganciclovir, 37 (90%) among commercially insured infants and 68 (87%) among Medicaid-insured infants had ≥1 CMV-associated condition and/or hearing loss. From 2009 to 2015, the percentages with a claim for valganciclovir increased from 0% to 29% among commercially insured infants and from 4% to 37% among Medicaid-insured infants (P < 0.0001). During 2009-2015, there was a strong upward trend in valganciclovir claims among insured infants who were diagnosed with congenital CMV disease, the majority of whom had CMV-associated conditions and/or hearing loss. Published by Elsevier Inc.

24 CFR 207.258 - Insurance claim requirements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... in 24 CFR part 200, subpart B, of its intention to file an insurance claim and of its election either..., ledger cards, documents, books, papers, and accounts relating to the mortgage transaction. (iv) All...

48 CFR 352.233-71 - Litigation and claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... the action in good faith. The Government shall not be liable for the expense of defending any action... compensated by insurance which was required by law or regulation or by written direction of the Contracting... FORMS SOLICITATION PROVISIONS AND CONTRACT CLAUSES Texts of Provisions and Clauses 352.233-71 Litigation...

48 CFR 3452.242-70 - Litigation and claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... proceed with the defense of the action in good faith. (e) To the extent not in conflict with any... compensated by insurance that was required by law, regulation, contract clause, or other written direction of... ACQUISITION REGULATION CLAUSES AND FORMS SOLICITATION PROVISIONS AND CONTRACT CLAUSES Texts of Provisions and...

75 FR 70003 - Agency Information Collection Activities: Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-16

... support offered by foreign governments and by absorbing credit risks that the private sector will not... Request. Form Title: Notice of Claim and Proof of Loss, Export Credit Insurance policies. SUMMARY: The Export-Import Bank of the United States (``Ex-Im Bank'') is the official export credit agency of the...

76 FR 5374 - Agency Information Collection Activities: Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-31

... support offered by foreign governments and by absorbing credit risks that the private sector will not... Request. Form Title: Notice of Claim and Proof of Loss, Export Credit Insurance policies. SUMMARY: The Export-Import Bank of the United States (``Ex-Im Bank'') is the official export credit agency of the...

Pricing the property claim service (PCS) catastrophe insurance options using gamma distribution

NASA Astrophysics Data System (ADS)

Noviyanti, Lienda; Soleh, Achmad Zanbar; Setyanto, Gatot R.

2017-03-01

The catastrophic events like earthquakes, hurricanes or flooding are characteristics for some areas, a properly calculated annual premium would be closely as high as the loss insured. From an actuarial perspective, such events constitute the risk that are not insurable. On the other hand people living in such areas need protection. In order to securitize the catastrophe risk, futures or options based on a loss index could be considered. Chicago Board of Trade launched a new class of catastrophe insurance options based on new indices provided by Property Claim Services (PCS). The PCS-option is based on the Property Claim Service Index (PCS-Index). The index are used to determine and payout in writing index-based insurance derivatives. The objective of this paper is to price PCS Catastrophe Insurance Option based on PCS Catastrophe index. Gamma Distribution is used to estimate PCS Catastrophe index distribution.

Modeling number of claims and prediction of total claim amount

NASA Astrophysics Data System (ADS)

Acar, Aslıhan Şentürk; Karabey, Uǧur

2017-07-01

In this study we focus on annual number of claims of a private health insurance data set which belongs to a local insurance company in Turkey. In addition to Poisson model and negative binomial model, zero-inflated Poisson model and zero-inflated negative binomial model are used to model the number of claims in order to take into account excess zeros. To investigate the impact of different distributional assumptions for the number of claims on the prediction of total claim amount, predictive performances of candidate models are compared by using root mean square error (RMSE) and mean absolute error (MAE) criteria.

20 CFR 429.206 - What if my claim involves a commercial carrier or an insurer?

Code of Federal Regulations, 2010 CFR

2010-04-01

... incident to your service and is insured in whole or in part, you must make demand in writing against the... against the Government. (c) Failure to make a demand on a carrier or insurer or to make all reasonable... service preclude reasonable filing of a claim or diligent prosecution, or the evidence indicates a demand...

77 FR 72920 - Federal Housing Administration (FHA) Section 232 Healthcare Mortgage Insurance Program: Partial...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-07

...This rule amends the regulations governing FHA's Section 232 Healthcare Mortgage Insurance program (Section 232 program) by establishing the criteria and process by which FHA will accept and pay a partial payment of a claim under the FHA mortgage insurance contract. The Section 232 program insures mortgage loans to facilitate the construction, substantial rehabilitation, purchase, and refinancing of nursing homes, intermediate care facilities, board and care homes, and assisted-living facilities. Through acceptance and payment of a partial payment of claim, FHA pays the lender a portion of the unpaid principal balance and recasts a portion of the mortgage under terms and conditions determined by FHA, as an alternative to the lender assigning the entire mortgage to HUD. Partial payment of claim also allows FHA- insured healthcare projects to continue operating and providing services.

[Principles of intervertebral disc assessment in private accident insurance].

PubMed

Steinmetz, M; Dittrich, V; Röser, K

2015-09-01

Due to the spread of intervertebral disc degeneration, insurance companies and experts are regularly confronted with related assessments of insured persons under their private accident insurance. These claims pose a particular challenge for experts, since, in addition to the clinical assessment of the facts, extensive knowledge of general accident insurance conditions, case law and current study findings is required. Each case can only be properly assessed through simultaneous consideration of both the medical and legal facts. These guidelines serve as the basis for experts and claims.managers with respect to the appropriate individual factual assessment of intervertebral disc degeneration in private accident insurance.

75 FR 24728 - Agency Information Collection Activities: Proposed Collection; Comment Request, 1660-0005...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-05

... acquisition or construction of buildings located, or to be located, within FEMA-identified special flood... Insurance Program--Claim Forms AGENCY: Federal Emergency Management Agency, DHS. ACTION: Notice; 60-day... Property; 086-0-7 (formerly 81-41) Worksheet-- Building; 086-0-8 (formerly 81-41A) Worksheet--Building...

Curb your premium: the impact of monitoring malpractice claims.

PubMed

Amaral-Garcia, Sofia; Grembi, Veronica

2014-02-01

We study a policy aimed at increasing the level of information on medical malpractice costs and the risk exposure of local public healthcare providers. The policy is based on enhanced monitoring of medical malpractice claims by the level of government that rules providers in a multilevel institutional setting. In particular, we implement a difference-in-differences strategy using Italian data at the provider level from 2001 to 2008 to evaluate the impact of monitoring claims on medical liability expenditures, measured as insurance premiums and legal expenditures, which was adopted by only some Regions. Our results show that this information-enhancing policy reduces paid premiums by around 15%. This reduced-form effect might arise by higher bargaining power on the demand side or increased competition on the supply side of the insurance market. Validity tests show that our findings are not driven by differential pre-policy trends between treated and control providers. Moreover, this policy could be cheaply implemented also in other institutional contexts with positive effects. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Performance Assessment of Ga District Mutual Health Insurance Scheme, Greater Accra Region, Ghana.

PubMed

Nsiah-Boateng, Eric; Aikins, Moses

This study assessed performance of the Ga District Mutual Health Insurance Scheme over the period 2007-2009. The desk review method was used to collect secondary data on membership coverage, revenue, expenditure, and claims settlement patterns of the scheme. A household survey was also conducted in the Madina Township by using a self-administered semi-structured questionnaire to determine community coverage of the scheme. The study showed membership coverage of 21.8% and community coverage of 22.2%. The main reasons why respondents had not registered with the scheme are that contributions are high and it does not offer the services needed. Financially, the scheme depended largely on subsidies and reinsurance from the National Health Insurance Authority for 89.8% of its revenue. Approximately 92% of the total revenue was spent on medical claims, and 99% of provider claims were settled beyond the stipulated 4-week period. There is an increasing trend in medical claims expenditure and lengthy delay in claims settlements, with most of them being paid beyond the mandatory 4-week period. Introduction of cost-containment measures including co-payment and capitation payment mechanism would be necessary to reduce the escalating cost of medical claims. Adherence to the 4-week stipulated period for payment of medical claims would be important to ensure that health care providers are financially resourced to deliver continuous health services to insured members. Furthermore, resourcing the scheme would be useful for speedy vetting of claims and also, community education on the National Health Insurance Scheme to improve membership coverage and revenue from the informal sector. Copyright © 2013, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.

Professional liability insurance in Obstetrics and Gynaecology: estimate of the level of knowledge about malpractice insurance policies and definition of an informative tool for the management of the professional activity

PubMed Central

2011-01-01

Background In recent years, due to the increasingly hostile environment in the medical malpractice field and related lawsuits in Italy, physicians began informing themselves regarding their comprehensive medical malpractice coverage. Methods In order to estimate the level of knowledge of medical professionals on liability insurance coverage for healthcare malpractice, a sample of 60 hospital health professionals of the obstetrics and gynaecology area of Messina (Sicily, Italy) were recluted. A survey was administered to evaluate their knowledge as to the meaning of professional liability insurance coverage but above all on the most frequent policy forms ("loss occurrence", "claims made" and "I-II risk"). Professionals were classified according to age and professional title and descriptive statistics were calculated for all the professional groups and answers. Results Most of the surveyed professionals were unaware or had very bad knowledge of the professional liability insurance coverage negotiated by the general manager, so most of the personnel believed it useful to subscribe individual "private" policies. Several subjects declared they were aware of the possibility of obtaining an extended coverage for gross negligence and substantially all the surveyed had never seen the loss occurrence and claims made form of the policy. Moreover, the sample was practically unaware of the related issues about insurance coverage for damages related to breaches on informed consent. The results revealed the relative lack of knowledge--among the operators in the field of obstetrics and gynaecology--of the effective coverage provided by the policies signed by the hospital managers for damages in medical malpractice. The authors thus proposed a useful information tool to help professionals working in obstetrics and gynaecology regarding aspects of insurance coverage provided on the basis of Italian civil law. Conclusion Italy must introduce a compulsory insurance system which could absorb, through a mechanism of "distribution of risk", the malpractice litigation and its costs. This will provide compensation in accidental cases where it wouldn't be possible to demonstrate carelessness, imprudence and/or lack of skill. PMID:22176996

Reducing medical claims cost to Ghana's National Health Insurance scheme: a cross-sectional comparative assessment of the paper- and electronic-based claims reviews.

PubMed

Nsiah-Boateng, Eric; Asenso-Boadi, Francis; Dsane-Selby, Lydia; Andoh-Adjei, Francis-Xavier; Otoo, Nathaniel; Akweongo, Patricia; Aikins, Moses

2017-02-06

A robust medical claims review system is crucial for addressing fraud and abuse and ensuring financial viability of health insurance organisations. This paper assesses claims adjustment rate of the paper- and electronic-based claims reviews of the National Health Insurance Scheme (NHIS) in Ghana. The study was a cross-sectional comparative assessment of paper- and electronic-based claims reviews of the NHIS. Medical claims of subscribers for the year, 2014 were requested from the claims directorate and analysed. Proportions of claims adjusted by the paper- and electronic-based claims reviews were determined for each type of healthcare facility. Bivariate analyses were also conducted to test for differences in claims adjustments between healthcare facility types, and between the two claims reviews. The electronic-based review made overall adjustment of 17.0% from GHS10.09 million (USD2.64 m) claims cost whilst the paper-based review adjusted 4.9% from a total of GHS57.50 million (USD15.09 m) claims cost received, and the difference was significant (p < 0.001). However, there were no significant differences in claims cost adjustment rate between healthcare facility types by the electronic-based (p = 0.0656) and by the paper-based reviews (p = 0.6484). The electronic-based review adjusted significantly higher claims cost than the paper-based claims review. Scaling up the electronic-based review to cover claims from all accredited care providers could reduce spurious claims cost to the scheme and ensure long term financial sustainability.

Multi-stage methodology to detect health insurance claim fraud.

PubMed

Johnson, Marina Evrim; Nagarur, Nagen

2016-09-01

Healthcare costs in the US, as well as in other countries, increase rapidly due to demographic, economic, social, and legal changes. This increase in healthcare costs impacts both government and private health insurance systems. Fraudulent behaviors of healthcare providers and patients have become a serious burden to insurance systems by bringing unnecessary costs. Insurance companies thus develop methods to identify fraud. This paper proposes a new multistage methodology for insurance companies to detect fraud committed by providers and patients. The first three stages aim at detecting abnormalities among providers, services, and claim amounts. Stage four then integrates the information obtained in the previous three stages into an overall risk measure. Subsequently, a decision tree based method in stage five computes risk threshold values. The final decision stating whether the claim is fraudulent is made by comparing the risk value obtained in stage four with the risk threshold value from stage five. The research methodology performs well on real-world insurance data.

Improve medical malpractice law by letting health care insurers take charge.

PubMed

Reinker, Kenneth S; Rosenberg, David

2011-01-01

This essay discusses unlimited insurance subrogation (UIS) as a means of improving the deterrence and compensation results of medical malpractice law. Under UIS, health care insureds could assign their entire potential medical malpractice claims to their first-party commercial and government insurers. UIS should improve deterrence by establishing first-party insurers as plaintiffs to confront liability insurers on the defense side, leading to more effective prosecution of meritorious claims and reducing meritless and unnecessary litigation. UIS should improve compensation outcomes by converting litigation cost- and risk- laden "tort insurance" into cheaper and enhanced first-party insurance. UIS also promises dynamic benefits through further reforms by contract between the first-party and liability insurers that would take charge of system. No UIS-related costs are apparent that would outweigh these benefits. © 2011 American Society of Law, Medicine & Ethics, Inc.

Algorithms to identify colonic ischemia, complications of constipation and irritable bowel syndrome in medical claims data: development and validation.

PubMed

Sands, Bruce E; Duh, Mei-Sheng; Cali, Clorinda; Ajene, Anuli; Bohn, Rhonda L; Miller, David; Cole, J Alexander; Cook, Suzanne F; Walker, Alexander M

2006-01-01

A challenge in the use of insurance claims databases for epidemiologic research is accurate identification and verification of medical conditions. This report describes the development and validation of claims-based algorithms to identify colonic ischemia, hospitalized complications of constipation, and irritable bowel syndrome (IBS). From the research claims databases of a large healthcare company, we selected at random 120 potential cases of IBS and 59 potential cases each of colonic ischemia and hospitalized complications of constipation. We sought the written medical records and were able to abstract 107, 57, and 51 records, respectively. We established a 'true' case status for each subject by applying standard clinical criteria to the available chart data. Comparing the insurance claims histories to the assigned case status, we iteratively developed, tested, and refined claims-based algorithms that would capture the diagnoses obtained from the medical records. We set goals of high specificity for colonic ischemia and hospitalized complications of constipation, and high sensitivity for IBS. The resulting algorithms substantially improved on the accuracy achievable from a naïve acceptance of the diagnostic codes attached to insurance claims. The specificities for colonic ischemia and serious complications of constipation were 87.2 and 92.7%, respectively, and the sensitivity for IBS was 98.9%. U.S. commercial insurance claims data appear to be usable for the study of colonic ischemia, IBS, and serious complications of constipation. (c) 2005 John Wiley & Sons, Ltd.

Insurance for the Compounding Business, Part 1: Who is Covered?

PubMed

Baker, Kenneth R

2008-01-01

The practice of pharmacy was simpler in the past. Prior to the 1980s, pharmacists did not have to worry about "duty to warn" claims, or lawsuits for failure to adequately perform a prospective drug review, or claims that the pharmacist failed to counsel the patient adequately. In those earlier days, if a pharmacist put the right tablet in the bottle with the correct directions, there would be no claim or lawsuit. Occasionally, pharmacists would make a medication error. Putting the wrong pill in the bottle or mistyping the directions could result in serious injury and a significant claim for damages. But the number of errors was in keeping with the lower volume of prescriptions filled, and claims were relatively few. Today, community pharmacies fill over three billion presciptions annually. In keeping with that statistic, the number of claims against compounding pharmacists and pharmacies has, understandably, also increased. Not all insurance policies for pharmacy professional liability have kept up with the changes in pharmacy. With the divergence in pharmacy pracitices, coupled with the changes in pharmacists' duties and pharmacy law, the pharmnacist must read and understand insurance policies to be sure coverage is adequate. This article is intended to help pharmacy owners and pharmacists understand their needs and what to look for in their insurance policies.

Value and Service Quality Assessment of the National Health Insurance Scheme in Ghana: Evidence from Ashiedu Keteke District.

PubMed

Nsiah-Boateng, Eric; Aikins, Moses; Asenso-Boadi, Francis; Andoh-Adjei, Francis-Xavier

2016-09-01

Ghana introduced the National Health Insurance Scheme (NHIS) in 2003 to provide financial access to health care for all residents. This article analyzed claims reimbursement data of the NHIS to assess the value of the benefit package to the insured and responsiveness of the service to the financial needs of health services providers. Medical claims data reported between January 1, 2010, and December 31, 2014, were retrieved from the database of Ashiedu Keteke District Office of the National Health Insurance Authority. The incurred claims ratio, promptness of claims settlements, and claims adjustment rate were analyzed over the 5-year period. In all, 644,663 medical claims with a cost of Ghana cedi (GHS) 11.8 million (US $3.1 million) were reported over the study period. The ratio of claims cost to contributions paid increased from 4.3 to 7.2 over the 2011-2013 period, and dropped to 5.0 in 2014. The proportion of claims settled beyond 90 days also increased from 26% to 100% between 2011 and 2014. Generally, the amount of claims adjusted was low; however, it increased consistently from 1% to about 4% over the 2011-2014 period. The reasons for claims adjustments included provision of services to ineligible members, overbilling of services, and misapplication of diagnosis related groups. There is increased value of the NHIS benefit package to subscribers; however, the scheme's responsiveness to the financial needs of health services providers is low. This calls for a review of the NHIS policy to improve financial viability and service quality. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

26 CFR 31.3406(g)-1 - Exception for payments to certain payees and certain other payments.

Code of Federal Regulations, 2010 CFR

2010-04-01

... the payee is— (i) An organization exempt from taxation under section 501(a) or an individual... form prescribed under section 3406 for claiming exempt status. (c) Prepaid or advance premium life..., 1996, on prepaid or advance premium life-insurance contracts to a payee who is the owner for tax...

Self-Insurance (Waukegan Style).

ERIC Educational Resources Information Center

Falkinham, Ken

The health and dental self-insurance program instituted in the Waukegan (Illinois) Public Schools can credit three major factors for much of its success. First, claims are processed in-house by the district, resulting in improved communications about claim decisions, faster payments, and higher employee satisfaction. Second, the plan is…

77 FR 3482 - Agency Information Collection Activities: Submission for OMB Review; Comment Request, National...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-24

... Insurance Claims Appeals Process. Type of Collection: Revision of a currently approved information collection. OMB Number: 1660-0095. Abstract: The process requires policyholders to submit a written appeal to..., National Flood Insurance Claims Appeals Process AGENCY: Federal Emergency Management Agency, DHS. ACTION...

Tuberculosis Prevention in the Private Sector: Using Claims-Based Methods to Identify and Evaluate Latent Tuberculosis Infection Treatment With Isoniazid Among the Commercially Insured.

PubMed

Stockbridge, Erica L; Miller, Thaddeus L; Carlson, Erin K; Ho, Christine

Targeted identification and treatment of people with latent tuberculosis infection (LTBI) are key components of the US tuberculosis elimination strategy. Because of recent policy changes, some LTBI treatment may shift from public health departments to the private sector. To (1) develop methodology to estimate initiation and completion of treatment with isoniazid for LTBI using claims data, and (2) estimate treatment completion rates for isoniazid regimens from commercial insurance claims. Medical and pharmacy claims data representing insurance-paid services rendered and prescriptions filled between January 2011 and March 2015 were analyzed. Four million commercially insured individuals 0 to 64 years of age. Six-month and 9-month treatment completion rates for isoniazid LTBI regimens. There was an annual isoniazid LTBI treatment initiation rate of 12.5/100 000 insured persons. Of 1074 unique courses of treatment with isoniazid for which treatment completion could be assessed, almost half (46.3%; confidence interval, 43.3-49.3) completed 6 or more months of therapy. Of those, approximately half (48.9%; confidence interval, 44.5-53.3) completed 9 months or more. Claims data can be used to identify and evaluate LTBI treatment with isoniazid occurring in the commercial sector. Completion rates were in the range of those found in public health settings. These findings suggest that the commercial sector may be a valuable adjunct to more traditional venues for tuberculosis prevention. In addition, these newly developed claims-based methods offer a means to gain important insights and open new avenues to monitor, evaluate, and coordinate tuberculosis prevention.

Associations with duration of compensation following whiplash sustained in a motor vehicle crash.

PubMed

Casey, Petrina P; Feyer, Anne Marie; Cameron, Ian D

2015-09-01

Continued exposure to compensation systems has been reported as deleterious to the health of participants. Understanding the associations with time to claim closure could allow for targeted interventions aimed at minimising the time participants are exposed to the compensation system. To identify the associations of extended time receiving compensation benefits with the aim of developing a prognostic model that predicts time to claim closure. Prospective cohort study in people with whiplash associated disorder. Time to claim closure, in a privately underwritten fault based third party traffic crash insurance scheme in New South Wales, Australia. Cox proportional hazard regression modelling. Of the 246 participants, 25% remained in the compensation system longer than 24 months with 15% remaining longer than three years. Higher initial disability (Functional Rating Index≥25 at baseline) (HRR: 95% CI, 1.916: 1.324-2.774, p<0.001); and lower initial mental health as measured by SF-36 Mental Component Score (HRR: 95% CI, 0.973: 0.960-0.987, p<0.001) were significantly and independently associated with an increased time-to-claim closure. Shorter time to claim closure was associated with having no legal involvement (HRR: 95% CI, 1.911: 1.169-3.123, p=0.009); and, not having a prior claim for compensation (HRR: 95% CI, 1.523: 1.062-2.198, p=0.022). Health and insurance related factors are independently associated with time to claim closure. Both factors need to be considered by insurers in their assessment of complexity of claims. Interventions aimed at minimising the impact of these factors could reduce claimants' exposure to the compensation system. In turn insurers can potentially reduce claims duration and cost, while improving the health outcomes of claimants. Copyright © 2015 Elsevier Ltd. All rights reserved.

Health and Stress Management and Mental-health Disability Claims.

PubMed

Marchand, Alain; Haines, Victor Y; Harvey, Steve; Dextras-Gauthier, Julie; Durand, Pierre

2016-12-01

This study examines the associations between health and stress management (HSM) practices and mental-health disability claims. Data from the Salveo study was collected during 2009-2012 within 60 workplaces nested in 37 companies located in Canada (Quebec) and insured by a large insurance company. In each company, 1 h interviews were conducted with human resources managers in order to obtain data on 63 HSM practices. Companies and workplaces were sorted into the low-claims and high-claims groups according to the median rate of the population of the insurer's corporate clients. Logistic regression adjusted for design effect and multidimensional scaling was used to analyse the data. After controlling for company size and economic sector, task design, demands control, gratifications, physical activity and work-family balance were associated with low mental-health disability claims rates. Further analyses revealed three company profiles that were qualified as laissez-faire, integrated and partially integrated approaches to HSM. Of the three, the integrated profile was associated with low mental-health disability claims rates. The results of this study provide evidence-based guidance for a better control of mental-health disability claims. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Prescription Opioid Abuse: Challenges and Opportunities for Payers

PubMed Central

Katz, Nathaniel P.; Birnbaum, Howard; Brennan, Michael J.; Freedman, John D.; Gilmore, Gary P.; Jay, Dennis; Kenna, George A.; Madras, Bertha K.; McElhaney, Lisa; Weiss, Roger D.; White, Alan G.

2013-01-01

Objective Prescription opioid abuse and addiction are serious problems with growing societal and medical costs, resulting in billions of dollars of excess costs to private and governmental health insurers annually. Though difficult to accurately assess, prescription opioid abuse also leads to increased insurance costs in the form of property and liability claims, and costs to state and local governments for judicial, emergency, and social services. This manuscript’s objective is to provide payers with strategies to control these costs, while supporting safe use of prescription opioid medications for patients with chronic pain. Method A Tufts Health Care Institute Program on Opioid Risk Management meeting was convened in June 2010 with private and public payer representatives, public health and law enforcement officials, pain specialists, and other stakeholders to present research, and develop recommendations on solutions that payers might implement to combat this problem. Results While protecting access to prescription opioids for patients with pain, private and public payers can implement strategies to mitigate financial risks associated with opioid abuse, using internal strategies, such as formulary controls, claims data surveillance, and claims matching; and external policies and procedures that support and educate physicians on reducing opioid risks among patients with chronic pain. Conclusion Reimbursement policies, incentives, and health technology systems that encourage physicians to use universal precautions, to consult prescription monitoring program (PMP) data, and to implement Screening, Brief Intervention, and Referral to6Treatment protocols, have a high potential to reduce insurer risks while addressing a serious public health problem. PMID:23725361

76 FR 78739 - Agency Information Collection (Payment and Reimbursement for Emergency Services for Non Service...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-19

...: Notice. SUMMARY: In compliance with the Paperwork Reduction Act (PRA) of 1995 (44 U.S.C. 3501-21), this... Non-VA Facilities, 38 U.S.C. 1725. OMB Control Number: 2900-0620. Type of Review: Extension of a... writing or complete a Health Insurance Claim Form CMS 1500 or Medical Uniform Institutional Provider Bill...

29 CFR 15.25 - Claims involving carriers or insurers.

Code of Federal Regulations, 2010 CFR

2010-07-01

... destroyed incident to the claimant's service and is insured in whole or in part, the claimant must make... coverage, prior to the filing of the claim against the Government. (c) Failure to make a demand on a... will be made where the circumstances of the claimant's service preclude reasonable filing of such a...

24 CFR 266.626 - Notice of default and filing an insurance claim.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Notice of default and filing an... AND OTHER AUTHORITIES HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS Contract Rights and Obligations Claim Procedures § 266.626 Notice of default and filing an...

Bonus-Malus System with the Claim Frequency Distribution is Geometric and the Severity Distribution is Truncated Weibull

NASA Astrophysics Data System (ADS)

Santi, D. N.; Purnaba, I. G. P.; Mangku, I. W.

2016-01-01

Bonus-Malus system is said to be optimal if it is financially balanced for insurance companies and fair for policyholders. Previous research about Bonus-Malus system concern with the determination of the risk premium which applied to all of the severity that guaranteed by the insurance company. In fact, not all of the severity that proposed by policyholder may be covered by insurance company. When the insurance company sets a maximum bound of the severity incurred, so it is necessary to modify the model of the severity distribution into the severity bound distribution. In this paper, optimal Bonus-Malus system is compound of claim frequency component has geometric distribution and severity component has truncated Weibull distribution is discussed. The number of claims considered to follow a Poisson distribution, and the expected number λ is exponentially distributed, so the number of claims has a geometric distribution. The severity with a given parameter θ is considered to have a truncated exponential distribution is modelled using the Levy distribution, so the severity have a truncated Weibull distribution.

44 CFR 11.74 - Claims not allowed.

Code of Federal Regulations, 2014 CFR

2014-10-01

... business. Claims are not payable for property normally used for business or profit. (9) Unserviceable... arose during the conduct of personal business are not payable. (2) Subrogation claims. Claims based upon..., insurance policies, money orders, and traveler's checks. (12) Government property. Claims are not payable...

32 CFR 536.156 - Procedures for claims involving tortfeasors other than nonappropriated fund employees.

Code of Federal Regulations, 2011 CFR

2011-07-01

... (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES Nonappropriated Fund... rise to non-NAFI RIMP claims will be reported to USARCS and the Army Central Insurance Fund immediately...

32 CFR 536.156 - Procedures for claims involving tortfeasors other than nonappropriated fund employees.

Code of Federal Regulations, 2010 CFR

2010-07-01

... (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES Nonappropriated Fund... rise to non-NAFI RIMP claims will be reported to USARCS and the Army Central Insurance Fund immediately...

26 CFR 1.801-5 - Total reserves.

Code of Federal Regulations, 2010 CFR

2010-04-01

... TAXES Life Insurance Companies § 1.801-5 Total reserves. (a) Total reserves defined. For purposes of... claimed. For example, during the taxable year 1958 a life insurance company sells life insurance and... insurance company may be illustrated by the following example: Example. The books of Y, an insurance company...

On the occurrence of rainstorm damage based on home insurance and weather data

NASA Astrophysics Data System (ADS)

Spekkers, M. H.; Clemens, F. H. L. R.; ten Veldhuis, J. A. E.

2014-08-01

Rainstorm damage caused by malfunctioning of urban drainage systems and water intrusion due to defects in the building envelope can be considerable. Little research on this topic focused on the collection of damage data, the understanding of damage mechanisms and the deepening of data analysis methods. In this paper, the relative contribution of different failure mechanisms to the occurrence of rainstorm damage are investigated, as well as the extent to which these mechanisms relate to weather variables. For a case study in Rotterdam, the Netherlands, a property level home insurance database of around 3100 water-related damage claims was analysed. Records include comprehensive transcripts of communication between insurer, insured and damage assessment experts, which allowed claims to be classified according to their actual damage cause. Results show that roof and wall leakage is the most frequent failure mechanism causing precipitation-related claims, followed by blocked roof gutters, melting snow and sewer flooding. Claims related to sewer flooding were less present in the data, but are associated with significantly larger claim sizes than claims in the majority class, i.e. roof and wall leakages. Rare events logistic regression analysis revealed that maximum rainfall intensity and rainfall volume are significant predictors for the occurrence probability of precipitation-related claims. Moreover, it was found that claims associated with rainfall intensities smaller than 7-8 mm in a 60 min window are mainly related to failures processes in the private domain, such as roof and wall leakages. For rainfall events that exceed the 7-8 mm h-1 threshold, failure of systems in the public domain, such as sewer systems, start to contribute considerably to the overall occurrence probability of claims. The communication transcripts, however, lacked information to be conclusive about to extent to which sewer-related claims were caused by overloading of sewer systems or failure of system components.

On the occurrence of rainstorm damage based on home insurance and weather data

NASA Astrophysics Data System (ADS)

Spekkers, M. H.; Clemens, F. H. L. R.; ten Veldhuis, J. A. E.

2015-02-01

Rainstorm damage caused by the malfunction of urban drainage systems and water intrusion due to defects in the building envelope can be considerable. Little research on this topic focused on the collection of damage data, the understanding of damage mechanisms and the deepening of data analysis methods. In this paper, the relative contribution of different failure mechanisms to the occurrence of rainstorm damage is investigated, as well as the extent to which these mechanisms relate to weather variables. For a case study in Rotterdam, the Netherlands, a property level home insurance database of around 3100 water-related damage claims was analysed. The records include comprehensive transcripts of communication between insurer, insured and damage assessment experts, which allowed claims to be classified according to their actual damage cause. The results show that roof and wall leakage is the most frequent failure mechanism causing precipitation-related claims, followed by blocked roof gutters, melting snow and sewer flooding. Claims related to sewer flooding were less present in the data, but are associated with significantly larger claim sizes than claims in the majority class, i.e. roof and wall leakages. Rare events logistic regression analysis revealed that maximum rainfall intensity and rainfall volume are significant predictors for the occurrence probability of precipitation-related claims. Moreover, it was found that claims associated with rainfall intensities smaller than 7-8 mm in a 60-min window are mainly related to failure processes in the private domain, such as roof and wall leakages. For rainfall events that exceed the 7-8 mm h-1 threshold, the failure of systems in the public domain, such as sewer systems, start to contribute considerably to the overall occurrence probability of claims. The communication transcripts, however, lacked information to be conclusive about to which extent sewer-related claims were caused by overloading of sewer systems or failure of system components.

Risk segmentation in Chilean social health insurance.

PubMed

Hidalgo, Hector; Chipulu, Maxwell; Ojiako, Udechukwu

2013-01-01

The objective of this study is to identify how risk and social variables are likely to be impacted by an increase in private sector participation in health insurance provision. The study focuses on the Chilean health insurance industry, traditionally dominated by the public sector. Predictive risk modelling is conducted using a database containing over 250,000 health insurance policy records provided by the Superintendence of Health of Chile. Although perceived with suspicion in some circles, risk segmentation serves as a rational approach to risk management from a resource perspective. The variables that have considerable impact on insurance claims include the number of dependents, gender, wages and the duration a claimant has been a customer. As shown in the case study, to ensure that social benefits are realised, increased private sector participation in health insurance must be augmented by regulatory oversight and vigilance. As it is clear that a "community-rated" health insurance provision philosophy impacts on insurance firm's ability to charge "market" prices for insurance provision, the authors explore whether risk segmentation is a feasible means of predicting insurance claim behaviour in Chile's private health insurance industry.

Will my malpractice case be settled? The physician-defendant's voice in the decision.

PubMed

Archambault, William H

2007-05-01

Malpractice claims are an unavoidable part of the practice of clinical medicine. Physicians purchase professional liability insurance to protect themselves from financial and other adverse consequences of such claims. Insurance policies require the insurer to hire attorneys to represent, defend and advise physicians who are named as defendants in medical malpractice lawsuits. Insurance policies require insurers to pay the costs associated with defending the lawsuit and paying, within policy limits, any damages for which a physician is determined to be liable. The relationship between insurer, defense counsel and physician can be complicated by divergent interests, concerns and priorities. It is important for physicians to be knowledgeable consumers when they are in the market for malpractice coverage. Familiarity with types of coverage, controls placed on defense costs and policy terms that determine decision-making authority on settlement issues are essential to making an informed purchase of insurance coverage.

Primary care closed claims experience of Massachusetts malpractice insurers.

PubMed

Schiff, Gordon D; Puopolo, Ann Louise; Huben-Kearney, Anne; Yu, Winnie; Keohane, Carol; McDonough, Peggy; Ellis, Bonnie R; Bates, David W; Biondolillo, Madeleine

Despite prior focus on high-impact inpatient cases, there are increasing data and awareness that malpractice in the outpatient setting, particularly in primary care, is a leading contributor to malpractice risk and claims. To study patterns of primary care malpractice types, causes, and outcomes as part of a Massachusetts ambulatory malpractice risk and safety improvement project. Retrospective review of pooled closed claims data of 2 malpractice carriers covering most Massachusetts physicians during a 5-year period (January 1, 2005, through December 31, 2009). Data were harmonized between the 2 insurers using a standardized taxonomy. Primary care practices in Massachusetts. All malpractice claims that involved primary care practices insured by the 2 largest insurers in the state were screened. A total of 551 claims from primary care practices were identified for the analysis. Numbers and types of claims, including whether claims involved primary care physicians or practices; classification of alleged malpractice (eg, misdiagnosis or medication error); patient diagnosis; breakdown in care process; and claim outcome (dismissed, settled, verdict for plaintiff, or verdict for defendant). During a 5-year period there were 7224 malpractice claims of which 551 (7.7%) were from primary care practices. Allegations were related to diagnosis in 397 (72.1%), medications in 68 (12.3%), other medical treatment in 41 (7.4%), communication in 15 (2.7%), patient rights in 11 (2.0%), and patient safety or security in 8 (1.5%). Leading diagnoses were cancer (n = 190), heart diseases (n = 43), blood vessel diseases (n = 27), infections (n = 22), and stroke (n = 16). Primary care cases were significantly more likely to be settled (35.2% vs 20.5%) or result in a verdict for the plaintiff (1.6% vs 0.9%) compared with non-general medical malpractice claims (P < .001). In Massachusetts, most primary care claims filed are related to alleged misdiagnosis. Compared with malpractice allegations in other settings, primary care ambulatory claims appear to be more difficult to defend, with more cases settled or resulting in a verdict for the plaintiff.

The insurance refund request: a legal analysis.

PubMed

Rollman, S O

1998-12-01

When an insurance payment is made erroneously to a healthcare provider and no contract between the insurer and provider addresses the issue of refunding such payments, the law relating to restitution generally applies. Restitution does not apply, however, to three exceptions that the courts have used to refuse claims by insurers for refunds of overpayments: the innocent third-party creditor exception, whereby the healthcare provider cannot be unjustly enriched by the overpayment, cannot have induced the mistaken payment, and cannot have known beforehand that the insurer was not obligated to pay; the material change in position exception, whereby the healthcare provider in good faith accepts an overpayment and so does not pursue other means of payment; and the assumption of the risk exception, which occurs when the insurer pays a claim without having complete information about it.

Premium analysis for copula model: A case study for Malaysian motor insurance claims

NASA Astrophysics Data System (ADS)

Resti, Yulia; Ismail, Noriszura; Jaaman, Saiful Hafizah

2014-06-01

This study performs premium analysis for copula models with regression marginals. For illustration purpose, the copula models are fitted to the Malaysian motor insurance claims data. In this study, we consider copula models from Archimedean and Elliptical families, and marginal distributions of Gamma and Inverse Gaussian regression models. The simulated results from independent model, which is obtained from fitting regression models separately to each claim category, and dependent model, which is obtained from fitting copula models to all claim categories, are compared. The results show that the dependent model using Frank copula is the best model since the risk premiums estimated under this model are closely approximate to the actual claims experience relative to the other copula models.

[Insurance system. Prevention from viewpoint of the insurer].

PubMed

Brechtbühl, P

1978-12-01

The purpose of an insurance must not be restricted to the payment of claims to those insured persons who suffered a loss, for loss prevention is much preferable to claim settlement. A whole range of different institutions and measures has been established by the Swiss insurers, in which many insurance branches participate. The loss preventing activities can be listed as follows:--Activities of the fire insurers to prevent and fight fires. This is the prevailing duty of the Consulting Agency for Fire Prevention (BfB) as well as the Fire Prevention Service for Industry and Trade (BVD).--Activities of the accident insurers to prevent accidents. The fight against accidents, mostly traffic accidents, in sports and at home is the foremost task of the Swiss Council for the Prevention of Accidents (BfU), an institution created by the Conference of Accident Insurance Managers (UDK) and the Swiss National Accident Insurance Fund (SUVA).--The Health Service in life insurance, after all the periodical medical examinations and consultations granted by many insurers to their insured persons, as well as the pamphlets aiming at health education published by several Companies and finally institutions and measures to promote fitness, e.g. VITA-Parcours.

22 CFR 201.47 - Use of marine insurance loss proceeds.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Use of marine insurance loss proceeds. 201.47... Commodity-Related Services § 201.47 Use of marine insurance loss proceeds. The borrower/grantee shall pay... marine insurance claim under a marine insurance policy financed pursuant to this part 201, if such...

22 CFR 201.47 - Use of marine insurance loss proceeds.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Use of marine insurance loss proceeds. 201.47... Commodity-Related Services § 201.47 Use of marine insurance loss proceeds. The borrower/grantee shall pay... marine insurance claim under a marine insurance policy financed pursuant to this part 201, if such...

24 CFR 221.275 - Method of paying insurance benefits.

Code of Federal Regulations, 2010 CFR

2010-04-01

... AUTHORITIES LOW COST AND MODERATE INCOME MORTGAGE INSURANCE-SAVINGS CLAUSE Contract Rights and Obligations-Low Cost Homes § 221.275 Method of paying insurance benefits. If the application for insurance benefits is acceptable to the Commissioner, all of the insurance claim shall be paid in cash unless the mortgagee files a...

20 CFR 61.3 - Purpose and scope of this part.

Code of Federal Regulations, 2010 CFR

2010-04-01

... and assistance to any person, insurance carrier, self-insured employer, or compensation fund seeking... Act. (c) Subpart B describes the procedure by which an insurance carrier, self-insured employer, or... miscellaneous provisions concerning disclosure of program information, approval of claims for legal services...

24 CFR 203.283 - Refund of one-time MIP.

Code of Federal Regulations, 2010 CFR

2010-04-01

... SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Mortgage Insurance Premiums-One-Time... the mortgage was endorsed for insurance. The Commissioner shall determine the applicable premium... generated by insurance claims, and (3) expected future payments of premium refunds. [48 FR 28806, June 23...

24 CFR 203.283 - Refund of one-time MIP.

Code of Federal Regulations, 2011 CFR

2011-04-01

... SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Mortgage Insurance Premiums-One-Time... the mortgage was endorsed for insurance. The Commissioner shall determine the applicable premium... generated by insurance claims, and (3) expected future payments of premium refunds. [48 FR 28806, June 23...

"Wrapping Up" Your Construction Insurance.

ERIC Educational Resources Information Center

Ferraro, Mark

1998-01-01

School facility managers are beginning to use a special insurance-management technique called wrap-up. The project owner purchases a bulk construction insurance policy consisting of general liability, excess liability, workers' compensation, and builders' risk insurance. Wrap-ups ensure competitive pricing, safety incentives, lower claims costs,…

An Analysis of the Number of Medical Malpractice Claims and Their Amounts

PubMed Central

Bonetti, Marco; Cirillo, Pasquale; Musile Tanzi, Paola; Trinchero, Elisabetta

2016-01-01

Starting from an extensive database, pooling 9 years of data from the top three insurance brokers in Italy, and containing 38125 reported claims due to alleged cases of medical malpractice, we use an inhomogeneous Poisson process to model the number of medical malpractice claims in Italy. The intensity of the process is allowed to vary over time, and it depends on a set of covariates, like the size of the hospital, the medical department and the complexity of the medical operations performed. We choose the combination medical department by hospital as the unit of analysis. Together with the number of claims, we also model the associated amounts paid by insurance companies, using a two-stage regression model. In particular, we use logistic regression for the probability that a claim is closed with a zero payment, whereas, conditionally on the fact that an amount is strictly positive, we make use of lognormal regression to model it as a function of several covariates. The model produces estimates and forecasts that are relevant to both insurance companies and hospitals, for quality assurance, service improvement and cost reduction. PMID:27077661

Planning outstanding reserves in general insurance

NASA Astrophysics Data System (ADS)

Raeva, E.; Pavlov, V.

2017-10-01

Each insurance company have to ensure its solvency through presentation of accounts for its own reserves in the start of the year. Usually the task of the actuary is to estimate the state of the company on an annual basis and the expectation of the status of the company for a future period. One of the major problem when calculating the liabilities of the incurred claims, is related to the delay of payments. Object of consideration in the present note are the outstanding claim reserves, which are set aside to cover claims, occurred before the date of the annual account, but still not paid, and related with them expenses. There may be different reasons for the delay of claims settlement. For example, continuation the process of the liquidation of the damage waiting for necessary documents or the presence of controversial cases whose permission takes time, etc. Thus the claims, which determine the outstanding reserves could be divided in the following types: claims, which are reported, but not settled (RBNS); claims, which are incurred but not reported (IBNR); claims, whose case is finished, but it is possible to be reopened. When calculating the reserves for IBNR claims, most widely used is the Chain-ladder method and its modification presented by the Bornhuetter - Ferguson method. For modeling the outstanding claims, the available data should be presented in so called run-off triangle, which underlies in the basis of such methods. The present work provides a review of the algorithm for calculating insurance outstanding claim reserves according to the Chain-ladder method. Using available data for claims related to liability of drivers, registered in Bulgaria an example is constructed to illustrate the methodology of the Chain-Ladder method. Back-testing approach is used for validating the results.

Utilization Trends in Diagnostic Imaging for a Commercially Insured Population: A Study of Massachusetts Residents 2009 to 2013.

PubMed

Flaherty, Stephen; Mortele, Koenraad J; Young, Gary J

2018-06-01

To report utilization trends in diagnostic imaging among commercially insured Massachusetts residents from 2009 to 2013. Current Procedural Terminology codes were used to identify diagnostic imaging claims in the Massachusetts All-Payer Claims Database for the years 2009 to 2013. We reported utilization and spending annually by imaging modality using total claims, claims per 1,000 individuals, total expenditures, and average per claim payments. The number of diagnostic imaging claims per insured MA resident increased only 0.6% from 2009 to 2013, whereas nonradiology claims increased by 6% annually. Overall diagnostic imaging expenditures, adjusted for inflation, were 27% lower in 2009 than 2013, compared with an 18% increase in nonimaging expenditures. Average payments per claim were lower in 2013 than 2009 for all modalities except nuclear medicine. Imaging procedure claims per 1,000 MA residents increased from 2009 to 2013 by 13% in MRI, from 147 to 166; by 17% in ultrasound, from 453 to 530; and by 12% in radiography (x-ray), from 985 to 1,100. However, CT claims per 1,000 fell by 37%, from 341 to 213, and nuclear medicine declined 57%, from 89 claims per 1,000 to 38. Diagnostic imaging utilization exhibited negligible growth over the study period. Diagnostic imaging expenditures declined, largely the result of falling payments per claim in most imaging modalities, in contrast with increased utilization and spending on nonimaging services. Utilization of MRI, ultrasound, and x-ray increased from 2009 to 2013, whereas CT and nuclear medicine use decreased sharply, although CT was heavily impacted by billing code changes. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.

32 CFR 757.15 - Claims not asserted.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 5 2013-07-01 2013-07-01 false Claims not asserted. 757.15 Section 757.15 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY CLAIMS AFFIRMATIVE CLAIMS... self-insured, non-appropriated-fund activities but does not include private associations. (b) Injured...

32 CFR 757.15 - Claims not asserted.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 5 2014-07-01 2014-07-01 false Claims not asserted. 757.15 Section 757.15 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY CLAIMS AFFIRMATIVE CLAIMS... self-insured, non-appropriated-fund activities but does not include private associations. (b) Injured...

32 CFR 757.15 - Claims not asserted.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 5 2012-07-01 2012-07-01 false Claims not asserted. 757.15 Section 757.15 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY CLAIMS AFFIRMATIVE CLAIMS... self-insured, non-appropriated-fund activities but does not include private associations. (b) Injured...

32 CFR 757.15 - Claims not asserted.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false Claims not asserted. 757.15 Section 757.15 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY CLAIMS AFFIRMATIVE CLAIMS... self-insured, non-appropriated-fund activities but does not include private associations. (b) Injured...

32 CFR 757.15 - Claims not asserted.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 5 2011-07-01 2011-07-01 false Claims not asserted. 757.15 Section 757.15 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY CLAIMS AFFIRMATIVE CLAIMS... self-insured, non-appropriated-fund activities but does not include private associations. (b) Injured...

Validation of current procedural terminology codes for rotavirus vaccination among infants in two commercially insured US populations.

PubMed

Hoffman, Veena; Everage, Nicholas J; Quinlan, Scott C; Skerry, Kathleen; Esposito, Daina; Praet, Nicolas; Rosillon, Dominique; Holick, Crystal N; Dore, David D

2016-12-01

We validated procedure codes used in health insurance claims for reimbursement of rotavirus vaccination by comparing claims for monovalent live-attenuated human rotavirus vaccine (RV1) and live, oral pentavalent rotavirus vaccine (RV5) to medical records. Using administrative data from two commercially insured United States populations, we randomly sampled vaccination claims for RV1 and RV5 from a cohort of infants aged less than 1 year from an ongoing post-licensure safety study of rotavirus vaccines. The codes for RV1 and RV5 found in claims were confirmed through medical record review. The positive predictive value (PPV) of the Current Procedural Terminology codes for RV1 and RV5 was calculated as the number of medical record-confirmed vaccinations divided by the number of medical records obtained. Medical record review confirmed 92 of 104 RV1 vaccination claims (PPV: 88.5%; 95% CI: 80.7-93.9%) and 98 of 113 RV5 vaccination claims (PPV: 86.7%; 95% CI: 79.1-92.4%). Among the 217 medical records abstracted, only three (1.4%) of vaccinations were misclassified in claims-all were RV5 misclassified as RV1. The medical records corresponding to 9 RV1 and 15 RV5 claims contained insufficient information to classify the type of rotavirus vaccine. Misclassification of rotavirus vaccines is infrequent within claims. The PPVs reported here are conservative estimates as those with insufficient information in the medical records were assumed to be incorrectly coded in the claims. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

A Bayesian hierarchical model with spatial variable selection: the effect of weather on insurance claims

PubMed Central

Scheel, Ida; Ferkingstad, Egil; Frigessi, Arnoldo; Haug, Ola; Hinnerichsen, Mikkel; Meze-Hausken, Elisabeth

2013-01-01

Climate change will affect the insurance industry. We develop a Bayesian hierarchical statistical approach to explain and predict insurance losses due to weather events at a local geographic scale. The number of weather-related insurance claims is modelled by combining generalized linear models with spatially smoothed variable selection. Using Gibbs sampling and reversible jump Markov chain Monte Carlo methods, this model is fitted on daily weather and insurance data from each of the 319 municipalities which constitute southern and central Norway for the period 1997–2006. Precise out-of-sample predictions validate the model. Our results show interesting regional patterns in the effect of different weather covariates. In addition to being useful for insurance pricing, our model can be used for short-term predictions based on weather forecasts and for long-term predictions based on downscaled climate models. PMID:23396890

31 CFR 50.52 - Initial Notice of Insured Loss.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance: Treasury 1 2011-07-01 2011-07-01 false Initial Notice of Insured Loss. 50.52 Section 50.52 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Claims Procedures § 50.52 Initial Notice of Insured Loss. Each insurer shall submit to Treasury an...

31 CFR 50.52 - Initial Notice of Insured Loss.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance: Treasury 1 2014-07-01 2014-07-01 false Initial Notice of Insured Loss. 50.52 Section 50.52 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Claims Procedures § 50.52 Initial Notice of Insured Loss. Each insurer shall submit to Treasury an...

31 CFR 50.52 - Initial Notice of Insured Loss.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance: Treasury 1 2012-07-01 2012-07-01 false Initial Notice of Insured Loss. 50.52 Section 50.52 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Claims Procedures § 50.52 Initial Notice of Insured Loss. Each insurer shall submit to Treasury an...

38 CFR 6.19 - Evidence to establish death of the insured.

Code of Federal Regulations, 2013 CFR

2013-07-01

... death of the insured. 6.19 Section 6.19 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS UNITED STATES GOVERNMENT LIFE INSURANCE Death Benefits § 6.19 Evidence to establish death of the insured. Whenever a claim is filed on account of the death of a person insured under yearly renewable term...

38 CFR 6.19 - Evidence to establish death of the insured.

Code of Federal Regulations, 2012 CFR

2012-07-01

... death of the insured. 6.19 Section 6.19 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS UNITED STATES GOVERNMENT LIFE INSURANCE Death Benefits § 6.19 Evidence to establish death of the insured. Whenever a claim is filed on account of the death of a person insured under yearly renewable term...

38 CFR 6.19 - Evidence to establish death of the insured.

Code of Federal Regulations, 2014 CFR

2014-07-01

... death of the insured. 6.19 Section 6.19 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS UNITED STATES GOVERNMENT LIFE INSURANCE Death Benefits § 6.19 Evidence to establish death of the insured. Whenever a claim is filed on account of the death of a person insured under yearly renewable term...

Do Zero-Cost Workers’ Compensation Medical Claims Really Have Zero Costs?

PubMed Central

Asfaw, Abay; Rosa, Roger; Mao, Rebecca

2015-01-01

Objective Previous research suggests that non–workers’ compensation (WC) insurance systems, such as group health insurance (GHI), Medicare, or Medicaid, at least partially cover work-related injury and illness costs. This study further examined GHI utilization and costs. Methods Using two-part model, we compared those outcomes immediately after injuries for which accepted WC medical claims made zero or positive medical payments. Results Controlling for pre-injury GHI utilization and costs and other covariates, our results indicated that post-injury GHI utilization and costs increased regardless of whether a WC medical claim was zero or positive. The increases were highest for zero-cost WC medical claims. Conclusion Our national estimates showed that zero-cost WC medical claims alone could cost the GHI $212 million per year. PMID:24316724

26 CFR 1.801-5 - Total reserves.

Code of Federal Regulations, 2011 CFR

2011-04-01

... TAXES (CONTINUED) Life Insurance Companies § 1.801-5 Total reserves. (a) Total reserves defined. For... the reserve is claimed. For example, during the taxable year 1958 a life insurance company sells life... insurance company may be illustrated by the following example: Example. The books of Y, an insurance company...

26 CFR 1.801-5 - Total reserves.

Code of Federal Regulations, 2012 CFR

2012-04-01

... TAXES (CONTINUED) Life Insurance Companies § 1.801-5 Total reserves. (a) Total reserves defined. For... the reserve is claimed. For example, during the taxable year 1958 a life insurance company sells life... insurance company may be illustrated by the following example: Example. The books of Y, an insurance company...

26 CFR 1.801-5 - Total reserves.

Code of Federal Regulations, 2013 CFR

2013-04-01

... TAXES (CONTINUED) Life Insurance Companies § 1.801-5 Total reserves. (a) Total reserves defined. For... the reserve is claimed. For example, during the taxable year 1958 a life insurance company sells life... insurance company may be illustrated by the following example: Example. The books of Y, an insurance company...

26 CFR 1.801-5 - Total reserves.

Code of Federal Regulations, 2014 CFR

2014-04-01

... TAXES (CONTINUED) Life Insurance Companies § 1.801-5 Total reserves. (a) Total reserves defined. For... the reserve is claimed. For example, during the taxable year 1958 a life insurance company sells life... insurance company may be illustrated by the following example: Example. The books of Y, an insurance company...

24 CFR 241.885 - Insurance benefits.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Insurance benefits. 241.885 Section... § 241.885 Insurance benefits. (a) Method of payment. Payment of claims shall be made in the following... acceptable assignment of the note and security instrument to the Commissioner, the insurance benefits shall...

24 CFR 241.885 - Insurance benefits.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 2 2012-04-01 2012-04-01 false Insurance benefits. 241.885 Section... § 241.885 Insurance benefits. (a) Method of payment. Payment of claims shall be made in the following... acceptable assignment of the note and security instrument to the Commissioner, the insurance benefits shall...

24 CFR 241.885 - Insurance benefits.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false Insurance benefits. 241.885 Section... § 241.885 Insurance benefits. (a) Method of payment. Payment of claims shall be made in the following... acceptable assignment of the note and security instrument to the Commissioner, the insurance benefits shall...

24 CFR 241.885 - Insurance benefits.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Insurance benefits. 241.885 Section... § 241.885 Insurance benefits. (a) Method of payment. Payment of claims shall be made in the following... acceptable assignment of the note and security instrument to the Commissioner, the insurance benefits shall...

24 CFR 241.885 - Insurance benefits.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 2 2013-04-01 2013-04-01 false Insurance benefits. 241.885 Section... § 241.885 Insurance benefits. (a) Method of payment. Payment of claims shall be made in the following... acceptable assignment of the note and security instrument to the Commissioner, the insurance benefits shall...

Medical insurance claims associated with international business travel.

PubMed Central

Liese, B; Mundt, K A; Dell, L D; Nagy, L; Demure, B

1997-01-01

OBJECTIVES: Preliminary investigations of whether 10,884 staff and consultants of the World Bank experience disease due to work related travel. Medical insurance claims filed by 4738 travellers during 1993 were compared with claims of non-travellers. METHODS: Specific diagnoses obtained from claims were analysed overall (one or more v no missions) and by frequency of international mission (1, 2-3, or > or = 4). Standardised rate of claims ratios (SSRs) for each diagnostic category were obtained by dividing the age adjusted rate of claims for travellers by the age adjusted rate of claims for non-travellers, and were calculated for men and women travellers separately. RESULTS: Overall, rates of insurance claims were 80% higher for men and 18% higher for women travellers than their non-travelling counterparts. Several associations with frequency of travel were found. SRRs for infectious disease were 1.28, 1.54, and 1.97 among men who had completed one, two or three, and four or more missions, and 1.16, 1.28, and 1.61, respectively, among women. The greatest excess related to travel was found for psychological disorders. For men SRRs were 2.11, 3.13, and 3.06 and for women, SRRs were 1.47, 1.96, and 2.59. CONCLUSIONS: International business travel may pose health risks beyond exposure to infectious diseases. Because travellers file medical claims at a greater rate than non-travellers, and for many categories of disease, the rate of claims increases with frequency of travel. The reasons for higher rates of claims among travellers are not well understood. Additional research on psychosocial factors, health practices, time zones crossed, and temporal relation between travel and onset of disease is planned. PMID:9282127

Medical insurance claims associated with international business travel.

PubMed

Liese, B; Mundt, K A; Dell, L D; Nagy, L; Demure, B

1997-07-01

Preliminary investigations of whether 10,884 staff and consultants of the World Bank experience disease due to work related travel. Medical insurance claims filed by 4738 travellers during 1993 were compared with claims of non-travellers. Specific diagnoses obtained from claims were analysed overall (one or more v no missions) and by frequency of international mission (1, 2-3, or > or = 4). Standardised rate of claims ratios (SSRs) for each diagnostic category were obtained by dividing the age adjusted rate of claims for travellers by the age adjusted rate of claims for non-travellers, and were calculated for men and women travellers separately. Overall, rates of insurance claims were 80% higher for men and 18% higher for women travellers than their non-travelling counterparts. Several associations with frequency of travel were found. SRRs for infectious disease were 1.28, 1.54, and 1.97 among men who had completed one, two or three, and four or more missions, and 1.16, 1.28, and 1.61, respectively, among women. The greatest excess related to travel was found for psychological disorders. For men SRRs were 2.11, 3.13, and 3.06 and for women, SRRs were 1.47, 1.96, and 2.59. International business travel may pose health risks beyond exposure to infectious diseases. Because travellers file medical claims at a greater rate than non-travellers, and for many categories of disease, the rate of claims increases with frequency of travel. The reasons for higher rates of claims among travellers are not well understood. Additional research on psychosocial factors, health practices, time zones crossed, and temporal relation between travel and onset of disease is planned.

Estimating Epilepsy Incidence and Prevalence in the US Pediatric Population Using Nationwide Health Insurance Claims Data.

PubMed

Kim, Hyunmi; Thurman, David J; Durgin, Tracy; Faught, Edward; Helmers, Sandra

2016-05-01

This study aims to determine prevalence and incidence of epilepsy in the US pediatric population. We analyzed commercial claims and Medicaid insurance claims data between 2008 and 2012. Over 8 million continuously enrolled lives aged 0 to 19 years were included. Our definition of a prevalent case of epilepsy was based on International Classification of Diseases-coded diagnoses of epilepsy or seizures and evidence of prescribed antiepileptic drugs. Incident cases were identified in subjects continuously enrolled for ≥2 years of which the first 2 years had no indication of epilepsy or seizures. The overall prevalence estimate for 2012 was 6.8 per 1,000 children. The overall incidence estimate for 2012 was 104 per 100,000 pediatric population. This study provides estimates of the prevalence and incidence of epilepsy in the US pediatric population, using large claims datasets from multiple US population sectors. The findings appear reasonably representative of the US-insured pediatric population. © The Author(s) 2015.

24 CFR 266.632 - Withdrawal of claim.

Code of Federal Regulations, 2010 CFR

2010-04-01

... HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS Contract Rights and Obligations Claim Procedures § 266.632 Withdrawal of claim. In case of a default and... of the type of mortgage relief determined to be appropriate. If the default is cured after the claim...

32 CFR 842.110 - Claims not payable.

Code of Federal Regulations, 2013 CFR

2013-07-01

... International Agreements Claims Act. (4) The Air Force Admiralty Claims Act and the Admiralty Extensions Act. (5... National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE CLAIMS AND LITIGATION... providing employee benefits through insurance, local law, or custom and the United States pays for such...

32 CFR 842.110 - Claims not payable.

Code of Federal Regulations, 2010 CFR

2010-07-01

... International Agreements Claims Act. (4) The Air Force Admiralty Claims Act and the Admiralty Extensions Act. (5... National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE CLAIMS AND LITIGATION... providing employee benefits through insurance, local law, or custom and the United States pays for such...

32 CFR 842.110 - Claims not payable.

Code of Federal Regulations, 2012 CFR

2012-07-01

... International Agreements Claims Act. (4) The Air Force Admiralty Claims Act and the Admiralty Extensions Act. (5... National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE CLAIMS AND LITIGATION... providing employee benefits through insurance, local law, or custom and the United States pays for such...

32 CFR 842.110 - Claims not payable.

Code of Federal Regulations, 2014 CFR

2014-07-01

... International Agreements Claims Act. (4) The Air Force Admiralty Claims Act and the Admiralty Extensions Act. (5... National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE CLAIMS AND LITIGATION... providing employee benefits through insurance, local law, or custom and the United States pays for such...

The Application Law of Large Numbers That Predicts The Amount of Actual Loss in Insurance of Life

NASA Astrophysics Data System (ADS)

Tinungki, Georgina Maria

2018-03-01

The law of large numbers is a statistical concept that calculates the average number of events or risks in a sample or population to predict something. The larger the population is calculated, the more accurate predictions. In the field of insurance, the Law of Large Numbers is used to predict the risk of loss or claims of some participants so that the premium can be calculated appropriately. For example there is an average that of every 100 insurance participants, there is one participant who filed an accident claim, then the premium of 100 participants should be able to provide Sum Assured to at least 1 accident claim. The larger the insurance participant is calculated, the more precise the prediction of the calendar and the calculation of the premium. Life insurance, as a tool for risk spread, can only work if a life insurance company is able to bear the same risk in large numbers. Here apply what is called the law of large number. The law of large numbers states that if the amount of exposure to losses increases, then the predicted loss will be closer to the actual loss. The use of the law of large numbers allows the number of losses to be predicted better.

75 FR 45114 - Determination of Insufficient Assets To Satisfy Claims Against Financial Institution in Receivership

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-02

... FDIC as Receiver of Downey Savings and Loan Association, F.A., Attention: Claims Agent, 1601 Bryan... insured depository institution to pay claims. Under the statutory order of priority, administrative...

The effect of community health worker-led education on women's health and treatment-seeking: A cluster randomised trial and nested process evaluation in Gujarat, India.

PubMed

Desai, Sapna; Mahal, Ajay; Sinha, Tara; Schellenberg, Joanna; Cousens, Simon

2017-12-01

A community-based health insurance scheme operated by the Self-Employed Women's Association in Gujarat, India reported that the leading reasons for inpatient hospitalisation claims by its members were diarrhoea, fever and hysterectomy - the latter at the average age of 37. This claims pattern raised concern regarding potentially unnecessary hospitalisation amongst low-income women. A cluster randomised trial and mixed methods process evaluation were designed to evaluate whether and how a community health worker-led education intervention amongst insured and uninsured adult women could reduce insurance claims, as well as hospitalisation and morbidity, related to diarrhoea, fever and hysterectomy. The 18-month intervention consisted of health workers providing preventive care information to women in a group setting in 14 randomly selected clusters, while health workers continued with regular activities in 14 comparison clusters. Claims data were collected from an administrative database, and four household surveys were conducted amongst a cohort of 1934 randomly selected adult women. 30% of insured women and 18% of uninsured women reported attending sessions. There was no evidence of an intervention effect on the primary outcome, insurance claims (risk ratio (RR) = 1.03; 95% confidence interval (CI) 0.81, 1.30) or secondary outcomes amongst insured and uninsured women, hospitalisation (RR = 1.05; 95% CI 0.58, 1.90) and morbidity (RR = 1.09; 95% CI 0.87, 1.38) related to the three conditions. The process evaluation suggested that participants retained knowledge from the sessions, but barriers to behaviour change were not overcome. We detected no evidence of an effect of this health worker-led intervention to decrease claims, hospitalisation and morbidity related to diarrhoea, fever and hysterectomy. Strategies that capitalise on health workers' role in the community and knowledge, as well as those that address the social determinants of diarrhoea, fever and the frequency of hysterectomy - such as water and sanitation infrastructure and access to primary gynaecological care - emerged as areas to strengthen future interventions.

Provider Behavior Under Global Budgeting and Policy Responses: An Observational Study on Eye Care Services in Taiwan.

PubMed

Chang, Chao-Kai; Xirasagar, Sudha; Chen, Brian; Hussey, James R; Wang, I-Jong; Chen, Jen-Chieh; Lian, Ie-Bin

2015-01-01

Third-party payer systems are consistently associated with health care cost escalation. Taiwan's single-payer, universal coverage National Health Insurance (NHI) adopted global budgeting (GB) to achieve cost control. This study captures ophthalmologists' response to GB, specifically service volume changes and service substitution between low-revenue and high-revenue services following GB implementation, the subsequent Bureau of NHI policy response, and the policy impact. De-identified eye clinic claims data for the years 2000, 2005, and 2007 were analyzed to study the changes in Simple Claim Form (SCF) claims versus Special Case Claims (SCCs). The 3 study years represent the pre-GB period, post-GB but prior to region-wise service cap implementation period, and the post-service cap period, respectively. Repeated measures multilevel regression analysis was used to study the changes adjusting for clinic characteristics and competition within each health care market. SCF service volume (low-revenue, fixed-price patient visits) remained constant throughout the study period, but SCCs (covering services involving variable provider effort and resource use with flexibility for discretionary billing) increased in 2005 with no further change in 2007. The latter is attributable to a 30% cap negotiated by the NHI Bureau with the ophthalmology association and enforced by the association. This study demonstrates that GB deployed with ongoing monitoring and timely policy responses that are designed in collaboration with professional stakeholders can contain costs in a health insurance-financed health care system. © The Author(s) 2015.

[Disease management programs in Germany: Validity of the medical documentation].

PubMed

Linder, R; Horenkamp-Sonntag, D; Engel, S; Köppel, D; Heilmann, T; Verheyen, F

2014-01-01

The specific documentation for disease management programs (DMP) in Germany with respect to § 137 Social Code Book V is the basis for evaluating the DMP. DMP run up costs of the order of a billion euro without assessing evidence-based benefit so far. Aim of this study was to question if and to which extent this documentation may be suitable for reliable quality assurance in its present form. Data of nearly 300000 insured persons of a German Statutory Health Insurance (Techniker Krankenkasse, TK) which were continuously registered from July 1st 2009 until December 31st 2010 in a DMP were analyzed. We analyzed how items which were components of claims data and of DMP documentation were matched. With regard to prescriptions there were some considerable differences. Prescription of glibenclamid was documented twice as frequently in the DMP documentation compared to prescriptions filled in pharmacies. Only a fraction of emergency hospitalizations documented in the claims data were found in the DMP documentation. Investigations of the fundus oculi for diabetics are mentioned three times more frequently in the DMP documentation than they are accounted by ophthalmologists. There are considerable differences between claims data and DMP specific documentation. The latter shows a plainly reduced validity for investigated fields in the documentation forms. Reasons for this are manifold. Former evaluations of DM Ps carried out just on the basis of DMP documentation are thus highly questionable. Therefore, the DMPs themselves and their documentation have to be reformed. © Georg Thieme Verlag KG Stuttgart · New York.

Impact of electronic health records on malpractice claims in a sample of physician offices in Colorado: a retrospective cohort study.

PubMed

Victoroff, Michael S; Drury, Barbara M; Campagna, Elizabeth J; Morrato, Elaine H

2013-05-01

Electronic health records (EHRs) might reduce medical liability claims and potentially justify premium credits from liability insurers, but the evidence is limited. To evaluate the association between EHR use and medical liability claims in a population of office-based physicians, including claims that could potentially be directly prevented by features available in EHRs ("EHR-sensitive" claims). Retrospective cohort study of medical liability claims and analysis of claim abstracts. The 26 % of Colorado office-based physicians insured through COPIC Insurance Company who responded to a survey on EHR use (894 respondents out of 3,502 invitees). Claims incidence rate ratio (IRR); prevalence of "EHR-sensitive" claims. 473 physicians (53 % of respondents) used an office-based EHR. After adjustment for sex, birth cohort, specialty, practice setting and use of an EHR in settings other than an office, IRR for all claims was not significantly different between EHR users and non-users (0.88, 95 % CI 0.52-1.46; p = 0.61), or for users after EHR implementation as compared to before (0.73, 95 % CI 0.41-1.29; p = 0.28). Of 1,569 claim abstracts reviewed, 3 % were judged "Plausibly EHR-sensitive," 82 % "Unlikely EHR-sensitive," and 15 % "Unable to determine." EHR-sensitive claims occurred in six out of 633 non-users and two out of 251 EHR users. Incidence rate ratios were 0.01 for both groups. Colorado physicians using office-based EHRs did not have significantly different rates of liability claims than non-EHR users; nor were rates different for EHR users before and after EHR implementation. The lack of significant effect may be due to a low prevalence of EHR-sensitive claims. Further research on EHR use and medical liability across a larger population of physicians is warranted.

Nonparametric Fine Tuning of Mixtures: Application to Non-Life Insurance Claims Distribution Estimation

NASA Astrophysics Data System (ADS)

Sardet, Laure; Patilea, Valentin

When pricing a specific insurance premium, actuary needs to evaluate the claims cost distribution for the warranty. Traditional actuarial methods use parametric specifications to model claims distribution, like lognormal, Weibull and Pareto laws. Mixtures of such distributions allow to improve the flexibility of the parametric approach and seem to be quite well-adapted to capture the skewness, the long tails as well as the unobserved heterogeneity among the claims. In this paper, instead of looking for a finely tuned mixture with many components, we choose a parsimonious mixture modeling, typically a two or three-component mixture. Next, we use the mixture cumulative distribution function (CDF) to transform data into the unit interval where we apply a beta-kernel smoothing procedure. A bandwidth rule adapted to our methodology is proposed. Finally, the beta-kernel density estimate is back-transformed to recover an estimate of the original claims density. The beta-kernel smoothing provides an automatic fine-tuning of the parsimonious mixture and thus avoids inference in more complex mixture models with many parameters. We investigate the empirical performance of the new method in the estimation of the quantiles with simulated nonnegative data and the quantiles of the individual claims distribution in a non-life insurance application.

29 CFR 15.24 - Unallowable claims.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 7-12-12) Claims Under the Military Personnel and Civilian Employees' Claims Act of 1964 § 15.24... time spent by the claimant in its preparation or for supposed literary value. (g) Incidental expenses... family members, inconvenience, time spent in preparation of claim, or cost of insurance premiums) are not...

20 CFR 336.15 - How to claim extended benefits.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 1 2012-04-01 2012-04-01 false How to claim extended benefits. 336.15... INSURANCE ACT DURATION OF NORMAL AND EXTENDED BENEFITS Extended Benefits § 336.15 How to claim extended... unemployment or normal sickness benefits and who wishes to claim extended unemployment or extended sickness...

20 CFR 336.15 - How to claim extended benefits.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false How to claim extended benefits. 336.15... INSURANCE ACT DURATION OF NORMAL AND EXTENDED BENEFITS Extended Benefits § 336.15 How to claim extended... unemployment or normal sickness benefits and who wishes to claim extended unemployment or extended sickness...

20 CFR 336.15 - How to claim extended benefits.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false How to claim extended benefits. 336.15... INSURANCE ACT DURATION OF NORMAL AND EXTENDED BENEFITS Extended Benefits § 336.15 How to claim extended... unemployment or normal sickness benefits and who wishes to claim extended unemployment or extended sickness...

The Clinical and Economic Burden of Hyperkalemia on Medicare and Commercial Payers.

PubMed

Fitch, Kathryn; Woolley, J Michael; Engel, Tyler; Blumen, Helen

2017-06-01

Hyperkalemia (serum potassium >5.0 mEq/L) may be caused by reduced kidney function and drugs affecting the renin-angiotensin-aldosterone system and is often present in patients with chronic kidney disease (CKD). To quantify the burden of hyperkalemia in US Medicare fee-for-service and commercially insured populations using real-world claims data, focusing on prevalence, comorbidities, mortality, medical utilization, and cost. A descriptive, retrospective claims data analysis was performed on patients with hyperkalemia using the 2014 Medicare 5% sample and the 2014 Truven Health Analytics MarketScan Commercial Claims and Encounter databases. The starting study samples required patient insurance eligibility during ≥1 months in 2014. The identification of hyperkalemia and other comorbidities required having ≥1 qualifying claims in 2014 with an appropriate International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code in any position. To address the differences between patients with and without hyperkalemia, CKD subsamples were analyzed separately. Mortality rates were calculated in the Medicare sample population only. The claims were grouped into major service categories; the allowed costs reflected all costs incurred by each cohort divided by the total number of member months for that cohort. The prevalence of hyperkalemia in the Medicare and commercially insured samples was 2.3% and 0.09%, respectively. Hyperkalemia was associated with multiple comorbidities, most notably CKD. The prevalence of CKD in the Medicare and the commercially insured members with hyperkalemia was 64.8% and 31.8%, respectively. After adjusting for CKD severity, the annual mortality rate for Medicare patients with CKD and hyperkalemia was 24.9% versus 10.4% in patients with CKD without hyperkalemia. The allowed costs in patients with CKD and hyperkalemia in the Medicare and commercially insured cohorts were more than twice those in patients with CKD without hyperkalemia. Inpatient care accounted for >50% of costs in patients with CKD and hyperkalemia. Hyperkalemia is associated with substantial clinical and economic burden among US commercially insured and Medicare populations.

76 FR 50733 - Determination of Insufficient Assets To Satisfy Claims Against Financial Institution in Receivership

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-16

... to FDIC as Receiver of Westernbank Puerto Rico, Attention: Claims Agent, 7777 Baymeadows Way West... liquidation or other resolution of an insured depository institution to pay claims. Under the statutory order...

The Swedish system for compensation of patient injuries.

PubMed

Johansson, Henry

2010-05-01

Since 1975 Sweden has had a patient insurance system to compensate patients for health-related injuries. The system was initially based on a voluntary patient insurance solution, but in 1997 it was replaced by the Patient Insurance Act. The current Act covers both physical and mental injuries. Although about 9,000-10,000 cases are processed in Sweden annually, compensation is paid in barely half of these cases. In the Swedish patient injury claim processing system, the Patient Claims Panel is the authority that plays an important role in ensuring fair and consistent application of the Act.

78 FR 52782 - 30-Day Notice of Proposed Information Collection: Mortgage Insurance Termination; Application for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-26

... information is used whenever FHA mortgage insurance is terminated and no claim for insurance benefits will be... functions of the agency, including whether the information will have practical utility; (2) The accuracy of...

76 FR 46684 - Medicaid and Children's Health Insurance Programs; Disallowance of Claims for FFP and Technical...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-03

..., 433, 447, and 457 [CMS-2292-P] RIN 0938-AQ32 Medicaid and Children's Health Insurance Programs... Children's Health Insurance Program (CHIP) disallowance process to allow States the option to retain... [[Page 46685

44 CFR 78.1 - Purpose.

Code of Federal Regulations, 2013 CFR

2013-10-01

... INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION ASSISTANCE § 78.1 Purpose... of the Flood Mitigation Assistance (FMA) program, authorized by Sections 1366 and 1367 of the... eliminate claims under the National Flood Insurance Program (NFIP) through mitigation activities. The...

44 CFR 78.1 - Purpose.

Code of Federal Regulations, 2014 CFR

2014-10-01

... INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION ASSISTANCE § 78.1 Purpose... of the Flood Mitigation Assistance (FMA) program, authorized by Sections 1366 and 1367 of the... eliminate claims under the National Flood Insurance Program (NFIP) through mitigation activities. The...

44 CFR 78.1 - Purpose.

Code of Federal Regulations, 2012 CFR

2012-10-01

... INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION ASSISTANCE § 78.1 Purpose... of the Flood Mitigation Assistance (FMA) program, authorized by Sections 1366 and 1367 of the... eliminate claims under the National Flood Insurance Program (NFIP) through mitigation activities. The...

44 CFR 78.1 - Purpose.

Code of Federal Regulations, 2011 CFR

2011-10-01

... INSURANCE AND HAZARD MITIGATION National Flood Insurance Program FLOOD MITIGATION ASSISTANCE § 78.1 Purpose... of the Flood Mitigation Assistance (FMA) program, authorized by Sections 1366 and 1367 of the... eliminate claims under the National Flood Insurance Program (NFIP) through mitigation activities. The...

76 FR 69044 - HUD Debt Collection: Revisions and Update to the Procedures for the Collection of Claims

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-07

...' Group Life Insurance and ``Basic Life'' Federal Employees' Group Life Insurance premiums are considered to be normal life insurance premiums; all optional Federal Employees' Group Life Insurance premiums... employees. The revisions impose no significant economic impact on a substantial number of small entities...

76 FR 39221 - HUD Debt Collection: Revisions and Update to the Procedures for the Collection of Claims

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-05

...' Group Life Insurance and ``Basic Life'' Federal Employees' Group Life Insurance premiums are considered to be normal life insurance premiums; all optional Federal Employees' Group Life Insurance premiums... Other Actions, would include the procedures that apply when HUD seeks satisfaction of debts owed to HUD...

Farmers Insures Success

ERIC Educational Resources Information Center

Freifeld, Lorri

2012-01-01

Farmers Insurance claims the No. 2 spot on the Training Top 125 with a forward-thinking training strategy linked to its primary mission: FarmersFuture 2020. It's not surprising an insurance company would have an insurance policy for the future. But Farmers takes that strategy one step further, setting its sights on 2020 with a far-reaching plan to…

78 FR 25909 - Minimum Value of Eligible Employer-Sponsored Plans and Other Rules Regarding the Health Insurance...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-03

... Minimum Value of Eligible Employer-Sponsored Plans and Other Rules Regarding the Health Insurance Premium.... SUMMARY: This document contains proposed regulations relating to the health insurance premium tax credit... who enroll in qualified health plans through Affordable Insurance Exchanges (Exchanges) and claim the...

26 CFR 54.9815-2719T - Internal claims and appeals and external review processes (temporary).

Code of Federal Regulations, 2012 CFR

2012-04-01

... external review processes for group health plans and health insurance issuers that are not grandfathered...) In general. A group health plan and a health insurance issuer offering group health insurance...). (2) Requirements for group health plans and group health insurance issuers. A group health plan and a...

26 CFR 54.9815-2719T - Internal claims and appeals and external review processes (temporary).

Code of Federal Regulations, 2011 CFR

2011-04-01

... external review processes for group health plans and health insurance issuers that are not grandfathered...) In general. A group health plan and a health insurance issuer offering group health insurance...). (2) Requirements for group health plans and group health insurance issuers. A group health plan and a...

26 CFR 54.9815-2719T - Internal claims and appeals and external review processes (temporary).

Code of Federal Regulations, 2014 CFR

2014-04-01

... external review processes for group health plans and health insurance issuers that are not grandfathered...) In general. A group health plan and a health insurance issuer offering group health insurance...). (2) Requirements for group health plans and group health insurance issuers. A group health plan and a...

26 CFR 54.9815-2719T - Internal claims and appeals and external review processes (temporary).

Code of Federal Regulations, 2013 CFR

2013-04-01

... external review processes for group health plans and health insurance issuers that are not grandfathered...) In general. A group health plan and a health insurance issuer offering group health insurance...). (2) Requirements for group health plans and group health insurance issuers. A group health plan and a...

Administration: For Laptops and Tablets, Do You Even Need Insurance?

ERIC Educational Resources Information Center

Thompson, Greg

2013-01-01

At best, insurance is a crucial investment that leads to peace of mind after large educational technology expenditures. If something goes wrong, the insurer pays the claim. At worst, insurance premiums siphon money from school budgets while lining the pockets of distant company executives. John Connolly, director of technology at Consolidated High…

[Responsibility due to medication errors in France: a study based on SHAM insurance data].

PubMed

Theissen, A; Orban, J-C; Fuz, F; Guerin, J-P; Flavin, P; Albertini, S; Maricic, S; Saquet, D; Niccolai, P

2015-03-01

The safe medication practices at the hospital constitute a major public health problem. Drug supply chain is a complex process, potentially source of errors and damages for the patient. SHAM insurances are the biggest French provider of medical liability insurances and a relevant source of data on the health care complications. The main objective of the study was to analyze the type and cause of medication errors declared to SHAM and having led to a conviction by a court. We did a retrospective study on insurance claims provided by SHAM insurances with a medication error and leading to a condemnation over a 6-year period (between 2005 and 2010). Thirty-one cases were analysed, 21 for scheduled activity and 10 for emergency activity. Consequences of claims were mostly serious (12 deaths, 14 serious complications, 5 simple complications). The types of medication errors were a drug monitoring error (11 cases), an administration error (5 cases), an overdose (6 cases), an allergy (4 cases), a contraindication (3 cases) and an omission (2 cases). Intravenous route of administration was involved in 19 of 31 cases (61%). The causes identified by the court expert were an error related to service organization (11), an error related to medical practice (11) or nursing practice (13). Only one claim was due to the hospital pharmacy. The claim related to drug supply chain is infrequent but potentially serious. These data should help strengthen quality approach in risk management. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Individual Data Linkage of Survey Data with Claims Data in Germany—An Overview Based on a Cohort Study

PubMed Central

March, Stefanie

2017-01-01

Research based on health insurance data has a long tradition in Germany. By contrast, data linkage of survey data with such claims data is a relatively new field of research with high potential. Data linkage opens up new opportunities for analyses in the field of health services research and public health. Germany has comprehensive rules and regulations of data protection that have to be followed. Therefore, a written informed consent is needed for individual data linkage. Additionally, the health system is characterized by heterogeneity of health insurance. The lidA-living at work-study is a cohort study on work, age and health, which linked survey data with claims data of a large number of statutory health insurance data. All health insurance funds were contacted, of whom a written consent was given. This paper will give an overview of individual data linkage of survey data with German claims data on the example of the lidA-study results. The challenges and limitations of data linkage will be presented. Despite heterogeneity, such kind of studies is possible with a negligibly small influence of bias. The experience we gain in lidA will be shown and provide important insights for other studies focusing on data linkage. PMID:29232834

Individual Data Linkage of Survey Data with Claims Data in Germany-An Overview Based on a Cohort Study.

PubMed

March, Stefanie

2017-12-09

Research based on health insurance data has a long tradition in Germany. By contrast, data linkage of survey data with such claims data is a relatively new field of research with high potential. Data linkage opens up new opportunities for analyses in the field of health services research and public health. Germany has comprehensive rules and regulations of data protection that have to be followed. Therefore, a written informed consent is needed for individual data linkage. Additionally, the health system is characterized by heterogeneity of health insurance. The lidA-living at work-study is a cohort study on work, age and health, which linked survey data with claims data of a large number of statutory health insurance data. All health insurance funds were contacted, of whom a written consent was given. This paper will give an overview of individual data linkage of survey data with German claims data on the example of the lidA-study results. The challenges and limitations of data linkage will be presented. Despite heterogeneity, such kind of studies is possible with a negligibly small influence of bias. The experience we gain in lidA will be shown and provide important insights for other studies focusing on data linkage.

76 FR 50733 - Determination of Insufficient Assets To Satisfy Claims Against Financial Institution in Receivership

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-16

... FDIC as Receiver of R-G Premier Bank of Puerto Rico, Attention: Claims Agent, 7777 Baymeadows Way West... the liquidation or other resolution of an insured depository institution to pay claims. Under the...

44 CFR 80.17 - Project implementation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program PROPERTY ACQUISITION AND... encumbrances to the property must be extinguished before acquisition. (c) Purchase offer and supplemental... resulting in a National Flood Insurance Program (NFIP) claim of at least $5000. (2) For acquisition of...

Type 2 diabetes detection and management among insured adults.

PubMed

Dall, Timothy M; Yang, Weyna; Halder, Pragna; Franz, Jerry; Byrne, Erin; Semilla, April P; Chakrabarti, Ritashree; Stuart, Bruce

2016-01-01

The Centers for Disease Control and Prevention estimates that 28.9 million adults had diabetes in 2012 in the US, though many patients are undiagnosed or not managing their condition. This study provides US national and state estimates of insured adults with type 2 diabetes who are diagnosed, receiving exams and medication, managing glycemic levels, with diabetes complications, and their health expenditures. Such information can be used for benchmarking and to identify gaps in diabetes detection and management. The study combines analysis of survey data with medical claims analysis for the commercially insured, Medicare, and Medicaid populations to estimate the number of adults with diagnosed type 2 diabetes and undiagnosed diabetes by insurance type, age, and sex. Medical claims analysis used the 2012 de-identified Normative Health Information database covering a nationally representative commercially insured population, the 2011 Medicare 5% Sample, and the 2008 Medicaid Mini-Max. Among insured adults in 2012, approximately 16.9 million had diagnosed type 2 diabetes, 1.45 million had diagnosed type 1 diabetes, and 6.9 million had undiagnosed diabetes. Of those with diagnosed type 2, approximately 13.0 million (77%) received diabetes medication-ranging from 70% in New Jersey to 82% in Utah. Suboptimal percentages had claims indicating recommended exams were performed. Of those receiving diabetes medication, 43% (5.6 million) had medical claims indicating poorly controlled diabetes-ranging from 29% with poor control in Minnesota and Iowa to 53% in Texas. Poor control was correlated with higher prevalence of neurological complications (+14%), renal complications (+14%), and peripheral vascular disease (+11%). Patients with poor control averaged $4,860 higher average annual health care expenditures-ranging from $6,680 for commercially insured patients to $4,360 for Medicaid and $3,430 for Medicare patients. This study highlights the large number of insured adults with undiagnosed type 2 diabetes by insurance type and state. Furthermore, this study sheds light on other gaps in diabetes care quality among patients with diagnosed diabetes and corresponding poorly controlled diabetes. These findings underscore the need for improvements in data collection and diabetes screening and management, along with policies that support these improvements.

[Regional electro-hyperthermia--technical principles, clinical results and health insurance aspects].

PubMed

Heyll, Uwe

2012-06-01

The method of electro-hyperthermia is based on the production of alternating currents from capacitive coupled electrodes. Because of the associated heating of body tissues, the electro-hyperthermia is promoted as an alternative to the more sophisticated methods of scientific hyperthermia, which find use in oncologic diseases. The analysis of technical data, however, reveals that the electro-hyperthermia is not qualified for a focused, effective and therapeutically useful heating of circumscribed target areas. Data from clinical studies demonstrating efficacy for defined indications are not available. The application of electro-hyperthermia is excluded form the German system of public health insurance. As proof of medical necessity cannot be provided, there is also no claim for reimbursement from private health insurance. According to legal regulations in Germany, an invoice as hyperthermia treatment is usually not possible. Rather, an item from the electrotherapy section of the official provision of medical fees (GOA) has to be chosen.

20 CFR 336.15 - How to claim extended benefits.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 1 2014-04-01 2012-04-01 true How to claim extended benefits. 336.15 Section... INSURANCE ACT DURATION OF NORMAL AND EXTENDED BENEFITS Extended Benefits § 336.15 How to claim extended... unemployment or normal sickness benefits and who wishes to claim extended unemployment or extended sickness...

20 CFR 336.15 - How to claim extended benefits.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 1 2013-04-01 2012-04-01 true How to claim extended benefits. 336.15 Section... INSURANCE ACT DURATION OF NORMAL AND EXTENDED BENEFITS Extended Benefits § 336.15 How to claim extended... unemployment or normal sickness benefits and who wishes to claim extended unemployment or extended sickness...

Financial sustainability versus access and quality in a challenged health system: an examination of the capitation policy debate in Ghana.

PubMed

Atuoye, Kilian Nasung; Vercillo, Siera; Antabe, Roger; Galaa, Sylvester Zackaria; Luginaah, Isaac

2016-11-01

Policy makers in low and middle-income countries are frequently confronted with challenges of increasing health access for poor populations in a sustainable manner. After several years of trying out different health financing mechanisms, health insurance has recently emerged as a pro-poor health financing policy. Capitation, a fixed fee periodically paid to health service providers for anticipated services, is one of the payment policies in health insurance. This article examines claims and counter-claims made by coalitions and individual stakeholders in a capitation payment policy debate within Ghana's National Health Insurance Scheme. Using content analysis of public and parliamentary proceedings, we situate the debate within policy making and health insurance literature. We found that the ongoing capitation payment debate stems from challenges in implementation of earlier health insurance claims payment systems, which reflect broader systemic challenges facing the health insurance scheme in Ghana. The study illustrates the extent to which various sub-systems in the policy debate advance arguments to legitimize their claims about the contested capitation payment system. In addition, we found that the health of poor communities, women and children are being used as surrogates for political and individual arguments in the policy debate. The article recommends a more holistic and participatory approach through persuasion and negotiation to join interests and core evidence together in the capitation policy making in Ghana and elsewhere with similar contexts. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Decreasing Malpractice Claims by Reducing Preventable Perinatal Harm.

PubMed

Riley, William; Meredith, Les W; Price, Rebecca; Miller, Kristi K; Begun, James W; McCullough, Mac; Davis, Stanley

2016-12-01

To evaluate the association of improved patient safety practices with medical malpractice claims and costs in the perinatal units of acute care hospitals. Malpractice and harm data from participating hospitals; litigation records and medical malpractice claims data from American Excess Insurance Exchange, RRG, whose data are managed by Premier Insurance Management Services, Inc. (owned by Premier Inc., a health care improvement company). A quasi-experimental prospective design to compare baseline and postintervention data. Statistical significance tests for differences were performed using chi-square, Wilcoxon signed-rank test, and t-test. Claims data were collected and evaluated by experienced senior claims managers through on-site claim audits to evaluate claim frequency, severity, and financial information. Data were provided to the analyzing institution through confidentiality contracts. There is a significant reduction in the number of perinatal malpractice claims paid, losses paid, and indemnity payments (43.9 percent, 77.6 percent, and 84.6 percent, respectively) following interventions to improve perinatal patient safety and reduce perinatal harm. This compares with no significant reductions in the nonperinatal claims in the same hospitals during the same time period. The number of perinatal malpractice claims and dollar amount of claims payments decreased significantly in the participating hospitals, while there was no significant decrease in nonperinatal malpractice claims activity in the same hospitals. © Health Research and Educational Trust.

Linking individual medicare health claims data with work-life claims and other administrative data.

PubMed

Mokyr Horner, Elizabeth; Cullen, Mark R

2015-09-30

Researchers investigating health outcomes for populations over age 65 can utilize Medicare claims data, but these data include no direct information about individuals' health prior to age 65 and are not typically linkable to files containing data on exposures and behaviors during their worklives. The current paper is a proof-of-concept, of merging employers' administrative data and private, employment-based health claims with Medicare data. Characteristics of the linked data, including sensitivity and specificity, are evaluated with an eye toward potential uses of such linked data. This paper uses a sample of former manufacturing workers from an industrial cohort as a test case. The dataset created by this integration could be useful to research in areas such as social epidemiology and occupational health. Medicare and employment administrative data were linked for a large cohort of manufacturing workers (employed at some point during 1996-2008) who transitioned onto Medicare between 2001-2009. Data on work-life health, including biometric indicators, were used to predict health at age 65 and to investigate the concordance of employment-based insurance claims with subsequent Medicare insurance claims. Chronic diseases were found to have relatively high levels of concordance between employment-based private insurance and subsequent Medicare insurance. Information about patient health prior to receipt of Medicare, including biometric indicators, were found to predict health at age 65. Combining these data allows for evaluation of continuous health trajectories, as well as modeling later-life health as a function of work-life behaviors and exposures. It also provides a potential endpoint for occupational health research. This is the first harmonization of its kind, providing a proof-of-concept. The dataset created by this integration could be useful for research in areas such as social epidemiology and occupational health.

Managing moral hazard in motor vehicle accident insurance claims.

PubMed

Ebrahim, Shanil; Busse, Jason W; Guyatt, Gordon H; Birch, Stephen

2013-05-01

Motor vehicle accident (MVA) insurance in Canada is based primarily on two different compensation systems: (i) no-fault, in which policyholders are unable to seek recovery for losses caused by other parties (unless they have specified dollar or verbal thresholds) and (ii) tort, in which policyholders may seek general damages. As insurance companies pay for MVA-related health care costs, excess use of health care services may occur as a result of consumers' (accident victims) and/or producers' (health care providers) behavior - often referred to as the moral hazard of insurance. In the United States, moral hazard is greater for low dollar threshold no-fault insurance compared with tort systems. In Canada, high dollar threshold or pure no-fault versus tort systems are associated with faster patient recovery and reduced MVA claims. These findings suggest that high threshold no-fault or pure no-fault compensation systems may be associated with improved outcomes for patients and reduced moral hazard.

75 FR 21020 - Notice of Proposed Information Collection: Comment Request; Application for Insurance Benefits...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-22

... Information Collection: Comment Request; Application for Insurance Benefits; Multifamily Mortgage AGENCY... Service (1-800-877-8339). FOR FURTHER INFORMATION CONTACT: Betty Belin, Director, Multifamily Claims...: Multifamily Mortgagee's Application for Insurance Benefits. OMB Control Number, if applicable: 2502-0419...

5 CFR 179.203 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) Health insurance premiums; (8) Normal retirement contributions as explained in 5 CFR 581.105(e) (e.g... Federal Employee's Group Life Insurance premiums) exclusive of optional life insurance premiums. Employee... the paying agency to offset the salary of an employee. Claim See debt. Creditor agency means an agency...

Insurance for the compounding pharmacy business, part 2: what, when, and where.

PubMed

Baker, Kenneth R

2008-01-01

The practice of pharmacy was simpler in past years. Prior to the 1980s, pharmacists did not have to worry about "duty to warn" claims, lawsuits for failure to adequately perform a prospective drug review, or claims that the pharmacist failed to counsel the patient adequately. In those earlier days, if a pharmacist put the right tablet in the bottle with the correct directions, there would be no claim or lawsuit. Occasionally, pharmacists would make a medication error. Putting the wrong pill in the bottle or mistyping the directions could result in serious injury and a significant claim for damages, but the number of errors was in keeping with the lower volume of prescirptions filled, and claims were relatively few. Today, community pharmacies fill over three billion prescriptions annually. In keeping with that statistic, the number of claims against compounding pharmacists and pharmacies has, understandably, also increased. Not all insurance policies for pharmacy professional liability have kept up with the changes in pharmacy. With the divergence in pharmacy practices, coupled with the changes in pharmacists' duties and today's pharmacy law, the pharmacist must read and understand insurance policies to be sure they have adequate coverage for their professions. The information contained within this article is provided to help the pharmacy owners and pharmacists understand their needs and what to look for in their policies.

32 CFR 842.119 - Nonassertable claims.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 6 2013-07-01 2013-07-01 false Nonassertable claims. 842.119 Section 842.119 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE CLAIMS AND LITIGATION..., agency, or instrumentality of the United States. “Agency or instrumentality” includes any self-insured...

32 CFR 842.119 - Nonassertable claims.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 6 2012-07-01 2012-07-01 false Nonassertable claims. 842.119 Section 842.119 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE CLAIMS AND LITIGATION..., agency, or instrumentality of the United States. “Agency or instrumentality” includes any self-insured...

32 CFR 842.119 - Nonassertable claims.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 6 2011-07-01 2011-07-01 false Nonassertable claims. 842.119 Section 842.119 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE CLAIMS AND LITIGATION..., agency, or instrumentality of the United States. “Agency or instrumentality” includes any self-insured...

32 CFR 842.119 - Nonassertable claims.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 6 2014-07-01 2014-07-01 false Nonassertable claims. 842.119 Section 842.119 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE CLAIMS AND LITIGATION..., agency, or instrumentality of the United States. “Agency or instrumentality” includes any self-insured...

20 CFR 325.4 - Claim for unemployment benefits.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Claim for unemployment benefits. 325.4 Section 325.4 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT REGISTRATION FOR RAILROAD UNEMPLOYMENT BENEFITS § 325.4 Claim for unemployment benefits. (a...

20 CFR 325.4 - Claim for unemployment benefits.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false Claim for unemployment benefits. 325.4 Section 325.4 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT REGISTRATION FOR RAILROAD UNEMPLOYMENT BENEFITS § 325.4 Claim for unemployment benefits. (a...

20 CFR 325.4 - Claim for unemployment benefits.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 1 2012-04-01 2012-04-01 false Claim for unemployment benefits. 325.4 Section 325.4 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT REGISTRATION FOR RAILROAD UNEMPLOYMENT BENEFITS § 325.4 Claim for unemployment benefits. (a...

20 CFR 325.4 - Claim for unemployment benefits.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 1 2013-04-01 2012-04-01 true Claim for unemployment benefits. 325.4 Section 325.4 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT REGISTRATION FOR RAILROAD UNEMPLOYMENT BENEFITS § 325.4 Claim for unemployment benefits. (a...

20 CFR 325.4 - Claim for unemployment benefits.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 1 2014-04-01 2012-04-01 true Claim for unemployment benefits. 325.4 Section 325.4 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT REGISTRATION FOR RAILROAD UNEMPLOYMENT BENEFITS § 325.4 Claim for unemployment benefits. (a...

How Family Status and Social Security Claiming Options Shape Optimal Life Cycle Portfolios

PubMed Central

Hubener, Andreas; Maurer, Raimond; Mitchell, Olivia S.

2017-01-01

We show how optimal household decisions regarding work, retirement, saving, portfolio allocations, and life insurance are shaped by the complex financial options embedded in U.S. Social Security rules and uncertain family transitions. Our life cycle model predicts sharp consumption drops on retirement, an age-62 peak in claiming rates, and earlier claiming by wives versus husbands and single women. Moreover, life insurance is mainly purchased on men’s lives. Our model, which takes Social Security rules seriously, generates wealth and retirement outcomes that are more consistent with the data, in contrast to earlier and less realistic models. PMID:28659659

Captive insurance: is it the right choice for your insurance exposures?

PubMed

Frese, Richard C

2015-12-01

Potential benefits of a captive insurance company include: Broader coverage Improved cash flow and stability. Direct access to reinsurance markets. Tax advantages. Better handling and control of risk management and claims. Potential drawbacks and challenges include: Startup capitalization. Underwriting losses. Administration and commitment.

24 CFR 232.885 - Insurance benefits.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 2 2013-04-01 2013-04-01 false Insurance benefits. 232.885 Section 232.885 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued....885 Insurance benefits. (a) Method of payment. Payment of claim shall be made in the following manner...

24 CFR 232.885 - Insurance benefits.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Insurance benefits. 232.885 Section 232.885 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued....885 Insurance benefits. (a) Method of payment. Payment of claim shall be made in the following manner...

24 CFR 232.885 - Insurance benefits.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 2 2012-04-01 2012-04-01 false Insurance benefits. 232.885 Section 232.885 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued....885 Insurance benefits. (a) Method of payment. Payment of claim shall be made in the following manner...

24 CFR 232.885 - Insurance benefits.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Insurance benefits. 232.885 Section 232.885 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued....885 Insurance benefits. (a) Method of payment. Payment of claim shall be made in the following manner...

24 CFR 232.885 - Insurance benefits.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false Insurance benefits. 232.885 Section 232.885 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued....885 Insurance benefits. (a) Method of payment. Payment of claim shall be made in the following manner...

24 CFR 266.636 - Insuring new loans for defaulted projects.

Code of Federal Regulations, 2010 CFR

2010-04-01

... AUTHORITIES HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS Contract Rights and Obligations Claim Procedures § 266.636 Insuring new loans for defaulted projects. The... projects. 266.636 Section 266.636 Housing and Urban Development Regulations Relating to Housing and Urban...

Perceptions and uptake of health insurance for maternal care in rural Kenya: a cross sectional study.

PubMed

Maina, Jackson Michuki; Kithuka, Peter; Tororei, Samuel

2016-01-01

In Kenya, maternal and child health accounts for a large proportion of the expenditures made towards healthcare. It is estimated that one in every five Kenyans has some form of health insurance. Availability of health insurance may protect families from catastrophic spending on health. The study intended to determine the factors affecting the uptake of health insurance among pregnant women in a rural Kenyan district. This was cross-sectional study that sampled 139 pregnant women attending the antenatal clinic at a level 5 hospital in a Kenyan district. The information was collected through a pretested interview schedule. The median age of the study participants was 28 years. Out of the 139 respondents, 86(62%) planned to pay for their deliveries through insurance. There was a significant relationship between insurance uptake and marital status Adjusted odds ratio (AOR) 6.4(1.4-28.8). Those with tertiary education were more likely to take up insurance AOR 5.1 (1.3-19.2). Knowing the benefits of insurance and the limits the insurance would settle in claims was associated with an increase in the uptake of insurance AOR 7.6(2.3-25.1), AOR 6.4(1.5-28.3) respectively. Monthly income and number of children did not affect insurance uptake. Being married, tertiary education and having some knowledge on how insurance premiums are paid are associated with uptake of medical insurance. Information generated from this study if utilized will bring a better understanding as to why insurance coverage may be low and may provide a basis for policy changes among the insurance companies to increase the uptake.

Perceptions and uptake of health insurance for maternal care in rural Kenya: a cross sectional study

PubMed Central

Maina, Jackson Michuki; Kithuka, Peter; Tororei, Samuel

2016-01-01

Introduction In Kenya, maternal and child health accounts for a large proportion of the expenditures made towards healthcare. It is estimated that one in every five Kenyans has some form of health insurance. Availability of health insurance may protect families from catastrophic spending on health. The study intended to determine the factors affecting the uptake of health insurance among pregnant women in a rural Kenyan district. Methods This was cross-sectional study that sampled 139 pregnant women attending the antenatal clinic at a level 5 hospital in a Kenyan district. The information was collected through a pretested interview schedule. Results The median age of the study participants was 28 years. Out of the 139 respondents, 86(62%) planned to pay for their deliveries through insurance. There was a significant relationship between insurance uptake and marital status Adjusted odds ratio (AOR) 6.4(1.4-28.8). Those with tertiary education were more likely to take up insurance AOR 5.1 (1.3-19.2). Knowing the benefits of insurance and the limits the insurance would settle in claims was associated with an increase in the uptake of insurance AOR 7.6(2.3-25.1), AOR 6.4(1.5-28.3) respectively. Monthly income and number of children did not affect insurance uptake. Results Being married, tertiary education and having some knowledge on how insurance premiums are paid are associated with uptake of medical insurance. Information generated from this study if utilized will bring a better understanding as to why insurance coverage may be low and may provide a basis for policy changes among the insurance companies to increase the uptake. PMID:27279952

Private Long-Term Care Insurance: Value to Claimants and Implications for Long-Term Care Financing

ERIC Educational Resources Information Center

Doty, Pamela; Cohen, Marc A.; Miller, Jessica; Shi, Xiaomei

2010-01-01

Purpose: The purpose of this study was to obtain a profile of individuals with private long-term care (LTC) insurance as they begin using paid LTC services and track their patterns of service use, satisfaction with services and insurance, claims denial rates, and transitions over a 28-month period. Design and Methods: Ten LTC insurance companies…

24 CFR 203.436 - Claim procedure-graduated payment mortgages.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Claim procedure-graduated payment... AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Graduated Payment Mortgages § 203.436 Claim procedure—graduated payment mortgages. All of the provisions of this subpart are applicable...

24 CFR 203.436 - Claim procedure-graduated payment mortgages.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Claim procedure-graduated payment... AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Graduated Payment Mortgages § 203.436 Claim procedure—graduated payment mortgages. All of the provisions of this subpart are applicable...

24 CFR 203.436 - Claim procedure-graduated payment mortgages.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false Claim procedure-graduated payment... AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Graduated Payment Mortgages § 203.436 Claim procedure—graduated payment mortgages. All of the provisions of this subpart are applicable...

24 CFR 203.436 - Claim procedure-graduated payment mortgages.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 2 2012-04-01 2012-04-01 false Claim procedure-graduated payment... AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Graduated Payment Mortgages § 203.436 Claim procedure—graduated payment mortgages. All of the provisions of this subpart are applicable...

24 CFR 203.436 - Claim procedure-graduated payment mortgages.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 2 2013-04-01 2013-04-01 false Claim procedure-graduated payment... AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Graduated Payment Mortgages § 203.436 Claim procedure—graduated payment mortgages. All of the provisions of this subpart are applicable...

24 CFR 220.820 - Maximum claim period.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Maximum claim period. 220.820 Section 220.820 Housing and Urban Development Regulations Relating to Housing and Urban Development... Contract Rights and Obligations-Projects Insured Project Improvement Loans § 220.820 Maximum claim period...

18 CFR 367.9250 - Account 925, Injuries and damages.

Code of Federal Regulations, 2014 CFR

2014-04-01

... company against injuries and damages claims of employees or others, losses of such character not covered by insurance, and expenses incurred in settlement of injuries and damages claims. It also must... against claims from injuries and damages by employees or others, such as public liability, property...

18 CFR 367.9250 - Account 925, Injuries and damages.

Code of Federal Regulations, 2011 CFR

2011-04-01

... company against injuries and damages claims of employees or others, losses of such character not covered by insurance, and expenses incurred in settlement of injuries and damages claims. It also must... against claims from injuries and damages by employees or others, such as public liability, property...

18 CFR 367.9250 - Account 925, Injuries and damages.

Code of Federal Regulations, 2013 CFR

2013-04-01

... company against injuries and damages claims of employees or others, losses of such character not covered by insurance, and expenses incurred in settlement of injuries and damages claims. It also must... against claims from injuries and damages by employees or others, such as public liability, property...

18 CFR 367.9250 - Account 925, Injuries and damages.

Code of Federal Regulations, 2012 CFR

2012-04-01

... company against injuries and damages claims of employees or others, losses of such character not covered by insurance, and expenses incurred in settlement of injuries and damages claims. It also must... against claims from injuries and damages by employees or others, such as public liability, property...

26 CFR 1.846-1 - Application of discount factors.

Code of Federal Regulations, 2011 CFR

2011-04-01

... (CONTINUED) INCOME TAXES (CONTINUED) Other Insurance Companies § 1.846-1 Application of discount factors. (a... losses based on their annual statement classification prior to the change. (2) Title insurance company reserves. A title insurance company may only take into account case reserves (relating to claims which have...

26 CFR 1.846-1 - Application of discount factors.

Code of Federal Regulations, 2010 CFR

2010-04-01

... (CONTINUED) INCOME TAXES Other Insurance Companies § 1.846-1 Application of discount factors. (a) In general... losses based on their annual statement classification prior to the change. (2) Title insurance company reserves. A title insurance company may only take into account case reserves (relating to claims which have...

Everything You Ought to Know About the Liability Insurance Crisis but Didn't Know How to Ask.

ERIC Educational Resources Information Center

Direnfeld-Michael, Bonnie; Michael, David R.

1987-01-01

A great deal of the current liability insurance crisis can be attributed to the industry itself. This article discusses insurance cyles, cash flow underwriting, reinsurance, company "capacity", rates determination, "claims-made" coverage of accidents, and regulation of the industry. (JD)

45 CFR 147.136 - Internal claims and appeals and external review processes.

Code of Federal Regulations, 2010 CFR

2010-10-01

... RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH... external review processes for group health plans and health insurance issuers that are not grandfathered...) In general. A group health plan and a health insurance issuer offering group or individual health...

45 CFR 147.136 - Internal claims and appeals and external review processes.

Code of Federal Regulations, 2013 CFR

2013-10-01

... RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH... external review processes for group health plans and health insurance issuers that are not grandfathered...) In general. A group health plan and a health insurance issuer offering group or individual health...

45 CFR 147.136 - Internal claims and appeals and external review processes.

Code of Federal Regulations, 2012 CFR

2012-10-01

... RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH... external review processes for group health plans and health insurance issuers that are not grandfathered...) In general. A group health plan and a health insurance issuer offering group or individual health...

45 CFR 147.136 - Internal claims and appeals and external review processes.

Code of Federal Regulations, 2014 CFR

2014-10-01

... RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH... external review processes for group health plans and health insurance issuers that are not grandfathered...) In general. A group health plan and a health insurance issuer offering group or individual health...

45 CFR 147.136 - Internal claims and appeals and external review processes.

Code of Federal Regulations, 2011 CFR

2011-10-01

... RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH... external review processes for group health plans and health insurance issuers that are not grandfathered...) In general. A group health plan and a health insurance issuer offering group or individual health...

75 FR 47345 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-05

... September 7, 2010 to be assured of consideration. Domestic Finance/Terrorism Risk Insurance Program (TRIP... claims for payment of the Federal share of compensation for insured losses resulting from a certified act... to amounts paid as the Federal share of compensation for insured losses in order to conduct...

The evaluation of trustworthiness to identify health insurance fraud in dentistry.

PubMed

Wang, Shu-Li; Pai, Hao-Ting; Wu, Mei-Fang; Wu, Fan; Li, Chen-Lin

2017-01-01

According to the investigations of the U.S. Government Accountability Office (GAO), health insurance fraud has caused an enormous pecuniary loss in the U.S. In Taiwan, in dentistry the problem is getting worse if dentists (authorized entities) file fraudulent claims. Several methods have been developed to solve health insurance fraud; however, these methods are like a rule-based mechanism. Without exploring the behavior patterns, these methods are time-consuming and ineffective; in addition, they are inadequate for managing the fraudulent dentists. Based on social network theory, we develop an evaluation approach to solve the problem of cross-dentist fraud. The trustworthiness score of a dentist is calculated based upon the amount and type of dental operations performed on the same patient and the same tooth by that dentist and other dentists. The simulation provides the following evidence. (1) This specific type of fraud can be identified effectively using our evaluation approach. (2) A retrospective study for the claims is also performed. (3) The proposed method is effective in identifying the fraudulent dentists. We provide a new direction for investigating the genuineness of claims data. If the insurer can detect fraudulent dentists using the traditional method and the proposed method simultaneously, the detection will be more transparent and ultimately reduce the losses caused by fraudulent claims. Copyright © 2016 Elsevier B.V. All rights reserved.

78 FR 78802 - Medicare Program; Right of Appeal for Medicare Secondary Payer Determination Relating to...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-27

...This proposed rule would implement provisions of the Strengthening Medicare and Repaying Taxpayers Act of 2012 (SMART Act) which require us to provide a right of appeal and an appeal process for liability insurance (including self-insurance), no-fault insurance, and workers' compensation laws or plans when Medicare pursues a Medicare Secondary Payer (MSP) recovery claim directly from the liability insurance (including self-insurance), no fault insurance, or workers' compensation law or plan.

The Clinical and Economic Burden of Hyperkalemia on Medicare and Commercial Payers

PubMed Central

Fitch, Kathryn; Woolley, J. Michael; Engel, Tyler; Blumen, Helen

2017-01-01

Background Hyperkalemia (serum potassium >5.0 mEq/L) may be caused by reduced kidney function and drugs affecting the renin-angiotensin-aldosterone system and is often present in patients with chronic kidney disease (CKD). Objective To quantify the burden of hyperkalemia in US Medicare fee-for-service and commercially insured populations using real-world claims data, focusing on prevalence, comorbidities, mortality, medical utilization, and cost. Methods A descriptive, retrospective claims data analysis was performed on patients with hyperkalemia using the 2014 Medicare 5% sample and the 2014 Truven Health Analytics MarketScan Commercial Claims and Encounter databases. The starting study samples required patient insurance eligibility during ≥1 months in 2014. The identification of hyperkalemia and other comorbidities required having ≥1 qualifying claims in 2014 with an appropriate International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code in any position. To address the differences between patients with and without hyperkalemia, CKD subsamples were analyzed separately. Mortality rates were calculated in the Medicare sample population only. The claims were grouped into major service categories; the allowed costs reflected all costs incurred by each cohort divided by the total number of member months for that cohort. Results The prevalence of hyperkalemia in the Medicare and commercially insured samples was 2.3% and 0.09%, respectively. Hyperkalemia was associated with multiple comorbidities, most notably CKD. The prevalence of CKD in the Medicare and the commercially insured members with hyperkalemia was 64.8% and 31.8%, respectively. After adjusting for CKD severity, the annual mortality rate for Medicare patients with CKD and hyperkalemia was 24.9% versus 10.4% in patients with CKD without hyperkalemia. The allowed costs in patients with CKD and hyperkalemia in the Medicare and commercially insured cohorts were more than twice those in patients with CKD without hyperkalemia. Inpatient care accounted for >50% of costs in patients with CKD and hyperkalemia. Conclusion Hyperkalemia is associated with substantial clinical and economic burden among US commercially insured and Medicare populations. PMID:28794824

Policy tenure under the U.S. National Flood Insurance Program (NFIP).

PubMed

Michel-Kerjan, Erwann; Lemoyne de Forges, Sabine; Kunreuther, Howard

2012-04-01

In the United States, insurance against flood hazard (inland flooding or storm surge from hurricanes) has been provided mainly through the National Flood Insurance Program (NFIP) since 1968. The NFIP covers $1.23 trillion of assets today. This article provides the first analysis of flood insurance tenure ever undertaken: that is, the number of years that people keep their flood insurance policy before letting it lapse. Our analysis of the entire portfolio of the NFIP over the period 2001-2009 reveals that the median tenure of new policies during that time is between two and four years; it is also relatively stable over time and levels of flood hazard. Prior flood experience can affect tenure: people who have experienced small flood claims tend to hold onto their insurance longer; people who have experienced large flood claims tend to let their insurance lapse sooner. To overcome the policy and governance challenges posed by homeowners' inadequate insurance coverage, we discuss policy recommendations that include for banks and government-sponsored enterprises (GSEs) strengthening their requirements and the introduction of multiyear flood insurance contracts attached to the property, both of which are likely to provide more coverage stability and encourage investments in risk-reduction measures. © 2011 Society for Risk Analysis.

44 CFR 63.9 - Sale while claim pending.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Sale while claim pending. 63.9 Section 63.9 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT... OF SECTION 1306(c) OF THE NATIONAL FLOOD INSURANCE ACT OF 1968 General § 63.9 Sale while claim...

24 CFR 203.417 - Rate of interest of certificate of claim.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Rate of interest of certificate of... Rate of interest of certificate of claim. Each certificate of claim shall provide that there shall... rate of 3 percent per annum. Mutual Mortgage Insurance Fund and Distributive Shares ...

20 CFR 429.205 - What is not allowable under this subpart?

Code of Federal Regulations, 2014 CFR

2014-04-01

... FEDERAL TORT CLAIMS ACT AND RELATED STATUTES Claims Under the Military Personnel and Civilian Employees... time you spent in its preparation or for supposed literary value. (g) Incidental expenses and..., inconvenience, time spent in preparation of claim, or cost of insurance premiums) are not compensable. (h) Real...

20 CFR 429.205 - What is not allowable under this subpart?

Code of Federal Regulations, 2013 CFR

2013-04-01

... FEDERAL TORT CLAIMS ACT AND RELATED STATUTES Claims Under the Military Personnel and Civilian Employees... time you spent in its preparation or for supposed literary value. (g) Incidental expenses and..., inconvenience, time spent in preparation of claim, or cost of insurance premiums) are not compensable. (h) Real...

20 CFR 429.205 - What is not allowable under this subpart?

Code of Federal Regulations, 2011 CFR

2011-04-01

... FEDERAL TORT CLAIMS ACT AND RELATED STATUTES Claims Under the Military Personnel and Civilian Employees... time you spent in its preparation or for supposed literary value. (g) Incidental expenses and..., inconvenience, time spent in preparation of claim, or cost of insurance premiums) are not compensable. (h) Real...

20 CFR 429.205 - What is not allowable under this subpart?

Code of Federal Regulations, 2012 CFR

2012-04-01

... FEDERAL TORT CLAIMS ACT AND RELATED STATUTES Claims Under the Military Personnel and Civilian Employees... time you spent in its preparation or for supposed literary value. (g) Incidental expenses and..., inconvenience, time spent in preparation of claim, or cost of insurance premiums) are not compensable. (h) Real...

24 CFR 201.63 - Claims against lenders.

Code of Federal Regulations, 2010 CFR

2010-04-01

... TITLE I PROPERTY IMPROVEMENT AND MANUFACTURED HOME LOANS Debts Owed to the United States Under Title I § 201.63 Claims against lenders. Claims against lenders for money owed to the Department, including unpaid insurance charges and unpaid repurchase demands, shall be collected in accordance with 24 CFR part...

Cost of a lymphedema treatment mandate-10 years of experience in the Commonwealth of Virginia.

PubMed

Weiss, Robert

2016-12-01

Treatment of chronic illness accounts for over 90 % of Medicare spending. Chronic lymphedema places over 3 million Americans at risk of recurrent cellulitis. Health insurers and legislators have taken an active role in fighting attempts to mandate the treatment of lymphedema for fear that provision of the physical therapy and compression materials would result in large and uncontrollable claim costs. The author knows of no open source of lymphedema treatment cost data based on population coverage or claims. Published studies compare cost of treatment versus cost of non-treatment for a select group of lymphedema patients. They do not provide the data necessary for insurance underwriters' estimations of expected claim costs for a larger general population with a range of severities, or for legislators' evaluations of the costs of proposed mandates to cover treatment of lymphedema according to current medical standards. These data are of interest to providers, advocates and legislators in Canada, Australia and England as well as the U.S.The Commonwealth of Virginia has had a lymphedema treatment mandate since 2004. Reported data for 2004-2013, representing 80 % of the Virginia healthcare insurance market, contains claims and utilization data and claims-based estimates of the premium impact of its lymphedema mandate. The average actual annual lymphedema claim cost was $1.59 per individual contract and $3.24 per group contract for the years reported, representing 0.053 and 0.089 % of average total claims. The estimated premium impact ranged 0.00-0.64 % of total average premium for all mandated coverage contracts. In this study actual costs are compared with pre-mandate state mandate commission estimates for proposed lymphedema mandates from Virginia, Massachusetts and California.Ten years of insurance experience with a lymphedema treatment mandate in Virginia shows that costs of lymphedema treatment are an insignificant part of insured healthcare costs, and that treatment of lymphedema may reduce costs of office visits and hospitalizations due to lymphedema and lymphedema-related cellulitis. Estimates based on more limited data overestimate these costs. Lymphedema treatment is a potent tool for reduction in healthcare costs while improving the quality of care for cancer survivors and others suffering with this chronic progressive condition.

24 CFR 251.3 - Case-by-case conversion to full insurance.

Code of Federal Regulations, 2010 CFR

2010-04-01

... AUTHORITIES COINSURANCE FOR THE CONSTRUCTION OR SUBSTANTIAL REHABILITATION OF MULTIFAMILY HOUSING PROJECTS... written notice under 24 CFR 207.258 of its intent to file an insurance claim upon the Commissioner's...

24 CFR 251.3 - Case-by-case conversion to full insurance.

Code of Federal Regulations, 2012 CFR

2012-04-01

... AUTHORITIES COINSURANCE FOR THE CONSTRUCTION OR SUBSTANTIAL REHABILITATION OF MULTIFAMILY HOUSING PROJECTS... written notice under 24 CFR 207.258 of its intent to file an insurance claim upon the Commissioner's...

24 CFR 251.3 - Case-by-case conversion to full insurance.

Code of Federal Regulations, 2014 CFR

2014-04-01

... AUTHORITIES COINSURANCE FOR THE CONSTRUCTION OR SUBSTANTIAL REHABILITATION OF MULTIFAMILY HOUSING PROJECTS... written notice under 24 CFR 207.258 of its intent to file an insurance claim upon the Commissioner's...

Supreme Court says suit against insurer can continue.

PubMed

1996-04-05

The Oregon Supreme Court is allowing the estate of [name removed], a restaurant worker, to seek damages against an insurance company that refused to cover his employer when it was determined that [name removed] had Pneumocystis carinii pneumonia, an AIDS-defining condition. [Name removed]'s lawsuit charges that the PAAC Health Plan Inc. denied the application for insurance filed by employer [name removed] [name removed] of the Old Wives' Tales Restaurant. [Name removed] sued PAAC, [name removed], and the insurance broker. Before [name removed]'s death in August 1993, an appeals court voted 2-1 to affirm a trial judge's decision to dismiss claims against the broker, but reversed an order granting summary judgment to PAAC. State Supreme Court Justice Wallace P. Carson, Jr., heard PAAC's appeal and ruled that [name removed]'s estate could proceed with claims against PAAC.

Moral Hazard: How The National Flood Insurance Program Is Limiting Risk Reduction

DTIC Science & Technology

2016-12-01

Management and Budget, Paperwork Reduction Project (0704-0188) Washington DC 20503. 1. AGENCY USE ONLY (Leave blank) 2. REPORT DATE December...assessment, floodplain management , and flood insurance. A study of the NFIP concludes that aspects of the program limit risk reduction...floodplain management , risk assessment, disaster recovery, flood insurance claim, pre-flood insurance rate map 15. NUMBER OF PAGES 123 16. PRICE CODE

A Comparative Analysis of the Financial Incentives of Two Distinct Experience-Rating Programs.

PubMed

Tompa, Emile; McLeod, Chris; Mustard, Cam

2016-07-01

The aim of this study was to compare the association between insurance premium incentives and claim outcomes in two different workers' compensation programs. Regression models were run for claim outcomes using data from two Canadian jurisdictions with different experience-rating programs-one with prospective (British Columbia) and another with retrospective (Ontario) adjustment of premiums. Key explanatory variables were past premium adjustments. For both programs, past premium adjustments were significantly associated with claim outcomes, suggesting adjustments provided incentives for claims reduction. The magnitudes of effects in the prospective program were smaller than the retrospective one, though relative persistence of effects over time was larger. Having large and immediate employer responses to incentives may appear desirable, but insurers should consider the time required for employers to improve and sustain good practices, and create incentives that parallel such time lines.

Medical malpractice in endourology: analysis of closed cases from the State of New York.

PubMed

Duty, Brian; Okhunov, Zhamshid; Okeke, Zeph; Smith, Arthur

2012-02-01

Medical malpractice indemnity payments continue to rise, resulting in increased insurance premiums. We reviewed closed malpractice claims pertaining to endourological procedures with the goal of helping urologists mitigate their risk of lawsuit. All closed malpractice claims from 2005 to 2010 pertaining to endourological procedures filed against urologists insured by the Medical Liability Mutual Insurance Company of New York were examined. Claims were reviewed for plaintiff demographics, medical history, operative details, alleged complication, clinical outcome and lawsuit disposition. A total of 25 closed claims involved endourological operations and of these cases 10 were closed with an indemnity payment. The average payout was $346,722 (range $25,000 to $995,000). Of the plaintiffs 16 were women and mean plaintiff age was 51.4 years. Cystoscopy with ureteral stent placement/exchange resulted in 13 lawsuits, ureteroscopic lithotripsy 8, percutaneous stone extraction 2 and shock wave lithotripsy 2. There were 17 malpractice suits brought for alleged operative complications. Failure to arrange adequate followup was implicated in 4 cases. Error in diagnosis and delay in treatment was alleged in 3 claims. Urologists are not immune to the current medical malpractice crisis. Endourology and urological oncology generate the greatest number of lawsuits against urologists. Most malpractice claims involving endourological procedures result from urolithiasis and alleged technical errors. Therefore, careful attention to surgical technique is essential during stone procedures to reduce the risk of malpractice litigation. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

75 FR 21021 - Notice of Proposed Information Collection: Comment Request; Mortgage Insurance Termination...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-22

... mortgage insurance is terminated and no claim for insurance benefits will be filed. This information is... proposed information collection requirement described below will be submitted to the Office of Management... information will have practical utility; (2) evaluate the accuracy of the agency's estimate of the burden of...

Questions to Ask Your Liability Insurance Broker

ERIC Educational Resources Information Center

Neugebauer, Roger

2006-01-01

This paper discusses some important questions to ask an insurance broker regarding liability insurance. The author based these questions on his interviews with Kathryn Hammerback, Craig Hammer, and Mike North: (1) Are centers covered when...?; (2) How can a center director cut costs on this policy?; (3) Is this an "occurrence" or a "claims-made"…

School Property Insurance: Experiences at State Level. Bulletin, 1956, No. 7

ERIC Educational Resources Information Center

Viles, N. E., Sr.

1956-01-01

School insurance programs often present major problems in school administration. School insurance of various types is one means of preventing or limiting financial loss from property damage or the claims of individuals for injury or damage payments. In varying degrees the States have delegated to certain local administrative school units and/or…

24 CFR 241.865 - Election by the lender.

Code of Federal Regulations, 2010 CFR

2010-04-01

... insurance benefits or may exercise its rights under the note and security instrument in lieu of making a claim for insurance benefits. If the lender elects the latter course, the Commissioner shall be so...

Professional dental and oral surgery liability in Italy: a comparative analysis of the insurance products offered to health workers.

PubMed

Di Lorenzo, Pierpaolo; Paternoster, Mariano; Nugnes, Mariarosaria; Pantaleo, Giuseppe; Graziano, Vincenzo; Niola, Massimo

2016-01-01

In Italy there has been an increase in claims for damages for alleged medical malpractice. A study was therefore conducted that aimed at assessing the content of the coverage of insurance policy contracts offered to oral health professionals by the insurance market. The sample analysed composed of 11 insurance policy contracts for professional dental liability offered from 2010 to 2015 by leading insurance companies operating in the Italian market. The insurance products analysed are structured on the "claims made" clause. No policy contract examined covers the damage due to the failure to acquire consent for dental treatment and, in most cases, damage due to unsatisfactory outcomes of treatment of an aesthetic nature and the failure to respect regulatory obligations on privacy. On entering into a professional liability insurance policy contract, the dentist should pay particular attention to the period covered by the guarantee, the risks both covered and excluded, as well as the extent of the limit of liability and any possible fixed/percentage excess. When choosing a professional liability contract, a dentist should examine the risks in relation to the professional activity carried out before signing.

Reduction of catastrophic health care expenditures by a community-based health insurance scheme in Gujarat, India: current experiences and challenges.

PubMed Central

Ranson, Michael Kent

2002-01-01

OBJECTIVE: To assess the Self Employed Women's Association's Medical Insurance Fund in Gujarat in terms of insurance coverage according to income groups, protection of claimants from costs of hospitalization, time between discharge and reimbursement, and frequency of use. METHODS: One thousand nine hundred and thirty claims submitted over six years were analysed. FINDINGS: Two hundred and fifteen (11%) of 1927 claims were rejected. The mean household income of claimants was significantly lower than that of the general population. The percentage of households below the poverty line was similar for claimants and the general population. One thousand seven hundred and twelve (1712) claims were reimbursed: 805 (47%) fully and 907 (53%) at a mean reimbursement rate of 55.6%. Reimbursement more than halved the percentage of catastrophic hospitalizations (>10% of annual household income) and hospitalizations resulting in impoverishment. The average time between discharge and reimbursement was four months. The frequency of submission of claims was low (18.0/1000 members per year: 22-37% of the estimated frequency of hospitalization). CONCLUSIONS: The findings have implications for community-based health insurance schemes in India and elsewhere. Such schemes can protect poor households against the uncertain risk of medical expenses. They can be implemented in areas where institutional capacity is too weak to organize nationwide risk-pooling. Such schemes can cover poor people, including people and households below the poverty line. A trade off exists between maintaining the scheme's financial viability and protecting members against catastrophic expenditures. To facilitate reimbursement, administration, particularly processing of claims, should happen near claimants. Fine-tuning the design of a scheme is an ongoing process - a system of monitoring and evaluation is vital. PMID:12219151

Reduction of catastrophic health care expenditures by a community-based health insurance scheme in Gujarat, India: current experiences and challenges.

PubMed

Ranson, Michael Kent

2002-01-01

To assess the Self Employed Women's Association's Medical Insurance Fund in Gujarat in terms of insurance coverage according to income groups, protection of claimants from costs of hospitalization, time between discharge and reimbursement, and frequency of use. One thousand nine hundred and thirty claims submitted over six years were analysed. Two hundred and fifteen (11%) of 1927 claims were rejected. The mean household income of claimants was significantly lower than that of the general population. The percentage of households below the poverty line was similar for claimants and the general population. One thousand seven hundred and twelve (1712) claims were reimbursed: 805 (47%) fully and 907 (53%) at a mean reimbursement rate of 55.6%. Reimbursement more than halved the percentage of catastrophic hospitalizations (>10% of annual household income) and hospitalizations resulting in impoverishment. The average time between discharge and reimbursement was four months. The frequency of submission of claims was low (18.0/1000 members per year: 22-37% of the estimated frequency of hospitalization). The findings have implications for community-based health insurance schemes in India and elsewhere. Such schemes can protect poor households against the uncertain risk of medical expenses. They can be implemented in areas where institutional capacity is too weak to organize nationwide risk-pooling. Such schemes can cover poor people, including people and households below the poverty line. A trade off exists between maintaining the scheme's financial viability and protecting members against catastrophic expenditures. To facilitate reimbursement, administration, particularly processing of claims, should happen near claimants. Fine-tuning the design of a scheme is an ongoing process - a system of monitoring and evaluation is vital.

Closed Claims Analysis of Medical Malpractice Lawsuits Involving Midwives: Lessons Learned Regarding Safe Practices and the Avoidance of Litigation.

PubMed

McCool, William F; Guidera, Mamie; Griffinger, Ellie; Sacan, Dulcy

2015-01-01

The risk of litigation remains of concern to midwives, their practice partners, employers, and malpractice insurance providers. Closed claims analysis is a method of examining risk patterns and behaviors in lawsuits, including those involving health care practices. The purpose of this investigation was to evaluate claims brought against midwives, with the intent of developing strategies to decrease the incidence of litigation. Data were collected in joint meetings with members of the American College of Nurse-Midwives (ACNM); the American Association of Birth Centers; the American International Group (AIG), a major malpractice insurer for certified nurse-midwives/certified midwives (CNMs/CMs); and Contemporary Insurance Services, an independent insurance agency that has worked with AIG to facilitate the writing of malpractice insurance policies for CNMs/CMs. The purpose of the meetings was to review 162 litigation cases that involved midwives insured by AIG and had been closed between the years 2002 and 2011. Follow-up analyses of data and reporting of results were performed by the authors, who are members of the Professional Liability Section of the ACNM Division of Standards and Practice. Findings reflected 7 major categories of liability risk ranging from the most prevalent (ie, fetal/newborn complications or death) to the least prevalent (ie, attending a vaginal birth after cesarean). Data also were examined regarding the highest amounts incurred in court decisions or pretrial settlements because they were related to types of adverse outcomes that occurred. Recommendations for improving clinical practice and avoiding litigation based on findings from the closed claims analysis include, but are not limited to, the need for thorough and accurate documentation in practice, appropriate and timely consultation and collaboration, and the presence of practitioners whose clinical skills match the level of care assessed to be necessary for each woman for whom care is offered. © 2015 by the American College of Nurse-Midwives.

20 CFR 335.4 - Filing statement of sickness and claim for sickness benefits.

Code of Federal Regulations, 2012 CFR

2012-04-01

... RAILROAD UNEMPLOYMENT INSURANCE ACT SICKNESS BENEFITS § 335.4 Filing statement of sickness and claim for... circumstances beyond the employee's control; or (4) The employee mistakenly registered for unemployment benefits... unemployment benefits were denied; or (5) Notwithstanding the foregoing, any claim that is not filed within two...

20 CFR 335.4 - Filing statement of sickness and claim for sickness benefits.

Code of Federal Regulations, 2011 CFR

2011-04-01

... RAILROAD UNEMPLOYMENT INSURANCE ACT SICKNESS BENEFITS § 335.4 Filing statement of sickness and claim for... circumstances beyond the employee's control; or (4) The employee mistakenly registered for unemployment benefits... unemployment benefits were denied; or (5) Notwithstanding the foregoing, any claim that is not filed within two...

20 CFR 335.4 - Filing statement of sickness and claim for sickness benefits.

Code of Federal Regulations, 2014 CFR

2014-04-01

... RAILROAD UNEMPLOYMENT INSURANCE ACT SICKNESS BENEFITS § 335.4 Filing statement of sickness and claim for... circumstances beyond the employee's control; or (4) The employee mistakenly registered for unemployment benefits... unemployment benefits were denied; or (5) Notwithstanding the foregoing, any claim that is not filed within two...

20 CFR 335.4 - Filing statement of sickness and claim for sickness benefits.

Code of Federal Regulations, 2013 CFR

2013-04-01

... RAILROAD UNEMPLOYMENT INSURANCE ACT SICKNESS BENEFITS § 335.4 Filing statement of sickness and claim for... circumstances beyond the employee's control; or (4) The employee mistakenly registered for unemployment benefits... unemployment benefits were denied; or (5) Notwithstanding the foregoing, any claim that is not filed within two...

30 CFR 253.61 - When is a guarantor subject to direct action for claims?

Code of Federal Regulations, 2010 CFR

2010-07-01

... INTERIOR OFFSHORE OIL SPILL FINANCIAL RESPONSIBILITY FOR OFFSHORE FACILITIES Claims for Oil-Spill Removal...) If you participate in an insurance guaranty for a COF incident (i.e., oil-spill discharge or substantial threat of the discharge of oil) that is subject to claims under this part, then your maximum...

32 CFR 842.136 - Claim payments and deposits.

Code of Federal Regulations, 2011 CFR

2011-07-01

... more than $2500: HQ AAFES, Comptroller, Insurance Branch, P.O. Box 660202, Dallas, TX 75266-0202. (2) Claims payable for $2500 or less: AAFES Operations Center (OSC-AC), 2727 LBJ Highway, Dallas TX 75266...

76 FR 50733 - Determination of Insufficient Assets To Satisfy Claims Against Financial Institution in Receivership

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-16

..., Attention: Claims Agent, 7777 Baymeadows Way West, Jacksonville, Florida 32256. SUPPLEMENTARY INFORMATION... amounts realized from the liquidation or other resolution of an insured depository institution to pay...

Putting a premium on medical staffs. A novel way to insure physician liability (and loyalty).

PubMed

Jones, T M; O'Hare, P K

1989-05-01

The physician malpractice insurance crisis is having an adverse financial impact on both hospitals and their medical staffs. Innovative hospitals are exploring ways to create insurance arrangements to cover the professional liability of their medical staffs. Hospital risk managers often have theorized that if the same insurer covered both hospitals and their staff physicians, providers and their patients would benefit. These programs--often referred to as "channeling" or "channeled programs"--use a common risk management program, common claims administration, and a common claims defense for insured hospitals and their medical staffs, reducing costs, unfavorable verdicts, and, thus, premiums. Unfortunately only a few commercial carriers now offer such a program. Some hospitals and systems have therefore turned to "captive" insurance companies to provide the benefits of a channeled program. Hospitals or systems and their medical staffs can establish a captive (i.e., a controlled insurance company designed to insure its owners and their affiliates) either offshore (typically in a tax-free jurisdiction such as the Cayman Islands, Barbados, or Bermuda) or onshore (typically in a state with facilitating legislation). The Tax Reform Act of 1986, together with the Liability Risk Retention Act of 1986, generally tips the regulatory balance in favor of onshore captives by allowing these entities to operate as risk retention groups (RRGs).

[Development of second-line occupational health services: toward an integrated network of insurers and care providers].

PubMed

Plomp, H N

2000-06-10

To describe the development of the second-line Occupational Health Services and the role of private insurance companies in it over the period 1994-1999. Descriptive cross-sectional study. Data were collected in 1999 from written documents and supplementary interviews with the five largest private providers of disability insurance, the National Insurance Institute, nine Occupational Health Services of different natures and 24 institutions for second-line occupational health service. After the privatization of the Health Law in 1996 and parts of the Law on disability Insurance, most employers covered the risk of continued payment of wages in case of disability with private insurers. These attempted to keep claims down by active engagement in arbitration, treatment and diagnostics of disabled employees so as to counteract avoidable absenteeism. Under the influence of the insurance companies, a trend developed toward integrated nation-wide chains in which the services provided by insurers, by occupational health services and by implementing institutions are geared for one another. Commercial provision of Occupational Health Service is a new, demand-active form of care provision in which the financier plays a key part. This provision of services supplied important innovating impulses for health care in its entirety because of its large scale, strong protocolling of processes and management on the basis of continuous cost-benefit analyses. A lucid and socially acceptable regulation of commercial providers of occupational health services was lacking.

Medical insurance claims and surveillance for occupational disease: analysis of respiratory, cardiac, and cancer outcomes in auto industry tool grinding operations.

PubMed

Park, R M

2001-04-01

To evaluate medical insurance claims for chronic disease investigation, claims from eight automotive machining plants (1984 to 1993) were linked with work histories (1967 to 1993), and associations with respiratory, cardiac, and cancer conditions were investigated, in a case-control design analyzed with logistic regression. The primary focus was tool grinding, but other important processes examined were metal-working, welding, forging, heat treat, engine testing, and diverse-skilled trades work. Considerable variability in claim-derived incidence rates across plants was not explained by age or known exposure differences. Asthma incidence increased in tool grinding (at mean cumulative duration: odds ratio [OR], 3.0; 95% confidence interval [CI], 0.90 to 10.0), as did non-ischemic heart disease (cardiomyopathy, cor pulmonale, rheumatic heart disease, or hypertension; OR, 3.1; 95% CI, 1.26 to 7.6). These trends appeared in models with deficits (OR < 1.0) for those ever exposed to tool grinding because of exposure-response miss-specification, demographic confounding, or removal of high-risk workers from the exposed group. The apparent cancer rates identified from claims greatly exceeded the expected rates from a cancer registry, suggesting that diagnostic, "rule-out," and surveillance functions were contributing. This study supports the epidemiologic use of medical insurance records in surveillance and, possibly, etiologic investigation and identifies issues requiring special attention or resolution.

How health care reform can lower the costs of insurance administration.

PubMed

Collins, Sara R; Nuzum, Rachel; Rustgi, Sheila D; Mika, Stephanie; Schoen, Cathy; Davis, Karen

2009-07-01

The United States leads all industrialized countries in the share of national health care expenditures devoted to insurance administration. The U.S. share is over 30 percent greater than Germany's and more than three times that of Japan. This issue brief examines the sources of administrative costs and describes how a private-public approach to health care reform--with the central feature of a national insurance exchange (largely replacing the present individual and small-group markets)--could substantially lower such costs. In three variations on that approach, estimated administrative costs would fall from 12.7 percent of claims to an average of 9.4 percent. Savings--as much as $265 billion over 2010-2020--would be realized through less marketing and underwriting, reduced costs of claims administration, less time spent negotiating provider payment rates, and fewer or standardized commissions to insurance brokers.

Claims, errors, and compensation payments in medical malpractice litigation.

PubMed

Studdert, David M; Mello, Michelle M; Gawande, Atul A; Gandhi, Tejal K; Kachalia, Allen; Yoon, Catherine; Puopolo, Ann Louise; Brennan, Troyen A

2006-05-11

In the current debate over tort reform, critics of the medical malpractice system charge that frivolous litigation--claims that lack evidence of injury, substandard care, or both--is common and costly. Trained physicians reviewed a random sample of 1452 closed malpractice claims from five liability insurers to determine whether a medical injury had occurred and, if so, whether it was due to medical error. We analyzed the prevalence, characteristics, litigation outcomes, and costs of claims that lacked evidence of error. For 3 percent of the claims, there were no verifiable medical injuries, and 37 percent did not involve errors. Most of the claims that were not associated with errors (370 of 515 [72 percent]) or injuries (31 of 37 [84 percent]) did not result in compensation; most that involved injuries due to error did (653 of 889 [73 percent]). Payment of claims not involving errors occurred less frequently than did the converse form of inaccuracy--nonpayment of claims associated with errors. When claims not involving errors were compensated, payments were significantly lower on average than were payments for claims involving errors (313,205 dollars vs. 521,560 dollars, P=0.004). Overall, claims not involving errors accounted for 13 to 16 percent of the system's total monetary costs. For every dollar spent on compensation, 54 cents went to administrative expenses (including those involving lawyers, experts, and courts). Claims involving errors accounted for 78 percent of total administrative costs. Claims that lack evidence of error are not uncommon, but most are denied compensation. The vast majority of expenditures go toward litigation over errors and payment of them. The overhead costs of malpractice litigation are exorbitant. Copyright 2006 Massachusetts Medical Society.

Developing alternative methods for determining the incidence, prevalence, and cost burden of coronary heart disease in a corporate population.

PubMed

Beckowski, Meghan Short; Goyal, Abhinav; Goetzel, Ron Z; Rinehart, Christine L; Darling, Kathryn J; Yarborough, Charles M

2012-08-01

To determine the most appropriate methods for estimating the prevalence and incidence of coronary heart disease (CHD), the associated risk factors, and health care costs in a corporate setting. Using medical insurance claims data for the period of 2005-2009 from 18 companies in the Thomson Reuters MarketScan reg database, we evaluated three alternative methods. Prevalence of CHD ranged from 2.1% to 4.0% using a method requiring a second confirmatory claim. Annual incidence of CHD ranged from 1.0% to 1.6% using a method requiring 320 days of benefits enrollment in the previous year, and one claim for a diagnosis of CHD. Alternative methods for determining the epidemiologic and cost burden of CHD using insurance claims data were explored. These methods can inform organizations that want to quantify the health and cost burden of various diseases common among an employed population.

Malpractice risk prevention for primary care physicians.

PubMed

Blackston, Joseph W; Bouldin, Marshall J; Brown, C Andrew; Duddleston, David N; Hicks, G Swink; Holman, Honey E

2002-10-01

The recent medical malpractice "crisis" has seen skyrocketing liability premiums and increasing fear of liability. Primary care physicians, especially family medicine and internal medicine physicians, have historically experienced low rates of malpractice claims, both in number and amount of payment. This can be attributed to several factors: the esteem held by internal medicine and family medicine physicians in their communities, relatively low numbers of invasive procedures, reluctance of patients to include "their" primary care physician in any potential litigation, and, probably most importantly, the atmosphere of mutual trust and communication between the internist or family physician and the patient. Recent years have seen this trend erased, as insurance industry data suggest primary care physicians presently face significant potential exposure for medical malpractice claims. It is imperative that primary care physicians take steps to insure they are adequately covered in case of a malpractice claim and that they practice aggressive but appropriate risk management to lessen the likelihood of a claim.

Methodology to improve process understanding of surface runoff causing damages to buildings by analyzing insurance data records

NASA Astrophysics Data System (ADS)

Bernet, Daniel; Prasuhn, Volker; Weingartner, Rolf

2015-04-01

Several case studies in Switzerland highlight that many buildings which are damaged by floods are not located within the inundation zones of rivers, but outside the river network. In urban areas, such flooding can be caused by drainage system surcharge, low infiltration capacity of the urbanized landscape etc. However, in rural and peri-urban areas inundations are more likely caused by surface runoff formed on natural and arable land. Such flash floods have very short response time, occur rather diffusely and, thus, are very difficult to observe directly. In our approach, we use data records from private, but mostly from public insurance companies. The latter, present in 19 out of the total 26 Cantons of Switzerland, insure (almost) every building within the respective administrative zones and, in addition, hold a monopoly position. Damage claims, including flood damages, are usually recorded and, thus, data records from such public insurance companies are a very profitable data source to better understand surface runoff leading to damages. Although practitioners agree that this process is relevant, there seems to be a knowledge gap concerning spatial and temporal distributions as well as triggers and influencing factors of such damage events. Within the framework of a research project, we want to address this research gap and improve the understanding of the process chain from surface runoff formation up to possible damages to buildings. This poster introduces the methodology, which will be applied to a dataset including data from the majority of all 19 public insurance companies for buildings in Switzerland, counting over 50'000 damage claims, in order to better understand surface runoff. The goal is to infer spatial and temporal patterns as well as drivers and influencing factors of surface runoff possibly causing damages. In particular, the workflow of data acquisition, harmonization and treatment is outlined. Furthermore associated problems and challenges are discussed. Ultimately, the improved process understanding will be used to develop a new modeling approach.

[The essentials of workplace analysis for examining occupational disability claims].

PubMed

Wachholz, St

2015-12-01

The insurance branch that covers the risk of occupational disability ranks among the most important private entities for offering security as far as the limitation or loss of one's ability to work is concerned. The financial risk of the insurer, the existential concerns and expectations of the claimant, as well as the legal framework and the need for a careful interdisciplinary evaluation, necessitate a professional review and assessment of the facts conducted with a sense of both responsibility and sensitivity. Carefully deliberated and sustainable decisions benefit both insurers and the insured. In order to achieve this, an opinion is required in many--and especially the more complex--cases from an external medical expert, which in turn can only be plausible and conclusive when based on a comprehensive review of the claimant's working environment and its particular (and often unique) requirements. This article is intended to increase the reader's understanding of the coherencies of workplace analysis and medical assessments, as required by insurance law and legislation. In addition, the article delivers valuable clues and guidance, both for medical experts and claims managers at insurance companies. Primarily, the claimant's occupation, as conceived in the terms and conditions of the insurance companies, is explained. The reader is then introduced to the various criteria to be considered when a claimant has several jobs at the same time, is self-employed, could be transferred to another job, is simply unable to commute to the workplace, or is prevented from working due to legal restrictions related to an illness. The article goes on to address the crucial aspect of how the degree of disability is to be measured under different circumstances, namely using the quantitative and the qualitative approach. As a reliable method for obtaining the essential data regarding the claimant's specific working conditions, which are required by both the medical expert and the insurance company's claims manager, the reader is provided with an insider's insights into on-site workplace analysis. The value of this pragmatic and proven method is subsequently demonstrated when the article addresses the often decisive part of the medical expert's assessment. In its conclusion the article points out the importance of workplace analysis to the entire process of evaluating occupational disability claims and the effort and monies to be saved by attaching value to thorough workplace analysis at an early stage.

Nonlife Insurance Pricing:

NASA Astrophysics Data System (ADS)

Darooneh, Amir H.

We consider the insurance company as a physical system which is immersed in its environment (the financial market). The insurer company interacts with the market by exchanging the money through the payments for loss claims and receiving the premium. Here, in the equilibrium state, we obtain the premium by using the canonical ensemble theory, and compare it with the Esscher principle, the well-known formula in actuary for premium calculation. We simulate the case of car insurance for quantitative comparison.

Using Self-reports or Claims to Assess Disease Prevalence: It's Complicated.

PubMed

St Clair, Patricia; Gaudette, Étienne; Zhao, Henu; Tysinger, Bryan; Seyedin, Roxanna; Goldman, Dana P

2017-08-01

Two common ways of measuring disease prevalence include: (1) using self-reported disease diagnosis from survey responses; and (2) using disease-specific diagnosis codes found in administrative data. Because they do not suffer from self-report biases, claims are often assumed to be more objective. However, it is not clear that claims always produce better prevalence estimates. Conduct an assessment of discrepancies between self-report and claims-based measures for 2 diseases in the US elderly to investigate definition, selection, and measurement error issues which may help explain divergence between claims and self-report estimates of prevalence. Self-reported data from 3 sources are included: the Health and Retirement Study, the Medicare Current Beneficiary Survey, and the National Health and Nutrition Examination Survey. Claims-based disease measurements are provided from Medicare claims linked to Health and Retirement Study and Medicare Current Beneficiary Survey participants, comprehensive claims data from a 20% random sample of Medicare enrollees, and private health insurance claims from Humana Inc. Prevalence of diagnosed disease in the US elderly are computed and compared across sources. Two medical conditions are considered: diabetes and heart attack. Comparisons of diagnosed diabetes and heart attack prevalence show similar trends by source, but claims differ from self-reports with regard to levels. Selection into insurance plans, disease definitions, and the reference period used by algorithms are identified as sources contributing to differences. Claims and self-reports both have strengths and weaknesses, which researchers need to consider when interpreting estimates of prevalence from these 2 sources.

7 CFR 1499.10 - Claims for damage to or loss of commodities.

Code of Federal Regulations, 2010 CFR

2010-01-01

....10 Claims for damage to or loss of commodities. (a) FAS will be responsible for claims arising out of... collections pursuant to commercial insurance contracts; and (2) Notifying FAS immediately and providing... § 1499.9(e)(1). (e) If FAS determines that a participant is not exercising due diligence in the pursuit...

7 CFR 1499.10 - Claims for damage to or loss of commodities.

Code of Federal Regulations, 2011 CFR

2011-01-01

....10 Claims for damage to or loss of commodities. (a) FAS will be responsible for claims arising out of... collections pursuant to commercial insurance contracts; and (2) Notifying FAS immediately and providing... § 1499.9(e)(1). (e) If FAS determines that a participant is not exercising due diligence in the pursuit...

41 CFR 102-72.69 - What additional terms and conditions apply to an Executive agencies' delegation of ancillary...

Code of Federal Regulations, 2012 CFR

2012-01-01

... liability and property damage insurance policies to cover claims arising from or relating to the contractor... liability, either directly or indirectly, for any contractual claims or disputes that arise out of or relate to the performance of ancillary repair and alteration work, except to the extent such claim or...

30 CFR 553.61 - When is a guarantor subject to direct action for claims?

Code of Federal Regulations, 2012 CFR

2012-07-01

... THE INTERIOR OFFSHORE OIL SPILL FINANCIAL RESPONSIBILITY FOR OFFSHORE FACILITIES Claims for Oil-Spill... 7 or 11. (b) If you participate in an insurance guaranty for a COF incident (i.e., oil-spill discharge or substantial threat of the discharge of oil) that is subject to claims under this part, then...

30 CFR 553.61 - When is a guarantor subject to direct action for claims?

Code of Federal Regulations, 2013 CFR

2013-07-01

... THE INTERIOR OFFSHORE OIL SPILL FINANCIAL RESPONSIBILITY FOR OFFSHORE FACILITIES Claims for Oil-Spill... 7 or 11. (b) If you participate in an insurance guaranty for a COF incident (i.e., oil-spill discharge or substantial threat of the discharge of oil) that is subject to claims under this part, then...

30 CFR 553.61 - When is a guarantor subject to direct action for claims?

Code of Federal Regulations, 2014 CFR

2014-07-01

... THE INTERIOR OFFSHORE OIL SPILL FINANCIAL RESPONSIBILITY FOR OFFSHORE FACILITIES Claims for Oil-Spill... 7 or 11. (b) If you participate in an insurance guaranty for a COF incident (i.e., oil-spill discharge or substantial threat of the discharge of oil) that is subject to claims under this part, then...

Deep venous thrombosis associated with corporate air travel.

PubMed

Dimberg, L A; Mundt, K A; Sulsky, S I; Liese, B H

2001-01-01

Deep venous thrombosis (DVT) is commonly seen among bedridden and postoperative patients. Its association with travel may also make DVT an occupational health risk to otherwise healthy business travelers. We estimated the incidence of and risk factors for DVT among 8,189 World Bank employees and a subset of 4,951 international business travelers. Occurrence of DVT between 1995 and 1998 was determined using 1) medical insurance claims; 2) Workers' Compensation claims; and 3) intra-office E-mail solicitation followed by interview. For each insurance claim case, 10 controls were randomly selected from among World Bank employees insured during the same month and year as the case's claim was filed, and case-control analyses were performed to identify potential predictors or risk factors for DVT. Thirty individuals filed claims for DVT of the legs (annual incidence rate: 0.9 per 1,000 employees); three of these claims were filed within 30 days after a travel mission. Two employees reported DVT as a Workers' Compensation injury, and five staff with verified DVT participated in interviews. After controlling for age and gender, no association with any travel-related covariate was seen. Results of analyses considering all thrombophlebitis and thromboembolism followed the same pattern. The average annual incidence of DVT occurring within 30 days of mission among traveling staff ranged from 0.10 per 1,000 to 0.25 per 1,000 travelers, depending on the case-finding method. No association between DVT and travel was observed after adjustment for gender and age. These results, however, are preliminary, and due to the rarity of DVT, based on small numbers.

76 FR 37207 - Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-24

...This document contains amendments to interim final regulations implementing the requirements regarding internal claims and appeals and external review processes for group health plans and health insurance coverage in the group and individual markets under provisions of the Affordable Care Act. These rules are intended to respond to feedback from a wide range of stakeholders on the interim final regulations and to assist plans and issuers in coming into full compliance with the law through an orderly and expeditious implementation process.

Temporal trend in the use of hysteroscopic vs laparoscopic sterilization and the characteristics of commercially insured and Medicaid-insured females in the US who have had the procedures

PubMed Central

Carney, Patricia I; Lin, Jay; Xia, Fang; Law, Amy

2016-01-01

Purpose Limited research has examined the factors associated with female permanent contraception procedures. This study evaluated the temporal trend in the use of hysteroscopic sterilization (HS) vs laparoscopic sterilization (LS) and characteristics of commercially insured and Medicaid-insured women in the US who have had the procedures. Methods Women aged 15–49 years with claims for HS and LS procedures were identified from two MarketScan databases, one consisting of commercial claims and the other Medicaid claims, during the time period of January 1, 2003 to December 31, 2012 and January 1, 2006 to December 31, 2011, respectively. Proportions and characteristics of women who underwent HS or LS procedures were determined. Multivariable logistic regressions were used to identify characteristics associated with the use of HS vs LS. Results Commercially insured women who had HS (n=32,012) vs LS (n=64,725) were slightly older (37.2 years vs 36.4 years, respectively, P<0.001) but had similar Charlson Comorbidity Index scores. Among commercially insured women, those who had a sterilization procedure during 2008–2012 were more likely to undergo HS (odds ratio: 7.1, P<0.001) than those who had a sterilization procedure during 2003–2007. Medicaid-insured women who had HS (n=2,001) were also slightly older than women who had LS (n=12,523; 30.1 years vs 28.8 years, respectively, P<0.001) but had a higher mean Charlson Comorbidity Index score (0.32 vs 0.25, respectively, P<0.001). Among Medicaid-insured women, the likelihood of having HS vs LS increased 3.3-fold (P<0.001) in years 2009–2011 compared to years 2006–2008. Among both populations, older age, obesity, and the use of oral contraceptives within the previous 12 months were associated with having HS vs LS. Conclusion Among both commercially insured and Medicaid-insured women, the likelihood of having HS vs LS increased over time. PMID:27257393

5 CFR 831.106 - Disclosure of information.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., health benefits and life insurance eligibility, medical records supporting disability claims, and designations of beneficiaries. (iv) Claims review and correspondence files pertaining to benefits under the Federal Employees Health Benefits Program. (v) Suitability determination files on applicants for Federal...

5 CFR 841.108 - Disclosure of information.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the retirement application, health benefits and life insurance eligibility, medical records supporting... to benefits under the Federal Employees Health Benefits Program. (v) Documentation of claims made for life insurance and health benefits by annuitants under a Federal Government retirement system other...

33 CFR 136.111 - Insurance.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Insurance. 136.111 Section 136.111 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL RESPONSIBILITY AND COMPENSATION OIL SPILL LIABILITY TRUST FUND; CLAIMS PROCEDURES...

33 CFR 136.111 - Insurance.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Insurance. 136.111 Section 136.111 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL RESPONSIBILITY AND COMPENSATION OIL SPILL LIABILITY TRUST FUND; CLAIMS PROCEDURES...

33 CFR 136.111 - Insurance.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Insurance. 136.111 Section 136.111 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL RESPONSIBILITY AND COMPENSATION OIL SPILL LIABILITY TRUST FUND; CLAIMS PROCEDURES...

33 CFR 136.111 - Insurance.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false Insurance. 136.111 Section 136.111 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL RESPONSIBILITY AND COMPENSATION OIL SPILL LIABILITY TRUST FUND; CLAIMS PROCEDURES...

33 CFR 136.111 - Insurance.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Insurance. 136.111 Section 136.111 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL RESPONSIBILITY AND COMPENSATION OIL SPILL LIABILITY TRUST FUND; CLAIMS PROCEDURES...

76 FR 8742 - Proposed Information Collection Activity; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-15

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Proposed... the Social Security Act (the Act) to authorize the Secretary, through the Federal Parent Locator... with information maintained by insurers (or their agents) concerning insurance claims, settlements...

20 CFR 321.1 - Filing applications electronically.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Section 321.1 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT ELECTRONIC FILING OF APPLICATIONS AND CLAIMS FOR BENEFITS UNDER THE RAILROAD UNEMPLOYMENT... under the Railroad Unemployment Insurance Act may be filed electronically through the Board's Internet...

20 CFR 321.1 - Filing applications electronically.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Section 321.1 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT ELECTRONIC FILING OF APPLICATIONS AND CLAIMS FOR BENEFITS UNDER THE RAILROAD UNEMPLOYMENT... under the Railroad Unemployment Insurance Act may be filed electronically through the Board's Internet...

20 CFR 321.1 - Filing applications electronically.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Section 321.1 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT ELECTRONIC FILING OF APPLICATIONS AND CLAIMS FOR BENEFITS UNDER THE RAILROAD UNEMPLOYMENT... under the Railroad Unemployment Insurance Act may be filed electronically through the Board's Internet...

20 CFR 321.1 - Filing applications electronically.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Section 321.1 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT ELECTRONIC FILING OF APPLICATIONS AND CLAIMS FOR BENEFITS UNDER THE RAILROAD UNEMPLOYMENT... under the Railroad Unemployment Insurance Act may be filed electronically through the Board's Internet...

20 CFR 321.1 - Filing applications electronically.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Section 321.1 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT ELECTRONIC FILING OF APPLICATIONS AND CLAIMS FOR BENEFITS UNDER THE RAILROAD UNEMPLOYMENT... under the Railroad Unemployment Insurance Act may be filed electronically through the Board's Internet...

Professional dental and oral surgery liability in Italy: a comparative analysis of the insurance products offered to health workers

PubMed Central

Paternoster, Mariano; Nugnes, Mariarosaria; Pantaleo, Giuseppe; Graziano, Vincenzo; Niola, Massimo

2016-01-01

Abstract Introduction In Italy there has been an increase in claims for damages for alleged medical malpractice. A study was therefore conducted that aimed at assessing the content of the coverage of insurance policy contracts offered to oral health professionals by the insurance market. Material and methods The sample analysed composed of 11 insurance policy contracts for professional dental liability offered from 2010 to 2015 by leading insurance companies operating in the Italian market. Results The insurance products analysed are structured on the “claims made” clause. No policy contract examined covers the damage due to the failure to acquire consent for dental treatment and, in most cases, damage due to unsatisfactory outcomes of treatment of an aesthetic nature and the failure to respect regulatory obligations on privacy. Discussion On entering into a professional liability insurance policy contract, the dentist should pay particular attention to the period covered by the guarantee, the risks both covered and excluded, as well as the extent of the limit of liability and any possible fixed/percentage excess. Conclusions When choosing a professional liability contract, a dentist should examine the risks in relation to the professional activity carried out before signing. PMID:28352805

Attitudes towards evaluation of psychiatric disability claims: a survey of Swiss stakeholders.

PubMed

Schandelmaier, Stefan; Leibold, Andrea; Fischer, Katrin; Mager, Ralph; Hoffmann-Richter, Ulrike; Bachmann, Monica Susanne; Kedzia, Sarah; Busse, Jason Walter; Guyatt, Gordon Henry; Jeger, Joerg; Marelli, Renato; De Boer, Wout Ernst Lodewijk; Kunz, Regina

2015-01-01

In Switzerland, evaluation of work capacity in individuals with mental disorders has come under criticism. We surveyed stakeholders about their concerns and expectations of the current claim process. We conducted a nationwide online survey among five stakeholder groups. We asked 37 questions addressing the claim process and the evaluation of work capacity, the maximum acceptable disagreement in judgments on work capacity, and its documentation. Response rate among 704 stakeholders (95 plaintiff lawyers, 285 treating psychiatrists, 129 expert psychiatrists evaluating work capacity, 64 social judges, 131 insurers) varied between 71% and 29%. Of the lawyers, 92% were dissatisfied with the current claim process, as were psychiatrists (73%) and experts (64%), whereas the majority of judges (72%) and insurers (81%) were satisfied. Stakeholders agreed in their concerns, such as the lack of a transparent relationship between the experts' findings and their conclusions regarding work capacity, medical evaluations inappropriately addressing legal issues, and the experts' delay in finalising the report. Findings mirror the characteristics that stakeholders consider important for an optimal work capacity evaluation. For a scenario where two experts evaluate the same claimant, stakeholders considered an inter-rater difference of 10%‒20% in work capacity at maximum acceptable. Plaintiff lawyers, treating psychiatrists and experts perceive major problems in work capacity evaluation of psychiatric claims whereas judges and insurers see the process more positively. Efforts to improve the process should include clarifying the basis on which judgments are made, restricting judgments to areas of expertise, and ensuring prompt submission of evaluations.

32 CFR 536.148 - Claims generated by the acts or omissions of NAFI employees.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 3 2010-07-01 2010-07-01 true Claims generated by the acts or omissions of NAFI employees. 536.148 Section 536.148 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY... parachute activities), the claim will be referred to the insurer as outlined in § 536.148(d). See Department...

32 CFR 536.148 - Claims generated by the acts or omissions of NAFI employees.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 3 2012-07-01 2009-07-01 true Claims generated by the acts or omissions of NAFI employees. 536.148 Section 536.148 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY... parachute activities), the claim will be referred to the insurer as outlined in § 536.148(d). See Department...

32 CFR 536.148 - Claims generated by the acts or omissions of NAFI employees.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 3 2011-07-01 2009-07-01 true Claims generated by the acts or omissions of NAFI employees. 536.148 Section 536.148 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY... parachute activities), the claim will be referred to the insurer as outlined in § 536.148(d). See Department...

32 CFR 756.3 - Notification.

Code of Federal Regulations, 2014 CFR

2014-07-01

... as flying clubs, carry private commercial insurance to protect them from claims for property damage... Composite Insurance Program, if desired: Child welfare centers, billeting funds, chapel funds, and civilian welfare funds. (c) When the operations of NAFI's result in property damage or personal injury, the...

32 CFR 756.3 - Notification.

Code of Federal Regulations, 2011 CFR

2011-07-01

... as flying clubs, carry private commercial insurance to protect them from claims for property damage... Composite Insurance Program, if desired: Child welfare centers, billeting funds, chapel funds, and civilian welfare funds. (c) When the operations of NAFI's result in property damage or personal injury, the...

32 CFR 756.3 - Notification.

Code of Federal Regulations, 2010 CFR

2010-07-01

... as flying clubs, carry private commercial insurance to protect them from claims for property damage... Composite Insurance Program, if desired: Child welfare centers, billeting funds, chapel funds, and civilian welfare funds. (c) When the operations of NAFI's result in property damage or personal injury, the...

32 CFR 756.3 - Notification.

Code of Federal Regulations, 2012 CFR

2012-07-01

... as flying clubs, carry private commercial insurance to protect them from claims for property damage... Composite Insurance Program, if desired: Child welfare centers, billeting funds, chapel funds, and civilian welfare funds. (c) When the operations of NAFI's result in property damage or personal injury, the...

32 CFR 756.3 - Notification.

Code of Federal Regulations, 2013 CFR

2013-07-01

... as flying clubs, carry private commercial insurance to protect them from claims for property damage... Composite Insurance Program, if desired: Child welfare centers, billeting funds, chapel funds, and civilian welfare funds. (c) When the operations of NAFI's result in property damage or personal injury, the...

78 FR 27248 - Notice of Proposed Information Collection; Comment Request: Application for Insurance Benefits...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-09

... Information Collection; Comment Request: Application for Insurance Benefits Multifamily Mortgage AGENCY...). FOR FURTHER INFORMATION CONTACT: Steven Trojan, Accountant, Multifamily Claims Branch, Department of... submission of responses. This Notice also lists the following information: Title of Proposal: Multifamily...

Obesity and trends in malpractice claims for physicians and surgeons.

PubMed

Weber, Cynthia E; Talbot, Lindsay J; Geller, Justin M; Kuo, Marissa C; Wai, Philip Y; Kuo, Paul C

2013-08-01

The increasing prevalence of obesity has altered the practice of medicine and surgery, with the emergence of new operations and medications. We hypothesized that the landscape of medical malpractice claims has also changed. We queried the Physician Insurers Association of American database for 1990 through 1999 and 2000 through 2009 for cases corresponding to International Classification of Diseases, 9th edition, codes for obesity. We extracted adjudicatory outcome, closed and paid claims data, indemnity payments, primary alleged error codes, National Association of Insurance Commissioners severity of injury class, procedural codes, and medical specialty data. A total of 411 obesity claims were filed from 1990 to 1999 and 1,591 obesity claims were filed from 2000 to 2009. General surgery was the specialty with the greatest number of obesity claims from 1990 to 1999 and was second to family practice for 2000 to 2009. Although the percentage of paid general surgery obesity claims has decreased significantly from 69% in 1990-1999 to 36% in 2000-2009, the mean indemnity payments have increased substantially ($94,000 to $368,000). Recently, the percentage of paid general surgery obesity claims has significantly decreased; however, individual and total indemnity payments have increased. Obesity continues to impact general surgery malpractice substantially. Efforts to manage this component of physician and hospital practices must continue. Copyright © 2013 Mosby, Inc. All rights reserved.

Healthcare Service Use and Costs for Autism Spectrum Disorder: A Comparison between Medicaid and Private Insurance

ERIC Educational Resources Information Center

Wang, Li; Mandell, David S.; Lawer, Lindsay; Cidav, Zuleyha; Leslie, Douglas L.

2013-01-01

Healthcare costs and service use for autism spectrum disorder (ASD) were compared between Medicaid and private insurance, using 2003 insurance claims data in 24 states. In terms of costs and service use per child with ASD, Medicaid had higher total healthcare costs (22,653 vs. 5,254), higher ASD-specific costs (7,438 vs. 928), higher psychotropic…

Analysis of professional malpractice claims in implant dentistry in Italy from insurance company technical reports, 2006 to 2010.

PubMed

Pinchi, Vilma; Varvara, Giuseppe; Pradella, Francesco; Focardi, Martina; Donati, Michele D; Norelli, Gianaristide

2014-01-01

The aim of the study was to analyze the characteristics of implant dentistry claims in Italy based on insurance company technical reports for malpractice claims. One hundred twenty-one technical reports of cases of professional malpractice in implant dentistry between 2006 and 2010 were included in the study. Data included the sex and age of the patient and dentist, the kind of negligence claimed, and the damages awarded as a consequence of the alleged misconduct. Of the cases examined in this study, 9.9% went to court. The patients were female in 73.6% of the cases. Most of the technical errors were committed during implant insertion (82.6%). In 50.4% of cases, the technical error involved the surrounding structures, such as damage to the inferior alveolar nerve (32.2%) or the lingual nerve (2.5%), invasion of the maxillary sinus (9.1%), or pulpal dental necrosis in adjacent teeth (6.6%). Incomplete clinical documentation was apparent in 54.5% of cases. In 9.9% of cases, a civil suit had already been filed before a visit, and medicolegal advice from the insurance expert had been procured. The discrepancy between the total number of cases examined and those that went to court indicates that implant malpractice claims in Italy are most often settled out of court. The large number of intraoperative errors seen and the high proportion of injuries to surrounding structures suggest that implant dentists would benefit from further specific training. Also, clinical documentation vital to a defense against any claims relating to professional misconduct was incomplete or absent in more than half of the cases.

Public transit risk management : a handbook for public transit executives

DOT National Transportation Integrated Search

1978-12-01

Transit is seen by insurers as a risk with high loss potential. Since people are transported in large numbers, a single accident may yield many claims. One solution to this insurance situation that has been employed by transit system operators is to ...

Trends in malpractice litigation.

PubMed Central

Holder, A. R.

1980-01-01

Physicians who make mistakes are not necessarily negligent, contrary to prevailing opinion in the medical community. The article discusses the legal concepts of "standard of care" and "proximate cause." The incidence of favorable jury verdicts in those cases in which malpractice suits are litigated is quite high. The effects of insurance company policies in decisions about settlements on the incidence of claims is discussed and alternatives are suggested. The prevailing belief that a consent form with a patient's signature on it is sufficient to prevent a malpractice suit is also discussed. PMID:7445540

Profiling primary care physicians for a new managed care network.

PubMed

Ozminkowski, R J; Noether, M; Nathanson, P; Smith, K M; Raney, B E; Mickey, D; Hawley, P M

1997-08-01

We developed methods for comparing physicians who would be selected to participate in a major employer's self-insurance program. These methods used insurance claims data to identify and profile physicians according to deviations from prevailing practice and outcome patterns, after considering differences in case-mix and severity of illness among the patients treated by those providers. The discussion notes the usefulness and limitations of claims data for this and other purposes. We also comment on policy implications and the relationships between our methods and health care reform strategies designed to influence overall health care costs.

Some pain, no gain: experiences with the no-claim rebate in the Dutch health care system.

PubMed

Holland, J; Van Exel, N J A; Schut, F T; Brouwer, W B F

2009-10-01

To contain expenditures in an increasingly demand driven health care system, in 2005 a no-claim rebate was introduced in the Dutch health insurance system. Since demand-side cost sharing is a very controversial issue, the no-claim rebate was launched as a consumer friendly bonus system to reward prudent utilization of health services. Internationally, the introduction of a mandatory no-claim rebate in a social health insurance scheme is unprecedented. Consumers were entitled to an annual rebate of 255 eruos if no claims were made. During the year, all health care expenses except for GP visits and maternity care were deducted from the rebate until the rebate became zero. In this article, we discuss the rationale of the no-claim rebate and the available evidence of its effect. Using a questionnaire in a convenience sample, we examined people's knowledge, attitudes, and sensitivity to the incentive scheme. We find that only 4% of respondents stated that they would reduce consumption because of the no-claim rebate. Respondents also indicated that they were willing to accept a high loss of rebate in order to use a medical treatment. However, during the last month of the year many respondents seemed willing to postpone consumption until the next year in order to keep the rebate of the current year intact. A small majority of respondents considered the no-claim rebate to be unfair. Finally, we briefly discuss why in 2008 the no-claim rebate was replaced by a mandatory deductible.

Characteristics of construction firms at risk for future workers' compensation claims using administrative data systems, Washington State.

PubMed

Marcum, Jennifer L; Foley, Michael; Adams, Darrin; Bonauto, Dave

2018-06-01

Construction is high-hazard industry, and continually ranks among those with the highest workers' compensation (WC) claim rates in Washington State (WA). However, not all construction firms are at equal risk. We tested the ability to identify those construction firms most at risk for future claims using only administrative WC and unemployment insurance data. We collected information on construction firms with 10-50 average full time equivalent (FTE) employees from the WA unemployment insurance and WC data systems (n=1228). Negative binomial regression was used to test the ability of firm characteristics measured during 2011-2013 to predict time-loss claim rates in the following year, 2014. Claim rates in 2014 varied by construction industry groups, ranging from 0.7 (Land Subdivision) to 4.6 (Foundation, Structure, and Building Construction) claims per 100 FTE. Construction firms with higher average WC premium rates, a history of WC claims, increasing number of quarterly FTE, and lower average wage rates during 2011-2013 were predicted to have higher WC claim rates in 2014. We demonstrate the ability to leverage administrative data to identify construction firms predicted to have future WC claims. This study should be repeated to determine if these results are applicable to other high-hazard industries. Practical Applications: This study identified characteristics that may be used to further refine targeted outreach and prevention to construction firms at risk. Published by Elsevier Ltd.

Analysis of 23 364 patient-generated, physician-reviewed malpractice claims from a non-tort, blame-free, national patient insurance system: lessons learned from Sweden.

PubMed

Pukk-Härenstam, K; Ask, J; Brommels, M; Thor, J; Penaloza, R V; Gaffney, F A

2009-02-01

In Sweden, patient malpractice claims are handled administratively and compensated if an independent physician review confirms patient injury resulting from medical error. Full access to all malpractice claims and hospital discharge data for the country provided a unique opportunity to assess the validity of patient claims as indicators of medical error and patient injury. To determine: (1) the percentage of patient malpractice claims validated by independent physician review, (2) actual malpractice claims rates (claims frequency / clinical volume) and (3) differences between Swedish and other national malpractice claims rates. DESIGN, SETTING AND MATERIAL: Swedish national malpractice claims and hospital discharge data were combined, and malpractice claims rates were determined by county, hospital, hospital department, surgical procedure, patient age and sex and compared with published studies on medical error and malpractice. From 1997 to 2004, there were 23 364 inpatient malpractice claims filed by Swedish patients treated at hospitals reporting 11 514 798 discharges. The overall claims rate, 0.20%, was stable over the period of study and was similar to that found in other tort and administrative compensation systems. Over this 8-year period, 49.5% (range 47.0-52.6%) of filed claims were judged valid and eligible for compensation. Claims rates varied significantly across hospitals; surgical specialties accounted for 46% of discharges, but 88% of claims. There were also large differences in claims rates for procedures. Patient-generated malpractice claims, as collected in the Swedish malpractice insurance system and adjusted for clinical volumes, have a high validity, as assessed by standardised physician review, and provide unique new information on malpractice risks, preventable medical errors and patient injuries. Systematic collection and analysis of patient-generated quality of care complaints should be encouraged, regardless of the malpractice compensation system in use.

24 CFR 203.474 - Maximum claim period.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Maximum claim period. 203.474 Section 203.474 Housing and Urban Development Regulations Relating to Housing and Urban Development... SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Rehabilitation Loans § 203.474 Maximum...

Development of a claim review and payment model utilizing diagnosis related groups under the Korean health insurance.

PubMed

Shin, Y S; Yeom, Y K; Hwang, H

1993-02-01

This paper describes the development of a claim review and payment model utilizing the diagnosis related groups (DRGs) for the fee for service-based payment system of the Korean health insurance. The present review process, which examines all claims manually on a case-by-case basis, has been considered to be inefficient, costly, and time-consuming. Differences in case mix among hospitals are controlled in the proposed model using the Korean DRGs. They were developed by modifying the US-DRG system. An empirical test of the model indicated that it can enhance the efficiency as well as the credibility and objectivity of the claim review. Furthermore, it is expected that it can contribute effectively to medical cost containments and to optimal practice pattern of hospitals by establishing a useful mechanism in monitoring the performance of hospitals. However, the performance of this model needs to be upgraded by refining the Korean DRGs which play a key role in the model.

Impact of a Comprehensive Workplace Hand Hygiene Program on Employer Health Care Insurance Claims and Costs, Absenteeism, and Employee Perceptions and Practices

PubMed Central

Arbogast, James W.; Moore-Schiltz, Laura; Jarvis, William R.; Harpster-Hagen, Amanda; Hughes, Jillian; Parker, Albert

2016-01-01

Objective: The aim of this study was to determine the efficacy of a multimodal hand hygiene intervention program in reducing health care insurance claims for hygiene preventable infections (eg, cold and influenza), absenteeism, and subjective impact on employees. Methods: A 13.5-month prospective, randomized cluster controlled trial was executed with alcohol-based hand sanitizer in strategic workplace locations and personal use (intervention group) and brief hand hygiene education (both groups). Four years of retrospective data were collected for all participants. Results: Hygiene-preventable health care claims were significantly reduced in the intervention group by over 20% (P < 0.05). Absenteeism was positively impacted overall for the intervention group. Employee survey data showed significant improvements in hand hygiene behavior and perception of company concern for employee well-being. Conclusion: Providing a comprehensive, targeted, yet simple to execute hand hygiene program significantly reduced the incidence of health care claims and increased employee workplace satisfaction. PMID:27281645

Impact of a Comprehensive Workplace Hand Hygiene Program on Employer Health Care Insurance Claims and Costs, Absenteeism, and Employee Perceptions and Practices.

PubMed

Arbogast, James W; Moore-Schiltz, Laura; Jarvis, William R; Harpster-Hagen, Amanda; Hughes, Jillian; Parker, Albert

2016-06-01

The aim of this study was to determine the efficacy of a multimodal hand hygiene intervention program in reducing health care insurance claims for hygiene preventable infections (eg, cold and influenza), absenteeism, and subjective impact on employees. A 13.5-month prospective, randomized cluster controlled trial was executed with alcohol-based hand sanitizer in strategic workplace locations and personal use (intervention group) and brief hand hygiene education (both groups). Four years of retrospective data were collected for all participants. Hygiene-preventable health care claims were significantly reduced in the intervention group by over 20% (P < 0.05). Absenteeism was positively impacted overall for the intervention group. Employee survey data showed significant improvements in hand hygiene behavior and perception of company concern for employee well-being. Providing a comprehensive, targeted, yet simple to execute hand hygiene program significantly reduced the incidence of health care claims and increased employee workplace satisfaction.

Incidence of workers compensation indemnity claims across socio-demographic and job characteristics.

PubMed

Du, Juan; Leigh, J Paul

2011-10-01

We hypothesized that low socioeconomic status, employer-provided health insurance, low wages, and overtime were predictors of reporting workers compensation indemnity claims. We also tested for gender and race disparities. Responses from 17,190 (person-years) Americans participating in the Panel Study of Income Dynamics, 1997-2005, were analyzed with logistic regressions. The dependent variable indicated whether the subject collected benefits from a claim. Odds ratios for men and African-Americans were relatively large and strongly significant predictors of claims; significance for Hispanics was moderate and confounded by education. Odds ratios for variables measuring education were the largest for all statistically significant covariates. Neither low wages nor employer-provided health insurance was a consistent predictor. Due to confounding from the "not salaried" variable, overtime was not a consistently significant predictor. Few studies use nationally representative longitudinal data to consider which demographic and job characteristics predict reporting workers compensation indemnity cases. This study did and tested some common hypotheses about predictors. Copyright © 2011 Wiley-Liss, Inc.

Do benefits in kind or refunds affect health service utilization and health outcomes? A natural experiment from Japan.

PubMed

Takaku, Reo; Bessho, S

2017-05-01

Although the payment systems of public health insurance vary greatly across countries, we still have limited knowledge of their effects. To quantify the changes from a benefits in kind system to a refund system, we exploit the largest physician strike in Japan since the Second World War. During the strike in 1971 led by the Japan Medical Association (JMA), JMA physicians resigned as health insurance doctors, but continued to provide medical care and even health insurance treatment in some areas. This study uses the regional differences in resignation rates as a natural experiment to examine the effect of the payment method of health insurance on medical service utilization and health outcomes. In the main analysis, aggregated monthly prefectural data are used (N=46). Our estimation results indicate that if the participation rate of the strike had increased by 1% point and proxy claims were refused completely, the number of cases of insurance benefits and the total amount of insurance benefits would have decreased by 0.78% and 0.58%, respectively compared with the same month in the previous year. Moreover, the average amount of insurance benefits per claim increased since patients with relatively less serious diseases might have sought health care less often. Finally, our results suggest that the mass of resignations did not affect death rates. Copyright © 2017 Elsevier B.V. All rights reserved.

Pediatric prescription pick-up rates after ED visits.

PubMed

Kajioka, Eric H; Itoman, Erick M; Li, M Lily; Taira, Deborah A; Li, Gaylyn G; Yamamoto, Loren G

2005-07-01

To determine the compliance rate in filling outpatient medication prescriptions written upon discharge from the emergency department (ED). Emergency department records of children during a 3-month period were examined along with pharmacy claim data obtained in cooperation with the largest insurance carrier in the community (private and Medicaid). Pharmacy claim data were used to validate the prescription pick-up date. Overall, 65% of high-urgency prescriptions were filled. The prescription pick-up rate in the 0-to 3-year age group (75%) was significantly higher than in the rest of the cohort (55%) ( P < .001). Children with private insurance were more likely to fill their prescriptions (68%) compared to children with Medicaid insurance (57%) ( P = .03). This study demonstrates that filling a prescription after discharge from an ED represents a substantial barrier to medication compliance.

Medical professional liability risk among US cardiologists.

PubMed

Mangalmurti, Sandeep; Seabury, Seth A; Chandra, Amitabh; Lakdawalla, Darius; Oetgen, William J; Jena, Anupam B

2014-05-01

Medical professional liability (MPL) remains a significant burden for physicians, in general, and cardiologists, in particular, as recent research has shown that average MPL defense costs are higher in cardiology than other specialties. Knowledge of the clinical characteristics and outcomes of lawsuits against cardiologists may improve quality of care and risk management. We analyzed closed MPL claims of 40,916 physicians and 781 cardiologists insured by a large nationwide insurer for ≥1 policy year between 1991 and 2005. The annual percentage of cardiologists facing an MPL claim was 8.6%, compared with 7.4% among physicians overall (P < .01). Among 530 claims, 72 (13.6%) resulted in an indemnity payment, with a median size of $164,988. Mean defense costs for claims resulting in payment were $83,593 (standard deviation (s.d.) $72,901). The time required to close MPL claims was longer for claims with indemnity payment than claims without (29.6 versus 18.9 months; P < .001). More than half of all claims involved a patient's death (304; 57.4%), were based on inpatient care (379; 71.5%), or involved a primary cardiovascular condition (416; 78.4%). Acute coronary syndrome was the most frequent condition (234; 44.2%). Medical professional liability claims involving noncardiovascular conditions were common (66; 12.5%) and included falls or mechanical injuries had while under a cardiologist's care and a failure to diagnose cancer. Rates of malpractice lawsuits are higher among cardiologists than physicians overall. A substantial portion of claims are noncardiovascular in nature. Copyright © 2014 Mosby, Inc. All rights reserved.

Utility indifference pricing of insurance catastrophe derivatives.

PubMed

Eichler, Andreas; Leobacher, Gunther; Szölgyenyi, Michaela

2017-01-01

We propose a model for an insurance loss index and the claims process of a single insurance company holding a fraction of the total number of contracts that captures both ordinary losses and losses due to catastrophes. In this model we price a catastrophe derivative by the method of utility indifference pricing. The associated stochastic optimization problem is treated by techniques for piecewise deterministic Markov processes. A numerical study illustrates our results.

Health insurance premium tax credit. Final regulations.

PubMed

2013-02-01

This document contains final regulations relating to the health insurance premium tax credit enacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010.These final regulations provide guidance to individuals related to employees who may enroll in eligible employer-sponsored coverage and who wish to enroll in qualified health plans through Affordable Insurance Exchanges (Exchanges) and claim the premium tax credit.

Tracking spending among commercially insured beneficiaries using a distributed data model.

PubMed

Colla, Carrie H; Schpero, William L; Gottlieb, Daniel J; McClurg, Asha B; Albert, Peter G; Baum, Nancy; Finison, Karl; Franzini, Luisa; Kitching, Gary; Knudson, Sue; Parikh, Rohan; Symes, Rebecca; Fisher, Elliott S

2014-08-01

To explore the feasibility of using a distributed data model for ongoing reporting of local healthcare spending, specifically to investigate the contribution of utilization and pricing to geographic variation and trends in reimbursements for commercially insured beneficiaries younger than 65 years. Retrospective descriptive analysis. Commercial claims were obtained for beneficiaries in 5 states for the years 2008 to 2010 using a distributed data model. Claims were aggregated to the hospital service area (HSA) level and healthcare utilization was quantified using a novel, National Quality Forum-endorsed measure that is independent of price and allows for the calculation of resource use across all services in standardized units. We examined trends in utilization, prices, and reimbursements over time. To examine geographic variation, we mapped resource use by HSA in the 3 states from which we had data from multiple insurers. We calculated the correlation between commercial and Medicare reimbursements and utilization. Medicare claims were obtained from the Dartmouth Atlas. We found that much of the recent growth in reimbursements for the commercially insured from 2008 to 2010 was due to increases in prices, particularly for outpatient services. As in the Medicare population, resource use by this population varied by HSA. While overall resource use patterns in the commercially insured did not mirror those among Medicare beneficiaries, we observed a strong correlation in inpatient hospital use. This research demonstrates the feasibility and value of public reporting of standardized area-level utilization and price data using a distributed data model to understand variation and trends in reimbursements.

Receipt of human papillomavirus vaccine among privately insured adult women in a U.S. Midwestern Health Maintenance Organization.

PubMed

Kharbanda, Elyse Olshen; Parker, Emily; Nordin, James D; Hedblom, Brita; Rolnick, Sharon J

2013-11-01

To describe human papillomavirus (HPV) vaccine coverage among adult privately insured women including variation in coverage by race/ethnicity. This cross-sectional, observational study included women 18-26 years of age with continuous enrollment in a U.S. Midwestern health insurance plan and at least one visit to a plan affiliated practice. Vaccination data came from insurance claims and the electronic medical record. Primary outcomes were: receipt of at least 1 HPV vaccine (HPV1) and completion of the 3-dose HPV vaccine series (HPV3). Coverage was described for the entire cohort and stratified by race/ethnicity. For a subset of women, automated data was compared to personal recall. As of June 2010, among 2546 privately insured women 18-26 years, 72.7% had received their first HPV vaccine and 57.9% completed the 3-dose series. Compared to white women, African American and Asian women had significantly lower coverage for HPV1 and HPV3. There was 94.5% (95% CI: 88.5-100%) agreement between personal recall and claims/EMR for receiving HPV1. In this cohort of privately insured women, a majority received HPV1 and more than half completed the 3-dose vaccine series. Marked disparities in receipt of HPV vaccine by race/ethnicity were observed. © 2013.

[The effectiveness of compensation system for mesotheliomas due to occupational exposure to asbestos and determinants for requests and awards: an evaluation based on record-linkage between the Veneto Mesothelioma Register and the claims and compensations recorded by the National Insurance Institute (INAIL)].

PubMed

Merler, Enzo; Bressan, Vittoria; Bilato, Anna Maria; Marinaccio, Alessandro

2011-01-01

To determine the rate of requests for compensation and of compensations awarded for mesothelioma cases due to occupational exposure to asbestos; to identify factors that may influence the outcome; to provide an appreciation of the amount of compensation. Record-linkage study at individual level between the new cases of mesothelioma occurred among the residents of the Veneto Region (Northern Italy) between 1999- 2007 and the file of the Insurance Institute, with individual data on all claims and compensations. Adjusted logistic regression models were used to estimated the association between submitting claims and obtaining an award and socio-demographic and other characteristics. 349 on 499 mesotheliomas considered to be due to occupational exposure to asbestos submitted a claim (70% of those of occupational origin) and 72%of claims were accepted. The welfare system covers only 35%of mesothelioma occurred. The probability of submitting and obtaining a claim was associated with gender, cancer site, age at diagnosis, vital status, and residence or local office in charge of the evaluation. A strong discrimination against women is observed. If exposure to asbestos at work was due to a direct manipulation of asbestos, claims were more easily accepted.As a consequence,mesothelioma occurred among construction workers, the occupational activity at the origin of the largest number of occurring mesotheliomas, are more frequently rejected.When submitted by a relative, the lag between a request for compensation and the decision is on average of about two years. This is the first study in Italy using a record-linkage method and was made possible thanks to a population based mesothelioma Register and the availability of memorized information of the Insurance Institute.The welfare system shown clear limitations and there is the need for more appropriate strategies.

Enforcing prompt-payment regulations: the Texas approach.

PubMed

McCoy, Jim E; Han, Michael C; Malloy, Michael S

2002-07-01

To ensure that insurance carriers pay providers in a timely manner, Texas has adopted strict payment regulations. Enforcement of the regulations has led to restitution payments for many providers. However, issues such as clean claims, underpayment, discrepancies in payment dates, and self-funded claims continue to present challenges.

Current and projected patient and insurer costs for the care of patients with non-small cell lung cancer in the United States through 2040.

PubMed

Hess, Lisa M; Cui, Zhanglin Lin; Wu, Yixun; Fang, Yun; Gaynor, Paula J; Oton, Ana B

2017-08-01

The objective of this study was to quantify the current and to project future patient and insurer costs for the care of patients with non-small cell lung cancer in the US. An analysis of administrative claims data among patients diagnosed with non-small cell lung cancer from 2007-2015 was conducted. Future costs were projected through 2040 based on these data using autoregressive models. Analysis of claims data found the average total cost of care during first- and second-line therapy was $1,161.70 and $561.80 for patients, and $45,175.70 and $26,201.40 for insurers, respectively. By 2040, the average total patient out-of-pocket costs are projected to reach $3,047.67 for first-line and $2,211.33 for second-line therapy, and insurance will pay an average of $131,262.39 for first-line and $75,062.23 for second-line therapy. Claims data are not collected for research purposes; therefore, there may be errors in entry and coding. Additionally, claims data do not contain important clinical factors, such as stage of disease at diagnosis, tumor histology, or data on disease progression, which may have important implications on the cost of care. The trajectory of the cost of lung cancer care is growing. This study estimates that the cost of care may double by 2040, with the greatest proportion of increase in patient out-of-pocket costs. Despite the average cost projections, these results suggest that a small sub-set of patients with very high costs could be at even greater risk in the future.

Use of major surgery in south India: A retrospective audit of hospital claim data from a large, community health insurance program.

PubMed

Shaikh, Maaz; Woodward, Mark; Rahimi, Kazem; Patel, Anushka; Rath, Santosh; MacMahon, Stephen; Jha, Vivekanand

2015-05-01

Information on the use of major surgery in India is scarce. In this study we aimed to bridge this gap by auditing hospital claims from Rajiv Aarogyasri Community Health Insurance Scheme, which provides access to free hospital care through state-funded insurance to 68 million beneficiaries, an estimated 81% of population in the states of Telangana and Andhra Pradesh. Publicly available deidentified hospital claim data for all surgery procedures conducted between mid-2008 and mid-2012 were compiled across all 23 districts in Telangana and Andhra Pradesh. A total of 677,332 operative admissions (80% at private hospitals) were recorded at an annual rate of 259 per 100,000 beneficiaries, with male subjects accounting for 56% of admissions. Injury was the most common cause for operative admission (27%) with operative correction of long bone fractures being the most common procedure (20%) identified in the audit. Diseases of the digestive (16%), genitourinary (12%), and musculoskeletal (10%) systems were other leading causes for operative admissions. Most hospital bed-days were used by admissions for injuries (31%) and diseases of the digestive (17%) and musculoskeletal system (11%) costing 19%, 13%, and 11% of reimbursement. Operations on the circulatory system (8%) accounted for 21% of reimbursements. Annual per capita cost of operative claims was US$1.48. The use of surgery by an insured population in India continued to be low despite access to financing comparable with greater spending countries, highlighting need for strategies, beyond traditional health financing, that prioritize improvement in access, delivery, and use of operative care. Copyright © 2015 Elsevier Inc. All rights reserved.

Should Governments engage health insurance intermediaries? A comparison of benefits with and without insurance intermediary in a large tax funded community health insurance scheme in the Indian state of Andhra Pradesh.

PubMed

Nagulapalli, Srikant; Rokkam, Sudarsana Rao

2015-09-10

A peculiar phenomenon of engaging insurance intermediaries for government funded health insurance schemes for the poor, not usually found globally, is gaining ground in India. Rajiv Aarogyasri Scheme launched in the Indian state of Andhra Pradesh, is first largest tax funded community health insurance scheme in the country covering more than 20 million poor families. Aarogyasri Health Care Trust (trust), the scheme administrator, transfers funds to hospitals through two routes one, directly and the other through an insurance intermediary. The objective of this paper is to find out if engaging an insurance intermediary has any effect on cost efficiency of the insurance scheme. We used payment data of RAS for the period 2007-12, to find out the influence of insurance intermediary on the two variables, benefit cost ratio defined as benefit payment divided by premium payment, and claim denial ratio defined as benefit payment divided by treatment cost. Relationship between scheme expenditure and number of beds empanelled under the scheme is examined. OLS regression is used to perform all analyses. We found that adding an additional layer of insurance intermediary between the trust and hospitals reduced the benefit cost ratio under the scheme by 12.2% (p-value = 0.06). Every addition of 100 beds under the scheme increases the scheme payments by US$ 0.75 million (p-value < 0.001). The gap in claim denial ratio between insurance and trust modes narrowed down from 2.84% in government hospitals to 0.41% in private hospitals (p-value < 0.001). The scheme is a classic case of Roemer's principle in operation. Introduction of insurance intermediary has the twin effects of reduction in benefit payments to beneficiaries, and chocking fund flow to government hospitals. The idea of engaging insurance intermediary should be abandoned.

Pluvial, urban flood mechanisms and characteristics - Assessment based on insurance claims

NASA Astrophysics Data System (ADS)

Sörensen, Johanna; Mobini, Shifteh

2017-12-01

Pluvial flooding is a problem in many cities and for city planning purpose the mechanisms behind pluvial flooding are of interest. Previous studies seldom use insurance claim data to analyse city scale characteristics that lead to flooding. In the present study, two long time series (∼20 years) of flood claims from property owners have been collected and analysed in detail to investigate the mechanisms and characteristics leading to urban flooding. The flood claim data come from the municipal water utility company and property owners with insurance that covers property loss from overland flooding, groundwater intrusion through basement walls and flooding from the drainage system. These data are used as a proxy for flood severity for several events in the Swedish city of Malmö. It is discussed which rainfall characteristics give most flooding and why some rainfall events do not lead to severe flooding, how city scale topography and sewerage system type influence spatial distribution of flood claims, and which impact high sea level has on flooding in Malmö. Three severe flood events are described in detail and compared with a number of smaller flood events. It was found that the main mechanisms and characteristics of flood extent and its spatial distribution in Malmö are intensity and spatial distribution of rainfall, distance to the main sewer system as well as overland flow paths, and type of drainage system, while high sea level has little impact on the flood extent. Finally, measures that could be taken to lower the flood risk in Malmö, and other cities with similar characteristics, are discussed.

[Collective versus selective contracts from a legal point of view].

PubMed

Schirmer, Horst Dieter

2006-01-01

The historically proven organisational model of service relations between sickness funds and healthcare providers are collective contracts. A collective contract as a standards treaty ("Normenvertrag") is particularly pronounced concerning the panel doctor law ("Vertragsarztrecht") defining medical care on the basis of the principle of benefits in kind governing benefit claims of the insured in case of illness. The collective contract is a suitable instrument for ensuring both consistent and exhaustive provision of care and for organising the conditions of care, especially the quality and reimbursement of professional medical services. For several years the legislator has been "experimenting" with parallel contract design patterns such as the contract of integrated care in the form of selective contracts between health insurances or their associations and healthcare providers or groups of healthcare providers. More recently, allowances for conclusion of such contracts have been supposed to lead to competition between the contractual systems. It is doubtful whether this "push-start" will contribute to overcoming the systematic legal disadvantages of selective contracting as an organisational model for the provision of healthcare services to the insured.

76 FR 68773 - Notice of Proposed Information Collection: Comment Request; FHA-Insured Mortgage Loan Servicing...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-07

... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5484-N-34] Notice of Proposed Information Collection: Comment Request; FHA- Insured Mortgage Loan Servicing Involving the Claims and Conveyance Process, Property Inspection/Preservation AGENCY: Office of the Assistant Secretary for Housing...

24 CFR 207.258 - Insurance claim requirements.

Code of Federal Regulations, 2014 CFR

2014-04-01

... by mortgagee. (1) When the mortgagee becomes eligible to receive mortgage insurance benefits pursuant... proceedings. If the laws of the State where the property is located do not permit institution of foreclosure... property and to obtain the income therefrom under the mortgage and the law of the particular jurisdiction...

24 CFR 207.258 - Insurance claim requirements.

Code of Federal Regulations, 2013 CFR

2013-04-01

... by mortgagee. (1) When the mortgagee becomes eligible to receive mortgage insurance benefits pursuant... proceedings. If the laws of the State where the property is located do not permit institution of foreclosure... property and to obtain the income therefrom under the mortgage and the law of the particular jurisdiction...

24 CFR 207.258 - Insurance claim requirements.

Code of Federal Regulations, 2012 CFR

2012-04-01

... by mortgagee. (1) When the mortgagee becomes eligible to receive mortgage insurance benefits pursuant... proceedings. If the laws of the State where the property is located do not permit institution of foreclosure... property and to obtain the income therefrom under the mortgage and the law of the particular jurisdiction...

31 CFR 50.53 - Loss certifications.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance: Treasury 1 2011-07-01 2011-07-01 false Loss certifications. 50.53 Section 50.53 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Claims Procedures § 50.53 Loss certifications. (a) General. When an insurer has paid aggregate...

31 CFR 50.53 - Loss certifications.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance: Treasury 1 2014-07-01 2014-07-01 false Loss certifications. 50.53 Section 50.53 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Claims Procedures § 50.53 Loss certifications. (a) General. When an insurer has paid aggregate...

31 CFR 50.53 - Loss certifications.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance: Treasury 1 2012-07-01 2012-07-01 false Loss certifications. 50.53 Section 50.53 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Claims Procedures § 50.53 Loss certifications. (a) General. When an insurer has paid aggregate...

12 CFR 330.5 - Recognition of deposit ownership and fiduciary relationships.

Code of Federal Regulations, 2014 CFR

2014-01-01

... relationships. 330.5 Section 330.5 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION REGULATIONS AND... fiduciary relationships. (a) Recognition of deposit ownership—(1) Evidence of deposit ownership. Except as... relationships—(1) Recognition. The FDIC will recognize a claim for insurance coverage based on a fiduciary...

12 CFR 330.5 - Recognition of deposit ownership and fiduciary relationships.

Code of Federal Regulations, 2012 CFR

2012-01-01

... relationships. 330.5 Section 330.5 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION REGULATIONS AND... fiduciary relationships. (a) Recognition of deposit ownership—(1) Evidence of deposit ownership. Except as... relationships—(1) Recognition. The FDIC will recognize a claim for insurance coverage based on a fiduciary...

12 CFR 330.5 - Recognition of deposit ownership and fiduciary relationships.

Code of Federal Regulations, 2013 CFR

2013-01-01

... relationships. 330.5 Section 330.5 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION REGULATIONS AND... fiduciary relationships. (a) Recognition of deposit ownership—(1) Evidence of deposit ownership. Except as... relationships—(1) Recognition. The FDIC will recognize a claim for insurance coverage based on a fiduciary...

12 CFR 330.5 - Recognition of deposit ownership and fiduciary relationships.

Code of Federal Regulations, 2011 CFR

2011-01-01

... relationships. 330.5 Section 330.5 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION REGULATIONS AND... fiduciary relationships. (a) Recognition of deposit ownership—(1) Evidence of deposit ownership. Except as... relationships—(1) Recognition. The FDIC will recognize a claim for insurance coverage based on a fiduciary...

An Insurance Crisis Looms--Again.

ERIC Educational Resources Information Center

Henke, Cliff

1993-01-01

The insurance industry has experienced a round of claims costs as a result of recent natural disasters. These costs are passed on to customers. To avoid higher premiums, student-transportation systems can take the following money-saving steps: raise the deductible; beef up driver training; focus on driver retention; and get the fleet's loss…

A bill to amend the National Flood Insurance Act of 1968 to include a system for indeterminate loss insurance claims, and for other purposes.

THOMAS, 112th Congress

Sen. Wicker, Roger F. [R-MS

2011-05-26

Senate - 05/26/2011 Read twice and referred to the Committee on Banking, Housing, and Urban Affairs. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Conversations with your actuary: getting to the right number.

PubMed

Frese, Richard C

2013-05-01

A healthcare finance leader can guarantee recognition of his or her organization's insurance program and better manage the program's liability by discussing changes in the following areas with an actuary: Claims management. Exposure. Coverage or retention Financial reporting of losses. Management goals. Other insurance and operational matters.

Underutilization of worker's compensation insurance among professional orchestral musicians.

PubMed

Chimenti, Ruth L; Van Dillen, Linda R; Prather, Heidi; Hunt, Devyani; Chimenti, Peter C; Khoo-Summers, Lynnette

2013-03-01

Orchestral musicians commonly have playing-related symptoms (PRS) but few use worker's compensation (WC) insurance for assessment and treatment. The purpose of this study was to examine the frequency of, and factors related to, filing a WC claim among musicians. An online questionnaire was completed by 261 members of the International Conference of Symphony and Opera Musicians (ICSOM). The responses were analyzed to describe the frequency and type of injuries, perceived cause of PRS, and severity of injury in musicians who did and did not file a WC claim. Of the musicians, 93% reported PRS in the 12 months prior to the study. Only 9 musicians filed WC claims during their careers, and all claims were for upper extremity injuries. The most frequent reason for not filing a WC claim was insufficient severity. Yet among musicians describing their PRS as not severe enough for a WC claim, 47% had symptoms for >15 minutes after playing and 16% had symptoms that interfered with daily activities. These data suggest there is frequent under-reporting of injuries to WC among professional orchestral musicians. Although most musicians reported PRS that persisted after playing, the most common reason for not filing a WC claim was insufficient severity of symptoms perceived by the musicians. Future research should focus on clearly defining severity for PRS-related injuries and determining when treatment for overuse syndromes should be paid for through the WC system.

Analysis of multi drug resistant tuberculosis (MDR-TB) financial protection policy: MDR-TB health insurance schemes, in Chhattisgarh state, India.

PubMed

Kundu, Debashish; Sharma, Nandini; Chadha, Sarabjit; Laokri, Samia; Awungafac, George; Jiang, Lai; Asaria, Miqdad

2018-01-27

There are significant financial barriers to access treatment for multi drug resistant tuberculosis (MDR-TB) in India. To address these challenges, Chhattisgarh state in India has established a MDR-TB financial protection policy by creating MDR-TB benefit packages as part of the universal health insurance scheme that the state has rolled out in their effort towards attaining Universal Health Coverage for all its residents. In these schemes the state purchases health insurance against set packages of services from third party health insurance agencies on behalf of all its residents. Provider payment reform by strategic purchasing through output based payments (lump sum fee is reimbursed as per the MDR-TB benefit package rates) to the providers - both public and private health facilities empanelled under the insurance scheme was the key intervention. To understand the implementation gap between policy and practice of the benefit packages with respect to equity in utilization of package claims by the poor patients in public and private sector. Data from primary health insurance claims from January 2013 to December 2015, were analysed using an extension of 'Kingdon's multiple streams for policy implementation framework' to explain the implementation gap between policy and practice of the MDR-TB benefit packages. The total number of claims for MDR-TB benefit packages increased over the study period mainly from poor patients treated in public facilities, particularly for the pre-treatment evaluation and hospital stay packages. Variations and inequities in utilizing the packages were observed between poor and non-poor beneficiaries in public and private sector. Private providers participation in the new MDR-TB financial protection mechanism through the universal health insurance scheme was observed to be much lower than might be expected given their share of healthcare provision overall in India. Our findings suggest that there may be an implementation gap due to weak coupling between the problem and the policy streams, reflecting weak coordination between state nodal agency and the state TB department. There is a pressing need to build strong institutional capacity of the public and private sector for improving service delivery to MDR-TB patients through this new health insurance mechanism.

17 CFR 229.801 - Securities Act industry guides.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Securities Act industry guides... AND CONSERVATION ACT OF 1975-REGULATION S-K List of Industry Guides § 229.801 Securities Act industry... claims and claim adjustment expenses of property-casualty insurance underwriters. (g) Guide 7...

12 CFR 1408.6 - Demand for payment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Demand for payment. 1408.6 Section 1408.6 Banks and Banking FARM CREDIT SYSTEM INSURANCE CORPORATION COLLECTION OF CLAIMS OWED THE UNITED STATES Administrative Collection of Claims § 1408.6 Demand for payment. (a) A total of three progressively stronger...

32 CFR 751.7 - Claims not payable.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) Loss or damage to property to the extent of any available insurance coverage. Except for claims for loss or damage to household goods or privately-owned vehicles (POVS) while shipped or stored at... quality. (h) Loss or damage to property due to negligence of the claimant. Negligence is a failure to...

32 CFR 751.7 - Claims not payable.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) Loss or damage to property to the extent of any available insurance coverage. Except for claims for loss or damage to household goods or privately-owned vehicles (POVS) while shipped or stored at... quality. (h) Loss or damage to property due to negligence of the claimant. Negligence is a failure to...

32 CFR 751.7 - Claims not payable.

Code of Federal Regulations, 2011 CFR

2011-07-01

...) Loss or damage to property to the extent of any available insurance coverage. Except for claims for loss or damage to household goods or privately-owned vehicles (POVS) while shipped or stored at... quality. (h) Loss or damage to property due to negligence of the claimant. Negligence is a failure to...

32 CFR 751.7 - Claims not payable.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) Loss or damage to property to the extent of any available insurance coverage. Except for claims for loss or damage to household goods or privately-owned vehicles (POVS) while shipped or stored at... quality. (h) Loss or damage to property due to negligence of the claimant. Negligence is a failure to...

32 CFR 751.7 - Claims not payable.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) Loss or damage to property to the extent of any available insurance coverage. Except for claims for loss or damage to household goods or privately-owned vehicles (POVS) while shipped or stored at... quality. (h) Loss or damage to property due to negligence of the claimant. Negligence is a failure to...

20 CFR 404.1522 - When you have two or more unrelated impairments-initial claims.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false When you have two or more unrelated impairments-initial claims. 404.1522 Section 404.1522 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Determining Disability and Blindness...

12 CFR 1408.13 - Contracting for collection services.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Contracting for collection services. 1408.13 Section 1408.13 Banks and Banking FARM CREDIT SYSTEM INSURANCE CORPORATION COLLECTION OF CLAIMS OWED THE UNITED STATES Administrative Collection of Claims § 1408.13 Contracting for collection services. The...

12 CFR 1408.4 - Delegation of authority.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Delegation of authority. 1408.4 Section 1408.4 Banks and Banking FARM CREDIT SYSTEM INSURANCE CORPORATION COLLECTION OF CLAIMS OWED THE UNITED STATES Administrative Collection of Claims § 1408.4 Delegation of authority. The Corporation official(s) designated by...

38 CFR 6.7 - Claims of creditors, taxation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Claims of creditors, taxation. 6.7 Section 6.7 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS UNITED... creditors, taxation. (a) Effective January 1, 1958, payments of insurance to a beneficiary under a United...

38 CFR 6.7 - Claims of creditors, taxation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Claims of creditors, taxation. 6.7 Section 6.7 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS UNITED... creditors, taxation. (a) Effective January 1, 1958, payments of insurance to a beneficiary under a United...

Insurers' medical loss ratios and quality improvement spending in 2011.

PubMed

Hall, Mark A; McCue, Michael J

2013-03-01

The Affordable Care Act's medical loss ratio (MLR) regulation requires insurers to spend 80 percent or 85 percent of premiums on medical claims and quality improvements. In 2011, insurers falling below this minimum paid more than $1 billion in rebates. This brief examines how insurers spend their premium dollars--particularly their investment in quality improvement activities--focusing on differences among insurers based on corporate traits. In the aggregate, insurers paid less than 1 percent of premiums on either MLR rebates or quality improvement activities in 2011, with amounts varying by insurer type. Publicly traded insurers had significantly lower MLRs in each market segment (individual, small group, and large group), and were more likely to owe a rebate in most segments compared with non-publicly traded insurers. The median quality improvement expenditure per member among nonprofit and provider-sponsored insurers was more than the median among for-profit and non-provider-sponsored insurers.

Mesothelioma incidence surveillance systems and claims for workers' compensation. Epidemiological evidence and prospects for an integrated framework.

PubMed

Marinaccio, Alessandro; Scarselli, Alberto; Merler, Enzo; Iavicoli, Sergio

2012-07-05

Malignant mesothelioma is an aggressive and lethal tumour strongly associated with exposure to asbestos (mainly occupational). In Italy a large proportion of workers are protected from occupational diseases by public insurance and an epidemiological surveillance system for incident mesothelioma cases. We set up an individual linkage between the Italian national mesothelioma register (ReNaM) and the Italian workers' compensation authority (INAIL) archives. Logistic regression models were used to identify and test explanatory variables. We extracted 3270 mesothelioma cases with occupational origins from the ReNaM, matching them with 1625 subjects in INAIL (49.7%); 91.2% (1,482) of the claims received compensation. The risk of not seeking compensation is significantly higher for women and the elderly. Claims have increased significantly in recent years and there is a clear geographical gradient (northern and more developed regions having higher claims rates). The highest rates of compensation claims were after work known to involve asbestos. Our data illustrate the importance of documentation and dissemination of all asbestos exposure modalities. Strategies focused on structural and systematic interaction between epidemiological surveillance and insurance systems are needed.

Mesothelioma incidence surveillance systems and claims for workers’ compensation. Epidemiological evidence and prospects for an integrated framework

PubMed Central

2012-01-01

Background Malignant mesothelioma is an aggressive and lethal tumour strongly associated with exposure to asbestos (mainly occupational). In Italy a large proportion of workers are protected from occupational diseases by public insurance and an epidemiological surveillance system for incident mesothelioma cases. Methods We set up an individual linkage between the Italian national mesothelioma register (ReNaM) and the Italian workers’ compensation authority (INAIL) archives. Logistic regression models were used to identify and test explanatory variables. Results We extracted 3270 mesothelioma cases with occupational origins from the ReNaM, matching them with 1625 subjects in INAIL (49.7%); 91.2% (1,482) of the claims received compensation. The risk of not seeking compensation is significantly higher for women and the elderly. Claims have increased significantly in recent years and there is a clear geographical gradient (northern and more developed regions having higher claims rates). The highest rates of compensation claims were after work known to involve asbestos. Conclusions Our data illustrate the importance of documentation and dissemination of all asbestos exposure modalities. Strategies focused on structural and systematic interaction between epidemiological surveillance and insurance systems are needed. PMID:22545679

Examining the influence of health insurance literacy and perception on the people preference to purchase private voluntary health insurance.

PubMed

Mathur, Tanuj; Das, Gurudas; Gupta, Hemendra

2018-01-01

Most studies have associated "un-affordability" as a plausible cause for the lower take-up of private voluntary health insurance plans. However, others refuted this claim on the pretext that when people can afford "inpatient-care" from pocket then insurance premium cost is far less than those payments. Thus, economic factors remain insufficient in clearly explaining the reason for poor private voluntary health insurance take-up. An attempt is being made by shifting the focus towards non-economic factors and understanding the role of perception and health insurance literacy in transforming people preferences to invest in private voluntary health insurance plans. The study findings will conspicuously support decision-makers in developing strategy to increase the private voluntary health insurance take-up.

Hospital response to a global budget program under universal health insurance in Taiwan.

PubMed

Cheng, Shou-Hsia; Chen, Chi-Chen; Chang, Wei-Ling

2009-10-01

Global budget programs are utilized in many countries to control soaring healthcare expenditures. The present study was designed to evaluate the responses of Taiwanese hospitals to a new global budget program implemented in 2002. Using data obtained from the Bureau of National Health Insurance (NHI) and two nationwide surveys conducted before and after the global budget program, changes in the length of stay, treatment intensity, insurance claims, and out-of-pocket fees were compared in 2002 and 2004. The analysis was conducted using the Generalized Estimating Equations (GEEs) method. Regression models revealed that implementation of the global budget was followed by a 7% increase in length of stay and a 15% increase in the number of prescribed procedures and medications per admission. The claim expenses increased by 14%, and out-of-pocket fees per admission increased by 6%. Among the hospitals, no coalition action was found during the study period. In the present study, it appears that hospitals attempted to increase per-case expense claims to protect their reimbursement from possible discounts under a global budget cap. How Taiwanese hospitals respond to this challenge in the future deserves continued, long-term observation.

Empirical findings on legal difficulties among practicing psychiatrists.

PubMed

Reich, James H; Maldonado, Jose

2011-11-01

This article reviews the published literature on areas of legal difficulty among practicing psychiatrists. A literature search using PubMed identified studies of malpractice lawsuits or medical board discipline of psychiatrists between 1990 and 2009. Eight studies of physician discipline in the United States and one from the United Kingdom were identified. Information from 3 insurance companies and 3 sets of aggregated insurance company data also were available. One follow-up study of hospitalized psychiatric patients also was reviewed. Studies of medical board discipline indicate that, compared with other specialties, psychiatrists are at an increased risk of disciplinary action. Psychiatrists who were female, board certified, and in practice for a short period of time had a lower chance of medical board discipline. Psychiatry claims accounted for a very small proportion of overall malpractice claims and settlements. The amount of patient disability secondary to alleged malpractice was the most important variable predicting insurance payout. Psychiatrists appear to be disciplined by medical boards at an above-average frequency compared with other medical specialties. However, few malpractice suits reach the courts, and psychiatry represents a very small proportion of overall physician malpractice claims and dollars of settlement.

Medical Malpractice Damage Caps and Provider Reimbursement.

PubMed

Friedson, Andrew I

2017-01-01

A common state legislative maneuver to combat rising healthcare costs is to reform the tort system by implementing caps on noneconomic damages awardable in medical malpractice cases. Using the implementation of caps in several states and large database of private insurance claims, I estimate the effect of damage caps on the amount providers charge to insurance companies as well as the amount that insurance companies reimburse providers for medical services. The amount providers charge insurers is unresponsive to tort reform, but the amount that insurers reimburse providers decreases for some procedures. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Challenges in provider payment under the Ghana National Health Insurance Scheme: a case study of claims management in two districts.

PubMed

Sodzi-Tettey, S; Aikins, M; Awoonor-Williams, J K; Agyepong, I A

2012-12-01

In 2004, Ghana started implementing a National Health Insurance Scheme (NHIS) to remove cost as a barrier to quality healthcare. Providers were initially paid by fee - for - service. In May 2008, this changed to paying providers by a combination of Ghana - Diagnostic Related Groupings (G-DRGs) for services and fee - for - service for medicines through the claims process. The study evaluated the claims management processes for two District MHIS in the Upper East Region of Ghana. Retrospective review of secondary claims data (2008) and a prospective observation of claims management (2009) were undertaken. Qualitative and quantitative approaches were used for primary data collection using interview guides and checklists. The reimbursements rates and value of rejected claims were calculated and compared for both districts using the z test. The null hypothesis was that no differences existed in parameters measured. Claims processes in both districts were similar and predominantly manual. There were administrative capacity, technical, human resource and working environment challenges contributing to delays in claims submission by providers and vetting and payment by schemes. Both Schemes rejected less than 1% of all claims submitted. Significant differences were observed between the Total Reimbursement Rates (TRR) and the Total Timely Reimbursement Rates (TTRR) for both schemes. For TRR, 89% and 86% were recorded for Kassena Nankana and Builsa Schemes respectively while for TTRR, 45% and 28% were recorded respectively. Ghana's NHIS needs to reform its provider payment and claims submission and processing systems to ensure simpler and faster processes. Computerization and investment to improve the capacity to administer for both purchasers and providers will be key in any reform.

Comparison of Low-Value Care in Medicaid vs Commercially Insured Populations.

PubMed

Charlesworth, Christina J; Meath, Thomas H A; Schwartz, Aaron L; McConnell, K John

2016-07-01

Reducing unnecessary tests and treatments is a potentially promising approach for improving the value of health care. However, relatively little is known about whether insurance type or local practice patterns are associated with delivery of low-value care. To compare low-value care in the Medicaid and commercially insured populations, test whether provision of low-value care is associated with insurance type, and assess whether local practice patterns are associated with the provision of low-value care. This cross-sectional study of claims data from the Oregon Division of Medical Assistance Programs and the Oregon All-Payer All-Claims database included Medicaid and commercially insured adults aged 18 to 64 years. The study period was January 1, 2013, through December 31, 2013. Low-value care was assessed using 16 claims-based measures. Logistic regression was used to test the association between Medicaid vs commercial insurance coverage and low-value care and the association between Medicaid and commercial low-value care rates within primary care service areas (PCSAs). This study included 286 769 Medicaid and 1 376 308 commercial enrollees in 2013. Medicaid enrollees were younger (167 847 [58.5%] of Medicaid enrollees were aged 18-34 years vs 505 628 [36.7%] of those with commercial insurance) but generally had worse health status compared with those with commercial insurance. Medicaid enrollees were also more likely to be female (180 363 [62.9%] vs 702 165 [51.0%]) and live in a rural area (120 232 [41.9%] vs 389 964 [28.3%]). A total of 10 304 of 69 338 qualifying Medicaid patients (14.9%; 95% CI, 14.6%-15.1%) received at least 1 low-value service during 2013; the corresponding rate for commercially insured patients was 35 739 of 314 023 (11.4%; 95% CI, 11.3%-11.5%). No consistent association was found between insurance type and low-value care. Compared with commercial patients, Medicaid patients were more likely to receive low-value care for 10 measures and less likely to receive low-value care for 5 others. For 7 of 11 low-value care measures, Medicaid patients were significantly more likely to receive low-value care if they resided in a PCSA with a higher rate of low-value care for commercial patients. Oregon Medicaid and commercially insured patients received moderate amounts of low-value care in 2013. No consistent association was found between insurance type and low-value care. However, Medicaid and commercial rates of low-value care were associated with one another within PCSAs. Low-value care may be more closely related to local practice patterns than to reimbursement generosity or insurance benefit structures.

76 FR 66316 - Notice of Submission of Proposed Information Collection to OMB, Multifamily Insurance Benefits...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-26

... Proposed Information Collection to OMB, Multifamily Insurance Benefits Claims Package AGENCY: Office of the.... When the terms of a Multifamily contract are breached or when a mortgagee meets conditions stated within the Multifamily contract for an automatic assignment, the holder of the mortgage may file for...

44 CFR Appendix A to Part 62 - Federal Emergency Management Agency, Federal Insurance Administration, Financial Assistance...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Federal Emergency Management... 62 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND... OF CLAIMS Pt. 62, App. A Appendix A to Part 62—Federal Emergency Management Agency, Federal Insurance...

29 CFR 2590.715-2719 - Internal claims and appeals and external review processes.

Code of Federal Regulations, 2011 CFR

2011-07-01

... may not own or control, or be owned or controlled by a health insurance issuer, a group health plan... SECURITY ADMINISTRATION, DEPARTMENT OF LABOR GROUP HEALTH PLANS RULES AND REGULATIONS FOR GROUP HEALTH... for group health plans and health insurance issuers that are not grandfathered health plans under...

78 FR 66653 - Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2014...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-06

... procedure, Adverse selection, Health care, Health insurance, Health records, Organization and functions... practice and procedure, Claims, Health care, Health insurance, Health plans, penalties, Reporting and... DEPARTMENT OF HEALTH AND HUMAN SERVICES 45 CFR Parts 153, 155, 156, 157, and 158 [CMS-9964-F3] RIN...

24 CFR 201.54 - Insurance claim procedure.

Code of Federal Regulations, 2012 CFR

2012-04-01

... application shall be supported by the following: (1) Documentation of the lender's efforts to effect recourse... needed to provide forbearance on a property improvement loan. (3) If a borrower is a “person in military... on a loan insured under this part, any period of military service after the date of default shall be...

24 CFR 201.54 - Insurance claim procedure.

Code of Federal Regulations, 2010 CFR

2010-04-01

... application shall be supported by the following: (1) Documentation of the lender's efforts to effect recourse... needed to provide forbearance on a property improvement loan. (3) If a borrower is a “person in military... on a loan insured under this part, any period of military service after the date of default shall be...

24 CFR 201.54 - Insurance claim procedure.

Code of Federal Regulations, 2013 CFR

2013-04-01

... application shall be supported by the following: (1) Documentation of the lender's efforts to effect recourse... needed to provide forbearance on a property improvement loan. (3) If a borrower is a “person in military... on a loan insured under this part, any period of military service after the date of default shall be...

24 CFR 201.54 - Insurance claim procedure.

Code of Federal Regulations, 2011 CFR

2011-04-01

... application shall be supported by the following: (1) Documentation of the lender's efforts to effect recourse... needed to provide forbearance on a property improvement loan. (3) If a borrower is a “person in military... on a loan insured under this part, any period of military service after the date of default shall be...

24 CFR 201.54 - Insurance claim procedure.

Code of Federal Regulations, 2014 CFR

2014-04-01

... application shall be supported by the following: (1) Documentation of the lender's efforts to effect recourse... needed to provide forbearance on a property improvement loan. (3) If a borrower is a “person in military... on a loan insured under this part, any period of military service after the date of default shall be...

7 CFR Exhibit L to Subpart A of... - Insured 10-Year Home Warranty Plan Requirements

Code of Federal Regulations, 2010 CFR

2010-01-01

..., construction inspection procedures, coverage provided and claims procedures. (5) A sample copy of the warranty... AGENCY, DEPARTMENT OF AGRICULTURE PROGRAM REGULATIONS CONSTRUCTION AND REPAIR Planning and Performing Construction and Other Development Pt. 1924, Subpt. A, Exh. L Exhibit L to Subpart A of Part 1924—Insured 10...

Implementation of an Interorganizational System: The Case of Medical Insurance E-Clearance

ERIC Educational Resources Information Center

Bose, Indranil; Liu, Han; Ye, Alex

2012-01-01

The patients receiving treatment from a hospital need to interact with multiple entities when claiming reimbursements. The complexities of the medical service supply chain can be simplified with an electronic clearance management system that allows hospitals, medical insurance bureau, bank, and patients to interact in a seamless and cashless…

46 CFR 326.7 - Litigation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... INSURANCE UNDER AGREEMENTS WITH AGENTS § 326.7 Litigation. (a) If a court suit of a P&I nature is filed... insurance, the Agent shall immediately forward copies of the pleading and all other related legal documents... claim of a P&I nature, unless approved in advance by MARAD, and by the underwriter, where applicable...

Effectiveness of an on-site health clinic at a self-insured university: a cost-benefit analysis.

PubMed

McCaskill, Sherrie P; Schwartz, Lisa A; Derouin, Anne L; Pegram, Angela H

2014-04-01

This study assessed the impact and cost-effectiveness of an on-site health clinic at a self-insured university. Health care costs and number of claims filed to primary care providers were trended before and after the clinic was established to determine savings. A retrospective chart review of all full-time, insured employees treated for upper respiratory tract infections (URIs) during a 1-year study period was conducted. On-site clinic costs for the treatment of URIs were compared to costs at outside community providers for similar care. Community cost norms for the treatment of URIs were provided by Primary Physicians Care, the administrator of insurance claims for the University. A cost-benefit analysis compared the cost of services on-site versus similar services at an outside community provider. Based on the results of this study, the University's on-site health care services were determined to be more cost-effective than similar off-site health care services for the treatment of URIs. [Workplace Health Saf 2014;62(4):162-169.]. Copyright 2014, SLACK Incorporated.

Insurance claims data: a possible solution for a national sports injury surveillance system? An evaluation of data information against ASIDD and consensus statements on sports injury surveillance.

PubMed

Aman, Malin; Forssblad, Magnus; Henriksson-Larsén, Karin

2014-06-12

Before preventive actions can be suggested for sports injuries at the national level, a solid surveillance system is required in order to study their epidemiology, risk factors and mechanisms. There are guidelines for sports injury data collection and classifications in the literature for that purpose. In Sweden, 90% of all athletes (57/70 sports federations) are insured with the same insurance company and data from their database could be a foundation for studies on acute sports injuries at the national level. To evaluate the usefulness of sports injury insurance claims data in sports injury surveillance at the national level. A database with 27 947 injuries was exported to an Excel file. Access to the corresponding text files was also obtained. Data were reviewed on available information, missing information and dropouts. Comparison with ASIDD (Australian Sports Injury Data Dictionary) and existing consensus statements in the literature (football (soccer), rugby union, tennis, cricket and thoroughbred horse racing) was performed in a structured manner. Comparison with ASIDD showed that 93% of the suggested data items were present in the database to at least some extent. Compliance with the consensus statements was generally high (13/18). Almost all claims (83%) contained text information concerning the injury. Relatively high-quality sports injury data can be obtained from a specific insurance company at the national level in Sweden. The database has the potential to be a solid base for research on acute sports injuries in different sports at the national level. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Responding to the Medical Malpractice Insurance Crisis: A National Risk Management Information System

PubMed Central

Wess, Bernard P.; Jacobson, Gary

1987-01-01

In the process of forming a new medical malpractice reinsurance company, the authors analyzed thousands of medical malpractice cases, settlements, and verdicts. The evidence of those analyses indicated that the medical malpractice crisis is (1)emerging nation- and world-wide, (2)exacerbated by but not primarily a result of “predatory” legal action, (3)statistically determined by a small percentage of physicians and procedures, (4)overburdened with data but poor on information, (5)subject to classic forms of quality control and automation. The management information system developed to address this problem features a tiered data base architecture to accommodate medical, administrative, procedural, statistical, and actuarial analyses necessary to predict claims from untoward events, not merely to report them.

Windstorms and Insured Loss in the UK: Modelling the Present and the Future

NASA Astrophysics Data System (ADS)

Hewston, R.; Dorling, S.; Viner, D.

2006-12-01

Worldwide, the costs of catastrophic weather events have increased dramatically in recent years, with average annual insured losses rising from a negligible level in 1950 to over $10bn in 2005 (Munich Re 2006). When losses from non-catastrophic weather related events are included this figure is doubled. A similar trend is exhibited in the UK with claims totalling over £6bn for the period 1998-2003, more than twice the value for the previous five years (Dlugolecki 2004). More than 70% of this loss is associated with storms. Extratropical cyclones are the main source of wind damage in the UK. In this research, a windstorm model is constructed to simulate patterns of insured loss associated with wind damage in the UK. Observed daily maximum wind gust speeds and a variety of socioeconomic datasets are utilised in a GIS generated model, which is verified against actual domestic property insurance claims data from two major insurance providers. The increased frequency and intensity of extreme events which are anticipated to accompany climate change in the UK will have a direct affect on general insurance, with the greatest impact expected to be on property insurance (Dlugolecki 2004). A range of experiments will be run using Regional Climate Model output data, in conjunction with the windstorm model, to simulate possible future losses resulting from climate change, assuming no alteration to the vulnerability of the building stock. Losses for the periods 2020-2050 and 2070- 2100 will be simulated under the various IPCC emissions scenarios. Munich Re (2006). Annual Review: Natural Catastrophes 2005. Munich, Munich Re: 52. Dlugolecki, A. (2004). A Changing Climate for Insurance - A summary report for Chief Executives and Policymakers, Association of British Insurers

[Claim and reality of selective contact options : experiences in finalizing selective contracts in urological care].

PubMed

Ex, P; Schroeder, A

2014-08-01

Selective contracts are an important component in addition to the total healthcare concept in order to introduce process-related innovations into the healthcare system. Since 2011 the Berufsverband der Deutschen Urologen (BDU, Professional Association of German Urologists) has held negotiations with individual health insurance companies and care providers in order to view selective contracts as collective contracts, not only as pilot projects but also as additional forms of care.This article illustrates the experiences of the BDU in the initiation and finalizing of selective contracts as well as existing weak points in the framework conditions.

12 CFR 1408.12 - Charges for interest, administrative costs, and penalties.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Charges for interest, administrative costs, and penalties. 1408.12 Section 1408.12 Banks and Banking FARM CREDIT SYSTEM INSURANCE CORPORATION COLLECTION OF CLAIMS OWED THE UNITED STATES Administrative Collection of Claims § 1408.12 Charges for interest...

76 FR 41301 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; Report on...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-13

... for OMB Review; Comment Request; Report on Alien Claims Activity ACTION: Notice. SUMMARY: The... information collection request (ICR) titled, ``Report on Alien Claims Activity,'' to the Office of Management... information collection allows the ETA to determine the number of aliens filing for unemployment insurance, the...

31 CFR Appendix A to Part 5 - Treasury Directive 34-01-Waiving Claims Against Treasury Employees for Erroneous Payments

Code of Federal Regulations, 2011 CFR

2011-07-01

...: (1) Pay and allowances (e.g., health and life insurance) and (2) travel, transportation, and... allowances, travel, transportation, and relocation expenses and allowances. A waiver may be considered when..., travel, transportation, and relocation expenses and allowances, aggregating less than $5,000 per claim...

16 CFR Appendix to Part 600 - Commentary on the Fair Credit Reporting Act

Code of Federal Regulations, 2010 CFR

2010-01-01

... no other purpose.) For example, a claims reporting service could use such a certification to avoid..., in item 5-C under this subsection.) Reports provided to insurers by claims investigation services... their individual customers from an outside source (such as a bank or a finance company). The...

29 CFR 2590.715-2719 - Internal claims and appeals and external review processes.

Code of Federal Regulations, 2012 CFR

2012-07-01

... SECURITY ADMINISTRATION, DEPARTMENT OF LABOR GROUP HEALTH PLANS RULES AND REGULATIONS FOR GROUP HEALTH... and appeals and external review processes for group health plans and health insurance issuers that are..., 2010. (b) Internal claims and appeals process—(1) In general. A group health plan and a health...

29 CFR 2590.715-2719 - Internal claims and appeals and external review processes.

Code of Federal Regulations, 2014 CFR

2014-07-01

... SECURITY ADMINISTRATION, DEPARTMENT OF LABOR GROUP HEALTH PLANS RULES AND REGULATIONS FOR GROUP HEALTH... and appeals and external review processes for group health plans and health insurance issuers that are..., 2010. (b) Internal claims and appeals process—(1) In general. A group health plan and a health...

29 CFR 2590.715-2719 - Internal claims and appeals and external review processes.

Code of Federal Regulations, 2013 CFR

2013-07-01

... SECURITY ADMINISTRATION, DEPARTMENT OF LABOR GROUP HEALTH PLANS RULES AND REGULATIONS FOR GROUP HEALTH... and appeals and external review processes for group health plans and health insurance issuers that are..., 2010. (b) Internal claims and appeals process—(1) In general. A group health plan and a health...

7 CFR 278.7 - Determination and disposition of claims-retail food stores and wholesale food concerns.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 4 2011-01-01 2011-01-01 false Determination and disposition of claims-retail food... PROGRAM PARTICIPATION OF RETAIL FOOD STORES, WHOLESALE FOOD CONCERNS AND INSURED FINANCIAL INSTITUTIONS § 278.7 Determination and disposition of claims—retail food stores and wholesale food concerns. (a...

7 CFR 278.7 - Determination and disposition of claims-retail food stores and wholesale food concerns.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 4 2013-01-01 2013-01-01 false Determination and disposition of claims-retail food... PROGRAM PARTICIPATION OF RETAIL FOOD STORES, WHOLESALE FOOD CONCERNS AND INSURED FINANCIAL INSTITUTIONS § 278.7 Determination and disposition of claims—retail food stores and wholesale food concerns. (a...

7 CFR 278.7 - Determination and disposition of claims-retail food stores and wholesale food concerns.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 4 2014-01-01 2014-01-01 false Determination and disposition of claims-retail food... PROGRAM PARTICIPATION OF RETAIL FOOD STORES, WHOLESALE FOOD CONCERNS AND INSURED FINANCIAL INSTITUTIONS § 278.7 Determination and disposition of claims—retail food stores and wholesale food concerns. (a...

7 CFR 278.7 - Determination and disposition of claims-retail food stores and wholesale food concerns.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 4 2012-01-01 2012-01-01 false Determination and disposition of claims-retail food... PROGRAM PARTICIPATION OF RETAIL FOOD STORES, WHOLESALE FOOD CONCERNS AND INSURED FINANCIAL INSTITUTIONS § 278.7 Determination and disposition of claims—retail food stores and wholesale food concerns. (a...

78 FR 75238 - Federal Housing Administration (FHA) Risk Management Initiatives: New Manual Underwriting...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-11

...-AJ07 Federal Housing Administration (FHA) Risk Management Initiatives: New Manual Underwriting... the number of claims. FHA can control costs through risk management practices. The lower costs are a... insurance claim rates and risk of loss to FHA. \\1\\ U.S. Department of Housing and Urban Development, Annual...

A guide for the utilization of Health Insurance Review and Assessment Service National Patient Samples

PubMed Central

Kim, Logyoung; Kim, Jee-Ae; Kim, Sanghyun

2014-01-01

The claims data of the Health Insurance Review and Assessment Service (HIRA) is an important source of information for healthcare service research. The claims data of HIRA is collected when healthcare service providers submit a claim to HIRA to be reimbursed for a service that they provided to patients. To improve the accessibility of healthcare service researchers to claims data of HIRA, HIRA has developed the Patient Samples which are extracted using a stratified randomized sampling method. The Patient Samples of HIRA consist of five tables: a table for general information (Table 20) containing socio-demographic information such as gender, age and medical aid, indicators for inpatient and outpatient services; a table for specific information on healthcare services provided (Table 30); a table for diagnostic information (Table 40); a table for outpatient prescriptions (Table 53) and a table for information on healthcare service providers (Table of providers). Researchers who are interested in using the Patient Sample data for research can apply via HIRA’s website (https://www.hira.or.kr). PMID:25078381

Scientific relevance of Swiss property insurance data on flood risks and losses

NASA Astrophysics Data System (ADS)

Röthlisberger, Veronika; Bernet, Daniel; Keiler, Margreth

2015-04-01

The databases of Swiss flood insurance companies build a valuable but to date rarely used source of information for flood risk research. Detailed insights into the Swiss flood insurance system are crucial to evaluate the potential of the different databases for scientific analysis. Even though the flood insurance system modalities are mainly regulated on cantonal level there are some common principles that apply throughout Switzerland. First of all coverage against floods (and other particular natural hazards) is an integral part of every fire insurance policy for buildings or contents in Switzerland. This coupling of insurance as well as the statutory obligation to insure buildings in most of the cantons and movables in some of the cantons lead to a very high penetration. Second, in case of damage, the reinstatement costs (value as new) are compensated and third there are no (or little) deductible and co-pay. Thus the different datasets of the flood insurance companies would allow a very comprehensive data analysis. Moreover, insurance companies not only store electronically data about losses (typically date, amount of claims payment, cause of damage, identity of the insured object or policyholder) but also about insured objects. For insured objects the (insured) value and the details on the policy and its holder are the main feature to record. On buildings the insurance companies usually computerize additional information such as location, volume, year of construction or purpose of use. For the 19 (of total 26) cantons with a cantonal monopoly insurer the data of these insurance establishments have the additional value to represent (almost) the entire building stock of the respective canton. However, scientists face a wide range of the opportunities and challenges when using insurance data for flood research. The origin of flood insurance data implies that they are not generated for research but for business management. The presentation will highlighted pro and cons as well as challenges of different aspects such as data compilation and geocoding, spatial and temporal coverage of data, data generation regarding the purpose of efficient and correct management of policies and claims, data protection regulations, differences in the use of technical key terms between risk research and insurance business to answer the questions how relevant and useful are the flood insurance data for flood risk analysis. An outlook will be provided how to encourage the (data) exchange between flood risk business and research.

Effectiveness of employer financial incentives in reducing time to report worker injury: an interrupted time series study of two Australian workers' compensation jurisdictions.

PubMed

Lane, Tyler J; Gray, Shannon; Hassani-Mahmooei, Behrooz; Collie, Alex

2018-01-05

Early intervention following occupational injury can improve health outcomes and reduce the duration and cost of workers' compensation claims. Financial early reporting incentives (ERIs) for employers may shorten the time between injury and access to compensation benefits and services. We examined ERI effect on time spent in the claim lodgement process in two Australian states: South Australia (SA), which introduced them in January 2009, and Tasmania (TAS), which introduced them in July 2010. Using administrative records of 1.47 million claims lodged between July 2006 and June 2012, we conducted an interrupted time series study of ERI impact on monthly median days in the claim lodgement process. Time periods included claim reporting, insurer decision, and total time. The 18-month gap in implementation between the states allowed for a multiple baseline design. In SA, we analysed periods within claim reporting: worker and employer reporting times (similar data were not available in TAS). To account for external threats to validity, we examined impact in reference to a comparator of other Australian workers' compensation jurisdictions. Total time in the process did not immediately change, though trend significantly decreased in both jurisdictions (SA: -0.36 days per month, 95% CI -0.63 to -0.09; TAS: 0.35, -0.50 to -0.20). Claim reporting time also decreased in both (SA: -1.6 days, -2.4 to -0.8; TAS: -5.4, -7.4 to -3.3). In TAS, there was a significant increase in insurer decision time (4.6, 3.9 to 5.4) and a similar but non-significant pattern in SA. In SA, worker reporting time significantly decreased (-4.7, -5.8 to -3.5), but employer reporting time did not (-0.3, -0.8 to 0.2). The results suggest that ERIs reduced claim lodgement time and, in the long-term, reduced total time in the claim lodgement process. However, only worker reporting time significantly decreased in SA, indicating that ERIs may not have shortened the process through the intended target of employer reporting time. Lack of similar data in Tasmania limited our ability to determine whether this was a result of ERIs or another component of the legislative changes. Further, increases in insurer decision time highlight possible unintended negative effects.

Medicaid Coverage of Smoking Cessation Counseling and Medication Is Underutilized for Pregnant Women.

PubMed

Scheuermann, Taneisha S; Richter, Kimber P; Jacobson, Lisette T; Shireman, Theresa I

2017-05-01

Policies to promote smoking cessation among Medicaid-insured pregnant women have the potential to assist a significant proportion of pregnant smokers. In 2010, Kansas Medicaid began covering smoking cessation counseling for pregnant smokers. Our aim was to evaluate the use of smoking cessation benefits provided to pregnant women as a result of the Kansas Medicaid policy change that provided reimbursement for physician-provided smoking cessation counseling. We examined Kansas Medicaid claims data to estimate rates of delivery of smoking cessation treatment to Medicaid-insured pregnant women in Kansas from fiscal year 2010 through 2013. We analyzed the number of pregnant women who received physician-provided smoking cessation counseling indicated by procedure billing codes (ie, G0436 and G0437) and medication (ie, nicotine replacement therapy, bupropion, or varenicline) located in outpatient managed care encounter and fee-for-service claims data. We estimated the number of Medicaid-insured pregnant smokers using the national smoking prevalence (14%) in this population and the number of live births reported in Kansas. Annually from 2010 to 2013, approximately 27.2%-31.6% of pregnant smokers had claims for nicotine replacement therapy, bupropion, or varenicline. Excluding claims for bupropion, a medication commonly prescribed to treat depression, claims ranged from 9.3% to 11.1%. Following implementation of Medicaid coverage for smoking cessation counseling, less than 1% of estimated smokers had claims for counseling. This low claims rate suggests that simply changing policy is not sufficient to ensure use of newly implemented benefits, and that there probably remain critical gaps in smoking cessation treatment. This study evaluates the use of Medicaid reimbursement for smoking cessation counseling among low-income pregnant women in Kansas. We describe the Medicaid claims rates of physician-provided smoking cessation counseling for pregnant women, an evidence-based and universally recommended treatment approach for smoking cessation in this population. Our findings show that claims rates for smoking cessation benefits in this population are very low, even after policy changes to support provision of cessation assistance were implemented. Additional studies are needed to determine whether reimbursement is functioning as intended and identify potential gaps between policy and implementation of evidence-based smoking cessation treatment. © The Author 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

An evaluation of the real-world safety effect of a lane change driver support system and characteristics of lane change crashes based on insurance claims data.

PubMed

Isaksson-Hellman, Irene; Lindman, Magdalena

2018-02-28

Lane changes, which frequently occur when vehicles travel on major roads, may contribute to critical situations that significantly affect the traffic flow and traffic safety. Thus, knowledge of lane change situations is important for infrastructure improvements as well as for driver support systems and automated driving development projects. The objectives of this study were to evaluate the crash avoidance performance of a lane change driver support system, the Blind Spot Information System (BLIS) in Volvo car models, and to describe the characteristics of lane change crashes by analyzing detailed information from insurance claim reports. An overall evaluation of the safety effect of BLIS was performed by analyzing crash rate differences in lane change situations for cars with and without the optionally mounted BLIS system based on a population of 380,000 insured vehicle years. Further, crashes in which the repair cost of the host vehicle exceeded approximately US$1,250 were selected and compared. Finally, the study examined different precrash factors and crash configurations, using in-depth insurance claims data from representative lane change crash cases including all severity levels in a population of more than 200,000 insured vehicle years. The technology did not significantly reduce the overall number of crashes when all types of lane change crashes and severity levels were considered, though a significant crash-reducing effect of 31% for BLIS cars was found when more severe crashes with a repair cost exceeding US$1,250 were analysed. Cars with the BLIS technology also have a 30% lower claim cost on average for reported lane change crashes, indicating reduced crash severity. When stratifying the data into specific situations, by collecting precrash information in a case-by-case study, the influence of BLIS was indicated to differ for the evaluated situations, although no significant results were found. For example, during general lane change maneuvers (i.e., not while exiting or entering highways or during weaving/merging situations) the crash rate was reduced by 14%, whereas in weaving/merging situations the crash rate increased. The insurance data analyzed provided useful information about real-world lane change crash characteristics by covering collisions in all crash severities and thus revealed information beyond what is available in, for example, data sets of police-reported crashes. This will guide further development of driver support systems. For crashes with repair cost exceeding US$1,250, a significant crash reduction was found, although the technology did not significantly reduce the total number of lane change crashes. An average lower insurance claim cost for cars equipped with the BLIS technology also indicated that the technology contributes to reduced crash severity even if crashes were not totally avoided. Stratifying the data into different lane change crash situations gave indications of the condition-specific performance of the system, even if the results were not statistically significant at the 95% level.

Tablet splitting of narrow therapeutic index drugs: a nationwide survey in Taiwan.

PubMed

Chou, Chia-Lin; Hsu, Chia-Chen; Chou, Chia-Yu; Chen, Tzeng-Ji; Chou, Li-Fang; Chou, Yueh-Ching

2015-12-01

Tablet splitting or pill splitting frequently occurs in daily medical practice. For drugs with special pharmacokinetic characters, such as drugs with narrow therapeutic index (NTI), unequal split tablets might lead to erroneous dose titration and it even cause toxicity. The aim of this study was to investigate the frequency of prescribing split NTI drugs at ambulatory setting in Taiwan. A population-based retrospective study was conducted using the National Health Insurance Research Database in Taiwan. All ambulatory visits were analyzed from the longitudinal cohort datasets of the National Health Insurance Research Database. The details of ambulatory prescriptions containing NTI drugs were extracted by using the claims datasets of one million beneficiaries from National Healthcare Insurance Research Database in 2010 in Taiwan. The analyses were stratified by dosage form, patient age and the number of prescribed tablets in a single dose for each NTI drugs. Main outcome measures Number and distinct dosage forms of available NTI drug items in Taiwan, number of prescriptions involved split NTI drugs, and number of patients received split NTI drugs. A total of 148,548 patients had received 512,398 prescriptions of NTI drugs and 41.8 % (n = 62,121) of patients had received 36.3 % (n = 185,936) of NTI drug prescriptions in form of split tablets. The percentage of splitting was highest in digoxin prescriptions (81.0 %), followed by warfarin (72.0 %). In the elderly patients, split tablets were very prevalent with digoxin (82.4 %) and warfarin (84.5 %). NTI drugs were frequently prescribed to be taken in split forms in Taiwan. Interventions may be needed to provide effective and convenient NTI drug use. Further studies are needed to evaluate the clinical outcome of inappropriate split NTI drugs.

Aviation or space policy: New challenges for the insurance sector to private human access to space

NASA Astrophysics Data System (ADS)

van Oijhuizen Galhego Rosa, Ana Cristina

2013-12-01

The phenomenon of private human access to space has introduced a new set of problems in the insurance sector. Orbital and suborbital space transportation will surely be unique commercial services for this new market. Discussions are under way regarding space insurance, in order to establish whether this new market ought to be regulated by aviation or space law. Alongside new definitions, infrastructures, legal frameworks and liability insurances, the insurance sector has also been introducing a new approach. In this paper, I aim to analyse some of the possibilities of new premiums, capacities, and policies (under aviation or space insurance rules), as well as the new insurance products related to vehicles, passengers and third party liability. This paper claims that a change toward new insurance regimes is crucial, due to the current stage in development of space tourism and the urgency to adapt insurance rules to support future development in this area.

Frequency of medical malpractice claims: The effects of volumes and specialties.

PubMed

Buzzacchi, Luigi; Scellato, Giuseppe; Ughetto, Elisa

2016-12-01

A medical malpractice occurs when a physician or healthcare personnel, because of lack of skill or negligence, causes injury to a patient, who can decide to claim for the damages suffered by suing the facility and/or healthcare personnel. In this paper we analyze the frequency of medical malpractice insurance claims in an Italian region, in order to estimate the presence of significant trends and to identify volume effects at both department and healthcare organization levels. We rely on a unique dataset reporting the universe of 2144 injuries caused by medical or surgical errors that resulted in a request to the insurer for coverage over the years 2004-2010 in ten public healthcare organizations. Results show the presence of positive volume effects, as the number of malpractice claims grows less than proportionally with respect to department volumes. Volume effects are particularly relevant for orthopedics and general surgery. We also find the presence of significant positive volume effects at the level of healthcare organizations. Finally, the joint observation of the results on the frequency of malpractice claims and on the time lag between the occurrence of the malpractice event and the filing of the related claim, suggests that the number of malpractice claims has increased over time. Results indicate that organizational and managerial actions concerning the increase in volumes of specific departments or health organizations are context specific and must be specifically tailored. Copyright © 2016 Elsevier Ltd. All rights reserved.

Validity assessment of self-reported medication use by comparing to pharmacy insurance claims

PubMed Central

Fujita, Misuzu; Sato, Yasunori; Nagashima, Kengo; Takahashi, Sho; Hata, Akira

2015-01-01

Objectives In Japan, an annual health check-up and health promotion guidance programme was established in 2008 in accordance with the Act on Assurance of Medical Care for the Elderly. A self-reported questionnaire on medication use is a required item in this programme and has been used widely, but its validity has not been assessed. The aim of this study was to evaluate the validity of this questionnaire by comparing self-reported usage to pharmacy insurance claims. Setting This is a population-based validation study. Self-reported medication use for hypertension, diabetes and dyslipidaemia is the evaluated measurement. Data on pharmacy insurance claims are used as a reference standard. Participants Participants were 54 712 beneficiaries of the National Health Insurance of Chiba City. Primary and secondary outcome measures Sensitivity, specificity and κ statistics of the self-reported medication-use questionnaire for predicting actual prescriptions during 1 month (that of the check-up) and 3 months (that of the check-up and the previous 2 months) were calculated. Results Sensitivity and specificity scores of questionnaire data for predicting insurance claims covering 3 months were, respectively, 92.4% (95% CI 91.9 to 92.8) and 86.4% (95% CI 86.0 to 86.7) for hypertension, 82.6% (95% CI 81.1 to 84.0) and 98.5% (95% CI 98.4 to 98.6) for diabetes, and 86.2% (95% CI 85.5 to 86.8) and 91.0% (95% CI 90.8 to 91.3) for dyslipidaemia. Corresponding κ statistics were 70.9% (95% CI 70.1 to 71.7), 77.1% (95% CI 76.2 to 77.9) and 69.8% (95% CI 68.9 to 70.6). The specificity was significantly higher for questionnaire data covering 3 months compared with data covering 1 month for all 3 conditions. Conclusions Self-reported questionnaire data on medication use had sufficiently high validity for further analyses. Item responses showed close agreement with actual prescriptions, particularly those covering 3 months. PMID:26553839

Health insurance and the demand for medical care: Instrumental variable estimates using health insurer claims data.

PubMed

Dunn, Abe

2016-07-01

This paper takes a different approach to estimating demand for medical care that uses the negotiated prices between insurers and providers as an instrument. The instrument is viewed as a textbook "cost shifting" instrument that impacts plan offerings, but is unobserved by consumers. The paper finds a price elasticity of demand of around -0.20, matching the elasticity found in the RAND Health Insurance Experiment. The paper also studies within-market variation in demand for prescription drugs and other medical care services and obtains comparable price elasticity estimates. Published by Elsevier B.V.

Surgical exploration of hand wounds in the emergency room: Preliminary study of 80 personal injury claims.

PubMed

Mouton, J; Houdre, H; Beccari, R; Tarissi, N; Autran, M; Auquit-Auckbur, I

2016-12-01

The SHAM Insurance Company in Lyon, France, estimated that inadequate hand wound exploration in the emergency room (ER) accounted for 10% of all ER-related personal injury claims in 2013. The objective of this study was to conduct a critical analysis of 80 claims that were related to hand wound management in the ER and led to compensation by SHAM. Eighty claims filed between 2007 and 2010 were anonymised then included into the study. To be eligible, claims had to be filed with SHAM, related to the ER management of a hand wound in an adult, and closed at the time of the study. Claims related to surgery were excluded. For each claim, we recorded 104 items (e.g., epidemiology, treatments offered, and impact on social and occupational activities) and analysed. Of the 70 patients, 60% were manual workers. The advice of a surgeon was sought in 16% of cases. The most common wound sites were the thumb (33%) and index finger (17%). Among the missed lesions, most involved tendons (74%) or nerves (29%). Many patients had more than one reason for filing a claim. The main reasons were inadequate wound exploration (97%), stiffness (49%), and dysaesthesia (41%). One third of patients were unable to return to their previous job. Mean sick-leave duration was 148 days and mean time from discharge to best outcome was 4.19%. Most claims (79%) were settled directly with the insurance company, 16% after involvement of a public mediator, and 12% in court. The mean compensatory damages award was 4595Euros. Inadequate surgical exploration of hand wounds is common in the ER, carries a risk of lasting and sometimes severe residual impairment, and generates considerable societal costs. IV. Copyright © 2016. Published by Elsevier Masson SAS.

Antibiotic prescription patterns for upper respiratory tract infections in the outpatient Qatari population in the private sector.

PubMed

Butt, Adeel Ajwad; Navasero, Cristina S; Thomas, Bright; Marri, Salih Al; Katheeri, Huda Al; Thani, Asmaa Al; Khal, Abdullatif Al; Khan, Tasnim; Abou-Samra, Abdul-Badi

2017-02-01

Antibiotics are often inappropriately prescribed for upper respiratory tract infections (URTIs) in developed countries. Data on the proportion of inappropriate prescriptions are lacking from the Middle East and other developing countries. Health insurance claims for all antibiotics prescribed for URTIs in the private sector in the State of Qatar between May 2014 and December 2015 were retrieved. During the study period, health insurance was limited to Qatari nationals. Topical antibiotics were excluded. Data on the prescriber's specialty, as listed with the licensing authority, were also retrieved. Diagnoses were classified as appropriate or inappropriate based on the likelihood of a bacterial etiology that may warrant antibiotic use. A total of 75 733 claims were made during the study period. Of these, 41 556 (55%) were for an appropriate indication, while 34 177 (45%) were for an inappropriate indication. The most common antibiotic classes prescribed were cephalosporins (43% of claims; 44% inappropriate), penicillins (28% of claims; 44% inappropriate), macrolides (19% of claims; 52% inappropriate), and fluoroquinolones (9% of claims; 40% inappropriate). Nearly 5% of antibiotics were prescribed in intravenous formulations. The most common prescribers were General/Family Practice physicians (53% of claims; 50% inappropriate), followed by Pediatrics (18.6% of claims; 36% inappropriate) and Internal Medicine (14.1% of claims; 44% inappropriate). There is a high rate of inappropriate antibiotic prescription for acute URTIs in the private health care sector in the State of Qatar. Further studies are needed to determine the population-based rates across the country. Interventions to decrease inappropriate use in such settings are urgently needed. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Analysis of the Uniform Accident And Sickness Policy Provision Law: lessons for social work practice, policy, and research.

PubMed

Cochran, Gerald

2010-01-01

The Uniform Accident and Sickness Policy Provision Law (UPPL) is a state statute that allows insurance companies in 26 states to deny claims for accidents and injuries incurred by persons under the influence of drugs or alcohol. Serious repercussions can result for patients and health care professionals as states enforce this law. To examine differences within the laws that might facilitate amendments or reduce insurance companies' ability to deny claims, a content analysis was carried out of each state's UPPL law. Results showed no meaningful differences between each state's laws. These results indicate patients and health professionals share similar risk related to the UPPL regardless of state.

Alternatives to Crop Insurance for Mitigating Hydrologic Risk in the Upper Mississippi River Basin

NASA Astrophysics Data System (ADS)

Baker, J. M.; Griffis, T. J.; Gorski, G.; Wood, J. D.

2015-12-01

Corn and soybean production in the Upper Mississippi River Basin can be limited by either excess or shortage of water, often in the same year within the same watershed. Most producers indemnify themselves against these hazards through the Federal crop insurance program, which is heavily subsidized, thus discouraging expenditures on other forms of risk mitigation. The cost is not trivial, amounting to more than 60 billion USD over the past 15 years. Examination of long-term precipitation and streamflow records at the 8-digit scale suggests that inter-annual hydrologic variability in the region is increasing, particularly in an area stretching from NW IL through much of IA and southern MN. Analysis of crop insurance statistics shows that these same watersheds exhibit the highest frequency of coincident claims for yield losses to both excess water and drought within the same year. An emphasis on development of water management strategies to increase landscape storage and subsequent reuse through supplemental irrigation in this region could reduce the cost of the crop insurance program and stabilize yield. However, we also note that analysis of yield data from USDA-NASS shows that interannual yield variability at the watershed scale is much more muted than the indemnity data suggest, indicating that adverse selection is probably a factor in the crop insurance marketplace. Consequently, we propose that hydrologic mitigation practices may be most cost-effective if they are carefully targeted, using topographic, soil, and meteorological data, in combination with more site-specificity in crop insurance data.

24 CFR 266.634 - Reinstatement of the contract of insurance.

Code of Federal Regulations, 2010 CFR

2010-04-01

... insurance. (c) Payment. Within 30 days of the date of the notice under paragraph (b) of this section, the HFA shall pay HUD an amount equal to the initial claim amount, as determined under § 266.628(a)(1), plus an amount equal to the accrued and unpaid interest on the HFA Debenture through the reinstatement...

Use of health insurance claim patterns to identify patients using nonsteroidal anti-inflammatory drugs for rheumatoid arthritis.

PubMed

Bernard, Marie-Agnès; Bénichou, Jacques; Blin, Patrick; Weill, Alain; Bégaud, Bernard; Abouelfath, Abdelilah; Moore, Nicholas; Fourrier-Réglat, Annie

2012-06-01

To determine healthcare claim patterns associated using nonsteroidal anti-inflammatory drugs (NSAIDs) for rheumatoid arthritis (RA). The CADEUS study randomly identified NSAID users within the French health insurance database. One-year claims data were extracted, and NSAID indication was obtained from prescribers. Logistic regression was used in a development sample to identify claim patterns predictive of RA and models applied to a validation sample. Analyses were stratified on the dispensation of immunosuppressive agents or specific antirheumatism treatment, and the area under the receiver operating characteristic curve was used to estimate discriminant power. NSAID indication was provided for 26,259 of the 45,217 patients included in the CADEUS cohort; it was RA for 956 patients. Two models were constructed using the development sample (n = 13,143), stratifying on the dispensation of an immunosuppressive agent or specific antirheumatism treatment. Discriminant power was high for both models (AUC > 0.80) and was not statistically different from that found when applied to the validation sample (n = 13,116). The models derived from this study may help to identify patients prescribed NSAIDs who are likely to have RA in claims databases without medical data such as treatment indication. Copyright © 2012 John Wiley & Sons, Ltd.

20 CFR 332.7 - Consideration of evidence.

Code of Federal Regulations, 2010 CFR

2010-04-01

... INSURANCE ACT MILEAGE OR WORK RESTRICTIONS AND STAND-BY OR LAY-OVER RULES § 332.7 Consideration of evidence... as to lay-over or stand-by status as may be necessary for the determination of his claim. An employee's statement in connection with his claim that he was not out of service because of a lay-over or...

42 CFR 405.376 - Suspension and termination of collection action and compromise of claims for overpayment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Suspension and termination of collection action and compromise of claims for overpayment. 405.376 Section 405.376 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED...

42 CFR 405.376 - Suspension and termination of collection action and compromise of claims for overpayment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Suspension and termination of collection action and compromise of claims for overpayment. 405.376 Section 405.376 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED...

7 CFR 1499.10 - Claims for damage to or loss of commodities.

Code of Federal Regulations, 2012 CFR

2012-01-01

... to or loss of commodities. (a) FAS will be responsible for claims arising out of damage to or loss of... commercial insurance contracts; and (2) Notifying FAS immediately and providing detailed information about..., less any funds generated if such commodities are sold in accordance with § 1499.9(e)(1). (e) If FAS...

7 CFR 1499.10 - Claims for damage to or loss of commodities.

Code of Federal Regulations, 2014 CFR

2014-01-01

... to or loss of commodities. (a) FAS will be responsible for claims arising out of damage to or loss of... commercial insurance contracts; and (2) Notifying FAS immediately and providing detailed information about..., less any funds generated if such commodities are sold in accordance with § 1499.9(e)(1). (e) If FAS...

7 CFR 1499.10 - Claims for damage to or loss of commodities.

Code of Federal Regulations, 2013 CFR

2013-01-01

... to or loss of commodities. (a) FAS will be responsible for claims arising out of damage to or loss of... commercial insurance contracts; and (2) Notifying FAS immediately and providing detailed information about..., less any funds generated if such commodities are sold in accordance with § 1499.9(e)(1). (e) If FAS...

20 CFR 429.206 - What if my claim involves a commercial carrier or an insurer?

Code of Federal Regulations, 2011 CFR

2011-04-01

... the maximum payment limitations set forth in § 429.201. However, if the resulting amount after making... service preclude reasonable filing of a claim or diligent prosecution, or the evidence indicates a demand... correspondence, documents, and other evidence pertinent to the matter. (e) You must assign to the United States...

20 CFR 429.206 - What if my claim involves a commercial carrier or an insurer?

Code of Federal Regulations, 2014 CFR

2014-04-01

... the maximum payment limitations set forth in § 429.201. However, if the resulting amount after making... service preclude reasonable filing of a claim or diligent prosecution, or the evidence indicates a demand... correspondence, documents, and other evidence pertinent to the matter. (e) You must assign to the United States...

20 CFR 429.206 - What if my claim involves a commercial carrier or an insurer?

Code of Federal Regulations, 2013 CFR

2013-04-01

... the maximum payment limitations set forth in § 429.201. However, if the resulting amount after making... service preclude reasonable filing of a claim or diligent prosecution, or the evidence indicates a demand... correspondence, documents, and other evidence pertinent to the matter. (e) You must assign to the United States...

20 CFR 429.206 - What if my claim involves a commercial carrier or an insurer?

Code of Federal Regulations, 2012 CFR

2012-04-01

... the maximum payment limitations set forth in § 429.201. However, if the resulting amount after making... service preclude reasonable filing of a claim or diligent prosecution, or the evidence indicates a demand... correspondence, documents, and other evidence pertinent to the matter. (e) You must assign to the United States...

41 CFR 102-72.69 - What additional terms and conditions apply to an Executive agencies' delegation of ancillary...

Code of Federal Regulations, 2014 CFR

2014-01-01

... alteration work, the Executive agency shall deliver, or cause its contractor to deliver, to the building... liability and property damage insurance policies to cover claims arising from or relating to the contractor... liability, either directly or indirectly, for any contractual claims or disputes that arise out of or relate...

41 CFR 102-72.69 - What additional terms and conditions apply to an Executive agencies' delegation of ancillary...

Code of Federal Regulations, 2013 CFR

2013-07-01

... alteration work, the Executive agency shall deliver, or cause its contractor to deliver, to the building... liability and property damage insurance policies to cover claims arising from or relating to the contractor... liability, either directly or indirectly, for any contractual claims or disputes that arise out of or relate...

41 CFR 102-72.69 - What additional terms and conditions apply to an Executive agencies' delegation of ancillary...

Code of Federal Regulations, 2011 CFR

2011-01-01

... alteration work, the Executive agency shall deliver, or cause its contractor to deliver, to the building... liability and property damage insurance policies to cover claims arising from or relating to the contractor... liability, either directly or indirectly, for any contractual claims or disputes that arise out of or relate...

41 CFR 102-72.69 - What additional terms and conditions apply to an Executive agencies' delegation of ancillary...

Code of Federal Regulations, 2010 CFR

2010-07-01

... alteration work, the Executive agency shall deliver, or cause its contractor to deliver, to the building... liability and property damage insurance policies to cover claims arising from or relating to the contractor... liability, either directly or indirectly, for any contractual claims or disputes that arise out of or relate...

14 CFR 1261.108 - Recovery from carriers, insurers, and other third parties.

Code of Federal Regulations, 2011 CFR

2011-01-01

... offers a settlement which is less than the amount of the demand, the claimant shall consult with the... comply with these procedures may reduce or preclude payment of the claim. (b) Demand on carrier... responsible, the claimant shall make a written demand on such party, either before or after submitting a claim...