The process of arriving at an amount of settlement for a claim. It may consist of a series of computations to arrive at the amount of a loss, as in a complicated fire loss. It may involve discussions of liability, quantum, and other such matters as might be the case in a problem liability claim. It may contain both.
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MEDICAL, US:
1. Posting an entry to a patient’s financial account to indicate a change to the balance due such as additional payment, partial payment, courtesy adjustment, write off, discount. 2. Change made to correct an error in billing, processing of a claim, or as a result of a retroactive rate change (e.g., late charges for a previously submitted bill). These situations may be found by either claims personnel or by the provider. Possible errors that would allow adjustments to be processed include overpayment, underpayment, or payments to the wrong provider.
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The process of dealing with a claim starting with its investigation and concluding with its settlement or disposal. The work can be carried out by the insurer’s own claims staff or by a loss adjuster.
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The process of determining the cause and amount of a loss, the amount of indemnity the amount of indemnity the insured may recover after all proper allowances and deductions have been made, and the proportions that each Company is required to pay under its contract if there is more than one Insurance Company involved.