The initial indemnity limit under a reinsurance contract minus the losses paid during the current contract period. It is the amount of cover remaining unless reinstatement applies.
Insurance Encyclopedia
Adjusted Net Worth
The capital, surplus and voluntary reserves of an insurer, plus an estimated value for business on the books and unrealized capital gains, less the potential income tax on such gains.
Adjusted payment rate (APR)
Amount of money that the Centers for Medicare and Medicaid Services will pay Medicare risk health maintenance organizations (HMOs) to cover a Medicare beneficiary. The rate is taken from the adjusted average per capita cost (AAPCC) based on health risk factors for the beneficiaries.
Adjusted premium
A premium comprised of a net-level premium and an amount defined as the first year’s acquisition expenses divided by the current value of a life annuity due.
Adjuster
A person who investigates and settles losses for an insurance carrier.
*****
1. Employed representative of the insurance company who is responsible for handling insurance claims as they are received from patients and medical practices and who determines the dollar amount of a claim or debt. 2. In industrial cases, a representative of the insurer who investigates, evaluates, and negotiates the patient’s insurance claim and acts for the company in the settlement of claims. Adjusters may be employees of the insurance company or an individual operating independently and hired by a company to adjust a particular loss. Also called claims administrator, claims examiner, claims processor, claim representative, or health insurance adjuster.
*****
A person who may act either on behalf of the insurance company or the insured in the settling of a claim. Employee adjusters work for an insurer, while independent adjusters represent the insurance company on a fee basis and public adjusters represent the insured on a fee basis.
*******
Individual at the workers’ compensation insurance carrier overseeing an industrial case, authorizing diagnostic testing and medical treatment, and communicating with the provider of medical care.
*******
One who settles insurance claims. This typically involves investigation of the loss and a determination of the extent of coverage. In the context of first-party (e.g., property) insurance, the adjuster negotiates a settlement with the insured. In liability insurance, the adjuster coordinates the insured’s defense and participates in settlement negotiations. Adjusters may be employees of the insurer (staff adjusters) or of independent adjusting bureaus (independent adjusters) that represent insurers and self-insureds on a contract basis. Public adjusters are consultants who specialize in assisting insureds in presenting claims to insurance companies in a manner that will maximize their recovery.
******
Person responsible for the evaluation and settlement of an insured claim. An adjuster may be an employee of an Insurer, or an individual operating independently and engaged by an Insurer or insured to adjust a particular loss or claim. Insurance Company adjuster -Adjuster who is a full time employee of an Insurer, adjusting only losses and claims covered by that Insurer. Public adjuster -Independent adjuster hired by any Insurer or insured to represent that client’s interest in the adjustment of a specific, often complex insured loss or claim.Adjuster Average : An adjuster who specializes in adjusting marine losses.
******
See LOSS ADJUSTER.
Adjuster (loss)
an independent professional individual who is engaged by insurers to settle large or complex claims.
Adjusters
companies use adjusters to negotiate settlements of claims for damages by a policyholder. Adjusters fall into three categories: employees of insurance companies, public adjusters, and independent adjusters. adjusters are employed by insurance companies to evaluate losses and settle claims with policyholders. The adjuster represents the insurance company and seeks to minimize damage costs for the company while maintaining a positive relationship with the insured. The adjuster also gathers information from the insured and collects evidence of the loss in case of future legal actionor intervention by an attorney. Another type of adjuster is the public adjuster. Public adjusters are retained by the insured to negotiate with insurance company. Public adjusters work on behalf of the policyholder and seek to maximize the claim payout for the insured. For his or her services, public adjusters normally receive a portion of the claims settlement.The third type of adjuster is the independent adjuster. Independent adjusters are independent contractors and for multiple insurance companies. Their services are retained by insurance companies who do not employ adjusters, do not have adjusters in a particular geographic area, or need additional adjusters for a disaster.
Adjusting
The process of settling loss with or by an Insurance Buyer.
*****
US: The process of investigating and settling losses with or by an insurance carrier.
Adjustment
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.
******
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.
******
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.
****
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.
Adjustment Bureau
An organization that contracts with insurers to provide loss settlement services on behalf of those insurers.
******
Organization for adjusting insurance claims that is supported by insurers using the bureau’s services.