System of making hospital payments through a formal agreement with an insurance payer to accept for a patient or group of patients a discounted amount instead of actual fees as full payment for medical services.
Insurance Encyclopedia
Contractual allowance
Legal agreement between a provider and third-party payers such as Medicare or Medicaid to provide medical services for a predetermined fee; often used in a discounted fee arrangement. Also called purchase discount. See also disallowance.
Contractual Duty
In accident Insurance, proposal forms are always used. These forms are designed to obtain all material information about the subject matter of Insurance. The form contains a declaration. The proposer has to declare that he has answered all the questions truly and correctly, and that he agrees that the proposal and declaration shall be the basis of the contract between him and the Insurers. The legal effect of this declaration is that the Insurers can avoid the contract if any answer is inaccurate or incorrect even if the answer is not material to the risk. This means that the answers are required to be fully and absolutely true and correct. This is called the contractual duty of utmost good faith which is far more strict then the common law duty.
Contractual Liability
“Contractual liability is covered under the Commercial General Liability Policy (CGL) subject to some limitations. The coverage is necessary because many business firms enter into contracts with others where they agree to assume the tort liability of someone else. A common such agreement is a “”hold harmless agreement”” between a tenant and a landlord. Here the tenant agrees to hold the landlord harmless for any acts of the tenant, the tenant’s visitor, employees, or independent contractors.For example, a tenant hires a plumber to install new bathroom fixtures in his office restroom. Several days later, a pipe ruptures and floods the office below. The tenant in the lower office sues the landlord for negligence in maintenance of the building’s plumbing. Further investigation leads to the fact that it was the negligence of the plumber in installing the new fixtures. The hold harmless agreement states that the tenant will reimburse the landlord for any acts of the tenant’s independent contractors. While the plumber may ultimately be the one who pays the damages, the landlord is not concerned with this problem. The tenant pays the damages to the office below him and the landlord is not involved. Thus, the landlord has transferred the risk of having tenants in his building to each of his tenants by .means of a hold harmless
The Commercial General Liability excludes the assumption of liability in a contract with two exceptions:
Liability is provided by the insured if the liability would be imposed without any contract or agreement, and,
Liability that is assumed under an “”insured contract.””
Insured contracts include, but are not limited to:
Lease of premises (but not for a promise to pay fire damage to a premises you rent or occupy)
Sidetrack agreement Easement or license agreement (not for construction or demolition on or within 50 feet of a railroad) Indemnify a municipality (except for work for the municipality)
H Elevator maintenance agreement
Broad form contractual coverage may be added to the Commercial General Liability policy that covers the insured for any tort liability the insured assumes for someone else.”
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Legal liability assumed under contract. See Also: “Liability, contractual liability.”
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UK: Liability that arises as a result of a contract, as opposed to liability, imposed by common law or statute. Liability policies exclude liability for liquidated damages as, unlike unliquidated damages, they are agreed under contract.
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Liability that does not arise by way of negligence but by assumption under contract. For example, in certain leases, a tenant may assume a landlord’s liability to others for unsafe conditions on the premises. Some such assumptions are covered automatically under the Commercial General Liability form.
Contractual Liability for Liability Insurance
Insurance against loss under a contractual liability agreement.
Contractual liability insurance
Insurance that covers liability of the insured assumed in a contract. Under the standard commercial general liability (CGL) policy, such coverage is limited to liability assumed in any of a number of specifically defined insured contracts or to liability that the insured would have even in the absence of the contract.
Contractual liability insurance (Liability)
Insurance that covers the insured against liabilities they are responsible for as stated in a written contract.
Contractual Saving
Saving where the decision to save was made previously and binds current saving decisions.
Contractual Subrogation
Subrogation which is created or modified by a contractual agreement between the Subrogee and the Subrogor in contrast to equitable subrogation which is recognized by common law and does not need to be made explicit in a contract.Equitable Subrogation : Right, recognized by common law, of a third party. (such as an Insurer) who has met an obligation for which another is primarily responsible (such as a tort feasor) to seek repayment from the party primarily concerned.Waiver of Subrogation : Voluntary relinquishment, before a loss occurs by a Subrogee (Insurer) of rights which after a loss, it may become subrogated. Under an Insurance Policy covering the interests of two or more parties who may later become involved in a legal dispute such as Insurance covering both the builder and owner of a structure in progress) the Insurer frequently waives, with respect to each insured. the rights to which it may become subrogated because of the wrong-doing of another insured.Subrogation Clause : A clause giving an insurer the right to pursue any course of action, in its own name or the name of a policy owner, against a third party who is liable for a loss which has been paid by the insurer. One of its purposes is to make sure that an insured does not make any profit from his insurance. This clause prevent him from collecting from both his insurer and a third party. It is never a part of a Life Insurance Policy.Subrogation Form : A standard form used in Marine insurance by signing which the insured when a claim has arisen, acknowledges the insurer’s right to claim from a third party in the name of the insured.
Contrast material
See: contrast medium.