See: adjuster or claims processor.
Insurance Encyclopedia
Claims advice clause
See: Claims Cooperation Clause.
Claims Analysis
In a situation of deteriorating claim results, the claim database need to be analyzed as to whether there is a pattern in the losses. The report may indicate (i) unusual frequency viz., more number of claims than were estimated, or (ii)more severity i.e., more amounts to be paid out than was the expected norms.
Claims and eligibility real-time software (CERTS)
Computer software that allows Medi-Cal providers to electronically verify recipient eligibility, clear share of cost liability, reserve Medi-Services, perform Family PACT (planning, access, care, treatment) client eligibility transactions, and submit pharmacy or CMS-1500 claims using a personal computer.
Claims assistance professional (CAP)
Practitioner who works for the consumer and helps patients organize, complete, file, and negotiate health insurance claims of all types to obtain maximum benefits, as well as tell patients what checks to write to providers to eliminate overpayment.
Claims Closed
Claims on which no further payments are anticipated by the insurer.
Claims Conciliation Committees for Motor
(Settlement of Motor Accident Related Cases through alternative forum) : The legal Services Authorities Act, 1987 provides for organizing of Lok Adalat by the Legal Services Committees at various levels to determine and arrive at a compromise or settlement between parties to a dispute in respect of any case pending before any court for which the Lok Adalat is organized. The Insurance industry has also established Claims Conciliation Committees and Jald Rahat Yojana which enables negotiated settlements. The award by these would not carry any interest. Thus, the settlement through the above enable the companies to save the interest and administration charges.
Claims condition
A condition setting out what the insured has to do in the event of a claim. It covers notice of loss, assistance to the insurer and proofs of loss, and in the case of liability policies there is a control of proceedings clause and a non-admission of liability clause.
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A condition in many types of insurance policy setting out the insured’s duties in the event of a claim.
Claims Cooperation Clause
A clause in a reinsurance treaty providing for early notice of possible claims and cooperation in the defence of claim that may affect the reinsurer and stipulating that the insurers shall not admit liability for such a claim without the reinsurer’s consent.
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UK: Requires the reinsured to give prompt or immediate notice to the reinsurer on becoming aware of a loss likely to involve the reinsurer. The reinsured must at all times cooperate with the reinsurer in the negotiation and settlement of the loss. In liability claims the reinsured must not admit liability without the reinsurer’s consent.
Claims Cooperation Clause, Reinsurance
Refer: “Reinsurance, Claims Cooperation Clause.”