Agreements between insurers involved in the same incidents or losses to settle matters between them by way of a prescribed formula rather than resort to costly and regular litigation. The knock-for-knock agreement has been replaced by the memorandum of agreement.
Insurance Encyclopedia
Claims Handling Expense Provision
A provision or reserve to cover the estimated expenses of settling all claims, reported and unreported, outstanding at the accounting date; often known as Unallocated Loss Adjustment Expenses (ULAE). It excludes external expenses and those which can be directly attributed to the settlement of individual known expenses (such as legal expenses and claims assessors’ fees) as these are commonly identified in statistics as a form of claim payment and thus provided for within the provision or reserve for outstanding claims, known as Allocated Loss Adjustment Expenses (ALAE). It usually includes expenses that are not directly attributable to specific claims department staff and premises cost allocations.
Claims handling expenses
expenses incurred in negotiating and settling claims, including the direct expenses of the claims department (loss adjusters’ fees, court fees, etc.) and any part of general administration expenses associated with the claims function.
Claims Incurred
Claims that have occurred, irrespective of whether or not they have been reported to the insurer. (01) In the context of a particular year of original, all claims (whether reported or not) arising out of incidents in that year; (02) In the context of a revenue account under one year accounting the amounts paid on claims during the year plus the increase in the total reserves for outstanding claims over the year. (a decrease in reserves being treated as a negative increase). (03) In the context of three year accounting, all claims (whether reported or not) arising from the underwriting year of cover as determined at the time of closure of the account. Typically, incurred claim values include some expenses of payment claims such as those allocated to individual claims.
Claims inquiry form (CIF)
A Medi-Cal form used for tracing a claim, resubmitting a claim after a denial, or when requesting an adjustment for underpaid or overpaid claims.
Claims made
a term referring to liability policies covering all claims notified in the policy period, regardless of the time of the occurrence (contrast losses occurring).
Claims made basis liability coverage (Liability Insurance)
Under this type of coverage, claims submitted during the term of a liability policy must be paid, even if the event causing the claim did not occur during the term.
Claims Made Basis Reinsurance Agreements
The provision in a reinsurance contract that affords coverage for claims that occur and are made during the contract term, for losses that occur on or after the retroactive date specified in the contract. Claims reported during the term of the reinsurance agreement are therefore covered regardless of when they occurred. A claims made agreement does not cover claims reported after the term of the reinsurance contract unless the reporting period is extended by special agreement.
Claims Made Coverage
The provision in a policy of insurance that affords coverage only for claims that are made during the term of the policy for losses that occur on or after the retroactive date specified in the policy. A claims made policy is said to “cut-off the tail” on liability business by not covering claims reported after the term of the insurance policy unless the reporting period is extended by special agreement. (Also see Occurrence Coverage).
Claims made policy
A policy which only pays claims that are notified to the insurer during a specified period.