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Deleted claim

Insurance claim that has been canceled, deleted, or voided by a Medicare fiscal intermediary for the following reasons: CMS-1500 (08-05) or current CMS-1450 is not used, itemized charges are not provided, more than six line items are submitted on the CMS-1500 (08-05) claim form, patient’s address is missing, internal clerical error was made, Certificate of Medical Necessity (CMN) was not with the Part B claim or was incomplete or invalid, and name of the store is not on the receipt that includes the price of the item.

Deliberate concealment

1. The deliberate concealment of a material fact by a proposer is a fraudulent breach of the utmost good faith. 2. Limitation Act 1980, s.2, defines the term as ‘the deliberate commission of a breach of duty in circumstances in which it is unlikely to be discovered for some time. The six-year limitation period runs from time of discovery of deliberate concealment with no long-stop provision. Professional negligence errors could go undiscovered for years, but the House of Lords rejected the view that an act of negligence could amount to deliberate concealment (Cave v. Robinson Jarvis & Rolf (2002)). A contrary decision would have meant open-ended liability for negligent professionals.

Deliberate Damage Damages for Pollution Hazard Clause

This covers loss of or damage to the property insured caused by Governmental or Civil Authorities for the public welfare or to mitigate a pollution hazard or other civil disaster or threat thereof, provided that the accident or occurrence creating the situation which required such Government action would have resulted in a recoverable claim under the policy, if the property assured would have sustained physical loss of damage as a direct result of such accident or occurrence.