Under the Medicaid program, recovery of financial assistance from certain deceased Medicaid recipients’ estates up to the amount spent by the state for all Medicaid services (e.g., nursing facilities, intermediate care facilities for mentally retarded, home and community-based services, hospitals, prescription drug services). Federal law mandates that each state have an estate recovery program.
Insurance Encyclopedia
Estate tax (Estate)
A tax based on the worth of the deceased’s estate, which is due to the federal government.
Estimated future liability
In the Lloyd’s annual solvency test on an open year of account, an estimate has to be made of the provision required by a syndicate to cover claims and other adjustments likely to arise from risks accepted during that year. The basis for calculation is laid down in the instructions for the guidance for auditors.
estimated length of stay (ELOS)
Average number of days of hospitalization required for a specific illness or procedure. These data are based on previous histories of patients who have been hospitalized for the same condition or procedure.
Estimated maximum loss (EML)
UK: an estimate of the monetary loss which could be sustained by insurers on a single risk as a result of a single fire or explosion considered by the underwriter to be within the realms of possibility (an expression used only in fire, explosion and material damage policies).
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An expression used in Fire, explosion and material damage policies only. An estimate of the monetary loss which could be sustained by insurers on a single risk as a result of a single fire or explosion considered by the underwriter to be within the realms of possibility.
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UK: Estimate of the maximum probable loss developing from an insured peril. It takes account of factors that will lessen the risk, e.g. fire protection, and factors that will increase the risk, e.g. combustible materials. It ignores coincidences such as all protective devices failing simultaneously with serious human error and other untoward circumstances. Insurers use EML (also called probable maximum loss) when fixing their retention on individual risks.
Estimated premium
A projected premium amount that is later adjusted.
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A provisional premium subject to final adjustment on ascertainment of the necessary facts. For example, in Workers Compensation Insurance an estimated premium is based on estimated payrolls for the coming year. At the end of the year, final payrolls are determined and the final premium is computed.
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See: Deposit premium.
Estimated Probable (or Possible) Maximum (EPML) for Loss
The worst loss that is likely to occur because of a single event.
Estoppel
The legal doctrine that a party may be precluded from denying that certain rights exist if, by behavior or implication that such rights did, in fact, exist, another party has acted upon this information to his or her detriment.
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The legal principle whereby a person loss the right to deny that a certain condition exists by virtue of his having acted in such a way as to persuade others that the condition does exist. For example, if an insurer allow an insured to violate one of the conditions of the policy, he cannot at a later date void the policy because the condition was violated. The insurer has acted in such a way as to lead the insured to believe that the violation did not void the coverage.
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UK: The rule of evidence or doctrine of law that precludes a person from denying the truth of some statement formerly made by him, or the existence of facts, which he has by words or conduct led others to believe. Where an insurer continues to deal with a claim despite knowing of a breach giving him the right of avoidance, he may be estopped from denying liability (Evans v. Employers Mutual (1936)).
Estoppel (also known as Non-Waiver Clause)
A provision in a reinsurance agreement which reserves to the reinsurer every right under the reinsurance agreement not previously waived, and to the ceding company every right which had not been forfeited.
Estoppel (Legal Terminology)
A legal term referring to an individual losing the ability to deny the existence of a condition by virtue of his or her behavior. For example, if a health insurer has paid out several claims to an individual with a certain disease in the past, he or she may be estopped from later claiming the disease is not covered, because the insured was reasonably led to believe it was covered.