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Flue gas explosion

Explosion of gases in boiler flues (i.e. pipes). It is the result of ignition and not of the sudden release of internal pressure as in the case of a steam boiler explosion. The boiler and pressure plant policy can be extended to cover the explosion of gas in the furnaces or flues of the plant. Cover follows the terms of the boiler policy and therefore covers self-damage and the consequences thereof in terms of surrounding property and third party risks.

Flying risks

Term used by personal accident insurers in connection with the risk of accidental bodily injury arising from flying either as a member of the crew of an aircraft or as a fare-paying passenger on a scheduled flight. The former risk is underwritten in the aviation department and the latter is covered under conventional personal accident insurance.

focused medical review (FMR)

Analysis of national data by Centers for Medicare and Medicaid Services (CMS) of Medicare insurance claims to locate the greatest risk of inappropriate program payment. This gathering of data is done to reduce the number of noncovered claims or unnecessary services. CMS provides its findings to the fiscal intermediaries who develop their review policies to identify abuse and overutilization of services.

Focused studies

State-required studies that examine a specific aspect of health care (such as prenatal care) for a defined point in time. These projects are usually based on information extracted from medical records or managed care organizations’ data (enrollment files, encounter or claims data). State staff, External Quality Review Organization (EQRO) staff, managed care organization (MCO) staff, or more than one of these entities may perform such studies at the discretion of the state.

Follow the Fortunes

REINSURANCE: A clause in a reinsurance treaty whereby the reinsurer undertakes to follow the fortunes of the insurer. Thus, if the insurer settles a claim ex-gratia, the reinsurer may be expected not to deny liability for his share in the settlement.
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UK: a clause in reinsurance contracts under which the reinsurer is committed to following the decisions on claims made by the direct insurer.
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UK:A proportional reinsurance principle, not always stated in the policy, under which the reinsurer shares the same fate as the cedant in regard to the underwriting and contractual risks. It does not include the cedant’s commercial risk, i.e. total business risk or ex-gratia payments unless agreed or allowed under any relevant clause.
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A provision in reinsurance agreements, not always specifically identified as such, in which it is agreed that the reinsurer is bound to the same fate as the cedant with respect to risks covered.
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REINSURANCE: Follow the fortunes generally provides that a reinsurer must follow the underwriting fortunes of its reinsured and, therefore, is bound by the decisions of its reinsured in the absence of fraud, collusion or bad faith. It requires a reinsurer to accept a reinsured’s good faith, business-like reasonable decision that a particular risk is covered by the terms of the underlying policy. The term is often used interchangeably with follow the settlements, and there may be overlap between the affect of follow the fortunes and follow the settlements when the “risk” is what generated the loss. Follow the fortunes is focused on “risk” determination, not necessarily tied to a loss settlement.
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REFERENCE: See: “Reinsurance, Follow the Fortunes.”