Under the Medicare program, economic restrictions for outpatient rehabilitation services became effective after July 1, 2003. These affect physical therapy, occupational therapy, and speech-language pathology insurance claims submitted by physicians, nurse practitioners, clinical nurse specialists, physician’s assistants, physical therapists, occupational therapists, and speech-language pathologists.
Insurance Encyclopedia
Financial Loss
Insurance of legal liability for financial loss not involving bodily injury or loss of or damage to property.
Financial loss cover
Insures legal liability for (pure) financial loss by extending public and/or product liability cover as opposed to financial loss flowing from physical injury or damage to person or property. The extension is claims-made, subject to an excess or co-insurance and has a separate annual aggregate limit of indemnity. Liquidated damages are excluded. The financial loss extension under product liability cover includes the efficacy risk. The main insuring clause of the public liability policy covers financial loss following accidental obstruction, accidental nuisance, etc.
Financial Ombudsman Service
an independent organisation set up under the Financial Services and Markets Act 2000, covering firms and activities regulated by the Financial Services Authority, which replaced a number of former complaints handling schemes.
Financial Ombudsman Service (FOS)
A ‘free to consumers’ dispute resolution service with three divisions: banking and loans, insurance and investment. Firms are bound when the Ombudsman makes decisions in favour of the consumer up to £100,000 plus interest, above which the Ombudsman may recommend full payment. Decisions are not binding on the consumer. FOS can also direct firms to take any steps deemed just. The FOS is funded by a general levy on all firms covered by its service. Membership is compulsory for all authorised firms. The Pensions Ombudsman operates separately.
Financial planning
Investment service that reviews an individual’s or family’s economic picture and then determines a course of action to obtain financial goals within a certain period of time. This can include budgeting, planned accumulation of income through various investments, risk analysis, minimizing taxes, and estate planning. Also called total-needs programming .
Financial Planning Certificate (FPC)
CII qualification accepted by the FSA as proof that a candidate has the level of knowledge required to become a financial adviser. Holders are eligible to join the Society of Financial Advisers.
Financial policy statement
Document signed by patients stating liability in paying for medical services received. This protects the physician’s right to collect payment for professional services provided to patients.
Financial promotion
Regime introduced under FSMA, s.21. A financial promotion is the communication, in the course of business, of an invitation or inducement to engage in an investment activity. It is unlawful if it is not made by an authorised person or has not been approved by such a person. ‘Communication’ embraces all forms of communication in place of previous separate rules for insurance advertisement, unsolicited calls, etc.
Financial quota share
A form of reinsurance that enables a cedant to increase its statutory surplus by the amount of the ceding commission in the reinsured unearned premium reserve. Surplus relief arises because statutory accounting requires insurers and reinsurers to charge immediately all acquisition costs to the accounting period in which the business is written, even when the premium is unearned at the end of the period. Referred to as pre-paid acquisition costs in the unearned premium reserve, or the equity in the unearned premium reserve.
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UK: Cedant and reinsurer share the risk in agreed proportions. The cover applies to future and current years. Reinsurance commission is on a sliding scale starting with 30 per cent commission for a loss ratio of 70 per cent. For every loss ratio change of 1 per cent, the commission changes by 1 per cent. A commission that increases with the loss ratio helps the cedant when it is most needed. If the cedant has an expense ratio of 30 per cent then the cedant will have an underwriting result of zero regardless of the actual loss ratio for the year. This improves the solvency margin.