Appeal by a physician to a third-party payer for medical services not yet provided to the patient. Also see appeal, postservice appeal, and expedited appeal.
Insurance Encyclopedia
Pressure plant
Plant designed to contain gas or vapour, such as steam, under pressure. The majority of items have to be inspected under statutory provisions. A steam boiler is an example. The principal risk is explosion and/or collapse.
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Any unfired closed container under steam, gas or fluid pressure.
Pressure Systems Safety Regulations 2000
The aim is to prevent injury from the hazard of stored energy due to system failure. Pressure system users/owners must show that they know the safe operating limits, mainly pressure and temperature, of their pressure systems, and that the systems are safe under those conditions. They need to: (a) have a suitable written scheme of examination before the system is operated; (b) ensure that the pressure system is examined in accordance with the written scheme; (c) ensure that the scheme is certified by a competent person.
Pressure vessel
In boiler and machinery insurance, a type of container designed to hold liquids or gasses under pressure. Types are categorized as fired (such as a boiler) and unfired (such as an oxygen or hydrogen tank).
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A container designed to hold steam, gas or other vapor under pressure.
Presumption
Legal assumption that a fact exists.
Presumption of agency
An agency relationship that is legally enforceable, although no agreement has been signed. This presumption of a relationship exists when the insurer acts in a way that gives the idea that someone is his or her agent before the agent has truly been accepted by them; for example, by providing that person with materials bearing the company logo for distribution. The insurer may later be legally liable for that person’s acts.
Presumptive disability
Assumption of total disability when an insured is considered totally disabled (blindness, loss of hearing, speech, or limbs). The insurance company may pay a lump sum in addition to monthly payments for a maximum benefit period.
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A disability involving loss of sight, hearing, speech or any two limbs, which is presumed to be a permanent and total disability. In such cases, the insurer does not require the insured to submit to periodic medical examinations to prove continuing disability.
Presumptive disability (Health Insurance)
A disability assumed to be permanent and total; for example, a disability that entails loss of vision or hearing or the loss of two or more limbs. Policyholders having this type of disability do not have to repeatedly undergo medical examinations to show that their disability continues to impair them.
presumptive eligibility (PE)
A federal/state program designed to ease access to prenatal care offering immediate temporary coverage to low-income women pending a formal Medi-Cal application.
Presumptive father
Possible biological father of a child but not necessarily the legal parent or the confirmed father. Also referred to as alleged father.