Individual who appeals a claim decision.

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The person making an appeal to the higher court.

1. Person applying for insurance coverage. 2. Practitioner, provider, or supplier that is applying for a Medicare national provider number.

1. Request form to be completed with pertinent data when applying for employment. This may be done in person, by telephone, or on the Internet. 2. Statement of information form that is completed and signed by an individual to obtain insurance coverage. The prospective insured is required to undergo a medical examination. The information supplied on this form and the results of the medical examination assist the insurance company in making a decision whether to accept or reject the risk. The application is usually made part of the policy.

In workers’ compensation cases, the process of determining if some portion of an injured worker’s permanent disability is due to a cause other than the current injury. This is an estimate of the degree of either occupational or nonoccupational factors that may have contributed to the impairment. Apportionment applies only to permanent disability.

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The method of dividing a loss among insurers in the same proportions as their participation when two or more companies cover the same loss.

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The method of dividing a loss among multiple insurers that cover the same loss.

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A method of dividing a claim among more than one insurance company.

Professional evaluation to determine a property’s insurable value or the amount of a loss.

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An assessment to determine the value of an item or property to obtain adequate insurance coverage or determine replacement value.

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A determination of the value of property for the purposes of determining the proper amount of insurance to be bought or in adjusting a loss. In event of a loss and the carrier and insured disagree on the amount of the loss, either may request an appraisal. Each party then selects an appraiser, and the appraisers select an umpire. An agreement between two of the three determines settlement.

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Survey or examination of real or personal property to determine its value. In real estate transactions, the appraisal normally measures the market value of the property. In Insurance, appraisals normally measure the actual cash value, replacement cost, or other insurable value of property. Refer “Value, actual cash value,” and “Replacement Cost.”

Term used by some health plans to define the proper setting of medical care for which the expected health benefits exceeds the expected negative outcome by sufficient margin to justify treatment. Also referred to as appropriateness of care .

Nineteen criteria for admission under the prospective payment system, separated into two categories: severity of illness and intensity of illness. To allow a patient admission to an acute care facility, one criterion from each category must be met.