The total amount which the Insurance Company will pay under the terms of a liability Policy for claims which may arise from acts of independent contractors. This is frequent found in the construction field.
Tag: RAW
Aggregate retention
The aggregate amount of risk retained by the insured, i.e. losses up to the level that are selfinsured rather than assumed by an insurer
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An additional retention kept net by the cedant of losses otherwise recoverable from the reinsurer. There are two retentions in a program having an aggregate retention. The first retention applies to each risk or occurrence. The second, or aggregate retention, applies to amounts that would normally be recoverable from the reinsurer. Only after the aggregate retention is exceeded can the cedant recover from the reinsurer.
Aggregate stop loss
Agreement in a managed care plan to relieve the amount of liability for insurance claims that are in excess of the amount anticipated for the contract year. Also see stop loss.
Aggregate stop loss insurance
Insurance coverage that becomes effective when an employer who has self-insurance has its total group medical insurance claims reach a specific threshold chosen by the employer. This threshold is a percentage of its yearly predicted group health claim costs.
Aggregated Diagnosis Groups (ADGs)
Under a system developed by Johns Hopkins University called adjusted clinical groups (ACGs) , ACGs are a comprehensive family of measurement tools designed to help explain and predict how health care resources are delivered and consumed. ACGs are based on building blocks called aggregated diagnosis groups (ADGs). ADGs are a grouping of diagnosis codes that are similar in terms of severity and likelihood of persistence of the health condition over time. There are two categories of ADGs, ambulatory diagnostic groups–major diagnostic category (ADG-MDC) and ambulatory diagnostic groups–hospital dominant (ADG-HosDom).
Aggregation clause
See: Claims Series Clause.
Aging accounts receivable (A/R) report
Document used to determine outstanding balances from each patient’s account showing status of 30, 60, 90, or 120 days from the date of insurance claim submission. It can be generated by using the date an insurance claim was filed to assess the age of the claim in days. Sometimes referred to as an aging report.
Aging report
1. Document that reports the status of insurance claims to the provider of the medical services and identifies individual transactions that need to be followed up (e.g., appeal or resubmit a corrected a claim). 2. See aging accounts receivable (A/R) report.
Agony of the moment / the principle of alternative danger
Where the defendant pleads contributory negligence, the claimant’s contribution to the accident may be excused if he acted ‘in the agony of the moment’. In Jones v. Boyce (1816) the claimant, fearing that a fast-driven coach would overturn, broke his leg when jumping for safety. The coach did not overturn but his action was justified. The principle of ‘alternative danger’ applies to emergencies generally and may apply even when property is under threat.
Agreed Amount
An agreed amount endorsement waives the coinsurance clause on the insured property. Thus, there is no coinsurance penalty at the time of the claim. While there is no allowance for depreciation, there is also usually no allowance forappreciation. This endorsement is often used for property that cannot be replaced with like kind and quality. For example, very old homes or historical buildings are often insured under an agreed amount. This is also known as a “valued policy.” (See Valued Policy).