Language providing a means of resolving differences between the reinsurer and the reinsured without litigation. Usually, each party appoints and arbiter. The two thus appointed select a third arbiter, or umpire, and a majority decision of the three becomes binding on the parties to the arbitration proceedings.
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UK: A policy condition that commits the insured and the insurer to use arbitration as a means of settling disputes as to the amount of a claim liability otherwise being admitted. The clause does not appear in liability policies.
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A provision found in reinsurance contracts whereby the parties agree to submit their disputes to a non-judicial adjudication panel rather than a court of law, generally subject to selection criteria and procedures set out in the clause. The arbitration panel produces an award, ultimately enforceable by a court of law, binding both parties.
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The clause in an insurance policy that spells out how disagreements over a claim are settled. Generally, each party chooses an arbiter the arbiters agree on an umpire and these three agree on a resolution of the dispute. Under some clauses, an unsatisfied party may have the option to seek judicial relief following an arbitration finding.
A clause stating that in case of a disagreement regarding the amount of a claim, each party (the insured and the insurer) will appoint an appraiser, who will then select an mediator. An amount will then be determined by at least two of these three, and this settlement will be binding.
On payment of additional premium the expenses incurred towards Architects, Surveyors and Consulting/Engineers for plans, specification tenders, quantities and services in connection with the superintendence of the reinstatement for the building, machinery, accessories and equipment insured under the policy up to 7.5% of the adjusted loss is covered. However, this does not include any cost in connection with the preparation of the insured’s claim or estimate of loss in the event of damage by insured perils.
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the expenses incurred towards Architects, Surveyors and Consulting/Engineers for plans, specification tenders, quantities and services in connection with the superintendence of the reinstatement for the building, machinery, accessories and equipment insured under the policy up to 3% of the adjusted loss is covered. However, this does not include any cost in connection with the preparation of the insured’s claim or estimate of loss in the event of damage by insured perils.
These fees are covered when relating to insured property damage either by making due allowance in the sum insured or by a special item. The fees are payable for plans, specifications, etc., and general supervision of rebuilding in the event of fire or other insured perils. Increasing the buildings sum insured by 12.5 per cent and the machinery sum insured by 7.5 per cent often provides cover, but insureds with very large sums insured may insure the fees on a first loss basis. Fees paid by the insured for preparing the claim are not covered.
Local (city or county) organization, funded under the federal Older Americans Act, that plans and coordinates various social and health service programs for persons 60 years of age or more. These needs include adult day care, skilled nursing care/therapy, transportation, personal care, respite care, and meals. The network of AAA offices consists of more than 600 approved agencies.
Simultaneous or rapid successive ignition of a number of individual fires that are spaced to support each other and spread the fire quickly.
In fire investigation parlance, the place where a fire started.
Software program created by the Office of the Inspector General (OIG) that helps to access provider claims data and to limit the need for the OIG to send multiple requests to insurance carriers for claims information. It can assist in detection of aberrant billing practices of providers.
See: Association of Registered Health Care Professionals (ARHCP).
In workers’ compensation cases, a criterion for determining liability, or whether a claim is or is not compensable. AOE refers to how the activity of work led to the injury in question. It is one of the legal tests that must be met for a medical condition to be covered by workers’ compensation insurance. COE refers to how the activity the employee was engaged in at the time of injury must grow out, or be incidental to, the employment.