If the insured has committed a breach of condition or warranty, the claim becomes non-standard. In a strict legal sense, these claims are not payable. But Insurers do not wish to rely on technicalities. Hence, settlement of these claims is considered subject to certain rules and regulations framed by Insurers. Usually. an extra premium is charged, the Policy rectified and payment made, depending upon the nature of the breach.
Tag: RAW
Claim Payment, Standard claims
These are claims which fall clearly within the scope of the Policy. Settlement of these claims presents no difficulty.
Claim provision
A clause outlining the process of submitting and administrating claims.
Claim Ratio
The ratio of paid or incurred claims to earned premiums over a defined period. Alternatively it may be the ratio of paid or incurred claims on business written in an underwriting period to the written premiums for that period. It may be either net or gross of reinsurance. Also, often called the loss ratio.
Claim reference number (CRN)
Number assigned to a Medicare insurance claim for processing by the fiscal intermediary.
Claim report
A report compiled by an agent detailing the specifics of a claim.
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A report filed by a person setting forth the facts of a claim.
Claim representative
See: adjuster.
Claim reserve
In insurance, an estimate of the amount of money to set aside that will be needed to pay insurance claims. The claim department gathers information during the course of handling the claim to obtain this estimate. These data may include the extent to which the claim is covered by the policy, the effect of previously paid claims on the amount of coverage available to pay a current claim, and the effect of any applicable reinsurance coverage on the claim.
Claim Run-Off Analysis
A tabulation showing the speed of settlement for cohorts of claims. Also, called a claims delay table. The analysis may be in terms of claim numbers or claim amounts. It is often presented as an intermediate step in a chain ladder method projection.
Claim services only (CSO) agreement
Type of contract in which the insurance company provides claims processing and bases its fee on the number of processed claims.