A professional indemnity clause whereby the insurer agrees to pay any claim without requiring the insured to contest it unless a QC advises that it can probably be successfully defended.
Tag: RAW
Query
Request from an insurance company for additional information about a patient.
Question of liability admissible for Disputes
Disputes relating to question liability are to be settled through litigation. for example, if the Insurers contend that the loss is not payable because it is not covered under the Policy the matter has to be decided by a court of law. Against, if the Insurers refuse to pay the claim on the ground that the Policy is void because it was obtained through fraudulent non-disclosure of material facts (breach of legal duty of ‘utmost good faith’) the issue has to be resolved through litigation.
Questionable covered procedures
Under the Medicare program, medical procedures that may be a benefit depending on the medical situation. When a procedure listed in Medicare’s Outpatient Code Editor is billed, the insurance company must conduct a medical review of the claim to make a decision on payment. Formerly called development needed procedures .