A.M. Best rating

 

An evaluation published by A.M. Best Company of all life, property, and casualty insurers domiciled in the United States and U.S. branches of foreign property insurer groups active in the United States. The ratings are frequently used to assess insurance companies’ claims-paying ability, suitability, service record, and financial stability. Standard & Poor’s, Conning & Company, Fitch, and Moody’s are some of the other rating agencies.

A.T.

American Terms is a term used to differentiate between the conditions of American policies from those of other nations, principally England.

A1

MARINE: This is the highest rating given by Lloyd’s Register to a ship for its seaworthiness. It is also known as “First Class.” The letter “A” indicates that the ship’s hull is strong and safe on the water, and the letter “1” indicates that its rigging and gear are in good condition.

USA MEDICAL: HCPCS Level II modifier for wound dressing that can be used with CPT or HCPCS Level II codes. The use of this modifier has an impact on Medicare payment.

ABI

Automated Brokerage Interface (ABI): A system that allows U.S. Customs Brokers with computer capabilities and customs certification to transmit and exchange customs entries and other information, allowing for the timely release of imported cargo.

Association of British Insurers (ABI): The principal representative body for companies, including some foreign companies, authorised to carry on insurance business in the UK.

Absolute Liability

A legal doctrine that states that one can be held liable even if negligence has not been proven, as in the case of worker’s compensation.

Liability that is triggered automatically when an egregious activity is performed, when the performance of an act is so dangerous that it is enough to trigger liability regardless of the degree of negligence. e.g:

  • Triggering explosives
  • Sending workers aloft for construction or repair at great heights.

Also called  strict liability.

 

Actual Cash Value (ACV)

1) The cost of replacing or restoring property at prices prevailing at the time and place of the loss, less depreciation, however caused; 2) replacement cost minus depreciation.
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Method for placing value on property at the time of its loss or damage. ACV is usually the cost less depreciation. The market value of the property may help determine its actual cash value.

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An amount equivalent to the fair market value of the stolen or damaged property immediately preceding the loss. For real property, this amount can be based on a determination of the fair market value of the property before and after the loss. For vehicles, this amount can be determined by local area private party sales and dealer quotations for comparable vehicles.******Medical: Flexible valuation standard, most often defined as the current replacement of an item of property minus its accumulated depreciation.Insurance provision in which the policy owner receives a dollar amount that is equal to the replacement value of damaged property minus the depreciation.
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Similar to market value; this amount is the cost of replacing damaged or destroyed items with new property. Consideration is given to the condition and depreciation of the item.
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A method for placing value on property as of the time of its loss or damage. Actual cash value may be determined by market value (the current price for a like item in the same general condition) or replacement cost new less use depreciation (the cost of the same item branch new minus the insured’s contribution to pay for the added life expectancy of the property new property). The insured may generally select whichever method is more favorable. Contrast with replacement cost.
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“Insurance companies use two primary methods of calthe amount of payment given to a policyholder for insured losses to both real and personal property. Actual cash value is one method; the other is replacement . The key difference between the two methods is .

Actual cash value (ACV) is the method commonly preby insurance companies. The actual cash value is equal to the replacement cost minus depreciation. The purpose of ACV is to put the insured back into the same financial condition he or she was before the loss. For example, if an insured owns a 10-year-old car and has an automobile accident, he or she is entitled to aftermarket or rebuilt parts in order to put the insured back in a 10year-old car. To put original equipment manufacturer (OEM) parts results in “”betterment” or increasing the value of the damaged property after a loss. If OEM parts are all that is available, the insurance company will pay only for what the rebuilt or aftermarket parts would

have cost. (See Aftermarket Parts). Depreciation is based on the age of the property damaged and the extent of wear and tear. The language of most insurance policies states that the company has the option of repairing or replacing with “”like kind or quality.”” For example, an insured who purchases an inland marine policy to cover jewelry may have the insurance company replace a stolen Rolex with another Rolex rather than pay the insured cash.

(See Replacement Cost Coverage)”

Adjuster

A person who investigates and settles losses for an insurance carrier.
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1. Employed representative of the insurance company who is responsible for handling insurance claims as they are received from patients and medical practices and who determines the dollar amount of a claim or debt. 2. In industrial cases, a representative of the insurer who investigates, evaluates, and negotiates the patient’s insurance claim and acts for the company in the settlement of claims. Adjusters may be employees of the insurance company or an individual operating independently and hired by a company to adjust a particular loss. Also called claims administrator, claims examiner, claims processor, claim representative, or health insurance adjuster.

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A person who may act either on behalf of the insurance company or the insured in the settling of a claim. Employee adjusters work for an insurer, while independent adjusters represent the insurance company on a fee basis and public adjusters represent the insured on a fee basis.

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Individual at the workers’ compensation insurance carrier overseeing an industrial case, authorizing diagnostic testing and medical treatment, and communicating with the provider of medical care.

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One who settles insurance claims. This typically involves investigation of the loss and a determination of the extent of coverage. In the context of first-party (e.g., property) insurance, the adjuster negotiates a settlement with the insured. In liability insurance, the adjuster coordinates the insured’s defense and participates in settlement negotiations. Adjusters may be employees of the insurer (staff adjusters) or of independent adjusting bureaus (independent adjusters) that represent insurers and self-insureds on a contract basis. Public adjusters are consultants who specialize in assisting insureds in presenting claims to insurance companies in a manner that will maximize their recovery.

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Person responsible for the evaluation and settlement of an insured claim. An adjuster may be an employee of an Insurer, or an individual operating independently and engaged by an Insurer or insured to adjust a particular loss or claim. Insurance Company adjuster -Adjuster who is a full time employee of an Insurer, adjusting only losses and claims covered by that Insurer. Public adjuster -Independent adjuster hired by any Insurer or insured to represent that client’s interest in the adjustment of a specific, often complex insured loss or claim.Adjuster Average : An adjuster who specializes in adjusting marine losses.

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See LOSS ADJUSTER.