Monies obtained from a successful judgment, settlement, erroneous, or conditional payment. Also called recovery of money .

In workers’ compensation cases, refers to symptoms that occur or may have been expected to occur of a previous industrial injury or illness without relationship to the current employment. This would not constitute a new injury.

Provision in an insurance policy that details the benefits payable if an insured becomes disabled again by the same illness or condition when benefits previously were paid.

Identifying information replaced with or XXX, or blacked out with a permanent marker throughout a patient’s medical documentation such as patient’s name, Social Security number, insurance number, city, facility’s name, or physician’s name.

In the Medicare program, this was formerly referred to as the appeal process . If a patient disagrees with any decision about health care services or if Medicare does not pay for an item or service, the initial Medicare decision may be reviewed again using this process. It has five levels: (1) redetermination (telephone, letter, or CMS-20027 form); (2) hearing officer (HO) hearing or reconsideration; (3) administrative law judge (ALJ) hearing; (4) Departmental Appeal Board review; and (5) judicial review in U.S. District Court.

Civil rights issue wherein an insurance company denies coverage to questionable or high risks in a given geographical area.
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Unfair discrimination based not on the risk’s characteristics but on its location. The term is commonly associated with an insurer’s refusal to consider insuring any home or business within a specific area marked by a line drawn on a map.