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Hyman, David A., Joshua Lerner, David J. Magid, and Bernard Black. "Association of Past and Future Paid Medical Malpractice Claims." JAMA Health Forum 4, no. 2 (February 10, 2023): e225436. http://dx.doi.org/10.1001/jamahealthforum.2022.5436.
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ImportanceMany physicians believe that most medical malpractice claims are random events. This study assessed the association of prior paid claims (including a single prior claim) with future paid claims; whether public disclosure of prior paid claims affects future paid claims; and whether the association of prior and future paid claims decayed over time.ObjectiveTo examine the association of 1 or more prior paid medical malpractice claims with future paid claims.Design, Setting, and ParticipantsThis study assessed the association between prior paid claims (including a single prior claim) with future claims; whether public disclosure of prior claims affects future paid claims; and whether the association of prior and future paid claims decayed over time. This retrospective case-control study included all 881 876 licensed physicians in the US. All data analysis took place between July, 2018 and January, 2023.ExposurePaid medical malpractice claims.Main Outcome and MeasuresAssociation between a prior paid medical malpractice claim and likelihood of a paid claim in a future period, compared with simulated results expected if paid claims are random events. Using the same outcomes, we also assessed whether public disclosure of paid claims affects future paid claim rates.ResultsThis study included all 881 876 physicians licensed to practice in the US at the time of the study. Overall, 3.3% of the 841 961 physicians with 0 paid claims in the prior period had 1 or more claims in the future period vs 12.4% of the 34 512 physicians with 1 paid claim in the prior period; 22.4% of the 4189 physicians with 2 paid claims in the prior period; and 37% of the 1214 physicians with 3 paid claims in the prior period. The association between prior claims and future claims was similar for high-medical-malpractice-risk and lower-risk specialties; 1 prior-period claim was associated with a 3.1 times higher likelihood of a future-period claim for high-risk specialties (95% CI, 2.8-3.4) vs a 4.2 times higher likelihood for lower-risk specialties (95% CI, 3.8-4.6). The predictive power of a prior paid claim for future claims declined gradually as the time since the prior claim increased, for prior or future periods up to 10 years. Public disclosure did not affect the association between prior and future paid claims.Conclusions and RelevanceIn this study of paid medical malpractice claims for all US physicians, a single prior paid claim was associated with substantial, long-lived higher future claim risk, independent of whether a physician was practicing in a high- or low-risk specialty, or whether a state publicly disclosed paid claims. Timely, noncoercive intervention, including education, has the potential to reduce future claims.
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Sussman, Romi L., Anne T. McMahon, and Elizabeth P. Neale. "An Audit of the Nutrition and Health Claims on Breakfast Cereals in Supermarkets in the Illawarra Region of Australia." Nutrients 11, no. 7 (July 15, 2019): 1604. http://dx.doi.org/10.3390/nu11071604.
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Nutrition and health claims can promote healthier food choices but may lead to consumer confusion if misused. Regular monitoring of claims is therefore required. This study aimed to explore the prevalence of nutrition and health claims carried on breakfast cereals in supermarkets, and to assess claim compliance with regulations. Nutrition and health claims on breakfast cereal products across five supermarkets in the Illawarra region of New South Wales, Australia, were recorded in a cross-sectional audit. Prevalence of claim type and claim compliance was determined. Claims were compared across categories of breakfast cereal. Almost all (95.7%) products audited carried at least one nutrition or health claim; nutrition content (n = 1096) was more prevalent than health claims (n = 213). Most claims (91.6%) were compliant with regulations. Additionally, claim prevalence and type differed according to breakfast cereal category, with the highest proportion of claims appearing on ‘health and wellbeing’ and ‘muesli’ products. There is a high prevalence of nutrition and health claims on breakfast cereals, with most claims compliant with regulations. Research should investigate consumer interpretation of claims and the impact of applying nutrient profiling for all claims to assist consumers to make informed health choices.
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Roe, Mark, Catherine Blake, Conor Gissane, and Kieran Collins. "Injury Scheme Claims in Gaelic Games: A Review of 2007–2014." Journal of Athletic Training 51, no. 4 (April 1, 2016): 303–8. http://dx.doi.org/10.4085/1062-6050-51.4.07.
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Gaelic games (Gaelic football and hurling) are indigenous Irish sports with increasing global participation in recent years. Limited information is available on longitudinal injury trends. Reviews of insurance claims can reveal the economic burden of injury and guide cost-effective injury-prevention programs.Context: To review Gaelic games injury claims from 2007–2014 for male players to identify the costs and frequencies of claims. Particular attention was devoted to lower limb injuries due to findings from previous epidemiologic investigations of Gaelic games.Objective: Descriptive epidemiology study.Design: Open-access Gaelic Athletic Association Annual Reports from 2007–2014 were reviewed to obtain annual injury-claim data.Setting: Gaelic Athletic Association players.Patients or Other Participants: Player age (youth or adult) and relationships between lower limb injury-claim rates and claim values, Gaelic football claims, hurling claims, youth claims, and adult claims.Main Outcome Measure(s): Between 2007 and 2014, €64 733 597.00 was allocated to 58 038 claims. Registered teams had annual claim frequencies of 0.36 with average claim values of €1158.4 ± 192.81. Between 2007 and 2014, average adult claims were always greater than youth claims (6217.88 versus 1036.88), while Gaelic football claims were always greater than hurling claims (5395.38 versus 1859.38). Lower limb injuries represented 60% of all claims. The number of lower limb injury claims was significantly correlated with annual injury-claim expenses (r = 0.85, P = .01) and adult claims (r = 0.96, P = .01) but not with youth claims (r = 0.69, P = .06).Results: Reducing lower limb injuries will likely reduce injury-claim expenses. Effective injury interventions have been validated in soccer, but whether such changes can be replicated in Gaelic games remains to be investigated. Injury-claim data should be integrated into current elite injury-surveillance databases to monitor the cost effectiveness of current programs.Conclusions:
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Bodansky, Daniel, and J. Romesh Weeramantry. "Diplomatic Claims (Eritrea v. Ethiopia), Eritrea ' s Claim 20/Ethiopia ' s Claim 8, Partial Awards; Economic Loss Throughout Ethiopia (Ethiopia v. Eritrea), Ethiopia ' s Claim 7, Partial Award; Jus ad Bellum (Ethiopia v. Eritrea), Ethiopia ' s Claims 1-8, Partial Award; Loss of Property in Ethiopia Owned by Non-Residents (Eritrea v. Ethiopia), Eritrea ' s Claim 24, Partial Award; Pensions (Eritrea v. Ethiopia), Eritrea ' s Claims 15, 19 & 23, Final Award; Ports (Ethiopia v. Eritrea), Ethiopia ' s Claim 6, Final Award; Western & Eastern Fronts (Ethiopia v. Eritrea), Ethiopia ' s Claims 1 & 3, Partial Award; Western Front, Aerial Bombardment & Related Claims (Eritrea v. Ethiopia), Eritrea ' s Claims 1, 3, 5, 9-13, 14, 21, 25 & 26, Partial Award." American Journal of International Law 101, no. 3 (July 2007): 616–27. http://dx.doi.org/10.1017/s0002930000029833.
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Diplomatic Claims (Eritrea v. Ethiopia), Eritrea's Claim 20/Ethiopia's Claim 8, Partial Awards. At <http://www.pca-cpa.org>.Eritrea Ethiopia Claims Commission, December 19, 2005.Economic Loss Throughout Ethiopia (Ethiopia v. Eritrea), Ethiopia's Claim 7, Partial Award. At <http://www.pca-cpa.org>.Eritrea Ethiopia Claims Commission, December 19, 2005.Jus ad Bellum (Ethiopia v. Eritrea), Ethiopia's Claims 1–8, Partial Award. At <http://www.pca-cpa.org>.Eritrea Ethiopia Claims Commission, December 19, 2005.Loss of Property in Ethiopia Owned by Non-Residents (Eritrea v. Ethiopia), Eritrea's Claim 24, Partial Award. At <http://www.pca-cpa.org>.Eritrea Ethiopia Claims Commission, December 19, 2005.Pensions (Eritrea v. Ethiopia), Eritrea's Claims 15, 19 & 23, Final Award. At <http://www.pca-cpa.org>.Eritrea Ethiopia Claims Commission, December 19, 2005.Ports (Ethiopia v. Eritrea), Ethiopia's Claim 6, Final AwardS At <http://www.pca-cpa.org>.Eritrea Ethiopia Claims Commission, December 19, 2005.Western & Eastern Fronts (Ethiopia v. Eritrea), Ethiopia's Claims 1 & 3, Partial Award. At <http://www.pca-cpa.org>.Eritrea Ethiopia Claims Commission, December 19, 2005.Western Front, Aerial Bombardment & Related Claims (Eritrea v. Ethiopia), Eritrea's Claims 1, 3, 5, 9–13,14, 21, 25 & 26, Partial Award. At <http://www.pca-cpa.org>.Eritrea Ethiopia Claims Commission, December 19, 2005.On December 19, 2005, the Eritrea Ethiopia Claims Commission (Commission) issued seven partial awards and two final awards. These awards determined the respective international responsibility of Eritrea and Ethiopia arising out of the 1998–2000 armed conflict between those two states.
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Yang, Song Sen, and Jing Xu. "Construction Claims Management of Civil Engineering." Advanced Materials Research 243-249 (May 2011): 6348–51. http://dx.doi.org/10.4028/www.scientific.net/amr.243-249.6348.
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Construction claims are contractor's legitimate rights from contract. And it is also the legal means to maintain economic interests. The quality of claim reports comprehensively shows the level of claim management. This paper expounds the constituents of claim reports and their correlations. Calculations for financial claims and time claims are mainly analyzed and skills of making claim reports is analyzes too. This paper provides reference to claims management personnel.
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Lui, Sheng Jie, Cheng Xiang, and Shonali Krishnaswamy. "KAMEL: Knowledge Aware Medical Entity Linkage to Automate Health Insurance Claims Processing." Proceedings of the AAAI Conference on Artificial Intelligence 38, no. 21 (March 24, 2024): 22797–805. http://dx.doi.org/10.1609/aaai.v38i21.30314.
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Automating the processing of health insurance claims to achieve "Straight-Through Processing" is one of the holy grails that all insurance companies aim to achieve. One of the major impediments to this automation is the difficulty in establishing the relationship between the underwriting exclusions that a policy has and the incoming claim's diagnosis information. Typically, policy underwriting exclusions are captured in free-text such as "Respiratory illnesses are excluded due to a pre-existing asthma condition". A medical claim coming from a hospital would have the diagnosis represented using the International Classification of Disease (ICD) codes from the World Health Organization. The complex and labour-intensive task of establishing the relationship between free-text underwriting exclusions in health insurance policies and medical diagnosis codes from health insurance claims is critical towards determining if a claim should be rejected due to underwriting exclusions. In this work, we present a novel framework that leverages both explicit and implicit domain knowledge present in medical ontologies and pre-trained language models respectively, to effectively establish the relationship between free-text describing medical conditions present in underwriting exclusions and the ICD-10CM diagnosis codes in health insurance claims. Termed KAMEL (Knowledge Aware Medical Entity Linkage), our proposed framework addresses the limitations faced by prior approaches when evaluated on real-world health insurance claims data. Our proposed framework have been deployed in several multi-national health insurance providers to automate their health insurance claims.
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Troxel, David B. "An Insurer's Perspective on Error and Loss in Pathology." Archives of Pathology & Laboratory Medicine 129, no. 10 (October 1, 2005): 1234–36. http://dx.doi.org/10.5858/2005-129-1234-aipoea.
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Abstract Objectives.—To identify errors in surgical pathology practice that lead to malpractice claims, and to define the frequency and severity of pathology malpractice claims and discuss the implications. Design.—Three hundred seventy-eight pathology malpractice claims reported to The Doctors Company of Napa, Calif, between 1998 and 2003, were reviewed. Nuisance claims and autopsy claims were excluded; the 335 remaining claims were analyzed. Results.—Pathology claim frequency is low. Pathology claim severity is high, especially for claims involving a misdiagnosis of melanoma or a false-negative Papanicolaou test. Fifty-seven percent of claims involved the following 5 categories: breast specimens, melanoma, Papanicolaou smears, gynecologic specimens, and operational error. Sixty-three percent of claims involved failure to diagnose cancer, resulting in delay in diagnosis or inappropriate treatment. Conclusion.—A false-negative diagnosis of melanoma is the single most common reason for filing a malpractice claim against a pathologist. Nearly one third of misdiagnoses involve melanoma misdiagnosed as Spitz nevus, “dysplastic” nevus, spindle cell squamous carcinoma, atypical fibroxanthoma, and dermatofibroma.
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Syifausufi, Syavira, and Aulianda Anisa Putri. "Application of the Collective Risk Model to the Number of Claims with a Negative Binomial Distribution and the Size of Claims with a Discrete Uniform Distribution." International Journal of Global Operations Research 5, no. 2 (May 27, 2024): 119–26. http://dx.doi.org/10.47194/ijgor.v5i2.303.
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An insurance claim is a form of request from the policy holder to obtain protection against financial losses due to a risk that occurs. Claims that occur every time there is a risk are called individual claims, while the total of individual claims during one insurance period is called aggregate claims. Claims are an important factor in optimizing insurance company expenses, where one of the calculations that insurance companies need to know based on claims is aggregate loss. Aggregate loss is the total loss in a period experienced by policy holders covered by an insurance company. This study aims to determine the average and variance of claims for the number of claims (frequency) with a Negative Binomial distribution and the amount of claims (severity) with a Discreate Uniform distribution in claim payments according to all types of guarantees and the nature of PT injuries. Jasa Raharja (Persero) Purwakarta Representative during the 2018-2020 period. This research uses a collective risk model and the help of Easyfit software to determine the best distribution for the number and size of claims. The results of the research show that from the recapitulation data of claim payments according to all types of coverage and nature of injury in PT. Jasa Raharja (Persero) Purwakarta Representative during the 2018-2020 period, with the number of claims having a Negative Binomial distribution and the amount of claims having a Discrete Uniform distribution, the average aggregate claim occurrence was IDR with a variance of IDR during the 2018-2020 insurance period.
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Poskrebnev, Maksim E. "The Рrocedural and Legal Nature of the Competition of Claims." Rossijskoe pravosudie, no. 3 (February 26, 2024): 72–81. http://dx.doi.org/10.37399/issn2072909x.2024.3.72-81.
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In the article, the author examined the main features of competition of claims in order to identify their procedural and legal nature. To achieve this goal, the author mainly used the historical method, as well as methods of comparison and analysis. As a result of the study, the author formulated general conclusions that are placed in the conclusion: 1) although competition begins with the choice of a method of defense, its final formalization lies in the concept of a claim addressed to the court, which must select a competing claim, i. e., qualify an offense; 2) the common purpose of competing claims lies in the factual basis of the claim, in circumstances that are the same for the competing claims. However, the unifying feature of competition claims does not include a legal component. It is different for competing claims and stems from different norms of civil law, and therefore entails confrontation between these claims; 3) the termination of other competing claims by the award of the first claim is a key feature of the competition of the claim, indicating the procedural and legal nature of the competition.
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Krisdiantha, Krisdiantha, M. Jibril Khalifatullah, Tione Daffaxa Dumamika, and Lienda Noviyanti. "The Comparison of Estimated Reserve Claims with the Classical Chain Ladder and Bornhuetter-Double Chain Ladder Method." Jurnal Matematika, Statistika dan Komputasi 20, no. 1 (September 6, 2023): 207–20. http://dx.doi.org/10.20956/j.v20i1.27673.
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In the world of insurance, insurance companies need to back up claims to ensure that the company can cover expenses resulting from filing claims from policyholders. Claim reserves represent the estimated value of claim payments in the future, where there are differences in the estimated and actual value of claim payments. Errors in predicting claim reserves will result in inaccuracies and disrupt the insurance company's financial stability. There are several ways to estimate claim reserves, one of the most common methods is using a Chain Ladder. However, the Chain Ladder method is very susceptible to outliers, so another method is needed to estimate claims reserves that are more accurate. This study discusses the comparison between the Chain Ladder method and one of the development methods, namely Bornhuetter-Double Chain Ladder in estimating claim reserves. The Bornhuetter-Double Chain Ladder method uses data on claims that have occurred as a whole, the amount of claims that have been paid, and the number of claims that have occurred. Based on the research results, it can be concluded that the Bornhuetter-Double Chain Ladder method is capable of producing more stable and accurate claim reserves compared to the Chain Ladder method.
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Abbasi, K. "Claims and counter claims." BMJ 327, no. 7423 (November 8, 2003): 0—g—0. http://dx.doi.org/10.1136/bmj.327.7423.0-g.
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Kaur, Asha, Peter Scarborough, Anne Matthews, Sarah Payne, Anja Mizdrak, and Mike Rayner. "How many foods in the UK carry health and nutrition claims, and are they healthier than those that do not?" Public Health Nutrition 19, no. 6 (July 9, 2015): 988–97. http://dx.doi.org/10.1017/s1368980015002104.
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AbstractObjectiveThe present study aimed to measure the prevalence of different types of health and nutrition claims on foods and non-alcoholic beverages in a UK sample and to assess the nutritional quality of such products carrying health or nutrition claims.DesignA survey of health and nutrition claims on food packaging using a newly defined taxonomy of claims and internationally agreed definitions of claim types.SettingA national UK food retailer: Tesco.SubjectsThree hundred and eighty-two products randomly sampled from those available through the retailer’s website.ResultsOf the products, 32 % (95 % CI 28, 37 %) carried either a health or nutrition claim; 15 % (95 % CI 11, 18 %) of products carried at least one health claim and 29 % (95 % CI 25, 34 %) carried at least one nutrition claim. When adjusted for product category, products carrying health claims tended to be lower in total fat and saturated fat than those that did not, but there was no significant difference in sugar or sodium levels. Products carrying health claims had slightly higher fibre levels than products without. Results were similar for comparisons between products that carry nutrition claims and those that do not.ConclusionsHealth and nutrition claims appear frequently on food and beverage products in the UK. The nutrient profile of products carrying claims is marginally healthier than for similar products without claims, suggesting that claims may have some but limited informational value. The implication of these findings for guiding policy is unclear; future research should investigate the ‘clinical relevance’ of these differences in nutritional quality.
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Williams, PhD, MS, Rachel E., Timothy J. Sampson, BS, Linda Kalilani, MBBS, PhD, John I. Wurzelmann, MD, MPH, and Stephen W. Janning, PharmD. "Epidemiology of opioid pharmacy claims in the United States." Journal of Opioid Management 4, no. 3 (January 30, 2018): 145. http://dx.doi.org/10.5055/jom.2008.0019.
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Objective: To describe opioid pharmacy claims patterns in the United States among an insured population.Design: Information was obtained from the US insurance claims database, IMS Lifelink™, between 1997 and 2002. Descriptive statistics of opioid claims patterns were described with stratification by gender, age, and year of use.Results: The prevalence of insured people with opioid claims increased from 17.1 percent in 1997 to 18.4 percent in 2002. Among people with an opioid claim, 24 percent had ≥30 days and 10 percent had ≥90 days of days supplied based on the insurance claims. Prevalence varied by type of opioid; 56 percent of people with a claim received propoxyphene, 43 percent received codeine, 23 percent received oxycodone, and 17 percent received hydrocodone. Sustained-release opioids were found among 6 percent of those with a claim. With respect to the dose of opioids in the pharmacy claims (expressed as morphine equivalent total daily dose), 71 percent had claims for <50 mg, 55 percent had claims for 50-99 mg, and 24 percent had claims for ≥100 mg. Women, individuals with cancer, and older patients had significantly more pharmacy claims as well as claims for higher doses of opioids (p < 0.05). Internal medicine and family practice specialists were responsible for 22.4 percent and 20.9 percent of all opioid claims.Conclusions: Opioid pharmacy claims increased slightly over time. Older patients, women and patients with a cancer diagnosis had significantly more opioid claims and claims for higher doses than the younger patients, men, and those without cancer.
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André, Quentin, Pierre Chandon, and Kelly Haws. "Healthy Through Presence or Absence, Nature or Science?: A Framework for Understanding Front-of-Package Food Claims." Journal of Public Policy & Marketing 38, no. 2 (February 1, 2019): 172–91. http://dx.doi.org/10.1177/0743915618824332.
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Food products claim to be healthy in many ways, but prior research has investigated these claims at either the macro level (using broad descriptions such as “healthy” or “tasty”) or the micro level (using single claims such as “low fat”). The authors use a meso-level framework to examine whether these claims invoke natural or scientific arguments and whether they communicate about positive attributes present in the food or negative attributes absent from the food. They find that common front-of-packaging claims can be appropriately classified into (1) science- and absence-focused claims about “removing negatives,” (2) science- and presence-focused claims about “adding positives,” (3) nature- and absence-focused claims about “not adding negatives,” and (4) nature- and presence-focused claims about “not removing positives.” The authors conduct validation studies using breakfast cereals, a category for which nutrition quality varies but food claims are constant. They find that claim type is completely uncorrelated to actual nutrition quality yet influences inferences consumers make about taste, healthiness, and dieting. Claim type also helps predict the effects of hedonic eating, healthy eating, or weight loss goals on food choice.
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Mahlow, Nils, and Joël Wagner. "Process landscape and efficiency in non-life insurance claims management." Journal of Risk Finance 17, no. 2 (March 21, 2016): 218–44. http://dx.doi.org/10.1108/jrf-07-2015-0069.
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Purpose In view of the fact that claim payouts account for about 70 per cent of annual direct costs in non-life insurance companies and that claims-handling staff sums up to 10-20 per cent of all employees, an optimal claims management environment is of strategic importance. The purpose of this paper is twofold, i.e. on the one hand, the authors introduce a standardized claims management process model and, on the other hand, they apply process benchmarks to various operational parameters. Design/methodology/approach The proposed claims management process landscape comprises current industry standards for claims handling from a theoretical perspective, supported by practice insights from the industry. Our model aims to reflect the most important claims processing activities. The claims-handling work flow is structured into five core steps, namely, notification, registration, coverage audit, settlement and closing of the claim. For these core steps, the authors differentiate between three claim complexity categories and their associated back-office levels. In the second part of the paper, the authors assess the industry’s claims-handling efficiency. The authors benchmark industry processes with reference to detailed claims management data from 11 insurers in Germany and Switzerland. Findings The benchmarks are based on the previously defined claims management model and are applied separately to the three retail business lines of car, property and liability insurance. We measure claim process times (cycle times) as well as claim quantities and average claim payouts at different levels. Overall, within each business line, more than 30 data points are gathered from each respondent insurer. This allows us to compare the process performance of different insurance companies and to describe significant differences in their process patterns. Furthermore, principal findings are derived from descriptive statistics as well as ad hoc data analyses. Originality/value The paper seeks to contribute to the discussion of how different insurance companies perform in claims management and to define best practice. Our findings are relevant to academics and practitioners alike.
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Gough, David. "Appraising Evidence Claims." Review of Research in Education 45, no. 1 (March 2021): 1–26. http://dx.doi.org/10.3102/0091732x20985072.
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For research evidence to inform decision making, an appraisal needs to be made of whether the claims are justified and whether they are useful to the decisions being made. This chapter provides a high level framework of core issues relevant to appraising the “fitness for purpose” of evidence claims. The framework includes (I) the variation in the nature of research, the evidence claims it produces, and in the values, perspectives, and ethical issues that underlie it; (II) the main components of the bases of evidence claims in terms of (i) how relevant evidence has been identified and synthesized to make a claim, (ii) the technical quality and relevance of the included evidence, and (iii) the totality of evidence to justify the warrant of the evidence claim (including the potential for there to be alternative explanations); (III) evidence standards to appraise evidence claims and examples of guides and tools to assist with aspects of such appraisal; and (IV) engagement with evidence: (i) the communication of evidence claims, (ii) the fitness for purpose of these evidence claims for decision makers, and (iii) and the interpretation of such claims to provide recommendations and guidance.
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Bolancé, Catalina, and Raluca Vernic. "Frequency and Severity Dependence in the Collective Risk Model: An Approach Based on Sarmanov Distribution." Mathematics 8, no. 9 (August 21, 2020): 1400. http://dx.doi.org/10.3390/math8091400.
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In actuarial mathematics, the claims of an insurance portfolio are often modeled using the collective risk model, which consists of a random number of claims of independent, identically distributed (i.i.d.) random variables (r.v.s) that represent cost per claim. To facilitate computations, there is a classical assumption of independence between the random number of such random variables (i.e., the claims frequency) and the random variables themselves (i.e., the claim severities). However, recent studies showed that, in practice, this assumption does not always hold, hence, introducing dependence in the collective model becomes a necessity. In this sense, one trend consists of assuming dependence between the number of claims and their average severity. Alternatively, we can consider heterogeneity between the individual cost of claims associated with a given number of claims. Using the Sarmanov distribution, in this paper we aim at introducing dependence between the number of claims and the individual claim severities. As marginal models, we use the Poisson and Negative Binomial (NB) distributions for the number of claims, and the Gamma and Lognormal distributions for the cost of claims. The maximum likelihood estimation of the proposed Sarmanov distribution is discussed. We present a numerical study using a real data set from a Spanish insurance portfolio.
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Klemick, Griffin. "Constitution, Causation, and the Final Opinion." History of Philosophy Quarterly 40, no. 3 (July 1, 2023): 237–57. http://dx.doi.org/10.5406/21521026.40.3.04.
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Abstract In “The Fixation of Belief,” Peirce apparently accepts the causal claim that real physical objects cause us to reach an indefeasible “final opinion” concerning them. In “How to Make Our Ideas Clear,” he apparently accepts the constitutive claim that for physical objects to be real just is for them to be represented in that opinion. These claims initially seem inconsistent, since causal claims are explanatory and since equivalent claims cannot explain one another. Contrary to prominent suggestions that Peirce rejected the constitutive claim, however, he actually accepted both, reconciling them via a Humean denial that causal claims are genuinely explanatory.
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Lynam, Ann-Marie, Aideen McKevitt, and Michael J. Gibney. "Irish consumers’ use and perception of nutrition and health claims." Public Health Nutrition 14, no. 12 (May 6, 2011): 2213–19. http://dx.doi.org/10.1017/s1368980011000723.
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AbstractObjectiveTo investigate Irish consumers’ use and understanding of and their belief in nutrition and health (NH) claims in the context of the European Union (EU) legislation (Regulation no. 1924/2006), which permits a number of NH claims on food products.DesignAn interview-assisted questionnaire was administered to consumers (n 400). Preference for three types of NH claims across six products was tested. Perception of NH claims was assessed across a further eight food products. Claims were categorised as content, structure–function and disease–risk factor reduction claims.SettingSix supermarkets in the Republic of Ireland.SubjectsFour hundred adult Irish supermarket consumers.ResultsOlder (P < 0·001), female (P < 0·01) consumers were more likely to seek NH claims. Structure–function and content claims were preferred across six products. Consumers’ perception was associated with the health benefit claimed rather than with the strength of the claim itself. Preference for claim type and claim perception differed with gender, age and educational level.ConclusionsIrish consumers prefer content and simpler NH claims rather than more complex disease–risk factor reduction claims. The food industry may thus be better served using these types of claims. Although the reported levels of understanding were high, evidence of positivity bias and misinterpretation was found. Thus, with regard to Regulation 1924/2006, consumers need more information on both simpler and more complex claims. Public health messages should be targeted according to gender, age and educational level.
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Siaw, Kok Keng, Xueyuan Wu, David Pitt, and Yan Wang. "Matrix-form Recursive Evaluation of the Aggregate Claims Distribution Revisited." Annals of Actuarial Science 5, no. 2 (April 20, 2011): 163–79. http://dx.doi.org/10.1017/s1748499511000042.
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AbstractThis paper aims to evaluate the aggregate claims distribution under the collective risk model when the number of claims follows a so-called generalised (a, b, 1) family distribution. The definition of the generalised (a, b, 1) family of distributions is given first, then a simple matrix-form recursion for the compound generalised (a, b, 1) distributions is derived to calculate the aggregate claims distribution with discrete non-negative individual claims. Continuous individual claims are discussed as well and an integral equation of the aggregate claims distribution is developed. Moreover, a recursive formula for calculating the moments of aggregate claims is also obtained in this paper. With the recursive calculation framework being established, members that belong to the generalised (a, b, 1) family are discussed. As an illustration of potential applications of the proposed generalised (a, b, 1) distribution family on modelling insurance claim numbers, two numerical examples are given. The first example illustrates the calculation of the aggregate claims distribution using a matrix-form Poisson for claim frequency with logarithmic claim sizes. The second example is based on real data and illustrates maximum likelihood estimation for a set of distributions in the generalised (a, b, 1) family.
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Firdaus, Rayyan, and Nurul Akmal. "ANALISIS PENERAPAN SISTEM INFORMASI AKUNTANSI PEMBAYARAN KLAIM ASURANSI JIWA DALAM MENINGKATKAN PELAYANAN KEPADA NASABAH (STUDI KASUS PADA PT ASURANSI JIWASRAYA PERSERO AREA LHOKSEUMAWE)." Jurnal Akuntansi dan Keuangan 7, no. 2 (October 1, 2019): 93. http://dx.doi.org/10.29103/jak.v7i2.1848.
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This study was conducted to analyze the application of the Jiwasraya insurance claims payment accounting information system in improving service to customer life insurance claims. The data used in this study were primary data directly through the results of interviews with Jiwasraya Insurance Company employees, and customers. This is a descriptive qualitative study. The results of the study showed that the application of the life insurance claims payment accounting information system in improving service to customers at PT. Jiwasraya Insurance Persero Lhokseumawe area consisted of customers preparing all documents used in filing life insurance claims either died due to death or died due to accidents, following procedures for handling and administering death claims, waiting when checking procedures for recording life insurance claims i.e. by opening a claim payment in LBK in accordance with the account or estimated claim number in accordance with the applicable provisions, waiting for the results of life insurance claim reporting, and waiting for the results of the claim disbursement decision to be approved or rejected.
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YOUSEFI, Vahidreza, Siamak HAJI YAKHCHALI, Mostafa KHANZADI, Ehsan MEHRABANFAR, and Jonas ŠAPARAUSKAS. "PROPOSING A NEURAL NETWORK MODEL TO PREDICT TIME AND COST CLAIMS IN CONSTRUCTION PROJECTS." JOURNAL OF CIVIL ENGINEERING AND MANAGEMENT 22, no. 7 (July 12, 2016): 967–78. http://dx.doi.org/10.3846/13923730.2016.1205510.
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Despite broad improvements in construction management, claims still are an inseparable part of many con-struction projects. Due to huge cases of claim in construction industry, this study argues that claim management is a significant factor in construction projects success. In this study, the most possible causes of these emerging claims are identified and statistically ranked by Probability-Impact Matrix. Subsequently, by classifying claims in different cases, the most important ones are ranked in order to achieve a better understanding of claim management in each project. In this regard, a new index is defined, being able to be applied in a variety of projects with different time and cost values, to calculate the amount of possible claims in each project along with related ratios with respect to the cost and time of each claim. This study introduces a new model to predict the frequency of claims in construction projects. By using the proposed model, the rate of possible claims in each project can be obtained. This model is validated by applying it into fitting case studies in Iran construction industry.
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Shahi, Gautam Kishore. "FakeKG: A Knowledge Graph of Fake Claims for Improving Automated Fact-Checking (Student Abstract)." Proceedings of the AAAI Conference on Artificial Intelligence 37, no. 13 (June 26, 2023): 16320–21. http://dx.doi.org/10.1609/aaai.v37i13.27020.
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False information could be dangerous if the claim is not debunked timely. Fact-checking organisations get a high volume of claims on different topics with immense velocity. The efficiency of the fact-checkers decreases due to 3V problems volume, velocity and variety. Especially during crises or elections, fact-checkers cannot handle user requests to verify the claim. Until now, no real-time curable centralised corpus of fact-checked articles is available. Also, the same claim is fact-checked by multiple fact-checking organisations with or without judgement. To fill this gap, we introduce FakeKG: A Knowledge Graph-Based approach for improving Automated Fact-checking. FakeKG is a centralised knowledge graph containing fact-checked articles from different sources that can be queried using the SPARQL endpoint. The proposed FakeKG can prescreen claim requests and filter them if the claim is already fact-checked and provide a judgement to the claim. It will also categorise the claim's domain so that the fact-checker can prioritise checking the incoming claims into different groups like health and election. This study proposes an approach for creating FakeKG and its future application for mitigating misinformation.
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Wuryaningrum, Rusdhianti, Arju Muti'ah, and Ahmad Syukron. "Claim Category in Indonesian Coffee Discourse Argument." JURNAL ARBITRER 9, no. 1 (May 8, 2022): 17. http://dx.doi.org/10.25077/ar.9.1.17-26.2022.
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The objective of this research is to describe the construction of claims in the strategies used in the coffee discourse. The claim in the argument can show cognition about coffee that is implanted by the producer. his research takes data from the online discourse of Indonesian coffee. The data of this research are statements that are contextually interpreted as claims and then examined from the Toulmin concept. By studying the types of claims, types of claims and its strategy to connect claims and ground, the researcher describes the arguments in the coffee discourse. From the results of the qualitative study, it is obtained that there are three types of claims, namely fact-based claims, judgment and value claims, and claim-based policies. From the three types of claims it can be concluded that there are. From the results and discussion it can be stated that there are subjective and objective claims formed in the coffee discourse. Objective claims are proven by geographical location, research, knowledge and environmental conservation in industrial agriculture (future knowledge). Subjective claims are shown by personality and support quality. Regarding history, as an aspect of judgment and value claims, it is subjective and objective. From these claims, it can be seen that the coffee discourse contains cognitions about coffee companies with historical authority, personality, and taste; future knowledge and research references; taste, packaging, and good process.
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Hodgkins, Charo, Bernadette Egan, Matthew Peacock, Naomi Klepacz, Krista Miklavec, Igor Pravst, Jure Pohar, et al. "Understanding How Consumers Categorise Health Related Claims on Foods: A Consumer-Derived Typology of Health-Related Claims." Nutrients 11, no. 3 (March 2, 2019): 539. http://dx.doi.org/10.3390/nu11030539.
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The Nutrition and Health Claims Regulation (NHCR) EC No 1924/2006 aims to provide an appropriate level of consumer protection whilst supporting future innovation and fair competition within the EU food industry. However, consumers’ interpretation of health claims is less well understood. There is a lack of evidence on the extent to which consumers are able to understand claims defined by this regulatory framework. Utilising the Multiple Sort Procedure (MSP), a study was performed (N = 100 participants across five countries: Germany, the Netherlands, Slovenia, Spain and the United Kingdom) to facilitate development of a framework of health-related claims encompassing dimensions derived from consumers. Our results provide useful insight into how consumers make sense of these claims and how claims may be optimised to enhance appropriate consumer understanding. They suggest consumers may not consciously differentiate between a nutrition claim and a health claim in the way that regulatory experts do and provide insight into where this might occur. A consumer-derived typology of health-related claims based on three key dimensions is proposed: (1) Familiarity with the nutrient, substance or food stated in the claim; (2) statement type in terms of simplicity/complexity; (3) relevance of the claim, either personally or for a stated population group.
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LACAYO, RAMON. "EXPANSION IN BELL POLYNOMIALS OF THE DISTRIBUTION OF THE TOTAL CLAIM AMOUNT WITH WEIBULL-DISTRIBUTED CLAIM SIZES." ANZIAM Journal 49, no. 4 (April 2008): 495–501. http://dx.doi.org/10.1017/s1446181108000187.
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AbstractThe total claim amount for a fixed period of time is, by definition, a sum of a random number of claims of random size. In this paper we explore the probabilistic distribution of the total claim amount for claims that follow a Weibull distribution, which can serve as a satisfactory model for both small and large claims. As models for the number of claims we use the geometric, Poisson, logarithmic and negative binomial distributions. In all these cases, the densities of the total claim amount are obtained via Laplace transform of a density function, an expansion in Bell polynomials of a convolution and a subsequent Laplace inversion.
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Chandrasekhar, S. "Modeling of Motor Vehicle Claims Using Extreme Value Methodology and Monte Carlo Stimulation: A Comparative Study." Asia Pacific Business Review 4, no. 4 (October 2008): 96–103. http://dx.doi.org/10.1177/097324700800400409.
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Motor Vehicle Insurance claims form a substantial component of Non life insurance claims and it is also growing with increasing number of vehicles on roads. It is also desirable to have an idea of what will be the likely claim amount for the coming future (Monthly, Quarterly, Yearly) based on past claim data. If one looks at the claim amount one can make out that there will be few large claims compared to large number of average and below average claims. Thus the distributions of claims do not follow a Symmetric pattern which makes it difficult using normal Statistical analysis. The methodology followed to analyze such data is known as Extreme value Analysis. Extreme value analysis is a general name which covers (i) Generalised Extreme Value (GEV) (ii) Generalised Pareto Distribution (GPD). Basically these techniques can deal with non symmetric shape of the distribution which is close to reality. Normally one fits a generalised Extreme Value distribution (GEV)/Generalised Pareto Distribution (GPD) and using parameters of fitted distribution future, forecast of likely losses can be predicted. Second method of analyzing such data is using methodology of simulation. Here we fit a Poisson distribution for arrival of claims and weibull/pareto/Lognormal for claim amount. Using Monte Carlo Simulation one combines both the distributions for future prediction of claim amount. This paper shows a comparison of the above techniques on motor vehicle claims data.
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A. Olanrewaju, AbdulLateef, and Paul J. Anavhe. "Perceived claim sources in the Nigerian construction industry." Built Environment Project and Asset Management 4, no. 3 (July 7, 2014): 281–95. http://dx.doi.org/10.1108/bepam-05-2013-0014.
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Purpose – With the increase in the cases of construction claims in Nigeria, many projects have remained uncompleted, while many of those completed receive poor client satisfaction. The purpose of this paper is to investigate how construction claims are managed. Design/methodology/approach – In total, 58 claim factors were identified and addressed to construction professionals through survey to indicate the extent at which the factors contributed to claims. A case study was conducted to illustrate claim management. Findings – In total, 37 factors were the major source of claims. Late payment, delayed approval of change order and delay cost were the extremely influential while the least were storage charges, loss of productivity, and costs of preparing claims. Evidences revealed that all stakeholders should play active roles to deliver “claim free” projects. Practical implications – The findings will be useful to practitioners in the effort to improve project delivery by providing some guidance on claim minimization. It is hoped that this study will encourage academics to conduct more research on this issue. Originality/value – There is no known conclusive empirical study on construction claim factors in Nigeria. In light of this, the findings offer greater opportunities for claim minimization/avoidance.
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Gupta, Ashwin, Ashley Snyder, Allen Kachalia, Scott Flanders, Sanjay Saint, and Vineet Chopra. "Malpractice claims related to diagnostic errors in the hospital." BMJ Quality & Safety 27, no. 1 (August 9, 2017): 53–60. http://dx.doi.org/10.1136/bmjqs-2017-006774.
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BackgroundLittle is known about the incidence or significance of diagnostic error in the inpatient setting. We used a malpractice claims database to examine incidence, predictors and consequences of diagnosis-related paid malpractice claims in hospitalised patients.MethodsThe US National Practitioner Database was used to identify paid malpractice claims occurring between 1 January 1999 and 31 December 2011. Patient and provider characteristics associated with paid claims were analysed using descriptive statistics. Differences between diagnosis-related paid claims and other paid claim types (eg, surgical, anaesthesia, medication) were assessed using Wilcoxon rank-sum and χ2 tests. Multivariable logistic regression was used to identify patient and provider factors associated with diagnosis-related paid claims. Trends for incidence of diagnosis-related paid claims and median annual payment were assessed using the Cochran-Armitage and non-parametric trend test.Results13 682 of 62 966 paid malpractice claims (22%) were diagnosis-related. Compared with other paid claim types, characteristics significantly associated with diagnosis-related paid claims were as follows: male patients, patient aged >50 years, provider aged <50 years and providers in the northeast region. Compared with other paid claim types, diagnosis-related paid claims were associated with 1.83 times more risk of disability (95% CI 1.75 to 1.91; p<0.001) and 2.33 times more risk of death (95% CI 2.23 to 2.43; p<0.001) than minor injury, after adjusting for patient and provider characteristics. Inpatient diagnostic error accounted for $5.7 billion in payments over the study period, and median diagnosis-related payments increased at a rate disproportionate to other types.ConclusionInpatient diagnosis-related malpractice payments are common and more often associated with disability and death than other claim types. Research focused on understanding and mitigating diagnostic errors in hospital settings is necessary.
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Chimedtseren, Nyamragchaa, Bridget Kelly, Anne-Therese McMahon, and Heather Yeatman. "Prevalence and Credibility of Nutrition and Health Claims: Policy Implications from a Case Study of Mongolian Food Labels." International Journal of Environmental Research and Public Health 17, no. 20 (October 13, 2020): 7456. http://dx.doi.org/10.3390/ijerph17207456.
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Nutrition and health claims should be truthful and not misleading. We aimed to determine the use of nutrition and health claims in packaged foods sold in Mongolia and examine their credibility. A cross-sectional study examined the label information of 1723 products sold in marketplaces in Ulaanbaatar, Mongolia. The claim data were analysed descriptively. In the absence of national regulations, the credibility of the nutrition claims was examined by using the Codex Alimentarius guidelines, while the credibility of the health claims was assessed by using the European Union (EU) Regulations (EC) No 1924/2006. Nutritional quality of products bearing claims was determined by nutrient profiling. Approximately 10% (n = 175) of products carried at least one health claim and 9% (n = 149) carried nutrition claims. The credibility of nutrition and health claims was very low. One-third of nutrition claims (33.7%, n = 97) were deemed credible, by having complete and accurate information on the content of the claimed nutrient/s. Only a few claims would be permitted in the EU countries by complying with the EU regulations. Approximately half of the products with nutrition claims and 40% of products with health claims were classified as less healthy products. The majority of nutrition and health claims on food products sold in Mongolia were judged as non-credible, and many of these claims were on unhealthy products. Rigorous and clear regulations are needed to prevent negative impacts of claims on food choices and consumption, and nutrition transition in Mongolia.
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Yulita, Tiara, and Adhitya Ronnie Effendie. "ESTIMATION OF IBNR AND RBNS RESERVES USING RDC METHOD AND GAMMA GENERALIZED LINEAR MODEL." MEDIA STATISTIKA 15, no. 1 (June 10, 2022): 24–35. http://dx.doi.org/10.14710/medstat.15.1.24-35.
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Estimation of claims reserves is a very important role for insurance companies because the information will be used to assess the insurance company’s ability to meet future claim payment obligations. In practice, claims reserves are divided into two Incurred but Not Reported (IBNR) and Reported but Not Settled (RBNS). Reserving by Detailed Conditioning (RDC) is one of the individual methods that can estimate claims reserves of both the IBNR and RBNS, which involves detailed condition so-called claim characteristics, and some information else so-called background variable. The result of estimating claims reserves using RDC with background variable is not stable because many combinate of calculation from each background variable. The purpose of this study is to overcome these problems, which we can combine RDC and Gamma Generalized Linear Model (GLM) as an effective method for estimating claims reserves. By using Bootstrapping Individual Claims Histories (BICH) method, the results show that estimation of claims reserves using RDC and Gamma GLM gives the fewest value of Mean Square Error of Prediction (MSEP) rather than RDC with Poisson GLM, RDC, and Chain Ladder. Where the smaller the value of the resulting MSEP estimate, the closer to the actual claim reserve value.
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Yang, Yang, Xinzhi Wang, Xiaonan Su, and Aili Zhang. "Asymptotic Behavior of Ruin Probabilities in an Insurance Risk Model with Quasi-Asymptotically Independent or Bivariate Regularly Varying-Tailed Main Claim and By-Claim." Complexity 2019 (October 20, 2019): 1–6. http://dx.doi.org/10.1155/2019/4582404.
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This paper considers a by-claim risk model under the asymptotical independence or asymptotical dependence structure between each main claim and its by-claim. In the presence of heavy-tailed main claims and by-claims, we derive some asymptotic behavior for ruin probabilities.
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Artik, N. "FUNCTIONAL CLAIMS: ANTIOXIDANTS AND CLAIMS." Acta Horticulturae, no. 877 (November 2010): 105–19. http://dx.doi.org/10.17660/actahortic.2010.877.7.
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d’Almeida, Luís Duarte, and James Edwards. "Some Claims About Law’s Claims." Law and Philosophy 33, no. 6 (November 2014): 725–46. http://dx.doi.org/10.1007/s10982-013-9202-5.
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Gao, Qingwu, and Xijun Liu. "Uniform Asymptotics for a Delay-Claims Risk Model with Constant Force of Interest and By-Claims Arriving according to a Counting Process." Mathematical Problems in Engineering 2019 (February 7, 2019): 1–15. http://dx.doi.org/10.1155/2019/6385647.
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The insurance risk model involving main claims and by-claims has been traditionally studied under the assumption that every main claim may be accompanied with a by-claim occurring after a period of delay, but in reality each main claim can cause many by-claims arriving according to a counting process. To this end, we construct a new insurance risk model that is also perturbed by diffusion with constant force of interest. In the presence of heavy tails and dependence structures among modelling components, we obtain some asymptotic results for the finite-time ruin probability and the tail probability of discounted aggregate claims, where the results hold uniformly for all times in a finite or infinite interval.
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LANGE, BENJAMIN. "Restricted Prioritarianism or Competing Claims?" Utilitas 29, no. 2 (June 28, 2016): 137–52. http://dx.doi.org/10.1017/s0953820816000182.
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I here settle a recent dispute between two rival theories in distributive ethics: Restricted Prioritarianism and the Competing Claims View. Both views mandate that the distribution of benefits and burdens between individuals should be justifiable to each affected party in a way that depends on the strength of each individual's separately assessed claim to receive a benefit. However, they disagree about what elements constitute the strength of those individuals’ claims. According to restricted prioritarianism, the strength of a claim is determined in ‘prioritarian’ fashion by both what she stands to gain and her absolute level of well-being, while, according to the competing claims view, the strength of a claim is also partly determined by her level of well-being relative to others with conflicting interests. I argue that, suitably modified, the competing claims view is more plausible than restricted prioritarianism.
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Miasary, Seftina Diyah. "Analisis Jumlah Klaim Agregasi Berdistribusi Negative Binomial Dan Besar Klaim Berdistribusi Discreate Uniform Dengan Menggunakan Metode Konvolusi." Journal of Mathematics : Theory and Application 4, no. 2 (November 17, 2022): 50–56. http://dx.doi.org/10.31605/jomta.v4i2.2010.
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Claims are a form of demands from insurance policy holders in order to get protection against financial losses due to risks that occur. Claims that arise every time a risk occurs are called individual claims, while the total of individual claims during an insurance period is called aggregation claims. In addition, claims are one of the important elements in optimizing the minimum expenditure of insurance companies where one of the calculations that insurance companies need to know based on claims is aggregate loss. Aggregate loss is the total loss in a period experienced by the policyholder which is borne by an insurance company. This study aims to determine the estimated total aggregate loss claims for the number of claims with a Negative Binomial distribution and the size of the claims with a Discrete Uniform distribution in the recapitulation of claim payments according to all types of guarantees and the nature of injuries in 2018-2020 PT. Jasa Raharja, Purwakarta. This study uses the convolution method with the help of Easyfit and R Studio software. The convolution method is a method of calculating the number of multiplication pairs of a probability density function. The results of this study indicate that from the recapitulation data on claim payments according to all types of insurance and nature of injury in 2018-2020 PT. Jasa Raharja, Purwakarta, the estimated total monthly aggregate loss claims for the years 2021-2023 using Jasa Raharja's insurance claim data from 2018 to 2020 based on the Negative Binomial distribution and the Discrete Uniform distribution is IDR 4,278,5545,000 and the variance value of 2.128412e-06.
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Manago, Cleo. "Manhood—who Claims it? who does it Claim?" Black Scholar 26, no. 1 (December 1996): 48–49. http://dx.doi.org/10.1080/00064246.1996.11430774.
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Nasution, Sri Lestari Ramadhani, Yohana Candra Andini Hutabarat, and Chrismis Novalinda Ginting. "Evaluation of the Role of Internal Verification Doctors in Reducing Pending Claims at Murni Teguh Medan Hospital in 2022." Jurnal Penelitian Pendidikan IPA 9, SpecialIssue (December 25, 2023): 563–69. http://dx.doi.org/10.29303/jppipa.v9ispecialissue.5533.
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In the claim verification process, errors are still encountered which cause the claim to be pending. The problem of pending claims that occurs causes many losses for the Hospital. Therefore, an internal verifier is needed to supervise claim verification so that problems with pending claims can be minimized. Internal verification doctors have an important task in reducing the number of pending claims, especially to control the suitability of coding with diagnoses on medical resumes. The aim of this research is to analyze and describe the contribution of internal verifier doctors in reducing pending claims as well as the factors that cause pending claims and claims coding errors. The type of research used in this research is qualitative research. The research design used in this research is a descriptive research design. This research has sources as key informants, namely 4 internal verification doctors. This research also has sources as supporting informants, namely coder representatives. The conclusions of this research are: (1). Factors causing pending claims at RSU Murni Teguh Medan include: (a). Administrative factors, (b). Coding factors, (c). Medical factors. (2). The factors that cause errors in coding claims at RSU Murni Teguh Medan include: (a). HR Factors (Natural Resources) and; (b). Disagreement factor. The role of the internal verifier doctor in reducing pending claims includes: (a). Medical Document Examination; (b). In-Depth Clinical Verification; (c). Collaboration with the Filing Team; (d). Communication with BPJS.
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Addo, Rebecca, Justice Nonvignon, and Huihui Wang. "VP36 Benefit Cost Analysis Of Electronic Claims Processing System In Ghana." International Journal of Technology Assessment in Health Care 34, S1 (2018): 168–69. http://dx.doi.org/10.1017/s0266462318003513.
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Introduction:Since the inception of the Ghana National Health Insurance Scheme (NHIS), it has been pursuing a number of provider payment mechanisms that could not only control the continuous escalating costs of claims payout, but also facilitate the claims processing time. In lieu of this, electronic processing of claims (E-claims) was introduced in 2013 as part of the World Bank supported Health Insurance project that sought to facilitate the financial and operational management of the NHIS. It was piloted in 29 health facilities up to March 2014. They reported cost savings made by the NHIS using E-claims, creating interest in scaling it up. However, the comparative effectiveness and cost effectiveness of E-claims to the health system compared to manual claims processing is unknown. Therefore, to provide decision makers with the appropriate information to choose between manual and E-claims processing, this study sought to evaluate the cost-benefit of E-claims.Methods:A benefit-cost analysis was used to evaluate the efficiency of E-claims from the perspective of the health system. Health providers and the purchaser (NHIS claims processing center) were the study population. Resource use and costs were obtained from the study population. The volumes and values of claims reimbursed and the claims rejection rate were used as the benefits of claims processing. The incremental benefit-cost ratio (IBCR) was estimated for the provider, purchaser and the entire health system. Analysis was conducted in Microsoft Excel.Results:The total cost per claim for providers were USD 1,177.04 and USD 1,240.65 for E-claims and paper claims respectively. The total cost per E-claims and paper claims for the purchaser were 592.17 and 502.19 respectively. Total benefit per E-claim and paper claim processing for the providers were USD 8,562.90 and USD 8,888.37 respectively while that for the purchaser was USD 11,037.62 and USD 8,737.60 respectively. Processing claims electronically led to incremental gains by both providers and purchasers. Providers gained additional USD 2008.51 while the purchaser gained USD 2,300.02. The IBCR was estimated at −19.75, 25.56 and 5.10 for all providers, purchaser and both providers and purchaser of the health system respectively. Thus the IBCR was less than 1for the providers and more than 1 for purchaser and both purchaser and providers.Conclusions:The electronic processing of claims is more efficient compared to manual processing in the Ghana NHIS. This provides decision makers with evidence for scaling it up to all the facilities in Ghana.
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Zhang, Yiying. "On transform orders for largest claim amounts." Journal of Applied Probability 58, no. 4 (November 22, 2021): 1064–85. http://dx.doi.org/10.1017/jpr.2021.12.
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AbstractThis paper investigates the ordering properties of largest claim amounts in heterogeneous insurance portfolios in the sense of some transform orders, including the convex transform order and the star order. It is shown that the largest claim amount from a set of independent and heterogeneous exponential claims is more skewed than that from a set of independent and homogeneous exponential claims in the sense of the convex transform order. As a result, a lower bound for the coefficient of variation of the largest claim amount is established without any restrictions on the parameters of the distributions of claim severities. Furthermore, sufficient conditions are presented to compare the skewness of the largest claim amounts from two sets of independent multiple-outlier scaled claims according to the star order. Some comparison results are also developed for the multiple-outlier proportional hazard rates claims. Numerical examples are presented to illustrate these theoretical results.
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Jaffey, Peter. "DUTIES AND LIABILITIES IN PRIVATE LAW." Legal Theory 12, no. 2 (June 2006): 137–56. http://dx.doi.org/10.1017/s1352325206060265.
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Private law is generally formulated in terms of right–duty relations, and accordingly, private-law claims are understood to arise from breaches of duty, or wrongs. Some claims are not easy to explain on this basis because the claim arises from an act that the defendant was justified in doing. The violation/infringement distinction seems to offer an explanation of such claims, but it is argued that the explanation is illusory. Claims of this sort are best understood as based not on a primary right–duty relation at all but on a “primary liability” or “right–liability” relation. A primary-liability claim is not a claim arising from the breach of a strict-liability duty. The recognition of primary-liability claims does not involve skepticism about duties or rules or legal relations and it is consistent with the analysis of private law in terms of corrective justice.
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Sevilla, Julio, Mathew S. Isaac, and Rajesh Bagchi. "Format Neglect: How the Use of Numerical Versus Percentage Rank Claims Influences Consumer Judgments." Journal of Marketing 82, no. 6 (October 4, 2018): 150–64. http://dx.doi.org/10.1177/0022242918805455.
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Marketers often claim to be part of an exclusive tier (e.g., “top 10”) within their competitive set. Although recent behavioral research has investigated how consumers respond to rank claims, prior work has focused exclusively on claims having a numerical format. But marketers often communicate rankings using percentages (e.g., “top 20%”). The present research explores how using a numerical format claim (e.g., “top 10” out of 50 products) versus an equivalent percentage format claim (e.g., “top 20%” out of 50 products) influences consumer judgments. Across five experiments, the authors find robust evidence of a shift in evaluations whereby consumers respond more favorably to numerical rank claims when set sizes are smaller (i.e., <100) but more favorably to percentage rank claims when set sizes are larger (i.e., >100), even when the claims are mathematically equivalent. They further show that this change in evaluations occurs because consumers commit format neglect when making their evaluations by relying predominantly on the nominal value conveyed in a rank claim and insufficiently accounting for set size.
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Abekah-Nkrumah, Gordon, Maxwell Antwi, Alex Yao Attachey, Wendy Janssens, and Tobias F. Rinke de Wit. "Readiness of Ghanaian health facilities to deploy a health insurance claims management software (CLAIM-it)." PLOS ONE 17, no. 10 (October 5, 2022): e0275493. http://dx.doi.org/10.1371/journal.pone.0275493.
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Introduction Inadequate, inefficient and slow processing of claims are major contributors to the cost of health insurance schemes, and therefore undermining their sustainability. This study uses the Technology, Organisation and Environment (TOE) framework to examine the preparedness of health facilities of the Christian Health Association of Ghana (CHAG) to implement a digital mobile health insurance claims processing software (CLAIM-it), which aims to increase efficiency. Methods The study used a cross-sectional mixed method design to collect data (technology and human capital capacity and baseline operational performance of claims management) from a sample of 20 CHAG health facilities across Ghana. While quantitative data was analysed using simple descriptive statistics statistics (frequencies, mean, minimum and maximum values), qualitative interviews were recorded, transcribed and abstracted into two major themes that were reported to re-enforce the quantitative findings. Results The quantitative results revealed challenges including inadequate computers and accessories, adequate numbers and skills for claims processing, poor intranets and internet access, absence of a robust post-implementation support system and inadequate standard operating procedures (SOPs) for seamless automation of claims processing. In addition to the above, the qualitative results emphasised the need to make CLAIM-it more flexible and capable of being integrated into third-party softwares. Notwithstanding the challenges, decision-makers in CHAG health facilities see the CLAIM-it software as having better functionality and superior capabilities compared to existing claims processing systems in Ghana. Conclusion Notwithstanding the challenges, the CLAIM-it software is more likely to be adopted by decision-makers, given the positive perception in terms of superior functionality. It is important that key actors in claims management at the National Health Insurance collaborate with relevant stakeholders to adopt the CLAIM-it software for claims processing and management in Ghana.
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Nilasari, Tengku, Wahyuni Dian Purwati, and Rian Adi Pamungkas. "Implementation Model of Timeliness of BPJS Claims Based on Penomenology Study." Jurnal Health Sains 4, no. 2 (February 8, 2023): 44–55. http://dx.doi.org/10.46799/jhs.v4i2.831.
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The purpose of this study was to explore the factors of delay in BPJS claims for inpatients at the Yukum Medical Center Hospital. The type of research in this study using qualitative research using a qualitative approach is expected to produce a basic model in providing the most appropriate recommendations in solving the problem of the timeliness of submitting BPJS claims at the Yukum Medical Center hospital. This subject is the accuracy of BPJS claims. The object of this research is the Yukum Medical Center casemix team. The results of the analysis conclude that the claim procedure already has an SPO/regulation that regulates the procedure for submitting a BPJS claim but has not run according to the SPO/regulation. The delay in BPJS claims in 2021 is around 80%. delays in BPJS claims as a result of the lack of quality of the casemix team's human resources and inaccurate and incomplete medical resumes. Factors causing delays in BPJS claims from aspects of Man, Method, Machine, Material, and Money. Expected recommendations so that recommendations/solutions are proposed again. The claim procedure is in accordance with the implementation flow, but the SPO/regulation has not been running well. BPJS RS claim. Yukum Medical Center 80% of 2021 claims are late. Factors causing delays in BPJS claims there is no evaluation of the competency of the casemix team (man), late and incomplete medical resumes (material), lack of printers when there is an increase in the number of patients (mechine), lack of budget for HR training (money). The BPJS claim recommendations at the Yukum Medical Center Hospital have been running but the results of the implementation have not been in line with expectations, so recommendations are needed.
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Al-Ani, Haya H., Anandita Devi, Helen Eyles, Boyd Swinburn, and Stefanie Vandevijvere. "Nutrition and health claims on healthy and less-healthy packaged food products in New Zealand." British Journal of Nutrition 116, no. 6 (August 9, 2016): 1087–94. http://dx.doi.org/10.1017/s0007114516002981.
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AbstractNutrition and health claims are displayed to influence consumers’ food choices. This study assessed the extent and nature of nutrition and health claims on the front-of-pack of ‘healthy’ and ‘less-healthy’ packaged foods in New Zealand. Foods from eight categories, for which consumption may affect the risk of obesity and diet-related chronic diseases, were selected from the 2014 Nutritrack database. The internationally standardised International Network for Food and Obesity/Non-Communicable Diseases Research, Monitoring and Action Support (INFORMAS) taxonomy was used to classify claims on packages. The Nutrient Profiling Scoring Criterion (NPSC) was used to classify products as ‘healthy’ or ‘less healthy’. In total, 7526 products were included, with 47 % (n 3557) classified as ‘healthy’. More than one-third of products displayed at least one nutrition claim and 15 % featured at least one health claim on the front-of-pack. Claims were found on one-third of ‘less-healthy’ products; 26 % of those products displayed nutrition claims and 7 % featured health claims. About 45 % of ‘healthy’ products displayed nutrition claims and 23 % featured health claims. Out of 7058 individual claims, the majority (69 %) were found on ‘healthy’ products. Cereals displayed the greatest proportion of nutrition and health claims (1503 claims on 564 products), of which one-third were displayed on ‘less-healthy’ cereals. Such claims could be misleading consumers’ perceptions of nutritional quality of foods. It needs to be explored how current regulations on nutrition and health claims in New Zealand could be further strengthened (e.g. using the NPSC for nutrition claims, including general health claims as per the INFORMAS taxonomy) to ensure consumers are protected and not misled.
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Prabowo, Agung. "PENENTUAN TARIF PREMI PADA ASURANSI KENDARAAN DENGAN BESAR KLAIM BERDISTRIBUSI EKSPONENSIAL DAN GAMMA." Premium Insurance Business Journal 10, no. 1 (July 31, 2023): 29–41. http://dx.doi.org/10.35904/premium.v10i1.46.
Full textAbstract:
Calculation of vehicle insurance premium rates can be done using the aggregate claims model. The aggregate claims model consists of a combination of two independent random variables, namely the number of claims that occur and the amount of claims for each event. The research method is in the form of literature studies and case studies using secondary data in the form of data on the number of claims and the amount of claims collected from January 2013 to December 2019. Based on the data collected, there were 802 claims with the smallest claim being IDR 50,000 and the largest being IDR 211,715,000. Testing the hypothesis shows that the data on the number of claims has a Poisson distribution, and the amount of claims follows two types of distribution, namely the exponential and gamma distribution so that the aggregate claim distribution is a combination of Poisson-Exponential and Poisson-Gamma. Parameter estimation for each distribution is carried out by the moment method with available secondary data. This study concludes that the use of the pure premium principle provides the same premium rate for both distributions of aggregate claims, amounting to IDR 82,856.39 per month per person. While the use of the expected value principle provides a premium rate for the Poisson-Gamma aggregate claims distribution 8.76 times greater than the Poisson- Exponential aggregate claims distribution, namely IDR 1,920,019.55 per month and IDR 219,155.20 per month, respectively.
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Donelson, Raff. "Describing Law." Canadian Journal of Law & Jurisprudence 33, no. 1 (February 2020): 85–106. http://dx.doi.org/10.1017/cjlj.2019.31.
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Legal philosophers make a number of bold, contentious claims about the nature of law. For instance, some claim that law necessarily involves coercion, while others disagree. Some claim that all law enjoys presumptive moral validity, while others disagree. We can see these claims in at least three, mutually exclusive ways: (1) We can see them as descriptions of law’s nature (descriptivism), (2) we can see them as expressing non-descriptive attitudes of the legal philosophers in question (expressivism), or (3) we can see them as practical claims about how we should view law or order our society (pragmatism). This paper argues that we should understand these claims in the pragmatist way, as claims about how we should view law or order society.
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Talib Bon, Abdul, Muhammad Iqbal Al-Banna Ismail, Sukono ., and Adhitya Ronnie Effendie. "Collective Value-At-Risk (Colvar) In Life Insurance Collection." International Journal of Engineering & Technology 7, no. 3.7 (July 4, 2018): 25. http://dx.doi.org/10.14419/ijet.v7i3.7.16199.
Full textAbstract:
Analysis of risk in life insurance claims is very important to do by the insurance company actuary. Risk in life insurance claims are generally measured using the standard deviation or variance. The problem is, that the standard deviation or variance which is used as a measure of the risk of a claim can not accommodate any claims of risk events. Therefore, in this study developed a model called risk measures Collective Modified Value-at-Risk. Model development is done for several models of the distribution of the number of claims and the distribution of the value of the claim. Collective results of model development Modified Value-at-Risk is expected to accommodate any claims of risk events, when given a certain level of significance
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Abouleish, Amr E., Donald S. Prough, and Rakesh B. Vadhera. "Influence of the Type of Anesthesia Provider on Costs of Labor Analgesia to the Texas Medicaid Program." Anesthesiology 101, no. 4 (October 1, 2004): 991–98. http://dx.doi.org/10.1097/00000542-200410000-00026.
Full textAbstract:
Background The Texas Medicaid Program (Medicaid) defines billable time for labor analgesia as face-to-face time; therefore, anesthesia providers determine billed time. The authors' goal was to determine the influence of anesthesia providers on labor analgesia costs billed to Medicaid. Methods Under the Freedom of Information Act, Medicaid provided data on claims paid for 6 months in 2001 for labor analgesia administered during the course of a vaginal delivery. Claims were either time based (codes 00946 or 00955) or a flat fee (codes 26311 or 26319). Using modifiers, the authors grouped time-based claims as either anesthesiologist group or certified registered nurse anesthetist (CRNA) group. The cost to Medicaid was based on the 2001 fee schedule. The conversion factor was 18.21 USD per American Society of Anesthesiologists unit. The flat-fee reimbursement was 152.50 USD. CRNA services were paid at 85% of the fee schedule. Average time per time claim, percent of providers with more than 4 h of billed time, and cost per claim were determined for each group. Providers with more than 120 claims (> 20 claims/month) were considered high-volume. Results The database included 21,378 claims (anesthesiologist group: 12,698 claims from 219 providers; CRNA group: 8,680 claims from 117 providers). For time-based claims, the average time per case was significantly higher in the CRNA group (146 min) than in the anesthesiologist group (105 min). The CRNA group cost to Medicaid (225.11 USD) was 19% more per claim than the anesthesiologist group (189.26 USD). The difference in cost per claim was greater among high-volume providers--213.10 USD for the CRNA group versus 168.76 USD for the anesthesiologist group. If a flat-fee program were instituted using the average cost per claim for all groups (203.81 USD), the Texas Medicaid program would save more than 500,000 USD annually. Conclusions The costs of labor analgesia billed to Texas Medicaid were 19% to 26% less per patient when provided by anesthesiologists than by CRNAs, despite lower per-unit reimbursement of CRNAs.