Claim settlement is one of the most important services that an insurance company can provide to its customers. Insurance companies have an obligation to settle claims promptly.Technology is now being increasingly utilised to make the insurance claims simpler, faster and more cost effective The nature of the claims process makes certain tasks repetitive, and the outdated processes do little to improve claim turnaround times, leading to frustrated customers. Advancements are being made in the field of Artificial Intelligence (AI), and the technology holds enormous potential for disrupting the insurance industry, especially the claims process. Times are changing slowly but surely as insurance companies are embracing technology in an attempt to make the claims process faster, consistent and qualitative.
The National Academy of Construction (NAC) has determined that disputes, and their accompanying inefficiencies and costs, constitute a significant problem for the industry. In 2002, the NAC assessed the industry's progress in attacking this problem and determined that although the tools, techniques, and processes for preventing and efficiently resolving disputes are already in place, they are not being widely used. In 2003, the NAC helped to persuade the Center for Construction Industry Studies (CCIS) at the University of Texas and the Alfred P. Sloan Foundation to finance and conduct empirical research to develop accurate information about the relative transaction costs of various forms of dispute resolution. In 2004 the NAC teamed with the Federal Facilities Council (FFC) of the National Research Council to sponsor the "Government/Industry Forum on Reducing Construction Costs: Uses of Best Dispute Resolution Practices by Project Owners." The forum was held on September 23, 2004, at the National Academy of Sciences in Washington, D.C. Speakers and panelists at the forum addressed several topics. Reducing Construction Costs addresses topics such as the root causes of disputes and the impact of disputes on project costs and the economics of the construction industry. A second topic addressed was dispute resolution tools and techniques for preventing, managing, and resolving construction- related disputes. This report documents examples of successful uses of dispute resolution tools and techniques on some high-profile projects, and also provides ways to encourage greater use of dispute resolution tools throughout the industry. This report addresses steps that owners of construction projects (who have the greatest ability to influence how their projects are conducted) should take in order to make their projects more successful.
Established in order to consider legal claims resulting from the significant historic events, Mass Claims Processes have become increasingly important phenomena in international dispute resolution. Processes covered in this book include the Iran-US Claims Tribunal, the UN Compensation Commission (relating to Iraq's invasion of Kuwait) and Mass Claims Processes relating to the Holocaust, the conflicts in Bosnia and Kosovo, and the war between Eritrea and Ethiopia. The book is structured around forty-seven basic topics that typically arise when creating an international Mass Claims Process, offering commentary on the ways in which the various Processes have dealt with each topic.
The Model Rules of Professional Conduct provides an up-to-date resource for information on legal ethics. Federal, state and local courts in all jurisdictions look to the Rules for guidance in solving lawyer malpractice cases, disciplinary actions, disqualification issues, sanctions questions and much more. In this volume, black-letter Rules of Professional Conduct are followed by numbered Comments that explain each Rule's purpose and provide suggestions for its practical application. The Rules will help you identify proper conduct in a variety of given situations, review those instances where discretionary action is possible, and define the nature of the relationship between you and your clients, colleagues and the courts.
This volume from the International Bureau of the PCA presents a collection of studies on innovative responses to the unique challenges of resolving large numbers of claims arising from common, often tragic, circumstances-mass claims. The mass claims processes discussed in this volume were created in the aftermath of war or other atrocities, and redress is often an important component of settlement for the victims. The authors consider mass claims processes both from a conceptual and a practical perspective through lessons learned over twenty-five years. This book covers innovations to speed mass claims processes by means of new standards of proof and the use of information technology, as well as specific mass claims processes: the United Nations Compensation Commission; the Austrian General Settlement Fund; the French Commission for the Compensation of Victims of Spoliation; the German Forced Labour Compensation Programme; and the reparations provisions of the Statute of the International Criminal Court. From a North American perspective, authors address the litigation of mass claims involving slavery under United States law, the United States Indian Claims Commission, and the successful completion of the September 11th Victim Compensation Fund. In addition, Volume 1 of the Final Report of the Special Master of the September 11th Victim Compensation Fund is reprinted in its entirety. The responses of the international community to current issues of compensation and reparations, the role of civil society actors in reparations legislation, and recent instruments adopted by the Council of Europe and the United Nations Commission on Human Rights are also reviewed.
ERISA and Health Insurance Subrogation In All 50 States is the most complete and thorough treatise covering the complex subject of ERISA and health insurance subrogation ever published. NEW TO THE FIFTH EDITION! • Updated To Include All The Newest Case Law! • Updated To Include Medicaid Subrogation and Preemption of FEHBA ! • New Plan Language Recommendations! • Complete Health Insurance Subrogation Laws In All 50 States • Covers The Application of ERISA In Every Federal Circuit The Fifth Edition of ERISA and Health Insurance Subrogation In All 50 States has been completely revised, edited, and reorganized. This was partly to reflect the new direction recent case decisions have taken regarding health insurance subrogation as well as the crystallization of formerly uncertain and nebulous areas of the law which have now received some clarity. An entirely new chapter entitled, “What Constitutes Other Appropriate Equitable Relief?” has been added and replaces the old Chapter 9, which merely dealt with Knudson and Sereboff. The new edition introduces new state court decisions addressing the issue of causation and whether and when a subrogated Plan seeking reimbursement must prove that the medical benefits it seeks to recover were causally related to the original negligence of the tortfeasor. An entirely new section was added concerning the subrogation and reimbursement rights of Medicare Advantage Plans, a statutorily-authorized Plan which provides the same benefits an individual is entitled to recover under Medicare. This includes recent case law which detrimentally affects the rights of such Plans to subrogate. Also added to the new edition is additional law and explanation regarding Medicaid subrogation, including the differentiation between “cost avoidance” and “pay and chase” when it comes to procedures for paying Medicaid claims. Significant improvements have been made to suggested Plan language which maximizes a Plan’s subrogation and reimbursement rights. The suggested language stems from recent decisions and developments in ERISA and health insurance subrogation from around the country since the last edition. The new edition has been completely reworked both in substance and organization. Recent case law has necessitated consolidation of several portions of the book and elimination or editing of others. A new section entitled “Liability of Plaintiff’s Counsel” has been added, which provides a clearer exposition on the laws applicable and remedies available when plaintiff’s attorneys and Plan beneficiaries settle their third-party cases and fail to reimburse the Plan. Also new to the book are recently-passed anti-subrogation measures such as Louisiana’s Senate Bill 169, § 1881, which states that no health insurer shall seek reimbursement from automobile Med Pay coverage without first obtaining the written consent of the insured. The new edition also goes into much greater detail on the procedures for and law underlying the practice of removal of cases from state court to federal court, and the possibility of remand back to state court. This includes the Federal Courts Jurisdiction and Venue Clarification Act of 2011, effective Jan. 6, 2012, which amended federal removal, venue, and citizenship determination statutes in very significant ways. The new edition also delves into, for the first time, the role which the federal Anti-Injunction Act plays when beneficiaries sue in state court to enforce the terms of an ERISA Plan, while the Plan files suit in federal court seeking an injunction against the state court action. New case law and discussion on preemption of FEHBA subrogation and reimbursement claims have been added to Chapter 10 in the wake of new decisions regarding same.
