Fraudulent insurance claims : recent legal developments

Insurance fraud continues to be a major problem worldwide. This article will canvass recent legal developments in relation to selected issues and matters of particular concern to the insurance industry. This article is confined to fraudulent claims. Fraud may arise at various points in the insurance relationship, including initial fraud on placement and fraudulent breach of contract by the assured. Fraud at the outset by the assured is treated differently from innocent or negligent conduct. "Fraud" in the context of this paper embraces all claims where an insured intednds to deceive an insurer by getting out i money to which the insured knew he had no right. This article will examine fraudulent insurance claims.

Testing for the non-separability of bi-ambiguous compounds

Separability is a concept that is very difficult to define, and yet much of our scientific method is implicitly based upon the assumption that systems can sensibly be reduced to a set of interacting components. This paper examines the notion of separability in the creation of bi-ambiguous compounds that is based upon the CHSH and CH inequalities. It reports results of an experiment showing that violations of the CHSH and CH inequality can occur in human conceptual combination.

The role of non-factorizability in determining "pseudo-classical" non-separability

This article introduces a “pseudo classical” notion of modelling non-separability. This form of non-separability can be viewed as lying between separability and quantum-like non-separability. Non-separability is formalized in terms of the non-factorizabilty of the underlying joint probability distribution. A decision criterium for determining the non-factorizability of the joint distribution is related to determining the rank of a matrix as well as another approach based on the chi-square-goodness-of-fit test. This pseudo-classical notion of non-separability is discussed in terms of quantum games and concept combinations in human cognition.

Cranes, claims and a statutory right of user

In larger developments there is potential for construction cranes to encroach into the airspace of neighbouring properties. To resolve issues of this nature, a statutory right of user may be sought under s 180 of the Property Law Act 1974 (Qld). Section 180 allows the court to impose a statutory right of user on servient land where it is reasonably necessary in the interests of effective use in any reasonable manner of the dominant land. Such an order will not be made unless the court is satisfied that it is consistent with public interest, the owner of the servient land can be adequately recompensed for any loss or disadvantage which may be suffered from the imposition and the owner of the servient land has refused unreasonably to agree to accept the imposition of that obligation. In applying the statutory provision, a key practical concern for legal advisers will be the basis for assessment of compensation. A recent decision of the Queensland Supreme Court (Douglas J) provides guidance concerning matters relevant to this assessment. The decision is Lang Parade Pty Ltd v Peluso [2005] QSC 112.

Loss of chance in medical negligence claims now a lost cause?

The question whether the loss of chance of a better medical outcome in cases of medical negligence should be recognised as actionable damage is ‘a question which has divided courts and commentators throughout the common law world.’ In April 2010, the High Court handed down its anticipated decision in the case of Tabet (by her Tutor Sheiban) v Gett (2010) 240 CLR 537. The issue considered by the court was whether the appellant could claim in negligence for the loss of a chance of a better medical outcome. This issue had not been considered by the High Court previously, the most relevant cases being Rufo v Hosking (2004) 61 NSWLR 678 and Gavalas v Singh (2001) 3 VLR 404. Claiming for a loss of chance in a personal injury action raises questions as to recognised damage and causation, and the members of the High Court considered both of these.

Fuelling traffic : abolitionist claims of a causal nexus between legalised prostitution and trafficking

Over the last decade, researchers and legislators have struggled to get an accurate picture of the scale and nature of the problem of human trafficking. In the absence of reliable data, some anti-prostitution activists have asserted that a causal relationship exists between legalised prostitution and human trafficking. They claim that systems of legalised or decriminalised prostitution lead to increases in trafficking into the sex industry. This paper critically analyses attempts to substantiate this claim during the development of anti-trafficking policy in Australia and the United States. These attempts are explored within the context of persistent challenges in measuring the scale and nature of human trafficking. The efforts of abolitionist campaigners to use statistical evidence and logical argumentation are analysed, with a specific focus on the characterisation of demand for sexual services and systems of legalised prostitution as ‘pull’ factors fuelling an increase in sex trafficking. The extent to which policymakers sought to introduce evidence-based policy is also explored.

Quantum-like non-separability of concept combinations, emergent associates and abduction

Consider the concept combination ‘pet human’. In word association experiments, human subjects produce the associate ‘slave’ in relation to this combination. The striking aspect of this associate is that it is not produced as an associate of ‘pet’, or ‘human’ in isolation. In other words, the associate ‘slave’ seems to be emergent. Such emergent associations sometimes have a creative character and cognitive science is largely silent about how we produce them. Departing from a dimensional model of human conceptual space, this article will explore concept combinations, and will argue that emergent associations are a result of abductive reasoning within conceptual space, that is, below the symbolic level of cognition. A tensor-based approach is used to model concept combinations allowing such combinations to be formalized as interacting quantum systems. Free association norm data is used to motivate the underlying basis of the conceptual space. It is shown by analogy how some concept combinations may behave like quantum-entangled (non-separable) particles. Two methods of analysis were presented for empirically validating the presence of non-separable concept combinations in human cognition. One method is based on quantum theory and another based on comparing a joint (true theoretic) probability distribution with another distribution based on a separability assumption using a chi-square goodness-of-fit test. Although these methods were inconclusive in relation to an empirical study of bi-ambiguous concept combinations, avenues for further refinement of these methods are identified.

Melbourne and Brisbane: The Claims of Suburbs

This chapter critiques the imagined geography of creative cities and the creative industries, which presumes that inner cities are densely clustered hubs of urban culture and creativity while suburbs are dull, homogeneous dormitories from which creative people must escape in order to realize their potential. Drawing upon a study on creative industries workers in Melbourne and Brisbane, the authors argue that these workers are as likely to be located in the suburbs as in the inner city, and that they clearly identify advantages to being in outer suburban locations. Their findings provide a corrective to dominant urban cultural policy narratives that stress cultural amenity in the inner cities.

Who claims gifts as a tax deduction? An examination of tax deductible gift statistics

Many donors, particularly those contemplating a substantial donation, consider whether their donation will be deductible from their taxable income. This motivation is not lost on fundraisers who conduct appeals before the end of the taxation year to capitalise on such desires. The motivation is also not lost on Treasury analysts who perceive the tax deduction as “lost” revenue and wonder if the loss is “efficient” in economic terms. Would it be more efficient for the government to give grants to deserving organisations, rather than permitting donor directed gifts? Better still, what about contracts that lock in the use of the money for a government priority? What place does tax deduction play in influencing a donor to give? Does the size of the gift bear any relationship to the size of the tax deduction? Could an increased level of donations take up an increasing shortfall in government welfare and community infrastructure spending? Despite these questions being asked regularly, little has been rigorously established about the effect of taxation deductions on a donor’s gifts.

Ideas as "possessitives" : claims and counter claims in a playground dispute

In the shared space of a school playground, matters of ownership and possession are seriously attended to by children in their everyday encounters with others. The study reported here uses conversation analysis and an ethnomethodological approach to investigate a dispute between two children, aged four to six years, as they decide whose idea for the game will be used. Drawing on Sacks’ (1995a) notion of possession, and Sharrock’s (1974) paper “on owning knowledge”, this paper demonstrates how children draw on the phrase, “that’s my idea”, to claim ownership. Analysis of their video-recorded interaction shows how the children used physical actions, gaze and talk to invoke their own intellectual property as a commodity in the dispute. Whilst invoking ownership, analysis highlights that entitlement over people, objects and the decisions of the shared interactional space did not occur unproblematically. Material objects were used to counter claims to ideas, and it was the uptake of the game and the use of play objects by others that led to whether the idea of game category was upheld. This analysis enables adults a glimpse into the complex social organisation of children’s peer group.

Agreement between self-reported use of in vitro fertilization or ovulation induction, and medical insurance claims in Australian women aged 28–36 years

STUDY QUESTION: What is the self-reported use of in vitro fertilization (IVF) and ovulation induction (OI) in comparison with insurance claims by Australian women aged 28–36 years? SUMMARY ANSWER: The self-reported use of IVF is quite likely to be valid; however, the use of OI is less well reported. WHAT IS KNOWN AND WHAT THIS PAPER ADDS: Population-based research often relies on the self-reported use of IVF and OI because access to medical records can be difficult and the data need to include sufficient personal identifying information for linkage to other data sources. There have been few attempts to explore the reliability of the self-reported use of IVF and OI using the linkage to medical insurance claims for either treatment. STUDY DESIGN: This prospective, population-based, longitudinal study included the cohort of women born during 1973–1978 and participating in the Australian Longitudinal Study on Women's Health (ALSWH) (n = 14247). From 1996 to 2009, participants were surveyed up to five times. PARTICIPANTS AND SETTING: Participants self-reported their use of IVF or OI in two mailed surveys when aged 28–33 and 31–36 years (n = 7280), respectively. This study links self-report survey responses and claims for treatment or medication from the universal national health insurance scheme (i.e. Medicare Australia). MAIN RESULTS AND THE ROLE OF CHANCE: Comparisons between self-reports and claims data were undertaken for all women consenting to the linkage (n = 3375). The self-reported use of IVF was compared with claims for OI for IVF (Kappa, K = 0.83), oocyte collection (K = 0.82), sperm preparation (K = 0.83), intracytoplasmic sperm injection (K = 0.40), fresh embryo transfers (K = 0.82), frozen embryo transfers (K = 0.64) and OI for IVF medication (K = 0.17). The self-reported use of OI was compared with ovulation monitoring (K = 0.52) and OI medication (K = 0.71). BIAS, CONFOUNDING AND OTHER REASONS FOR CAUTION: There is a possibility of selection bias due to the inclusion criteria for participants in this study: (1) completion of the last two surveys in a series of five and (2) consent to the linkage of their responses with Medicare data. GENERALIZABILITY TO OTHER POPULATIONS: The results are relevant to questionnaire-based research studies with infertile women in developed countries. STUDY FUNDING/COMPETING INTEREST(S): ALSWH is funded by the Australian Government Department of Health and Ageing. This research is funded by a National Health and Medical Research Council Centre of Research Excellence grant.