Principles of claim adjusting; a manual explaining the procedure , with background material, for settling claims under life, health and accident insurance policies.

Mode of access: Internet.

Practice and procedure - Motor Accident Insurance Act 1994 s45 - duty of claimant to cooperate with insurer

In Suncorp Metway Insurance Limited v Brown [2004] QCA 325 the Queensland Court of Appeal considered the extent of the duty of cooperation imposed on a claimant under s45 of the Motor Accident Insurance Act 1994 (Qld). The issue is an important one because it affects virtually all claims made under the Act.

The adjuster's manual for the settlement of accident and health claims /

Includes index.

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.

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.

Motor Accident Insurance Act 1994 - request for information

In Angus v Conelius [2007] QCA 190 the Queensland Court of Appeal concluded that the obligations under the Motor Accident Insurance Act 1994 (Qld), and in particular s 45 of the Act (duty of claimant to cooperate with insurer), continue beyond the commencement of court proceedings

Mandatory offers under the Motor Accident Insurance Act 1994 - with interest please!

In Windon v Edwards [2005] QDC 029 Robin QC DCJ considered the cost consequence of mandatory final offers under the Motor Accident Insurance Act 1994 (Qld)

Practice and Procedures - Motor Accident Insurance Act 1994 ss 39 and 57

In Bermingham v Priest [2002] QSC 057 jones J considered the position of persons seeking to claim damages where the Motor Accident Insurance Act 1994 applies prior to its amendment by the Motor Accident Insurance Amendment Act 2000, and where proceedings are brought close to expiration of the statutory limitation period.

Motor Accident Insurance Act 1994 - obligation to disclose

In Turpin v Allianz Australia Insurance Ltd (unreported, Supreme Court of Queensland, S5216 of 2001), Mullins J, 17.10.2001) the plaintiff applied for a declaration that the respondent disclose pursuant to s47 of the Motor Accident Insurance Act 1994 copies of three statements referred to in a loss assessor's investigation report as "attached". The issue involved determination of whether the statements must be disclosed under s48(2) even though protected by legal professional privilege. The Court applied the decision of the Queensland Court of Appeal in James v Workcover Queensland.

Motor Accident Insurance Act 1994 - whether vehicle in question a vehicle "for which registration is required"

In Gideona v Nominal Defendant [2005] QCA 261, the Queensland Court of Appeal reconsidered the question of what is the material time for determining whether registration of a motor vehicle is required. The Court declined to follow the decision in Kelly v Alford [1988] 1 Qd R 404; deciding that the material time was the time when the accident occurred.

Motor Accident Insurance Act 1994 s45 - whether obligation to co-operate may authorise order requiring commencement of proceedings by minor prior to expiration of limitation period

In Australian Associated Motor Insurers Ltd v McPaul; Council of the City of Gold Coast v McPaul [2005] QSC 278 the applicant insurer sought an order requiring a claimant who had been injured in a motor vehicle accident some years earlier when he was five years old to commence a proceeding to determine the question of the applicant's liability to him. The applicant's interest in seeking the order was to avoid the prejudice which could follow from further delay, particularly delay until the respondent became obliged to commence proceedings to avoid a limitations bar.

Motor Accident Insurance Act 1994 - reasonable excuse for delay in giving notice under s37

The decisions in Perdis v The Nominal Defendant [2003] QCA 555, Miller v the Nominal Defendant [2003] QCA 558 and Piper v the Nominal Defendant [2003] QCA 557 were handed down contemporaneously by the Queensland Court of Appeal on December 15 2003. They consider important issues as to the construction of key provisions of the Motor Accident Insurance Act 1994 (Qld)

Motor Accident Insurance Act 1994 - compulsory conferences and offers to settle

In Lindsay v Aumaali [2004] QDC 028 the Court considered whether it could, in effect, postpone the requirement for a compulsory conference under s51A of the Moror Accident insurance Act 1994 (Qld) or the exchange of final offers under s51C of the Act until after the start of proceedings.