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.

Analysis of 1981 and 1982 insurance claims to determine effect of 1981 and 1982 bumpers on crash damage. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Analysis of insurance claims to determine bumper effect on crash damage. Final report.

National Highway Traffic Safety Administration, Office of Plans and Programs, Washington, D.C.

Analysis of insurance claims to determine bumper effect on crash damage - 1979 model year. Final report addendum.

National Highway Traffic Safety Administration, Office of Plans and Programs, Washington, D.C.

Handbook on transportation insurance claims

"An analytical digest of adjusting practices, procedures, legislative history, legal principles, decisions, definitions and insurance coverages in the field of transportation insurance."

Development of a Strengths-Based Model for Insurance Automobile, Property, and Casualty Claims Operations

ABSTRACT \ Employers know that to have a successful organization, they must have the right people in the right jobs. But how will they know whom to place where? The development of a model based upon an individual's personality traits and strengths, and how to best use them, is a good place to start. Employees working in positions in which their traits and strengths are maximized enjoy work more, are more efficient, and are less apt to be absent or to look for work elsewhere. It is a mutually beneficial process of selection for both employers and employees. This model illustrates the process in an automobile and property insurance claims operation through utilization of the Myers-Briggs Type Indicators and the StrengthsFinder Profiles.

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.

A Retrospective Claims Analysis of Medication Adherence and Persistence Among Patients Taking Antidepressants for the Treatment of Major Depressive Disorder (MDD)

Thesis (Master's)--University of Washington, 2015

A comparative analysis of decision trees vis-à-vis other computational data mining techniques in automotive insurance fraud detection

The development and application of computational data mining techniques in financial fraud detection and business failure prediction has become a popular cross-disciplinary research area in recent times involving financial economists, forensic accountants and computational modellers. Some of the computational techniques popularly used in the context of - financial fraud detection and business failure prediction can also be effectively applied in the detection of fraudulent insurance claims and therefore, can be of immense practical value to the insurance industry. We provide a comparative analysis of prediction performance of a battery of data mining techniques using real-life automotive insurance fraud data. While the data we have used in our paper is US-based, the computational techniques we have tested can be adapted and generally applied to detect similar insurance frauds in other countries as well where an organized automotive insurance industry exists.

New Jersey disability insurance program.

"October 1950."

Reference guide for Medicare physician & supplier billers : helping front office personnel navigate Medicare rules for Part B claims processing.

"ICN 006209"--P. [4] of cover.