“the contractor shall further insure that all medical, dental, and mental health services are secured from a Medicaid approved provider and that charges for services shall be at the Medicaid approved rates. If no Medicaid provider is available the contractor must make every
Question 1 – Should coverage provisions be construed broadly and exclusion clauses narrowly? If so, why? If not, why not?
In Maryland, insurance policies are generally construed in the same manner as contracts. Collier v. MD-Individual Practice Ass 'n, Inc., 327 Md. 1, 5, 607 A.2d 537 (1992). An insurance contract, like any other contract, is measured by its terms unless a statute, a regulation, or public policy is violated thereby. Pac. Indem. Co. v. Interstate Fire & Cas. Co., 302 Md. 383, 388, 488 A.2d 486 (1985). We do not follow the rule, adopted in other jurisdictions, that an insurance policy is to be construed most strongly against the insurer. Collier, 327 Md. at 5; Cheney, 315 Md. at 766. We construe the instrument as a whole in order to determine the parties’ intent. Pac. Indem., 302 Md. at 388; Collier, 327 Md. at 5; Aragona v. St. Paul Fire & Marine Ins. Co., 281 Md. 371, 375, 378 A.2d 1346 (1977). In order to determine the intention of the parties, “Maryland courts should examine the character of the contract, its purpose, and the facts and circumstances of the parties at the time of execution.” Pac. Indem., 302 Md. at 388 (citations omitted). In doing so, we give the words their usual, ordinary, and accepted meanings. Id.; Mut. Fire Ins. Co. v. Ackerman, 162 Md. App. 1, 5, 872 A.2d 110 (2005) (citing Nationwide Mut. Ins. Co. v. Scherr, 101 Md. App. 690, 695, 647 A.2d 1297 (1994)). The test is what meaning a reasonably prudent layperson would attach to the term. Pac. Indem., 302 Md. at 388.
To conclude this report, there are four considerations of a legal and valid insurance contracts that patients may present at the provider’s office or clinic. The guide to understand and remember are as follows: (a) the patient or person insured must be a mentally competent adult and should not be under the influence of drugs or alcohol; (b) the insurance company must have a signed application and offer the policy to the patient, then the patient or person should accept the issuance of the policy without misrepresentation of facts on the application of the person being insured; (c) the services produced and sold or the exchange of value and the first premium payment should be submitted with the application considered must be presented together; and (d) there should be a legal purpose which is an insurable interest in the case of a person’s healthcare insurance policy. These are good guidelines to know and understand for the success of an administrative life cycle of a physician-based claim (CMS
COMES NOW, Defendant the State Farm Fire & Casualty Company (“State Farm”), by and through Mark J. Stiller, Esq., Bryant S. Green, Esq., and Niles, Barton & Wilmer, LLP, and hereby files this Memorandum of Law in Support of its Motion for Sanctions for Failure to Respond to Discovery pursuant to Md. Rule 3-421(h), and in support thereof, states as follows:
State Farm has asked whether it has a duty to defend the insured pursuant to the insured’s homeowners policy. It is our opinion that State Farm has no duty to defend the insured under the insured’s homeowners policy. The insured’s homeowners policy entitled the insured to a defense for “a suit brought against an insured for damages because of bodily injury or property damage to which this coverage applies, caused by an occurrence.” In this case, these elements initially triggering the insured’s homeowners policy are likely satisfied. Nevertheless, the SECTON II – Exclusions section provides that the liability coverage does not apply to any of the fifteen exclusions specifically enumerated therein.
This includes any such benefits for which the Insured Person or the Insured Person’s family is eligible or that are paid to the Insured Person, to a third party on the Insured Person’s behalf, pursuant to any:
Fire is one of the risks of a construction project against which Allianz’s policy insures; yet it is only one, and given the wide range coverage of the policy, it seemed odd to the presiding judges to classify it as a fire risk insurance policy. A fire insurance policy is subjected to 19 separate requirements, and until 1990, Michigan legislature, rather than trying to define “fire insurance policy”, provided that a “standard fire policy” (with all 19 mandatory minimum provisions) would not be required for a variety of types of insurance. The structure of this Michigan statute implied any form of insurance that was not exempt was a “standard fire policy”, including a builders risk policy, and so the 19 mandatory provisions would have to have been included when indemnity was sought after. However, this legislature was repealed in 1990, well before Allianz issued the
Coverage: Appears to be proper. Insured has no PUP. Only an active Homeowners and Auto. Loss occurred on named insured property and the named insured is the responsible party. The lawn mower is under the 40hp exclusion, mower is 14hp.
There are many different types of coverage for health insurance, each having their own unique processes as well as reimbursement methods. Heath insurance coverage can either be offered by an employer, paid for monthly by beneficiary, or may be obtained through serving in the armed forces. Insurance can be categorized under as ether individual insurance or group insurance. With individual insurance only applies to the individual that’s enrolled in the policy and the individuals’ dependents. Individual insurance isn’t available through a group rate thus; premiums will be higher than if the individual had group insurance. Group insurance is a master policy that’s usually purchased by an organization or employer that that covers the employees as well as their dependents. The policyholder’s dependents are the spouse and children under a certain age. Group insurance usually offers lower premiums with better benefits. The different types of insurance coverage includes, hospital insurance, an indemnity plan or fee for service plan, hospital indemnity insurance, medical insurance, surgical insurance outpatient insurance, special risk insurance, major medical insurance, catastrophic insurance, short-term insurance, full-service insurance, long-term insurance,
BlueCross BlueShield Association (BCBSA) is an independent health insurance association which is founded in 1929. It is made up by 37 different health insurance organizations and companies in the United States. They directly or indirectly provide health insurance to over 100 million Americans. Under the Association, it has two famous products. One is Health Maintenance Organizations (HMOs), and the other is Preferred Provider Organization (PPOs). Most American who has health insurance from their employer are enrolled either an HMO or PPO. All of these managed care plans go through the health plan’s network, which contract with doctors, health care providers, clinics, and hospital.
Prior to the accident, Plaintiff purchased a disability insurance policy (the “Policy”) from Defendant Common Insurance Company in New Amsterdam which provided issued insurance policy to Plaintiff.