Understanding Insurance Coverage Essay

As you learn about health care delivery in the United States, it is important to understand the various models of health insurance to develop a working knowledge as you progress through the course. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers as important foundational information for your role as a future health care worker. Fill in the following matrix. Each box must contain responses between 50 and 100 words using complete sentences.

"Insurance is a legal contract that protects people from the financial costs that result from loss of life, loss of health, lawsuits or property damage."(Nielson.) This protection is given to the customer in exchange for a monthly payment to the company. This is a legal contract which is known as a policy, binds the customer to the insurance company for the duration of the policy. Insurance, whether it be life, health or auto, helps customers feel safe from everyday risks that can happen in life. Most insurance is optional, although some states enforce a law that automobile insurance must be purchased in order to register a car. Automobile insurance is very important. It helps the policy holder to protect their car

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.

David A. Goldmeier and Terry C. Goldmeier v. Allstate Insurance Company 337 F.3d 629 (6th Cir 2003) case supports our

place learn sometimes to their delight, other times to their horror -that insurance is a quirky affair,

Facts: This is a UIM claim arising from a motor vehicle accident in Oxford, Alabama. The plaintiff and your insured, Jamie Holt, was stopped behind another vehicle at a red light on Highway 21. A vehicle struck Mr. Holt’s vehicle from the rear while traveling at approximately 40 mph, pushing Mr. Holt’s vehicle into the vehicle directly in front of his. Mr. Holt was taken to Regional Medical Center in Anniston, Alabama via ambulance. Mr. Holt has already settle with the tortfeasor insurer, Progressive, for the policy limits of $100,000.00.

As a “comprehensive major medical insurance policy,” the Dumonts’ coverage includes basic health insurance for hospital, surgical, and physician expense needs, as well as major medical expense coverage. The latter is very important to extend the basic coverage to protect the Dumonts from the financial effects of a catastrophic illness or accident. The policy has a very adequate lifetime cap of $3,000,000 per insured. The Dumonts should continually analyze the health plans from both employers to determine which offers the best overall plan. But, the annual coinsurance, stop-loss amount, and family

Liability insurance protects the policyholder in the event that lawsuits or similar claims are brought against them.

An estimated 249 million private sector insurance claims will have been filed in 2011 (U.S. Department of Treasury, 2010, p. 43343). If the government sector and the market for individual coverage are included, an additional 70 and 62 million claims, respectively, were expected to be filed. Of these, 48.1 million or 12.6% will be denied. Only a small percentage of denied claims are expected to be appealed, approximately 162,300 or 0.34%, but nearly 40% of these should be successful. This essay describes the appeal process and its benefits.

In the instant matter, the claims against the insured certainly, allege bodily injury and property damage. Moreover, the facts suggest that this claim ultimately has arisen from an accident. Rather, Progressive’s duty to defend Tristate depends on whether the accident arising out of the use of an insured

Perhaps one way to analyze the situation is through concepts of loss-shifting and loss-spreading. I would anticipate such insurers directly or directly support tort reform aimed at limiting the quantum of damages. On the other hand, I would be surprised if they supported substantial removal of the right to sue in tort, because that is part of their business. (Journal of Patient Safety) Anyone with a valid claim stands to receive compensation, but only up to a specified amount, which often leads to dissatisfaction and complaint There are qualitative factors, of course, that add to the complexity of these scenarios. I believe there are some interesting studies around no-fault apology that might contribute to a reduction in claims, for example. It would also be interesting to see what improvements collaborative law processes might bring.

Among the five forces of competition; existing competitive rivalry between suppliers, threat of new market entrants, bargaining power of buyers, power of suppliers and threat of substitute products, the most significant for UnitedHealth Group are threats for substitute products and rivalry among competing firms. Given the fact that there are numerous healthcare insurance firms in the world; there are also a number of substitutes for the corporation products and services. In recent years, the banking industry has become involved in insurance activities. They provide some medical plans, which act as substitutes to the UnitedHealth Group products. Banc assurance, otherwise known as the bank insurance model, is a very common phenomenon in this global world. Banc assurance is an arrangement in which a bank and an insurance company form a partnership so that the insurance company can sell its products to the bank’s client base. This type of partnership can be profitable for both, the bank and the insurance company. Banks can earn additional revenue by selling the insurance products and insurance companies are

Answer: Property and casualty insurance protects property (houses, cars, boats, and so on) against losses due to accidents, fire, disasters, and other calamities. Property and casualty policies tend to be short-term contracts and, that’s why the subject to frequent renewal is, and one more characteristic feature is the absence of savings component. Property and casualty premiums are based on the probability of sustaining the loss. To estimate the key determinant of the price of an insurance policy, i.e. risks, insurance companies take third-party proceedings that develop models of catastrophe loss probabilities. Based on the numbers form Exhibit 5 of the case we see that

Use online platforms to check out if the selected Insurers are licensed by the necessary authority. This can be through online

Recently, using an “insurance score” as tool to determine risk is popular. The insurance score is used to foresee the likelihood of filing a claim or the level of risk. It is based on some of the information in ones credit report.