Six Steps in Making an Insurance Claim

AIDS-related insurance claim experience.

Fuzzy claim reserving in non-life insurance

This paper develops several expressions to quantify claim provisions to account in financial statements of a non-life insurance company under the hypothesis of a fuzzy environment. Concretely, by applying the expected value of a fuzzy number and the more general concept of value of a fuzzy number to the ANOVA claim predicting model [2] we estimate claim reserves to account in insurer’s balance ...

The Regulation of Insurance Claim Practices

Insurance claim practices determine the extent to which insurers will or will not honor their promises. This Article describes the failure in the market for claim practices, the failure of the regulatory responses to that failure, and the ways in which litigation can provide a partial corrective. The Article explains why the market fails to guarantee fair claim practices, how market forces migh...

A Fraud Resilient Medical Insurance Claim System

As many countries in the world start to experience population aging, there are an increasing number of people relying on medical insurance to access healthcare resources. Medical insurance frauds are causing billions of dollars in losses for public healthcare funds. The detection of medical insurance frauds is an important and difficult challenge for the artificial intelligence (AI) research co...

Health Insurance Claim Review Using Information Technologies

OBJECTIVES The objective of this paper is to describe the Health Insurance Review and Assessment Service (HIRA)'s payment request (PARE) system that plays the role of the gateway for all health insurance claims submitted to HIRA, and the claim review support (CRS) system that supports the work of claim review experts in South Korea. METHODS This study describes the two systems' information te...