Causes Of Claims Research Articles

Identify the cause of claims on construction contracts in the West Papua Provincial Government Area

Along with the development of the construction service industry today, which is increasingly complex, construction service actors must carry out better project management so that the planned design can be realised properly. Before carrying out a construction project, the parties will agree on a legal basis in the form of a letter of agreement or a contract. In the execution of construction contracts, sometimes there are differences in interpretation and other things that can cause claims or claims. The formulation of the problem in this study is what are the potential risk factors of claims on construction contracts, what are the variables of potential claim risk on construction contracts, what are the variables of claims-forming models, what are the causes of risks in model-forming variables and what are the improvement recommendations produced in this study. The data collection method for this questionnaire was obtained by distributing the questionnaire three times. The results to be achieved in this study are to be able to determine the potential risks of what factors and variables can cause construction claims (first questionnaire), find out the variables of the claim-forming model (second questionnaire), and find out the causes of risk in the model-forming variables (third questionnaire). By knowing the level of influence of factors and variables, conclusions can be drawn about what needs to be anticipated in construction claims. Thus, appropriate recommendations are given to the West Papua Provincial Government to regulate the articles in the contract in more detail to minimise the potential for construction claims

Assessing the Delay, Cost, and Quality Risks of Claims on Construction Contract Performance

Conflicts are frequent within the complex professional environment of the construction industry. If claims cannot be overcome amicably, they result in disputes that lead to litigation. Identification of the causes of these claims and their impact on the duration, cost, and quality of the final project is expected to facilitate the prevention of unsuccessful performance of construction contracts. The novelty of this study is that after codifying the most common causes of construction contract claims derived from the extant literature, they are further investigated in terms of their probability of occurrence and the perceived impact they have on the project completion time, its total cost, and quality. Based on calculated relative importance indices from expert opinion, this paper proposes probability and severity of impact values for 39 common causes of claims in the construction industry. These can be applied to calculate their risk values for stakeholders in public construction contracts to plan mitigation measures for contractual claims. The findings show that the top five highest risk causes of contractual claims in the Greek construction industry are changes in quantities, work, or scope, design quality deficiencies or errors, payment delays, delays in work progress, and the financial failure of the contractor.

Employee Benefits Program Valuation with Multiple Decrement Model Based on PSAK 24 Post-COVID-19 Pandemic

In this article, we evaluate the post-labor compensation program based on PSAK-24 in the new normal era of the COVID-19 pandemic. In order to create a table multiple decrements based on a single table decrement namely, death, withdrawal, total permanent disability, and retirement. In the new normal era of the COVID-19 pandemic, the benefits of death, death caused by COVID-19, withdrawal, total permanent disability, and retirement were then aggregated. The method used in this study is a quantitative method with a case study approach of COVID-19. The data used is secondary data on the number of COVID-19 positive cases in Indonesia from January 2021 to December 2022. In this study, an actuarial model, the Multiple Decrement Model, was applied to calculate the valuation of the post-labor compensation program based on PSAK-24 using five decrements as the cause of claims consisting of death, death cause of COVID-19, withdrawal, total permanent disability and retirement. The calculation results that can be seen that large annual net premiums multiple decrement cases that provide benefits according to the cause of failure getting bigger as that person gets older.

Assessing the causes of claims in highway construction projects with a case study: a construction practitioner’s perspective

Assessing the causes of claims in highway construction projects with a case study: a construction practitioner’s perspective

Identifying Causes of Claims in The Egyptian Construction Sector

This research aims to study the causes of claims in the construction industry. The scope of the study is located in Egypt because of the huge number of projects in the construction sector. The occurrence of claims between the parties involved in the project (the owner, consultant, and contractor) leads to a loss of time, money, and effort. Knowing the causes of claims leads to avoiding them and thus increasing the chances of success of construction projects. The factors and causes of claims in the construction industry were determined by reviewing previous studies and interviewing experts working in the field, then A questionnaire survey was conducted and 385 specialists in the construction industry were exposed Statistical analysis was done, and the results concluded that the most important causes of claims in the construction industry in Egypt are: increase in cost due to changes prices, lack of funding to the contractor, change and fluctuation of the exchange rate and the rate of inflation changes in design and specifications, Increases in costs and quantities more than 25% of the contract value, increases of variation orders, lack of coordination between the design and implementation processes and delay to get approvals and permissions. Mitigation actions proposed to deal with avoid claim factors revolve around a good study of the contract documents at the tender stage, good coordination, and careful follow-up by the participating parties during the ring construction phase.

Statistical Analysis and Evaluation of Claims Using Control Charts in Certification Bodies

The article discusses the basic principles of using control charts in relation to the process of analyzing claims from consumers, namely the types of control charts, their main characteristics, and issues of their practical application. The scientific novelty of the conducted research lies in identifying the main aspects of the use of the control chart methodology in the assessment and analysis of claims received from consumers by the certification body. The purpose of the study is to assess the causes of variability affecting the number of claims received from consumers by the certification body. To achieve this goal, the following tasks were solved: types of control charts were selected, taking into account the specifics of the collected statistical information on types of claims and types of services; the basic principles of using control charts to the claims analysis process have been adapted; control charts were constructed and an analysis of the causes of variability was carried out using the example of a certification body. Based on the conducted research, claims were identified whose occurrence is influenced by special reasons; for the remaining reasons, it was established that their variability is due to ordinary reasons. To determine the most significant factors influencing the special causes of claims, it is recommended to apply the Ishikawa diagram, and then develop measures aimed at reducing the influence of these factors. The data and recommendations obtained by the author as a result of the study can be used by various enterprises and organizations to analyze claims within the framework of the quality management system. The proposed approach will make it possible to make informed management decisions and increase customer satisfaction.

Investigating the Source of Claims with the Importance of BIM Application on Reducing Construction Disputable Claims in KSA

The construction industry in the Kingdom of Saudi Arabia (KSA) is a significant sector in the Middle East, with annual expenditures surpassing USD 120 billion. It employs approximately 15% of the workforce and consumes more than 14% of the country’s energy resources. However, the Saudi construction sector encounters numerous challenges, including a deficiency in skilled labor, escalating costs, disputes, and material shortages. This study aims to investigate the origins of construction disputes in KSA and emphasize the significance of employing Building Information Modeling (BIM) applications to diminish the factors causing claims in both commercial and residential construction projects. The methodology employed comprises a comprehensive literature review and a field survey consisting of interview sessions. This study analyzes a total of 50 contributing factors to the causes of claims, along with conducting a field survey interview session involving 35 participants. The findings reveal seven substantial sources that give rise to construction claims in the KSA, impacting 75 projects, as discussed in this study. Furthermore, the research critically evaluates the advantages of utilizing BIM technology to mitigate construction disputes in the KSA. The data analysis results indicate that the reliance on traditional project management approaches is one of the catalysts for the emergence of disputes in the construction industry, particularly in the KSA.

1117 The NHS in Crisis; Assessment of the Impact of Litigation Trends Over 20 Years in General Surgery

Abstract Introduction A rising proportion of the National Health Service (NHS) annual budget is being spent on medico-legal costs, with over 1.6% of total UK healthcare spending on litigation in the year 2018/19. This is a risk to both patient care and public opinion of the NHS and as per business definitions the system is in crisis. This paper aims to assess the scale of the litigation crisis to fuel further work into mitigating it to improve value for patients and staff alike. Method Data was obtained from NHS resolution for claims relating to General Surgery between January 2000 and December 2020 to include the following: number of claims, cost of settled claims with and without damages paid, age/sex of patients, and primary injuries/causes. Results Between 2000 and 2020, 17,542 claims were made against General Surgical units in England with an increase in claims per year. Successfully closed claims cost the NHS £1.3 billion. The three most common causes for claims were intra-operative problems, failure/delay of treatment and failure/delay of diagnosis. Conclusions The NHS is threatened by a litigation crisis, with case volume and cost rising out of proportion to surgical workload and inflation. The most common causes for claims are known complications discussed as part of a standard consenting process, indicating that current practice may fail to achieve adequate patient understanding of surgical risk. More research is required to improve the current consenting process and identify demographics that may increase an individual’s propensity to make a claim.

342 The NHS in crisis; assessment of the impact of litigation trends over 20 years in general surgery

Abstract Introduction A rising proportion of the NHS annual budget is being spent on medico-legal costs, with over 1.6% of total UK healthcare spending on litigation in the year 2018/19. This is a risk to both patient care and public opinion of the NHS. Despite this, surgical litigation is a relatively understudied subject. This paper aims to assess the scale of the litigation crisis to fuel further work into mitigating it and improve value for patients and staff alike. Method Data was obtained via a Freedom of Information request from NHS resolution for all claims relating to General Surgery between January 2000 and December 2020. Results 17,542 claims were made against General Surgical units in England with a gradual increase in claims per year. The successfully closed claims cost £1.3 billion. This was out of proportion to both inflation and case volume. The three most common causes for claims were intra-operative problems, failure/delay of treatment and failure/delay of diagnosis. Conclusion The NHS is threatened by a litigation crisis, with case volume and cost rising out of proportion to surgical workload and inflation. The most common causes for claims against surgical units are known complications discussed as part of a standard consenting process, indicating that current practice may fail to achieve adequate patient understanding of surgical risk. More research is required to design methods to improve the current consenting process, and to identify specific demographics that may increase an individual’s propensity to make a claim and establish modifiable risk factors.

Mitigating Claims and Disputes for Public–Private–Partnership Transportation Projects in the United States

As the construction industry continues to lead the economic growth of many countries, alternative contracting methods have been increasing as a valuable tool to implement on projects. The public–private–partnership (P3) delivery method is becoming an increasingly popular delivery method for megaprojects due to its many advantages, such as private entity financing and the transfer of design, construction operations, and maintenance risks to a concessionaire. As more P3 transportation projects are being executed in the United States, researchers are considering how effectively contracts have been negotiated and drafted between owners and contractors to account for project risks and, consequently, reduce claims and disputes. The objective of this study was to (1) investigate how P3 transportation projects’ contracts are drafted to allocate risks, (2) identify the leading causes of claims and disputes on such projects, and (3) provide recommendations on how risks can be managed and allocated during the contract negotiation phase to reduce claims and disputes. To achieve these objectives, 10 case studies were conducted on 10 P3 transportation projects nationwide with a total cost of $11 billion. The case studies included both content analysis of bid and contract documents and follow-up interviews with project team members to identify risks that caused claims on the projects. The results showed that right of way (ROW) availability, utility relocations, staffing, governmental approvals, and differing site conditions were the leading causes of claims and disputes on the P3 transportation projects included in this case analysis. The results and recommendations can be used to mitigate the negative impact of such risks on future P3 transportation projects.

Litigation in Septorhinoplasty Surgery: A Pan-Specialty Review of National Health Service (the United Kingdom) Data.

Success in septorhinoplasty surgery can be difficult to assess due to a lack of objective and measurable outcomes. If patients' expectations are not met, it places surgeons performing septorhinoplasty at risk of litigation which can be stressful and costly. The National Institute of health (NHS) Resolution is a government-funded organization in the United Kingdom that provides expertise to the NHS on resolving patient concerns. Data were requested from NHS Resolution for claims involving septorhinoplasty surgery over a period of 5 years between April 2015 and April 2020. Rhinoplasty claims performed by all specialties were included. Data included the claim status, incident details, alleged injury, damages claimed, and damages paid. A total of 31 claims were identified by the study, equating to a total cost of £1,347,336.10. Of the 31 claims for rhinoplasty or septorhinoplasty, 9 cases were open (29%, £962,361.00) and 22 cases were closed (71%, £384,975.10). The common causes for claims were "intraoperative problems (32%)," "failure to warn-informed consent (19%)," and "foreign body left in situ (13%)." The most common injuries were "cosmetic disfigurement (39%)," "unnecessary pain (29%)," and "additional/ unnecessary operation (29%)." This study highlights the need for improved awareness of clinical negligence claims among surgeons who perform septorhinoplasty. Results are applicable to all specialties who perform the procedure. The study highlights the importance of assessing patients' motives and expectations prior to surgery and emphasizes the need for a well-documented rigorous consent process.

Comparative Analysis Performance of Naïve Bayes and K-NN Using Confusion Matrix and AUC To Predict Insurance Fraud

Based on claim submission data from year 2019 to 2021 can be seen that the percentage of claims in one province is much higher than other provinces. During that period, the percentage of claims in that province reached 22% while the highest percentage in other provinces was only 6%. It is suspected that there has been a claim fraud in the province. The fraud allegedly started when customer submits a policy issuance for the elderly insured with a low sum insured so that the premium is also low. The insured's health condition at that time may not be good but it is not explained in the insurance application letter. To increase the sum insured, the policy is usually added with additional coverage. Fraud claim creates big loss for insurance company since the company has to pay the claim that they should not pay. Insurance company need to have a mechanism to avoid the fraud claim. From this research, it is expected to find the best methodology to be able to predict the potential of insurance claim fraud early when customers apply for policy issuance so that additional checks can be carried out for suspected submissions. The initial data available for this research is 14,778 claim records with attributes are : the date of claim submission, policy effective date, sum assured, type of claim, cause of claim, province and fraud. In order to get the best methodology on the accuracy and performance aspect to fulfill the expectation, two methodologies (Naïve Bayes and K-NN) are compared. Both Naive Bayes and K-NN methods are used with a comparison of training data and testing data is 80:20. Several combinations were performed for each of these methods. By using Confusion Matrix and AUC to measure the accuracy and performance of the two methods, it can be concluded that the best one is Naive Bayes with accuracy is 90% and AUC is 0.761. The attributes used are province, sum assured, additional coverage and the insured is the policy holder.

Risk Level of the Types and Causes of Claims in Construction Projects of Pakistan

Managing claims is very essential for successful construction projects. For this, the identification of claims and the causes of occurrence of the claims are very crucial. Hence, this research investigated the types and causes of claims and their risk level in construction projects in Pakistan. The study was carried out based on a quantitative mode of research using a questionnaire survey. The survey was conducted amongst the professionals (client, consultant, and contractors) involved in handling construction projects. The survey was done by visiting the participants in person and electronically. A total of 51 completed questionnaire forms were received. Data were analyzed using the SPSS (v20) and Microsoft Excel spreadsheet program. The results suggested that payment-related issues, evaluation of the quality and quantity of completed works, Final cost, Awarding bid to the lowest bidder, and Change or variation orders are the top 5 claim causes with the highest risk level. At the same time, the top 5 types of claims with the highest risk level are Extra-work claims, Payment/Financial, Extension of time, Change claims, and Escalation. This study will help practitioners to recognize the risk-related issues of claims occurring in construction projects

Malpractice lawsuits in orthopedic trauma surgery: a meta-analysis of the literature.

The objectives for this study were to identify whether diagnostic or procedural errors more commonly resulted in lawsuit, as well as to elucidate how specific variables affected mean indemnity. Systematic review of English-language articles in the PubMed and Google Scholar databases (through 2020) using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Meta-analysis was performed to estimate measures of proportions and differences in mean indemnity. The estimated probability of lawsuits related to orthopedic trauma in overall studies was 23.3%. There were no significant rate differences between main causes of claims (diagnostic vs procedural errors) and areas of injury (upper vs lower). There was no significant difference of mean indemnity between the probabilities of trauma-related claims, diagnostic error, and procedural error. Non-trauma cases were more likely to result in lawsuit than trauma cases. Procedural errors accounted for most malpractice claims. The average indemnity increased according to the higher diagnostic errors, while the indemnity was lower with a relatively higher proportion of procedural errors. The most common cause of litigation varied between studies; however, among the most cited reasons were missed diagnosis/error in diagnosis, improper/substandard surgical performance, and, though not specifically studied in this analysis, errors of informed consent. Economic and Decision Analyses Level VI.

Performance Prediction of Construction Projects Based on the Causes of Claims: A System Dynamics Approach

Conflict in human relations is unavoidable; therefore, it can occur in construction projects that are full of many human relationships. These conflicts can lead to claims if interlocutors do not agree. The main result of the claims is the delay and overrun of costs in construction projects. Additionally, poor management of claims affects the success of construction projects and their budget and schedule. Moreover, controlling claims ensures the successful completion of construction projects and minimizes delays and disputes. This study sought to improve the project performance by ranking the causes of claims and examining their impacts on Key Performance Indicators (KPI) using the combined AHP-TOPSIS (Analytic Hierarchy Process-Technique for Order of Preference by Similarity to Ideal Solution) method. Given that construction projects are constantly evolving and becoming more complex and have many linear and nonlinear relationships and structures, these projects can be considered as a kind of system dynamics. The system dynamics have been used for nearly four decades to analyze and improve the performance of construction projects. This study attempted to provide a model with a system dynamics approach to predict the performance of construction projects based on the reasons for the claim. In this model, the most important performance indicators, interactions between them, and the relationship of these indicators with the reasons for claiming were simulated. The results showed that delays are the most important reasons for making claims, and they have a great impact on the KPIs such as scheduling, sustainability, customer satisfaction, quality, and team satisfaction, respectively. In the modeling and simulation discussion in this study, the proposed model simulated the dependencies between the KPIs of construction projects and their changes over time and provides a better understanding of how performance indicators interact with each other. Additionally, it can be used as a basis for simulating different management policies to find the best solution to prevent and correct the negative effects of poor performance.

Identification of critical paths leading to cost claims for underground metro projects: a system dynamics approach

PurposeInfrastructure projects play a vital role in the development of countries' economies. However, these projects, notably underground ones, are encountering growing claims as they are subject to many unknowns. Without having a clear insight into the causes of claims and their influence on one another, it is not possible to mitigate their adverse impacts on these projects' goals. To this aim, the main purpose of this study is to identify the critical paths leading to cost claims for underground metro projects.Design/methodology/approachFirst, causes of claims were identified through a literature review and then refined to 22 main causes according to the opinions of 148 Iranian experts. A qualitative system dynamics (SD) model was then provided to visualize how various causes interact with each other. The model was developed and validated by drawing on the expertise of industry-related experts, and the critical paths were finally recognized based on their frequency and severity indexes.FindingsThe findings revealed that each cause should be evaluated based on their connections with others as there are complex relations among the causes. It was also shown that the major claim paths among others were initiated due to ambiguous contract clauses, unforeseen physical conditions and land handover problems.Originality/valueThe findings of this study provide a better insight into how various causes of claims for underground metro projects are related to each other and can eventually assist project managers of different parties, even in other countries, to select proportional strategies to mitigate their adverse impacts.

A Malpractice Claims Study of a Family Medicine Department: A 20-Year Review.

This study describes medical malpractice claims from a large academic family medicine department over 20 years. The intent of this investigation is to analyze trends within the department, seeking to better understand how to improve the quality of patient care. The Office of Patient Relations and Clinical Risk (PRCR) at University of Michigan Health maintains a centralized database of family medicine malpractice claims dating back to 1987. Records from 2000 to 2020 were requested from this database and received in a deidentified manner to protect patient confidentiality, and as such this study was exempt from IRB review. A total of 55 claims occurred during this time period. These claims were then analyzed in both qualitative and quantitative terms. Of the 55 claims, 87.3% involved adult patients; 76.5% of the claims occurred in the outpatient setting; 98.1% of the claims involved attending physicians and 26.9% involved resident physicians; 54.5% of the claims were closed without payment and 43.6% of the claims were settled. The average settled claim amount was $742,110.50 which dropped to $160,838.59 after excluding obstetric claims. In addition, 61.8% of the claims were related to diagnosis related allegations and 16.4% of the claims involved treatment related allegations. Primarily involving allegations of missed or delayed diagnoses of cancer, 29.1% of the claims were cancer related. While 79.2% of settled claims did not meet standard of care, 83.3% of the claims closed without payment did meet standard of care. Most claims involved adult patients, occurred in the outpatient setting, and involved diagnosis related allegations. Although representing a minority of the claims, obstetric claims made up most of the total settlement amount. Missed or delayed diagnoses of cancer were a common cause for claims, reinforcing the important role that primary care physicians have in supervising and administering preventative health care to patients. This study also emphasizes the value of peer review committees to help inform medical-legal consultants as evidenced by the high correlation between standard of care determination and final claims outcomes.

Decision Support System for Analyzing Key Performance Indicators in Construction Projects Management

Many factors play a role in the life cycle of construction industry projects, focusing on human resources and relationships as the main axis of business development. Thus, the conflict of interests between the stakeholders in the construction industry projects is a clear and challenging problem. The increased number of stakeholders in the project complicates human relationships and, consequently, increases the possible conflicts. The conflicts may result in claims if not resolved. The success of construction projects and their cost and time management can be affected by the poor management of claims. Therefore, this research aims to take a significant step to improve the efficiency of projects by identifying and ranking the causes of claims and analyzing their effects on key efficiency indicators. Firstly, causes of claim are collected according to experts’ opinions and literature and classified based on key efficiency indicators using the integrated analytic hierarchy process-technique for order preference by similarity to ideal solution (AHP-TOPSIS) technique. According to findings, delays with a proximity coefficient of 0.728 are the most significant factors in making claims with a great effect on the key efficiency indicators of the construction project. The changes in most construction projects are ranked in second place, followed by acceleration command, extra work, changing workshop conditions, and contractual ambiguities. The present study results may reduce the challenges in managing the construction industry claims and ensure the successful completion of projects.

Claims in construction projects: how causes are linked to effects?

PurposeClaims are increasingly becoming a norm in construction projects and thus an area that is attracting interventions through researches. This paper aims to establish causes–effects relationship of claims in construction projects.Design/methodology/approachThis is correlation study type of study that attempts to establish causes–effects relationship of claims in construction projects. Significant causes and effects of construction claims were determined using one-sample t-test. To establish the relationship, the significant causes and effects of construction claims were correlated using bivariate correlation analysis.FindingsAmong the significant causes, variations, change of scope of the project and delay in completion of works have high level of significant positive relationship with five to six other causes and positive relationship with multiple effects ranging from five to six. Besides, among significant effects, delay in completion and delivering of construction projects, poor contractual relationship among parties and extension of time have significant positive relationship with multiple causes.Research limitations/implicationsThe findings of this study are limited to causes-causes relationship and causes–effects relationship of claims in construction projects. This means effects–effects relationship was not covered that could be an important area to investigate as some of causes and effects are at times termed interchangeably.Practical implicationsWith reference to previous studies which have focused on determining the causes and effects of construction claims, the findings of the current study have specific contribution on claims management as it divulges the causes of constructions claims that have multiplier effects to the project as a result of their linkage.Originality/valueThe paper unveils causes of claims with multiplier effects to construction projects for project participants to devise strategies to minimize and consequently eliminate them.

Injuries during Laparoscopic Cholecystectomy: A Scoping Review of the Claims and Civil Action Judgements.

Background. To define what type of injuries are more frequently related to medicolegal claims and civil action judgments. Methods. We performed a scoping review on 14 studies and 2406 patients, analyzing medicolegal claims related to laparoscopic cholecystectomy injuries. We have focalized on three phases associated with claims: phase of care, location of injuries, type of injuries. Results. The most common phase of care associated with litigation was the improper intraoperative surgical performance (47.6% ± 28.3%), related to a “poor” visualization, and the improper post-operative management (29.3% ± 31.6%). The highest rate of defense verdicts was reported for the improper post-operative management of the injury (69.3% ± 23%). A lower rate was reported in the incorrect presurgical assessment (39.7% ± 24.4%) and in the improper intraoperative surgical performance (21.39% ± 21.09%). A defense verdict was more common in cystic duct injuries (100%), lower in hepatic bile duct (42.9%) and common bile duct (10%) injuries. Conclusions. During laparoscopic cholecystectomy, the most common cause of claims, associated with lower rate of defense verdict, was the improper intraoperative surgical performance. The decision to take legal action was determined often for poor communication after the original incident.