Settlement Of Claims Research Articles

Forecasting Life Insurance Loss Reserves Using Time Series Analysis.

Purpose: To determine an accurate predictive model that captures trends and seasonality in life insurance claims. Methodology: Time Series Analysis is used to forecast Secondary data on life insurance claims. The researcher aims at using a non-actuarial and accurate predictive model that captures trends and seasonality in life insurance claims over time. The dataset, comprising monthly claim amounts from May 2018 to March 2024 obtained from an insurance company. Findings: Life insurance claims increases with time hence the insurance companies are to set up an appropriate reserve to cater for future occurrence. It is realized that ARIMA (2,1,1) is appropriate for modelling the life insurance claim amounts with a least Log Likelihood value of -766.99, AIC value of 1521.97, AICc value of 1522.6, and BIC value of 1530.91. An ACF plot and Ljung Box test on the residuals shows the residuals are free from autocorrelation and free from heteroscedasticity respectively and hence the model is a white noise and adequate for further analysis. The result of the twelve months forecast indicates an increase in the life insurance claims. Unique contribution to theory, practice and policy: Managers in the insurance companies should focus on risk management and reserve allocation of fund in order to meet short term and long term claims settlement.

Extension of CARAMEL Model by Customer Satisfaction Factor for Indian Private Life Insurance Companies in India

This paper explores the efficiency of private life insurance companies in India. The study employed the CARAMEL model to gauge the technical proficiency of Indian life insurance providers. However, the CARAMEL model has ignored the customer satisfaction factor, which is nowadays an essential factor for measuring efficiency. So, in this study, the CARAMEL model is extended by another factor: customer satisfaction. Customer satisfaction is measured by the persistency ratio, claim settlement ratio, and number of grievances reported. Compare the ranks of private life insurance companies according to the CARAMEL model without customer satisfaction score and with customer satisfaction score. Correlation coefficient and t-test was used to find out whether there is any significant association between the ranks according to the CARAMEL model without customer satisfaction and with the customer satisfaction factor. The data used in this study, which spans the last ten years from 2013-14 to 2022-23, was entirely secondary and was gathered from the IRDA official website. Ageas Federal Life Insurance Company ranked 1st according to CARAMEL model without customer satisfaction and ICICI Prudential Life Insurance Company ranked 1 with customer satisfaction factor. Spearman’s Rank correlation coefficient shows that there is an insignificant association between the CARAMEL model ranks with customer satisfaction and without customer satisfaction factors. When there is no significant association between ranking without customer satisfaction factors and with customer satisfaction factors, we extend the CARAMEL model by the customer satisfaction factor.

Leveraging Telemedicine for Disaster Response: Longitudinal Study on Return-to-Work Programs During the COVID-19 Crisis.

Since COVID-19, Indonesia has legalized telemedicine in medical services, including Return to Work (RTW). RTW programs help occupational injury-disabled workers return to work. This research examines how telemedicine supports RTW for employees with occupational injuries. The study used Interrupted Time Series Analysis (ITSA) to find patterns and trends in RTW program telemedicine case numbers and claim settlements over time. A total of 1 314 data were obtained from the Indonesian National Social Security Agency on Employment (BPJS Ketenagakerjaan) from July 1, 2015, to December 2022. Telemedicine reduces the frequency of recurrent occupational injuries in persons with impairments (Relative Risk [RR] = 0.59). In addition, the integration of telemedicine into health care practices exhibits promising prospects in terms of mitigating the financial burden on social security programs. This is supported by a robust RR (0.6). Telemedicine reduced the number of repeat cases and optimized medical claims cost in the RTW program during the COVID-19 pandemic. The results will contribute to policy and assist health care professionals and employers in improving RTW outcomes for disabled people.

Public Perception Towards Insurance Companies in Malaysia

Nowadays, the insurance sector is regulated and driven by profit maximization, just like other providers of financial services. We have been taught that insurance is essential for peace of mind, yet customers generally have a poor perception of insurance providers, and this view is even more evident among younger clients who are so important to the industry's future. The objective of this study is to investigate factors that influence public perception of insurance companies in Malaysia, including fraud, claim settlement, and knowledge. The study adopted a cross-sectional survey research design. This survey was conducted using questionnaires and 110 randomly selected insurance policyholders. The study's findings suggest that the public's perception of insurance companies is significantly influenced by knowledge. As a result, this outcome will assist insurance companies in developing new formulas that take the criteria mentioned above into account to serve the public interest.

Aotearoa’s Western governance structure: a challenge to Te Kōpuka’s allyships

Te Awa Tupua (The Whanganui River Claims Settlement Act 2017), which granted legal personhood to the Whanganui River) is often discussed as a leading example of the Rights of Nature movement, which aims to grant rights to non-humans. Rather than discussing Te Awa Tupua in relation to Rights of Nature, this article offers new data on the relationships between Māori (Indigenous peoples of New Zealand), tauiwi (non-Indigenous person who has recently settled in New Zealand), and Pākehā (New Zealanders of predominantly European ancestry) stakeholders in Te Kōpuka nā te Awa Tupua (advisory body that works to uphold Te Awa Tupua; Te Kōpuka). I argue that these relationships are positive and based on collaboration because tauiwi and Pākehā stakeholders seem to grasp Māori values. However, Te Kōpuka’s mandate is challenging to achieve because of colonial and Western-minded government structures in New Zealand.

Research on Strengthening China's Economic Losses from Ship Oil Pollution Based on Compensation Mechanisms

The oil pollution compensation system in China was established late, and the design of the legal system is not perfect, which exposes many problems in the practice of claim settlement. This paper analyzes the present situation and problems of compensation mechanism for oil pollution damage from ships in China, and draws lessons from the legislative experience of Canada and the United States, and puts forward some suggestions for improvement. The specific contents include the legislative status and existing problems of compensation for oil pollution damage from ships in China, the relevant legislative status of representative countries, the comparison of three major international compensation systems, and the legislative choice and specific system suggestions of China. By using the method of literature analysis, this paper systematically analyzes the legislative status, advantages and disadvantages of compensation for oil pollution damage from ships in various countries through the study of relevant legal documents and practical cases at home and abroad. Through comparative study and drawing lessons from international experience, it is suggested that China adopt a dual-track compensation mechanism.

Selection of Health Insurance Policy: Using Analytic Hierarchy Process and Combined Compromised Solution Approach Under Spherical Fuzzy Environment

The process of health insurance policy selection is a critical decision with far–reaching financial implications. The complexity of health insurance policy selection necessitates a structured approach to facilitate informed decision-making amidst numerous criteria and provider options. This study addresses the health insurance policy selection problem by employing a comprehensive methodology integrating Spherical Fuzzy Analytic Hierarchy Process (SF–AHP) and Combined Compromise Solution (CoCoSo) Algorithm. Eight experienced experts, four from academia and industry each, were engaged, and eleven critical factors were identified through literature review, survey, and expert opinions. SF–AHP was utilized to assign weights to these factors, with Claim settlement ratio (C9) deemed the most significant. Subsequently, CoCoSo Algorithm facilitated the ranking of insurance service providers, with alternative A6 emerging as the superior choice. The research undertakes sensitivity analysis, confirming the stability of the model across various scenarios. Notably, alternative A6 consistently demonstrates superior performance, reaffirming the reliability of the decision-making process. The study’s conclusion emphasizes the efficacy of the joint SF–AHP and CoCoSo approach in facilitating informed health insurance policy selection, considering multiple criteria and their interdependencies. Practical implications of the research extend to individuals, insurance companies, and policymakers. Individuals benefit from making more informed choices aligned with their healthcare needs and financial constraints. Insurance companies can tailor policies to customer preferences, enhancing competitiveness and customer satisfaction. Policymakers gain insights to inform regulatory decisions, promoting fair practices and consumer protection in the insurance market. This study underscores the significance of a structured approach in navigating the intricate health insurance landscape, offering practical insights for stakeholders and laying a foundation for future research advancements.

Effects of Selected Macroeconomic Variables on Insurance Claims Settlement in Nigeria

Effects of Selected Macroeconomic Variables on Insurance Claims Settlement in Nigeria

Individual’s Choice on Buying Life Insurance Products in Nepal

This study examines the factors influencing individual’s choice on buying life insurance products in Nepal. An individual’s choice on buying life insurance policy is selected as the dependent variable. The independent variables are company loyalty, premium charge, agent, claim settlement and company image. The primary source of data is used to assess the opinions of the respondents regarding individual’s choice on buying insurance products in Nepal. The study is based on primary data with 151 respondents. To achieve the purpose of the study, structured questionnaires is prepared. The correlation coefficients and regression models are estimated to test the significance and importance of different factors driving individual’s choice on buying life insurance products in Nepal. The study showed that company loyalty has a positive impact on individual’s choice on buying life insurance policy. It indicates that company’s loyalty towards consumer stimulates the individual’s choice on buying insurance products in Nepal. Similarly, premium charge has a positive impact on individual’s choice on buying life insurance products. It indicates that fair premium charge stimulates the individual choice. Similarly, agent of the respective company has a positive impact on individual’s choice on buying life insurance products. It indicates that the behaviour and knowledge of agents impulse individuals’ choice on buying life insurance products. The study also showed that claim settlement has a positive impact on individual’s choice. It indicates that proper claim settlement process stimulates the individuals’ choice on buying life insurance products. Furthermore, company image has a positive impact on individual’s choice on buying life insurance policy. It indicates that good company image stimulates individual’s choice on buying life insurance products in Nepal.

Industrial Relation Climate and Provision of Labour Welfare Measures in Manufacturing Sector

The study was conducted on a sample population of 150 employees of two manufacturing units based in West Bengal, India. Mostly permanent workers at plant level and employees of the zonal offices were considered for the purpose of the study. The overall objectives of the study focus on finding the general causes of job dissatisfaction and industrial fatigue among workers in the manufacturing sector, including the problem of industrial relations and getting proper statutory labour welfare benefits. Improper job scheduling, overburden of work and job complexities were some of the major factors of industrial fatigues that had been detected from structured questionnaire survey. Though majority of the employees revealed that the general industrial climate was good, in many cases employees were not aware of the claim settlement procedure about various provisions under the Gratuity Act and ESI Act leading to delays and payments not being received in time. This study also established the fact that overall industrial relation climate, availability of welfare measures and awareness level of the employees about different social security schemes varies with the educational level, total tenure of the employees in the present company and total years of working experience of the employees in the manufacturing sector. Lastly, lack of proper trade union to reflect employee grievances, proper training and engagement programmes are the other causes of disengagement and attrition of employees in the manufacturing sector, as also reflected from this study.

An Analysis of Claims Settlement and Insurance Companies’ Profitability in Nigeria (1981-2022)

This study analyzed claims settlement and insurance companies’ profitability in Nigeria (1981-2022). Problems arise when there is a claim report. The problems range from non-payment of claims, even when paid, it is not settled promptly and only a negligible proportion of claims are settled. On many occasions, disputes arise in claims settlement between the insured and the insurer. Violation of policy provisions can vitiate an insurance contract and is also capable of hindering claims settlement. The study is an empirical research and the secondary data used for the study were obtained from the Central Bank of Nigeria (CBN) Statistical Bulletin and Annual Report of NAICOM. The regression method was used to test the hypothesis. The finding revealed that there are significant influences of total expenditure and total income on the profitability of the Nigerian insurance companies while total claims settlement and total premium income have no significant influences on profitability. It was recommended that there is a need for the insurance industry to carry out sensitization and awareness campaigns on loss control devices for the insured. This reduces the loss frequency and claims amount considerably for sustainable profit. Managers of claims and the holders of policies should be educated in reporting claims processes such as loss minimization, claims verification, investigation, evaluating the degree of the damage preceding any replacement or repair and loss evaluation. This reduces claims report frequency and enhances the profitability and premium income of insurance companies. Insurance income generated in terms of premiums should be reinvested to upsurge insurance companies’ profits.

Indonesia’s Settlement Procedure of Small Claims: A Proposal for the Implementation of Online Dispute Resolution

This research primarily aims to investigate the opportunities for the internalized implementation of Online Dispute Resolution (ODR) within the judicial system for the settlement of small claims in Indonesia. Several positive features of ODR, such as its ease, speed, and cost-effectiveness, can serve as catalysts for the settlement of small claims. Currently, Article 6A of the Supreme Court Regulations No. 4 of 2019 concerning the Settlement Procedure of Small Claims (the Small Claims Regulation) also allows for the use of electronic case administration in accordance with relevant legislation. This study employs a normative juridical research approach with a qualitative descriptive analysis method. The data used consist of secondary data, including primary legal sources from various legislative regulations. Additionally, data from journal articles, reports, and other literature related to ODR and small claims are utilized. A comparative study with the United States is employed to gain insights into best practices for implementing ODR in small claims settlement. Subsequently, this research proposes several steps for the ODR process in resolving simple lawsuits, including case initiation, negotiation, mediation, and adjudication. Furthermore, it emphasizes the principles of ODR that need to be upheld, such as voluntariness, accountability, and impartiality. Ultimately, integrating technology into civil justice systems through ODR will enhance the effectiveness and accessibility of justice in resolving small claims.

IMPACT OF CLAIMS SETTLEMENT ON PROFITABILITY OF GENERAL INSURANCE COMPANIES IN NIGERIA: A STUDY OF SELECTED LISTED GENERAL INSURANCE COMPANIES

This study investigates the impact of claims settlement practices on the profitability of general insurance companies in Nigeria. The study employed an ex post facto research design with the use of twenty (20) years’ financial data from 2003 to 2022 from published annual financial reports of five (5) sampled listed non-life insurance companies carrying on insurance business in Nigeria. Hypothesizing the dependent and independent variables with the proxies ROA; and LR, ER; CR. Panel data methods were used with other supporting tests using E-views (version 10) data analysis tool. With a balanced data of 100 observation - five cross-sectional data of 20 years period, the results revealed a negative relationship between the proxies (ER, LR and CR) of the independent variable – Claims settlement practices, as they could only explain to a negligible extent, the changes that occurs in the dependent variable. Premised on the findings, it is recommended that general insurance firms settle genuine claims as prompt as possible while the maintain required underwriting standard to avoid problem of adverse selection engendering possibility of ruin.

Factors Affecting Choice of Comprehensive Motor Insurance in Nepal

Purpose: Compared to third party liability insurance, comprehensive motor insurance offers far more coverage. Nevertheless, despite the bigger benefit, owners of motor vehicles are not particularly motivated to purchase comprehensive auto insurance. The purpose of this study is to determine the primary determinants that influence the owners’ choice of auto insurance.
 Methodology: The study used a descriptive and quantitative research approach to look into how consumers’ choice of automobile insurance is influenced by social, psychological, economic, and vehicle factors. A systematic questionnaire was used to collect data, and it was disseminated both physically and digitally. A total of 247 samples were collected and determined to be useful for the study. Using the Statistical Package for Social Sciences (SPSS), version 26, twelve hypotheses were tested through the use of correlation, multiple regression, and crosstabs (chi-square) analysis in the study of the data.
 Findings and Conclusion: In addition, the study found that the choice of comprehensive motor insurance was significantly influenced by factors such as marital status, income, age and value of the vehicle, insurance knowledge, and claim history. It also found that psychological and economic factors had a significant impact on this decision. The study’s conclusions showed that people who could afford to pay a large premium, were financially secure, had higher insurance knowledge, and had a favorable claim settlement experience were the main factors influencing their decision to purchase comprehensive auto insurance.
 Implications: The research was conducted with few variables and there are a lot more variables that might be associated to the choice of motor insurance, as the R square value was only 32.4%. Further variables can be explored and the study can be carried out separately for four wheelers or two wheelers to be more specific. Based on the results, it is recommended that insurance companies focus on educating the public about the insurance coverages, risks, and advantages of having a comprehensive motor insurance, and simultaneously improve the claim service for the loss bearers.

Comparative Assessment of External Third Party Administrators and In-house Teams of Insurers in Health Insurance Claims Settlement Process in Bangalore, India

Claim servicing in health insurance is an important area for insurers. Third party administrators (TPAs) are a critical link in India that process health insurance claims. Several insurers have started in-house claim teams for health insurance claims instead of outsourcing the work to TPAs. The study aims to explore the role played by external TPAs in terms of value addition done by them for insurers, policyholders and healthcare providers. The study aims to find the benefits of roping in an in-house team to settle health claims and the benefits accruing out of this decision to policyholders and hospitals. The role of TPAs in claim processing, issues faced by customers while making a claim, and improvement areas in the process have also been examined. The author has tried to explore and research this area so that policyholders can choose a health insurance company without bias whether it has an in-house claim settlement process or engages an external TPA. The study brings out the concerns of customers and hospitals regarding the settlement of health insurance claims and suggests improvement areas required for both TPAs and in-house teams in claim settlements by evaluating the same.

Beyond legal personhood for the Whanganui River: collaboration and pluralism in implementing the Te Awa Tupua Act

ABSTRACT There is now a large body of scholarly literature on the legal and governance arrangements for the Whanganui River in Aotearoa New Zealand, given the rights of a legal person under Te Awa Tupua (Whanganui River Claims Settlement) Act 2017. Most of this literature focuses on the innovation of legal personhood and rights of nature rather than situating the Act in its local context or examining its implementation in practice. This article analyzes two cases of implementation – Te Pūwaha (the revitalisation of the Port of Whanganui); and Te Kōpuka nā Te Awa Tupua, the collaborative group charged with developing a strategy for the river. We shift attention away from legal personality to three other elements: The centrality of Māori kawa (value-based, Indigenous law); the establishment of a comprehensive set of new institutions and practices; and the devolution of authority to hapū (subtribes) and communities. These elements represent a paradigm shift towards a relational and reciprocal form of governance. While Te Awa Tupua Act does have some alignment with rights of nature, it should primarily be understood as recognising Indigenous rights and the authority of Indigenous law.

Factors Influence on Customers’ Satisfaction in Government Owned Life Insurance Firm: A Case of Rastriya Beema Sansthan, Nepal

Customer service is an integral part of any life insurance company. It is necessary to identify the key success factors in the life insurance industry, in terms of customer satisfaction, so as to survive the intense competition and increase insurance penetration (Nyaguthii, 2013). The important factor in creating customer satisfaction is the appropriate insurer with customers. Insurers believe the factors such as behavior and dealing effectively with the insured, ability of insurance agents to transmit accurate information, establish long term relationships with customers are the important factors in the success of the insurance industry (Vazifehdust & Farokhian, 2013). Thus, the study aims in analyzing the determinants of customer satisfaction in Rastriya Beema Sansthan, an insurance company of developing country Nepal. The study has adopted descriptive and analytical research design. The purposive sampling method is used to collect the primary response from the respondents. The descriptive analysis, correlation analysis and regression analysis have been conducted to analyze the relationship between customer satisfaction with premium, communication, claim settlement, service recovery and service quality in Rastriya Beema Sansthan. The study concludes that the service quality has no impact on customer satisfaction whereas other variables tested have been found significant. The results of the research are expected to hit the policy of Rastriya Beema Sansthan with broadening the scope of the study.

Claim Settlement Excellence: Keys to Customer Satisfaction in Health Insurance

Claim Settlement Excellence: Keys to Customer Satisfaction in Health Insurance

A Comprehensive Study on Life Insurance at ICICI Prudential Life Insurance: Insights into Customer Perceptions and Industry Dynamics

This research endeavors to conduct an in-depth examination of life insurance offerings at ICICI Prudential Life Insurance, a prominent player in the insurance industry. With life insurance being a critical component of financial planning, this study aims to explore customer perceptions, satisfaction levels, and industry dynamics to provide a comprehensive understanding of ICICI Prudential's position in the market. Utilizing a mixed-methods approach, this research combines qualitative insights gathered through customer interviews and focus group discussions with quantitative surveys to analyze and compare various aspects of life insurance offerings at ICICI Prudential. The qualitative aspect seeks to uncover nuanced perspectives on customer experiences, while quantitative analysis aims to identify trends, correlations, and statistical significance. The study will explore the range of life insurance products offered by ICICI Prudential, including term insurance, endowment plans, and unit-linked insurance plans (ULIPs). It will assess customer satisfaction levels regarding policy features, premium affordability, claim settlement processes, and overall service quality. Furthermore, the research will investigate industry dynamics, including market trends, regulatory influences, and competitive positioning, to provide a holistic view of ICICI Prudential Life Insurance within the broader insurance landscape. The findings from this research are expected to offer valuable insights for insurance professionals, policymakers, and customers alike. By understanding customer perceptions and industry dynamics, ICICI Prudential can refine its strategies, enhance customer satisfaction, and contribute to the ongoing development of the life insurance sector. This study serves as a foundation for informed decision-making and future research within the realm of life insurance at ICICI Prudential Life Insurance.

Reviving Indian Country: Expanding Alaska Native Villages’ Tribal Land Bases Through Fee-to-Trust Acquisitions

For the last fifty years, the possibility of fee-to-trust acquisitions in Alaska has been precarious at best. This is largely due to the Alaska Native Claims Settlement Act of 1971 (ANCSA), which eschewed the traditional reservation system in favor of corporate land ownership and management. Despite its silence on trust acquisitions, ANCSA was and still is cited as the primary prohibition to trust acquisitions in Alaska. Essentially, ANCSA both reduced Indian Country in Alaska and prohibited any opportunities to create it, leaving Alaska Native Villages without the significant territorial jurisdiction afforded to Lower 48 tribes. However, recent policy changes from the Department of Interior reaffirmed the eligibility of trust acquisitions post-ANCSA and a proposed rule from the Bureau of Indian Affairs signals a favorable presumption of approval for Alaska Native fee-to-trust applications. This Note reviews the history and controversy of trust acquisitions in Alaska, and more importantly, it demonstrates the methods in which Alaska Native Villages may still acquire fee land for trust acquisitions after ANCSA.