Individual Claims Research Articles

Policy and practice: Stakeholders’ satisfaction with conventional and participatory land use planning in Ghana

Land use planning remains an integral tool for guiding the growth and development of human settlements due to competing interests and claims of individuals over land. Two major land use planning approaches are adopted - conventional and participatory - with inconclusive findings on the best approach to employ towards promoting orderly development and growth. This study thus contributes to this debate by exploring how conventional and participatory land use planning approaches affect the preparation and outcome of land use plans in Ghana, using Abuakwa Newtown in the Atwima Nwabiagya Municipality and Krapa No.1 of in the Ejisu Municipality as case study areas. Through a comparative case research design, quantitative and qualitative approaches were employed to gather and analyse data from 397 property owners and other relevant stakeholders. The aim was to explore the similarities and differences between the two approaches and stakeholders’ perception and satisfaction with both processes. The findings largely revealed differences in the land use plan preparation process – plan initiation, preparation and approval - in the two communities. It was revealed that only plan implementation activities had similar outcomes in both communities. The ordered logistic regression model deemed significant at p ≤ 0.05, revealed a negative relationship of satisfaction between tenure security, plan initiation and preparation in Abuakwa Newtown, but a positive relationship in Krapa No.1. The research recommends that planning authorities adopt participatory land use planning and improve upon communication in the processes for active participation and involvement.

Between Asylum and Liberation: The New Palestinian Refugees

Abstract Contemporary Palestinian asylum seekers raise fundamental questions regarding the relationship between the institution of asylum and struggles for national liberation. Underlying the legal framework that applies to them is an assumption of inverse correlation: the more Palestinians obtain access to individual asylum claims, the less secure are the fundamental Palestinian claims of self-determination and return. But is this trade-off acceptable today? Comparable dilemmas animate other large-scale displacements, but scholars seldom discuss their full implications for international legal theory. Rather than providing a definite answer to the question, this article maps out four major aspects of how individual protection and self-determination are interrelated, or, indeed, bifurcated, in international law. The new Palestinian refugees are important to consider not only because their continued displacement is foreseeable but also because their exceptional plight invites a reconsideration of the political foundations of refugee law. How can policy makers and legal interpreters uphold principles of both individual and collective protection, preventing the two from cutting against each other?

Business Case for Transit Bus Automated Collision Avoidance Systems

Although the National Transportation Safety Board has strongly recommended the application of collision avoidance warning systems and automated emergency braking (CAWS/AEB), the transit industry has lagged behind autos and trucks. CAWS/AEB for buses is more complex than for cars and trucks and represents a niche market. If bus manufacturers and suppliers are to invest in developing this technology, they will need to be convinced there is a market for it. Transit agencies also will need to be convinced that the technology works and is affordable. For both vendors and purchasers, a business case could be made that some or all of the expense of procuring and deploying the technology can be recovered through savings from reduced insurance premiums and claims payouts by preventing or mitigating collisions. This paper describes two methods for estimating the business case for equipping transit buses with CAWS/AEB. First, industrywide data on the numbers of collisions and casualty and liability expenses incurred by transit agencies were examined, and statistical relationships were modeled to determine whether reducing the numbers of collisions would reduce casualty and liability expenses. Second, individual collision claims records for specific transit agencies were examined to determine whether the collisions could have been prevented by CAWS/AEB, and the potential savings.

Individual Reparations Claims and Holocaust Research: The Forschungsgruppe Berliner Widerstand 1933–1945

The stacks of materials and amount of information collected as part of the individual reparation process since the late 1940s are immense. It is the largest untapped Holocaust-related archive. One might ask, what should we do with this enormous collection of documents? Will these documents provide new insights on the Holocaust? How will they change what we know about post-war societies? This is of course not the first time that such questions have been raised. By looking at the work of a group of historians using compensation claim files as a historical source at the end of 1950s in Berlin, my paper will seek to provide some insight into the compound interplay between individual compensation claims and historical research. The Forschungsgruppe Berliner Widerstand 1933–1945 commenced its work in October 1956. Funded by the Berlin city lottery, with overheads covered by the Berlin Ministry of Interior, this research unit was to conduct a broad-based study of persecution and resistance in Berlin during the Nazi period. Using extensive documentary evidence, the project was supposed to focus on the fate of the victims of Nazi policy and the efforts of individual groups to offer resistance. In terms of its approach and method, the project was ahead of its time. The initial idea of using individual victim experiences as a starting point for the depiction of Nazi crimes and the opposition against it made, even if only for a brief period of time, the compensation claim files into a valuable historical resource. The exploration of this Forschungsgruppe will help us to better understand the challenges of working with personal compensation claims as historical documents and will raise stimulating questions about the place of German reparation in Holocaust studies and commemoration of the Holocaust.

#5673 ESTIMATING AND VALIDATING MEASURES OF CKD PREVALENCE AND INCIDENCE USING OBSERVATIONAL AND CLAIMS DATA IN PERSONS AGED 70+

Abstract Background and Aims Estimating prevalence and incidence of chronic kidney disease (CKD) based on claims data often underlies bias and limitations due to uncertainty of diagnostic validity. We investigated CKD prevalence and incidence over time using data from a community-dwelling cohort of individuals aged 70+ linked to individual claims data. We assessed the diagnostic validity of the claims-based compared with the eGFR-based CKD definition. Method We assessed CKD prevalence and incidence in two data sources: 1) eGFR values of participants aged 70+ (n = 2,069) of the Berlin Initiative Study (BIS), including five biennial study visits from 2009-2019, and 2) claims data of BIS participants matched on person-level. Using eGFR, we defined CKD prevalence as eGFR <60 ml/min/1.73m² calculated with the creatinine-based CKD-EPI (2009) equation. For each study visit, prevalent CKD cases were considered as incident if eGFR was ≥60 ml/min/1.73m² in the respective previous study visit. In claims data, in- and outpatient ICD-10 diagnoses (N18.3, N18.4, N18.5, N18.8, N18.9, N19) in the year preceding and/or following the study visit date were used to determine CKD prevalence. Incidence was defined as prevalent cases without a diagnosis in the year preceding the first CKD diagnosis. The denominator for incidence was defined as all persons at risk, i.e., who were not prevalent in a respective previous study visit and still under observation. We assessed the diagnostic validity of claims-based CKD prevalence and incidence using eGFR data as a reference. Analyses were stratified by sex. Results Between 2009 and 2019, CKD prevalence increased from 0.42 to 0.51 based on eGFR and from 0.30 to 0.43 based on claims data. Incidence varied between 0.16–0.22 using eGFR and 0.07–0.13 using BIS claims data. There was no clear time trend for incidence in any data source. Diagnostic validity of claims-based CKD prevalence and incidence detection is displayed in Table 1. Sensitivity for prevalence increased while other indicators remained stable over time. Detection of incident cases showed lower sensitivity (0.18–0.30 vs. 0.58–0.70) and PPVs (0.40–0.60 vs. 0.79–0.83) compared to prevalence, respectively. Prevalence and incidence based on claims data were slightly higher in males compared to females (Figure 1). Conclusion Using the eGFR-based or claims-based definition of CKD we found an increase in prevalence between 2009 and 2019. This might be due to the introduction of the KDIGO guidelines in 2012. During the same time, CKD incidence rates were stable. Comparing the claims-based with eGFR-based CKD definition, we found a sensitivity of 0.58-0.70 for prevalence and 0.18-0.30 for incidence, indicating that there is a risk of underdetection of CKD when using solely claims data, in particular for incident cases.

The Privilege of Art

The Privilege of Art

Pleading competition damages claims and defences: recent guidance from the Court of Appeal and the Competition Appeal Tribunal

The Court of Appeal and the Competition Appeal Tribunal have recently handed down guidance in NTN v. Stellantis and O’Higgins and Evans, as to the requirements that must be satisfied to plead a competition law claim or defence, whether the claim is an individual claim or a collective action. This article considers the economic and legal issues that need to be addressed in pleadings, in the light of that guidance. Both judgments make clear that economists must be consulted at the very earliest stage to ensure that the pleadings, whether a claim or defence, or in an individual claim or a collective action, reflect clearly the economic theories relied upon and do so by reference to underlying facts. If a pleading does not comply with this guidance, it risks being struck out.

Effects of Cost Sharing on Ophthalmic Care Utilization in the Affordable Care Act Marketplace

ABSTRACT Purpose To determine the distribution and quantity of ophthalmic care consumed on Affordable Care Act (ACA) plans, the demographics of the population utilizing these services, and the relationship between ACA insurance coverage plan tier, cost sharing, and total cost of ophthalmic care consumed. Methods This cross-sectional study analyzed ACA individual and small group market claims data from the Wakely Affordable Care Act (WACA) 2018 dataset, which contains detailed claims, enrollment, and premium data from Edge Servers for 3.9 million individual and small group market lives. We identified all enrollees with ophthalmology-specific billing, procedure, and national drug codes. We then analyzed the claims by plan type and calculated the total cost and out-of-pocket (OOP) cost. Results Among 3.9 million enrollees in the WACA 2018 dataset, 538,169 (13.7%) had claims related to ophthalmology procedures, medications, and/or diagnoses. A total of $203 million was generated in ophthalmology-related claims, with $54 million in general services, $42 million in medications, $20 million in diagnostics and imaging, and $86 million in procedures. Average annual OOP costs were $116 per member, or 30.9% of the total cost, and were lowest for members with platinum plans (16% OOP) and income-driven cost sharing reduction (ICSR) subsidies (17% OOP). Despite stable ocular disease distribution across plan types, beneficiaries with silver ICSR subsidies consumed more total care than any other plan, higher than platinum plan enrollees and almost 1.5× the cost of bronze plan enrollees. Conclusions Ophthalmic care for enrollees on ACA plans generated substantial costs in 2018. Plans with higher OOP cost sharing may result in lower utilization of ophthalmic care.

890 Disparities in Supportive Care Utilization Among Neurosurgical Patients With Malignant Central Nervous System Tumors

INTRODUCTION: Patients with central nervous system (CNS) malignancies benefit from palliative care (PC) in addition to other supportive services, such as home health and social work. Guidelines also propose early PC for patients with advanced cancers. Racial disparities exist in healthcare access, and we introduce a novel construct, “provider patient racial diversity index” (provider pRDI), higher categories of which refer to higher proportions of non-white patients a provider sees as a measure of the provider’s exposure to racial diversity and cultural sensitivity. METHODS: Using Optum Clinformatics Datamart Database, all patients with at least one neurosurgery encounter, diagnosis of primary or secondary CNS malignancy, and no prior supportive services were included. Patient-level demographics were collated. Supportive services were defined based on provider categorization on individual claims. RESULTS: The cohort of 48,722 patients demonstrated significantly low rates of PC, home health, and social work services among racial minorities. However, patients who saw providers categorized into high provider pRDI categories were increasingly more likely to interface with supportive services and at an earlier point in their disease courses. Patient race did not impact supportive service spending, but higher provider pRDI was associated with monotonic increases in spending on PC. CONCLUSIONS: Neurosurgical patients with CNS malignancies from minority backgrounds are less likely to receive supportive services. Such effect is mitigated when they encounter at least one provider who scores highly in provider pRDI; patients receive supportive services earlier and demonstrate greater utilization. Our study highlights patient-level healthcare disparities and the need for provider-level intervention to address cultural sensitivity.

Association of the Kidney Failure Risk Equation With High Health Care Costs

The Kidney Failure Risk Equations (KFRE) are accurate and validated to predict the risk of kidney failure in individuals with chronic kidney disease (CKD), but their potential to predict health care costs in the US health care system is unknown. We assessed the association of kidney failure risk from the 4-variable and 8-variable 2-year KFRE models with monthly health care costs in US patients with CKD stages G3 and G4. This was an ancillary study to a larger observational, retrospective cohort study examining the association between serum bicarbonate and adverse kidney outcomes. Monthly medical costs were calculated from individual health care insurance claims. Generalized linear regression models were used to examine the association of KFRE score with health care costs. A total of 1721 patients qualified for the study (1475 and 246 with CKD stages G3 and G4, respectively). For 8-variable KFRE, each 1% (absolute) increase in risk was associated with 13.5% (P< 0.001) and 4.1% (P< 0.001) higher monthly costs for patients with CKD stage G3 and G4, respectively. For 4-variable KFRE, a 1% increase in risk was associated with 6.7% (P= 0.016) and 2.9% (P= 0.014) increase in monthly costs for patients with CKD stage G3 and G4, respectively. Higher risks of kidney failure as predicted by the 4-variable or 8-variable KFRE were associated with higher 2-year medical costs for patients with CKD stages G3 and G4. The KFRE may be a useful tool to anticipate medical costs and target cost-reducing interventions for patients at risk of kidney failure.

You Cannot Have the Cake and Eat It – How to Reconcile Liberal Fundamental Rights with Answers to the Climate Crisis

Abstract Our Western-style constitutional systems are not only built on 16th to 18th century social contract theory, but also mainly on a liberal understanding of individual human rights. They are an element of constitutions and international treaties and are increasingly used as a basis for claims of individuals against states for more action to tackle the climate change crisis. However, a human right to a sustainable climate meets plenty of challenges if understood as a classic human right. The question is whether human rights offer a solution to legal questions of the climate crisis by empowering people to demand specific measures from states. The authors demonstrate how the search for solutions has altered the understanding of human rights globally and will continue to do so. It sheds a light on whether the premises on the relationship between state and individual and burdens on individual freedom can still be answered by paradigms from social contract theories and whether the social contract needs to be enlarged by including non-human actors (like eco-systems) or future generations.

In Search of Humanity: The Moral and Legal Discrepancy in the Redress of Violations in International Humanitarian Law

AbstractBoth international humanitarian law (IHL) and international human rights law (IHRL) make extensive references to humanity. Yet the role attributed to humanity differs between the two. Humanity is seen in IHRL as the source of the rights, whereas in IHL it is interpreted as a moral obligation to avoid harm. This article challenges this perspective. Relying upon contemporary interpretations of IHL, it will be argued that, in a moral sense, IHL matches up closely with IHRL. Crucial here is that humanity, rather than reflect a utilitarian perspective to avoid harm, is worded in stronger terms. To reflect this accurately, it is argued that IHL is best seen as a reflection of TM Scanlon's contractualism as opposed to utilitarian reasoning. Relying upon the similarities in moral reasoning visible in both bodies of law, the article argues that this should also be reflected when it comes to redress for violations. In a concrete sense, the argument here is that this also presents a moral requirement to recognise individual claims within IHL. To give legal effect to this moral demand, it is suggested that IHRL might play a role in bridging the gap between the moral and legal considerations in IHL.

A True Copy? Documents and the Production of Legality in the Bombay Inam Commission

This essay examines the role of Indian-language documentation in the production of legality in colonial western India, focusing on the workings of the Bombay Inam Commission (1852-1863). It situates legal validation of claims to tax-free land revenue within the broader process of securing, organizing, classifying, and registering Marathi- and Persian-language documents. Combating the effects of rain, dirt, and pests on old state records often sold as “waste paper,” the Inam Commission deployed material interventions to secure a legal archive for verifying individual claims to property. While such evidence weighed heavily in the evaluation of the testimony and corroborating documents of an individual claimant’s case-file, questions of writing also shaped the legal reasoning of the Commission. Inquiries about any given document’s conformity to or deviation from conventional style figured prominently in judgments about its authenticity. The scribe Sayyid Usman’s investigation in 1856 of a date in a Persian document attributed to the Mysore ruler Tipu Sultan struggled to establish the parameters of conventional style against the plurality of entangled regimes of property. I argue that a material approach to writing allows us to better understand the imperfect and dispersed production of legal truth in imperial settings.

Unfair Commercial Practices and Individual Consumer Claims for Damages – The Transposition of Art. 11a UCP Directive in Germany and Austria

Abstract Article 11a(1) UCP Directive obliges the Member States to provide individual rights for consumers harmed by unfair commercial practices. This new provision is intended to ensure that consumers have access to proportionate and effective remedies, including compensation for damage suffered and, where relevant, a price reduction or the termination of the contract. Although the laws against unfair competition in Germany and Austria have similar basic structures, the transposition of Art. 11a(1) UCP Directive shows some significant differences in the way national law provides individual protection for consumers. The legal systems in Germany and Austria are confronted with challenges both in the correct transposition of Art. 11a(1) UCP Directive and the incorporation of individual consumer claims for damages into the structures of domestic law. This article intends both to give a first overview and also to attempt to answer some of the open questions.

Micro‐level reserving for general insurance claims using a long short‐term memory network

AbstractDetailed information about individual claims are completely ignored when insurance claims data are aggregated and structured in development triangles for loss reserving. In the hope of extracting predictive power from the individual claims characteristics, researchers have recently proposed to use micro‐level loss reserving approaches. We introduce a discrete‐time individual reserving framework incorporating granular information in a deep learning approach named Long Short‐Term Memory (LSTM) neural network. At each time period, the network has two tasks: first, classifying whether there is a payment or a recovery, and second, predicting the corresponding non‐zero amount, if any. Based on a generalized Pareto model for excess payments over a threshold, we adjust the LSTM reserve prediction to account for extreme payments. We illustrate the estimation procedure on a simulated and a real general insurance dataset. We compare our approach with the chain‐ladder aggregate method using the predictive outstanding loss estimates and their actual values.

Investigating the collective value at risk model (CVaR) and its application on real data for life insurance

Life insurance is designed to reduce the risk of financial loss due to unforeseen consequences related to the insured's death. In life insurance, the insurer provides death benefits as a claim when the insured suffers death. The claim is the compensation for a risk loss. Individual claim in one-period insurance is called aggregation claim, while aggregation claim is a collective risk. Collective risk is usually measured using a variance. However, the variance risk measure cannot often accommodate any event risk because there is a risk of claims beyond the amount of variance. Using the proposed method CVaR and confidence level are taken from α = 0.25% until 4%. This study found that the proposed method CVaR scored more fairly than Collective Risk. In conclusion, this study indicated that the collective risk model is just included using mean and variance without any confidence level. Therefore, only one result for the Collective Risk model, which automatically shows the model using mean, variance and standard deviation, could not accommodate all risk events.

Application of Factoring in Business Operations

Assignment of receivables as an institution of current civil law is rooted in ancient legal systems. The abovementioned institution was introduced to the Polish legal system under the Code of Obligations of 27 October 1933. This solution occurs in various specific forms serving various legal and economic goals, beginning with the satisfaction of claims of individuals, to securing a claim, to improvement of financial liquidity of the assignor. Thanks to the constant development of the above legal institution it functions in numerous legal systems and constitutes a real support in securing business transactions and making them more efficient.

Combined Modelling of Micro-Level Outstanding Claim Counts and Individual Claim Frequencies in General Insurance

Combined Modelling of Micro-Level Outstanding Claim Counts and Individual Claim Frequencies in General Insurance

Abortion policies at the bedside: incorporating an ethical framework in the analysis and development of abortion legislation

About 6% of women in the world live in countries that ban all abortions, and 34% in countries that only allow abortion to preserve maternal life or health. In the...

Demons of density do higher-density environments put people at greater risk of contagious disease?

We study the relationship between density and COVID during three distinct waves of the pandemic in New York City. Unlike prior work, our analysis uses individual Medicaid claims records, which include a rich array of demographic characteristics and pre-existing medical conditions and cover a near universe of low-income New Yorkers. In brief, our results suggest that living in higher density neighborhoods did not heighten the risk of COVID hospitalization. The size of a multifamily building made little difference either, and people living in public housing developments, which are typically highly dense environments, were less likely to be hospitalized for COVID. However, while neighborhood and building density do not seem to matter, we find significant, positive relationships between COVID hospitalization rates and household size. Specifically, we see that people living in large households or in neighborhoods with high levels of crowding were more likely to be hospitalized for COVID. In other words, our results suggest that crowded living quarters – which can occur at any level of population density – and not density itself, increase the risk of COVID hospitalization. We also see a strong correlation between being unstably housed or living in institutional settings and COVID hospitalizations.