Payment Of Claims Research Articles

On the issue of maintaining a balance of private and public interests in satisfying creditors’ claims in bankruptcy proceedings

The article analyzes the problems of satisfying creditors’ claims in bankruptcy proceedings. In the context of a conflict of interests of creditors caused by insufficient property of an insolvent debtor, the search for an optimal model for satisfying their claims was carried out. Common conflict situations arising between pledgees and authorized bodies have been identified. For example, in cases of satisfaction of claims for mandatory payments secured by the seizure of a taxpayer’s property. The tax authorities, as current creditors, also file claims for payment of income tax, property tax and land tax. The legal positions of the Constitutional Court of the Russian Federation are analyzed. It is concluded that it is necessary to eliminate the imbalance of interests of collateral creditors and authorized bodies, and restoration of the security function of the pledge.

Tinjauan Atas Prosedur Pengajuan Hingga Pembayaran Klaim Asuransi Kendaraan Bermotor

The development of the number of vehicles is inseparable from the risk of uncertainty that lurks. Therefore, motor vehicle insurance is present as a place to transfer risk from unexpected things that happen to vehicles, or to parties included in the policy. The accounting information system exists because of the need to monitor business activities. In submitting an insurance claim, a procedure is needed regarding the claim submission flow to facilitate the company and monitor the company's performance. The purpose of this review is to determine the application of the system in the procedure for submitting to paying JP-Astor claims. This research was conducted by the author at PT. Asuransi Jasaraharja Putera Bogor Marketing Office located at Jl. Re. Martadinata Komp. Ruko Sentra Air Mancur No. 2h, Bogor Tengah, Bogor City. The results of the review indicate that PT Asuransi Jasaraharja Putera Bogor Marketing Office has been quite good at carrying out the procedure for submitting to paying JP-Astor claims. The claim submission and claim payment system at Jasaraharja Putera Bogor Marketing Office has helped the work of employees and insured parties, so that they know the extent of the claim process that has been submitted. Accounting Information System implemented through Care System helps companies in registering and remote authorization. Keywords: Submission, Payment, Claim, Motor Vehicle

Forecasting the outcomes of construction contract disputes using machine learning techniques

PurposeThis study aims to develop a predictive model using machine learning techniques to forecast construction dispute outcomes, thereby minimizing economic and social losses and promoting amicable settlements between parties.Design/methodology/approachThis study develops a novel conceptual model incorporating project characteristics, root causes, and underlying causes to predict construction dispute outcomes. Utilizing a dataset of arbitration cases in Türkiye, the model was tested using five machine learning algorithms namely Logistic Regression, Support Vector Machines, Decision Trees, K-Nearest Neighbors, and Random Forest in a Python environment. The performance of each algorithm was evaluated to identify the most accurate predictive model.FindingsThe analysis revealed that the Support Vector Machine algorithm achieved the highest prediction accuracy at 71.65%. Twelve significant variables were identified for the best model namely, work type, root causes, delays from a contractor, extension of time, different site conditions, poorly written contracts, unit price determination, penalties, price adjustment, acceptances, delay of schedule, and extra payment claims. The study’s results surpass some existing models in the literature, highlighting the model’s robustness and practical applicability in forecasting construction dispute outcomes.Originality/valueThis study is unique in its consideration of various contract, dispute, and project attributes to predict construction dispute outcomes using machine learning techniques. It uses a fact-based dataset of arbitration cases from Türkiye, providing a robust and practical predictive model applicable across different regions and project types. It advances the literature by comparing multiple machine learning algorithms to achieve the highest prediction accuracy and offering a comprehensive tool for proactive dispute management.

Direct Economic Burden of Cubital Tunnel Surgery in the United States: Total Payments and Components of Cost

Despite its widespread prevalence, the cost of cubital tunnel syndrome (CuTS) in the United States to patients and insurers is not well understood. The purpose of this study was to quantify the direct payments associated with operative treatment of CuTS. We hypothesized that CuTS represents a substantial cost to the payer in facility fees, surgeon fees and other expenses. Utilizing the MarketScan database of insured patients (commercial and Medicaid), we identified a cohort of 41,777 patients aged 18-64 years with surgically treated CuTS from 2006 to 2018. We estimated the median 90-day payments from encounters associated with cubital tunnel release (CuTR) and/or ulnar nerve transposition surgery by summing all payments for claims within 90 days after the index surgery. Published estimates of the annual number of cubital tunnel surgeries were used to calculate the annual expenditure. Of 41,777 patients, the median (interquartile range [IQR]) values of total direct payments were $5,522 [$3,426, $9,541]. With an estimated 94,645 cases/year, this leads to an annual payment of more than $522 million. Index facility payments (median[IQR] $2,555 [$1,359, $4,708] were the highest, followed by index provider payments ($1,691 [$1,328, $2,217]). The median index surgeon payment (median[IQR] $905 [$707, $1,184]) represented just over half of the provider payments. Post-operative care had a median [IQR] payment of $377 ($424, $1,987). Limitations of claims databases prevented assessment of other indirect costs associated with cubital tunnel surgery. Payments for the surgical treatment of CuTS from the index surgery to 90 days post-operatively have an estimated median of $5,522 per patient, totaling $52 million annually. Index facility fees are responsible for more than 46% of payments, while index payments to surgeons represent approximately 16%. Defining this data is critical to understanding one component of the economic impact of CuTS. Level IV.

PROBLEM OF THE APPLICATION OF POTESTATIVE TERMS IN CONTRACTS FOR THE PERFORMANCE OF EXPERIMENTAL DESIGN WORK IN THE FIELD OF STATE DEFENSE ORDER

The purpose of the research. The article examines the actual problems of the application of potestative (suspensive) terms in contracts for the performance of experimental design work in the field of state defense orders, highlights the specific features of the legal regulation of the legal relations in question, provides their interpretation in the legal doctrine, as well as in the current legislation of the Russian Federation. The author conducted a review of Russian judicial practice, identified and recorded its positive and negative trends. Potestative terms in a contractual obligation are definitely permissible, should not be dependent or counter, are a priori feasible by virtue of the law, are associated with the volitional actions of the party to the transaction, simultaneously responding to the sign of uncertainty and the criterion of reality, while theoretically possible in reality, although their occurrence is unknown in advance. The research is conducted in order to identify and overcome legal gaps, develop recommendations for effective law enforcement of existing norms and improve individual legal acts, norms and institutions. Results. As a result of the conducted research, the author comes to the conclusion about the practical ineffectiveness of potestative terms in contracts for the performance of experimental design work in the field of state defense orders, aggravating the legal position of the head contractor, destabilizing his financial stability in the form of an array of simultaneous claims and claims for payment of completed and accepted works.

Implications of crop yield distributions for multiperil crop insurance rating in Ghana: a lasso model application

PurposeThe objective of this paper is to examine crop yield predictions and their implications on MPCI in Ghana. Farmers in developing countries struggle with their ability to deal with agricultural risks. Providing aid for farmers and their households remains instrumental in combatting poverty in Africa. Several studies have shown that correctly understanding and implementing risk management strategies will help in the poverty alleviation agenda.Design/methodology/approachThis study examines the importance of crop yield distributions in Ghana and its implication on multiperil crop insurance (MPCI) rating using the Lasso regression model. A Bonferroni test was employed to test the independence of crop yields across the regions while the Kruskal-Wallis H test was conducted to examine statistical differences in mean yields of crops across the ten regions. The Bayesian information criteria and k-fold cross-validation methods are used to select an appropriate Lasso regression model for the prediction of crop yields. The study focuses on the variability of the threshold yields across regions based on the chosen model.FindingsIt is revealed that threshold yields differ significantly across the regions in the country. This implies that the payment of claims will not be evenly distributed across the regions, and hence regional disparities need to be considered when pricing MPCI products. In other words, policymakers may choose to assign respective weights across regions based on their threshold yields.Research limitations/implicationsThe primary limitation is the unavailability of regional climate data which could have helped in a better explanation of the variation across the regions.Originality/valueThis is the first study to examine the implications of regional crop yield variations on multiperil crop insurance rating in Ghana.

Liability for Delay in Disbursement of Insurance Claims at Joint Life Insurance Bumi Putera 1912

Through the whole of the year 2020, the organization has been operating with a deficit that has a value of (5.4) five point four trillion Rupiah. Despite the fact that a number of policyholders have not been successful in obtaining scholarships up to this point, the policyholders have fulfilled their obligations by paying premiums in accordance with the minimum amount. The purpose of this study is to investigate the degree to which Joint Life Insurance Bumi Putera is able to fulfill its corporate duty to its clientele. Approaches of empirical research are used in this study. These approaches include conducting interviews and observations with policyholders and AJB Bumi Putera 1912, using a statutory analysis methodology. According to the findings of the data analysis, Joint Life Insurance Bumi Putera Company is going to have to deal with a lot of serious implications as a result of default. On the other hand, the corporation is only capable of meeting the solvency level of -1197.39 percent, which would be regarded to be lower than the goal solvency level of 120 percent that was established. Consequently, the researcher arrives to the ultimate conclusion that Joint Life Insurance Bumi Putera will make payments for insurance if the policyholder satisfies the standards that have been presented by the organization itself. This study has a number of consequences, one of which is that the procedure of submitting a claim for redemption should be accompanied with a deadline, such as a maximum of one month, in order to ensure that there is clarity about the time limit for claim payment.

Pelaksanaan Sistem Informasi Akuntansi Pembayaran Klaim Jaminan Hari Tua Pada BPJS Ketenagakerjaan Mojokerto

In this research, the problem faced is that many customers want to file a claim at BPJS Ketenagakerjaan Mojokerto, but often fail or are delayed. The number of workers filing claims has increased, including those who have been laid off or whose contracts have ended. In addition, many participants postpone filing their claims until Hari Raya gets closer, which causes the queue for Old Age Security claims to increase.This journal was written using a qualitative descriptive approach. The focus of the research is the problems related to the implementation of the accounting information system for the payment of old-age security claims at BPJS Ketenagakerjaan Mojokerto. Theoretical studies are used to analyze the data obtained, selected, and processed. The results show that the process of paying Old Age Security claims at BPJS Ketenagakerjaan Mojokerto is in accordance with the accounting information system

Sistem Tata Kelola Tagihan Pembayaran Klaim Jaminan Kecelakaan Kerja Pada BPJS Ketenagakerjaan Cabang Surabaya Karimunjawa

BPJS Employment cooperates with many employer companies and Work Accident Service Centers in managing Work Accident Insurance. In its management, of course, the company must have an effective and efficient governance system. The research entitled "Governance System for Payment Bills for Work Accident Guarantee Claims at Bpjs Ketenagakerjaan Surabaya Karimunjawa Branch" has the aim of conducting an ongoing analysis of the governance of bills for payment of work accident guarantee claims. The results obtained in this study are that researchers know the benefits of Work Accident Insurance and the procedures and Management System for JKK Payment Bills which are carried out very well by the BPJS Employment Surabaya Karimunjawa.

The Effect of the Claim Recovery Process on Claim Payments in Insurance

The Effect of the Claim Recovery Process on Claim Payments in Insurance

The right of re-measurement of settlements in the Middle Ages in the light of the legal practice of Bohemia and Silesia in the 13th and 14th centuries

Summary During the High Middle Ages, hereditary land tenure prevailed throughout East-Central Europe, often in a formalised manner based upon the ius emphyteuticum, whereby peasants were guaranteed a stable amount of land rents to be paid to landlords. There was, however, a legal institution that enabled the landlords to practically renegotiate original settlement contracts without openly violating them, in order to increase their income: the law of re-measurement of settlements (ius mensurationis). On examples from Silesia and Bohemia we have demonstrated that the landlords used this means plentifully, either directly through its actual implementation, or indirectly by renouncing their claims for payment. We have also hypothesized on the rationale and origin of the ius mensurationis, analyzed who could raise claims based upon it, and commented on the formulas related to this legal institution, which may be found there in Silesian and Bohemian charters.

Efficient Damage Assessment of Rice Bacterial Leaf Blight Disease in Agricultural Insurance Using UAV Data

In Indonesia, where the agricultural insurance system has been in full operation since 2016, a new damage assessment estimation formula for rice diseases was created through integrating the current damage assessment method and unmanned aerial vehicle (UAV) multispectral remote sensing data to improve the efficiency and precision of damage assessment work performed for the payments of insurance claims. The new method can quickly and efficiently output objective assessment results. In this study, UAV images and bacterial leaf blight (BLB) rice damage assessment data were acquired during the rainy and dry seasons of 2021 and 2022 in West Java, Indonesia, where serious BLB damage occurs every year. The six-level BLB score (0, 1, 3, 5, 7, and 9) and damage intensity calculated from the score were used as the BLB damage assessment data. The relationship between normalized UAV data, normalized difference vegetation index (NDVI), and BLB score showed significant correlations at the 1% level. The analysis of damage intensities and UAV data for paddy plots in all cropping seasons showed high correlation coefficients with the normalized red band, normalized near-infrared band, and NDVI, similar to the results of the BLB score analysis. However, for paddy plots with damage intensities of 70% or higher, the biased numbering of the BLB score data may have affected the evaluation results. Therefore, we conducted an analysis using an average of 1090 survey points for each BLB score and confirmed a strong relationship, with correlation coefficients exceeding 0.9 for the normalized red band, normalized near-infrared band, and NDVI. Through comparing the time required by the current assessment method with that required by the assessment method integrating UAV data, it was demonstrated that the evaluation time was reduced by more than 60% on average. We are able to propose a new assessment method for the Indonesian government to achieve complete objective enumeration.

Can employment salvage payments be entitled to a maritime lien and allowed in the general average? A comparative analysis of the UK, US, and China

The International Convention on Salvage 1989 established the basic framework on the “no cure, no pay” principle and also allowed for freedom of contract. Employment salvage is defined as services performed under a contract to pay a given sum or per diem or horam wages, payable at all events, regardless of the salvage is successful or unsuccessful. This study provides a thorough analysis of the differences between employment salvage payments and “no cure, no pay” salvage rewards, identifying key distinctions in their legal natures, principles for calculating remuneration, and conditions of payment. By comparing the legal frameworks in the United Kingdom, the United States, and China, it is determined that claims for employment salvage payments should not be entitled to maritime liens. Moreover, if such claims satisfy the criteria of general average, they should be allowed in general average and contributed to by the relevant beneficiaries. To prevent the dilution of the "no cure, no pay" principle in maritime salvage due to the increased freedom of contract, this study advocates for a stricter scrutiny of contractual freedom in employed salvage to avoid potential abuses by salvors. It is crucial to balance the interests of salvors and other maritime stakeholders, ensuring that while salvors are incentivized for their risky work, other parties are also safeguarded against excessive or unwarranted financial burdens. Additionally, to reduce legal conflicts among nations, it is advisable for countries to coordinate their legislation and establish appropriate international guidelines to promote a greater harmonization of international maritime law.

EE379 Assessing Trends in the Distribution of Prescription Claim Payments (2011-2021) and Implications for Retail Pharmacies

EE379 Assessing Trends in the Distribution of Prescription Claim Payments (2011-2021) and Implications for Retail Pharmacies

Consumers’ perception of distribution channel for the Malaysian microtakaful scheme: an exploratory study

Purpose This paper aims to investigate consumers’ preferences regarding the distribution channels for subscription, contribution payment and compensation claims of microtakaful scheme in Malaysia. Design/methodology/approach Consumers’ preferences were explored through questionnaires and focus group discussions (FGD) conducted among the bottom 40% income classification households (B40) in five zones: northern, central, eastern, southern and Sabah and Sarawak. Findings Empirical findings from cross-tabulation analysis revealed that takaful company is the preferred distribution channel for purchasing protection plans and making compensation claims. However, the online platform is the favoured channel to make contribution payments. Further investigation through FGD suggested that the selection of a channel for subscription, contribution payment and compensation claim is influenced by consumer trust, cost-effectiveness and simplicity of procedure. Research limitations/implications Limitation is pertaining to only cross-tabulation analysis used in explaining the choice of distribution channel for microtakaful among B40 group. Thus, advanced analysis is required to strengthen the findings. Practical implications Findings of this study would help marketers and practitioners to formulate strategies to promote their microtakaful protection to enhance subscription among the low-income population. Originality/value Empirical findings offer academic contributions to the existing body of knowledge on microtakaful area as the primary data collected will eventually allow future researchers to explicate the contribution of the current study to understand the important of distribution channel for microtakaful from the perspective of subscribers and potential subscribers.

Treatment patterns and hospitalizations following rejection, reversal, or payment of the initial once-monthly paliperidone palmitate long-acting injectable antipsychotic claim among patients with schizophrenia or schizoaffective disorder.

Once-monthly paliperidone palmitate (PP1M) is a long-acting injectable antipsychotic approved for the treatment of schizophrenia and schizoaffective disorder (SCA) in adults. To assess treatment patterns and schizophrenia/SCA-related hospitalization following payer rejection, patient reversal, or payment of an initial PP1M claim. This was a retrospective cohort study using the IQVIA Formulary Impact Analyzer database linked to the Medical Claims, Hospital Charge Detail Master, and Experian consumer databases. Patients with schizophrenia/SCA and ≥1 PP1M pharmacy claim from January 1, 2018, to February 28, 2022, were identified and stratified into 3 cohorts based on the transaction status of the initial PP1M claim (index date): rejected (payer not approved), reversed (payer approved, patient abandoned), and paid (payer approved, patient filled). Patient characteristics during the 12 months before the index date, subsequent treatment patterns, and schizophrenia/SCA-related hospitalization for patients with >6 months of follow-up were assessed by cohort. The rejected, reversed, and paid cohorts included 1,260, 1,046, and 1,686 patients, respectively. Across these cohorts, the mean ages ranged between 39.2 and 44.5 years; more than half were male (50.8%-51.6%) and White (50.6%-58.3%); 19.8%-24.6% of patients had a Quan-Charlson Comorbidity Index score of ≥2. Rates of prior atypical oral and long-acting injectable antipsychotic use ranged between 76.4%-80.3% and 7.8%-12.7%, respectively. Among patients with ≥6 months of follow-up, 52.2% in the rejected and 53.1% in the reversed cohorts had a subsequent paid PP1M claim during the study period; the median (quartile 1-quartile 3) time to the first paid PP1M claim was 22 (5-74) days for rejection and 11 (1-41) days for reversal. In the rejected and reversed cohorts, 10.2% (n = 111) and 9.8% (n = 90) of patients, respectively, did not receive any paid claim for an antipsychotic after the initial PP1M rejection/reversal. The prevalence of schizophrenia/SCA-related hospitalization during follow-up was similar between patients with a paid (7.4%) and rejected PP1M claim (7.0%; P = 0.689) but higher among patients with a reversed claim (10.8%; P = 0.004). After adjusting for confounders, patients in the reversed cohort were 39% more likely to have a schizophrenia/SCA-related hospitalization than those in the paid cohort (odds ratio = 1.39; 95% CI = 1.03-1.87). Payer rejection and patient reversal of initial PP1M claims is a form of primary nonadherence and may influence patient trajectory. Data from this study suggest that patient reversal of PP1M may lead to an increased risk of schizophrenia/SCA-related hospitalizations, potentially caused by missed or delayed treatment. Policy initiatives that remove barriers to primary adherence or fulfillment may help improve patients' clinical outcomes.

Analysis of Real Hospital Cost on Ina-Cbgs Rates for Cesarean Section Patients

A caesarean section is an artificial birth that is carried out by making a small incision in the abdominal wall and uterine wall, but the uterus must be intact and the fetus weighs >500 grams. The high cost of a cesarean section has prompted the Indonesian government to launch the National Health Insurance (JKN) program as an implementation of the National Health Insurance (JKN) which has been regulated regarding to the payment patterns to advanced health facilities by applying Indonesian Case Based Groups (INA-CBG's). This study aims to determine the difference between real hospital cost rates and INA-CBGs rates for payment of claims by JKN participants for caesarean section inpatients at Dr. Soedomo Regional Hospital Trenggalek. The research method is analytical observation with a cross sectional approach which refers to the hospital's perspective by comparing the direct medical costs of BPJS’s (Social Security Agency on Health) participant patients and the INA-CBG's rates. The populations of this study were BPJS recipients of class I, II, III inpatients who received mild category of caesarean section at Dr. Soedomo Regional Hospital Trenggalek in 2020. The sample used in this study was medical record documents that met the inclusion and exclusion criteria. Purposive sampling method was used. In treatment of I, II, III classes, a significant difference was found between the average total direct medical costs of mild category of caesarean section patients (O-6-10-I) compared to the INA-CBGs rates. The treatment of class I had a difference of IDR 886,582. (p<0.05). The treatment of class II had a difference of IDR 754,881. (p<0.05) and the treatment of Class III, the difference obtained was IDR 1,109,368. (p<0.05).

A comparative study of real hospital costs and INA-CBG rates for stroke in Indonesia

Background: The claim payment method in JKN program uses the prospective Indonesian Case Base Groups (INA-CBG) method, in which the rate has been determined before health services are provided based on the diagnosis code group. This potentially causes a discrepancy in the costs incurred by health facilities. Objective: This systematic review aimed to provide an overview of the comparison of actual hospital costs with the INA-CBG rates of the JKN program for inpatient stroke. Method: The collection method used a PRISMA flowchart on several databases. This systematic review is a comparative study comparing the significance of the average actual direct medical costs with the INA-CBG rates. Result: Cost differences on intracerebral haemorrhage (I619) and unspecified stroke diagnosis (I64) consistently give a negative difference around IDR 110,659 – IDR 8,184,007/patient/episode. Medicine and medical equipment are the most significant components of stroke treatments. Factors that significantly influence direct medical costs are the length of stay (LOS), class of JKN, and age. Conclusion: Cost differences can be influenced by several factors that can affect the direct medical costs of hospitals. The factor that has the most influence on the amount of direct medical cost is LOS.

Perbandingan Bentuk Kelembagaan Program Penjaminan Polis Asuransi Antara Indonesia dengan United Kingdom dan Jepang

Insurance company defaults in Indonesia have a negative impact on policyholders. Suing the company for bankruptcy is the last resort for policyholders to obtain compensation from the company's assets, but the enforcement of court judgements is difficult due to obstacles such as abuse of receivership powers. Policyholders' rights are often violated as they do not receive insurance claim payments. Law No. 40 of 2014 requires insurance companies to participate in the Policy Guarantee Programme and establish a Policy Guarantee Agency within two years. However, such an institution has not yet been established in Indonesia. This research compares the Policy Guarantee Programmes in the UK and Japan to show the importance of establishing a similar institution to protect the rights of policyholders. This research uses normative research with a comparative approach and legislation. By studying the sustainability of the Financial Services Compensation Scheme in the UK and the Life Insurance Policyholders Protection Corporation in Japan, the research recommends that the Indonesian government promptly establishes a Policy Guarantee Corporation, either as an independent institution or in conjunction with the existing Deposit Insurance Corporation for the banking sector.

Manajemen digitalisasi layanan marketing terhadap performa pemasaran agensi PT.Equity Life Indonesia

This study aims to understand the implementation of digital services by customers and agents, and to evaluate the effect of digital marketing usage on service quality at PT. Equity Life Indonesia Makassar branch. A qualitative approach with case study and descriptive research types was used through interviews with eight informants, including the support team, agents, and customers. Data collection was carried out through observation, interviews, and documentation, while data analysis used qualitative descriptive methods. The results of the study show that PT. Equity Life Indonesia has provided digital services such as websites, My Elife, Online Chat WhatsApp, CMS applications for agents, and social media with features that can be used directly by agents and customers. Although many have used digital services, some agents and customers still prefer to get information directly from agents, support teams, and customer service. Agents use social media to prospect and recruit new agents, attract public attention by uploading superior products, proof of claim payments, rewards, agent contests, and other activities that help the company's branding. So, it can be concluded that PT. Equity Life Indonesia has provided comprehensive digital services, which can be accessed and used by agents and customers.