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Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
Delay, Deny, Defend is a critical exploration of the property and casualty insurance industry, examining how its practices affect policyholders.Feinman, a law professor specializing in consumer rights and insurance law, argues that the industry prioritizes profits over policyholders' needs, often using tactics like delaying or denying legitimate claims to bolster financial performance.
Term. Meaning. Appraisal. An appraisal is a detailed assessment of either the property or property damage. An appraisal is written by an adjuster to estimate the amount of damage from a loss.
Crime rates: If you live in an area with a high rate of home break-ins or theft, it is possible that your home insurance premium could be more expensive. You may even consider an alarm system to ...
In workers' compensation cases, de facto denial of coverage due to non-response can occur if an insurer fails to respond in writing within a certain time. [3] In the United States, particularly in health insurance markets, there are often state requirements that insurers do not engage in de facto denials by non-response or delayed responses. [4]
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