Results for 'insurance claim review'

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  1. Moral, social, and economic dimensions of insurance claims fraud.Sharon Tennyson - 2008 - Social Research: An International Quarterly 75 (4):1181-1204.
    Insurance claims fraud receives increasing attention in the insurance industry, in academic studies and in public policy spheres. Claims fraud is variously viewed as an economic-contractual problem, a moral-psychological problem, a moral-sociological problem or a criminal problem. This article discusses these theoretical perspectives on insurance claims fraud and reviews the empirical evidence on its nature and prevalence. Most research concludes that opportunistic soft fraud is more prevalent than planned criminal fraud, and that consumer ethics, attitudes and psychology (...)
     
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  2.  8
    Insurance Brokers’ behaviour: the effect of policy collection on management decisions.Miguel Ángel Latorre Guillem - 2022 - Human Review. International Humanities Review / Revista Internacional de Humanidades 11 (3):1-10.
    Spanish legislation on insurance and reinsurance mediation stipulates that intermediary can only receive commissions and fees for the management of their policies and prohibits any other form of remuneration. However, it is possible that financial intermediaries who manage larger risks wait until the end of the legal deadline to settle with insurance companies. This common practice in the insurance market hides additional remuneration in defiance of the law. It also means that the risk is not covered within (...)
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  3.  52
    Harvey R. brown: Physical relativity: Space‐time structure from a dynamical perspective Robert DiSalle: Understanding space‐time: The philosophical developments of physics from Newton to Einstein.Reviewed by Nick Huggett - 2009 - Philosophy of Science 76 (3).
    The two books discussed here make important contributions to our understanding of the role of spacetime concepts in physical theories and how that understanding has changed during the evolution of physics. Both emphasize what can be called a ‘dynamical’ account, according to which geometric structures should be understood in terms of their roles in the laws governing matter and force. I explore how the books contribute to such a project; while generally sympathetic, I offer criticisms of some historical claims concerning (...)
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  4.  17
    How to insure against utilitarian overconfidence.Nicholas Agar - 2014 - Monash Bioethics Review 32 (3-4):162-171.
    This paper addresses two examples of overconfident presentations of utilitarian moral conclusions. First, there is Peter Singer’s widely discussed claim that if the consequences of a medical experiment are sufficiently good to justify the use of animals, then we should be prepared to perform the experiment on human beings with equivalent mental capacities. Second, I consider defences of infanticide or after-birth abortion. I do not challenge the soundness of these arguments. Rather, I accuse those who seek to translate these (...)
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  5.  15
    Melting contestation: insurance fairness and machine learning.Laurence Barry & Arthur Charpentier - 2023 - Ethics and Information Technology 25 (4):1-13.
    With their intensive use of data to classify and price risk, insurers have often been confronted with data-related issues of fairness and discrimination. This paper provides a comparative review of discrimination issues raised by traditional statistics versus machine learning in the context of insurance. We first examine historical contestations of insurance classification, showing that it was organized along three types of bias: pure stereotypes, non-causal correlations, or causal effects that a society chooses to protect against, are thus (...)
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  6.  53
    Perceived Ethicality of Insurance Claim Fraud: Do Higher Deductibles Lead to Lower Ethical Standards?Anthony D. Miyazaki - 2009 - Journal of Business Ethics 87 (4):589-598.
    Insurance claim fraud costs insurance companies, policymakers, and taxpayers billions of dollars every year and has been described as the second largest white collar crime. The most common insurance fraud activity and one that contributes a significant portion of dollar losses is the practice of padding claim amounts in the event of a loss. One of the largest issues insurance companies face is that policyholders often do not perceive insurance claim padding as (...)
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  7.  1
    Predicting insurance claims through a variety of data mining techniques: facing lots of missing values and moderate class-imbalanced levels.Paola Santana-Morales & Antonio J. Tallón-Ballesteros - forthcoming - Logic Journal of the IGPL.
    This paper copes with a real-world classification problem related to the management of claims received in an insurance company. The way to obtain the classifier is not easy due to the high amount of missing values as well as the inherent imbalanced scenario within class labels. Once the data partition has been done, the training set is submitted to an intensive double grid search in order to obtain the most promising type of missing value imputation approach and then a (...)
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  8.  32
    Multiple Book Review of Speech perception by ear and eye: A paradigm for psychological inquiry.Dominic W. Massaro - 1989 - Behavioral and Brain Sciences 12 (4):741-755.
    This book is about the processing of information in face-to-face communication when a speaker makes both audible and visible information available to a perceiver. Both auditory and visual sources of information are evaluated and integrated to achieve speech perception. The evaluation of the information source provides information about the strength of alternative interpretations, rather than just all-or-none categorical information, as claimed by “categorical perception” theory. Information sources are evaluated independently; the integration process insures that the least ambiguous sources have the (...)
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  9.  15
    Book Review: Spirits Hovering Over the Ashes: Legacies of Postmodern Theory. [REVIEW]Thomas Leddy - 1996 - Philosophy and Literature 20 (2):511-514.
    In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Spirits Hovering Over the Ashes: Legacies of Postmodern Theory,Thomas LeddySpirits Hovering Over the Ashes: Legacies of Postmodern Theory, by H. L. Hix; x & 208 pp. Albany: SUNY Press, 1995, $16.95 paper.This intriguing, rich and witty book is a collection of twelve mainly previously published essays each of which is titled “Postmodern” something.“Postmodern Grief,” which first appeared in Philosophy and Literature (1993), is a wonderful and fun deconstruction (...)
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  10.  31
    The Impact of Defense Expenses in Medical Malpractice Claims.Aaron E. Carroll, Parul Divya Parikh & Jennifer L. Buddenbaum - 2012 - Journal of Law, Medicine and Ethics 40 (1):135-142.
    The objective of this study was to take a closer look at defense-related expenses for medical malpractice cases over time. We conducted a retrospective review of medical malpractice claims reported to the Physician Insurers Association of America's Data Sharing Project with a closing date between January 1, 1985 and December 31, 2008. On average a medical malpractice claim costs more than $27,000 to defend. Claims that go to trial are much more costly to defend than are those that (...)
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  11.  20
    Studying fraud: is insurance claim information confidential?Angela R. Holder - 1989 - IRB: Ethics & Human Research 12 (4):4-4.
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  12.  14
    Constitutional Law: U.S. Supreme Court Clarifies Procedural Requirements for Workers’ Compensation Benefits Claim.Kathleen A. Collins - 1999 - Journal of Law, Medicine and Ethics 27 (2):198-200.
    The U.S. Supreme Court held, in American Manufacturers Mutual Insurance Co. v. Sullivan, 119 S. Ct. 988, that state workers’ compensation system insurers cannot be sued for withholding health care benefits for work-related injuries while they decide whether the treatment is “reasonable” and “necessary.” The respondents, ten employees and two organizations representing employees who received medical benefits under the Workers’ Compensation Act, brought a 42 U.S.C. § 1983 action against state officials, the Pennsylvania State Workers’ Insurance Fund, private (...)
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  13.  3
    Kant et le Kantisme (review). [REVIEW]Ted Humphrey - 1968 - Journal of the History of Philosophy 6 (2):183-186.
    In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 183 Moore goes on to provide an analysis, all of which goes to support the contentions (1) that, except in philosophy, there is no puzzle ("In the first place: Are you puzzled?...I am in a way, in spite of all the Critical Phil. I've done. But I'm not sure my puzzlement is all of the sort B. means: it seems such a queer question to ask: Why (...)
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  14.  11
    Psychiatrists, Confidentiality, & Insurance Claims.Bennett L. Rosner - 1980 - Hastings Center Report 10 (6):5-7.
  15.  25
    Healing Deconstruction: Postmodern Thought in Buddhism and Christianity (review).Mark David Wood - 2000 - Buddhist-Christian Studies 20 (1):267-278.
    In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 20 (2000) 267-278 [Access article in PDF] Book Review Healing Deconstruction: Postmodern Thought in Buddhism and Christianity Healing Deconstruction: Postmodern Thought in Buddhism and Christianity. Edited by David Loy. Atlanta: Scholars Press, 1996. 120 pp. The philosophers have only interpreted the world, in various ways; the point, however, is to change it.--Karl Marx, Eleventh Thesis on Feuerbach Healing Deconstruction, edited by David Loy, is a collection (...)
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  16.  41
    Quality of care for diabetes patients using National Health Insurance claims data in Japan.Jun Tomio, Satoshi Toyokawa, Shinichi Tanihara, Kazuo Inoue & Yasuki Kobayashi - 2010 - Journal of Evaluation in Clinical Practice 16 (6):1164-1169.
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  17.  22
    Perceptions of the ethicality of consumer insurance claim fraud.Dwane Hal Dean - 2004 - Journal of Business Ethics 54 (1):67-79.
    It was proposed that ethical evaluation of insurance claim padding behavior would be affected by characteristics of the policyholder, insurance agent, and company. These three factors were manipulated in written scenarios and the premise was tested in a factorial experimental design. No significant support was found for an effect of any of the three factors on ethical perceptions of claim padding. However, females found claims padding to be significantly less ethical than males. Given a claim (...)
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  18.  18
    A statistical analysis of 'rule‐out' diagnoses in outpatient health insurance claims in Japan.Shinichi Tanihara, Etsuji Okamoto & Hiroshi Une - 2011 - Journal of Evaluation in Clinical Practice 17 (6):1070-1074.
  19.  16
    Physician adherence to asthma treatment guidelines in Japan: focus on inhaled corticosteroids.Toshitaka Morishima, Tetsuya Otsubo, Etsu Gotou, Daisuke Kobayashi, Jason Lee & Yuichi Imanaka - 2013 - Journal of Evaluation in Clinical Practice 19 (2):223-229.
  20.  14
    Republican States Bolstered Their Health Insurance Rate Review Programs Using Incentives From the Affordable Care Act.Brent D. Fulton, Ann Hollingshead, Pinar Karaca-Mandic & Richard M. Scheffler - 2015 - Inquiry: The Journal of Health Care Organization, Provision, and Financing 52:004695801560416.
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  21.  27
    Catastrophe insurance equilibrium with correlated claims.Radoslav S. Raykov - 2015 - Theory and Decision 78 (1):89-115.
    Catastrophe insurance differs from regular insurance in that individual claims are correlated and insurers have to pay more clients at once, which creates a liquidity strain. In this paper, I show two related findings: first, that when customers know their claims are correlated, this correlation can cause positive-sloping demand at low prices, and second, that because of this, a catastrophe insurance market can fail. Market failure is a stable equilibrium, which provides a better understanding of the frequent (...)
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  22.  12
    Claim Amount Forecasting and Pricing of Automobile Insurance Based on the BP Neural Network.Wenguang Yu, Guofeng Guan, Jingchao Li, Qi Wang, Xiaohan Xie, Yu Zhang, Yujuan Huang, Xinliang Yu & Chaoran Cui - 2021 - Complexity 2021:1-17.
    The BP neural network model is a hot issue in recent academic research, and it has been successfully applied to many other fields, but few researchers apply the BP neural network model to the field of automobile insurance. The main method that has been used in the prediction of the total claim amount in automobile insurance is the generalized linear model, where the BP neural network model could provide a different approach to estimate the total claim (...)
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  23.  14
    Book Review: Health Insurance.Curtis Florence - 2009 - Inquiry: The Journal of Health Care Organization, Provision, and Financing 46 (2):241-242.
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  24.  5
    Policy Review Essay: Insurers, Consumers, and Testing: The AIDS Experience.Peter Hiam - 1987 - Journal of Law, Medicine and Ethics 15 (4):212-222.
  25.  1
    Policy Review Essay: Insurers, Consumers, and Testing: The AIDS Experience.Peter Hiam - 1987 - Journal of Law, Medicine and Ethics 15 (4):212-222.
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  26.  14
    Book Review: The Theory of Demand for Health Insurance.William J. Boyes - 2004 - Inquiry: The Journal of Health Care Organization, Provision, and Financing 41 (1):106-107.
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  27.  8
    Book Review: Health InsuranceHealth Insurance. ByMorriseyMichael A., Chicago: Health Administration Press. 2008. 409 pp. $94. [REVIEW]Curtis Florence - 2009 - Inquiry: The Journal of Health Care Organization, Provision, and Financing 46 (2):241-242.
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  28.  12
    Book Review: Probable Justice: Risk, Insurance, and the Welfare State_, by Rachel Z. Friedman and _Insurance Era: Risk, Governance, and the Privatization of Security in Postwar America, by Caley Horan. [REVIEW]Roni Hirsch - forthcoming - Political Theory.
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  29.  17
    Review of Mark A. Rothstein (ed.), Genetics and Life Insurance, Medical Underwriting and Social Policy. Cambridge, MA: The MIT Press, 2004. 293 pp. $34.00, hardcover. [REVIEW]Richard A. Stein - 2007 - American Journal of Bioethics 7 (4):88-89.
    The 1953 discovery of the DNA double helix (Watson and Crick 1953) and the elucidation of the molecular basis for inheritance marked the dawn of a new era. When the U.S. Human Genome Project was in...
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  30.  19
    Review Article: Forgiveness and the Claims of Retribution.Christopher Bennett - 2004 - Journal of Moral Philosophy 1 (1):89-101.
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  31.  5
    Hide or report When insurance agents face policyholders’ fraudulent claims.Wanjie Niu, Haizhen Wang, Xin Ai, Xuefeng Wang & Jianming Bai - 2024 - International Journal of Business Governance and Ethics 1 (1).
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  32.  10
    Surgical And Medical Error Claims In Ethiopia: Trends Observed From 125 Decisions Made By The Federal Ethics Committee For Health Professionals Ethics Review.Biruk Wamisho, Mesafint Abeje Tiruneh & Lidiya Enkubahiry Teklemariam - 2019 - Medicolegal and Bioethics:23-31.
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  33.  4
    Book Review: Expansion of Publicly Funded Health Insurance in the United States: The Children's Health Insurance Program and Its Implications. By Jennie Jacobs Kronenfeld. Lanham, MD: Lexington Books, 2006. 161 pp., $60.00. [REVIEW]Sarah Jane Brubaker - 2008 - Gender and Society 22 (1):134-136.
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  34.  14
    Review: Edmund C. Berkeley, Boolean Algebra (The Technique for Manipulating "and," "or," "not," and Conditions) and Applications to Insurance[REVIEW]Alonzo Church - 1938 - Journal of Symbolic Logic 3 (2):90-90.
  35.  5
    Book Reviews : Uncovered Boundaries: Historical Sociology and Actor Network Theory Geen kwestie van leeftijd: Verzorgingsstaat, wetenschap en discussies rond ouderen in Nederland, 1945-1982 (Not a matter of age: Welfare state, science and discussions about the elderly in the Netherlands, 1945-1982), by Karin Bijsterveld. Amsterdam: Van Gennep, 1996, 384 pp. Dfl.69.50. ISBN 90-5515-090-8. Verzekerd leven: Artsen en levensverzekeringsmaatschappijen, 1880-1920 (Insured life: Doctors and life insurance companies, 1880-1920), by Klasien Horstman. Amsterdam: Babylon-De Geus, 1996, 285 pp. Dfl.49.50. ISBN 90-6222-315-X. [REVIEW]Hans Harbers - 1998 - Science, Technology and Human Values 23 (3):351-361.
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  36.  32
    Reviewing the Unsubstantiated Claims for the Methodological Superiority of 'Placebo' over 'Active' Controlled Trials: Reply to Open Peer Commentaries.Jeremy Howick - 2009 - American Journal of Bioethics 9 (9):5-7.
    A resilient issue in research ethics is whether and when a placebo-controlled trial is justified if it deprives research subjects of a recognized treatment. The clinicians' moral duty to provide the best available care seems to require the use of ‘active’ controlled trials that use an established treatment as a control whenever such a therapy is available. In another regard, ACTs are supposedly methodologically inferior to PCTs. Hence, the moral duty of the clinical researcher to use the best methods will (...)
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  37.  4
    Essay Review: The “Claim” of Cesalpino and the First and Second Editions of His “Peripatetic Questions”: Andreae Caesalpini Aretini Medici Clarissimi atque Philosophi Subtilissimi Peritissimi Perpateticarum Questionum. Libri QuinqueAndreae Caesalpini Aretini Medici Clarissimi atque Philosophi Subtilissimi Peritissimi Perpateticarum Questionum. Libri Quinque . 14, 128 leaves.Walter Pagel - 1975 - History of Science 13 (2):130-138.
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  38.  9
    Review Article: Law and Medical Practice: Rights, Duties, Claims and Defences [Book Review].Anna Stokes - 1998 - Chisholm Health Ethics Bulletin 4 (1):7.
  39. Insuring the Community against Loss: Roycean Reflections on the Tasks of Interpretation.Daniel J. Brunson - 2013 - The Pluralist 8 (2):36-59.
    In his final years, Josiah Royce worked to develop his theories of community and interpretation in practical directions. In particular, he developed an account of insurance as a special community of interpretation, and proposed the creation of an international board of insurance as a deterrent for war. Rather than evaluating Royce’s policy recommendations, this paper explores how his conception of insurance clarifies his account of interpretation. For Royce, insurance provides the best model for communal interpretation thus (...)
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  40.  16
    Review of Paul Guyer: Kant and the Claims of Taste[REVIEW]Peter Kivy - 1981 - Ethics 91 (2):317-320.
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  41.  17
    Book Review: Post-Truth 2.0: The High Stakes of Testing Truth Claims. [REVIEW]Raphael Sassower - 2023 - Philosophy of the Social Sciences 53 (3):239-248.
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  42. Genetic testing and insurance: The complexity of adverse selection.Maureen Durnin, Michael Hoy & Michael Ruse - 2012 - Ethical Perspectives 19 (1):123-54.
    The debate on whether insurance companies should be allowed to use results of individuals’ genetic tests for underwriting purposes has been both lively and increasingly relevant over the past two decades. Yet there appears to be no widely agreed upon resolution regarding appropriate and effective regulation. There exists today a gamut of recommendations and actual practices addressing this phenomenon ranging from laissez-faire to voluntary industry moratoria to strict legal prohibition. One obvious reason for such a variance in views and (...)
     
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  43.  44
    The Claim of Reason: Wittgenstein, Skepticism, Morality, and Tragedy (review).Stanley Bates - 1980 - Philosophy and Literature 4 (2):266-273.
  44. Ali, Claudine eyraud.[Review] hcpital 187 &tihique: R cles et dzfis Des comitgs d'&hique clinique Allman, Richard L. the woman who wasn't 71 herself: Moral response to medical insurance fraud. [REVIEW]Shahid Aziz, Accepting Death & Carol Bayley - 1989 - Hec Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues 8 (6):403-407.
     
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  45.  24
    Review article: Forgiveness and the claims of retribution.Christopher Bennett - 2004 - Journal of Moral Philosophy 1 (1):89-101.
  46.  12
    Critical review of claims for ultra-hardness in nanocomposite coatings.A. C. Fischer-Cripps, S. J. Bull & N. Schwarzer - 2012 - Philosophical Magazine 92 (13):1601-1630.
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  47.  3
    The Insurance Market and Discriminatory Practices.Tom Sorell - 2004 - In Justine Burley & John Harris (eds.), A Companion to Genethics. Oxford, UK: Blackwell. pp. 398–407.
    Reviews issues in the ethics of access to health insurance based on health problems due to genetic inheritance.
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  48.  15
    The EU 's role in income redistribution and insurance: Support, norm‐setter or provider? A review of justice‐based arguments.Frank Vandenbroucke - 2022 - European Journal of Philosophy 30 (2):471-487.
    Income redistribution and insurance are core functions of welfare states. What role should the EU play in this domain? I examine the purchase of normative theorizing on social justice on this question, focusing on the contrast between three models of EU involvement: the EU as Support, which implies the sharing of resources through intergovernmental transfers; the EU as Provider, which implies EU cross‐border transfers towards individual citizens; the EU as Norm‐setter, which implies that the EU formulates normative policy ideals. (...)
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  49.  40
    Review: Guyer, Kant and the Claims of Knowledge. [REVIEW]Dorothy Coleman - 1990 - Idealistic Studies 20 (3):258-259.
    Revitalizing the “patchwork theory” of Hans Vaihinger and Norman Kemp Smith, yet repudiating their assumption that a chronological order of composition can be discerned in the disjointed lines of argumentation in Kant’s Critique of Pure Reason, Paul Guyer’s Kant and the Claims to Knowledge presents a formidable though questionable analysis of the Critique showing Kant’s sustained ambivalence between ontological realism and transcendental idealism that begins in his early writings and continues through the revision of the Critique and in his later (...)
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  50.  2
    Review: Max Black, The Claims of Intuitionism. [REVIEW]Alice Ambrose - 1936 - Journal of Symbolic Logic 1 (3):117-117.
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