(a) How two forms of reinsurance could limit net claims
Reinsurance are insurances obtained or purchased by an insurance company as a form of risk management and to protect insurer’s bottom line by sharing risk with reinsurers and protecting themselves from adverse loss experience. Reinsurance is a contractual arrangement whereby an insurer secures and obtains coverage from a reinsurer from a potential loss to which they are exposed under insurance policies issued to original insured.
Proportional reinsurance across a portfolio is characterized by a proportional division of premium and liability between the ceding company and the reinsurer of all the risks that falls within a specified criteria. The Cedent Insurer pays the reinsurer a predetermined
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In such reinsurance arrangements, the ceding company is not obliged to cede all risks to the reinsurer, but neither is the reinsurer compelled to accept and provide reinsurance protection. The portion of the risk that the reinsurer accepts or writes is referred to as ceded risk, and the portion the cedant accepts is referred to as the reinsurance retention. Such facultative reinsurance can again be on a quota share or surplus basis. For example, if ABC plc has a 10 percent facultative quota share reinsurance for this policy, the facultative reinsurer shall bear £1 million of that loss. The net claim in the above circumstances will be £ 5 million to ABC plc (i.e. £4 million recovered from the proportional portfolio reinsurer and £1 million recovered from the facultative quota share …show more content…
It is therefore very important that the claims handlers should know to whom to refer any complaints received. When a formal complaint is received, the insurer is expected to send the client a copy of the FOS explanatory leaflet. It should also advice them that they can refer the complaint to the FOS if the insurers complaints process does not lead to a satisfactory resolution. For commercial clients, the FCA complaints handling requirements follow the same principles, but are less strict in detailed provisions. Complaints from all insured’s must be recorded and reported to the
6.8. Client and Broadspire agree to the following terms for Arkansas insured workers’ compensation claims; (i) Broadspire is acting on behalf of the insurer for the payment of claims both within and in excess of the deductible; (ii) Broadspire shall periodically provide accurate and timely data to the Client’s Arkansas workers’ compensation insurance carrier (“Carrier”) on all claims paid from “first dollar”; (iii) the Carrier shall immediately replenish the Loss Fund Account if it is not replenished timely by the Client and shall bill the Client for such amount; and if the Loss Fund Account is funded by the Client, Broadspire must notify injured workers that the claim is being adjusted and will be paid on behalf of the Carrier; (iv) the
• Ensure service members’ records were filed properly and maintained in the individual record. • Procure service member records in-order to be mailed out to other claim offices, having major effects on individuals. • Ensure all regulatory requirements pertaining to individual privacy were adhered to. • Research and obtain all necessary paperwork and relevant information regarding cases and issues pertaining to individual records. • Identify records, inconsistencies and initiated actions to correct the problems.
1. There will be the use of a secure medical records system used in order to protect the privacy of the patient. Through the use of the WebPT, medical records can only be accessed by healthcare providers directly involved in that case. WebPT is a password protected system (HA-10). 2.
In celebration of your daughter’s recent high school graduation, you are hosting a party in the backyard. The plan is to enjoy spending time with family and friends, grill some delicious food, celebrate your daughter’s accomplishment and just enjoy a little downtime. Everything is going according to plan when suddenly you hear your neighbor scream. You turn around in time to see your dog clamping down on the plate trying to steal a bite of the hamburger your neighbor is eating. Before you can tell her not to move, the dog jumps up, aiming for the hamburger but finds her hand instead.
Firstly, providing services for a client often involves more than one service professional that may or may not be within the same agency. Communication between those professionals is key to the quality of care that client will receive. Secondly, many agencies also include more than one service program, and inter-agency communication between service providers, program directors, and executive management is vital to sustainability. Lastly, there is also the fact that many services are fund either by a government assistance program, or through insurance, and those agencies require good communication. Due to the diversity of audience, writing in this field is made very clear and often straight to the point.
Respond to complaint by Listening to the complaint Keeping record of complaint Respect and keep confidentiality Refer to company complaint policy When a complaint is made, it should be taken seriously and the correct organisational procedure should be followed by referring to employee handbook which state that all complaint by a service user be reported to the care coordinator immediately. It is advised to suggest to the service users to put their complaint in writing or use the complaint forms which they can find in their care plan folder. 3.2 Explain the main points of agreed procedures for handling complaints. The main points of agreed procedures for handling complaints
In the ever changing landscape of health and social care and children and young person’s settings there are many pieces of government legislation and regulatory framework that service providers and organisations must now comply with. For example Care Quality Commission (CQC) introduced the essential standards of quality and safety which are central to the workplace. Every staff member has responsibility for providing good quality social care. Social care governance is the process by which organisations ensure good service delivery and promote good outcomes for people who use services.
Each case is unique, as each client. We never forget this and treat every client as the individual they are, one in crisis who needs help
The CQC uses and monitors services continuously, it is also the entity responsible for gathering and analysing information, then publish their findings to give consumers clear information when making choices and to help services improve. The kind of information they use is inclusive of: information collected directly from care providers, information about people’s experiences and vies from their families and carers and lastly data used to plan inspection
1.1 Identify the regulatory requirements, codes of practice and relevant guidance for managing concerns and complaints in own area of work. The Local Complaint Stage (1) Immediately after hearing of a complaint, contact the complainant to determine where their issues lie and what they would like to see as a result of the investigation. It is important that the local manager • Demonstrates a caring attitude and shows that there is a genuine attempt to understand the problem. • Ensures the complainant is aware of the complaint process and timelines • Provides the complainant with their contact name and telephone number • Obtains all complaint details at this point of contact to avoid the customer having to repeat themselves
1. What problems did you encounter when handling the complaint? Whenever I received complaints, the problem is that the subordinates usually deny or come up with some explanations making it difficult to discuss it in a genuine manner. Sometimes even if we reprimand them for their mistakes it creates a very tense environment in the hospital and it also affects the quality of work.
Risk Based Monitoring (RBM) is becoming more popular and widely used in clinical trials in the past few years. The concept of the risk based monitoring is to transform the traditional 100 % source data verification (SDV) monitoring approach towards a new concept of monitoring that includes varies of centralised activities in critical data evaluation and process monitoring. RBM is a monitoring approach which combines risk assessment and risk management by utilising key data indicators, along with analytical tools to identify risk at study level, site level and subject level respectively. It also introduces the new term Source Data Review (SDR) to the industry. Source Data Verification which is known as SDV is defined as “the process by which
As the single point of contact, our agency has obligations not only to you but also to the members of the systems with whom you interact with. Second, case management
Given the risk considerations provided in the RCD tool and the Portfolio Theory, the next step should be understanding the available risk/return metrics and determining an optimal mix of assets. Risk Metrics and Advantage/Disadvantages There are two risk metrics used in the model, Conditional Tail Expectation (CTE) and Value at Risk (VaR). These two metrics both look at the tail of the distribution. VaR is a measure of particularly poor outcomes in a stochastic projection. Its major shortcoming is its lack of statistical coherency.
Insurance is the equitable transfer of risk of a loss, from one entity in exchange of money. In today’s world, it is difficult to find a person who is not fully insured. Thus, insurance is a means to manage possible risks, as no one wants to face any type of a loss. It is evident that the insurance companies are now profiting to a greater extent since everyone wants to be on a safer side and avoid risks. This has in turn helped in the economy’s development and growth.