Insurance Fraud
After tax evasion, insurance fraud is considered the highest-ranked among white-collar crimes. The original concept of insurance, as a for-profit endeavor, was to collect funds from a large number of people to pay for damages and accidents that involved a small percentage of the population that paid premiums. Insurance fraud is an ever-growing problem. Solving or eliminating this problem requires the resources and knowledge of individuals or associations with expertise ranging from not only insurance, but also law enforcement, legal issues and the social sciences. The concept of insurance fraud, both, by an individual and a corporation, has become so pervasive in today's society that the general population has learned to tolerate and condone these crimes.

Various organizations, funded by state and federal governments, and supported by the insurance company, are trying to increase the awareness of this problem among the general population. Annually, an average American family spends approximately,…...

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Bibliography

AAA, American Automobile Association. Insurance Fraud-- It Costs Consumers Billions of Dollars Every Year, but Csaa Is Fighting Back - and You Can Help. 2002. Available. October 15, 2002. http://www.csaa.com/global/articledetail/0,8055,1005000000%257C2974,00.html

CAIF, Coalition Against Insurance Fraud. Insurance Fraud: The Crime You Pay For. 2002. Available. October 25, 2002. http://www.insurancefraud.org/about_us_set.html

Phony Health Coverage -- People Left Dangerously Uncovered Throughout U.S. 2002. Available. October 27, 2002. http://www.insurancefraud.org/search_set.html

Childers, S. David, and Christy A. Chism. The Extraordinary Scope and Potential Regulatory Pitfalls of the Insurance Fraud Protection Act. 2002. Available. October 27, 2002. http://www.ibrinc.com/ifpa.html

However, as Schwarcz notes, the reasonable expectations doctrine fails in practical use for several reasons. hie th doctrine may have widespread support from insurance law commentators, "Only a handful of state courts follow the rule, and the case law endorsing it is confused and inconsistent. Moreover, contract law scholars have largely debunked the contracts-of-adhesion argument on which the reasonable expectations doctrine was originally justified. They have established that neither consumer assent nor government regulation is necessary to lead firms to design efficient standard forms when market forces work sufficiently well" (Schwarcz para. 5). Because the doctrine has a record of stunted evolution in the courts and because there has been an academic undermining of its core rationale, many view it to be both antiquated and largely irrelevant. Still, the reasonable expectations doctrine has served as the primary theoretical and doctrinal construct for the judicial regulation of insurance over the past…...

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Works Cited

Chu, Kathy. "State Farm Agrees to Pay Up for Katrina in Mississippi." USA Today (23 Jan 2007). August 11, 2007.  http://www.usatoday.com/money/industries/insurance/2007-01-23-state-farm-katrina_x.htm .

Hartwig, Robert P. "Hurricane Katrina Insurance Issues: Robert P. Hartwig." Congressional Testimony (28 Feb 2007). August 10, 2007.  http://www.highbeam.com/doc/1P1-135515555.html .

Homeowners Drop Insurance After Katrina." Associated Press/AP Online (19 March 2007). August 10, 2007.  http://www.highbeam.com/doc/1Y1-104396426.html .

Hurricane Katrina Victims Denied Insurance Claims." Insurance Related News (08 March 2007). August 11, 2007. http://insurance.newsik.net/related/Hurricane-Katrina-Victims-Denied-Insurance-Claims-13161618.html.

All workers in the United States are covered by the Workers' Compensation Law. When an employee dies or becomes injured while working, the worker's compensation law requires that worker's compensation insurance be paid to the person or his or her surviving spouse and/or dependents. The insurance only applies to injuries and disabilities related to one's job ("What is Worker's Compensation?" 2008) Liability insurance, on the other hand, simply protects a firm from being held responsible for the other party's losses -- whether financial, physical, or otherwise. Liability insurance, unlike worker's compensation insurance, is not required by law ("What is Liability Insurance" 2008).

Occurrence claims policies and claims-made policies are two kinds of liability insurances that can be purchased by an individual or small company. Occurrence claims policies require insurance companies to pay for claims that occur during the period of coverage, regardless of when the claim occurred, while claims-made policies only…...

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References

Choosing the Right Health Plan for Your Employees. 2008. Retrieved August 8, 2008, from Find Law Web Site:  http://smallbusiness.findlaw.com/employment-employer/employment-employer-benefits/employment-employer-benefits-basics-health.html 

How Does Insurance Work. (n.d.) Retrieved August 8, 2008, from Super Pages Web Site:  http://www.superpages.com/supertips/how-does-insurance-work.html 

Managed Health Care Plans 2008. Retrieved August 8, 2008, from American Heart

Association Web Site:  http://www.americanheart.org/presenter.jhtml?identifier=4663

If a patient who approaches the doctor is subjected to a deductible for going outside the PPO network, then the cost incurred would be applied to the deductible. If this amount were to satisfy the deductible, then the rest would automatically be reimbursed, and this would be done at the out of network benefits plan. All insurance companies would require a valid prescription from the attending physician, along with explanations about the necessity of the plan, before they would reimburse the amount agreed upon. The patient receipt and the prescription must both be produced when the individual is billing for health care insurance under the PPO. If the insurer is a government employee, then his PPO insurance may not be able to cover this particular procedure. (Health Insurance Coverage, are the scans covered by my insurance?)
The typical costs for this type of relatively new form of insurance known as…...

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References

Affordable Healthcare: HMO, PPO, POS, FFS Definitions" Retrieved at   Accessed 7 November, 2005http://www.website101.com/Health_Insurance/Affordable-healthcare.htm .

Check up on health insurance choices" Retrieved at   7 November, 2005http://www.ahrq.gov/consumer/insuranc.htm#head16Accessed 

Health Insurance Coverage, are the scans covered by my insurance?" Retrieved at Accessed 7 November, 2005http://www.scandirectory.com/content/health_insurance_coverage.asp.

PPO, the Preferred Provider Organization" Retrieved at   Accessed 7 November, 2005http://www.badfaithinsurance.org/reference/HL/0040m.htm .

Ace, too, bears some liability. Although they told Perfect Products plc, ostensibly in good faith, that their situation was hopeless and liquidation was the only answer, when Perfect Products decided to ignore their advice and attempt to avoid voluntary liquidation, Ace failed to use diligence in making the case for liquidation; later, when they are notified in writing that Perfect Products intends to cancel insurances, lay off workers and generally attempt to struggle along despite the opinions of two of its own directors that it cannot survive, the accountants fail to respond. In this respect, they are also failing to exercise diligence in carrying out their role as accountants to the company. Indeed, the accountants' liability would have been minimized at that point had they made a second written representation of their findings and recommendation, even recommending strongly against the hopeless efforts the Chairman was almost forcing the company to…...

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References

Bergman, D. (1998) Bosses get away with murder. New Statesman. Questia database. Accessed 20 June 2005 at www.questia.com.

Fact sheet: Sex discrimination legislation in Britain. (2005). U.K. government Web site. Accessed 20 June 2005 at http://www.womenandequalityunit.gov.uk/legislation/

Foster, P. (2001) Tracking down U.K. company information. Online. Highbeam Research. Accessed 20 June 2005 at www.highbeam.com.

Miller, S.K. (1998) Piercing the corporate veil among affiliated companies in the European Community and in the U.S.: A comparative analysis of U.S., German, and U.K. veil-piercing approaches. American Business Law Journal, 36(1). Highbeam Research. Accessed 20 June 2005 at www.questia.com.

So, with these very expensive claims related costs, it is essential that carriers surrogate as many of these costs as possible and because of the inherent relation to the claims process, claims management offices and functions should be fully responsible for investigating and implementing the subrogation process. Claims managers have the authority to oversee settlements and to point claims adjusters in the right direction for initiating any necessary investigations in regard to subrogation.
Conclusion

In conclusion, this report aimed to discuss how to minimize net claims payments through the process of pursuing subrogated recoveries and how this should be a central claims management responsibility. The objective of the report was to provide insights into why it is critical for carriers to understand the inherent costs of business fire claims including the ever expensive business interruption principles of subrogation. It must be emphasized that the responsibility of claims management be responsible to…...

Insurance Summary
As insurance companies go, the particular organization that was the subject of this study -- i.e. The place of employment for the team members involved in the research and analysis -- was fairly standard. Several different departments existed in one large room of cubicles in a building owned and wholly occupied by the company, several other departments existed in separate rooms and executives offices were on the top of the third floor building. This physical structure of the organization largely reflected the organizational structure of authority and decision making power, with this power very much concentrated at the top and command highly centralized. Though this is not generally the recommended structure for organizations involved in many industries, and particularly for manufacturing concerns that deliver more tangible products to consumers, this top-down organization and high degree of rigid hierarchy actually seems to serve the organization fairly well in many regard,…...

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References

Advameg. (2011). Problem solving styles. Accessed 21 February 2011.  http://www.referenceforbusiness.com/encyclopedia/Per-Pro/Problem-Solving-Styles.html 

Kotelnikov, V. (2011). Flat organizational structure. Accessed 21 February 2011.  http://www.1000ventures.com/business_guide/organization_flat.html

Insurance Discrimination
The number of people who need a liver transplant is currently far greater than the number of donor livers available. Unfortunately, this can lead to discrimination by insurance companies against alcoholics who they believe have caused their own ill health and are, therefore, less deserving of the liver than other individuals. However, medical principles should guide treatment procedures not prejudice. Alcoholics should have the same access to health care as anyone else.

The discrimination against alcoholics occurs because insurance companies fail to recognize the disease nature of addiction. According to the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine, "Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations."

This definition recognizes alcoholism as a disease, i.e., as an involuntary disability and accepts a genetic vulnerability in some people. Thus, to discriminate against alcoholics because of the belief…...

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Bibliography

Alcoholics Discriminated Against in Liver Transplant Programs." 03 Sept. 1999. Join Together. 09 Dec.2003.  http://www.jointogether.org/sa/news/summaries/reader/0,1030,260110,00.html 

Alcoholism." Infoplease.com. 09 Dec. 2003.  http://www.infoplease.com/ce6/sci/A0803142.html .

Gunning, Karel F. "Why Not Euthanasia." Oregon Right to Life. 08 Dec. 2003. http://www.ortl.org/suicide/euthanasia_gunning.htm.

Alcoholics Discriminated Against in Liver Transplant Programs." 03 Sept. 1999. Join Together. 09 Dec.2003.

Insurance Sales
Using an independent sales force vs. A career sales force produces immediate and obvious advantages. Independent salespeople quickly provide more 'feet on the street,' for a company desiring to expand. They are hungry for a commission, unlike more complacent career salespeople with already established salaries and networks within the company's traditional reach. Independent salespeople bring more diverse experiences and an array of new business networks and sales connections originally inaccessible to the company.

The advantages and disadvantages of using commission vs. career sales are also relatively obvious -- the use of commission sales encourages salesmen and women to use high-pressure sales techniques to secure their salaries. However, this also encourages a high turnover rate and low company loyalty, as salaries are not secure. Fly by night rather than respectable individuals are attracted to the workforce. But career salespeople with built-in salaries tend to stick to their territories, as they are…...

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Resources conflict remains unresolved, independent contractors continue to be used to meet the increased demand within the industry.

While it could also be accomplished in group training formats, that approach is much less flexible with respect to accommodating corporate cultural nuances (George & Jones, 2008; obbins & Judge, 2009).
The optimal implementation of customer service training would comprise various stages, all of which would be conducted on-site. The first stage would be orientation; it would consist of a direct guided observation of Citizen's customer service call center agents handling communications. The observation would be guided in the sense that trainers will provide narrative guidance followed by the opportunity to connect that narrative to the actual performance of existing call center representatives.

That stage would be followed by direct one-on-one observation whereby representatives in training observe trainers conduct actual customer service interactions. The calls are discussed and the trainee takes actual calls under the supervision of the trainer. In the last stage, the trainee is allowed to perform a partial…...

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References

George, J.M. And Jones, G.R. (2008). Understanding and Managing Organizational

Behavior. Upper Saddle River, NJ: Prentice Hall.

Robbins, S.P. And Judge, T.A. (2009). Organizational Behavior. Upper Saddle River,

NJ: Prentice Hall.

Introduction The industry on which this paper will focus is the insurance industry, which has the NAICS code of 524133. The insurance industry is divided among a number of subsections. These subsections function roughly the same way. An insurance company identifies the risks associated with something, and then offers up insurance against the negative event. The customer pays the insurance company based on what the insurance company expects to pay out, plus whatever markup the insurance company pays. The basic premise is that if the insurance company prices risk properly, it will be profitable, but if it misprices risk, it will not be profitable.
Critical Problem
The insurance industry's critical problem is pricing risk. There are a few interesting elements, though. One is that the insurance business is heavily regulated, and that can create specific situations that challenge the firms in the industry. An example would be the uncertainty that surrounds the fate…...

Q1
Annuities account for a great part of the protection one affords self against death. They do not follow the application of the law of large numbers as the law is traditionally utilized in life insurance. It has, therefore, been referred to as “upside-down life insurance.” When an annuitant passes away during the period of accumulation, their beneficiaries are paid a death benefit. The common treatment of annuities is to account for gross premium returns excluding interest or to account for the cash value, whichever is greater. The principle is for the principal sum to be liquidated over the annuitant’s lifetime regardless of the means of accumulation.
Q2
Annuities can fall under various classes. Traditionally, the following classifications have been used to differentiate annuities:
i. Individual vs. group annuity
ii. Fixed-dollar vs. variable annuity
iii. Deferred annuity vs. immediate annuity
iv. Installment annuity vs. single-premium annuity
v. Single life vs. joint life annuity
vi. Annuity certain vs. pure life…...

While the U.S. enjoys the largest insurance market, U.S. companies no longer own the majority of the insurance market share in the country. Foreign companies do with 74% (Vaughan & Vaughan, 2013). This goes to show the extent to which foreign companies have grown in the insurance industry thanks to the globalization of insurance but also to the spread of wealth throughout the world. Insurance companies and finance go together as the former depends upon the latter for return on investment (ROI). Part of the problem with the globalization of insurance is that everything has been globalized—right down to investable markets. Since 2008, central banks around the world have lowered rates to the point that it is impossible for insurance funds to obtain a targeted ROI without investing in risk assets. Likewise, regulatory bodies have gone global as well with organizations like the Common Framework for the Supervision of Internationally…...

The other necessary element in this process is procedure cost vs. reimbursement evaluation and proactive search of strong reimbursement for future volume. Analysis of the first element is crucial because it helps in ensuring that reimbursement documented in existing contracts is being effectively recorded. The information obtained during this stage can be used at any time of renegotiations or contribute to the development of effective alternative approaches. The assessment of the second element helps to determine how insurance contracts compare and to ensure reimbursement expectations are established within competitive market ranges. The third element can be used for defense in validating the need for higher reimbursement than the current offer.
Second Students' esponse:

As the use of managed care plans have increased in the past few years, there is an increased need for appropriate insurance contracting strategy. The existing managed care plans are primarily based on demand management through co-payments. While…...

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References:

Devers, K.J., Brewster, L.R. & Casalino, L.P. (2003, February). Changes in Hospital

Competitive Strategy: A New Medical Arms Race? Health Services Research, 38(1), 447-469. Retrieved from  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360894/pdf/hesr_124.pdf 

Jones, C.L. & Mills, T.L. (2006, November-December). Negotiating a Contract with a Health

Plan, Family Practice Management, 13(10), 49-55. Retrieved from  http://www.aafp.org/fpm/2006/1100/p49.html

Insurance Agent for State Farm Insurance
Success as an independent insurance agent does not come easy. In this industry, success has largely got to do with hard work and an exceptional ability to handle occasional rejections. However, the benefits for those who succeed in this case are immense.

In my opinion, I would say that my success as an effective independent insurance agent for State Farm Insurance has largely been founded on not only my personal character but also my past achievements and business related experience. To begin with, I have always been a hard worker. I believe in the power of effort especially when it comes to getting things accomplished. Further, I would say I am rather talkative. I also regard myself an effective communicator. Effective communication skills are important in the insurance business largely due to the need to keep in constant contact with the public. In addition to…...

Leasing to someone can be risky. Make sure you charge enough rent, and that you get a good security deposit. Check local laws in your area to find out how much of a deposit you can collect. In some places it's no more than 1.5 times the rent. Other places allow for a larger amount. Check the person's credit, background, and references. Look for problems paying bills, broken lease agreements, and any past criminal history. Also talk to your insurance company. If you're renting/leasing your home, you can't just keep your standard homeowner's policy. You won't be covered if you have....

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As health care’s share of gross domestic product (GDP) grows, people are struggling with how to estimate the value of the health care industry in the economy.  While it might seem like a straightforward answer, simply looking at the total amount paid for healthcare in proportion to the total GDP, that valuation would be a gross oversimplification. Generally, GDP is viewed as a proxy for standard of living, but in the United States standard of living might actually drop for many people as the percentage of GDP attributable to healthcare grows.  It is important to keep in....

It is difficult to address the issue of lack of mental health funding for first responders without first acknowledging the general lack of appropriate thoughts about mental health.  While physical illness is treated as a legitimate illness and self-care to help avoid that illness is supported, mental illness is oftentimes still treated like a character defect.  People who seek assistance for mental health not only have to face a lack of funding, but often have to worry about whether the stigma that attaches to seeking such help will work against them in their future professional lives. For....