Best Practice Injury Compensation Processes Following Intentional Vehicular Assaults and Other Large Scale Transport Incidents: A Delphi Review

Objective: Intentional vehicular assaults on civilians have become more frequent worldwide, with some resulting in mass casualties, injuries, and traumatized witnesses. Health care costs associated with these vehicular assaults usually fall to compensation agencies. There is, however, little guidance around how compensation agencies should respond to mental and physical injury claims arising from large-scale transport incidents. Methods: A Delphi review methodology was used to establish expert consensus recommendations on the major components of “no fault” injury claim processes for mental and physical injury. Results: Thirty-three international experts participated in a 3-round online survey to rate their agreement on key statements generated from the literature. Consensus was achieved for 45 of 60 (75%) statements, which were synthesized into 36 recommendations falling within the domains of (1) facilitating claims, (2) eligibility rules, (3) payments and benefits for clients, (4) claims management procedures, (5) making and explaining decisions, (6) support and information resources for clients, (7) managing scheme staff and organizational response, (8) clients with special circumstances, and (9) scheme values and integrity. Conclusions: The recommendations present an opportunity for agencies to review their existing claims management systems and procedures. They also provide the basis for the development of best practice guidelines, which may be adapted for application to compensation schemes in different contexts worldwide.

Key Performance Indicators in Claims Management: Definition of a set of indicators for the evaluation of the Medico-Legal Activity

Background: In recent decades, in the field of healthcare, awareness of the problems inherent to the quality has steadily increased. Currently, the evaluation of healthcare activities is one of the ways in which health systems regulate internal relationships and define strategic decisions. Objective: The study aims to describe in detail the entire process of developing a group of Key Performance Indicators for monitoring and implementing the management of litigation due to medical liability. Particularly, the objective is to centralize and standardize the indicators to provide scientifically reliable data on claims management to hospital professionals responsible for strategic choices. Methods: The study was conducted to analyze data relating to the claims management at Umberto I General Hospital in Rome from 2012 to 2018. All claims reported were classified according to a selection of the categories coded in the International Classification for Patient Safety system, the economic features, and the chronological references of the main management extrajudicial and judicial phases. The Process Analysis Method was followed to develop significant indicators for measuring the performance and the quality of claims management. Results and Conclusion: The results obtained demonstrate how the assessment of performance in claims management can potentially lead to greater risk control with significant repercussions in terms of reduction of disputes, speed in settling claims, reduction of management times, planning of loss prevention measures, and implementation of quality of care.

How Does Selective Reporting Distort Understanding of Workplace Injuries?

This study introduces and applies a new method for studying under-reporting of injuries. This method, “one-to-one injury matching”, involves locating and comparing individual incidents within company and insurer recording systems. Using this method gives a detailed measure of the difference in injuries recognised as “work-related” by the insurer, and injuries classified as “recordable” by the company. This includes differences in the volume of injuries, as well as in the nature of the injuries. Applying this method to an energy company shows that only 19% of injuries recognised by the insurer were recognised by the company as recordable incidents. The method also demonstrates where claiming behaviour and claims management have created systematic biases in the disposition of incidents. Such biases result in an inaccurate picture of the severity and nature of incidents, over-estimating strike injuries such as to the hand, and underestimating chronic and exertion injuries such as to the back.

Claims Solutions Using a Blockchain System in International Logistics

A claim can be understood as a negative result of the performance of a contract, as it is necessary to fulfill the obligation and/or indemnify (freight damage claim, for example). Today’s claims management faces a variety of problems, such as inefficient claims postings, possible data forgery, and a very lengthy claims resolution process. All these problems can be solved by using a synthesis of innovative tools, e.g., a blockchain system, game theory, and statistical methods. Theoretical possibilities and practical examples regarding solving claims management problems were identified by analyzing various scientific sources. However, it remained unclear whether these methods could interact with each other, complicate the existing claims settlement process or not, or whether a synthesis of such measures would be viable. Therefore, a qualitative study was conducted and answers to the above questions were found. The research revealed that 75% of international Lithuanian logistics companies can apply the synthesis of these methods in claims management and solutions. Using the concordance coefficient formula, the value of W was calculated. This coefficient indicated that the opinions of the experts who participated in the study were somewhat similar. The value of the actual χ2 distribution was also calculated. The result obtained shows that the experts’ opinions were somewhat harmonized and that their compatibility was not accidental. The use of blockchain system synthesis in combination with game theory and statistical methods could help international logistics companies to reduce their costs, speed up the management process, and increase data security and reliability while ensuring structured one-stop claims management.

PRAVNA PITANjA RAZLICITIH MODELA OSIGURANjA LICA PREKO INTERNETA

Digitalization aff ects the whole value chain of the insurance business: from the design to the distribution of products and claims management. Peer-to-peer (P2P) is one of the new operating models enabled by digitalization. Th is chapter describes the diff erent models of P2P that are operating in the insurance markets. Th e aim is to outline some legal issues these models pose regarding the EU regulatory framework on insurance.

Assessing Financial Resource Capability on Insurance Claims Management in Nigeria: The Moderating Role of Information Technology

This study examines the extent to which financial resource capability impacts claims management in the Nigerian insurance industry and also attempts to determine if this process is moderated by information technology. Given the numerous litigations arising from claims default, the Nigerian insurance sector has earned itself a bad reputation with the consequent customer apathy. However, it is also noteworthy that most of these insurance companies do not appear to possess the financial capacity to meet claims obligations as they arise, perhaps, due to low capitalisation, poor risk assessment and solvency constraints. The research is a quantitative design that utilises the survey strategy. It is predicated on a philosophical foundation of positivism and ontological orientation of objectivism. 17 insurance companies were included in the study using the stratified sampling technique. 280 questionnaires were distributed to the 17 sampled companies out of which 235 were returned and found usable for the study. Data was analysed using the Andy Hayes Process v3.3 for regression. Findings from the study revealed that financial resources and information technology have statistically significant relationship with claims management but the relationship between financial resources and claims management is not significantly moderated by information technology.