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In insurance, an adjustment clause in a contract specifies how the amount of a claim (particularly a claim against an insurance company) will be determined for the purposes of a settlement, giving consideration to objections made by the debtor or insurance company, as well as the allegations of the claimant in support of his claim. For example ...
Generally, secondary insurance pays only the amount the EOB says the member is responsible for. Secondary EOBs show if the patient still has any responsibility to the provider. After the member's insurances have processed the claim, the provider bills the member for the remaining balance, if any. [4]
For example, say you have $25,000 in property damage liability coverage but you total a car worth $40,000. The auto insurance company can pay up to the $25,000 allotted, but deny the remaining ...
If you get a phone call, voicemail, email or mailed letter from your adjuster, responding promptly can help your claim move faster. Ask questions: If you are unsure of something, always ask questions.
Adjustment of claims is not confined to claims against insurance companies. An allowance made by a creditor, particularly a storekeeper, in response to a complaint by the debtor respecting the accuracy of the account or other claim, or a reduction in the claim or account made to induce a prompt payment, is in a proper sense an adjustment.
After the claims adjudication process is complete, the insurance company often sends a letter to the person filing the claim describing the outcome. The letter, which is sometimes referred to as remittance advice, includes a statement as to whether the claim was denied or approved. If the company denied the claim, it has to provide an ...
The term "reservation of rights" (particularly a "reservation of rights letter”) is often used in connection with insurance claims. The insurance company issues a reservation of rights letter stating that it may deny coverage for some or all of the claim even while the company is investigating the claim or beginning to treat the claim as if ...
For policies that are complicated, where claims may be complex, the insured may take out a separate insurance policy add-on, called loss recovery insurance, which covers the cost of a public adjuster in the case of a claim. Adjusting liability insurance claims is particularly difficult because they involve a third party, the plaintiff, who is ...