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AT Legal Terminology

QuestionAnswer
Liability responsibility for one's acts or omissions
Negligence failure to exercise the care toward others or taking action which such a reasonable person would not
Duty of Care a requirement that a person act toward others and the public with the watchfulness, attention, caution and prudence that a reasonable person in the circumstances would use
Torts legal wrongs done unto another, must cause damages
Nonfeasance Failure to perform an act that is required by law
Malfeasance intentionally doing something either legally or morally wrong which one had no right to do
Misfeasance Improper application of skill he or she has legal right to do
Sovereign immunity protection against negligence for those employed by public/ state funded schools
Good Samaritan Law A law designed to protect a Good Samaritan from legal liability
Statutes of Limitation a law which sets the maximum period which one can wait before filing a lawsuit, depending on the type of case or claim.
Assumption of Risk taking a chance in a potentially dangerous situation.
Product liability the responsibility of manufacturers, distributors and sellers of products to the public, to deliver products free of defects which harm an individual or numerous persons and to make good on that responsibility if their products are defective.
Allowable charge the maximum dollar amount that a third party, usually an insurance company, will reimburse a provider for a specific service
Beneficiary A person or persons entitled to receive insurance proceeds at the event of death of the insured. This term is usually associated with life insurance.
Benefits Compensation for loss and other services provided by insurers under terms of insurance contracts.
Claim a claim may be a demand by an individual or corporation to recover, under a policy of insurance, for loss which may come within that policy.
Contract An agreement between two or more parties exhibiting the following necessary characteristics: mutual assent, competent parties, a valid consideration, and legal subject matter. Insurance policies are a form of contract.
Copayment A payment made by an individual who has health insurance, usually at the time a service is received, to offset some of the cost of care
Customary Fees the fee level determined by the administrator of a dental benefits plan from actual submitted fees for a specific dental procedure to establish the maximum benefit payable under a given plan for that specific procedure.
Deductible A portion of covered loss that is not paid by the insurer
Dependent A person who relies on another, esp. a family member, for financial support.
Exclusions A provision of an insurance policy or bond referring to hazards, perils, circumstances, or property not covered by the policy.
Fee Schedule A cost containment tool utilized in workers compensation to standardize and avoid excessive medical costs associated with claims
Gatekeeper Requirements that must be met before an individual can qualify for a long-term care plan. A person must qualify for the plan's benefits before he or she can be paid out
Participating Provider A provider (e.g., hospital, group practice, health care facility or individual Clinician) who has a participation agreement in effect to render medical services to covered persons in a particular plan and network
Policyholder Person in actual possession of insurance policy; policy owner
Premium The amount of money an insurer charges to provide the coverage described in the policy or bond
Third Party Administrator A firm that handles various types of administrative responsibilities, on a fee-for-services basis, for organizations involved in cash flow programs
UCR allowable charge the amounts an insurance carrier is willing to pay for a specific service.
Created by: sbschod
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