I was asked to prepare a response to an insurance coverage letter/reservation of rights. I have no experience with insurance coverage work. Where do I start? Is it just interpretation of the policies?

like
Posting as :
works at
You are currently posting as works at

The fun thing about insurance coverage is that it is so very fact-specific and fact-intensive. You can have the same policy language in ten different claims but the language is interpreted differently in each situation. As for responding, start with the coverage letter and policy. What are the bases for accepting or denying coverage? If the carrier is denying coverage, you’ll want to assess the policy for whether there is another coverage part or endorsement that would grant coverage. Might have to do some case law research on how the specific section being quoted to deny coverage has been interpreted in cases with underlying facts that are analogous to the case you have. You’ll generally want to address each of the points raised by the carrier and then make a demand for coverage/payment if the situation calls for it.

like

First, choice of law analysis. Can only look at 8 corners...4 corners of live petition/complaint and 4 corners of insurance policy. Google for cles regarding coverage.

like

Related Posts

We are looking to hire a nanny next year. Where did you find leads and what is the going rate per hour? Do you know of any services to help with payroll taxes and paying for their healthcare?

like
like

Looking for info in the requirements for New Transparency in Coverage rule and where in company websites the insurance links will be posted.

likeuplifting

Larsen & Toubro Infotech Hi folks, Please help me which organisation should I go with Citius tech or LTimindtree? As recession is approaching and due to which layoffs are going on as we all know so which one is more safe to join. Please share your thoughts, which will help me to take the decision.
For tech stack Azure Data Factory, SQL,Azure synapse, SSIS, ADLS with 7.5 yrs of experience. HCL Technologies Tata Consultancy Infosys Accenture IBM Larsen & Toubro Infotech Mindtree Fractal Citiustech Healthcare Technologies

like

Anyone from McKinsey’s Healthcare practice that would be willing to chat? Not looking for a referral per say, just interested in the work that goes on in the provider space. Many thanks in advance.

likehelpful

Taking control of my sexual health this year but I’m quite nervous about getting an IUD. What if it’s uncomfortable or my partner feels it during sex? Please share your personal experiences with me, have they been overall positive? Does it shift depending on how rough/ lengthy your partner is?

like

Health and benefits sector - how much should I aim for at Mercer for H&B consultant role with 4 YOE in regional brokerage? Washington DC area

like
like

After 6 years of temporary contracts and unstable situations, I find my dream job in my dream company. All of a sudden the world goes upside down and I get laid off. I start sending hundreds of applications, with only 2 recruiters getting back to me to say I don’t have experience for the job (this is how it works in Italy). Add a terrible health situation in my family and it seems there’s no light at the end of the tunnel. Ugh. 😞

like

Healthcare corporations… please note you have more then 1 shift of workers. You have 3 most times, each shift has to be treated equally. This is and always have been an issue, and you cannot figure out why the other shifts refuse to be active and participate in anything and definitely not engaged anymore.

Post Photo
like

Hello Fishes,

I am looking for a job change. So, I would like to give you a brief introduction about me.

I am working in DXC technology for 2 years as a Software Engineer.

Job Description-

Data analyst with 2 years of experience. Experienced in interpreting and analyzing data to drive growth for an insurance company. I have good amount of knowledge in Power BI , QuickSight , SQL, Excel, JIRA, ServiceNow.

Could someone please refer me for a suitable job.

like

Any 🐠 interested in looking for opportunities with firms that specialize in healthcare intelligent automation? Please DM me..Payor operational experience preferred!

like

Deducting S Corp owner health insurance when they aren't really an employee? Owner doesn't do anything for the business anymore, but still wants the health insurance.

"Health and accident insurance premiums paid on behalf of a greater than 2-percent S corporation shareholder-employee are deductible by the S corporation and reportable as wages on the shareholder-employee’s Form W-2, subject to income tax withholding."

like

Any women working in Commercial Insurance in B.C. (Broker, Underwriting, Account Manager or Management) that work for a company you like or love? I'd love to hear what company and why you like them.

like

I just did my pre-licencing certification and passed my CA state exam for property and casualty. No I have no idea what to do or where to start my career as an insurance agent since I have no experience in the real world, just lots of knowledge. Please help!

like

How supportive are your companies when it comes to taking PTO for mental health days?

likesmart

I keep taking calls with companies because I get some actually good offers on LinkedIn (I work in a growing area of health tech) but I have no intention of switching companies at the moment. I like to test the market. What is the proper time to stop interviewing? I don’t want to waste anyone’s time but I’m also obviously passively willing to chat and look around at opportunities

like
like

Anyone out there a nurse health coach? How do you like it?

like

Deloitte 🐠 what’s the salary range for senior manager in healthcare with consulting experience from a non-big four with a masters degree... Chicago

like

More Posts

Any recommendation on contrast trim shirts?

M36 - had a colonoscopy today. AMA.

like

Hey everyone, What would you say is the difference between an account director and a senior account manager. I was just promoted as an account director when I quit my job and moved to the U.K and now having so much trouble finding a job as an AD. My last interview feedback was that they really liked me but felt like I was lacking new bizz skills and that the organic business growth opportunities I found and jumped on were “luck aka right place at the right” moment kinda thing?

like

Tips for dealing with a colleague who is undermining you? The guy doesn’t pull his weight, takes credit for my work, blames me for his mistakes, etc. He belittles work I do to my manager (and I only hear about it other coworkers)

I’ve only been on this team a few months so I don’t want to come off as petty or rude but it’s starting to get out of hand and I don’t want to work in this role anymore

likesmart

What kind of questions asked in test conducted by Deloitte USI for 3 years of experience for Salesforce developer Deloitte USI Deloitte India

like

I’ve traded everything Forex, Futures, Options, Stocks, Crypto, it’s all the same shit. All it comes down to is risk management and chart work. If you could figure those two things out, you’ll be good for the rest of your life.

like

I’m looking for recommendations for a bench top bandsaw. I’m willing to invest in a nicer one down the line, but right now I want to keep it under $300. I mostly see Powertec, Shop Fox, or Wen. There is a $375 Grizzly I’d consider if it’s way better than the others. Any thoughts?

How much should LPNS make in Dr (allergy) office in Texas?

like

I desperately want to get my tubal ligation reversed bc of PTLD, and if it happens, another baby. I’m chasing my tail it feels like though

like

How much percentage of bump from your current CTC can you realistically ask for when you're shifting to a new company ?

like

Posted this in the Litigation and Arbitration bowl and I guess non-ADHDers just do not get how you can fall off track for an entire month. Anyway reposting my question here:
ID people, how long did it take you to get to billing 160-170 hours per month? I am 4 months in and had a terrible Sept. I only billed 75 hours and know I am capable of better. I was up to 120 the previous couple months, but just fell into the void last month. I keep hearing that it gets easier to bill and people don’t even

like

What is a high paying JD advantage job? I have 3 years of experience as an attorney

like

What’s the longest amount of time you’ve asked for when relocating for another job? Would be a cross-country move for me & recently had some family stuff come up that I need to take care of.

like

I’m a financial services regulatory / Fintech lawyer in Singapore, have you heard of foreign lawyers in the financial services regulatory space in US? I’m looking to move into the US market

like

Looking for recommendations on under-desk walking treadmill under $300.

like

Name your favorite true story finance movies

like

Anyone attended AC townhall call?
What was the outcome

like

Any good Ethiopian restaurants in the area?

like

Additional Posts in Law

Lol non lawyer just said “i mean imagine if lawyers didn’t get drug tested, it just would never happen.”

funnylike

FL fish - any insight on Hill Ward Henderson culture? Specifically the construction & design group?

like

Is anybody else a bipolar lawyer? I’m type 1. I feel like a unicorn.

like

Whoever said employers don’t care about grades and transcripts after your first job was a liar. Every lateral position that I’ve applied to as a 3rd year has requested transcripts. Why do we lie and tell grads that employers don’t check transcripts when they do. My coworker, a 5th yr, had to submit his transcripts also to lateral job. Side note - it speaks volume when multiple associates are trying to lateral at the same time

like

Dumb question : what is the difference between a blackline and a redline? I’ve always used redline. Also, anyone know how to do this “blackline” in Workshare compare?

like

I put in my notice last week at my current firm. MP was shaking with anger when I told him. Toxic partners, commonplace sexism, and widespread bullying. I was only there 6 months. Walking out of that office, I felt 50lbs lighter. I just want to remind you all that you’re better than some people will try to make you feel, and no one can look out for your interests better than you!

like

Any insight into GrayRobinson? As a whole and their litigation or healthcare areas specifically.

like

Anyone hearing any crazy bar exam stories?

like

Is there any PR issues incorporating/organizing a law firm in DE? If the principal place of business may be elsewhere? Attroneys are licensed in all states that they will practice in. No attroneys are licensed in DE.

like

If you could do a regular job outside of the law what would you do?

like

Anyone know what’s the deal with Polsinelli? Just trying to figure out whether they’re the right fit for me. I’m currently in a boutique IP firm. I work pretty hard but it’s obviously not Big Law.

like

Here to restate the understated truth of our profession..

Post Photo
likesmartuplifting

What percentage of time do you feel in control of everything and what percentage of time do you feel like you’ve lost your mind? About 50/50 here.

like

Any recruiter recommendations for LA / SoCal?

like

Besides reporting it up the chain, advice for an associate in dealing with a support staff whose lack of motivation is affecting cases negatively?

like

Easier to go from litigation to transactional or transactional to litigation? I’m currently in litigation but wondering if I I could make the switch later in my career.

like

EOY review time! Boutique firm with large workload. I’ve signed multiple clients and met my billable requirements in the months I’ve been here. Is a 20k raise request reasonable?

like

What is the market like now at big law firms after the salary increases? I am getting ready to leave my state clerkship and start applying to firms in NYC. I really don’t want to push it back any further but don’t want to waste my time networking and applying if it ultimately won’t yield anything.

like

Any insights into Lewis Brisbois? Interview later this week. I haven’t heard great things but wanted to crowd source for more data. TIA.

like

Some co workers were laughing about the lawyer dog case out of Louisiana. I was walking by and explained why it was the right ruling. Think I’m officially racist

funnylike

New to Fishbowl?

Download the Fishbowl app to
unlock all discussions on Fishbowl.
That was just a preview…
Sign Up to see all discussions
  • Discover what it’s like to work at companies from real professionals
  • Get candid advice from people in your field in a safe space
  • Chat and network with other professionals in your field
Sign up in seconds to unlock all discussions on Fishbowl.

Already a user?
Login here

Share

Embed this post

Copy and paste embed code on your site

Preview

Download the
Fishbowl app

See what’s happening in your industry
from the palm of your hand.

A phone with Fishbowl app

Send download link to your phone

OR

Scan your QR code to download
Fishbowl app on your mobile

By continuing you agree to Terms of Use and Privacy Policy.

Messaging rates may apply

Download app

Sign up for free to view this conversation on Fishbowl

By continuing you agree to Terms of Use and Privacy Policy

Already have an account? Log in

Sign up for free to continue using Fishbowl

By continuing you agree to Terms of Use(New) and Privacy Policy(New)
Messaging rates may apply

Already have an account? Log in

For account settings, visit Fishbowl on Desktop Browser or

General

Legal