• Journal of Convergence for Information Technology
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• v.9 no.9
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• pp.195-200
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• 2019

The purpose of this study is to analyze the characteristics of National Health Insurance claim data and to construct a pilot medical episode data considering it. In this study, the trends of respiratory disease (ICD10: J00-J99) cardiovascular disease (ICD10: I00-I99) from the day of onset of treatment to re-admission after admission were confirmed in Seoul, and the largest decrease was observed when the no-treatment period was 0 day. The data reduction rate when the no-treatment period is 0 day is judged to be due to the monthly separation claim of the health insurance claim data. Also, the result that there is a tendency of monthly separation request according to the type of medical treatment. Through this study, we constructed epidemic data for the pilot medical treatment considering the characteristics of the claim data of health insurance, and based on this, it can be used as a data processing method for calculating basic epidemiological information.

• Journal of Oral Medicine and Pain
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• v.30 no.2
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• pp.215-230
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• 2005

The study was intended to investigate how dentists in private dental clinic thought on the present claim and review of dental insurance to reflect it in future establishing dental insurance policies. 1,465 dentists who were running own dental clinic in Pusan Metropolitan City and the south part of Kyungsang province were surveyed in February, 2004. A total of 406 copies of finished questionnaire were finally retrieved and analyzed. The findings are as follows. 1. About insurance claim affairs : Most of the subject of insurance claim was by dentist himself or dental hygienist(nurse). Agency claiming was carried under 20% of total insurance claim. 2. The degree of attendance on insurance lecture : The degree of attendance on insurance lecture was relatively low. 3. Filing a protest against insurance claim : Filing a protest against insurance claim was reavealed about half-and-half for "have been" or "have not been". 4. Private clinic dentist,s opinion about the regulations affecting review of dental insurance : Private clinic dentists opinion about current guide for insurance review of dental fee was“the guidance is difficult and unfair cutback of claim fee may be carried”. 5. The affairs about health insurance review agency : About 70% of private clinic dentists have dissatisfaction on health insurance review agency. 6. Standpoint of private clinic dentists about issuance of receipt for dental fee : About 70% of private clinic dentist have an difficulty in issuance of receipt for dental fee. 7. The affairs about change insurance noncoverage treatment to insurance coverage treatment : Most of private clinic dentists hoped that insurance coverage about full mouth scaling, pit and fissure sealant, fluoride application. But they do not hoped that insurance coverage about geriatric denture, prothodontic treatment except precious metal, photopolymerization resin treatment.

• Journal of Preventive Medicine and Public Health
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• v.22 no.2 s.26
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• pp.259-267
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• 1989

The objective of this study was to analyze the influence of the hospital and insurer in causing delayed reimbursement of medical insurance benefits. We analyzed major variables at three different sized hospitals to examine the effect of the hospital and insurer using the two-way ANOVA method. The results were as follows: 1. The time interval between claim by hospitals and payment of the benefit was statistically different according to hospital in both admission and outpatient care. 2. The time needed by the insurer for investigating the claims was statistically different according to hospital and insurer in both admission and outpatient care. There was interaction between the hospital and insurer factors in outpatient care. 3. Although there was interaction between the hospital and insurer factors in admission care, the time interval between claim and payment was statistically different. In outpatient care, the payment interval between claim and payment was also statistically different according to the hospital and insurer.

• Proceedings of the Korean Institute Of Construction Engineering and Management
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• autumn
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• pp.341-344
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• 2002

Claims are on an increasing trend in the domestic construction field with changes of negative thought about them. But there are still many factors of causing disputes Potentially due to old customs that an owner is predominant over a contractor. Unless these factors are solved, it is obvious that many disputes will occur henceforward. This study derives claim factors that must be solved first of all through analyzing how claim factors influence construction management factors such as time, cost, quality, and presents countermeasures that may prevent these claims.

• The Journal of the Korean life insurance medical association
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• v.27 no.2
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• pp.107-111
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• 2008

The Cervical spondylotic myelopathy (CSM) is degenerative compressive myelopathy which initiation of symptoms seems to be induced by minor cervical trauma or spontaneous event. There was a case of Claim medical examination which was requested to discriminate the cause of ambulatory quadriparesis. Patient asserted that the onset of his myelopathy was followed by minor trauma. The author considered the medical recordings, MRI scan, Claim reports by claim manager. The space available for cord was the smallest at C3-4 level. But on MRI findings, the spinal cord at C3-4 level seemed to be already damaged. There were no recent injury evidences such as hemorrhages, spinal cord contusions, edema, soft tissue hemorrhages. If the space available for cord was small enough to compress the spinal cord, the serious neurologic deficits, non-ambulatory quadriplegia, etc were commonly induced by cervical extension trauma. Patient's asserts did not correspond to his clinical course after cervical trauma. The author reports a case of medical examination for the relationship between symptom onset of cervical spondylotic myelopathy and minor trauma within author's experience.

• THE INTERNATIONAL COMMERCE & LAW REVIEW
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• v.69
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• pp.63-84
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• 2016

Article 77 of CISG requires an aggrieved party, the promisee, claiming damages to take reasonable measures to mitigate losses. The reasonable measures required hereunder are limited to those that can be expected under the circumstances having regard to the principle of good faith. When taking such measures, the aggrieved party must do so within a reasonable time under the circumstances. The expenses incurred in taking such measures are recoverable from the promisor. If the aggrieved party fails to do so, the damages recoverable from the promisor are reduced in the amount the loss that should have been mitigated. The aggrieved party's duty to mitigate damages applies to claim for damages only. That is, the violation of this duty should not be invoked against other remedies available under CISG, such as the right to claim specific performance, the right to claim for the price or the right of reduction of price. In practice, under the provision of article 77, the aggrieved party, the seller or the buyer, is often required to enter into a substitute transaction as a measure to mitigate losses and many cases involving a substitute transaction are internationally reported. Therefore this paper intends to provide a certain understanding of the aggrieved party's duty to take measures to mitigate losses based on such cases reported.

• Proceedings of the Korean Institute of Building Construction Conference
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• 2010.05a
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• pp.225-228
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• 2010

It is an social issue that is various claim related on the defect of apartment house. The cost of defect repair is the most important matter that residents dispute constructers with the huge time wasting and cost loss. For resolve the matter of defect claim, it must to be analyze to the cost property that study and find to pending issue about the cost of defect repair. Therefore this study is investigated the cost property of defect repair relation on correlation analysis and regression analysis around the judgement cost. Consequently, cost of the judgment is associated with cost of the accusation and cost of the defect repair, is recognizable as them that is closely connected. Meanwhile, the more time of take effect and time of lawsuit increase, the more cost of the judgment decrease by draw the regression equation. On the contrary, there are same aspects in the case on the cost of the accusation and cost of the defect repair.

• Journal of the Korean Institute of Intelligent Systems
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• v.16 no.2
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• pp.172-178
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• 2006

This paper presents a development of court auction information system using time series forecasting. The system forecast a highest bid price for claim analysis, and it is designed to offer an quota information by the bid price. For this realization, we implemented input interface of object data and web interface of information support. Input interface can be input, update and delete function and web interface is support some information of court auction object. We propose a forecasting method of a highest bid price for auto-claim analysis with real time information support and the results are verified the feasibility of the proposed method by experiment.

• Proceedings of the Korean Institute Of Construction Engineering and Management
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• 2007.11a
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• pp.479-482
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• 2007

The volume of Construction project is increasing now in Korea. The complexity and variety makes the project many problems. But there are few construction contract experts. This results in a lot of managerial conflicts. Specially Engineer/Designer confront gigantic risk related to their job. So, to classify and to identify the risk practical investigation about Engineer/Designer's job. Therefore, to avoid and to prevent the claims for Engineer/Designer, clarification of the scope of service, use of external claim expert, and introduction of professional liability insurance should be accomplished.

• International Journal of Computer Science & Network Security
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• v.21 no.9
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• pp.125-131
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• 2021

Detecting fraudulent insurance claims is difficult due to small and unbalanced data. Some research has been carried out to better cope with various types of fraudulent claims. Nowadays, technology for detecting fraudulent insurance claims has been increasingly utilized in insurance and technology fields, thanks to the use of artificial intelligence (AI) methods in addition to traditional statistical detection and rule-based methods. This study obtained meaningful results for a fraudulent insurance claim detection model based on machine learning (ML) and deep learning (DL) technologies, using fraudulent insurance claim data from previous research. In our search for a method to enhance the detection of fraudulent insurance claims, we investigated the reinforcement learning (RL) method. We examined how we could apply the RL method to the detection of fraudulent insurance claims. There are limited previous cases of applying the RL method. Thus, we first had to define the RL essential elements based on previous research on detecting anomalies. We applied the deep Q-network (DQN) and double deep Q-network (DDQN) in the learning fraudulent insurance claim detection model. By doing so, we confirmed that our model demonstrated better performance than previous machine learning models.