• The Journal of the Korean life insurance medical association
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• v.28 no.1_2
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• pp.31-35
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• 2009

Background : Many of internists have been working for insurance industry. Insurance medicine is use of medical knowledge for insurance industry. There is social role of insurance medicine in terms of soundness of insurance administration. Recently social role of internists also have been being watched. Although theme of insurance medicine is medical risk selection, insurance claims administration also needs medical experts'opinion. There are not any corroborative study of medical consulting for insurance claims. Among insurance industry, someone called this medical review of insurance claims as 'medical claims review'. Aim : To investigate usefulness of medical review of insurance claims. Design : Questionnaire survey with claim staffs in one of insurance claim adjustment company in Korea. Methods : 265 claim staffs were divided into 4 groups and conducted survey using a questionnaire of 20 questions. Utility score, job satisfaction score, and difficult factors of claims administration were measured. Results : Utility score and job satisfaction score are highest in medical claims review group. The most difficult in claim administration to claim staffs was demonstrated to medical knowledge. Conclusion : Medical review of insurance claims is proved to be worthy. Document-based consulting method, namely medical claims review, is more useful than telephone-based simple query among claim staffs...Subjects of the medical claims review are medical record and it's principle is independent medical examination with evidence-based approach, it also has role of protecting fraud of insurance claims. Two main question types of medical claims review are verification and advice.

• Quality Improvement in Health Care
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• v.12 no.1
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• pp.52-61
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• 2006

Background : The promotion and advertisement of pharmaceuticals should be based on evidence from clinical trials. We conducted this study to assess whether the pharmaceutical advertisement claims in Korean medical journals had relevant references, and whether the claims were supported by the references. Methods : We reviewed pharmaceutical advertisements in five Korean medical journals issued during the first half of 1999 and during the first half of 2004. Three investigators independently reviewed the advertisements to see whether the studies quoted to endorse the advertising messages supported the corresponding claims. Using multiple logistic regression analyses, we investigated which factors were associated with the quality of the advertisement claims. Results : From the 550 advertisements in the five journals, we identified 157 different advertisements and 475 different promotional claims. Only 149 claims had at least one reference, and 105 claims had references of published article. We could find supporting evidences in the 90 claims. The factors which were associated with the quality of advertisement claims were category of drugs, category of claims, and the manufacturer characteristics. Claims for cardiovascular and endocrine drugs, and claims on efficacy, and claims of multinational company were more evidence-based. Conclusion : Majority of the pharmaceutical advertisement claims in Korea did not have appropriate references. Drug category, claim category, and the manufacturer characteristics were associated with the quality of advertisement claims, and the manufacturer characteristics was the most important determinants.

• Journal of the Korean Society of Clothing and Textiles
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• v.17 no.4
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• pp.550-564
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• 1993

The purpose of this study is to investigate the consumer's claims related to clothing merchandise. By th origination stage of claims, details of claims, and treatments of claims purchasing places of clothing merchandise, the consumer's claims are analyzed which were lodged to in consumer's complaint center, Seoul YWCA, in 1981-1990. To analyze these data statistically, frequency and percentile are used. The results of analysis for consumer's claims are as next : 1. Concerning the sex distinction, female complainers are more than male complainers. About the age bracket, twenties and thirties are the most numerous. The originations of claims being various. It is laundry and dry cleaning stage out of them that rank first, and total numbers of claims for clothing products continually have increased during 1981-1990. Out of the clothing items, outerwears are of the first rank and formal wear and coat are highest in rank of outerwears. For claims about purchasing places, agency ranked first and market, department store, custome-made and discount store came after in order. 2. Concerning the contents, quality of clothing product ranks first, inferior service, price, contrast, unfair transaction ranks in order. There are claims about quality of clothing product that color change ranks first and damage and form change rank in order. 3. The treatments of claims are that counsel, exchange, refund, repair and correction rank in order.

• International conference on construction engineering and project management
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• 2015.10a
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• pp.710-711
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• 2015

A nuclear power plant construction is a complex form of construction which comprises various stakeholders and contractors. Therefore, contract disputes will occur due to conflicting interests of contracting parties and unpredictable factors which arise during construction work. Even if the contract is well prepared, it cannot fully prepare for future situations in actuality. Claims management is very important in carrying out construction management. This study intends to define claim, and delve into development of claims management processes from the viewpoint of owners and contractor through consideration on international contract terms on claims management and the details of the claims management of the Construction Extension to the PMBOK. In addition, it is needed to accumulate and manage data on claims that have occurred so that they can be referenced in the future. As information should be accumulated so that type classification can be carried out and that lessons can be learned on claims that have occurred in each business site, study on establishing data-based systems relating to claims processes will be needed in the future.

• Communications for Statistical Applications and Methods
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• v.31 no.3
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• pp.323-336
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• 2024

The accurate forecasting of insurance claims is a critical component for insurers' risk management decisions. Hierarchical Bayesian parametric (BP) models can be used for health insurance claims forecasting, but they are unsatisfactory to describe the claims distribution. Therefore, Bayesian nonparametric (BNP) models can be a more suitable alternative to deal with the complex characteristics of the health insurance claims distribution, including heavy tails, skewness, and multimodality. In this study, we apply both a BP model and a BNP model to predict group health claims using simulated and real-world data for a private life insurer in Indonesia. The findings show that the BNP model outperforms the BP model in terms of claims prediction accuracy. Furthermore, our analysis highlights the flexibility and robustness of BNP models in handling diverse data structures in health insurance claims.

• Strategy21
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• s.45
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• pp.91-115
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• 2019

When compared to land territorial claims, maritime claims have not attracted as much attention from the public as well as the academia. However, after the ICOW (Issue Correlates of War) data was published and was expanded to include maritime and river claims, there have been many quantitative studies that analyze maritime claims or separate different types of territorial claims to explain various mechanisms over different types of territorial claims. These quantitative studies have provided valuable explanations about the onset and the management of maritime claims. This research tries to review these quantitative research. Most studies about maritime claims, especially regarding the management of claims, analyze maritime claims based on two different levels of factors. First, from the perspective of systemic level, several studies focus on the role of international institutions and systemic level of democracy to explain the management of maritime claims. Second, at the dyadic level, many studies explain how the issue salience, past experience, the presence of resources, joint democracy, and relative power influence the occurrence of peaceful settlement attempts or conflictual behaviors over maritime claims. Based on the review of these literature, this research tries to identify several factors to explain the Dokdo issue and to encourage peaceful settlement attempts over the Dokdo issue.

• Strategy21
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• s.44
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• pp.103-141
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• 2018

As the South China Sea maritime dispute illustrates, when considering the place where maritime claims occur, states do not have many choices to respond to maritime claims in which disputed areas are located far away from the land and are surrounded by the sea. As Mearsheimer (2014) points out, the sea stops power projection. Therefore, in order to adopt coercive as well as peaceful settlement policies to deal with maritime claims, states need to overcome obstacles (the sea) to project power. It means that if states want to conduct a specific foreign policy action, such as negotiating maritime borderlines or arguing sovereignty on islands, they need a tool (naval power) to coerce or to persuade the opponent. However, there are lack of research that studies maritime claims from the perspective of naval power. This research project fills this gap based on naval power. How do relative levels of naval power and (dis) parities of naval power influence the occurrence of MIDs over maritime claims? Naval power is a constitutive element during maritime claims. If disputants over maritime claims have required naval power to project their capability, it means that they have the capability to apply various ways, such as aggressive options including MIDs, to accomplish their goals. So, I argue that when two claimants have enough naval power to project their capabilities, the likelihood of MIDs over maritime claims increases. Given that one or both states have a certain level of naval power, how does relative naval power between two claimants influence the management of maritime claims? Based on the power transition theory, I argue that when the disparities of relative naval power between claimants becomes distinctive, militarized conflicts surrounding maritime territory are less probable. Based on the ICOW project which codes maritime claims from 1900 to 2001, the empirical results of the Poisson models show if both claimants have projectable naval power, the occurrence of MIDs over maritime claims increases. In addition, the result shows that when disputants maintain similar relative naval powers, they are more likely to initiate MIDs over maritime claims. To put it differently, if naval capabilities' gap between two claimants becomes larger, the probability of the occurrence of MIDs decreases.

• Journal of Information Technology Services
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• v.8 no.4
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• pp.175-185
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• 2009

Objectifying claims filed during the warranty period, analyzing the current circumstances and improving on the problem in question is an activity worth doing that could reduce the likelihood of claims to occur, cut down on the costs, and enhance the corporate image of the manufacturer. Existing analyses of claims are confronted with two problems. First, you can't precisely assess the risks of claims involved by means of the value of claims per 100 products alone. Second, even in a normal state, the existing approach fails to capture the probabilistic conflicts that escape the upper control limit of claims, thus leading to wrong control activities. To solve the first problem, this paper proposed that a time series detection concept where the claim rate is monitored based on the date when problems are processed and a hazard function for expression of the claim rate be utilized. For the second problem, this paper designed a model whereby to define a normal state by making use of PID (Proportion, Integral, Differential) and infer by way of a fuzzy concept. This paper confirmed the validity and applicability of the proposed approach by applying methods suggested in the actual past data of warranty claims of a large-scaled automotive firm, unlike hypothetical simulation data, in order to apply them directly in industrial job sites, as well as making theoretical suggestions for analysis of claims.

• Journal of Arbitration Studies
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• v.15 no.1
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• pp.95-112
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• 2005

In the inner turn key constructions the problems of uniform types are repeatedly occurred, and, especially, many problems happen up to the stage of pre-construction(from a bid to a contract) owing to the specialties of the turn key constructions. So the claim factors of the Korean turn key constructions were abstracted in antecedent paper. When the technicians meeting the interior turn key constructions for the first time and working here now are well acquainted with only these factors, many claims will be prevented. By analysing the degree of claims by claims factors through the questionnaires to the experts about the abstracted factors and surveying the amount of the claims through the case studies, what factors exerted how much of influence on the claims was tested and analyzed. Studying and Managing the factors affecting the claims much led the technicians in charge of internal turn key constructions to the prevention and the proper solution of the site claims.

• The Korean Journal of Applied Statistics
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• v.25 no.5
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• pp.813-820
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• 2012

A surplus process with two types of claims is considered, where Type I claims occur more frequently, however, their sizes are smaller stochastically than Type II claims. The ruin probabilities of the surplus caused by each type of claim are obtained by establishing integro-differential equations for the ruin probabilities. The formulas of the ruin probabilities contain an infinite sum and convolutions that make the formulas hard to be applicable in practice; subsequently, we obtain explicit formulas for the ruin probabilities when the sizes of both types of claims are exponentially distributed. Finally, we show through a numerical example, that Type II claims have more impact on the ruin probability of the surplus than Type I claims.