...C112 Claims Management Dec 2005 Exam Claims – Dec 2005 Exam Section A – Multiple-Choice Questions 1. (A)(1-3) To gain an understanding of a company’s commitment to it’s clients, the mission statement is a good place to start. It underpins the philosophy the claims department will embrace for handling claims. It often focuses on the company’s core strengths, values, or culture, and could specifically articulate an approach towards handling claims. The promises made in brochures and other advertising material to promote the sale of policies should also correspond. 2. (D)(1-9) Methods used to evaluate claims handlers performance include: • reviewing all files closed by new loss adjusters to assess procedural and process issues as well as technical claims handling • a claims audit, internal or external, could assess various aspects of identified claims handling issues • policyholders could be surveyed to assess customer service issues 3. (B)(1-11) Specialists deal with one type of claim or one line of business. Loss adjusters who specialize in the more complex areas of claims handling tend to have a broad base of experience in which their work is grounded, because at the beginning of their careers they would have handled a wide variety of claims. 4. (A)(1-26) Timing issues may be artificial. Urgency can easily be confused with emotionalism. 5. (D)(2-6) When assigning claims to independent or staff adjusters, most insurers will...
Words: 327 - Pages: 2
...The False Claims Act The False Claims Act is an American federal law that covers fraud involving any federally funded contract or program. It is the federal government primary tool in combating fraud against the government. Recent legislation, such as the Fraud Enforcement and Recovery Act of 2009 and the Patient Protection and Affordable Care Act of 2010, has broadened the scope of the False Claims Act. The definition of a false claim has been expanded, so now any false statement that is material to a claim can be actionable and liability has been expanded to knowingly failing to repay an overpayment (Cardinal 2013). According to the Wikipedia, this American federal law imposes liability on persons and companies typically federal contractors who defraud governmental programs. The law includes a qui tam provision that allows people who are not affiliated with the government, called "relators" under the law, to file actions on behalf of the government informally called "whistleblowing” especially when the relator is employed by the organization accused in the suit. Qui Tam. Qui Tam is a writ whereby a private individual who assists a prosecution can receive all or part of any penalty imposed (wiki 2015). Its name is an abbreviation of the Latin phrase qui tam pro domino rege quam pro se ipso in hac parte sequitur, meaning “he who sues in this matter for the king as well as for himself” (Wiki, 2015). There are many legal and regulatory principles and concepts affecting the issue...
Words: 784 - Pages: 4
...SUBJECT: Constructive Discharge Claim It has come to my attention that a previous employee plans to file a constructive discharge claim against our Company under Title VII of the Civil Rights Act of 1964. He bases his suit on religious discrimination due to the new production schedule that has recently taken effect. In his opinion, the new production schedule requires employees to work on holy days thereby, discriminating against employees whose religious practice does not allow them to work on these particular days. The employee alleges that enforcement of the new policy forced him to resign his position before the effective date of the new schedule. Religious discrimination involves treating someone different due to their religious or cultural belief system. In business, it is unacceptable and unlawful to treat someone unfavorably because of their culture, religious beliefs, religion, or ethical and moral ideals. Constructive discharge is a legal concept adapted by the Federal Equal Employment Opportunity Law (EEO) that prohibits discrimination in the work environment. Constructive discharge addresses changes in policy or regulations in which an employee feels he is being directly targeted for a reason which would cause any prudent person no other recourse, with the exception of terminating employment. In other words, the employee feels as though he is being forced to quit. (eeoc.gov) Therefore, in order to sue the company, the employee must prove to the court that the...
Words: 703 - Pages: 3
...MEMO To: Chief Executive Officer From: Elementary Division Manager Date: January 1, 2014 Subject: Former Employee, Constructive Discharge Claim Introduction Our attorney has notified me that a former employee has filed a claim against the company, citing Title VII of the Civil Rights Act of 1964, constructive discharge. Findings: A. Constructive Discharge Relevance During the first quarter of the New Year the company implemented a new production schedule as a result of company growth. Employees in the production group are now required to work 12-hour shifts, 4 days on and 4 days off. Because of this, some of the working days fell on the former- employee’s religious holy day. The employee in question quit shortly after the implementation of the new rule. The former employee has filed a constructive discharge claim because of the newly implemented rule. As part of my research, a constructive discharge claim occurs when an employee claims that their working conditions were so intolerable that he/she was forced to quit (Alexander Hamilton Institute, 2011). The plaintiff (our former employee) in this case will need to be able to show the Court that working conditions were not tolerable and forced him/her to resign their position on the production floor. In addition, the plaintiff will need to show prima facie evidence that the said discrimination actually occurred (legal-dictionary, 2014). In a case, Gregory Lawson vs. State of Washington 2002, it pointed out...
Words: 1514 - Pages: 7
...Running head: FALSE CLAIMS ACTS: 1 SHOULD THEY BE SEALED? False Claims Acts: Should they be sealed? Becky L. Garcia Abstract Throughout history the United States Government has been responsible for massive expenditures for government operations involving taxpayer dollars. Unfortunately, with all the different organizations and transactions transpiring, there have become endless opportunities for fraud or deceptive practices. The government enacted the False Claims Act for help in controlling the deceptive practices and additionally giving them a viable tool to expose the fraudulent acts. The False Claims Act allows a whistleblower or “qui tam” to come forward and help aide the government with the massive ongoing fraud that is enacted everyday against the government. A much needed provision that helps ‘seal’ and protects the whistleblowers identity was added into the FCA. The protection by sealing the name when a claim is enacted by a whistleblower is important because it allows the whistleblower to help the government with the pursuit of fraud while protecting the whistleblower from backlash from their employee or organization. There are many organizations within the Government that spend an enormous amount of taxpayer dollars. From within these organizations fraud and deceptive practices are found, and sometimes are a regular practice in everyday expenditures. The Government cannot stop or find all of the illegal practices going on within, but for...
Words: 2087 - Pages: 9
...I am writing this paper so that I can learn about the process for filing a small claims lawsuit in Santa Clara County. According to the Santa Clara County Superior Court of California website, small claim courts are courts in which plaintiffs can resolve their disputes in the quickest, easiest, and cheapest ways. Small claim courts also have procedures which are straight-forward as well as an informal hearing as part of their process. The form which the plaintiff obtains to file a small claims court against another person, also known as the defendant, is on the website for the California Judicial Branch. When you go to that website, you go to the “Forms and Rules” tab and click on the link for the “Browse All Forms” page. There, you go to the...
Words: 1238 - Pages: 5
...MGMT. 703 – 101 Ethics & Stakeholder’s Management Individual Assignment # 1 The Travel Expense Billing Controversy and The False Claims Act 1. Why would an independent audit firm, like PwC, that depends upon the maintenance of its reputation for integrity and professionalism, to retain and attract clients, risk the loss of that reputation by engaging in what appears to be unethical behavior (not returning travel expense rebates)? Explain your answer and reasoning. * Pricewaterhouse Coopers (PwC) is a major accounting firm and has a strong foothold in financial markets. The company remarked that their employers were engaged in unethical billing practices through which they are earning millions of dollars. The company was earning huge rebates on airline tickets and other travel expenses that were being charged to different clients associated with the company. The firm’s Global-Travel director replied it as, the negotiations were associated with the travel deals and not with the clients, so in this case any rebates or discounts earned are company’s profit. The company failed to attain integrity and industrial professionalism by committing this unethical practice for their own advantages. The company was greedy in earning profits through unethical practices and overlooked the reputation of the company in front of their clients and the overall financial market. It was not the company as a whole, but some of its senior executives who were not loyal and honest...
Words: 944 - Pages: 4
...A. Overview of Intellectual Property (Book 24-30) 1. TRADE SECRETS (Outline pgs 3-11) ▪ Trade secret laws are State law doctrines that protect against the misappropriation of certain confidential information. o There is no federal statute ▪ A form of private IP law under which creators establish contractual limitation or build legal fences that afford protection from misappropriation. ELEMENTS: a. The information must be Secret. a. Relative, not absolute, secrecy is required. b. The owner must take Reasonable step to maintain secrecy. a. Once a trade secret is disclosed, protection is lost. c. There is some economic or competitive advantage to the owner. i. Misappropriation of Trade Secret: 1) Where the secrets were obtained by theft or other improper means. 2) Where they were used or disclosed by the D in violation of a confidential relationship. ▪ Trade secret does not prevent competitors from “reverse engineering” which is permitted. 2. PATENTS (Outline pgs 12- 31) a. 5 Requirements: 1) patentable subject matter (g.15) 2) utility (pg.16) 3) Description & Enablement (pg.17) 4) novelty & Statutory bar (pg.19) 5) non-obviousness...
Words: 13010 - Pages: 53
...I. Synopsis: Case: The HOOVER COMPANY, Plaintiff, v. BISSELL INC., Defendant. No. 5:98-CV-1088. United States District Court, N.D. Ohio, Eastern Division. March 19, 1999. A. The Hoover Company History: Hoover vacuum cleaners have markets in the United States and Canada. In addition to vacuum cleaners, Hoover also produces and sells high quality washers and dryers. Maytag acquired The Hoover Company in 1989, providing Maytag an important foothold in the highly competitive international market. The company roots back to 1827, when Henry Hoover established a plant near Canton, OH. 80 years later led to him and his sons selling vacuum cleaners after purchasing rights to an electric suction sweeper, which was invented a year before by a guy named Murray Spangler. In 1908, Hoover bought Spangler’s patent, kept him as a partner and soon named the company Hoover Suction Sweeper Co. Hoover than began marketing the sweeper in stores all throughout the country. By 1921, Hoover had gone global and by 1923, sales reached $23 million. Hoover today specializes in all floor care and is a continued leader in the industry (Hoover: Fundinguniverse, 2006). B. Bissell Inc. Company History In 1876, Melville Bissell began marketing his carpet sweeper invention with revolving brushes. The revolving brushes picked up the dust and dirt and deposited it inside the sweeper housing. Being dependent on the rotation of the wheels to drive the sweeping mechanism, it only removed debris from...
Words: 1456 - Pages: 6
...In this case we will be talking about the company RIM (Research in Motion) and some of the Challenges they faced to protect their Intellectual Property. Research in Motion is best known as the developer of the Blackberry smartphone. Research in Motion was involved on several Patent Litigation with the different competitors. On 1999 Glenayre Technologies (formerly known as Glenayre Electonics) filed a patent infringement suit against RIM claiming that the Inter@ctive pager line used Glenayre’s power-generation from dual battery process. This litigation caused a delay on RIM’s contract renewal with the BellSouth company and also their quarterly earnings report came with lower than expected results. In order to get new customers RIM signed an agreement with Dell Computer and Dell started selling Blackberry to large corporate accounts. On 2001 RIM replied back to Glenayre filing a suit against them for infringing on RIM’s “Single Mailbox Integration” patent. Research in Motion won this patent and allowed them to collect royalties from other mobile device makers that were planning on utilizing this technology. On 2002 Research in Motion filed the first of four suits against Good Technology for misappropriation of trade secrets, this dispute continued until 2004 where they settled an agreement. Good Technology agreed to pay a sum of money and quarterly licensing fees. Another legal dispute was the patent for the keyboard design against Handspring for its Treo device but...
Words: 793 - Pages: 4
...August 2011 I realized recently that we may be able to solve part of the patent problem without waiting for the government. I've never been 100% sure whether patents help or hinder technological progress. When I was a kid I thought they helped. I thought they protected inventors from having their ideas stolen by big companies. Maybe that was truer in the past, when more things were physical. But regardless of whether patents are in general a good thing, there do seem to be bad ways of using them. And since bad uses of patents seem to be increasing, there is an increasing call for patent reform. The problem with patent reform is that it has to go through the government. That tends to be slow. But recently I realized we can also attack the problem downstream. As well as pinching off the stream of patents at the point where they're issued, we may in some cases be able to pinch it off at the point where they're used. One way of using patents that clearly does not encourage innovation is when established companies with bad products use patents to suppress small competitors with good products. This is the type of abuse we may be able to decrease without having to go through the government. The way to do it is to get the companies that are above pulling this sort of trick to pledge publicly not to. Then the ones that won't make such a pledge will be very conspicuous. Potential employees won't want to work for them. And investors, too, will be able to see that they're the...
Words: 679 - Pages: 3
...ALL ABOUT PATENTS IN BOTSWANA Procedures for filing patent applications in Botswana Filing requirements for national phase PCT applications are as follows: * Power of attorney (simply signed; can be late-filed within one month) * Copy of published international application (required on the day of filing) * Specification, claims and abstract in English, if publication not in English (required on the day of filing) * Copy of international search report (can be late-filed, no set deadline) Filing requirements for invention patents are: * Power of attorney (simply signed; can be late-filed, within one month) * Specification, claims and abstract in English (required on the day of filing) * Formal drawings, if applicable (required on the day of filing) * Assignment of invention (can be late-filed, no set deadlines) How long will it take to register a patent and what are the standard costs? Approximately three years from filing. The official fee for filing a Botswana patent application is P300 (approximately $40) and the official fee for grant and publication is an additional P300. What is the scope of patent protection in your jurisdiction? A Botswana patent for a product confers upon the patentee the right to preclude any other person from making, importing, selling, using the product, or offering it for sale. What types of inventions or ideas can be patented? Are there any notable or unusual exceptions? An invention is...
Words: 1483 - Pages: 6
...authority. <p>Your browser does not support iframes.</p> This led to a legal struggle between the two parties. The respondents had filed 23 revocation petitions before the Appellate Board, praying for the revocation of the patents held in the name of the appellant. They had also filed counterclaims, in response to the patent infringement suits brought about by the appellants. The litigation had now reached the Supreme Court, in order to determine the correct course of action to be adopted, in the light of compound proceedings having been invoked by the two parties. One of the questions before the court was whether the challenge, having been raised by the defendant through a counter-claim, can only be determined at the hands of the High Court, i.e., while dealing with the counter-claim....
Words: 4288 - Pages: 18
...Patent Warfare Per your request I reviewed the lawsuit notice and believe our company can handle the matter without litigation saving us time and money. Our first course of action should be to propose collaboration with the accuser in order to continue innovation. If the accuser turns out to be a patent troll or in other terms in the business of strictly making money on infringement cases we will have the case arbitrated by a subject matter expert. I recommend we offer the accuser a chance to collaborate with a business which recently launched a great new product supported by Apple iOS and Google Android platforms. Instead of being a killer of creativity the accuser might be a legitimate technology developer such as our company. The accuser may be more interested in developing newer and better versions of its product instead of getting a onetime payout. Collaboration will save both parties time and money by avoiding a long and expensive court case. It will also benefit both parties to share research and new ideas (Laudon, 2012). Nokia and HTC are a recent example of collaborations as they entered “into a collaboration agreement to provide access to each other’s patented technology to explore future projects” (Shankar, 2014). Working together will provide our business with new innovations making us more competitive. New innovations will develop an opportunity for new registered patents to our company, providing a defense system for possible future law suits. Licensing...
Words: 856 - Pages: 4
...Running Head: MIRROR WORLDS VERSUS APPLE, INC. 1 Mirror Worlds versus Apple, Inc. Willful Infringement MIRROR WORLDS VERSUS APPLE, INC. 2 ABSTRACT This paper will discuss the lawsuit filed by Mirror Worlds LLC against Apple, Inc. for infringement of four patents owned by Mirror Worlds. Mirror Worlds’ patents cover intellectual property; namely that of digital and visual media and the consolidation and sorting thereof. The jury’s verdict in this case awarded Mirror Worlds a substantial amount of money for damages caused by the supposed willful infringement of Apple, Inc. In addition, Apple, Inc.’s arguments, namely involving the claim of willful infringement, evolving into a counterclaim against Mirror Worlds will also be discussed. Keywords: intellectual property, patents, infringement, software, documents, counterclaim, willful infringement MIRROR WORLDS VERSUS APPLE, INC. 3 Mirror Worlds versus Apple, Inc. Willful Infringement In February of 2010, the United States Patent and Trademark Office, USPTO, granted Apple Inc. a design patent on Cover Flow, which covers the design and display of specific documents, but not the functionality. “A patent is a legal right, for a limited term, to exclude others from using, selling or making an invention or discovery.” (Kay, Millonzi and Passannante, 2001). Patent D609715 regards an “animated graphical user interface for a display screen or portion thereof. The process or period in which an image transitions to...
Words: 2081 - Pages: 9
