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Claims glossary

Here are the explainers for the technical terms used in insurance claims.

A

Activities of Daily Living (ADL)

The functions that people do daily to maintain an independent way of life. The 6 Activities of Daily Living are washing, dressing, feeding, toileting, mobility and transferring.

Administrator

Person appointed by the Court who is responsible for the distribution of the deceased's estate according to the Intestate Succession Act.


B

Biopsy Report

A report on the body tissue which was removed and examined by pathologist. Also known as Histopathology report.


C

CT Scan Report

An advanced x-ray technique that combines x-ray with computer technology to create cross-sectional images for diagnosis.

Cardiac Enzymes Report

A report on certain enzymes that are released from the heart muscle when the heart muscle dies.

Clinical Abstract Application

An authorisation given to Great Eastern Life to obtain medical or other information for processing of claim. The form is to be completed by the Life Assured or next-of-kin of the Life Assured (in the event where the Life Assured had passed away).

Coinsurance

A percentage of the eligible expenses that the Life Assured is required to pay first after the deductible, before the insurer pays.

Coroner's report

A report from the Coroner (Judge) citing the final cause of death. Usually required for unnatural cause of death.


D

Deductible

A flat dollar amount of eligible expenses that the Life Assured must incur out of his own pocket before the insurer pays.

 

E

Electrocardiogram (ECG)

A non-invasive test that detects and records the electrical activity of the heart.

Estate

The total assets of a person which can be valued in monetary terms.

Ex-gratia

A claim which is paid out on goodwill basis.

Executor/Executrix

A person who is appointed by the deceased to take care of his estate, to ensure that his assets are distributed according to his last written Will.

 

G

Grant of Letters of Administration/Probate

A Court Order stating the legal representatives who are entitled to deal with the deceased's estate.

 

I

Intestate

When a person dies without a Will.

Irrevocable Trust

A trust which cannot be revoke without the consent of all the beneficiaries.

 

M

MRI Report

A special radiology technique designed to image internal structures of the body using magnetism, radio waves, and a computer to produce the images of body structures.

 

P

Post Mortem Report

A systematic examination of the internal organs of the body (including the brain) in order to determine the cause of death and document the state of organ systems in the body.

Pre-existing condition

A physical and/or mental condition of the Life Assured that existed before the policy proposal.

 

R

Reimbursement

To pay back the expense amount which was incurred by the Life Assured.

Repudiated

Rejection of a claim.

 

T

Testate

When a person dies with a Will.

Toxicology Report

A report on the scientific study of the poisons, their effects and the methods of treatment for conditions they produce.

Troponin Report

A report on the troponin level in the blood. When a person has a heart attack, troponin is released into the blood. An abnormal level of troponin, together with other tests, may be used to diagnose a heart attack or other heart damage.

Trust

A legal arrangement whereby a property is held by a person or corporation (trustee) for the benefit of others (beneficiary).

 

U

Utmost good faith

The responsibility to disclose fully and faithfully all material facts which are known to the person concerning his or her insurability.

 

W

Waiting period

A specific period of time that must pass following the onset of a covered condition before any benefits will be paid.