Optimal Claim Settlement Strategies under Constraint of Cap on Claim Loss

In this paper, we examine the question of how to devise an optimal insurance claim settlement scheme under the constraint of a cap on the amount of the claim payment. We establish objective functions to maximize the net benefit due to exaggerated claims while at the same time maximizing the total expected wealth of the insured. Then, we establish a dual objective function to minimize the total expected loss, including the perspective of the insurer. Finally, we illustrate applications of our work and provide numerical analysis of it along with an example.

IMPLEMENTASI PROGRAM BANTUAN PEMERINTAH ASURANSI NELAYAN BPAN DI KECAMATAN TANGGETADA KABUPATEN KOLAKA

The purpose of this study is to analyze the implementation of the Fisherman Insurance Government Program in Tanggetada District, Kolaka Regency. This study uses a qualitative descriptive type of research that provides an overview of all the problems regarding the implementation of the Fisherman Insurance Government Assistance (BPAN) program in Tanggetada District, Kolaka Regency. The results, discussion and conclusions of this study indicate that there are four critical factors that affect the success of the implementation process. The first is communication, where the socialization of BPAN has not gone well, because information about the BPAN program has not been distributed properly to all fishermen in Tanggetada sub-district. Second, natural resources, where there is no socialization budget incentive for employees or extension workers. The third disposition, where the implementation of the Fisherman Insurance Government Assistance program, from the service is not committed because they have not felt the benefits as promised to provide welfare for themselves and their families, there is no democratic nature of the implementer because there are still fishermen who do not get a fisherman insurance card. The fourth is the bureaucratic structure, where the Fisherman Insurance Government Assistance program has SOPso that the implementation has a reference, namely the service is expected to be able to cooperate in the issuance process and the fishermen's insurance claim process.Keywords: Fisherman Insurance; Government Assistance; Implementation AbstrakTujuan penelitian ini adalah menganalisis Implementasi Program Pemerintah Asuransi Nelayan di Kecamatan Tanggetada Kabupaten Kolaka. Penelitian ini menggunakan jenis penelitian deskriptif kualitatif yaitu memberikan gambaran seluruh permasalahannya tentang implementasi program Bantuan Pemerintah Asuransi Nelayan (BPAN) di Kecamatan Tanggetada Kabupaten Kolaka. Hasil penelitian, pembahasan dan kesimpulan dari penelitian ini menunjukan bahwa terdapat empat critical factors yang mempengaruhi keberhasilan proses implementasi. Pertama komunikasi, dimana dalam sosialisasi BPAN belum berjalan dengan baik, karena informasi tentang program BPAN belum tersalurkan dengan baik kepada seluruh nelayan di kecamatan tanggetada. Kedua sumber daya alam, dimana dalam insentif anggaran sosialisasi yang dilakukan oleh pegawai maupun penyuluh tidak ada. Ketiga disposisi, dimana pelaksanaa program Bantuan Pemerintah Asuransi Nelayan, dari dinas tidak bersikap komitmen karena belum merasakan manfaat seperti yang dijanjikan memberikan kesejahtraan bagi dirinya dan keluarganya, tidak adanya sifat demokratis dari pelaksana karena masih ada nelayan yang tidak mendapatkan kartu asuransi nelayan. Keempat struktur birokrasi, dimana program Bantuan Pemerintah Asuransi Nelayan memiliki SOP agar pelaksanaannya memiliki acuan, yaitu dinas diharpakan dapat menjalin kerjasama dalmam proses penerbitan dan proses klaim asuransi nelayan. Kata Kunci: Asuransi Nelayan; Bantuan Pemerintah; Implementasi

Population-Based Distribution of Mycobacterium avium and Mycobacterium intracellulare in Japan

This study aimed to clarify the population-based distributions of Mycobacterium avium and Mycobacterium intracellulare in Japan. We conducted a combined analysis of the national insurance claim and microbiological databases. The incidence rates of M. avium by province were similar throughout the country, with some exceptions, such as in Okinawa, probably because the bathing customs are different from those in mainland Japan. In contrast, M. intracellulare showed a gradual increase from the central part of the country to the southwestern region, with precise gradation, which may indicate infection sources in the natural environment. This study found that assessment of the infection route of M. intracellulare in the natural environment, which is similar to the distribution of M. intracellular patients, is warranted. In conclusion, improvement of the household environment could decrease the incidence of M. avium, while environmental countermeasures will be required to decrease the incidence of M. intracellulare.

Rejection of Accident Insurance Claims by Insurance Companies

Insurance is a form of compensation for the occurrence of uncertain risks and the delegation of responsibility to bear those risks. The event of this risk is uncertain because it depends on uncertainty. The transfer of risk is carried out by making an insurance agreement or insurance agreement. The first party is usually referred to as the insured. The second is the party willing to accept the risk of the first party by accepting a payment called a premium. Risk takers are often referred to as insurance companies. The research method used in this study uses a legal approach research method (statute approach) and a conceptual approach (conceptual approach). Based on the results of this study, the researcher states that the basis or cause of the rejection of an insurance agreement is because the insurance agreement is a conditional agreement, where the insurer only bears the loss suffered by the insured party following the terms of the event that resulted in the loss to the insured as agreed, by the parties in the insurance agreement. Or the insured party does not carry out its obligations to pay premiums to the insurer. The legal remedy that the insured party can take if the insurer rejects the claim is to file a lawsuit at the local District Court, as regulated in Article 23 of Law no. 8 of 1999. It can be completed through the BMAI institution.Keywords: Insurance, Claim, Dispute Resolution.