Orange County NC Website
DocuSign Envelope ID: FCD9FE56-CF01-4E96-B983-B8E8DFE6811C 21 <br /> ALLOCATED LOSS ADJUSTMENT <br /> EXPENSE EXHIBIT <br /> In addition to the terms contained elsewhere in the Agreement,you agree to the provisions listed in this Allocated Loss Adjustment <br /> Exhibit. <br /> 1. Allocated Loss Adjustment Expense ("ALAE") has the same meaning as "Allocated Loss Adjustment Expense" or "ALAE" or <br /> "Defense Expense" or"claim expense" in the applicable Policy or, if the Policy contains no such definition, means the following <br /> costs which can be directly allocated to a particular claim: <br /> A. Fees of attorneys or other authorized representatives where permitted for legal services, whether by outside or staff <br /> representatives. <br /> B. Court,Alternate Dispute Resolution and other specific items of expense whether incurred by an outside vendor or by one of <br /> our employees,including but not limited to: <br /> • Medical examinations of a claimant to determine the extent of our liability, degree of permanency or length of <br /> disability; <br /> • Expert medical or other testimony; <br /> • Autopsy; <br /> • Witnesses and summonses; <br /> • Copies of documents such as birth and death certificates and medical treatment records; <br /> • Arbitration fees; <br /> • Fees or costs for surveillance or other professional investigations which are conducted as part of the handling of a <br /> claim; <br /> • Fees or costs for Risk Control personnel, rehabilitation nurses or other nurses, if the cost of such nurses is not included <br /> in losses,for services which are conducted as part of the handling of a claim; <br /> • Appeal bond costs and appeal filing fees;and <br /> • All reasonable expenses incurred by you in the investigation or defense of a claim. <br /> C. Medical cost containment expenses incurred with respect to a particular claim, whether by an outside vendor or done <br /> internally by an employee for the purpose of controlling losses, to ensure that only reasonable and necessary costs of <br /> services are paid. The expenses include but are not limited to: <br /> • Bill auditing expenses for any medical or vocational services rendered,including hospital bills(inpatient or outpatient), <br /> nursing home bills, physician bills, chiropractic bills, medical equipment charges, pharmacy charges, physical therapy <br /> bills,medical or vocational rehabilitation vendor bills; <br /> • Hospital and other treatment utilization reviews, including pre-certification/pre-admission,concurrent or retrospective <br /> reviews; <br /> • Preferred Provider Network/Organization expenses;and <br /> • Medical fee review panel expenses. <br /> D. Expense(s) not defined as losses which are directly related to and directly allocated to the handling of a particular claim and <br /> are required to be performed by statute or regulation. <br /> E. Supplementary Payments,as defined in those Policies which have a Supplementary Payments provision,except for salaries, <br /> overhead and traveling expenses of carrier employees who are not doing activities previously listed as allocated expenses. <br /> F. Defense Costs, as defined in those Policies which have a Defense Cost provision,except for salaries,overhead and traveling <br /> expense of carrier employees who are not doing activities previously listed as allocated expenses. <br /> G. The following shall not be included as"Allocated Loss Adjustment Expense"or"Defense Expense": <br /> • Salaries,overhead and traveling expenses of carrier employees, except for employees while doing activities previously <br /> listed as ALAE; <br /> • Fees paid to independent claims professionals or attorneys (hired to perform the function of claim investigation <br /> normally performed by claim adjusters)for developing and investigating a claim so that a determination can be made <br /> Version 09.16.19 ALAE Exhibit Orange County Page 19 <br /> CA Form-W041V16F19 <br /> ©(2019)The Travelers Indemnity Company.All rights reserved. <br />