The International Claim Association (ICA) is an association of life and health insurance companies operating primarily in the United States and Canada. The purposes of the ICA include promoting high standards of performance in claim administration and providing a forum for research, education, and the exchange of ideas relating to various aspects of claim administration.

ICA CLAIMS EDUCATION PROGRAM

The ICA Claims Education Program provides introductory and advanced level education in life and health insurance and claim administration for both individual and group coverages. The introductory level, which leads to the designation Associate, Life and Health Claims (ALHC), is divided into two segments: (1) two introductory courses and (2) four ICA courses. The introductory segment provides a foundation in the principal aspects of the life and health insurance business. The ICA segment provides students with a detailed understanding of the administration of life and health insurance claims. The ALHC Program consists of six courses in all, and a specific examination is given for each course. Only the four courses making up Section (2) are represented below. A more advanced level of claims education is also available through the Fellow, Life and Health Claims (FLHC) Program. The ICA Claims Education Program was developed by ICA in cooperation with LOMA and is administered by LOMA’s Education and Training Division.

Source of official student records: Registrar, Education and Training Division, LOMA, 2300 Windy Ridge Parkway, Suite 600, Atlanta, Georgia 30339-8443.

Titles of all evaluated learning experiences
Claim Administration (C3)
Life and Health Insurance Law (C2)
Management of Claim Operations (C4)
Medical Aspects of Claims (C1)
Medical Aspects of Claims (C2)
Medical and Dental Aspects of Claims (C1)

Descriptions and credit recommendations

Claim Administration (C3)
Location: Independent study and proficiency examination program administered from the central offices of LOMA on behalf of the ICA.
Length: Independent study.
Dates: Version 1:  January 1967 - November 1980. Version 2:  December 1980 - December 1988. Version 3: January 1989 - June 2001. Version 4: July 2001 - December 2006.
Objectives:  Version 1 or 2:  Toacquaint the student with the approaches to handling various insurance claim situations and with the administration of the claims department. Version 3 or 4: Apply current principles of claim administration to the various claims presented under life and health insurance contracts.
Instruction: Version 1:  Approaches to handling all types of claims presented under life, health, and group insurance contracts.  Life settlement options and major medical insurance; conduct of investigations, rehabilitation, antiduplication, Federal insurance programs, and tax matters; claims department organization, philosophy, functions, and cost control; special characteristics of Canadian business.  Version 2:  Approaches to handling all types of claims presented under life, health, and group insurance contracts.  Life settlement options and major medical insurance; conduct of investigations, rehabilitation, antiduplication, Federal insurance programs, and tax matters; claims department organization, philosophy, functions, and cost control; administration and processing of dental claims, creditor insurance claims, and reinsurance claims; extra-contractual liability; privacy and confidentiality; special characteristics of Canadian business.  Version 3: The claim decision process; life and health insurance coverages; when coverage begins and ends; misrepresentation in the insurance application; examination and payment of claims for life insurance and supplementary life insurance benefits; medical expense claim administration; disability claim administration; administration of dental expense, credit insurance, reinsurance, and annuity and endowment claims. Version 4: The claim decision process; determining when coverage begins and ends; analyzing and paying life insurance claims and supplemental benefits; handling life insurance; settlement options and taxes; analyzing and paying medical expense claims and supplemental benefits; analyzing and paying claims under disability, long-term care, and endowment insurance; analyzing and paying annuity claims; handling fraud in life, health, and annuity claims.
Credit recommendation: Version 1:  In the lower division baccalaureate/associate degree category or in the upper division baccalaureate category, 2 semester hours in Claims Administration (1/76).  Version 2:  In the upper division baccalaureate category, 3 semester hours in Claims Administration (3/84 revalidation).  Version 3 or 4: In the upper division baccalaureate degree category, 3 semester hours in Claims Administration or Insurance (5/90 revalidation) (12/95 revalidation) (6/02 revalidation).

Life and Health Insurance Law (C2)
(Formerly Life and Health Insurance Law [C1])
Location: Independent study and proficiency examination program administered from the central offices of LOMA on behalf of the ICA.
Length: Independent study.
Dates: Version 1: January 1965 - December 1985. Version 2: January 1986 -  June 1990. Version 3: September 1991 - December 1997.* Version 4: July 2005 - December 2006.*
Objectives: Version 1 or 2: To provide the student with an understanding of contract law as it affects life, health, and group insurance. Version 3: Describe the impact of contract and insurance law on the life and health insurance claim procedure; discuss the actions an insurer can legally take in a wide variety of claim situations; distinguish among and indicate the intent of an insurance policy’s provisions; describe the rights granted to policy-owners and beneficiaries of insurance policies. Version 3: List the sources of law in the United States and describe the regulation of insurance by U.S. state and federal governments; discuss the basic principles of contract law and the concept of agency; describe the provisions, limitations, and exclusions typically found in life and health insurance policies; discuss legal and regulatory issues specific to disability, accident, and group insurance; identify legal issues related to insurance beneficiaries and to wills and trusts; discuss policyowner rights and policy contests, remedies, and damages; explain laws relating to managed care and privacy and to insurance fraud.
Instruction: Version 1, 2,  or 3: Principles of contract law applied to individual and group life and health insurance; insurable interest; policy holder and beneficiary rights; policy provisions; regulation and taxation. Version 4: This course covers the life insurance policy as a legal contract and sets forth the legal aspects of life, health, and group claims. Topics covered include: Insurance law; contract law and agency law; laws related to insurance products; life and health insurance policy provisions, limitations, and exclusions; creation of an insurance contract; disability income and accident insurance issues; group insurance issues; issues related to beneficiaries; issues related to wills and trusts; insurance premium issues; policy contests, remedies, and damages; managed care and privacy; insurance fraud.
Credit recommendation: Version 1: In the lower division baccalaureate/associate degree category or in the upper division baccalaureate degree category, 3 semester hours in Business Law or Life and Health Insurance (1/76). Version 2 or 3: In the upper division baccalaureate degree category, 3 semester hours in Business Law or Life and Health Insurance (4/86 revalidation) (11/92 revalidation). Version 4: In the upper division baccalaureate degree category, 3 semester hours as an elective in Insurance (7/06 revalidation). *NOTE: There is an intentional gap in the credit recommendation between Versions 3 and 4.

Management of Claim Operations (C4)
Location: Independent study and proficiency examination program administered from the central offices of LOMA on behalf of the ICA.
Length: Independent study.
Dates: Version 1: May 1991 - November 1997.  Version 2: December 1997 -  June 2002.
Objectives: Version 1 or 2: Apply management theory to the operation of life and health insurance claim departments; differentiate among the management functions of planning, controlling, organizing, and leading; explain the importance of information management and operations management in the claim area; describe the factors involved in staffing a claim area.
Instruction: Version 1 or 2: Managing the claim area; managing claim staff; managing claim operations. Includes management principles, staffing principles, and decision making tools applicable to claim operations.
Credit recommendation: Version 1: In the upper division baccalaureate degree category, 3 semester hours in Management or Insurance (10/92). Version 2: In the upper division baccalaureate degree category, 3 semester hours as an elective in Management (12/97 revalidation)

Medical Aspects of Claims (C1)
(Formerly Medical and Dental Aspects of Claims (C1) and Medical Aspects of Claims [C2])
(Medical Terminology)*
Location: Independent study and proficiency examination program administered from the central offices of LOMA on behalf of the ICA.
Length: Independent study.
Dates: Version 1: January 1966 - December 1985. Version 2: January 1986 - December 1989. Version 3: January 1990 - January 2003.** Version 4: July 2004 - December 2006.
Objectives: Version 1: To provide the claim examiner with knowledge of human anatomy and disease needed to evaluate life and health insurance claims. Version 2: To provide the claim examiner with knowledge of human anatomy and disease needed to evaluate life, health, and dental insurance claims. Version 3: Apply knowledge of human anatomy, physiology, and disorders of the various body systems to the evaluation of life and health insurance claims; describe the anatomy of the oral cavity as well as dental disorders and corrective procedures and apply this knowledge to the evaluation of dental claims. Version 4: Explain a wide variety of medical terms; describe the anatomy and physiology of the various body systems; describe major pathological conditions affecting each body system; identify important laboratory tests, clinical procedures, and acronyms associated with each body system; identify medical tests and treatments currently in common use.
Instruction: Version 1: Introduction to anatomy, physiology, and disorders of the body systems and of the oral cavity and associated structures; dental corrective procedures; basic medical and dental terminology. Version 2: Introduction to anatomy, physiology, and disorders of the body systems and of the oral cavity and associated structures; dental corrective procedures; basic medical and dental terminology; dental insurance claims. Version 3: Introduction to anatomy, physiology, and disorders of the body systems and of the oral cavity and associated structures; dental corrective procedures; basic medical and dental terminology; life and health claim applications; dental insurance claims. Version 4: Basic word structure; suffixes and prefixes; terminology related to the anatomy and physiology of various body systems: digestive, urinary, reproductive, nervous, cardiovascular, respiratory, blood, lymphatic and immune, and musculoskeletal; terminology related to the skin, eye, and ear; diseases and disorders of the various body systems and organs; laboratory tests, clinical procedures, and acronyms associated with each body system; terminology related to specific areas of medicine: oncology, radiology and nuclear medicine, pharmacology, and psychiatry.
Credit recommendation: Version 1: In the lower division baccalaureate/associate degree category or in the upper division baccalaureate degree category, 3 semester hours in the Life Sciences (introductory), Medical Terminology, or Pathophysiology (introductory) (1/76). Version 2: In the upper division baccalaureate degree category, 3 semester hours in the Life Sciences (introductory), Medical Terminology, or Pathophysiology (introductory) (4/86 revalidation). Version 3: In the upper division baccalaureate degree category, 3 semester hours in the Life Sciences (introductory), Medical Terminology or Pathophysiology (introductory), or as an elective in Insurance (5/90 revalidation) (12/95 revalidation) (1/01 revalidation). Version 4: In the lower division baccalaureate/associate degree category or in the upper division baccalaureate degree category, 3 semester hours in the Life Sciences (introductory), Medical Terminology, or Pathophysiology (introductory) (12/04 revalidation).  *NOTE: This explanatory title, suggested by the National PONSI evaluation team, applies to Version 4. **NOTE: There is a gap of approximately 17 months between January 2003 and July 2004 when the credit recommendation did not apply.

Updated 2/28/07

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