Glossary

Qualified person with a disability is, within the scope of the Americans with Disabilities Act (ADA) of 1990, an individual with a disability who satisfies the requisite skills, experience, education, and other job-related requirements of the employment position. Such an individual can perform the essential functions of the position with or without reasonable accommodation.

A qualified plan is an employee benefit plan the Internal Revenue Service (IRS) has approved as meeting the requirements of Section 401(a) of the Internal Revenue Code. Such plans receive favorable tax advantages.

A qualified self-insurer is an organization that has satisfied state filing requirements, met the minimum financial and size criteria, and received approval to self-insure workers compensation or automobile liability. Each state has its own approval process, and its own restrictions on retention limits and security requirements.

A qualifying event, as it pertains to the Consolidated Omnibus Budget Reconciliation Act (COBRA), is an event that triggers the continuation of coverage provisions of the Act. According to the US Department of Labor, the health benefit provisions of COBRA "require group health plans to provide a temporary continuation of group health coverage that otherwise might be terminated." The continuation of coverage can range from 18 months to 36 months, depending on the type of qualifying event, and typically comes with a small administrative charge in addition to the regular premium. Qualifying events include the covered employee's termination, reduction of hours of employment, death of a covered spouse, divorce, entitlement to Medicare of a covered spouse, or bankruptcy of a private-sector employer.

Qualitative claim auditing is the comprehensive review of claim files that seeks to discover whether the claims are being appropriately managed. Some of the criteria used to measure the quality of the claim handling being delivered include adequacy of reserves, timeliness with which the files are handled, experience and skill level of the adjusters, and effectiveness of the internal communications system.

A quality indicator profile is a two-page report prepared by the Centers for Medicare and Medicaid Services that the federal government uses to monitor the level of patient care in federally funded nursing homes. Underwriters of long-term care (LTC) liability insurance also rely on the QIP as a key factor in making pricing and coverage decisions. The factors reflected in a QIP include the prevalence of falls by residents in the past 30 days and incidence of new bone fractures in the past 30 days. The key number found within a QIP is the facility's percentile rank, which can range from 1 to 99. This number indicates how the LTC facility compares to other LTC facilities in the same administrative region. The higher the percentile ranking, the greater the probability the LTC facility is having difficulty in delivering high-quality patient care.

Quantitative claim auditing is a type of audit in which claim files are reviewed to determine whether file reserves and the number of claims match a computer-generated loss run. This type of audit places the emphasis on accuracy rather than on whether the claims are being handled adequately.

A quantity discount is a premium discount given to purchasers of large face amount life insurance policies.

Quantum meruit is a Latin phrase meaning "as much as he deserves." It is usually a claim for a reasonable sum for services provided, where the basis for payment is not determined by a contract. It often arises when a contract fails to fix the price for goods or services supplied, or where there is no contract in place between the parties.

A quasi contract is a legal doctrine invoked by courts that imposes an obligation not actually established in a contract. The most frequent insurance application is in matters relating to preservation of salvage.