Medicare Managed Care Manual (Pub. 100-16), Ch. 18b § 170.1
Definition Under Liability Insurance
170.1 - Definition Under Liability Insurance
(Rev. 30, 09-05-03)
• Liability Insurance is insurance (including a self-insured plan) that provides
payment based on legal liability for injuries or illness or damages to property. It
includes, but is not limited to, automobile liability insurance, uninsured and
under-insured motorist insurance, homeowners' liability insurance, malpractice
insurance, product liability insurance, and general casualty insurance. It also
includes payments under state wrongful death statutes that provide payment for
medical damages.
NOTE: This provision does not apply when the homeowner receives payment
under his/her own homeowners' insurance policy, since such a payment does not
constitute a liability insurance payment.
• A Self-Insured Plan is a plan under which an individual or other entity is
authorized by state law to carry its own risk instead of taking out insurance with a
carrier. Authorized by state law means not prohibited by state law. The plan
established for the Federal government under the Federal Tort Claims Act is also
a self-insured plan.
• Uninsured Motorist Insurance is a liability insurance plan under which the
policyholder's insurer pays for damages caused by a motorist who has no
automobile liability insurance or who carries less than the amount of insurance
required by law.
• Under-Insured Motorist Insurance is optional liability insurance available in some
jurisdictions under which the policyholder's level of protection against losses
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caused by another is extended to compensate for inadequate coverage in the other
party's policy or plan.
• An accident is any occurrence or activity that the individual believes resulted in
injury or illness for which he/she holds another party liable.