Final answer:
The fundamental difference between adjusting claims in the healthcare industry and the property/casualty industry is the relative degree of legalism involved, as the latter requires a solid understanding of various legal doctrines and issues due to its complexity and litigious nature. Option D is correct.
Step-by-step explanation:
The question inquires about the fundamental difference between adjusting claims in the healthcare industry and the property/casualty industry. The correct answer is (D), which is the relative degree of legalism involved. Adjusting claims in the property and casualty industry requires a robust understanding of legal doctrines and issues, as the industry is inclined to involve more complex and litigious matters.
On the other hand, healthcare claim adjustments are primarily focused on the adjudication of medical claims, applying medical billing protocols, and ensuring compliance with healthcare regulations.
While the payment into insurance must cover claims, administrative costs, and allow for profit, the property and casualty sector demands deeper legal knowledge due to the nature of the claims which may involve accidents, workplace injuries, and liability issues. These types of claims can result in lawsuits and require adjusters to have familiarity with contracts, negligence, liability, and other legal concepts to properly handle claims.
Thus, a strong legal foundation is more crucial in property/casualty claims adjusting compared to the healthcare industry.