Adjudication is the legal process by which an arbiter or judge reviews evidence and argumentation, including legal reasoning set forth by opposing parties or litigants to come to a decision which determines rights and obligations between the parties involved.
Adjudication can also be the process, at dance competitions, in television game shows and at other competitive forums, by which competitors are evaluated and ranked and a winner is found.
"The legal process of resolving a dispute. The formal giving or pronouncing of a judgment or decree in a court proceeding; also the judgment or decision given. The entry of a decree by a court in respect to the parties in a case. It implies a hearing by a court, after notice, of legal evidence on the factual issue(s) involved. The equivalent of a determination. It indicates that the claims of all the parties thereto have been considered and set at rest."
"Claims adjudication" is a phrase used in the insurance industry to refer to the process of paying claims submitted or denying them after comparing claims to the benefit or coverage requirements. The adjudication process consists of receiving a claim from an insured person and then utilizing software to process claims and make a decision or doing so manually. If it is done automatically using software or a web-based subscription, the claim process is called auto-adjudication. Automating claims often improve efficiency and reduce expenses required for manual claims adjudication. Many claims are submitted on paper and are processed manually by insurance workers.
After the claims adjudication process is complete, the insurance company often sends a letter to the person filing the claim describing the outcome. The letter, which is sometimes referred to as remittance advice, includes a statement as to whether the claim was denied or approved. If the company denied the claim, it has to provide an explanation for the reason why under regional laws. The company also often sends an explanation of benefits that includes detailed information about how each service included in the claim was settled. Insurance companies will then send out payments to the providers if the claims are approved or to the provider’s billing service.
The process of claims adjudication, in this context, is also called "medical billing advocacy".
Adjudication is the process directly following a background investigation where the investigation results are reviewed to determine if a candidate should be awarded a security clearance, or be suitable for a public trust position, which is a job that requires a very knowledgeable and responsible person, often related to national security. It may be determined that the person is not suitable for a public trust position, but is suitable for a non-sensitive position. However, a person may be deemed unsuitable for any position.
From the United States Department of the Navy Central Adjudication Facility: "Adjudication is the review and consideration of all available information to ensure an individual's loyalty, reliability, and trustworthiness are such that entrusting an individual with national security information or assigning an individual to sensitive duties is clearly in the best interest of national security."
Adjudication is the "process of identifying, with reasonable certainty, the type or nature of material or device that set off an alarm and assessing the potential threat that the material or device might pose with corresponding implications for the need to take further action."
Referring to a minorEdit
Referring to a minor, the term adjudicated can refer to children that are under a court's jurisdiction, usually as a result of having engaged in delinquent behavior and not having a legal guardian that could be entrusted with being responsible for him or her. A child dependency or neglect adjudication can also result in a determination that a child is in need of services.
Different states have different processes for declaring a child as adjudicated.
Arizona state law defines a dually adjudicated child as "a child who is found to be dependent or temporarily subject to court jurisdiction pending an adjudication of a dependency petition and who is alleged or found to have committed a delinquent or incorrigible act."
According to Illinois state law, adjudicated means that the Juvenile Court has entered an order declaring that a child is neglected, abused, dependent, a minor requiring authoritative intervention, a delinquent minor or an addicted minor."
Each state and territory has enacted security of payment legislation which provide for adjudication of progress claims, starting with New South Wales in 1999. There is very little harmony between the legislation in each jurisdiction regarding the scope of contract covered and the adjudication procedure. However, in all jurisdictions, adjudications are interim pending final resolution of the dispute under the relevant terms of the contract.
In New South WalesEdit
The Building and Construction Industry Payment Act 1999 came into effect in New South Wales on 26 March 2000 and applies to all construction contracts commenced on or after that date. Amendments to the Act made in 2013 are not retrospective, however, earlier amendments are. The Act does not apply to mining work, however, construction work ancillary to the operation of a mine is covered. The Act also does not apply to work undertaken for a resident owner within the meaning of the Home Building Act 1989.
In NSW. the recent case of Probuild Constructions (Aust) Pty Ltd v Shade Systems Pty Ltd has allowed an adjudicator's determination for a non-jurisdictional error to be overturned through judicial review. The case went against Brodyn Pty Ltd v Davenport which previously held judicial intervention was limited to cases of a breach of essential and basic requirements.
The Building and Construction Industry Payments Act 2004 (BCIPA) came into effect in Queensland in October, 2004. Through a statutory-based process known as adjudication a claimant can seek to resolve payment on account disputes. The act covers construction, and related supply of goods and services, contracts, whether written or verbal. BCIPA is regulated by the Building and Construction Industry Payments Agency, a branch of the Queensland Building Services.
Adjudication is a relatively new process introduced by the government of Victoria, Australia, to allow for the rapid determination of progress claims under building contracts or sub-contracts and contracts for the supply of goods or services in the building industry. This process was designed to ensure cash flow to businesses in the building industry, without parties getting tied up in lengthy and expensive litigation or arbitration. It is regulated by the Building and Construction Industry Security of Payment Act 2002.
Builders, sub-contractors and suppliers need to carefully choose a nominating authority to which they make an adjudication application.
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