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The Legal Responsibility of Insurance Companies towards Customers for Mistakes by Commercial Health Insurance Agents in Indonesia Angdiarto, Ricardo Stanislaus; Huda, Mokhamad Khoirul
Soepra Jurnal Hukum Kesehatan Vol 10, No 1: Juni 2024
Publisher : Universitas Katolik Soegijapranata Semarang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24167/sjhk.v10i1.11930

Abstract

The relationship between the health insurance company and the customer is a coverage relationship which is proven by the existence of an insurance policy. KThe authority of an insurance agent to market an insurance product comes from an Agency Agreement.The insurance company's legal responsibility related to insurance agent errors can take the form of criminal, civil and administrative responsibility. The research aims 1) to explain the legal relationship of the parties in the health insurance agreement and 2) to explain the legal responsibility of the insurance company related to the insurance agent's error for health. The type of research used in writing this research is normative juridical research, namely research that examines the internal aspects of positive law. There are several types of approaches in legal research that were used in the preparation of this paper, namely 1) Statute approach, namely the approach used to study and analyze all laws and regulations relating to the legal issue being handled.[1]; 2) Conceptual approach (conceptual approach). The relationship between the agent and the helath insurance company is a contractual relationship as evidenced by an agency agreement for health. Agents act for and on behalf of insurance companies, where agents market and sell insurance products. The relationship between the insurance company and the customer is a coverage relationship which is proven by the existence of an insurance policy. The authority of an insurance agent to market an insurance product comes from an Agency Agreement. The conclusion of research showed that the legal relationship between the parties is interrelated and there is a policy agreement.
Perlindungan Hukum Rumah Sakit Atas Jasa Pelayanan Yang Tidak Dibayar Oleh Badan Penyelenggara Jaminan Sosial (BPJS) Shi, Ng Phi; Huda, Mokhamad Khoirul; Nugraheni, Ninis; Al-Hasni, Fariz
Jurnal Ilmiah Muqoddimah: Jurnal Ilmu Sosial, Politik dan Hummaniora Vol 8, No 3 (2024): Agustus 2024
Publisher : Universitas Muhammadiyah Tapanuli Selatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31604/jim.v8i3.2024.1348-1357

Abstract

BPJS Kesehatan memiliki kewajiban membayar Fasilitas Pelayanan Kesehatan (FASKES) atas layanan yang telah diberikan paling lambat 15 (lima belas) hari kerja setelah berkas klaim diterima lengkap dan benar. Terkait klaim pelayanan oleh rumah sakit kepada BPJS Kesehatan sering ditemui permasalahan, seperti ketidaksesuaian tarif yang diajukan dengan tarif yang tercantum dalam paket INA CBGs dan yang dibayarkan oleh BPJS Kesehatan, ataupun keterlambatan pembayaran klaim oleh BPJS Kesehatan.  Persoalan ini timbul dikarenakan, pihak BPJS menganggap bahwa berkas klaim yang diajukan oleh pihak rumah sakit masih ditemukan ketidaksesuaian dengan prosedur pengajuan klaim, padahal pelayanan yang telah dilakukan di rumah sakit sebelumnya telah diverifikasi oleh TIM verifikator BPJS dan pihak rumah sakit telah menerima sejumlah pembayaran 70% dari total pengajuan. Namun, ketika ada audit atau post review klaim, rumah sakit diminta mengembalikan dana yang sudah dibayarkan sebagai jasa pelayanan bahkan sudah dibukukan dalam laporan pajak. Kata kunci:  Perlindungan Hukum, Pelayanan, Rumah Sakit
Legal Responsibility of Orthopedic Physicians Towards the Authority to Assess Disability and Assess Return to Work in Workers with Extremity Disabilities Due to Work Accidents Henry Ricardo Handoyo; Mokhamad Khoirul Huda
Journal of Law, Politic and Humanities Vol. 5 No. 2 (2024): (JLPH) Journal of Law, Politic and Humanities
Publisher : Dinasti Research

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.38035/jlph.v5i2.1139

Abstract

This study analyzes the legal responsibility of orthopedic doctors in assessing disability and return to work fitness for workers with limb disabilities due to work accidents. The focus of this study includes aspects of legal regulation, medical ethics standards, and the legal implications of negligence in assessment practices. The analysis was conducted based on Article 46 of Law No. 44 of 2009 concerning Hospitals and the principle of vicarious liability, which highlights the importance of hospital responsibility for the actions of doctors operating under their supervision. This aims to protect patients and minimize the risk of litigation. The method used in this study is normative juridical with a descriptive-analytical approach. This study emphasizes the importance of clear communication and comprehensive documentation in medical practice as part of efforts to prevent negligence. The results of the study indicate that the application of strict professional standards and ongoing training can strengthen legal protection for orthopedic doctors. In addition, this also has the potential to increase patient trust in medical practice. Thus, this study contributes to the understanding of legal and ethical responsibility in the context of treating patients with disabilities due to work accidents.
Legal Protection of Participants of the Regional Contribution Assistance Social Security Agency in Choosing A First-Level Health Facility Hidayah, Nurul; Huda, Mokhamad Khoirul; Pramono, Agung
Journal of Language and Health Vol 5 No 3 (2024): Journal of Language and Health
Publisher : CV. Global Health Science Group

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/jlh.v5i3.5374

Abstract

In order to guarantee that all citizens, notably individuals who have enrolled in national health insurance, are capable of getting medical care without any barriers, national health insurance is necessary. This research indicates to analyze the legal safeguards provided for individuals that are part of the national health insurance program whenever choosing first level health facilities. This study combines a normative and empirical approach for examining the laws and regulations controlling the legal entitlements of national health insurance participants, as well as their implementation in practice. Legal materials for this study were collected from books, magazines, articles, papers, journals, newspapers, and works by legal experts to obtain relevant secondary legal data. The findings are presented systematically, linking the materials to address the research problem comprehensively. In the analysis phase, which is crucial for the study, the collected data is processed and interpreted to uncover truths that answer the research questions. The legal material was analyzed qualitatively using descriptive-analytical methods. This approach relates the identified issues to literature, expert opinions, and applicable legal regulations. The outcomes of the research reveal that, despite legal regulations granting national health insurance participants the opportunity to choose first-level health care facilities, this right is still violated. The key hurdles include the limited number of first-level health facilities that partner with national health insurance, unequal distribution of health facilities, and a lack of socialization from national health insurance. The research presented here suggests raising socialization about national health insurance participants' rights since deciding on first level healthcare facilities, raising the number of joining forces primary level with health facilities, and more rigorous oversight of participant rights implementation. With these efforts, it is envisaged that the rights of national health insurance participants to choose first level health facilities may be properly preserved and enable expanded access and quality of health services in Indonesia.
State Responsibility in the Fulfillment of Public Health Rights through JKN: A Comparative Study with the Republic of China Fitriyah, Dyah Kusumaning; Huda, Mokhamad Khoirul; Pramono, Budi
Journal of Language and Health Vol 5 No 3 (2024): Journal of Language and Health
Publisher : CV. Global Health Science Group

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/jlh.v5i3.5474

Abstract

The right to live with an adequate standard for the health and well-being of oneself and one's family is a human right recognized by all countries worldwide. Therefore, the state has a responsibility to provide proper healthcare to improve public health and the well-being of its citizens, where the implementation of social security is a prerequisite for a welfare state. Based on these circumstances, the following issues are formulated: 1) The regulation of the national health insurance system in Indonesia and the Republic of China; 2) The responsibilities of both countries in providing health protection through national health insurance. Objective to analyze the regulation of each national health insurance system in the Republic of China and Indonesia and analyze the legal efforts made by each country to protect its citizens to obtain welfare in terms of health insurance. This study is normative juridical research with a legislative approach, a conceptual approach, and a comparative approach. We employ a documentary study as a data collection method, involving primary, secondary, and tertiary sources related to the topic. Legal material analysis is conducted using a qualitative approach to address the research problems. This method produces descriptive-analytical data in the form of written, verbal, or actual behavior. The secondary data obtained through the documentary study will be analyzed concerning the applicable laws in both countries and compared accordingly. The findings of this thesis indicate that there are similarities and differences in the regulation of national health insurance in the two countries, particularly in terms of history, insurance providers, participation, covered services, and financing. Indonesia has fulfilled its constitutional obligation as stipulated in the 1945 Constitution and Law No. 40 of 2004 on the National Social Security System, which mandates the implementation of the Indonesian National Health Insurance to provide healthcare services for every citizen. Meanwhile, in the Republic of China (Taiwan), the National Health Insurance fulfills the constitutional obligations set forth in the Constitution of the Republic of China. The national health insurance systems in Taiwan and Indonesia have different approaches. Taiwan implements a centralized National Health Insurance, managed by the NHIA, with funding from individual contributions, employers, and government subsidies. In Indonesia, the National Health Insurance is managed by the Health Social Security Agency (Badan Penyelenggara Jaminan Sosial Kesehatan) under the Social Security Agency Act, despite facing accessibility and efficiency challenges. Both countries protect the health rights of their citizens through their respective legal bases. Taiwan relies on the Constitution of the Republic of China and National Health Insurance regulations, while Indonesia uses the 1945 Constitution and related regulations. To improve transparency, funding, and service quality, Indonesia can study Taiwan's National Health Insurance system and strengthen policy evaluation and public education.
The Responsibility of A Notary Regarding The Cancellation of a Notarial Deed Containing a Pretended Agreement Based on a Decision From the District Court Fitrotinisak, Istna Kamelina; Huda, Mokhamad Khoirul
JIHAD : Jurnal Ilmu Hukum dan Administrasi Vol 7, No 1 (2025): JIHAD : Jurnal Ilmu Hukum Dan Administrasi
Publisher : Lembaga Penelitian dan Pendidikan (LPP) Mandala

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58258/jihad.v7i1.8133

Abstract

There are various ways a person can obtain land rights, including borrowing and borrowing by handing over land rights as collateral. The lending party also makes a power of sale agreement and follows up on the sale and purchase agreement. When the borrower breaks the contract, the lending party approaches the PPAT to have a sale and purchase deed drawn up and registered with the Land Office for name change purposes. The method used is normative juridical with a statutory regulation approach, concept approach and case approach. The research results obtained: The land sale agreement made before the PPAT is not the same as in fact it does not have legal force, does not meet objective requirements, so the result is that it is null and void/is considered non-existent. PPATs that make pseudo-agreements do not apply the precautionary principle in making deeds, namely acting untrustworthy, dishonest, not thorough, not independent, taking sides, and not safeguarding the interests of the parties involved in legal actions. The notary's actions violate the Debtor's rights which are protected by law. Debtors can sue for compensation on the basis of violating Article 1365 of the Civil Code in conjunction with Article 16 paragraph (12) UUJN, violating Article 3 point 4 of the Notary Code of Ethics.
Perlindungan Hukum Rumah Sakit Atas Jasa Pelayanan Yang Tidak Dibayar Oleh Badan Penyelenggara Jaminan Sosial (BPJS) Shi, Ng Phi; Huda, Mokhamad Khoirul; Nugraheni, Ninis; Al-Hasni, Fariz
Jurnal Ilmiah Muqoddimah: Jurnal Ilmu Sosial, Politik dan Hummaniora Vol 8, No 3 (2024): Agustus 2024
Publisher : Universitas Muhammadiyah Tapanuli Selatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31604/jim.v8i3.2024.1348-1357

Abstract

BPJS Kesehatan memiliki kewajiban membayar Fasilitas Pelayanan Kesehatan (FASKES) atas layanan yang telah diberikan paling lambat 15 (lima belas) hari kerja setelah berkas klaim diterima lengkap dan benar. Terkait klaim pelayanan oleh rumah sakit kepada BPJS Kesehatan sering ditemui permasalahan, seperti ketidaksesuaian tarif yang diajukan dengan tarif yang tercantum dalam paket INA CBGs dan yang dibayarkan oleh BPJS Kesehatan, ataupun keterlambatan pembayaran klaim oleh BPJS Kesehatan.  Persoalan ini timbul dikarenakan, pihak BPJS menganggap bahwa berkas klaim yang diajukan oleh pihak rumah sakit masih ditemukan ketidaksesuaian dengan prosedur pengajuan klaim, padahal pelayanan yang telah dilakukan di rumah sakit sebelumnya telah diverifikasi oleh TIM verifikator BPJS dan pihak rumah sakit telah menerima sejumlah pembayaran 70% dari total pengajuan. Namun, ketika ada audit atau post review klaim, rumah sakit diminta mengembalikan dana yang sudah dibayarkan sebagai jasa pelayanan bahkan sudah dibukukan dalam laporan pajak. Kata kunci:  Perlindungan Hukum, Pelayanan, Rumah Sakit
Tanggung Jawab Hukum Rumah Sakit Gigi dan Mulut Pendidikan dalam Menjamin Standart Kompetensi Lulusan Pendidikan Profesi Dokter Gigi Artanty, Dian; Huda, Mokhamad Khoirul; Persada Putera, Andika
Jurnal Ilmu Hukum, Humaniora dan Politik Vol. 4 No. 6 (2024): (JIHHP) Jurnal Ilmu Hukum, Humaniora dan Politik (September - Oktober 2024)
Publisher : Dinasti Review Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.38035/jihhp.v4i6.2705

Abstract

Penelitian yang berjudul Tanggung Jawab Hukum Rumah Sakit Gigi Dan Mulut Pendidikan Dalam Menjamin Standart Kompetensi Lulusan Pendidikan Profesi Dokter Gigi ini bertujuan untuk  menganalisis tanggung jawab hukum rumah sakit gigi dan mulut pendidikan dalam menjamin terselenggaranya standart kompetensi pendidikan profesi dokter gigi dengan mengacu kepada PP 93 Tahun 2015 tentang rumah sakit pendidikan. Penelitian ini menggunakan metode yuridis normative dengan menggunakan pendekatan perundang-undangan, pendekatan konseptual, dan pendekatan komparatif. Hasil penelitian terdapat perbuatan melanggar hukum yang dilakukan oleh rumah sakit gigi dan mulut pendidikan terhadap mahasiswa pendidikan profesi dokter gigi karena tidak menyediakan pasien/klien sesuai dengan kebutuhan pembelajaran sesuai dengan Pasal 5 PP  93 Tahun 2015 tentang rumah sakit pendidikan, Perbuatan melanggar hukum yang dilakukan oleh rumah sakit gigi dan mulut pendidikan tersebut dapat dikenakan sanksi administrasi berupa teguran tertulis, denda administratif, pencabutan atau pembatalan status rumah sakit gigi dan mulut pendidikan, dan penghentian fungsi sebagai rumah sakit pendidikan.
Characteristics of Professional Liability Insurance for Doctors in Indonesia Setiawan, I Putu Gde Budhi; Huda, Mokhamad Khoirul
Jurnal Dinamika Hukum Vol 25 No 1 (2025)
Publisher : Faculty of Law Universitas Jenderal Soedirman

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20884/1.jdh.2025.25.1.15465

Abstract

Regulation of the Minister of Health of the Republic of Indonesia Number 755/MENKES/PER/IV/2011 concerning the Organization of Medical Committees in Hospitals in the section on credential mechanisms and granting of clinical authority for medical personnel in Hospitals in number 12 point D states that: "Doctors have Professional Indemnity Insurance ."This provision creates an obligation for hospitals or doctors to have professional liability insurance for doctors to protect their profession. This study aimed to determine the characteristics of professional liability insurance for doctors. The method used in this study is normative juridical with a statutory approach and a conceptual approach. This study indicates that professional liability insurance for doctors is included in loss insurance because what is insured is the risk of compensation for the doctor's profession carried out by the doctor in carrying out his profession. At the same time, the doctor's medical risk is not covered according to what is regulated in the policy. In addition, the characteristics of professional liability insurance for doctors are also related to the grouping of the level of risk of medical negligence in each classification of doctors. This group determines the premium and compensation paid to the doctor as compensation to the patient. Doctors use insurance claims to compensate patients if the doctor commits medical negligence and other costs.
Perlindungan Hukum Konsumen Terhadap Penjualan Air Minum Isi Ulang yang Tercemar Bakteri E-Coli Subagiyo, Rinka Laila; Huda, Mokhamad Khoirul; Adriano, Adriano
Innovative: Journal Of Social Science Research Vol. 4 No. 4 (2024): Innovative: Journal Of Social Science Research
Publisher : Universitas Pahlawan Tuanku Tambusai

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/innovative.v4i4.14539

Abstract

Kebutuhan akan air bersih dan layak konsumsi di Indonesia meningkat seiring dengan bertambahnya populasi. Studi ini menyelidiki perlindungan konsumen dari bahaya pembelian air minum isi ulang yang tercemar bakteri E-Coli, sekaligus mengeksplorasi kewajiban hukum penjual. Melalui pemanfaatan penelitian yuridis normatif yang meliputi metodologi perundang-undangan, konseptual, dan komparatif, ditemukan temuan bahwa penjual menanggung tanggung jawab perdata, pidana, dan administratif. Hal ini mencakup kewajiban untuk menawarkan restitusi, mematuhi peraturan kesehatan, dan melakukan penilaian rutin terhadap kemurnian air. Pelanggaran terhadap standar kesehatan ini berdampak serius pada kesehatan konsumen, menurunkan kepercayaan masyarakat, dan mengindikasikan perlunya pengawasan yang lebih ketat. Kesimpulannya, perlindungan hukum konsumen dan penegakan regulasi yang ketat sangat diperlukan. Penelitian selanjutnya disarankan untuk mengevaluasi efektivitas pengawasan dan penegakan hukum serta mengembangkan model edukasi konsumen yang lebih efektif.
Co-Authors Abdullah Khamdi Adilia Bi Maya Antari Adriano Adriano, Adriano Agung Pramono, Agung Agus Yudha Hernoko Ahmad Fadhli Busthomi Al-Hasni, Fariz Andika Persada Putera Andika Persada Putra Angdiarto, Ricardo Stanislaus Anton Cahyono Artanty, Dian Askan Asmuni Brilian TitaPutri BUDI PRAMONO Cempaka Dewi Chandranita Manuaba Cinderella A.N Rieuwpassa Deny Sulistyorini Desy Martha Panjaitan Dian Anggraini Wikamorys Dian Sari Pratiwi Dwikky Ananda Rinaldi Dyas Witri Murtiningsih Edwin Triwidianto Ernawaty Ernawaty Etik Nunuk Setyorini Fitriyah, Dyah Kusumaning Fitrotinisak, Istna Kamelina Gede Angga Dharmadiputra Gede Sanjaya Ghansham Anand Gregory Agung Himawan Heni Pujiastuti Henry Ricardo Handoyo Herliyani Nor Hidayat I Nyoman Sudastra Intan Sudarmadi Irma Indra Wahyuni Khusnul Huda Made Maylisca Theresia Mulya Diprasta Makhfudli Makhfudli Mohammad Zamroni Mohammad Zamroni Mohammad Zamroni Muhammad Firdan Resaldi Muhammad Joni Ardi Ninis Nugraheni Nisa AmaliyaVariansyah Noviana Indarti NURUL HIDAYAH Onge Margareth Hendro Putri, Ruri Eka Putu Bagus Redika Janasuta R. HardadiAirlangga Retno Ariani Rinaldi, Dwikky Ananda Rizka Dianita Sadjijono Sari, Betty Yunita Setiawan, I Putu Gde Budhi SherlyIntan Shi, Ng Phi Sri Ariani Sri Mugirahayu Subagiyo, Rinka Laila Sugianto Prajitno Sulaksono Sulaksono Sutarno Sutarno Suwondo Ariyanto Swabawa Wicaksana Sylvia Meylinda Tagor Sibarani Vinandita Nabila Karina Wahyudi Wahyuni, Irma Indra Waty Anton Widyana Beta Arthanti Widyasih Pritasari Yoan Nursari Simanjuntak Yuna Ariawan