Course Descriptions - 2016 Joint Conference
We hope you enjoy the variety of courses that we are offering at this year's event. Below, please find a more detailed description of the course and what the instructor intends to discuss. Don't forget to check out our Speaker Bio page for more information on the instructors, as well as our schedule of events!
Ethics (Credited Course)
This presentation will discuss the concepts of ethical behavior, conflicts of interest, and the rights of the investigator/insured during the investigation. Discussions will be had with regard to ethical and professional dilemmas that insurance professionals can face and solutions to those dilemmas, as well as how a code of ethics and solid insurance practices can promote high ethical and professional standards and limit bad faith and related claims.
Sometimes The Answer Isn't No
The goal of SIU is to gather facts to assist the insurer in determining whether or not coverage exists. Many times, an investigation will determine that coverage does indeed apply and the file will require final adjustment. This presentation will focus on what steps taken during a thorough SIU investigation can assist the claims department in the adjustment process. We will outline best practices for gathering valuable information on:
· Policy Limitations
· Quality of claimant’s proofs
In addition, attention will be paid to the reference proceeding and other alternative dispute resolution programs and how best to assemble and preserve evidence during this entire investigative process, inclusive of a SIU investigation. This presentation is appropriate for both claims and SIU personnel and hopefully will provide both with a better understanding on how to maximize the benefits of a SIU investigation.
Social Security Disability Fraud
The presentation will discuss Social Security disability fraud and how the Social Security Inspector General works with private insurance entities to fight fraud. Examples of high risk factors for fraud and impairments prevalent in fraud claims will be discussed in depth. Case studies of successful fraud investigations will be given and discussed with the audience
Investigating Body Shop & Dealership Rental Claims In RI
The proliferation of Body Shop / Dealership Affiliated Rental Companies in Rhode Island has presented unique challenges for Claims Departs and SIUs in respect to claims-handling, investigation and coverage determination . This seminar will address the unique aspects of handling Rhode Island rental claims in the context of “cash rentals” and Rhode Island Risk Policies and will discuss best practices in investigations and claims handling as well as the importance of understanding the dynamics of the Rhode Island Automobile Insurance Plan.
The Impact of Rideshare Fraud on the Insurance Industry
As the Rideshare phenomenon (Uber, Lyft, and Chariot) of the transportation industry enters its fourth year, Insurers are now regularly experiencing the far-reaching effects of this livery-type smartphone service – from misrepresentations and omissions in applications, to deceptive statements made during claims investigations, to the increased submission of fraudulent claims including staged accidents, jump-ins, and premium avoidance. Some Insurers are reacting to this new risk by writing new policies/endorsements, others are utilizing business classifications, some are devising new and innovative solutions…and some have yet to react at all. Many companies have chosen to wait for government legislation to be finalized, but few realize most legislation now in effect does little to help with the more prominent and immediate issues Insurers face. An updated and expanded look from previous presentations, come take an in-depth view of how Rideshare insurance policies and disclaimers work, what problems and issues are being faced by insurers, and how insurers can protect themselves while adapting to this new industry.
Workers Compensation Premium Insurance Fraud
This session will discuss the little known area of workers’ compensation insurance fraud called “premium fraud”. This type of fraud impacts workers’ compensation insurance carriers by hundreds of millions of dollars. The training will focus on what Liberty Mutual Insurance Company does when they receive or discover an allegation of premium fraud. Once Liberty Mutual confirms the allegation in Massachusetts, they refer the matter to the Insurance Fraud Bureau of Massachusetts (IFB). The training will then turn to what the IFB does during their investigation of premium fraud and what the focus points are. Lastly, the session will end with highlights of two successfully prosecuted premium fraud cases.
Identity Theft & Fraud
This class will discuss the proliferation of identity theft, how access to personal information is being gained, the schemes and trends associated with this type of theft, and how this can impact the insurance industry and related claims.
This course will discuss Federal Privacy Laws, Immunity Statutes for Sharing Information with NICB, as well as specific relevant laws for Maine, New Hampshire, Rhode Island, Massachusetts and Connecticut. There will be a brief update on immunity statutes being worked on in Vermont. Further he will discuss information sharing among insurance special investigation units, indemnity versus immunity, relevant case law and specific general laws unique to Massachusetts and the Insurance Fraud Bureau.
Case Study & Discussion: Operation Running Man
The NICB will be discussing a recent case study titled Operation Running Man, an FBI investigation supported by NICB and the insurance industry connecting six medical providers, and an attorney. Operation Running Man provides an inside look at a personal injury lawyer at the center of an automobile accident fraud mill. The presentation will discuss history, obstacles, impact, investigative hurdles and keys to a successful investigation. Actual undercover recordings will be played to confirm uncertainties the insurance industry already suspected.
This course will focus on the investigation of stolen boat and equipment claims. We will discuss case studies on methods uncovered for the transfer of stolen property, titling and registration fraud as well as insurance fraud and motives as they relate to marine insurance cases. Actual case history as well as statistical analysis will be utilized in this seminar. Theft trends will also be discussed. Lastly, we will discuss techniques available to the investigator, and underwriters, to investigate and combat marine insurance fraud and theft from the underwriting application through to the final proof of loss.
The Drone Explosion: Implications for the Insurance Industry
Drones are unmanned aerial vehicles, or UAVs, regularly equipped with hi-resolution lenses, remotely operable by your friendly neighborhood government official, and now, thanks to the recent emergence of affordable models, are readily available to small businesses, private investigators, insurers, as well as your average untrained consumer. The explosion of drones onto the market offers the insurance industry myriad new opportunities to uncover and investigate fraud – while simultaneously exposing insurers to a variety of new headaches with respect to personal and commercial claims for property damage, bodily injury, invasion of privacy, wiretapping, emotional distress, and trespass. Come learn about the FAA’s new regulations and how Insurers can legally utilize drones to enhance all types of claim and SIU investigations, while exploring ways to anticipate the submission of drone-related claims and mitigate your company’s exposure to new risks.
Handling litigation of Low Dollar Auto Cases In Subrogation and Litigation Basics in MA, ME, NH, RI & VT.
With auto cases valued at less than $7,500-is it worth it to pursue the at-fault party in court? What if they don’t have insurance? What if they don’t have a driver’s license, assets or employment?
We will discuss the challenges associated with these low dollar cases and the best techniques you can use to avoid litigation. When litigation cannot be avoided, we will cover and discuss litigation in the New England states, from Small Claims, District Court, Superior Court, and newly enacted Business Courts. We will also discuss post-judgment collection action that can be taken to try and recover judgments issued by the court.
Agent & Producer Fraud
This course seeks to provide training to investigators who may have an occasion to investigate a matter involving an insurance producer. The course will discuss the different ways producers steal money from customers, carriers and finance companies. The attendees will hear about real-life cases that were worked both from the SIU side as well as the role of the criminal investigator. The schemes will involve cases such as: producers creating fake insurance companies and selling multi-million dollar bonds, stealing customer’s identities and using the information to get money from finance companies, appointed producers who stole premium from the carrier, producers who simply steal money directly from the customers, and lastly the producer who provides fake Certificates of Liability to his customers and/or helps them commit insurance fraud.
Dissecting a Physical Therapy Record
This training class put on by Bruce Levine, PT, MS will discuss the unique language an investigator will encounter in a physical therapy record related to the evaluation and treatment of a patient. The objectives of this training are to clarify terminology and expound on the what the different components of an evaluation are and what the logical flow of an evaluation should look like.
Jewelers Block Claims "Different Shades of Grey "
Type and trends in claims
Avoiding Defamtion Liability: The Lessons of State Farm vs. Radcliff
The Indiana case of State Farm vs. Radcliff resulted in an affirmed award of $14.5 Million for State Farm SIU's alleged defamation of a roofing contractor, one of the largest defamation awards in US history. Overlaid with the facts and the verdict of the Radcliff case, this presentation will explore the legal elements of and defenses to defamation claims and outline strategies for avoiding defamation liability when investigating losses and claims suspected to be fraudulent.
An overview of Heavy Truck Event Data Recorders in Crash Investigation and Reconstruction Today and in the Future.
This course will discuss an overview of the systems and data in Event Data Recorder that are present today and what is in the future. Where possible, Mr. DiTallo will show how these stems are used in investigations, crash reconstructions and fraud investigations.
The Art of Surveillance
This course will cover:
• Perception of Surveillance vs Reality
• Surveillance Laws & Ethics
• Pretexting Do’s and Don’ts
• When to Utilize surveillance-Red Flags & Fraud Indicators
• Pre-Surveillance Efforts for a Successful Surveillance
• Examples of Effective Surveillance
Social Media Updates & Finding Your Target’s Facebook Profile When They Are Hiding
This course will give you an overview of current social media trends, and will discuss recent changes and advancements in the various social media platforms like Instagram, Twitter, etc. and how you can access someone's profile without loging in - legally. Any new and useful third party applications that can assist an investigator with their work will be reviewed as well. In addition to the general discussion on these platforms, this course will also delve more fully into Facebook, one of the most widely used social media platforms in use today. The likelihood of finding valuable evidence is extremely high, but finding an associated profile can be difficult. This section looks at Facebook from an insurance investigative standpoint: what features may produce results, how to locate information from a seemingly ‘private profile’, and how to locate a ‘hidden’ profile utilizing currently available data, even when someone may not be using their real name.
Everything Insurance Adjusters Need to Know About Airbags and EDRs, But Didn't Know to Ask
This presentation will provide an overview of Car and Light Truck Event Data Recorders: How they work, what they record, and the legal requirements to access and use the data. It will also provide and overview of how airbags and other supplemental restraints work and how to tell if they really deployed or if they were just made to look that way.