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.

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:

    · Damages
    · Policy Limitations
    · Exclusions
    · 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.

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

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.

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.

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.

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.

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.