IFM Program at a Glance

3:00 p.m.–5:00 p.m.

General Registration

6:00 p.m.–8:00 p.m.

Welcome Reception

7:00 a.m.–5:00 p.m.

Registration/Information Desk Open

7:00 a.m.–8:00 a.m.

Continental Breakfast in the Exhibit Hall

8:00 a.m.–9:30 a.m.

General Sessions:
Welcome

• Rich Della Rocca, ISO

NICB Operations

• Joseph Wehrle, National Insurance Crime Bureau

Keynote Address

• Jeff Atwater, Florida Department of Financial Services

9:30 a.m.–10:50 a.m.

101. Point-of-Sale Perimeter Defense
As the SIU develops information on questionable claims, are the underwriting and product development areas identifying and examining instances of control "white space?" This session will examine questionable claims and the correlating attributes that can be isolated and used to build better screening tools to resist the "purchase with intent scenario."

• Nick Bogdan, Gainsco Insurance
• Adam Featherling, Unitrin Insurance
  

102. NICB Medical Task Force Activities     
The NICB has made significant efforts in the intervention of large-scale medical ring activity throughout the country. The "task force" approach of using local investigative resources with specialized experience, training, and data analysis tools has taken hold and is producing positive results in teaming with law enforcement and carrier SIU personnel. This session will highlight the work of task forces that are in place and will discuss the potential for additional areas of pursuit.

•  Fred Burkhardt, NICB
• Jim Schweitzer, NICB

103. SIU Management Panel Forum
Senior SIU directors will field questions and share opinions on the issues of managing the investigative function from the home-office vantage point. This is a follow-up session from last year and will pick up on discussion topics including management strategy, budget planning, risk avoidance, trend analysis, and change preparedness from the points of view of national SIU directors.

• John Sargent, Met Life Home & Auto (moderator)
• Ken Jones, Travelers
• Doug Ashbridge, Farmers Insurance
• Jeff Moore, Progressive Insurance

104. Medical Service Provider Issues and Durable Medical Equipment Case Study
Medical service provider referrals bring with them certain challenges requiring innovative thinking in developing investigative techniques that lead to prompt and accurate conclusions. This session will explore the specialized skills and investigative regimens that can lead to greater productivity in these assignments. This session will also present the facts and resolution of a recent and prominent durable medical equipment case study that made headlines this past year.   

• Matthew J. Griffin, Met Life
• Barry I. Levy, Rivkin Radler LLP
• Thomas Lohmann, National Insurance Crime Bureau

10:50 a.m.–11:20 a.m.

Refreshment Break in the Exhibit Hall

11:20 a.m.–12:40 p.m.

201. Point-of-Sale Perimeter Defense
(A repeat of session 101)

202. NICB Medical Task Force Activities
(A repeat of session 102)

203. SIU Management Panel Forum
(A repeat of session 103)

204. Medical Service Provider Issues and Durable Medical Equipment Case Study
(A repeat of session 104)

12:40 p.m.–1:40 p.m.

Lunch in the Exhibit Hall

1:40 p.m.–3:00 p.m.

301. Social Network Data–Emerging Issues of Risk
The information superhighway has led to new areas of intelligence. Social networking is leaving a trail of information but the use of that information is not without risk. Led by a recognized authority in this developing arena, this session will examine the management of those risks, looking into the issues of privacy, investigative ethics, company constraints, and current case law. Get the latest on what information is out there, how to get it, and what pitfalls you need to avoid.

•  Roy Mura, Mura & Storm

302. Litigation Management Panel
The nature of SIU work can often lead to litigation. In a forum setting, five nationally recognized attorneys will discuss the latest issues in SIU-related litigation. Topics will include recent case law, provider trends, and long-term planning and strategy. Discussion will also include case triaging, early SIU intervention, cost control, council selection protocols, and relationship management.

• Frank Sztuk, Hanover Insurance (moderator)
• Jim Hailey, Deutsch, Kerrigan & Stiles
• Gordon Graber, Sullivan & Graber
• Glenda Ganem, McGovern, Snyder & Ganem
• Mario Delano,Campbell, Foley

303. Hail Storm Damage and Questionable Claims
Hail storm damage is becoming an increasing important issue in the world of SIU. Session topics will include investigation technique, management concerns, technology development, and the latest trends emerging on questionable hail claims. Discussion will also include additional weather issues.

• Kyle Beatty, AER
• Ann Marie Smith, State Farm
• Jeff Hester, State Farm

304. Management of Injury Causation
An engineering expert will examine the development of a process that sifts through claims with injuries and gets to the bottom of what actually happened. Was an injury actually work-related or did it happen at Sunday softball? Is an auto claim with injury truly crash-related or related to degenerative disc disease? Learn how a Biomechanical Engineering Analysis can help to answer these questions. This session will review the issues, which will be followed by case studies, examination of alleged injuries, and discussion of establishing protocols to determine how and when to involve the biomechanic. 

•  David L. Gushue, ARCCA Inc.

3:00 p.m.–3:30 p.m.

Refreshment Break in the Exhibit Hall

3:30 p.m.–4:50 p.m.

401. Social Network Data–Emerging Issues of Risk
(A repeat of session 301)

402. Litigation Management Panel
(A repeat of session 302)

403. Hail Storm Damage and Questionable Claims
(A repeat of session 303)

404. Management of Injury Causation
(A repeat of session 304)

5:00 p.m.–6:30 p.m.

Reception in the Exhibit Hall

7:00 a.m.–4:30 p.m.

Registration/Information Desk Open

7:30 a.m.–8:30 a.m.

Continental Breakfast in the Exhibit Hall

8:30 a.m.–9:50 a.m.

General Session:
Anti-fraud Strategy Development
In this panel session, discussion will center on finding a path to a sustainable strategy in the unified resistance of insurance fraud. The predominant mission of the investigative function is to resist misrepresented claims and misrepresented policy submissions. In the current state of the industry, what needs to be put in place to make a quantum leap in the execution of this mission? In addition to potential law enforcement cut backs, bad case law and increased expense control, what threats are on the horizon? Can we organize the national trade and state insurer groups with education and communication? Can we do the same with carriers' legislative affairs departments? With shifting public opinion, marketplace changes, and technological development, what can be done to prepare for the next ten years?

• Ken Pringle, Pringle & Quinn (moderator)
• Dennis Jay, Coalition Against Insurance Fraud
• Ross Silverman, Katten Muchin Rosenman LLP
• Glenn Wolf, Liberty Mutual

9:50 a.m.–10:10 a.m.

Refreshment Break in the Exhibit Hall

10:10 a.m.–11:30 a.m.

501. Managing the Anti-fraud Training Function at Your Company
Identifying potentially suspicious claims is an art that can be perfected at many levels within the workflow of an insurance company. Touch points of identification can take place with agents, call centers, customer service representatives, claim adjusters, damage appraisers, and investigators. Identification skills are, to a great extent, the result of a well-designed and well-managed anti-fraud training program. A national expert will discuss the issues of anti-fraud training planning, looking at content, delivery methods, effectiveness measures, and more. Get the latest on this very important topic.

• Tom Welsh, NICB

502. Managing Worker's Compensation Premium Issues
A national program designed to resist workers compensation fraud must consider the elements of premium misrepresentation on the part of the policyholder. Large-scale million dollar scams involve the manipulation of rates, classification, experience rating, and payroll. To identify and resolve these cases, protocols are necessary in the areas of premium audit, anomaly monitoring, and detailed investigation. Attend this session and hear from one of the foremost experts in the industry.

• Neil Johnson, Liberty Mutual Insurance

503. Emerging Issues Management
Our facilitators will host an open-forum discussion of the emerging issues that face the industry and how an emerging issues strategy can benefit your organization. This will be an opportunity for you to bring forth both issues and solutions facing your SIU operation. Each area of the country is challenged with issues relating to the state of the economy, including foreclosure, employment, and health care. An Emerging Issues program provides a platform for underwriters, claim departments, and investigative organizations to share real-time information regarding trends that will allow for proactive decisions and adjustments to business practices designed to combat fraud. Discussion will also include the use of data analysis, environmental scans for local trends, and communication strategies that will allow for increased opportunities to identify fraud trends.

• Russ Kesler, Travelers Insurance
• Erik Baise, Travelers Insurance

504. Leading Smaller SIU Operations
Most SIU operations rely on the assistance of outside sources of products and services. This is especially true of smaller and specialty investigative units. Other challenges faced by managers of smaller organizations include resource queuing, finding a seat at the table, and amplifying influence. These topics will be part of the lively discussion in this session.

• James Workinger, Scottsdale Insurance (moderator)
• Jerry Weidner, Vision Insurance
• Jim Potts, NY Central Mutual
• Robert Burgess, First Acceptance Services Insurance

11:30 a.m.–11:45 a.m.

Prize Drawing and Exhibit Hall Closing

11:45 a.m.–1:00 p.m.

Lunch in the Exhibit Hall

1:00 p.m.–2:20 p.m.

General Session:
IFD Directors Panel

• Alan Haskins, NICB (moderator)
• John Askins, Florida Department of Financial Services
• Ted Clark, Kansas Insurance Department
• Anthony M. Di Paolo, State of Massachusetts
• Julia Hearthway, Office of Attorney General, Pennsylvania
• Carolyn Henneman, Maryland Insurance Administration
• Keri Kish, NAIC

2:20 p.m.–2:50 p.m.

Refreshment Break

2:50 p.m.–4:10 p.m.

601. Managing Analytic Units 
Finding intelligence and actionable information in data sets is a developing area for SIU. Being able to identify association networks of people and entities working in concert to perpetrate large-scale scams is vital to a successful anti-fraud program. In this session, discussion will include analytic tactics and strategy, unit management concerns, personnel development, required tools, and NICB interface.

• Brian Smidt, NICB

602. SIU Resource Analysis
Management application of resources helps to determine the level of efficiency that a work unit achieves. How do you know if you have the right amount of SIU resources working on the right types of claims? With a finite cache of resources, how can you ensure you're being as efficient as possible? Through management analysis, you can determine the volume of potential referrals by region and identify the most prevalent and most costly types of losses. You can also determine the most common indicators triggering referral by claim office and identify the highs and lows in indicator recognition by unit. Attend this session and take part in this lively informative presentation.

• Dennis Schulkins, State Farm

603. Healthcare SIU Management Forum
The distinct lines between healthcare and property/casualty investigative concerns may become more blurred over the next year or so. Senior level healthcare SIU directors discuss the impact of federal reform, fraud trends, cross-over with property/casualty scams, and other related issues.

• Christie A. Moon, HCI (moderator)
• Barb Stencil, Humana
• Margie Sasaki, Blue Cross Blue Shield of Hawaii
• Amanda Purvis, Coventry Health

604. Managing the Public Adjuster Process
Property loss claims sometimes lead to including a public adjuster in the claim settlement process. When referred to SIU, these cases pose certain challenges and risks that have to be managed by the investigative team. In this session the discussion will touch upon process protocol, state regulation, license requirements, cost inflation, and the needs of the customer.

• Jim Cole, Marshall Dennehey
• Jeff Rapattoni, Marshall Dennehey

7:30 a.m.–11:00 a.m.

Registration/Information Desk Open

8:00 a.m.–8:30 a.m.

Continental Breakfast in Cumberland Foyer

8:30 a.m.–10:00 a.m.

General Session:
Claim Executive Forum
Senior claim executives will share the pressing issues they face regarding SIU and the discipline of resisting misrepresented claims and managing risk. Is the current model working? Is there a change in strategic planning on the horizon? What is the message from the top down? Points of discussion will include customer satisfaction, the drive for prompt action, identification of process and procedure weaknesses, the importance of well-designed controls, and the emergence of new technological solutions.

• Francis X. Sztuk, Hanover Insurance (moderator)
• Vincent Armentano, Travelers Insurance
• Richard Cammett, Hanover Insurance
• Kevin Hilyard, National Insurance

10:00 a.m.–10:30 a.m.

Refreshment Break

10:30 a.m.–Noon

General Session:

Medical Advisory Panel
Medical claims in the property/casualty arena have become more difficult and more challenging over the past five years. Where is the tipping point? Four nationally recognized experts will discuss the stark effects that are expected from the national healthcare legislation, the burgeoning proliferation of fraud, and what can be done to try and manage these risks. Don't miss this very important discussion that will examine the future of medical claim investigation.

• Dr. Randy Braddom, Pattern Analysis Inc.
• Dr. Barry Johnson, HCI
• Dr. Larry Spitz, Pattern Analysis Inc.
• Dr. Rick Wakefield, International Healthcare Consultants Inc.