Fraud Advanced

A full day workshop (8:00am – 4:00pm) combining the basics of fraud, but also covering various state regulations, to include mandatory reporting, SIUs, annual reports, anti-fraud plans and compliance. This course is designed for the claims or SIU professional requiring a general overview of the various state statutes and how to insure that their company is in compliance.

Fraud Basics

A ½ day seminar focusing on the terms and definitions of insurance fraud. This seminar is designed for the new examiner of 1-2 years of experience. Scenarios and case studies from the insurance industry are used to teach the student to evaluate whether the issues they face are compensability, abuse, or actual fraud issues.

Fraud Regulations & Compliance

A 1/2 day seminar focusing on various state regulations governing insurance fraud in the industry. This seminar will cover the regulations in a specified state or states as requested by the student(s) in the course. Topics will include state compliance, state fraud reporting (including the forms necessary), mandatory SIU regulations, anti-fraud plans and annual reports. Samples of the various reports will be provided based on student needs.

WC Claims Advanced

A full-day workshop (8:00am – 4:00pm) briefly covering the basics covered in the WC Basic course, as well as an in-depth look at the claims process and how to handle the claim from start to finish. Additional topics will include AOE/COE determinations, the investigative process, temporary and permanent disability determinations, AME/QME process and vocational rehabilitation.

This course will provide a general understanding of the Workers’ Compensation system and how to apply known facts during all phases of the claims handling process.

WC Claims Basics

A full-day workshop (8:00am – 4:00pm) covering the basics of the Workers’ Compensation system. Covered topics include, distinctions between first party liability and WC third party liability and defenses to legal liability based on state codes. Terminology such as AOE/COE, temporary disability, permanent disability, Qualified Injured Worker, Qualified Medical Examiner, etc will be discussed. The goal of this workshop is to provide a basic understanding of the Workers’ Compensation system and how to apply known facts and develop a theory of liability.

WC Fraud

A full-day workshop (8:00am – 4:00pm) focusing on the terms and definitions of Workers’ Compensation fraud files, as well as the tools that an adjuster can use to mitigate and/or prosecute fraud. This workshop will provide the student with investigative strategies, utilizing the most optimum timeframes to insure file closure and/or prosecution by the various state agencies. The student will also be provided with various state regulations relative to Insurance Fraud. The goal of this seminar is to improve the student’s ability to recognize a suspect claim and develop practical strategies for mitigating or denying these types of claims.

WC Investigations

A 1/2 day seminar covering the main theories of investigation from initial claims handling, through surveillance and ultimately potential fraud. Specific topics include, how to determine if an investigation is necessary, the legalities of surveillance investigations, the difference between abuse and fraud, and the repercussions to the claim. The goal of this seminar is to provide claims professionals with the knowledge of investigations to be able to better analyze and mitigate claims.