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Evaluating Documents for Potential Fraud

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The “Evaluating Documents for Potential Fraud” course teaches insurance professionals how to identify potential fraud in documents of all types. The module is presented by Kevin D. Hansen, Esq., Partner at McCormick Barstow, LLP, and Richard Harer, CFE, CPI, CFS, WCCA, Vice President of Specialized Investigations, Inc. The module explores insurers’ and insureds’ duties to one another, the technological means available to commit fraud, the technology available to defeat fraud, and skills for detecting and handling potential fraud cases. True-to-life examples are included as case studies.

After completing the course, the attendee will be able to explain the duties owed to and by the insured; identify red flags indicating potential fraud; notice inconsistencies in documents indicating potential fraud; prepare document requests for all required information, even for new modern sources of fraud detection; and take Examinations Under Oath in cases potentially involving fraud. The course is designed for insurance professionals working in the area of property and casualty adjusting.

What CE Credit is available?

Note: To qualify for credit, you must submit completion (including a passed final exam if required) within five days of completing the last quiz. No partial credits will be awarded.

State:
Adjuster General CE Hours:
Adjuster Ethics CE Hours:
Attorney General CLE Hours:
State's Course ID:
NH 2.0 600082514
TX (classroom equivalent) 1.0 114238
NC 2.0 209634
FL * ( Provider Number: 364169 ) 2.0 Optional 1186109
IL 2.0 524124
WY 2.0 29639
OK 2.0 6000038692

* This course has been approved by the Florida Department of Financial Services for insurance continuing education credit.

Course Content

Insurance Fraud Foundations
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Lesson Content
  1. Introduction
  2. Roadmap
  3. Cost of Insurance Fraud
  4. Broader Definition of Document
    1. Legal Definitions
  5. Duties After Loss
    1. Scope of Records
  6. Types of Data
  7. Good Faith and Fair Dealing
    1. California Rules
    2. Reasonableness
    3. Denying a Claim
  8. Conclusion
Means of Communicating Fraud
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Lesson Content
  1. Introduction
  2. Fake Receipts
    1. Jewelry Example
  3. Fake Paystubs
  4. Fraud Using Official Documents
    1. Examining the Documents
    2. Facts of Ferrari Case
  5. Examples of Altered Receipts
    1. Hand-Altered Receipt
    2. Sequential Checks
    3. Questionable Figures
    4. Non-Negotiated Checks
    5. Watch Example
Investigation of Insurance Fraud
Expand
Lesson Content
  1. Introduction
  2. Deleted Items
  3. Exemplar
  4. Estimates and Quotes
  5. Returns
  6. Alterations
  7. Sequencing
  8. Inconsistencies
  9. Inflated Amounts
    1. Need for Further Investigation
    2. Lease Example
  10. Handwritten Receipts
  11. Questionable Charges
  12. Medical Invoices
    1. Spelling Errors
    2. Missing CPT Codes
    3. Copied Language
  13. Questionable Photos: Desert Raceway Example
    1. Desk Investigation
    2. Field Investigation
    3. Eyewitness Accounts
  14. Be Perisistent
Today’s Technology to Defeat Fraud
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Lesson Content
  1. Introduction
  2. Surveillance Cameras
    1. Bus Example
    2. Smart Doorbells
    3. Smart Doorbell Example
    4. Body Cameras
  3. Electronic Locks
  4. Metadata
    1. High-Performance Engine Example
    2. Obtaining Metadata
    3. Potential Issues
      1. Incorrect Format
      2. Photo Libraries
      3. Editing Metadata
      4. Transmitting Photos
    4. Geotag Information
  5. Licence Plate Scans
    1. Location
    2. Damages to Vehicle
    3. Process Serving
    4. Legality
Tomorrow’s Technology to Defeat Fraud
Expand
Lesson Content
  1. Introduction
  2. Cell Phone Site Location Information
    1. Obtaining Records
    2. Analyzing Records
    3. GPS Data
    4. Misleading Data
    5. Burner Phones
  3. In-Car Communication Systems
  4. Electronic Data Recorders
    1. Analyzing the Data
  5. Telematics
    1. Types of Data Collected
    2. Alibis
    3. Objective Data
  6. Infotainment
  7. Internet of Things
    1. Statistics
    2. Types of Appliances
    3. HVAC Controls
    4. Pacemakers
    5. Types of Data Recorded
    6. Alibi Example
    7. Pitfalls
Other Tools to Defeat Fraud
Expand
Lesson Content
  1. Introduction
  2. Document Experts
  3. Handwriting Analysts
  4. Forensic Audio and Visual Experts
  5. Digital Forensic Experts
  6. Outside Investigators
    1. Taking Statements
    2. Conducting Field Investigations
    3. Using the Evidence
  7. Water Damage Fraud Ring Example
    1. Red Flags
    2. Revealing the Collusion
  8. SIU Attorneys
    1. Examinations Under Oath
    2. Document Requests
    3. Hiring Other Experts
    4. Confronting Claimants
  9. Low-Tech Example
    1. Theft of Furniture
    2. Photographs Provided
    3. Stumped Investigation
    4. Local Furniture Showroom
    5. Interviewing Furniture Salespeople
    6. Comparing Photographs
    7. Examinations Under Oath
  10. How to Obtain this Data
    1. Signed Authorizations
    2. Username and Passwords
    3. Subpoenas and Pre-Suit Petitions
    4. Preservation Letters
  11. Conclusion
Get CE Credit or Certificate of Completion.

Submit within 5 days to get CE Credit or Certificate of Completion.

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