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Navigating the SIU Minefield

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The course, “Navigating the SIU Minefield” is designed to enhance the student’s knowledge, understanding, and professional competence in the investigation and resolution of suspected arson/fraud claims. The module is presented by Douglas K. Wood, a Partner at Morris Polich & Purdy LLP, and Ulises Castellon, CPCU, RPA, the principal of a consulting business, ClaimsAnalysis.

Doug and Ulises begin by outlining red flags that may arise in an SIU investigation. They then address juror perceptions and attitudes, and the economics of arson or fraud. Throughout the course, they emphasize certain “Guiding Lights,” such as the importance of a truth-seeking mindset for an adjuster. Other Guiding Lights highlight the importance of internal documentation and external communication, how to address key decision-making forks in the road, and the key that the insured is in control of the timing. Next, they explain how to strike an appropriate balance in arson/fraud reporting. They discuss the when and why of the Reservation of Rights letter. They also consider how to work effectively with the Agent, how to deal with innocent co-insureds, and other potential issues and problems. They help identify set-up red flags in bad-faith set-up letters and how to avoid them. Finally, they address how to respond to requests by the fire or police departments or the insured’s attorney, and how to request witness statements.

After completing the course, the attendee should be able to:

identify red flags in an insurance claim; have an awareness of potential juror perceptions and attitudes; know the importance of a truth-seeking mindset when investigating a potential arson/fraud; identify key decision-making forks in the road; comply with arson/fraud reporting requirements such as Reporting and Immunity statutes; formulate a Reservation of Rights letter and know its value; obtain authorizations; identify the importance of the insured’s agent; understand the issues surrounding innocent co-insureds; identify the red flags in bad-faith set-up letters; craft a response to a bad faith set-up letter; respond appropriately to the fire or police departments, witnesses, or the insured’s attorney; and differentiate between Intentional Acts breaches and Concealment or Fraud breaches.

The course is designed for practitioners and insurance professionals working in the area of first-party property insurance coverage and litigation.

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 475032
TX (classroom equivalent) 2.0 137846
NC 2.0 C99025
FL * ( Provider Number: 364169 ) 2.0 1198951
IL 2.0 485541
WY 2.0 36205
OK 2.0 1025772

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

Course Content

Introduction and Guiding Lights
Expand
Lesson Content

1) Introduction
2) Red Flags
3) Juror perceptions and attitudes
a) Media conditioning
b) Juror willingness to conclude “fraud”
4) Arson Fraud Economics 101
a) The Economics
b) Why Bother?
5)Our Goals Today
6) Guiding Lights
a) The truth-seeking mindset
b) Internal documentation and external communications
7) Recap

Guiding Lights (continued)/Arson and Fraud Reporting
Expand
Lesson Content

1) The Power of Please and Thank You
2) Guiding Lights
a) Key decision-making forks in the road
b) The insured is in control of the timing
3) Arson and Fraud Reporting
a) Authorities: Friend or Foe?
4) Recap

Arson and Fraud Reporting (continued)/Reservation of Rights Letters
Expand
Lesson Content

1) Arson and Fraud Reporting
a) Reporting and Immunity statutes
b) How to strike an appropriate balance
c) What to do if…
2) Reservation of Rights letters
a) When should you send it?
b) Why should you send it?
c) How much detail is required?
d) Another opportunity to communicate effectively
e) Pattern letters or form letters
f) Avoid sending the Frankenstein letter
3) Recap

Authorizations/Innocent Co-insureds
Expand
Lesson Content

1) Authorizations
a) Make sure it is the right one
b) Obtaining but not using is dangerous
2) The Agent: Friend or Foe?
a) The agent as a conduit
b) The agency staff person
c) Rescission vs. Concealment or Fraud
3) Innocent Co-insured Issues and Problems
a) The nature of the problem
b) Significance of the policy language
i) The insured
ii) An insured
iii) Any insured
c) Historical perspective
d) “Substantially Benefit” test
e) Analysis of Century-National Ins. v. Garcia, 51 Cal. 4th 564, 246 P.3d 621 (2011)
4) Recap

Innocent Co-insureds (continued)/Bad-Faith Set Up Letters
Expand
Lesson Content

1) Issues and Problems
2) Intentional Acts breaches vs. Concealment or Fraud breaches
a) Section I – Exclusions
b) Section I – Conditions
3) Bad-Faith “Set Up” Letters
a) Set up red flags
b) Avoid pattern letter responses
c) Crafting the response
d) Example
4) Recap

Bad Faith Set Up Letters/Response Examples (continued)
Expand
Lesson Content

1) Elements of a good-faith response
a) Incendiary fire
b) Addressing coverage questions
c) Inculpatory vs. exculpatory evidence
2) Request for FD/PD communications
3) Request for witness statements
4) Requests by insured’s attorney
5) Other examples
a) Birds of a feather
b) Denial quotas
c) Cop mentality
6) Concluding remarks
7) Recap

Get CE Credit or Certificate of Completion.

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

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