Kelly Riddle of Kelmar Global shares tips for conducting insurance investigations.
To watch the webinar recording, visit: http://i-sight.com/webinar-investigating-insurance-fraud/
The document discusses insurance fraud, outlining what constitutes insurance fraud, penalties for committing insurance fraud, partners in fighting insurance fraud like the Division of Insurance Fraud and National Insurance Crime Bureau, and responsibilities of claims adjusters to be aware of fraud indicators and consult special investigation units if fraud is suspected. Insurance fraud is a serious crime that costs consumers an estimated $80 billion annually, so combating fraud protects consumers and helps control insurance costs.
A presentation on various frauds affecting the insurance industry along with cases emphasizing the need for forensic audit / accounting to uncover them and reduce losses
The document provides an overview of fraud awareness and prevention. It discusses common fraud schemes like financial statement fraud, assets misappropriation, and corruption. It also outlines red flags for detecting occupational fraud, how fraud is committed, and profiles of typical fraud perpetrators. The document emphasizes the importance of strong antifraud controls, training programs, and fostering an ethical organizational culture to help prevent and detect fraud.
This document discusses fraud risk and prevention. It begins with defining fraud and identifying common fraud schemes such as asset misappropriation, corruption, and financial statement fraud. Examples of each scheme are provided. The document also discusses elements that contribute to fraud occurrence, like opportunity and incentives. Effective fraud prevention controls are then outlined, including segregating duties, competitive bidding processes, and fraud hotlines. The importance of fraud risk assessments and creating an organizational culture of integrity are also emphasized.
Presentation given for Crowe Horwath Auditor's training session on 26/03/2016.
AML regulations are applicable to professional service providers also. See the presentation for more information
The document discusses red flags that can indicate the presence of fraud. It defines fraud and explains the fraud triangle of opportunity, pressure, and rationalization. It provides examples of general red flags related to employees and management. Specific red flags are given for cash/accounts receivable, payroll, and purchasing/inventory. Common types of fraud like lifestyle fraud and financial statement fraud are also summarized. The document stresses the importance of recognizing and investigating red flags instead of ignoring them.
The document provides details about a case study on forensic audit. It discusses what forensic audit is, types of fraud, the fraud triangle model, and the Satyam fraud case. The Satyam case involved falsified financial statements, inflated revenues and profits, fake bank balances and fixed deposits totaling Rs. 7,800 crores. Weak internal controls and governance failures at Satyam such as unethical conduct, false books, dubious roles of directors, auditors and banks allowed the fraud to occur and go undetected for years.
The document discusses insurance fraud, outlining what constitutes insurance fraud, penalties for committing insurance fraud, partners in fighting insurance fraud like the Division of Insurance Fraud and National Insurance Crime Bureau, and responsibilities of claims adjusters to be aware of fraud indicators and consult special investigation units if fraud is suspected. Insurance fraud is a serious crime that costs consumers an estimated $80 billion annually, so combating fraud protects consumers and helps control insurance costs.
A presentation on various frauds affecting the insurance industry along with cases emphasizing the need for forensic audit / accounting to uncover them and reduce losses
The document provides an overview of fraud awareness and prevention. It discusses common fraud schemes like financial statement fraud, assets misappropriation, and corruption. It also outlines red flags for detecting occupational fraud, how fraud is committed, and profiles of typical fraud perpetrators. The document emphasizes the importance of strong antifraud controls, training programs, and fostering an ethical organizational culture to help prevent and detect fraud.
This document discusses fraud risk and prevention. It begins with defining fraud and identifying common fraud schemes such as asset misappropriation, corruption, and financial statement fraud. Examples of each scheme are provided. The document also discusses elements that contribute to fraud occurrence, like opportunity and incentives. Effective fraud prevention controls are then outlined, including segregating duties, competitive bidding processes, and fraud hotlines. The importance of fraud risk assessments and creating an organizational culture of integrity are also emphasized.
Presentation given for Crowe Horwath Auditor's training session on 26/03/2016.
AML regulations are applicable to professional service providers also. See the presentation for more information
The document discusses red flags that can indicate the presence of fraud. It defines fraud and explains the fraud triangle of opportunity, pressure, and rationalization. It provides examples of general red flags related to employees and management. Specific red flags are given for cash/accounts receivable, payroll, and purchasing/inventory. Common types of fraud like lifestyle fraud and financial statement fraud are also summarized. The document stresses the importance of recognizing and investigating red flags instead of ignoring them.
The document provides details about a case study on forensic audit. It discusses what forensic audit is, types of fraud, the fraud triangle model, and the Satyam fraud case. The Satyam case involved falsified financial statements, inflated revenues and profits, fake bank balances and fixed deposits totaling Rs. 7,800 crores. Weak internal controls and governance failures at Satyam such as unethical conduct, false books, dubious roles of directors, auditors and banks allowed the fraud to occur and go undetected for years.
This document provides an overview of forensic accounting. It begins by defining forensic accounting as involving investigative services and litigation support related to fraud investigations and legal actions. It describes the roles of investigative forensic accountants and forensic accountants providing litigation support. It provides examples of situations forensic accountants investigate, such as employee theft, vendor fraud, and tax evasion. It also discusses the Association of Certified Fraud Examiners and internal auditing.
This document summarizes a presentation on bank fraud and data forensics. It discusses common types of internal and external bank fraud such as wire fraud, check fraud, and asset misappropriation. It outlines the fraud triangle of opportunity, pressure, and rationalization. It emphasizes the importance of strong internal controls and segregation of duties to prevent fraud. The presentation also discusses how digital forensics can be used to investigate inappropriate network activity, email, internet usage, and recover deleted files during fraud investigations. Contact information is provided for the three presenters.
The document discusses the implementation of forensic accounting techniques for fraud detection in Lagos, Nigeria. It begins with introducing forensic accounting and its importance in litigation support and fraud investigation. Some key forensic accounting concepts discussed include types of forensic accounting, skills required, and its scope. The document then covers concepts of fraud and fraud detection, including definitions, types of fraud, and techniques for detection. It presents two fraud cases investigated in Lagos, Nigeria using forensic accounting methods including statistical data analysis and artificial intelligence techniques for detection. The document aims to demonstrate how forensic accounting has aided in detecting various kinds of fraud in Nigeria.
This document provides an overview of anti-money laundering practices and suspicious transactions. It discusses the key stages of money laundering: placement, layering, and integration. It also outlines the elements of an effective AML program, including board approval, training, internal controls, and independent audits. Several typologies of money laundering are described, such as the use of shell companies and cash couriers. Guidelines for identifying and reporting suspicious transactions and clients are provided. Specific scenarios involving suspicious activities like structuring are reviewed.
This document provides an introduction to fraud, including definitions, types of fraud, who can commit fraud, potential triggers of fraud, reasons for fraud, and impacts of fraud. It defines fraud as any dishonest act or omission intended to gain advantage. Common types of fraud include cheating, forgery, misappropriation, and fraudulent transactions. Employees, customers, and outsiders can all perpetrate fraud. Triggers may include lifestyle changes or high-risk transactions. Fraud is often committed due to financial problems, knowledge of weaknesses, and rationalization. Impacts include financial, regulatory, and reputational risks for institutions, as well as punishments for individuals.
The document discusses fraud risk and consumer fraud management. It defines fraud and outlines the main categories. It provides data on fraud incidents and losses from regulatory reports. It then details common types of fraud like identity theft, credit card fraud, and phishing. The document outlines challenges in fraud management and provides examples of fraud attempts in Pakistan. It concludes with recommendations for financial institutions to strengthen anti-fraud culture, define clear roles and responsibilities, invest in fraud detection systems, and leverage fraud data and training to enhance consumer fraud management.
A powerpoint presentation giving basic insights on forensic audit,forensic auditors, how is the engagement conducted, its scope , the famous Satyam Case and the Nirav Modi case along with the RBI guidelines regarding the same. It is a presentation made for educational and awareness purpose and not to be copied or reproduced without prior consent.
This document provides an overview of understanding financial statement fraud from a forensic accounting perspective. It begins with an introduction to financial statements and documents, then discusses common financial statement fraud schemes such as overstating revenues or understating expenses. It also covers the motives, implications, and trends of financial statement fraud, and relates it to Donald Cressey's fraud triangle. Finally, it proposes strategies for preventing and detecting financial statement fraud, such as maintaining accurate accounting records, segregating duties, and encouraging strong leadership.
Fraud Risk Assessment- detection and prevention- Part- 2, Tahir Abbas
The document discusses various techniques for detecting and preventing fraud, including:
1) Establishing prevention techniques like controls, job rotation, and education to avoid fraud risks.
2) Implementing detection methods such as data analysis, forensic auditing, and link analysis to uncover fraud.
3) Asking vital questions within 24 hours of a fraud allegation to properly investigate and prevent future fraud.
This document discusses fraud in the Indian banking sector. It begins with an introduction that defines fraud and its rising occurrence in banking. It then reviews literature on previous studies of fraud's nature, causes, effects and management. Several sections provide statistics on banking fraud cases in India from 2009-2013, classify different types of fraud, and identify institutional and environmental factors that cause fraud. The effects of fraud on banks are erosion of confidence, reduced profits and depletion of capital. Fraud management techniques discussed include the classical fraud motivation model, a proactive right sourcing model, and other techniques like ethics training and data mining. Current approaches to fraud management are also categorized.
The document discusses money laundering and anti-money laundering (AML) laws and organizations. It defines money laundering as the process of making illegally gained money appear legal. It also discusses terrorist financing. The objective, stages, techniques, and causes of money laundering are described. Key AML laws and organizations mentioned are the Prevention of Money Laundering Act 2002 in India and the Financial Action Task Force, an intergovernmental body working to combat money laundering and terrorist financing globally.
The presentation provides overall insight of operational fraud risk management. It explains the operational fraud risk and mitigation strategies. The role of Internal audit and audit committee is further exemplified
Fraud Prevention, Detection and Investigation in the Payday Advance IndustryDecosimoCPAs
Fraud prevention, detection and investigation in the payday advance industry was discussed including defining fraud and embezzlement, how they occur in the industry, and steps that can be taken to prevent fraud such as implementing policies to segregate duties and conduct regular audits. Common types of fraud like internal and external fraud were described as well as ways fraud can be detected through analytical procedures and interviews. The roles of forensic accountants and methods of investigating probable fraud cases were also outlined.
Introduction to financial fraud, Financial and corporate fraud, Threats to the organization, Challenges, Case study on Bernard l. madoff investment securities LLC, How a Ponzi scheme works, Madoff Fraud
The document discusses the role and functions of forensic accountants. It begins with an introduction to forensic accounting in India and discusses the types of frauds such as bank, corporate, cyber, and securities frauds that forensic accountants investigate. The key roles of forensic accountants include conducting criminal investigations, assisting in matrimonial disputes, fraud investigations, providing expert witness testimony, computer forensics, and evaluating personal injury claims. Forensic accountants use their accounting and investigative skills to examine financial evidence, trace assets, and detect fraud to help legal cases. The document concludes that forensic accounting is a newer field in India that can help detect, investigate, and prevent financial frauds.
The document discusses money laundering prevention. It outlines the objectives of increasing awareness of anti-money laundering responsibilities and regulations. Non-compliance can result in penalties like imprisonment, fines, license revocation and more. Key aspects of money laundering prevention covered include know-your-customer procedures, suspicious transaction reporting, and the importance of monitoring transactions for consistency with customer profiles.
This document discusses frauds in insurance companies. It lists the names and roll numbers of group members studying insurance fraud. It then covers the causes of frauds like losses due to insurance fraud, hard fraud versus soft fraud, fraud through fire or theft claims, opportunistic fraud, criminal rings, exaggerated claims by policy holders. Real examples of insurance frauds that occurred in recent years are also presented along with a case study. The document concludes with a thank you.
Proving Insurance Fraud: Real Case StudiesRob Pohls
This case involves a $50,000 life insurance policy where the proposed insured, Stacey, died one day after the policy was approved. The insurer investigated and found inconsistencies in the application and interviews. Medical records showed Stacey had significant health issues contradicting the application. The insurer denied the claim, suspecting insurance fraud by the applicant and beneficiary, Cynthia and her children.
This document provides an overview of forensic accounting. It begins by defining forensic accounting as involving investigative services and litigation support related to fraud investigations and legal actions. It describes the roles of investigative forensic accountants and forensic accountants providing litigation support. It provides examples of situations forensic accountants investigate, such as employee theft, vendor fraud, and tax evasion. It also discusses the Association of Certified Fraud Examiners and internal auditing.
This document summarizes a presentation on bank fraud and data forensics. It discusses common types of internal and external bank fraud such as wire fraud, check fraud, and asset misappropriation. It outlines the fraud triangle of opportunity, pressure, and rationalization. It emphasizes the importance of strong internal controls and segregation of duties to prevent fraud. The presentation also discusses how digital forensics can be used to investigate inappropriate network activity, email, internet usage, and recover deleted files during fraud investigations. Contact information is provided for the three presenters.
The document discusses the implementation of forensic accounting techniques for fraud detection in Lagos, Nigeria. It begins with introducing forensic accounting and its importance in litigation support and fraud investigation. Some key forensic accounting concepts discussed include types of forensic accounting, skills required, and its scope. The document then covers concepts of fraud and fraud detection, including definitions, types of fraud, and techniques for detection. It presents two fraud cases investigated in Lagos, Nigeria using forensic accounting methods including statistical data analysis and artificial intelligence techniques for detection. The document aims to demonstrate how forensic accounting has aided in detecting various kinds of fraud in Nigeria.
This document provides an overview of anti-money laundering practices and suspicious transactions. It discusses the key stages of money laundering: placement, layering, and integration. It also outlines the elements of an effective AML program, including board approval, training, internal controls, and independent audits. Several typologies of money laundering are described, such as the use of shell companies and cash couriers. Guidelines for identifying and reporting suspicious transactions and clients are provided. Specific scenarios involving suspicious activities like structuring are reviewed.
This document provides an introduction to fraud, including definitions, types of fraud, who can commit fraud, potential triggers of fraud, reasons for fraud, and impacts of fraud. It defines fraud as any dishonest act or omission intended to gain advantage. Common types of fraud include cheating, forgery, misappropriation, and fraudulent transactions. Employees, customers, and outsiders can all perpetrate fraud. Triggers may include lifestyle changes or high-risk transactions. Fraud is often committed due to financial problems, knowledge of weaknesses, and rationalization. Impacts include financial, regulatory, and reputational risks for institutions, as well as punishments for individuals.
The document discusses fraud risk and consumer fraud management. It defines fraud and outlines the main categories. It provides data on fraud incidents and losses from regulatory reports. It then details common types of fraud like identity theft, credit card fraud, and phishing. The document outlines challenges in fraud management and provides examples of fraud attempts in Pakistan. It concludes with recommendations for financial institutions to strengthen anti-fraud culture, define clear roles and responsibilities, invest in fraud detection systems, and leverage fraud data and training to enhance consumer fraud management.
A powerpoint presentation giving basic insights on forensic audit,forensic auditors, how is the engagement conducted, its scope , the famous Satyam Case and the Nirav Modi case along with the RBI guidelines regarding the same. It is a presentation made for educational and awareness purpose and not to be copied or reproduced without prior consent.
This document provides an overview of understanding financial statement fraud from a forensic accounting perspective. It begins with an introduction to financial statements and documents, then discusses common financial statement fraud schemes such as overstating revenues or understating expenses. It also covers the motives, implications, and trends of financial statement fraud, and relates it to Donald Cressey's fraud triangle. Finally, it proposes strategies for preventing and detecting financial statement fraud, such as maintaining accurate accounting records, segregating duties, and encouraging strong leadership.
Fraud Risk Assessment- detection and prevention- Part- 2, Tahir Abbas
The document discusses various techniques for detecting and preventing fraud, including:
1) Establishing prevention techniques like controls, job rotation, and education to avoid fraud risks.
2) Implementing detection methods such as data analysis, forensic auditing, and link analysis to uncover fraud.
3) Asking vital questions within 24 hours of a fraud allegation to properly investigate and prevent future fraud.
This document discusses fraud in the Indian banking sector. It begins with an introduction that defines fraud and its rising occurrence in banking. It then reviews literature on previous studies of fraud's nature, causes, effects and management. Several sections provide statistics on banking fraud cases in India from 2009-2013, classify different types of fraud, and identify institutional and environmental factors that cause fraud. The effects of fraud on banks are erosion of confidence, reduced profits and depletion of capital. Fraud management techniques discussed include the classical fraud motivation model, a proactive right sourcing model, and other techniques like ethics training and data mining. Current approaches to fraud management are also categorized.
The document discusses money laundering and anti-money laundering (AML) laws and organizations. It defines money laundering as the process of making illegally gained money appear legal. It also discusses terrorist financing. The objective, stages, techniques, and causes of money laundering are described. Key AML laws and organizations mentioned are the Prevention of Money Laundering Act 2002 in India and the Financial Action Task Force, an intergovernmental body working to combat money laundering and terrorist financing globally.
The presentation provides overall insight of operational fraud risk management. It explains the operational fraud risk and mitigation strategies. The role of Internal audit and audit committee is further exemplified
Fraud Prevention, Detection and Investigation in the Payday Advance IndustryDecosimoCPAs
Fraud prevention, detection and investigation in the payday advance industry was discussed including defining fraud and embezzlement, how they occur in the industry, and steps that can be taken to prevent fraud such as implementing policies to segregate duties and conduct regular audits. Common types of fraud like internal and external fraud were described as well as ways fraud can be detected through analytical procedures and interviews. The roles of forensic accountants and methods of investigating probable fraud cases were also outlined.
Introduction to financial fraud, Financial and corporate fraud, Threats to the organization, Challenges, Case study on Bernard l. madoff investment securities LLC, How a Ponzi scheme works, Madoff Fraud
The document discusses the role and functions of forensic accountants. It begins with an introduction to forensic accounting in India and discusses the types of frauds such as bank, corporate, cyber, and securities frauds that forensic accountants investigate. The key roles of forensic accountants include conducting criminal investigations, assisting in matrimonial disputes, fraud investigations, providing expert witness testimony, computer forensics, and evaluating personal injury claims. Forensic accountants use their accounting and investigative skills to examine financial evidence, trace assets, and detect fraud to help legal cases. The document concludes that forensic accounting is a newer field in India that can help detect, investigate, and prevent financial frauds.
The document discusses money laundering prevention. It outlines the objectives of increasing awareness of anti-money laundering responsibilities and regulations. Non-compliance can result in penalties like imprisonment, fines, license revocation and more. Key aspects of money laundering prevention covered include know-your-customer procedures, suspicious transaction reporting, and the importance of monitoring transactions for consistency with customer profiles.
This document discusses frauds in insurance companies. It lists the names and roll numbers of group members studying insurance fraud. It then covers the causes of frauds like losses due to insurance fraud, hard fraud versus soft fraud, fraud through fire or theft claims, opportunistic fraud, criminal rings, exaggerated claims by policy holders. Real examples of insurance frauds that occurred in recent years are also presented along with a case study. The document concludes with a thank you.
Proving Insurance Fraud: Real Case StudiesRob Pohls
This case involves a $50,000 life insurance policy where the proposed insured, Stacey, died one day after the policy was approved. The insurer investigated and found inconsistencies in the application and interviews. Medical records showed Stacey had significant health issues contradicting the application. The insurer denied the claim, suspecting insurance fraud by the applicant and beneficiary, Cynthia and her children.
Fraud can take many forms but generally involves deception for financial or personal gain. There are three main types of fraud: corruption, asset misappropriation, and financial statement fraud. Fraud is most often committed due to pressure, opportunity, and the ability to rationalize one's actions. Companies can help prevent fraud by breaking this fraud triangle through strong internal controls, monitoring, and creating a culture of integrity and accountability.
Verity provides insurance claims and fraud investigation services to help companies validate claims and minimize losses. They have over 20 investigators with 15 years of experience who conduct surveillance, gather evidence through video and audio recordings, and produce full reports. Their services include devising an investigation plan, conducting 20 hours of surveillance with two investigators, collecting evidence, and compiling a report to analyze claimant behavior and lifestyles to determine claim integrity.
This document discusses an insurance fraud scheme involving collusion between an auto body shop owner and claims adjuster. The shop owner would inflate repair estimates and kick back half the profits to the adjuster. Motivations for the fraud included financial pressures and greed. Statistics show insurance fraud, including inflated repairs and staged accidents, is on the rise. Preventive actions recommended include vetting employees, oversight of claims, and educating customers on reporting suspicions.
Decision CAMP 2013 - sako hidetoshi - blaze consulting japan - Using Business...Decision CAMP
SMART InsuPector is an insurance claim fraud detection system delivered with over 400 rules extracted from 146 fraud cases. It uses the SMARTS rule engine to perform similarity checks between new claims and past fraud cases to detect fraud possibilities and provide red flags. The system also monitors performance and provides early warnings to help improve the claim process and prevent losses from fraud. While the document discusses desired analytic components, it notes that lack of sufficient fraud data limits the effectiveness of statistical analytics. Therefore, the system focuses on case-based analytics using rules developed by experts to represent actual fraud cases.
This document provides a course catalog for training programs offered by E Sun Hospitality Consultancy Malaysia. The training programs cover a wide range of topics and are divided into sections including: Fundamentals of Banking, Effective Communication, Insurance Service Professional Excellence, The Customer, Super Sales, Retention, and Financial Planning. Many of the individual training programs are 1-2 days and provide an overview of topics like banking basics, customer service, sales techniques, financial planning fundamentals, and communication skills. The course catalog is intended to equip professionals in the education and banking industries with skills through innovative and experience-based training methods.
This document outlines an sales training program called XLR8 from Pace360 that focuses on five critical sales skills: managing client relationships, sales call planning, questioning skills, presentation skills, and gaining commitments. It notes that these skills are trainable, measurable, and will result in dramatic performance improvement over time. The document also lists Pace360's services and products which are aimed at helping insurance producers and customer service representatives improve their sales.
We continued our Celebrating 40 Years of Excellence! Fall Webinar Series with a webinar titled Fraud Prevention and Detection: Surprise Fraudsters Before They Surprise You. This webinar was hosted by Sam BowerCraft, Senior Manager and Dave Hammarberg , IT Director with McKonly & Asbury.
Check out our Upcoming Events page for news and updates on our future seminars and webinars at http://www.macpas.com/events/.
View a full recap of this webinar at http://www.macpas.com/fraud-prevention-and-detection-webinar/.
Federal agents arrested individuals in multiple states for Medicare fraud totaling millions of dollars by billing for services that were never rendered. Common hospital billing errors that can lead to fraud include duplicate billing, inaccurate dates of service, billing for incorrect room charges, up-coding charges, and billing for canceled or non-existent services. Hospitals can implement compliance programs and regular audits to set policies, train staff, and monitor billing to prevent fraudulent activities and billing errors.
Insurance Sales Performance Dashboard Powered By Pm SquarePM square
PMSquare provides consulting services and solutions across various industries, focusing on customer analytics, finance/performance management, talent/organization performance, and operations/supply chain performance. The document also summarizes an insurance sales performance dashboard solution from IBM that provides key performance indicators and reports to help insurance companies track sales, revenue, productivity and performance. It includes prebuilt components like dashboards, scorecards and alerts.
On December 5, 2013, Ron Steinkamp, principal, government advisory services at Brown Smith Wallace, presented at the 2013 MIS Training Institute Governance, Risk & Compliance Conference. Ron focused on the following keys to fraud prevention, detection and reporting:
1. Anti-fraud culture
2. Fraud policy
3. Fraud awareness/training
4. Hotline
5. Assess fraud risks
6. Review/investigation
7. Improved controls
This document provides an overview of the role of financial institutions in India. It discusses the evolution of financial institutions from their foundation phase to the current reforms phase. It describes the various types of financial institutions in India including development banks, specialized institutions, state-level institutions, investment institutions, and non-banking financial companies. The document also outlines some of the key roles of financial institutions like providing services, mobilizing savings, and facilitating development. It discusses recent reports that aim to improve the financial services sector by 2020 with a focus on customer needs, inclusion, and tapping new market segments.
This document summarizes a project to reduce fraudulent card transactions for a US national bank. An ensemble technique using logistic regression and K-nearest neighbors was developed to classify transactions as fraudulent or legitimate in real time. The project was estimated to reduce fraudulent losses by $16-18 million while costing $4.2 million to develop. Testing on 1 year of transaction data accurately classified transactions and reduced fraudulent cases by 80-90%, saving the bank $16 million.
Fire insurance protects people from financial losses caused by fires. It involves sharing fire-related losses incurred by some through contributions to a common fund by all who are exposed to fire risk. Fire insurance pays for losses that are unexpected and occur due to chance. It aims to restore the insured's financial position prior to the loss through the principle of indemnity.
In the May-June 2013, we'll examine coverage for hotels facing fungi and bacteria claims, fraud & recovery, domestic violence in the industry, OSHA and whistleblowers, as well as provide you with updates for our upcoming travel and hospitality events.
For more information, please visit http://www.hospitalitylawyer.com.
Identity theft involves criminals stealing personal information like Social Security numbers and using it to open accounts or apply for loans. Around 10 million Americans are victims of identity theft each year. People can reduce their risk by checking credit reports annually, guarding their Social Security number, and ignoring suspicious emails. If someone becomes a victim, they should contact credit reporting agencies, close fraudulent accounts, file a police report, and potentially file an identity theft insurance claim for assistance recovering. ERIE insurance offers an identity theft endorsement for $20 per year that provides up to $25,000 to help restore someone's identity if stolen.
The LegalShield Identity Theft Plan provides identity theft protection and restoration services to help prevent identity theft and resolve issues if it occurs. The plan covers the member, spouse, and up to 8 dependents under 18. It includes credit monitoring and reports, identity consultation services, and assistance from Kroll to handle the restoration process for victims of identity theft by placing fraud alerts and disputing fraudulent accounts. If signing a limited power of attorney, Kroll will fully manage the restoration process; otherwise they will assist the member in taking actions themselves. The plan aims to resolve common identity theft issues like fraudulent accounts and records.
company names mentioned herein are for identification and educational purposes only and are the property of, and may be trademarks of, their respective owners.
Have you heard of Kroll? Probably not...but did you know they are the world\'s premier risk consulting firm in the field of identity theft detection, mitigation and restoration.
The document discusses four primary jurisdictional issues affecting the insurer-insured relationship:
1) Venue, choice of law, and mandatory arbitration clauses that can modify parties' rights and obligations under an insurance policy.
2) How "four corners" vs. "all available facts" jurisdictions approach defense rights, obligations, and investigations.
3) How jurisdictions approach the legal concept of "breach" of the duty to defend and its ramifications.
4) How jurisdictions evaluate available damage rights and remedies.
The panel will explore these issues through moderator Gary Gassman and presentations from industry professionals.
Experience, Expertise, and Preparation: Keys to a Successful Workers' Compen...NationalUnderwriter
Experience, Expertise, and Preparation: Keys to a Successful Workers' Compensation Fraud Investigation by Stacey Golden (from FC&S Legal: The Insurance Coverage Law Information Center)
Unfortunately, workers’ compensation fraud has been on the rise. The poor state of the U.S. economy is certainly a
factor with the associated mortgage meltdown and government cutbacks. Even rising student debt in this environment is placing pressure on young people. Equally unfortunate for those who see fraud as a solution to their challenges, many consider it easy money and are simply clueless to the potential consequences. There are also plenty of examples of sophisticated cases that require careful and persistent digging.
The document discusses identity theft, including how to protect yourself from identity theft and what to do if you become a victim. Some key points:
- Identity theft is a growing problem, affecting over 12% of people in a 2002 survey.
- To protect yourself, shred documents with personal information before throwing them out, use a locked mailbox, and regularly check your credit reports.
- If you become a victim, promptly report the fraud to law enforcement and credit bureaus, place a fraud alert and security freeze on your credit reports, and file an identity theft affidavit.
- Useful resources for information and assistance with identity theft include the Privacy Rights Clearinghouse, Identity Theft Resource Center, and your state Attorney General
The document discusses identity theft and provides tips to protect personal information. It notes that identity theft affects millions of people each year. The document outlines steps to take if identity theft occurs, including filing a report with law enforcement and credit bureaus, and placing a fraud alert or security freeze on credit reports. Useful resources for information on identity theft are also presented, such as the Privacy Rights Clearinghouse, Identity Theft Resource Center, and AnnualCreditReport.com for free credit checks.
If you’ve been injured in a crash involving a semi-truck, 18-wheeler or large commercial vehicle, protect yourself with these legal and safety steps:
1. Remain At The Scene Of The Accident
2. Call Emergency Services
3. Call The Police
4. Take Photos, Videos & Audio Recordings
5. Exchange Information
6. Avoid Statements of Any Kind Before Seeking Legal Advice
7. Get Your Case Reviewed By a Truck Accident Lawyer
8. Attend All Medical Appointments & Follow Doctor Advice
9. Report The Accident To The DMV
10. File A Lawsuit Without Delay – The Clock Is Ticking
Original source: https://www.azizilawfirm.com/truck-accident-lawyer/what-to-do-after-crash
The document discusses the standard of care that corporations are required to meet regarding workplace violence prevention and emergency response. It states that corporations must implement reasonable policies and plans to prevent incidents like active shooters, and failure to do so can result in legal liability. The document then provides a detailed list of 15 services and responsibilities that should be included in a corporate emergency response plan to address the needs of victims, survivors, and their families in the event of a violent incident. These include timely family notification procedures, establishing family assistance centers, assisting with transportation, personal belongings, funeral arrangements, and more. The plan aims to ensure an appropriate level of support is provided to alleviate harm from deliberate indifference.
This document provides examples of money laundering and suspicious transactions involving insurance that indicate potential criminal activity. It describes scenarios related to life insurance, non-life insurance, intermediaries, reinsurance, claims, and other insurance processes. The examples show how criminals attempt to disguise illicit funds and move money through insurance products and payments.
The document discusses identity theft and provides information on how employers can protect themselves and their employees. It summarizes identity theft laws like FACTA and the "Red Flag" rules, and explains that employers are responsible for protecting sensitive personal information and establishing an identity theft prevention program. It recommends designating a compliance officer, providing employee training, and having policies to securely handle and protect non-public information.
An examination under oath (EUO) is a formal proceeding where an insured is questioned under oath by an insurance company's representative about the details of an insurance claim. The purpose is to allow the insurance company to obtain truthful information needed to evaluate the claim. During an EUO, the insured is questioned orally while under oath and their responses are recorded by a court reporter. An insured's failure to fully cooperate with an EUO request can result in the denial of their insurance claim. The EUO allows insurance companies to investigate fraud, clarify insurable interests and damages, and determine if any policy defenses apply.
This document discusses the increasing problem of insurance fraud and how claims handlers can identify and manage fraudulent claims. It notes that fraud has risen significantly in recent years due to economic conditions creating more opportunities for fraud. The document advocates adopting a strategic, top-down approach to fraud management that involves identifying fraud risks, investigating suspicious claims, and regularly updating fraud indicators based on emerging fraud trends.
The document discusses identity theft protection services offered by Pre-Paid Legal Services and Kroll Background America. It notes they provide a suite of products to help with legal and identity theft issues before, during, and after a crime occurs. It also discusses the types of identity theft, how personal data is collected and stored in various databases, costs to individuals and businesses, and the coverage provided by their identity theft protection services.
The document discusses identity theft protection services offered by Pre-Paid Legal Services and Kroll Background America. It notes they provide a suite of products to help with legal and identity theft issues before, during, and after a crime occurs. It also discusses the types of identity theft, how personal data is collected and stored in various databases, costs to individuals and businesses, and the services offered to monitor credit and help restore identities.
Mark Goldwich is an insurance professional who started his own public adjusting firm called Gold Star Adjusters to help policyholders maximize their insurance claim settlements. He educates consumers about their insurance rights and the claims process. Some key points he makes are that insurance policies can be negotiated, adjusters do not work for the policyholder, and seeking professional help from a public adjuster can result in much higher claim payouts for clients. He provides several examples of past clients who received hundreds of thousands more dollars after hiring him to handle their claim.
How Best Practices in Triage Protocol Can Boost Compliance and Reduce RiskCase IQ
With recent announcements of increasingly stringent federal policies around record-keeping and due diligence, compliance and investigation professionals are feeling the pressure to demonstrate consistency and rigor in their case management processes.
Planning your investigation, having the right team members involved and reporting on outcomes of an investigation can all be difficult phases of the process.
However, being able to demonstrate that you are quickly, consistently and accurately triaging incidents is even more important now.
The key is to establish decision-making approaches and plan out your entire protocol before the matter comes to your attention through hotline reporting or other mechanism. This ensures structure and success as you triage, investigate, staff the investigation properly and meet the inevitable challenges of reporting and addressing the root causes of incidents.
How to Drive Efficiency and Reduce Risk with Investigative Case Management So...Case IQ
This document discusses the benefits of investigative case management software. It begins by introducing the presenters and providing an overview. It then discusses external and internal trends driving the need for such software, including more cases from employees reporting issues and the inefficiencies of manual processes. The document considers whether to build, repurpose, or buy a case management system. It outlines five key features that should be included: multichannel intake, flexibility to handle different case types, security controls, reporting capabilities, and configurability. Finally, it discusses how to make the business case for case management software through increased efficiency, reduced risk, and better insights to prevent future incidents. The presentation provides resources for learning more about ROI and next steps.
Who's Lying? Using the Cognitive Interview to Assess Credibility in Workplace...Case IQ
When investigating a “he said/she said” case of sexual harassment or other alleged misconduct, are you using scientifically validated methods to interview witnesses, assess their credibility, and reach a defensible conclusion?
Over the past 15 years, scientists have found that much of the conventional wisdom on how to effectively interview witnesses and determine truthfulness is wrong. At the same time, courts have found companies liable for using scientifically unproven interviewing techniques in workplace investigations.
In this webinar you will learn about the hundreds of research studies that scientists have conducted on how to best interview witnesses and assess credibility. You will learn how to apply these scientifically validated methods to your investigations.
Join the i-Sight team and former U.S. Department of Justice attorney Michael Johnson as they discuss how to apply these scientifically validated methods to your investigations.
Protecting the Mental Wellbeing of Corporate InvestigatorsCase IQ
Vicarious trauma is a type of second-hand psychological response most often associated with first responders and front-line crisis workers. Although corporate incident investigators and HR and compliance professionals are usually not the first on the scene, they frequently find themselves listening to both victims and accused people who recount what could be the worst days of their professional lives.
There is no doubt that the case management process can be stressful and sometimes triggering for those who are managing it. The personal and organizational impacts can include compromised risk assessment and investigations, investigator burnout and absenteeism, and a less healthy workplace overall.
Join expert workplace investigator Ken McCarthy as he shares his experience with vicarious trauma and compassion fatigue resulting from his involvement in workplace investigations.
As an investigator, you don’t define your value to the organization; leadership does. What are you doing to be a better business advisor and contribute to the organization’s goals? In other words, why should the bosses listen to you?
Because misconduct doesn’t happen in a vacuum! It results from a perfect storm of factors like employee ignorance, a failure to see the larger implications, a lack of training and procedures, or a failure of internal controls. And you have a view to all of this in your cases.
This webinar outlines how you can become a better strategic advisor, how to think like a business leader, and what keeps executives awake at night. You’ll learn how case management can drive a culture of prevention, and how you can prove the bottom-line ROI of investigations.
Join Meric Bloch, Strategic Advisor at Winter Investigations as he discusses how investigators can become business advisors to the C-suite using their knowledge of case management and risk assessment.
In this webinar, you will learn:
Goals of a strategic business advisor.
-What advice does a strategic advisor give?
-What should a strategic advisor not do?
-How an investigator can become a strategic advisor.
-How stellar case management positions investigators as strategic advisors.
5 Steps to Creating an Ethical Work CultureCase IQ
You get it. Being an ethical organization matters. A lot.
But ethics isn’t just a quarterly HR campaign or a glossy conduct guide; in order to really have a bottom-line business impact, organizational ethics must function as an integral pillar of company culture over time.
So, what are the best practices to make sure your organization is regularly thinking about ethics and including it in everyday decision making? What are some creative ways to bring focus to this vital but often overlooked function? And how can you most effectively deal with and investigate an incident or a breach when it occurs?
How to Assess, Level Up, and Leverage Your Culture of ComplianceCase IQ
Compliance officers know that a strong culture of compliance is indispensable to risk management and better business performance in the modern world. So how, exactly, can you capture insights into the current state of your corporate culture, and then use that information to (1) shore up weak spots in ethics and compliance operations; and (2) leverage a strong culture of compliance for better operations across the enterprise?
Join Matt Kelly, Editor and CEO of RadicalCompliance.com, as he discusses how and why compliance leaders need to use data to improve their investigations and corporate culture.
Everything You Need to Get E&C Investigations Right (According to the DOJ)Case IQ
Internal investigations have long been a part of every ethics & compliance program and every E&C professional’s tool kit. However, the US Department of Justice has made clear that internal investigations are more important than ever.
In October 2021, Deputy Attorney General Lisa Monaco reinstituted the substance of the Yates Memo, requiring companies to turn over all information on any culpable individuals. Recent criminal enforcement actions by the DOJ have thrown new and increasing scrutiny on internal investigations. Now, CCOs and CECOs must certify compliance in any FCPA settlement.
In short, getting E&C internal investigations right has taken on a new importance.
5 Ways to Build Employee Trust for Less Turnover and Fewer IncidentsCase IQ
Over the past few months, we’ve seen employees quit in record numbers. While there are many reasons for “The Great Resignation”, a standout is employee trust. A study from Gallup suggests that only one in three employees strongly agree that they trust the leadership of their organization.
Employees want to trust the companies they work at and the people they work with. They want to feel comfortable coming to HR with their complaints and concerns. But building trust takes time, and effort. As organizations are planning their post-pandemic strategies, now is a perfect time to place an intentional emphasis on building trust.
Hybrid Workplace Harassment: Are You Protecting Your Company from Hidden Thre...Case IQ
In today’s “new world of work,” many organizations run on a hybrid model, with some employees working remotely and others in the physical office. While this set-up is convenient, it can cause unique interpersonal issues between employees.
Reduced face-to-face communication makes it harder for teams to bond, while making it easier for harassers to get away with bad behavior. To reduce harassment incidents in your hybrid workplace, you need to foster a culture of openness, willingness to learn, and compassion.
Join workplace investigation and executive management expert Kenneth McCarthy as he outlines how to address and prevent hybrid workplace harassment incidents.
Finding Value Before a Crisis: How Workplace DEI Drives Revenue and Prevents ...Case IQ
The topic of workplace diversity, equity, and inclusion is at an all-time high right now. It has been proven that there is a direct correlation between inclusive workforces, productivity, and revenue. According to the McKinsey & Company diversity report, “companies in the top-quartile for ethnic and cultural diversity on executive teams were 33% more likely to have industry-leading profitability.”
Without a strong DEI program, though, your organization could face internal harassment incidents, discrimination lawsuits, high employee churn, and a poor corporate reputation, leading to lost customers and clients.
Join inclusive marketing consultant, speaker, and author Michelle Ngome as she outlines DEI best practices that will increase your organization’s revenue, as well as prevent workplace incidents.
How Not to Get Called Out on TikTok: Improving Your Brand Through Employer/Em...Case IQ
More and more, disgruntled employees have been taking to TikTok, Twitter, and other social media sites to share videos and posts of their bad work experiences. These stories are more likely than ever to go viral, which can lead to lost business, reputational damage, employee churn, and lawsuits, just to name a few unwelcome consequences for employers.
While some people might be acting in bad faith, employees have been finding tried traditional HR channels less than satisfactory. They feel un-heard and undervalued, and they turn to the internet to tell their stories, and receive fast responses.
You can’t build a brand or accomplish your mission statement without your employees. To avoid the repercussions of viral incidents and strengthen your brand, you have to repair your employer/employee relationship and work culture—or better yet, create a healthy, ethical culture from the start.
Join employment lawyer Janette Levey as she breaks down major viral incidents including Better.com, Starbucks, and Amazon, their consequences, and what to do to avoid them.
What is Psychological Safety in the Workplace?Case IQ
This document discusses how cultivating psychological safety and civility in the workplace can positively impact an organization's bottom line. It defines psychological safety as employees feeling comfortable speaking up without fear of negative consequences. The document outlines signs that psychological safety may be lacking, such as absenteeism and isolation. It also provides examples of leadership behaviors and organizational practices that can undermine psychological safety. Finally, it proposes conducting a psychological safety assessment through surveys and interviews in order to develop an action plan to improve workplace culture.
Misconduct or Missed Conduct? Ensuring Consistent SAR Reporting of Internal M...Case IQ
Case management is an integral component of any institution’s overall compliance program, let alone those with suspicious activity report (“SAR”) filing responsibilities. However, misconduct is often reported through multiple channels such as whistleblower complaints, HR, and even through a company’s legal department. If misconduct requires SAR filing, input from HR, and advice from legal, but comes in through possibly siloed teams, how can a company feel confident that they are accurately capturing and consistently dispositioning these cases?
The answer boils down to an often-overlooked area – case management systems.
Join financial crime compliance advisory and training specialist Michael Schidlow, as he explains best and worst practices in the field, gives tips on what case management tools should always and shouldn’t ever do, and describes how to utilize metrics from those systems to get an accurate snapshot of their company’s risk profile.
Building Effective Sexual Harassment Prevention Policies and TrainingCase IQ
There’s no place for sexual harassment in today’s workplace, and employers have a responsibility to investigate every allegation. But reacting after a complaint is made doesn’t fix a culture that allows sexual harassment to occur. A proactive approach, incorporating a strong policy, backed by training and commitment at all levels, is key to building an organizational culture that discourages sexual harassment.
Join Philip Miles, employment lawyer, McQuaide Blasko, as he outlines the steps for building policies and training plans to prevent sexual harassment in the workplace.
How to recognize and minimize unconscious bias in the workplaceCase IQ
The modern workplace should be an inclusive and welcoming environment for all employees but that isn’t always the case. In fact, systemic inequality is the norm for a vast number of workplaces throughout North America, Europe and beyond. And while the BLM and MeToo movements have received much media attention, the underlying factors that contribute to the inequality they point out aren’t always addressed.
Implicit, or unconscious, bias is the root of many systemic inequities in the workplace. It’s important that we recognize our personal biases, take action to mitigate them and actively serve as an ally to others.
On June 10, join Catherine Mattice-Zundel, president of Civility Partners, a training and consulting firm focused on helping organizations build positive workplace cultures, as she outlines strategies for uncovering and reducing implicit bias in workplace decision-making.
The webinar will cover:
● The origins of bias and four different types of bias
● Risk factors that increase our likelihood to engage in bias
● How to compensate for and attempt to overcome bias through clear and tangible actions
● Strategies to combat microaggressions and other exclusive behaviors using simple, tried and true
intervention methods
Search Engine Skills for Workplace InvestigatorsCase IQ
Whether you are investigating fraud, harassment or other misconduct, solid online research skills can serve you well. The internet is a valuable resource for finding information and evidence to support your case, and it’s important to stay up to date on its use and limitations.
Join Cynthia Hetherington, investigation expert, trainer and founder of Hetherington Group, as she explores techniques and tools for getting the information you need online.
Preventing Bullying and Harassment Through Diversity and Inclusion in the Wor...Case IQ
In a 2019 Monster survey, 90 per cent of employees said they had experienced bullying in the workplace. The Pew Research Center reports that 69 per cent of women say they have been sexually harassed in a professional setting. These numbers point to a serious problem that leaders can’t afford to ignore.
Policies and training are, of course, critical to the prevention of bullying and harassment, but there are other avenues that you may not have considered. Diversity and inclusion have benefits that go far beyond compliance. Not only do companies that embrace diversity and inclusion outperform those that don’t, but understanding, accepting and valuing differences ensures a fairer, more collaborative environment with less conflict.
Join Catherine Mattice-Zundel, president of Civility Partners, a training and consulting firm focused on helping organizations build positive workplace cultures, as she explores strategies for using diversity and inclusion to prevent harassment and bullying.
The webinar will cover:
What constitutes bullying and harassment in the workplace
Best practices for addressing and preventing bullying and harassment
How diversity and inclusion helps to reduce bullying and harassment
How to achieve diversity and inclusion
Case studies of how bullying, inequities and harassment tie together, and how resolving one requires resolving all
Insider Threat: Cases and Controls to Prevent Internal Fraud and PreventionCase IQ
“I never would have imagined”, said the company owner, manager, colleague, or workplace friend. It is hard to reconcile that people would engage in fraudulent behavior in the workplace, let alone the depth of these schemes. Financial misconduct and internal fraud are among the biggest threats to today’s organizations. Without the right controls and prevention measures in place, companies are at financial and reputational risk.
Join financial crime compliance advisory and training specialist Michael Schidlow, as he reviews recent cases of internal fraud, what we can learn from them, and controls that companies can put in place to prevent fraud
7 Ways to Increase Ethical Accountability and Decrease Fraud Risk Case IQ
It’s long been clear that organizations with strong ethical cultures perform better than those without. In addition to the multitude of positive impacts a strong ethical culture provides, these organizations will also typically experience less fraud and misconduct. However, to achieve maximum results, a strong ethical culture must focus on accountability and include robust fraud prevention measures.
Ethical accountability takes time and effort to build, but the rewards of fostering the right culture in an organization are measurable. Fewer fraud incidents, for example, can be demonstrated by hard numbers. A strong code of conduct is a great start, but it’s critical to have a comprehensive ethics program that fosters accountability.
Join Joseph Agins, CFE, CCEP, adjunct professor and fraud expert, as he outlines strategies organizations can use to ensure every employee from the C-Suite down has the tools they need to help them make ethical decisions and prevent fraud.
The webinar will cover:
The importance of tone from the top
Identifying the pressures employees face and thus the ethics and fraud risks
Understanding the resources employees have (or not) to report wrongdoing
Whether the internal imagining of the culture matches the reality
Developing tools and strategies for fostering ethics in the workplace
Anti-fraud measures that should be incorporated into every ethics policy
Encouraging ethics and accountability
Anny Serafina Love - Letter of Recommendation by Kellen Harkins, MS.AnnySerafinaLove
This letter, written by Kellen Harkins, Course Director at Full Sail University, commends Anny Love's exemplary performance in the Video Sharing Platforms class. It highlights her dedication, willingness to challenge herself, and exceptional skills in production, editing, and marketing across various video platforms like YouTube, TikTok, and Instagram.
LA HUG - Video Testimonials with Chynna Morgan - June 2024Lital Barkan
Have you ever heard that user-generated content or video testimonials can take your brand to the next level? We will explore how you can effectively use video testimonials to leverage and boost your sales, content strategy, and increase your CRM data.🤯
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Storytelling is an incredibly valuable tool to share data and information. To get the most impact from stories there are a number of key ingredients. These are based on science and human nature. Using these elements in a story you can deliver information impactfully, ensure action and drive change.
Unveiling the Dynamic Personalities, Key Dates, and Horoscope Insights: Gemin...my Pandit
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The Evolution and Impact of OTT Platforms: A Deep Dive into the Future of Ent...ABHILASH DUTTA
This presentation provides a thorough examination of Over-the-Top (OTT) platforms, focusing on their development and substantial influence on the entertainment industry, with a particular emphasis on the Indian market.We begin with an introduction to OTT platforms, defining them as streaming services that deliver content directly over the internet, bypassing traditional broadcast channels. These platforms offer a variety of content, including movies, TV shows, and original productions, allowing users to access content on-demand across multiple devices.The historical context covers the early days of streaming, starting with Netflix's inception in 1997 as a DVD rental service and its transition to streaming in 2007. The presentation also highlights India's television journey, from the launch of Doordarshan in 1959 to the introduction of Direct-to-Home (DTH) satellite television in 2000, which expanded viewing choices and set the stage for the rise of OTT platforms like Big Flix, Ditto TV, Sony LIV, Hotstar, and Netflix. The business models of OTT platforms are explored in detail. Subscription Video on Demand (SVOD) models, exemplified by Netflix and Amazon Prime Video, offer unlimited content access for a monthly fee. Transactional Video on Demand (TVOD) models, like iTunes and Sky Box Office, allow users to pay for individual pieces of content. Advertising-Based Video on Demand (AVOD) models, such as YouTube and Facebook Watch, provide free content supported by advertisements. Hybrid models combine elements of SVOD and AVOD, offering flexibility to cater to diverse audience preferences.
Content acquisition strategies are also discussed, highlighting the dual approach of purchasing broadcasting rights for existing films and TV shows and investing in original content production. This section underscores the importance of a robust content library in attracting and retaining subscribers.The presentation addresses the challenges faced by OTT platforms, including the unpredictability of content acquisition and audience preferences. It emphasizes the difficulty of balancing content investment with returns in a competitive market, the high costs associated with marketing, and the need for continuous innovation and adaptation to stay relevant.
The impact of OTT platforms on the Bollywood film industry is significant. The competition for viewers has led to a decrease in cinema ticket sales, affecting the revenue of Bollywood films that traditionally rely on theatrical releases. Additionally, OTT platforms now pay less for film rights due to the uncertain success of films in cinemas.
Looking ahead, the future of OTT in India appears promising. The market is expected to grow by 20% annually, reaching a value of ₹1200 billion by the end of the decade. The increasing availability of affordable smartphones and internet access will drive this growth, making OTT platforms a primary source of entertainment for many viewers.
Recruiting in the Digital Age: A Social Media MasterclassLuanWise
In this masterclass, presented at the Global HR Summit on 5th June 2024, Luan Wise explored the essential features of social media platforms that support talent acquisition, including LinkedIn, Facebook, Instagram, X (formerly Twitter) and TikTok.
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2. Kelly E. Riddle
Kelly Riddle has more than 35 years of investigative and
law enforcement experience. Prior to founding his own
company, Kelmar Global, in 1989, he worked for two
other private investigation companies and in the
insurance industry as an adjuster and an investigator.
On the law enforcement side, Kelly has been a member
of the SWAT Team, a training officer, emergency medical
technician, evidence technician, arson investigator,
traffic investigator and breathalyzer operator.
Kelly has a Bachelor of Science degree in Criminal
Justice from the University of North Alabama.
3. Understanding Insurance
Philosophy of Insurance: The concept of insurance is to spread the threat of
loss over a large, diverse segment of the populace. Insurance is based on
risk: NO RISK = NO INSURANCE.
Risk is everywhere
Risk is an uncertainty (which implies doubt about the future)
Risk is a chance or probability of loss
Risk is based on a lack of knowledge—if we knew a loss was going to
happen, we could act to prevent it
Insurance attempts to quantify the likelihood of an event and the severity
of damage from the event if it occurs
4. Causes of Loss
Peril: An event that will give rise to a loss — often beyond control
Hazard: A factor that may influence the outcome of a loss. A hazard are not
the cause themselves — they increase the likelihood of a peril occurring.
Chance of Profit or Loss: Pure risk entails a chance of loss without a
chance of profit. Insurance companies attempt to “wager” the possibility of
loss versus profit.
6. History of Insurance
Code of Hammurabi (Robbery):written by the King of Babylon
around 2000 BC is one of the earliest known applications of
insurance. A man was robbed and not caught. The Code described
restitution for the loss.
Cargo Insurance: Babylonian caravan owners pledged their assets
(including family) as security for safe transport of others goods.
Restitution was made if the goods were not safely delivered.
Marine Insurance: The sea-faring Phoenicians used the cargo
insurance idea while transporting cargo by sea.
Fire Insurance: The great fire of London in 1666 sparked the
formation of numerous insurance companies. Insurance companies
owned the early fire brigades.
7. Payment of Claims: Companies philosophies include paying “exactly
what is owed — not a penny less, and not a penny more”
The Enabler of Insurance Fraud: The philosophies of insurance help
create fraud. Paying “exactly what is owed” becomes the issue —
what exactly ARE the DAMAGES?
Is exaggerating a claim considered insurance fraud?
Until a loss occurs, an insured is the holder of an expensive piece of
paper that contains a promise. This is also a time to “regain” the
money spent for the policy.
8. Responsibilities of Insured
• Must give prompt notice of loss
• Must protect property from further damage — not abandon
• Must separate damaged from undamaged property
• Must prepare an inventory of damaged items
• Must complete all proof of loss forms, etc.
• Must cooperate with investigation
Failure to perform these actions can void the policy and allow for
legal denial of the claim.
9. Insurance Definitions
S.W.I.B.: The term that designates the Southwest Index Bureau. An
insurance company can subscribe to their service. If a person turns in a
claim for a bodily injury, the adjuster sends in a "SWIB" form. The
Southwest Index Bureau will notify the insurance adjuster of any other
claims filed by the person. Commonly used to assist in determining similar
injuries or a pattern of claims.
P.I.L.R.: Pronounced, "pillar." The term designates the Property Insurance
Loss Register. Insurance companies that subscribe to the services can use
the service to determine if the person has filed any other similar claims or
listed similar property as being stolen.
Activity Check: A term used by the client to request a P.I. to determine the
subject's current activities.
10. Claims department: This is the department that handles the claims
filed against the insured (person or company who bought the
policy).
Sales department: This department is responsible for selling the
insurance policy to the consumer.
Underwriting department: The underwriters are responsible for
reviewing insurance applications for potential risk and determine
the profitability for insuring the applicant.
Engineering department: This department has the loss control
and safety review agents that attempt to prevent losses by
recommending changes to the insured's property or business.
Auditing department. The auditor's review the books of companies they insure
to make sure that the company is being billed correctly based on payroll
guidelines.
11. Legal department: This involves staff attorneys that assist the
insurance company departments in legal issues.
Accounting department: The department accounts for the money
coming in and going out of the company.
Actuarial department: This department records, classifies and
interprets data for use in the individual rate determinations.
Declaration: This portion of the policy outlines the name and
address of the person being insured, the dates of the policy, the
amount of insurance, the location and the premium.
12. Current Trends in Fraud
Identity theft
Internet fraud (Ebay, etc.)
Financial fraud
Newspaper fraud (obituaries, garage sales)
Vendor fraud
Agent fraud
Travel-related fraud (theft, deaths)
Life insurance fraud
Nigerian scams
Fake hail claims
13. Bank and Financial Fraud
1) Domestic Bank Fraud:
a) Embezzlement or poor record keeping?
b) Tracking missing assets
2) International Bank Fraud:
a) Fake Banks
b) Methods of Hiding Assets
3) Stock Fraud
4) Sources for tracking assets
a) Law Enforcement
b) Following the Money Trail
14. Homeowner and Property Claims
Types of claims
1) Faking Burglary and Theft Claims
2) Exaggerating Burglary and Theft Claims
3) Arson
4) Water Damages
5) Liability
6) Slip and Fall Claims
15. Fake Documentation of Claim
1) Unusual Amount of Receipts
2) Receipts Returned
3) Fake Affidavits
4) Reused Photographs
5) Fake Walls & Floors
6) Family Albums
16. Legal Name Change Scam (Seattle, WA)
Teeshawndra Nelson used the legal system to change
her name 11 times in three years. Each time she changed
her name, she obtained a new Washington state ID card
or driver's license.
Nelson then used the IDs and stolen Social Security
Numbers to open bank accounts under her new name
and allegedly wrote scores of bad checks. Once the
bank caught on to the fraud, she would go back to court
to change her name and begin the cycle anew.
Nelson is one of 11 defendants facing federal charges as
a result of "Operation Name Game," a lengthy
investigation of a sophisticated new form of identity theft
that exploits the surprisingly easy process for legally
changing names.
17. Heavy Machinery and 18 Wheelers
1) 18-Wheeler Theft:
a) Witnesses
b) Location of Keys
c) Debt
d) Shops
e) Maintenance Records
2) Cargo Theft:
a) Driver Involvement?
b) Organized Crime
c) International Connections
18. Cargo and Transportation Theft
• Domestically, cargo thieves target five main
product types:
• Computer components and software
• Consumer electronics
• Cigarettes and pharmaceuticals
• Fashion apparel
• Copper and metal
22. Methods of Crime Activity
• Local gangs concentrate on local distribution centers, truck stops
and drop yards.
• Follow loaded tractor/trailer from DC awaiting an opportunity to take
the unit and will follow for hundreds of miles if necessary.
• Once driver leaves unit alone, they will steal the entire unit, by either
hot-wire or master keys.
• They immediately disable any QUALCOMM or asset control GPS on
the tractor or trailer.
• They either drive the stolen unit a short distance and park in a
remote or crowded area, and place it under surveillance for LE
response.
23. • If no one comes within a few hours, they either move it on or
trans-load the freight to a clean trailer.
• If freight is not recovered within 16 hours, chance of recovery is
very limited.
• Gangs will often put someone in a warehouse as a stake-out
employee to determine shipments and security.
• Gangs will often put a GPS in the shipment to track without
having to use direct surveillance.
• Must be able to work quickly and across borders if the equipment
and cargo is going to be recovered.
28. Personal Injury
1) Fake Claim/Documentation
a) doctor involvement
b) Attorney involvement
2) Auto Accidents
a) Claimants not really in car
b) Car previously damaged
3) Proper Defense of Claim and Use of Investigators
29. Plaintiff Attorney Abuse of System
1) Know insurance companies that investigate claims
2) Have “buddy” system with doctors and clinics
3) Use of forms from Doctor’s office
4) Knowledge of claimant’s fraud
5) Coaching to assist in fraud.
30. Arson: The Easy Insurance Abuse
1) Faking the Electrical Short
2) Signs of abuse:
a) No household goods
b) Rental Properties
c) Flame and Smoke Patterns
d) Pending Divorce or Financial Litigation
3) Agent Conflict
31. Unusual Statements
Mental or Physically Disabled (should obtain affidavit from physician
attesting to ability)
Children: Parental permission
Illiterate Individuals: use of witnesses
Different Language: use of interpreters
Telephone Statements: use of personal identifiers
32. Locating Insurance Coverage
1) Automobile Insurance:
a) Run license plate
b) Check lien holder
c) Police Survey
2) Property Insurance
a) Tax Assessor
b) Appraisal District
c) Mortgage Company
33. Vendor Fraud
1) Outside Investigators
a) not performing actual surveillance
b) conflict of interest
c) use of more than one PI company
2) Medical Review/Third Party Administrators
a) improper coding
b) conflict of interest
c) failure to investigate due to contract/budget
34. Subrogation
1) Hiding Insurance Coverage
2) Hiding Assets
3) Hiding Business Affiliations
4) Hiding Prior Litigation
5) Accident History
35. Conducting Investigations
1) Obtain a copy of the police report
2) Talk to the investigating officer and/or detective. Determine if the area has
been getting hit on a regular basis, if they have any suspects and what their
impression of the insured was when they talked to them.
3) Meet with the insured and obtain a recorded statement from the insured
regarding when the theft occurred, when it was reported, etc…
4) Obtain receipts for the reported items that were stolen.
5) If receipts are not available, obtain copies of owners manuals or similar
documentation
36. 6) Obtain copies of credit card statements to assist in verifying the purchase
7) Obtain copies of family photographs that may show the items in the
background.
8) If no receipts or other tangible proof of ownership has been provided,
determine which of their family members or friends you can contact to get a
sworn statement that the items were observed in the house.
9) If there are other similar items in the house, obtain the serial and model
numbers off the items.
10) Take photographs of the point of entry as well as the shelves or other
locations where the items were sitting when stolen.
37. 11) Determine if the insured had an alarm. If so, obtain the name of the alarm
company and contact them to see if they had any alarms on the day of the
theft.
12) Make an overall observation to determine if the person appears to live the
type of lifestyle that would indicate they could afford the items.
13) If things associated with hobbies such as guns, instruments or other items
were reported stolen, observe whether they live the lifestyle that suggests
they may have been involved in the hobby.
14) Do a neighborhood canvas and determine if anyone saw anything
suspicious, heard anything unusual or happens to know the financial
condition of the insured. Be sure to ask if the neighbors saw any trucks or U-haul
type vehicles and determine if they know if the insured is actually living
at the house.
38. 15) Conduct a preliminary civil and criminal search regarding the
insured and their spouse.
16) Attempt to validate the purchase of the stolen items through the
stores.
39. Interviewing: Make or Break a Claim
Setting the Stage for a Successful Interview
1) Know your interviewee
a) compile background information on subject
b) compile background of other parties involved
c) compile information about geographic area
2) Know the facts of the case
3) Select specific questions that will provide insight
4) Prepare Recording Equipment ahead of time
40. Control the Setting
You choose the location for the interview
a) Interview on your turf
b) Don’t conduct the interview where the subject knows everyone and
feels secure
c) Choose a location with limited distractions
d) Be early for the appointment
e) Make sure the interviewee has was if wanted
f) Inquire if they need to use bathroom facilities before the interview begins
g) Make sure interviewer & interviewee turn off cell phones and pagers
41. Set the Tempo of the Interview
a) Make small talk to relax the interviewee
b) Advise subject (in gentle & non-threatening manner) of rights to leave
or terminate interview
c) Ask very general and basic questions initially
d) Smile and be polite to ease the subject
e) Allow enough time for interview
f) Provide ample time for subject to answer
42. Study the Interviewee
1) Does the subject appear confident, nervous, afraid or timid?
2) Does the subject return smiles?
3) Study the interviewee’s eyes:
a) do they look you in the eyes before questions?
b) do they look you in the eyes while you talk?
c) do they look you in the eyes while answering?
d) do they glance away often?
e) do they look around often?
f) do they blink abnormally?
g) do their pupils dilate under pressure?
43. Study the Subject’s Body Language
a) do they sit upright and confident?
b) do they sit with arms folded?
c) do they fumble with a pen or other item?
d) do they sit with both feet on the floor?
e) do they hold on firmly to a purse/briefcase?
f) do they move their hands a lot while talking?
g) do they fumble with hair, beard, etc.?
h) do they shift positions while seated/standing?
I) do they stutter or swallow excessively?
44. Study the Interviewee’s Rhythms
a) do they sigh a lot?
b) do they take deep breaths?
c) does their respiration appear to change?
d) does the subject have a noticeable rhythm to their answers?
e) does the subject’s face turn red or pale?
f) does the subject’s ears, nose, neck or fingers turn red or pale?
g) does the subject take longer to answer with tougher questions?
I) does the subject request frequent breaks?
45. Proper Questioning
1) Proper questioning provides proper answers
2) Determine tendency of subject to answer truthfully from the onset:
a) ask questions with known factual response
b) ask basic questions about the incident
3) Insert a tough/key question during simple, relaxed questioning
4) Rephrase the same key question several different ways and ask again
several times
5) Utilize different voice fluctuations and rhythms to encourage responses
6) Utilize head/hand gestures to encourage response
46. Signed, Sealed and Delivered
1) Know ahead of time what wording to use for confession
2) Have access to witnesses for statement
3) Encourage subject by advising of your intentions with/without
cooperation
4) Be prepared to use statutes such as RICO
5) Have predetermine guidelines for arresting or escorting subject off
property
6) Have predetermine understanding of prosecutor’s requirements
47. Thank-you for participating
If you have any questions, please feel free
to email them to:
Kelly Riddle, President, Kelmar Global
kelly@kelmarglobal.com
or
Joe Gerard, Vice President Marketing and Sales, i-Sight
j.gerard@i-sight.com