Confronting Organized Insurance-Fraud Schemes and Sham Claims

Avoiding Payment of Sham Claims, Tools to Deter and Recover from Scheme Leaders, Seeking Criminal Prosecution

Recording of a 90-minute CLE webinar with Q&A


Conducted on Wednesday, May 27, 2020

Recorded event now available

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Program Materials

This CLE webinar will guide attorneys representing insurance companies in spotting and unraveling increasingly complex and organized fraud. These schemes may be related to only one claim but increasingly span multiple industries and types of policies, including commercial and property; life, health, disability; and third-party personal injury. The webinar will discuss “red flags” suggesting sham claims and offer aggressive strategies and practical techniques deterring fraud, recovering payments from the masterminds, dealing with State regulators, and whether to pursue criminal charges.

Description

Insurance fraudsters now have advanced digital tools to make more difficult distinguishing the fraudulent claim from the valid one. Particularly concerning, perpetrators of fraud can now manipulate medical records, including x-rays and pet-scans, photographs and video, and metadata to produce convincing forgeries that are difficult to spot and prove.

Insurance fraud will usually focus on recovering high-value claims, such as from business interruption (data theft), jewelry theft, fire and water damage, inland marine, and other specialized property losses. But the “scams” are perennial: inventory swapping; submitting claims for injuries or damage that never occurred; staging accidents; forgery, involving unwitting third parties, and more.

To deter and thwart these increasingly complex and sophisticated deceptions that may cross multiple industries and involve different kinds of coverage, insurers and their counsel need practical, decisive, and effective weapons. At the same time, they must balance the need to avoid claims of bad faith, making false accusations, and comply with insurance regulations. How much information to provide prosecutors is always a challenging question. State immunity laws do not always cover allegations of insurance fraud.

Listen as the panel discusses proactive steps to identify fraud early on and then and prevent payment of the falsified claim, and if payment has occurred, how to judiciously but vigorously recover payment from the masterminds.

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Outline

  1. Insurance fraud schemes involving property
    1. Inflated inventory
    2. Phony or inflated thefts
    3. Paper boats
    4. Arson for profit
  2. The "red flags" of insurance fraud
  3. The fraud examination with eye to litigation
  4. Pre-suit remedies to preserve assets
  5. Immunity laws
  6. Surveillance
  7. Making the case in court

Benefits

The panel will review these and other significant matters:

  • Red flags signaling fraud
  • Finding the right experts to assist with a sophisticated fraud examination
  • Using the right technology and the latest computer software to uncover "deep fakes"
  • How to build the fraud case from the beginning to ensure the best result
  • Dealing with immunity laws and responses from those being investigated
  • Pre-trial remedies to preserve assets

Faculty

Perkins, Linda
Linda D. Perkins

Counsel
White & Williams

Ms. Perkins’ practice includes cybersecurity and privacy law, complex civil litigation, internal corporate...  |  Read More

Spector, David
David I. Spector

Partner
Holland & Knight

Mr. Spector is the co-chair of Holland & Knight's Insurance Fraud and Recovery Team. He is an accomplished...  |  Read More

Valdivia, Joseph
Joseph Francisco Valdivia

Attorney
Holland & Knight

Mr. Valdivia is a West Palm Beach litigation attorney who practices commercial and civil litigation. He focuses his...  |  Read More

Other Formats
— Anytime, Anywhere

Strafford will process CLE credit for one person on each recording. All formats include program handouts. To find out which recorded format will provide the best CLE option, select your state:

CLE On-Demand Video

48 hours after event

$297

Download

48 hours after event

$297

DVD

10 business days after event

$297 + $24.45 S&H