Slip & Fall
Why is it so important to obtain any loss surveillance footage right away?
A. So we can laugh at the claimant
B. Most security systems only keep videos for a limited time, and they are then overwritten by new footage so timing is important
C. So we can deny the claim
B. Most security systems only keep videos for a limited time, and they are then overwritten by new footage so timing is important
What does RSU stand for?
A. Recovery Services Unit
B. Remote Surveillance Unit
C. Retroactive Subrogation Unit
D. Really Special Users
A. Recovery Services Unit
Which of the following is a red flag when it comes to a workers’ compensation claim?
A. Workplace accident being captured on video which confirms the claimant’s story on how he got injured
B. Workplace accident was witnessed
C. Workplace accident occurred at 2:45 PM on a Wednesday
D. The first notice of loss was provided by the claimant’s attorney
D. The first notice of loss was provided by the claimant’s attorney
A claim filed within the first ____ days of a policy or last ____ days of a policy is considered a red flag.
A. 30, 180
B. 60, 90
C. 30, 30
D. 120, 90
C. 30, 30
SIU submits fraud referrals for every case investigated by SIU?
A. True
B. False
B. False
When a suit alleges soft tissue injuries and it contains substantial medical documents, what is the best option for a records review?
A. Have SIU review the medical records and look for inconsistencies
B. Utilize The Physician’s Network (TPN) to do a full, comprehensive forensic records review
C. Ask a doctor friend to review the records for you
B. Utilize The Physician’s Network (TPN) to do a full, comprehensive forensic records review
Should all claims involving fire or water damage be referred to the RSU?
A. Yes
B. No
C. Maybe
A. Yes
Claimant gets injured one week after they started employment with the policyholder. Is this a red flag?
A. Yes. The odds of getting injured the first week on the job are pretty slim.
B. No. There’s a lot of clumsy people out there & this happens all the time.
A. Yes. The odds of getting injured the first week on the job are pretty slim.
Prior losses that are similar in nature are not of interest when investigating a claim for red flags.
1. True
2. False
2. False
Each State’s DOI has their own fraud bureau?
A. True
B. False
B. False (Wisconsin and Vermont do not)
What is one of the first things an insured should do after a slip and fall is reported?
A. Don’t worry about it
B. Document a very detailed incident report noting the event, circumstances, alleged injuries, conversations that took place, photos, etc.
C. File an insurance claim
D. Cancel your policy before a claim can be filed
B. Document a very detailed incident report noting the event, circumstances, alleged injuries, conversations that took place, photos, etc.
DOUBLE JEOPARDY
What is the gross amount of subrogation recovery dollars secured in 2021 by the RSU?
A. 8 Million
B. $49 million
C. 7 Million
D. 2.5 Million
B. $49 million
What is defined as “pretending or exaggerating incapacity or illness as to avoid duty or work”?
A. Loitering
B. Laziness
C. Malingering
D. Being a silly goose
C. Malingering
The following are red flags for a theft claim except:
A. The insured is in financial distress.
B. The loss date is 120 days after the policy was created.
C. Policy limits were very recently increased.
D. The insured cannot produce receipts/proof of ownership.
B. The loss date is 120 days after the policy was created.
Which state has the most stringent requirements to submit fraud referrals?
A. New York
B. Florida
C. California
D. Texas
C. California
A slip and fall is an example of what type of claim?
A. Professional Liability
B. Product Liability
C. Premises Liability
D. Select Risk
C. Premises Liability
When is the best time to refer a claim to the RSU for subrogation?
A. When you’ve identified subrogation potential
B. When counsel advises you to involve RSU
C. At the time of FNOL
D. Upon claim settlement
C. At the time of FNOL. When subrogation potential is identified it may be too late.
An individual files a workers’ compensation claim after they are terminated. Is this a red flag?
A. No. People often forget they get injured on the job until after they are terminated
B. Yes. This situation may be a retaliatory claim or an attempt to receive income after being terminated
B. Yes. This situation may be a retaliatory claim or an attempt to receive income after being terminated
Is the lack of a police report considered a red flag for theft?
1. Yes
2. No
1. Yes
Which entity/organization would NOT be a recipient of an SIU fraud referral?
A. State DOI
B. County Prosecutor
C. NICB (National Insurance Crime Bureau)
D State Treasurer
E. U.S. Attorney
D. State Treasurer
Which of the following are GL-slip and fall red flags?
A. No witnesses to the event
B. FNOL is submitted by a claimant attorney
C. The claimant’s attorney and doctor have been parties to numerous claims NICB identified as questionable
D. All of the above
D. All of the above
Does the RSU manage subrogation investigations for Markel Bermuda?
A. Yes
B. No
A. Yes
What services does the SIU provide that can assist in curtailing workers’ compensation fraud?
A. Social Media
B. Surveillance
C. ISO History Reports
D. Background Search
E. All of the above
F. None of the above
E. All of the above
Contents that are __________ with no receipt are a red flag.
A. Sparkly
B. Generic
C. Expensive
D. Cheap
C. Expensive
What is the most correct answer when determining if a fraud referral should be submitted by SIU?
A. Extensive criminal history
B. Misrepresentations were made
C. Claim was denied
D. Extensive ISO history
E. Non-pursuit of claim
B. Misrepresentations were made