SIU Trivia
Which Department submits the most referrals to the SIU?
A) Legal
B) Underwriting
C) Claims
D) Audit
C -- Claims
Is the lack of a date of service or the itemization of charges on Vet records a red flag?
A) No, it happens once in awhile
B) Yes, it's customary practice for Vet records to include a date of service and an itemization of charges
B - Yes. It's customary practice for Vet records to always have a date of service and an itemization of charges.
What is the most common personal injury (BI) claim?
A) Workplace accidents
B) Car accident claims
C) Slip & fall accidents
D) Product liability
B -- Car accident claims
1. Car accident claims
2. Slip & fall accidents
3. Medical malpractice
4. Assault
5. Workplace accidents
6. Premises liability
7. Product liability
8. Defamation claims (emotional harm)
9. Construction injuries
10. Dog bites
Employee is new on the job, reports an injury first thing Monday morning, known to play rugby (physically demanding sport) every weekend. Is this enough to cause an examiner to conduct due diligence and/or refer the matter to the SIU?
A) No
B) Yes
B -- Yes. All 3 factors are known NICB fraud indicators.
Additional due diligence is warranted by either the examiner or SIU.
What is the primary reason the SIU would conduct a video recorded statement versus a recorded statement over the phone?
A) Like to see what jewelry they are wearing
B) You can hear their voice better on video
C) Video is cheaper than a phone call
D) Observe the body language of the insured/claimant
D -- Observe the body language of the insured/claimant/witness during non-threatening questioning (establishing a baseline) versus uncomfortable questions (confronted with factual inconsistencies and contradictions)
97% of communication is non-verbal communication
Who on the SIU team recently got married?
A) Don Kohtz
B) Jerry Seinfeld
C) Michaela Michel
D) Betty White
C -- Michaela Michel, SIU Analyst
Generally speaking, why are claims filed shortly after the policy was purchased?
A) It's a coincidence
B) Because I can
C) Most times, the injury or death occurred prior to the policy being purchased, and insured is trying to get payment for a loss they are not entitled too
D) Simply getting benefits I contracted for from Markel
C -- Most times, the injury or death occurred prior to the policy being purchased.
Deceptive insureds who purchase a policy immediately after the loss, are trying to get payment for a loss, they are not entitled to under the terms of the policy.
In a slip & fall claim, the claimant (5'5" tall) reports that as they were walking towards the grocery store from the parking lot (flat surface) and a run-away empty cart came out of no-where and struck them head-on which caused them to fall forward over the cart landing face down on the concrete surface. Should you accept this statement and pay the claim?
A) No
B) Yes
A. No
What fraud scheme comes to mind, when after the injury, the employee is never available when you try to contact them at home?
A) Avoidance
B) Phone-A-Phobia
C) Malingering
D) Double-dipping (working while receiving WC benefits)
D -- Double-dipping (working while receiving WC benefits)
Telephone Conversations
Should you be concerned with chatty claimants? The claimant provides remarkably detailed information about everything except what you want to know, giving the specifics of what kind of day it was or what kind of clothing (s)he was wearing, but nothing about the loss (s)he is claiming.
A) Yes
B) No
A -- You should be concerned. The mass of detail, it is hoped, will distract you from delving deeper into the important information (telling too much).
Who on the SIU team usually wears his baseball cap backwards on Zoom (WebEx) calls?
A) Aaron Gissler
B) Doug Czepa
C) Nathan Humes
D) Paul McHenry
D -- Paul McHenry
What are some examples of a material misrepresentation for equine or pet claims?
A) Health of horse, breed of horse, cost of horse
B) Pre-existing conditions, cause of death, altered Vet records
C) Date pet became ill
D) All of the above
E) Both A & C
D --
Equine (health of horse, breed of horse, cost of horse, pre-existing conditions, cause of death, altered Vet records)
Pets (health of pet, date pet became ill, pre-existing conditions, altered Vet records)
What position was your body in at the time of impact? (position of head, torso, arms, legs)
Does this question address:
A) Accident details
B) Body movements and injuries
C) Liability
D) Staged accident dynamics
B -- Body movements and injuries
Why is it common to see more claims at the end of a seasonal job (e.g., landscaping) or near an upcoming layoff (large project at factory is concluded)?
A) It's expected
B) It's all about the money stream
B -- People are looking for an income after a job loss or preparing to secure a known source of income after a the job ends.
Telephone Conversation
Should you be alarmed when someone says "to tell you the truth" or "frankly speaking". Does that mean that they are usually lying or not being truthful?
Are they switching gears and telling the truth for a change?
A) It's no big deal, some people just talk that way
B) You should be concerned
B -- Something isn't right. Make a note, go back to that point later, and determine if there's a problem you need to investigate (assertions of honesty).
Who on the team recently had two children enrolled in college at the same time?
A) Eric Rhedin
B) Josh Anderson
C) Nathan Humes
D) Nancy Hennig
D -- Nancy Hennig, Sr. SIU Analyst
What type of fraud is occurring when an applicant provides incomplete information, false information, or omits prior losses on the application?
A) Stupidity
B) Application
C) Claims
D) No Fraud
B -- Application Fraud
What does the acronym S.O.A.P. translate to in medical records that insurers require in order to pay the bill?
A) Sterile, Observations, Accurate, Prognosis
B) Subjective, Objective, Accurate, Plan
C) Symptoms, Observations, Assessment, Plan
D) Symptoms, Overview, Assessment, Procedure
C --- Symptoms, Observations, Assessment, Plan
S - Subjective or symptoms
O - Objective or observations
A - Assessment
P - Plan or procedure
An accident shares many of the same factors of other claims reported by other employees in a relatively short period of time. What is the common reference to this phenomenon?
A) Coincidence
B) Copycat
C) Contagious
D) Complex
B -- Criminals are known to copycat other criminals.
Telephone Conversations
Do you have grounds for suspicion if the insured/claimant uses soft language, such as "taking money" rather than "steal", "improper use" rather than "fraud", and "honest mistake" rather than "embezzle"?
A) No, they are just being politically correct
B) Yes, it seems they are softening their language for some reason
B -- You would be suspicious if someone said that a person "came into" their house and "took" some things -- the person broke in and robbed them!
If a claimant seems to be "softening" their language, they may be trying to (psychologically) protect themselves for some reason. Look into it.
What city was Don Kohtz, Director of the SIU born in?
A) Omaha, Nebraska
B) York, Nebraska
C) St. Louis, Missouri
D) Seoul, Korea
D -- Seoul (Korea)
More Americans own this type of animal versus other animals?
A) Meow
B) Bark
C) Whinnie
D) Chirp
B -- Dogs
Dogs (38.4%)
Cats (25.4%)
Birds (2.8%)
Horses (0.7%)
Other (32.7)
Source: American Veterinary Medical Association (avma.org)
What are some Medical Provider red flags?
A) Wears a black lab coat instead of a white lab coat
B) Billing is received for unnecessary services
C) Attorney/Doctor established relationship
D) A & C
E) B & C
E -- Both B & C
*Attorney/Doctor established relationship
* Disproportionate medical expenses to vehicular damage (e.g., low speed impact under 10 mph, $20K in medical expenses)
*Billing is received for unnecessary services (strains/sprains -- MRI conducted)
*Medical facility often changes names
*Billing for services not rendered (not provided)
What are the Top Five injuries as a percentage of total claims?
Name at least 2 types of injuries.
*strains and sprains (30%)
*cuts or punctures (19%)
*contusions (12%)
*inflammation (5%)
*fractures (5%)
*Other (29%)
***Daily Double***
How often does the average adult lie in a day?
A) 1
B) 7
C) 3
D) 17
B -- 7 times a day.
Source: In Search of Truth, By Daniel T. Marsano, p. 51.
*Men lie to make themselves look better
*Women lie to make the person they are talking to feel better