SIU Trivia
Who is the SIU Manager?
Josh Anderson
What is the common phrase for treatment billed by a medical provider or clinic that never occurred?
Phantom treatment or billing for services not rendered.
With less miles driven in 2020, did auto thefts (personal & commercial) increase from prior years?
Yes, according to the National Insurance Crime Bureau (NICB)
What does the phrase triangulation refer to?
Analyzing the various cell towers from which the claimant's cell phone pinged to pinpoint the geo-location of the claimant or witness.
Lying about the health of a horse or its value/breed on the application is a ___________.
Material misrepresentation.
Ron Slone is the Chairman of the Markel Veterans Program and served in what branch of the U.S. Military?
United States Marine Corps, Special Operations
With more home-bound employees and people in general, we expect to see more bogus injury claims. How do you investigate with no witnesses?
Neighborhood canvass, video surveillance, medical canvass or medical authorization to verify treatment. If no treatment sought, request cell phone records to verify geo-location details at the date/time of the alleged event.
Did Markel receive a large number (over 100) of fraud related COVID claims?
No, most of our Insureds/Claimants stuck to the fraud schemes of the past.
The SIU has only received around 10 COVID related claims for investigation.
What types of evidence is potentially recoverable from mobile devices?
Email, text messages, geolocation data & GPS history, documents and files, internet history and social media, call logs and contacts, data from 3rd party apps such as banking transactions, calendar entries, to-do lists, photos & videos.
Describe the fraud scheme referred to as past posting?
Obtaining insurance coverage after a loss occurred, and then filing a fraudulent claim.
Which SIU Investigators have been to Austria/Germany for Oktoberfest?
Eric Rhedin & Paul McHenry
A lengthy delay in reporting a slip & fall by the claimant is or is not a red flag?
True or False?
True. Any delay is generally a red flag that should be reviewed and questioned.
A delay may be legit, or the delay may need to be reviewed and analyzed in greater detail.
In 2020, did the SIU see an increase of workers' compensation premium fraud schemes?
Yes, mainly in California.
Financial stress can contribute to businesses underreporting the number of employees and overall payroll to reduce the premium charged by Markel.
What is the legal way to conduct unmanned surveillance?
The recording device has to be on public property or a public easement. But always check to see if the laws have changed.
Some crooked claimants use a PDF editor or correction tape to alter dates of service on Vet records. Why?
They alter Vet records to match the false/reported date of loss to Markel so their claim is covered under the term and conditions of the policy.
Who does the SIU report to?
Richard Grinnan or Anna King -- the Legal & Compliance Department.
If the owner or witnesses to the slip & fall present different facts of the loss than the claimant, what should an examiner do?
Investigate and refer to the SIU, if the differing explanations cannot be resolved.
Did the search "How to start a fire" skyrocket after March 2020?
Yes, both Google and YouTube reported the search "How to start a fire" shot through the roof after March of 2020.
Individuals may torch their homes or businesses if they are unable to pay their mortgage. Common excuses include kitchen accidents (grease fires) as well as lit candles and cigarettes.
Red flags could be an increase in policy limits, changes to deductibles, and items scheduled to the policy shortly before the loss.
IoT (internet of things) -- wearables (Fitbit watch/band, Apple watch), Ring doorbell, appliances - refrigerator synced to the internet, smart home security equipment, asset tracking devices, thermostats, Alexa (voice assistants), fobs (in lieu of keys), etc. --- can Markel request data from these IoT devices if we believe the data will aid in an investigation and is relevant to the claim?
Yes, with a written authorization or consent by the owner of the device.
Question for Non-Equine & Pet Examiners:
What is a post-mortem examination of an animal called?
Necropsy -- is a post-mortem examination (dissection of the body) to determine why the animal died.
Which SIU team member used to get a discount as an employee of Black & Decker tool company?
Nathan Humes
Most soft-tissue injuries (strains, sprains, headaches) resolve themselves within 6 weeks after the occurrence. That being said, if the insured/claimant is still claiming the same injuries 6 months to a year later, what fraud scheme are they likely involved with?
Malingering -- exaggerating or feigning illness in order to escape duty or work.
And/Or
Medical build-up.
Has Markel seen recent claims involving jump-ins, where individuals not involved in an auto accident subsequently claim to be a victim of a bodily injury after an auto collision?
Yes, Hagerty has seen this occurring in larger cities.
***Daily Double***
What are some of the reasons you would request a Medical Canvass?
Verify date(s) of injury and treatment
Assess if the injury is related to the claim
Discover if the claimant has a history of prior claims
Determine if there are previous treatments for similar injuries
Uncovering a pattern of drug seeking behavior
Revealing possible misrepresentations about the claim
What do cats, dogs, and horses have in common?
They all walk on 4 legs.
Claimants' may take advantage of a health situation and file a suspicious claim.
They all can be treated by a Vet.