SIU Analyst Capabilities
What Social Media search cannot be done by the SIU Analysts?
A. Instagram
B. Facebook
C. Tik Tok
D. Snapchat
E. Twitter
D. Snapchat
Who has been identified by SIU as falsifying the most Certificates of Insurance?
A. Agents
B. Insureds
C. Brokers
D. Sub-Contractors
B. Insureds
Which of the following is a Workers' Compensation Scam?
A. Malingering or misrepresenting disability status to stay off work
B. There are no witnesses to the loss/injury
C. Injury is claimed after a layoff/termination or salary freeze
D. Injured worker is on WC Temporary Total Disability (TTD) and takes a job with another employer without disclosure
E. A, C, & D
E. A, C, & D
What percentage of all injuries are slip & fall injuries?
A. 5 percent
B. 10 percent
C. 15 percent
D. 20 percent
C. 15 percent
Slip & fall injuries make up 15 percent of all job related injuries, which account for between 12 & 15 percent of all Workers’ Compensation expenses. Source: www.lawfirms.com
What is the name of the Guide for Fire and Explosion Investigations and the Standard for Professional Qualifications for a Fire Investigator?
A. NFPA 1021 and NFPA 933
B. NFPA 912 and NFPA 3310
C. NFPA 921 and NFPA 1033
D. A and C
C. NFPA 921 and NFPA 1033
The NFPA 921 sets the bar for scientific-based investigation and analysis of fire and explosion incidents while the NFPA 1033 lays out the minimum qualifications for a fire investigator.
The most used social media platform in the world is Facebook, with ______ monthly active users across the world
A. 32 million
B. 5.8 billion
C. 5 million
D. 2.9 billion
D. 2.9 billion
How many agent/false document cases has SIU been involved with during the last 3 years?
A. 10 – 20
B. 20 – 30
C. 30 – 40
D. 40+
D. 40+
Being injured off the job prior to filing a Workers' Compensation claim for the same injury is commonly known as:
A. Malingering
B. Premium avoidance
C. Pre-existing conditions
D. Slip and fall
C. Pre-existing conditions
In 2019 how many questionable slip and fall insurance claims were analyzed by the NICB?
A. 538
B. 1,295
C. 4,587
D. 6,471
D. 6,471
Of the 6,471 questionable claims analyzed by the NICB, 56% were claimed on the businesses’ Commercial General Liability policy, with another 15% on a Commercial Liability Business Owners policy, and 8% filed under Commercial Multi-Peril policies. Source: www.nicb.org
True of False – if an Origin and Cause investigation is returned as “Undetermined” there is a need for an SIU Investigation.
A. True
B. False
A. True
Mandatory Referrals – include all fire where the O&C is returned as possible arson and/or is considered “Undetermined”.
The SIU Analyst can conduct a basic Asset search.
A. True
B. False
A. True
What type of document has not been falsified by agents?
A. Declaration Pages
B. Change of Agent/Broker Form
C. Premium Payment Checks
D. Surety Bonds
C. Premium Payment Checks
How can workers' compensation fraud be minimized?
A. Educate Employees about workers' compensation fraud
B. Investigate Immediately
C. Establish procedures for reporting accidents
D. Handle fired workers with care
E. All of the above
E. All of the above
What city/cities has/have the most questionable claims for slip and fall accidents?
A. New York
B. Los Angeles
C. Philadelphia
D. Las Vegas
E. Chicago
F. All of the above
F. All of the above
Source: www.nicb.org
What documents can assist with a fire investigation and should be obtained if available?
A. Police Report
B. Fire Report
C. Origin and Cause Report
D. State Fire Marshal Report
E. All of the above
E. All of the above
In order to complete a thorough evaluation of the fire loss, one needs to obtain all pertinent reports that can speak to the loss and coordinate with the various agencies involved with determine the origin and cause of the loss.
Which of the following services can be performed by the SIU Analysts?
A. Background checks, ISO searches and Internet/Social Media searches
B. Obtain Vehicle/License Plate/VIN Registration Information
C. Order Carfax and Weather reports
D. Conduct Civil & Criminal record searches
E. All of the above
E. All of the above
Who has made the least amount of agent case referrals to SIU?
A. Customer Service
B. Sales/Marketing
C. Underwriting
D. Competitors/Other Carriers
B. Sales/Marketing
Which of the following tools should be used in the initial stages of a workers' compensation investigation?
A. Medial Canvass
B. IME (Independent Medical Examination)
C. Surveillance
D. Background investigation on the Claimant (ISO, Skip Trace, Social Media, Criminal & Civil Etc.)
E. Both A & D
E. Both A & D
Can a legitimate slip & fall accident contain elements of fraud:
A. Yes
B. No
A. Yes
The claimant could be unaware & not participate in treatment that we receive billing for from an shady medical provider.
***Worth 5,000 Points***
Which response below is not a red flag for a fire loss?
A. Fire occurs on a holiday, at night or on a weekend
B. Fire began in only 1 location
C. Property was over-insured
D. Insured increased coverage before the loss
B. Fire began in only 1 location
Trick question – a fire loss that began in one location is not always a red flag, but be careful because this can still be considered a red flag if the one location is questionable (middle of the floor, etc.).
Which of the following reports cannot be provided by the SIU Analysts:
A. Skip Trace
B. LPR (License Plate Reader)
C. MVR (Driving Record)
D. Lightning Strike Report
C. MVR (Driving Record)
Which of these states has received the least amount of agent case referrals from SIU?
A. New York
B. California
C. Texas
D. Florida
A. New York
***DOUBLE JEOPARDY***
What investigative method is not appropriate to utilize when gathering information on a claimant?
A. Traditional/manned surveillance
B. Drones
C. Trash searches (at the curb)
D. Social media searches
E. Remote/unmanned surveillance
B. Drones
Which of the following is NOT a red flag for a claim involving a slip & fall?
A. Emergency medical responders were not called to the scene of the slip & fall
B. No evidence of the substance the claimant slipped & fell in found on their clothes/shoes
C. Owner/employee who witnessed the incident presents different facts of loss than the claimant
D. Slip & fall occurred in an area of the location that is under surveillance
E. The claimant did not receive medical treatment at an emergency room after the slip & fall
D. Slip & fall occurred in an area of the location that is under surveillance
A red flag would occur if there were no witnesses/surveillance video of the incident.
Which of the following are red flag indicators of arson?
A. Signs of accelerants
B. Missing accessories or personal property
C. No evidence of forced entry
D. Security and alarm system were disabled
E. All of the above
E. All of the above
Be thorough in the evaluation of all aspects to the claim/investigation. Obtaining all potential reports is critical along with understanding the remaining signs that are questionable and could point to the insured/claimant.