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Claim Investigation
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Book Synopsis The Claim Game by : Mario S. Pecoraro
Download or read book The Claim Game written by Mario S. Pecoraro and published by iUniverse. This book was released on 2015-10-08 with total page 104 pages. Available in PDF, EPUB and Kindle. Book excerpt: Organizations that fail to identify and eliminate fraud are losing hundreds of thousands of dollarsand many dont even know it! Many claims professionals dont have the time or resources to spot the red flags that indicate a fraudulent workers compensation claim, and even if they stumble upon one by chance, they fail to conduct a comprehensive investigation. Mario S. Pecoraro, CEO of Alliance Worldwide Investigative Group, provides proactive strategies that will save you resources, money, and time investigating claims. The twenty best practices he explores will help you: hire the type of employee who wont file a claim in the first place; engage in preventative maintenance throughout the life of a claim; determine who should conduct an investigation when a claim is filed; carry out the investigative process using a variety of tools. Filled with case studies demonstrating where investigations went wrong (and where they went right), youll be equipped to apply best practices and avoid common mistakes. Start saving money, and get the right team in place with The Claim Game.
Book Synopsis The Auto Policy and The Claim Investigation Process by : Hector Quiroga
Download or read book The Auto Policy and The Claim Investigation Process written by Hector Quiroga and published by Lulu.com. This book was released on with total page 187 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Medical Malpractice Claims Investigation by : Nancy Acerbo-Kozuchowski
Download or read book Medical Malpractice Claims Investigation written by Nancy Acerbo-Kozuchowski and published by Jones & Bartlett Learning. This book was released on 1997 with total page 298 pages. Available in PDF, EPUB and Kindle. Book excerpt: The book is designed as a primer for claims investigators, health care managers, QA/QI personnel, in-house counsel, paralegals, personal injury attorneys, and others whose duties include the investigation of actual and potential medical malpractice lawsuits. It can be used as a desktop reference, self-study guide, or as part of a formal orientation program for risk managers and quality assurance personnel. The book contains a step-by-step description of the claims investigation. It also provides instruction on reviewing medical records; identifying adverse patient occurrences; selecting, locating and interviewing personnel involved in occurrences; analyzing investigative findings; and writing the investigation report.
Book Synopsis The Claim Agent and His Work, Investigation and Settlement of Claims for Personal Injuries by : Smith Rufus Brittingham
Download or read book The Claim Agent and His Work, Investigation and Settlement of Claims for Personal Injuries written by Smith Rufus Brittingham and published by . This book was released on 1927 with total page 484 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis The Investigation and Adjustment of Liability Insurance Claims and Workmen's Compensation Losses by : Walter Loane Clark
Download or read book The Investigation and Adjustment of Liability Insurance Claims and Workmen's Compensation Losses written by Walter Loane Clark and published by . This book was released on 1914 with total page 120 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Claim Investigation Text by : Kaplan Financial
Download or read book Claim Investigation Text written by Kaplan Financial and published by Kaplan Publishing. This book was released on 2006 with total page 160 pages. Available in PDF, EPUB and Kindle. Book excerpt: Claim Investigation covers basic procedures and relevant laws for property and casualty claim investigations. The course describes specific steps to follow when investigating auto liability, workers’ compensation, fire, and fall-down claims. Relevant case studies show how to use information from a loss report in the investigation procedure.
Book Synopsis Healthcare Fraud Investigation Guidebook by : Charles E. Piper
Download or read book Healthcare Fraud Investigation Guidebook written by Charles E. Piper and published by CRC Press. This book was released on 2017-07-27 with total page 230 pages. Available in PDF, EPUB and Kindle. Book excerpt: Some have estimated that healthcare fraud in the United States results in losses of approximately $80 billion a year. Although there are many books available that describe how to "detect" healthcare fraud, few address what must be done after the fraud is detected. Filling this need, Charles Piper‘s Healthcare Fraud Investigation Guidebook details n
Download or read book Freight Claim Investigation written by and published by . This book was released on 1958 with total page 51 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Applications of Claim Investigation in Insurance Surplus and Claims Models by : Mirabelle Huynh
Download or read book Applications of Claim Investigation in Insurance Surplus and Claims Models written by Mirabelle Huynh and published by . This book was released on 2018 with total page 157 pages. Available in PDF, EPUB and Kindle. Book excerpt: Claim investigation is a fundamental part of an insurer's business. Queues form as claims accumulate and claims are investigated according to some queueing mechanism. The natural existence of queues in this context prompts the inclusion of a queue-based investigation mechanism to model features like congestion inherent in the claims handling process and further to assess their overall impact on an insurer's risk management program. This thesis explicitly models a queue-based claim investigation mechanism (CIM) in two classical models for insurance risk, namely, insurer surplus models (or risk models) and aggregate claim models (or loss models). Incorporating a queue-based CIM into surplus and aggregate claims models provides an additional degree of realism and as a result, can help insurers better characterize and manage risk. In surplus analysis, more accurate measures for ruin-related quantities of interest such as those relating to the time to ruin and the deficit at ruin can be developed. In aggregate claims models, more granular models of the claims handling process (e.g., by decomposing claims into those that are settled and those that have been reported but not yet settled) can help insurers target the source of inefficiencies in their processing systems and later mitigate their financial impact on the insurer. As a starting point, Chapter 2 proposes a simple CIM consisting of one server and no waiting places and superimposes this CIM onto the classical compound Poisson surplus process. An exponentially distributed investigation time is considered and then generalized to a combination of n exponentials. Standard techniques of conditioning on the first claim are used to derive a defective renewal equation (DRE) for the Gerber-Shiu discounted penalty function (or simply, the Gerber-Shiu function) m(u) and probabilistic interpretations for the DRE components are provided. The Gerber-Shiu function, introduced in Gerber and Shiu (1998), is a valuable analytical tool, serving as a unified means of risk analysis as it generates various ruin-related quantities of interest. Chapter 3 extends and generalizes the analysis in Chapter 2 by proposing a more complex CIM consisting of a single queue with n investigation units and a finite capacity of m claims. More precisely, we consider CIMs which admit a (spectrally negative) Markov Additive Process (MAP) formulation for the insurer's surplus and the analysis will heavily rely and benefit from recent developments in the fluctuation theory of MAPs. MAP formulations for four possible CIM generalizations are more specifically analyzed. Chapter 4 superimposes the more general CIM from Chapter 3 onto the aggregate claims process to obtain an "aggregate payment process". It is shown that this aggregate payment process has a Markovian Arrival Process formulation that is preserved under considerable generalizations to the CIM. A distributional analysis of the future payments due to reported but not settled claims ("RBNS payments") is then performed under various assumptions. Throughout the thesis, numerical analyses are used to illustrate the impact of variations in the CIM on the ruin probability (Chapters 2 and 3) and on the Value-at-Risk (VaR) and Tail-Value-at-Risk (TVaR) of RBNS payments (Chapter 4). Concluding remarks and avenues for further research are found in Chapter 5.
Author :American Bar Association. House of Delegates Publisher :American Bar Association ISBN 13 :9781590318737 Total Pages :216 pages Book Rating :4.3/5 (187 download)
Book Synopsis Model Rules of Professional Conduct by : American Bar Association. House of Delegates
Download or read book Model Rules of Professional Conduct written by American Bar Association. House of Delegates and published by American Bar Association. This book was released on 2007 with total page 216 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Model Rules of Professional Conduct provides an up-to-date resource for information on legal ethics. Federal, state and local courts in all jurisdictions look to the Rules for guidance in solving lawyer malpractice cases, disciplinary actions, disqualification issues, sanctions questions and much more. In this volume, black-letter Rules of Professional Conduct are followed by numbered Comments that explain each Rule's purpose and provide suggestions for its practical application. The Rules will help you identify proper conduct in a variety of given situations, review those instances where discretionary action is possible, and define the nature of the relationship between you and your clients, colleagues and the courts.
Book Synopsis The Investigation of Freight Claims by : George Henry Hunt
Download or read book The Investigation of Freight Claims written by George Henry Hunt and published by . This book was released on 1920 with total page 90 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis United States Attorneys' Manual by : United States. Department of Justice
Download or read book United States Attorneys' Manual written by United States. Department of Justice and published by . This book was released on 1988 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Insurance Claims Investigation and Agency Practice by : William Merrell
Download or read book Insurance Claims Investigation and Agency Practice written by William Merrell and published by . This book was released on 1998-06-01 with total page 201 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Fact Investigation by : Paul J. Zwier
Download or read book Fact Investigation written by Paul J. Zwier and published by Aspen Publishing. This book was released on 2015-01-23 with total page 222 pages. Available in PDF, EPUB and Kindle. Book excerpt: In a successful litigation, it isn’t enough to know the facts. You must also know how to interpret and use those facts, and thoughtfully delving into the stories behind them is a crucial task if you hope to prevail for your client. Fact Investigation, by longtime NITA authors Paul Zwier and Anthony Bocchino, will change the way you approach cases for the rest of your career. Every litigator’s investigation begins where the “official” investigation ends. During informal fact investigation, you must know how to engage your client so he shares the facts and stories critical to his case, then use them not just to develop but to implement a winning case theory. How do you do that? It all starts with your first meeting with your clientand what you say and how you do it. Find out how your word choice and body language lay the groundwork for connecting with your client, and how to establish the openness and trust that yield what you need to build a compelling case and be a persuasive advocate. From that client information, the authors take you through the steps necessary to build and implement effective alternative case theories that will inform your fact investigation process and lay the foundation for efficient use of formal discovery devices. Zwier and Bocchino model these practice skills through four familiar NITA case files: Quinlan v. Kane Electronics (business/contract case), Brown v. Byrd (auto accident and personal injury case), State v. Lawrence (criminal robbery case), and United States ex rel. Rodriguez v. Hughes (False Claims Act case). When you see these techniques modeled as case studies, you understand how to integrate them into your overall case planning and learn how to confront the thorny ethics of day-to-day lawyering. The Second Edition is fully revised, with special emphasis on the impact of the proposed Federal Rules Civil Procedure changes, and features an important new chapter on e-discovery. Rare is now the case that doesn’t involve some form of electronic evidence, and every litigator must know the ever-expanding issues surrounding it. Find out how e-discovery strategies differ from plaintiff to defendant and how to manage your client’s competing rights to both speech and privacy in our highly discoverable online world. From explaining how to use your opposing party’s social media indiscretions against it to helping you make sense of new federal rules that limit the use of electronic evidence, Zwier and Bocchino tell you everything you must know about the impact of e-discovery on the modern litigation practice.
Book Synopsis The Investigation and Adjustment of an Automobile Injury Claim and a Personal Injury Insurance Claim by : Edward James Jr Monaghan
Download or read book The Investigation and Adjustment of an Automobile Injury Claim and a Personal Injury Insurance Claim written by Edward James Jr Monaghan and published by . This book was released on 1961 with total page 24 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Insurance Fraud Volume II by : Barry Zalma
Download or read book Insurance Fraud Volume II written by Barry Zalma and published by . This book was released on 2019-10-31 with total page 460 pages. Available in PDF, EPUB and Kindle. Book excerpt: Insurance Fraud Is Epidemic Insurance fraud continually takes more money each year than it did the last from the insurance buying public. There is no certain number. Most attempts at insurance fraud succeed. Estimates of the extent of insurance fraud in the United States range from $87 billion to more than $300 billion every year.Insurers and government backed pseudo-insurers can only estimate the extent they lose to fraudulent claims. Lack of sufficient investigation and prosecution of insurance criminals is endemic. Most insurance fraud criminals are not detected. Those that are detected do so because they became greedy, sloppy and unprofessional so that the attempted fraud becomes so obvious it cannot be ignored.The National Insurance Crime Bureau (NICB) estimates that almost 25% of the bodily injury claims related to auto crashes are bogus. Property and casualty claims against auto insurance are not much better, coming in at around a 10% fraud rate.A person commits the offense of insurance fraud by knowingly and with the intent to defraud any insurer presents or causes to be presented to any insurer any statement forming a part of, or in support of, a claim that contains any false, incomplete or misleading information concerning any fact or thing material to the claim. [18 Pa.C.S.A. § 4117(a)(2).] A person acts "knowingly" when he or she is aware that it is practically certain that his or her conduct will cause such a result. Likewise, a person acts "intentionally" when "it is his or her conscious object to engage in conduct of that nature or to cause such a result.As the industry attempts to keep pace with fraudsters' varied, ever-shifting tactics, it must deploy more innovative, effective anti-fraud technologies or risk dire losses. Vendors and organizations include the Coalition Against Insurance Fraud (CAIF), CSC, Detica NetReveal, Equifax, Experian, FICO, IBM, Innovation Group, Insurance Bureau of Canada (IBC), ISO/Verisk, KPMG, LexisNexis, Mattersight, Mitchell, the National Insurance Crime Bureau (NICB), SAP, SAS, and TransUnion.Insurers must also generate a close relationship with the state insurance department's fraud division or fraud bureau, local police agencies, the FBI, the ATF, the Postal Investigation Service, the local fire department's arson unit, local prosecutors, and the local U.S. Attorneys if they are to have any chance to reduce the effect of insurance fraud. Insurers should also work to make the general public, state legislators, state governors, congress members and U.S. Senators, and the Attorney General of the United States aware of the effect insurance fraud has on the public at large and the insurance industry.Wherever insurance is written insurance fraud exists. It is an equal opportunity fraud committed by people of every race, religion or national origin. Insurers who do not exercise serious anti-fraud efforts often complain that the local district attorneys and police agencies give a low priority to the crime of insurance fraud. No matter how seriously the insurers work to prove fraud the authorities often ignore them. In response, police and prosecutors complain that the insurers do nothing that police and prosecutors can use to prosecute the crime of insurance fraud while insurers complain that prosecutors ignore them when they present evidence of a fraud. There is truth in both complaints. Insurers, although compelled by statute to investigate potential insurance fraud and to present the results of their investigations to prosecutors, they are not trained as police officers. This book is written to make it clear to insurers, police and prosecutors that it is necessary to stop complaining and start working together to reduce the extent of insurance fraud. If they do not work together the crime will continue to metastasize until it will be impossible to write insurance at a profit or for a price anyone can afford.
Book Synopsis The Investigation and Adjustment of Liability Insurance Claims and Workmen's Compensation Losses by : Walter Loane Clark
Download or read book The Investigation and Adjustment of Liability Insurance Claims and Workmen's Compensation Losses written by Walter Loane Clark and published by Theclassics.Us. This book was released on 2013-09 with total page 26 pages. Available in PDF, EPUB and Kindle. Book excerpt: This historic book may have numerous typos and missing text. Purchasers can usually download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1914 edition. Excerpt: ... Chapter VII. PHYSICIANS' LIABILITY INSURANCE PHYSICIANS' LIABILITY: Policies of this character have become a great necessity to all classes of physicians on account of the prevalence of suits for malpractice. Such actions are often brought to avoid payment for services rendered, sometimes for purposes of blackmail, and occasionally they are fostered through professional jealousy or enmity. The defense policy contemplates only the payment of counsel and witness fees and the management of the litigation, including investigation, advice and negotiations for settlement. The liability policy includes, in addition to such defense, the payment to the assured of the amount of any verdict, which he may be compelled to pay out on account of any alleged malpractice. The hazard insured against is the consequence of a civil suit for "malpractice" on account of bodily injuries, or death resulting from some alleged error on the part of the assured or his assistant. Prompt notice of all claims must be given so that a successful defense or favorable adjustment may be effected. Settlements may be made only with the consent of the assured, thus enabling him to insist upon a vindication if he deems it best. Ascertain whether the claim falls within the terms of the policy, particularly as to the date of the alleged treatment, the sobriety of the assured or his assistant, as well as compliance with the policy conditions. If suit has been instituted, arrangements should be made to prevent default until the investigation can be completed. No physician guarantees the success of his treatment, whether it be medical or surgical, and no presumption of carelessness arises from failure alone. Physicians are legally bound to place at the service of their patients a...
