1. Aggressive Contractor and Assignment of Benefits Challenges
· Explore property cases involving aggressive contractors
· Describe what an assignment of benefits contract is and who benefits from it
· Identify “red flags” for potential fraud involved with assignment of claim presentations
· Evaluate various strategies to help navigate your customer's claim through the waters of an assignment of benefits situation
2. Building Codes and Impact On Claims Adjustment
· Relationship between scope of loss, replacement with like kind, and code upgrade in a claim adjustment
· Adjustment problems related to claims in which both repair and enhancements are undertaken
· Interplay between law and ordinance coverage and period of restoration
3. Electronic Funds Transfer/Cyber
· Explore emerging risks from Cyber events, Ransomware, and electronic fund transfer issues
· Evaluate coverage and coverage issues from common policy language encountered
· Identify investigation and evaluation tips and tricks
· Review actual case studies and coverage analysis
4. Fraud Indicators: Evaluating Facts and Documents for Possible Fraud
· Evaluate various example claim documents for potential fraud
· Identify new red flags of fraud
· Distinguish between soft and hard fraud
· Identify new tools and technologies available to adjusters to better investigate and evaluate losses
· Utilize claim scenarios to identify tips for investigating fraudulent scenarios and documents
5. Hail Damage Roof Replacement vs. Repair
· Identify actual hail damage vs. other events
· Evaluate extent of damage and repair options
· Explore methods of repair, how to find materials and matching issues
· Review case studies and successful damage repair
6. Pollution Coverage Issues with Property Claims
· Analyze policy provisions dealing with potential pollutants and coverage issues involved
· Evaluate causation, proximate cause, and concurrent causation/resulting loss implications
· Explore case studies involving property losses with pollutants
7. Property Case Law Update (tailor to regional location of event)
· Review current trends and improve ability to forecast court decisions in connection with property claims
· Analyze property insurance coverage issues from national and state levels
· Use reasoning skills to apply policy provisions to actual factual scenarios
8. Water Damage and Fraud
· Identify various fraud scenarios including water damage fraud and indicators with water losses
· Devise strategies to effectively investigate and respond to potential fraud with various water claims: plumbing failure, hurricanes, floods, etc.
· Review fraud exposures and appropriate responses with additional living expense and fair rental value catastrophic claims
· Explore case studies involving alleged water damage fraud
1. Abuse and Molestation Claims and Coverage
· Identify the trends and sources of liability in abuse and molestation claims
· List methods to locate lost and/or old policies
· Determine whether coverage has been triggered and/or excluded
· Evaluate allocation and limits issues
2. Animal Liability
· Identify liability issues and duties owed by owners and harborer’s in cases involving injury caused by animals both domesticated and livestock
· Review available defenses in animal liability claims
· Develop strategies for evaluating and adjusting all types of animal liability claims based on potential available defenses and understanding what facts make an animal liability claim compensable
3. Brain Injury Claims: CTE and PTSD
· Recognize when common medical, mental, and nutritional disorders might account for signs and symptoms being attributed to brain injury from common accidents
· Identify the signs and symptoms of genuine brain damage in medical records
· Explore treatments and testing encountered with brain injury cases
4. Can I Have a Witness? Vehicles and The Evidence They Contain
· Explore how EDR, vehicle safety components and telematics can provide valuable investigative information
· Describe methods to secure and use this data in your investigation
· Review admissibility of data collected and legal implications
· Explore case studies involving use of this data in defending auto liability/SIU claims
5. CGL Policy and Work Product Coverage Condumdrums
· Explore coverage triggers encountered in work product cases
· Identify policy coverage issues including property damage, occurrence, work product exclusion and exceptions to those exclusions
· Review actual case studies with work product coverage issues and potentially multiple policies/policy periods triggered
6. Evaluating and Negotiating Complex Bodily Injury and Wrongful Death Claims
· Describe claim investigation techniques for pre- and post-litigation bodily injury and/or wrongful death claims, including proper injury evaluations
· Identify the key investigative materials (video, social media, vital data) and methods to assist in evaluation of the case
· Build an effective negotiation strategy based on the merits of the case especially on those with questionable liability but significant damage potential
· Explore case studies/scenarios and collaborate to develop resolution strategies
7. Medicare/Medicaid Set-Asides: Current and Emerging Issues
· Explain a liability insurer's essential obligations under the Medicare Secondary Payer Act
· Identify actions or omissions that could subject liability insurers to litigation under the Medicare Secondary Payer Act
· Establish strategies to avoid potential litigation and satisfy Medicare's right to recover
· Outline resources for staying abreast of changes in the applicable rules and regulations
8. Product Liability Cases Involving Emerging Risks: Vaping/Marijuana/Toxic Torts
· Identify the components/common allegations alleged in the pursuit of a products liability action
· Describe the potential defenses available in a products liability case
· Use case studies involving products currently in the news (vaping, marijuana, chemical exposure) to explore potential viability of emerging products claims
9. Social Media as an Investigative Tool
· Review social media resources and third-party profile services
· Identify general principles for guiding social media investigations
· Describe how to gather and record social media evidence
· Evaluate admissibility and authentication of evidence, and the power of a preservation letter
· Review the risks and regulations in collecting evidence, and how to manage the risk
1. 1st and 3rd Party Good Faith/Ethics
· Describe good faith claim handling practices and effective claim-file management
· Review fact patterns and judgments from bad faith cases from various federal and state jurisdictions
· Apply good faith claim handling practices and effective claim-file management techniques
· Make effective and good-faith based claim-file management decisions
2. Mediation Techniques & Strategies
· Describe optimal strategies to employ when preparing for a mediation
· Identify qualities that contribute to a successful mediation
· Demonstrate persuasive presentation techniques to enhance negotiation leverage
· Evaluate steps to take to conclude mediation with enforceable settlements
3. ROR/Denial Letters
· Recognize when a reservation of rights letter is needed
· Identify the components and content of a reservation of rights letter
· Describe how to deal with the insured's response to a reservation of rights letter
· Analyze the differences and consequences of reservation of rights versus declination letters and potential consent judgment concerns