February 24-26, 2013 Waldorf=Astoria New York City
Dedicated to Life, Accident & Health and Disability Claims
Dear Friends and Colleagues: On behalf of myself and to all those who have devoted their time and talents over the last year to make this Eastern Claims Conference happen, I am pleased and proud to welcome you to our annual meeting for 2013. Our goal is to provide you with a positive and fulfilling learning experience. As always our program is focused upon subject matter that is timely, meaningful, and stimulating. As we approach our 40th year, the ECC remains committed to producing the highest quality educational programs to claims professionals in the life, accidental death and dismemberment, health and disability product lines in a friendly and interactive environment which allows for both the establishment and renewal of valuable professional relationships. This year’s program promises to be one of the best ever. You will find updates on traditional claims subject matter, new hot ticket items, legal updates, and courses designed to assist you in your personal growth as a claim professional. Due to the excellent feedback we received from our 2010 attendees, we have once again engaged the popular body language expert, Janine Driver, (AKA “The Lyin’ Tamer”) as our keynote speaker. We are also pleased with our success in obtaining continuing education credits as we have done in the past. The ECC would not be possible without our valued hospitality sponsors, exhibitors, and Ad Journal sponsors. A directory with this year’s hospitality sponsors and exhibitors can be found on our website (www.easternclaimsconference.com). I would also like to express my gratitude to the ECC Board of Directors, Committee chairpersons, and Committee members and extend a special thank you to our speakers who volunteer their time and resources to share their knowledge, expertise, and experience with us. Lastly, and above all, we would like to thank you all for attending. We hope that we will continue to earn your loyalty for many years to come. You are the only reason the ECC exists. Sincerely, Daniel W. Maguire, Esq. Chairperson, Eastern Claims Conference
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2013 Eastern Claims Conference The Waldorf=Astoria Hotel New York, New York ECC – 2013
SUNDAY, FEBRUARY 24, 2013
REGISTRATION HOSPITALITY RECEPTION
1:30 p.m. – 6:30 p.m. (North Foyer-‐18th Floor) 5:00 p.m. – 7:00 p.m. (Starlight Roof)
Only Registered Attendees and Pre-‐registered Guests will be admitted to the Hospitality Receptions
REGISTRATION EXHIBITORS’ RECEPTION Starlight Roof and Palm Room WELCOME ADDRESS Starlight Roof INTRODUCTION KEYNOTE ADDRESS
MONDAY, FEBRUARY 25, 2013 7:30 a.m. – 3:30 p.m. (North Foyer) 8:00 a.m. – 9 a.m. Coffee and pastries will be available 9:00 a.m. – 9:15 a.m. Daniel W. Maguire, Esq. Burke, Williams & Sorensen, LLP, Palm Desert, CA Eastern Claims Conference Chairperson Donna A. Conticchio, ALHC, HIA, ACS Penn Mutual Life Insurance Company, Horsham, PA Vice President, Eastern Claims Conference Board 9:15 a.m. – 10:00 a.m. Janine Driver The Body Language Institute
Janine Driver, body language expert for NBC's Today Show and President of the Body Language Institute, is known as the "Lyin Tamer" because of her keen ability to detect when people are lying! Janine's background as a Federal Law Enforcement Officer with the U.S. Department of Justice, where she trained officers, lawyers and judges the skill of deciphering fact from fiction, has helped her to adapt the world’s most effective deception detection strategies into one versatile, user-‐friendly technique that empowers anyone to quickly decipher fact from fiction. Janine will share these strategies and help you to recognize the subtle cues of deceit. These techniques tap into the very same brain processes targeted in sophisticated lie detection technology, such as polygraphs, MRIs, and infrared eye scanners. However, as Janine reveals in her most recent book, "You Can't Lie To Me", Page 3
despite the billions of dollars spent developing and operating this technology, no machine ever built can exceed the abilities of well-‐trained human “lie detectors.” The simplicity and effectiveness of Janine’s technique will prove the only equipment individuals need to bust a liar is right between their ears! MONDAY, FEBRUARY 25, 2013 CONCURRENT SESSIONS 10:15 a.m. – 11:30 a.m. Panel 1. Accident, Suicide or Natural? -‐ Beyond the Darkness Elliot M. Gross, M.D., Medical Examiner, New York, NY When reviewing a death claim, the investigator is presented with a death certificate. Dr. Gross will go into what lies beyond it-‐-‐medical and police records; autopsy, toxicology and related reports; photographs and other evidence. Dr. Gross reveals how the medical examiner or coroner made their determination. Case studies will illustrate the pitfalls the official encounters and the claims investigator faces in their decision-‐making. Panel 2. On The Ground Unclaimed Property Audit Preparation and Lessons Learned Johnny O’Mahony, John Hancock Life Insurance Company, Boston, MA Valerie Loftin, Lincoln Financial, Greensboro, NC Kim Houston, Munich Re, Atlanta, GA Paul MacCready, MarketSphere, Overland Park, KS Val Jundt, Keane Unclaimed Property Services Group, Bismarck, ND If the adage is true that your company is either undergoing an unclaimed property audit, or soon will be undergoing an audit – this is a “must attend” session! This interactive panel discussion will help you with each stage of unclaimed property audits. Hear the lessons learned from those who have been on the ground with audits and market conduct exams, both from the carrier and the consultant perspective. Panel 3. The Economy and/or Psychological Impairment? -‐ Something Like Normal David M. Erlanger, PH.D., ABPP-‐CN, New York, NY Dr. Erlanger will discuss the psychological and neuropsychological assessment of individuals claiming work-‐related disability. Specific issues addressed will include how workers cope with and adjust to setbacks in their careers and how mental illness or neurologic disorder may—or may not—impact work-‐related skills. Dr. Erlanger will provide case studies examining a range of incomes and occupations and will consider the impact of specific work environment factors on an individual’s perception of their capacity to work. Diagnoses discussed will include Cognitive Disorder secondary to chemotherapy treatment, post-‐concussion disorder, bipolar disorder, depression, somatization disorder, and malingering.
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Panel 4. “You Can’t Lie To Me” in Action -‐ Explore Dangerously Deceptive Case Studies Janine Driver, The Body Language Institute, Alexandria, VA The smartest people can miss telltale signs of deceit and manipulation. In this one-‐of-‐a-‐kind workshop, you’ll learn all the tricks of the professionals! You Can't Lie to Me in Action will playfully engage participants to master the use of subtle, effective interviewing techniques, how to decipher nonverbal language clearly and accurately, and hear the vocal variance or see the micro-‐expression fluctuation that happens during 95 percent of all lies. Panel 5. The Impact of Disability Court Decisions Daniel Cozzo, Vice President, Life Insurance Company of North America, Glendale, CA Richard Lodi, Sr. Operations Representative, Life Insurance Company of North America, Pittsburgh, PA Sherril Colombo, Partner, Sherril Colombo & Wilson Elser, Miami, FL Are you current on recent court decisions? A panel of industry experts will discuss the interplay between disability court decisions and state regulations on carriers. The panel will address the resulting conditions that are imposed on carriers, such as the treatment of social security awards, among other issues. Panel 6. How to Audit a Medical Chart -‐ Below the Surface Peggy Barron, RN, CCM, CPUR, CPC, United Review Services, Piscataway, NJ Karen Weintraub, MA, AHFI, CPC-‐PCPMA, Healthcare Fraud Shield, Ringoes, NJ This session will demonstrate how to properly audit a medical chart, identify missing elements, walk through examples using interactive exercises, and “how to” lesson to report chart deficiencies. MONDAY, FEBRUARY 25, 2013 EXHIBITORS’ RECEPTION 11:30 a.m. – 12:15 p.m. Starlight Roof and Palm Room LUNCH 12:15 p.m. – 1:15 p.m. Starlight Roof MONDAY, FEBRUARY 25, 2013 CONCURRENT SESSIONS 1:30 p.m. – 2:45 p.m. Panel 7. Group Life Insurance Claims – What Are Your Pain Points? Michael Bell, Esq., Burke, Williams and Sorensen, LLP, Los Angeles, CA Ronald L. Campo, Jr., Sr. Business Consultant, Aetna Life Insurance Company, Hartford, CT Kevin Kearney, Life Operations Function Head, Aetna Life Insurance Company, Hartford, CT Take advantage of an excellent opportunity to engage in this interactive discussion on the challenging issues affecting Group Life Insurance claims adjudication today. Topics will range from managing third Page 5
party administrators during the adjudication process to challenges related to reliance on plan sponsor data supplied with the claim submission and the issues that need to be considered when the employee under an ERISA plan is divorced from the beneficiary. Panel 8. Will This Claimant Get Better? Treatment Types and Expectations for Resuming Work Ira K. Packer, Ph.D., University of Massachusetts Medical School, Worcester, MA Dr. Frederick S. Kadushin, Director of Massachusetts Neurobehavioral Institute, Longmeadow, MA Dr. Packer will focus on current standards for treatment and expected improvement in functioning of two disorders: Depression and PTSD. Factors that can impede recovery will be discussed as will nature and severity of symptoms, pre-‐morbid functioning, and ongoing stresses that may impact recovery. Dr. Kadushin will address mild traumatic brain injury symptoms: cognitive, physical and emotional. Potential interaction of these three spheres of symptoms may result in significant impairment. Cognitive deficits and physical impairments may be the direct result of the physical trauma, but are often made worse by frustration, tension, and pain. Adequate evaluation and appropriate treatment with goals for obtaining the highest level of functioning will be discussed. Panel 9. Career Pathing for the Disability Claim Representative Jeffrey Yeager, VP IDI Claim and Client Services, The Guardian Life Ins. Co., Pittsfield, MA An interactive session with front line personnel and management to discuss where we are with career pathing and development of our claims professionals. Anticipate future workplace requirements within our dynamic industry through training and planning. Panel 10. Life Case Law Update -‐ What Happens Next Adrienne C. Publicover, Esq., Partner, Wilson Elser Moskowitz Edelman & Dicker LLP, San Francisco, CA Kyle L. Jennings, Esq., AIG American General, Houston, TX Learn about current cases and developments impacting life insurance claim administration. You will hear from experienced inside and outside counsel who will explain recent cases and trends in life insurance case law and litigation developments. Panel 11. Medicare Part D Pharmacy Fraud Schemes -‐ This Means War Matthew H Berls, MA, Investigations Manager, UnitedHealthcare, Iselin, NJ Examine recent Part D trends and schemes including the West Hollywood Area Project, overutilization, diversion and counterfeit drugs. Gain investigative ideas through case examples and industry experience from health care fraud specialist focused on Part D investigations.
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MONDAY, FEBRUARY 25, 2013 CONCURRENT SESSIONS 3:00 p.m. – 4:15 p.m. Panel 12. Pick Your Reinsurer’s Brain -‐ The Other Dream Team Eli Wahby, FLHC, FLMI, LOG1q3, Toronto, Ontario, Canada Connie Wing, FLHC, FLMI, General Re Life Corp., Stamford, CT There’s more to reinsurance than timely reimbursement. Case studies of complex life claims will highlight the consultative nature of the reinsurance relationship. Are two heads better than one? Find out here! Panel 13. The Ever Changing World of Social Media in Disability Claims Laura L. Lefebvre, Regulatory Compliance Manager, Unum, Worcester, MA M. Holly Ramos, ALHC, ACS, Sr. Claim Consultant, Trustmark Insurance Company, Worcester, MA So you have some internet training under your belt, but what about the ever changing world of Social Media? What is it really, how do I search it, is what I see true? How can I get the internet to work for me 24/7? How can I make the most of five minutes on the internet? How do I document what I find? How do I create a internet research tool that will let me search my resources for what I need? A lot of questions to explore. This panel is designed to answer these questions, provide you with real life take-‐ away tools that you can use to manage the information you find. This is also a discussion; attendees are encouraged to bring their experiences to share with the group. Please feel free to email the presenter with thoughts or questions you might like discussed (
[email protected]). Panel 14. Forensic Handwriting Analysis Dennis J. Ryan, DABFDE, Senior Forensic Document Examiner, Applied Forensics LLC, East Meadow, NY Forensic Document Examinations go well beyond that of a handwriting expert. Mechanical fabrications of photocopies, ink jet & laser printer exams, indentation analysis, and ink examinations are just of few of the types of cases for a Forensic Document Examiner. Panel 15. Mitigating Risk: Assessing How Juror Attitudes Toward Insurance Companies Will Impact Your Case Matthew Kops, Ph.D., Director, Decision Quest, Atlanta, GA Gayle Rossi, Vice President, Decision Quest, Atlanta, GA Conventional wisdom tells us that jurors view insurance companies as uncaring, cold, and profit-‐driven. But what is the reality? And how does the reality impact juror perceptions of your specific case? This presentation discusses juror attitudes toward insurance companies based on data collected from jury research exercises over the past 8 to 10 years. The presentation will also consider various approaches available to assess how juror attitudes toward insurance companies will play out in how jurors decide specific cases as well as what impact the use of demonstratives has on jurors’ perceptions of insurance companies. Page 7
Panel 16. ICD-‐10 and How it Impacts Fraud Investigations -‐ Go On! Karen Weintraub, MA, AHFI, CPC-‐PCPMA, Healthcare Fraud Shield, Ringoes, NJ This session will highlight the differences between ICD-‐9 and ICD-‐10, how insurers need to prepare, and how it impacts auditing and investigating insurance claims. HOSPITALITY RECEPTION 5:00 p.m. – 7:00 p.m. Starlight Roof Only Registered Attendees and Pre-‐registered Guests will be admitted to the Hospitality Receptions TUESDAY, FEBRUARY 26, 2013 REGISTRATION 8:00 a.m. – 1:55 p.m. North Foyer EXHIBITORS’ RECEPTION 8:00 a.m. – 9 a.m. Starlight Roof and Palm Room Coffee and pastries will be available TUESDAY, FEBRUARY 26, 2013 CONCURRENT SESSIONS 9:00 a.m. – 10:15 a.m. Panel 17. Unclaimed Property Audits-‐ Surviving Progress Mary Jo Hudson, Bailey Cavalieri LLC, Columbus, OH John Crow, Associate Vice President, Nationwide Insurance Company, Columbus, OH Effective audit strategies are indispensible in dealing with policing of unclaimed property. Appreciating the varying approaches of state auditors, regulators and contingency fee auditors is necessary, as is an understanding of potential audit triggers. Best practices must be developed with an understanding of the auditors’ expectations and the capabilities of the company to generate information. This lively presentation will address the vexing issue of unclaimed property audits. Panel 18. Fitness for Duty Evaluations-‐ Safety Not Guaranteed Nick DeFilippis, Ph.D., Atlanta Psychological Associates, Atlanta, GA Kelly Wilson, Psy.D., L.P., PsyBar LLC, Minneapolis, MN The issue of risk of relapse is covered, with particular attention to assessing the significance for physicians who have addiction problems and have diverted narcotics. Factors that influence relapse risk are presented. Treatment variables and outcomes will be discussed. Further discussion on the incidence of violence in the workplace and characteristics of those at greatest risk. The most common threatening workplace behaviors, such as verbal, email, and social media threats will be discussed along with practical strategies for handling threatening individuals in the workplace. Page 8
Panel 19. Effective Phone Call Interviewing-‐ Cross My Heart Daniel W. Draz, M.S., CFE, Fraud Solutions, Naperville, IL Kevin Quinn, Director of Field Services, Disability Insurance Specialists, LLC, Bloomfield, CT A standard tool in most claims and investigations professional’s toolbox is the interview. While there are many reasons interviewing a claimant or insured in person is preferable, it’s not always possible, or practical to do so. Despite advances in technology, the telephone is still a useful tool in the insurance process and claimant interviews have significant value and impact when conducted properly. The reality, however, is that some professionals conduct better phone interviews than others. In this session, two industry professionals, with extensive insurance, claims, investigation and fraud experience, explore these issues and present their insights and observations on a variety of areas including: using the telephone interview process effectively, interviewing styles and techniques, eliciting cooperation, eliminating barriers to getting information, managing irate callers and increasing the amount and value of information returned in the claim and investigation process. Panel 20. Accidental Death Insurance -‐ If The Insurer Did Not Want to Cover This Loss, the Company Should Have Excluded It E. Ford Stephens, Esq., Christian & Barton LLP, Richmond, VA Gary Schuman, Esq., Sr. Counsel-‐Litigation, Combined Insurance Company of America, Glenview, IL The terms "accident" and "accidental bodily injury" are rarely defined in insurance policies. Courts struggle to find a common meaning, resulting in many types of losses -‐-‐ such as drunken driving, drug overdose, autoerotic behavior and medical mishaps -‐-‐ to be considered accidents, even though insurers never intended to cover them. Some courts seem to default to the notion that if insurers don't want to insure these types of losses, they have the ability to exclude coverage with carefully worded provisions. So what are some of the common exclusions and how do they apply? Join two experienced AD&D insurance lawyers who will discuss the current state of the law surrounding exclusionary language, how exclusions can be used in connection with certain losses, and how best an insurance company can protect itself from such coverage problems. Panel 21. Lower Back Protocols in Assessing Medical Files -‐ Know the Cause Dr. Tom Jones, D.C., C.E.S., CCRD, CSCS Independent Consultant, Toms River, NJ This presentation will give the claims reviewer valuable clinical information in understanding an accurate patient history that is relevant to the low back injury, the proper examination process, and proper knowledge of the diagnosis and treatment options for the patient. This presentation furthermore will demonstrate the inconsistencies and exaggerations when dealing with excessive treatments and billing.
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TUESDAY, FEBRUARY 26, 2013 CONCURRENT SESSIONS 10:30 a.m. – 11:45 a.m. Panel 22. Unclaimed Property and New York Regulation 200 -‐ You Got Served Catherine L. Venard, Assistant General Counsel, Nationwide Insurance Company, Columbus, OH Maeve O’Connor, Partner, Debevoise & Plimpton, New York, NY Insurance Regulation 200 was recently passed by the New York State Department of Financial Services in order to prompt life insurance companies and fraternal benefit societies to adopt reasonable procedures and standards for investigating claims and locating beneficiaries relating to unclaimed property. This knowledgeable panel will discuss the ramifications and implications of NY 200 and offer helpful solutions for compliance in working with the Department. Panel 23. Financial Analysis for Disability Claims – Fifty Shades of Gray Ernest Patrick Smith, CPA, CVA, CFE, Nawrocki Smith LLP, Melville, NY Darin Iacobelli, CPA, CFE, Nawrocki Smith LLP, Melville, NY What are financial statements? What financial records does a small businesses have or should have? How does a self employed or small business owner maintain records? How do you analyze financial information and why it is important in understanding and managing a disability claim? We will discuss what you should know about financial statements and financial information and the various techniques of analyzing them. We will go beyond the numbers and show how to interpret what is behind the numbers and why/how it impacts the claim you are managing. We will show the results of financial analysis in action through the use of recent case studies. Panel 24. Investigative Intuition -‐ The X Factor Daniel W. Draz, M.S., CFE, Fraud Solutions, Naperville, IL Insurance anti-‐fraud training often focuses on red flags, or the use of technology to analyze information and detect potentially fraudulent claims for further review. However, despite increased training and significant advances in technological tools, not all claims have red flags which are easily identifiable. In these cases, detecting fraud requires the expertise and experience of professionally trained investigators with well honed skills. This unique training session focuses exclusively on the use of intuition and how great investigators use their intuitive skills to successfully identify and investigate fraudulent insurance claims. Intuition is rarely discussed in insurance industry anti-‐fraud training around the country and is a "must have" skill in any good insurance investigators toolbox. Panel 25. Career Pathing for the Disability Claim Representative Jeffrey Yeager, VP IDI Claim and Client Services, The Guardian Life Ins. Co., Pittsfield, MA An interactive session with front line personnel and management to discuss where we are with career pathing and development of our claims professionals. Anticipate future workplace requirements within our dynamic industry through training and planning. Page 10
Panel 26. Changing Definitions in Changing Times -‐ Anything But Ordinary Philip M Howe, Esq., Lecomte, Emanuelson and Doyle, Quincy, MA Steve Allen, FLHC, ACS, FLMI, Trustmark Insurance Company, Worcester, MA Traditional group disability insurance policies, and some individual policies as well, change the definition of disability from one's "own occupation" to "any occupation" after an initial period of time, usually either 12 or 24 months. The criteria for “any occupation” are based largely on one's "training, education, and experience," which might include economic issues. These factors can be impacted significantly in trying economic times. This panel will review vocational, economic, as well as legal considerations in the review of changes in disability definitions. Panel 27. Hands-‐On Patient Exam Demonstration-‐Leverage Dr. Tom Jones, D.C., C.E.S., CCRD, CSCS Independent Consultant, Toms River, NJ
An orthopedic demonstration of the exams discussed will give a “hands on” look at what the providers are performing on the claimant. This will allow the claims examiner to understand what the claimant is being tested for and offers insight for referencing validity to other parts of the claimant’s overall medical records. Additionally this will allow the claims examiner to understand the tests and movements performed on the claimant and allow them a better understanding of how to gear their recorded statements. Further insight of diagnosis and treatment of the claimant will be gained by interpretation of findings of the exam situation. TUESDAY, FEBRUARY 26, 2013 EXHIBITORS’ RECEPTION 11:45 a.m. – 12:30 p.m. Starlight Roof and Palm Room LUNCH 12:30 p.m. – 1:30 p.m. Starlight Roof LUNCHEON SPEAKER Doris Erdman, FLMI, ALHC, ACS Woodmen of the World Life Insurance Society, Omaha, NE President, International Claim Association TUESDAY, FEBRUARY 26, 2013 CONCURRENT SESSIONS 1:45 p.m. – 3:00 p.m. Panel 28. Individual Life Claims/Contestable Investigations Stephen H. Broer, The Guardian Life Insurance Company of America, New York, NY Valerie Loftin, Lincoln Financial, Greensboro, NC Review industry best practices in the investigation and litigation of contestable life claims. The presenters, whose backgrounds include front line claims management and in house counsel, will review real case scenarios and lend their perspective on how to address difficult claims situations. Page 11
Panel 29. Self-‐Reported and Chronic Conditions: The Full and Fair Review Requirement of ERISA Kari Briscoe, Claims Consultant, Reinsurance Group of America, Minneapolis, MN William Hittler, Nilan Johnson Lewis PA, Minneapolis, MN Explore the challenges facing claims decision-‐makers in ERISA-‐governed plans where a claimant’s long-‐ term disability claim is based upon self-‐reported symptoms and there exists no definitive objective medical testing of a physical or mental impairment and in circumstances where the claimant has been approved for disability benefits by the Social Security Administration for the same or similar condition. Panel 30. An Investigator’s Internet Toolbox – Never Enough Matthew Berls, MA, Investigations Manager, UnitedHealthcare, Iselin, NJ Meghan Ellerman, Senior Investigator, UnitedHealthcare, Iselin, NJ To provide comprehensive training, that provides a user with Internet based investigative tools and resources. This session will be broken down into several distinct categories, i.e. "Coding Resources," "Pharmaceutical Resources," "Boards," and finally "Research."
Panel 31. Show Me The Money: Name Them, Find Them, Pay Them! Jeaneen J. Johnson, Esq., Counsel, Semmes, Bowen & Semmes, Baltimore, MD
A veteran life insurance attorney identifies and reviews problematic issues, and how to solve them, arising out of naming, changing, identifying, and paying the “rightful beneficiary” and the insurers’ obligations.
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