ECC Eastern Claims Conferenceit-mis.com/easternclaims/pdfs/ECC_2014_Invitation.pdfEastern Claims...

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ECC

Excellence Through Education

February 23-25, 2014

Waldorf=Astoria New York City

Dedicated to Life, Accident & Health and Disability Claims

Dear Friends and Colleagues: As the Conference Chairperson and on the behalf of the entire committee, it is my honor and pleasure to welcome you to our Annual 2014 Eastern Claims Conference. I would like to personally thank all of those involved in working so hard over the past year in making this year’s conference a success. 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. This year's conference will draw attendance from leading insurance professionals, handling claims from all over the world. Our speakers representing the insurance industry will present and discuss the latest topics from their area of expertise including: accidental death and dismemberment, life, legal, fraud, disability and medical issues. They will be sharing with you their strategies, experiences and research techniques. The program schedule over the next few days is going to be one of the best. We have included a wide variety of topics where you will find updates on: traditional claims subject matter, mock depositions, fraud and legal updates and other hot topics. These courses were designed to assist you in your personal growth as a claim professional. This is an excellent opportunity for you to meet with other insurance professionals. We are also pleased with our success in obtaining continuing education credits as we have done in the past. In addition, our conference rates were not increased for 2014. 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 and look forward to seeing you again next year! Sincerely, Jennifer Cobb, CFE, FCLS, ALHC ACE A&H / Combined Insurance Select Programs Conference Chairperson, Eastern Claims Conference

2014 Eastern Claims Conference The Waldorf=Astoria Hotel

New York, New York ECC – 2014

SUNDAY, FEBRUARY 23, 2014

REGISTRATION 1:30 p.m. – 6:30 p.m. (North Foyer-‐18th Floor) HOSPITALITY RECEPTION 5:00 p.m. – 6:30 p.m. (Starlight Roof) MEET AND GREET (First time attendees) 4:00 p.m. – 5:00 p.m. (18th Floor)

Only Registered Attendees and Pre-‐registered Guests will be admitted to the Hospitality Receptions

MONDAY, FEBRUARY 24, 2014 REGISTRATION 7:30 a.m. – 3:30 p.m. (North Foyer) EXHIBITORS’ RECEPTION 8:00 a.m. – 9 a.m. Starlight Roof & Palm Room Coffee and pastries will be available WELCOME ADDRESS 9:00 a.m. – 9:15 a.m. Starlight Roof Jennifer Cobb, CFE, FCLS, ALHC ACE A&H / Combined Insurance, Red Bank, NJ Eastern Claims Conference Chairperson INTRODUCTION Donna A. Conticchio, ALHC, HIA, ACS AIG Benefit Solutions, Neptune, NJ President, Eastern Claims Conference Board KEYNOTE ADDRESS 9:15 a.m. – 10:00 a.m. Steve Allen, FLHC, FLMI, ACS

Claims: From the Inside Out Kicking off the Eastern Claims Conference in 2014 will be an address by Steve Allen, FLHC, FLMI, ACS. Steve is a Senior Field Claims Consultant with Trustmark Insurance Company, based in Worcester, MA. He has served with the nation's largest disability insurance carriers, always responsible for "front-‐line" personal field visits. Steve is a claims veteran of over 40 years (and former Marine) who believes the profession of Claims Examiner has a nobility of purpose. Our insurance products fill a societal need and our claim professionals deliver this service with empathy and understanding. Communication is key, as is a genuine passion to "do the right thing," for customers as well as our companies. Having met thousands of claimants and their representatives, Steve brings a unique approach to claim evaluation and adjudication by using a practical approach to information gathering along with “sixth sense” review. Steve will inspire claim professionals from all lines of business!

MONDAY, FEBRUARY 24, 2014

CONCURRENT SESSIONS 10:00 a.m. – 11:15 a.m. Panel 1. Show Me The Money – Name them, Find them, Pay them! Donald A. Murday, Esq., Chittenden, Murday & Novotny, Chicago, Il Joseph R. Jeffrey, Esq., Chittenden, Murday & Novotny, Chicago, Il Listen to two experienced life, health, disability, and ERISA litigation attorneys discuss in depth problems arising out of beneficiary designations or failures to designate, how to solve those problems, how to head them off, and recent legislative developments affecting “rightful beneficiary” determinations. Particular attention will be paid to divorces as they impact beneficiaries and designations and same-‐sex marriages. Panel 2. The First 6 months of a Disability Claim Richard Beckel, FLMI, ARA, Munich Re, Atlanta, GA Rick Denman, FLMI, ALHC, ACS, Munich Re, Atlanta, GA Tracey Bostwick, Munich Re, Atlanta, GA This real account of our colleague’s devastating accident and resulting disability claim during his recovery will provide new perspective to assist the claims professional to gain better insight, underscore the importance of claim management during this crucial period, and assist in achieving better results. In addition to completing claim forms, claimants are busy attending primary and specialist doctor appointments, rehabilitation, communicating with their employer to sort through the maze of all their benefit coverage, assessing the potential for work accommodation or the real possibility of eventual termination. Panel 3. Management Focus Kevin Sherman, ALHC, Berkshire Life Insurance Company, Pittsfield, MA Steve Rutledge, SunLife, Windsor, CT What's involved in developing a curriculum to provide basic, industry, and management training, focused on performance management, to build consistent bench strength and to produce a sustainable succession plan. Panel 4. The “Greatest Hits” of AD&D E. Ford Stephens, Esq., Christian & Barton LLP, Richmond, VA Gary Schuman, Esq., Sr. Counsel-‐Litigation, Combined Insurance Company of America, Glenview, IL Over the last several years, ECC presentations on accidental death & dismemberment have covered many areas and concepts, including what constitutes an “accident,” whether fatalities from acts such as drunk driving, drug overdoses and medical mishaps are compensable, and how exclusions can limit coverage. This year, our presenters -‐-‐ experienced in-‐house and outside lawyers -‐-‐ will select some of their favorite cases, both new and old, to discuss relevant factors to be considered when grappling with AD&D claims and to provide helpful investigation pointers. Come armed with your own favorite war stories and join in what promises to be a lively discussion.

Panel 5. Treatment Options for Chiropractic Care Dr. Tom Jones, D.C., C.E.S., CCRD, CSCS Independent Consultant, Toms River, NJ

Develop an understanding of different treatment methods involved in Chiropractic treatment and physical therapy.

-‐The role of passive physical therapy modalities -‐Identifying buildup of treatment from appropriate care -‐Understanding appropriate chiropractic treatment relative to patient diagnoses


EXHIBITORS’ RECEPTION 11:15 a.m. – 12:00 p.m. Starlight Roof LUNCH 12:00 p.m. – 1:00 p.m. Starlight Roof


CONCURRENT SESSIONS 1:15 p.m. – 2:30 p.m. Panel 6. The Evolution of Reinsurance Iraida Labra, FLMI, ALHC, Munich Re, Atlanta, GA Kim Houston, Munich Re, Atlanta, GA Ever wonder how reinsurance began? Join this discussion focused on how a reinsurer is beneficial to the adjudication of claims, as well as the collaboration of reinsurers and other operational areas. Panel 7. Roundtable – Individual DI Focus Ernest Patrick Smith, CPA, CVA, CFE, Nawrocki Smith LLP, Melville, NY Tom Loftus, Munich Re, Atlanta, GA Join us for an open discussion on Individual Disability Insurance. Moderators will solicit topics in advance from registered attendees and guide the discussion. Panel 8. Roundtable – Group Disability Focus Stan Kulesa, Standard Life Insurance Company, White Plains, NY Jeff Verrill, Salt & Associates, Yarmouth, ME Join us for an open discussion on Group Disability Insurance. Moderators will solicit topics in advance from registered attendees and guide the discussion. Panel 9. Using the Internet as an Investigative Tool Marc Schwartz, Swiss Re Life & Health America, Inc., Fort Wayne, IN

This workshop will highlight valuable information that is available online 'Free' & 'Fee' relevant to your claim adjudication. Ensure your risk is properly protected, Marc will provide you with additional tools in uncovering potential fraud. 'BIG DATA' used in predictive analytics will also be discussed.

Panel 10. Life Case Law Update: The Next Dimension 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 the most current cases and developments impacting life insurance claim administration in both the United States and Canada. Listen to experienced inside and outside counsel explain recent cases and trends in life insurance case law and litigation developments. Panel 11. ERISA Update David F. Schmidt, Esq., Chittenden, Murday & Novotny, Chicago, IL A nationally recognized, experienced veteran litigator of contested ERISA claims will describe and explain recent litigation and legislative and administrative developments in the ERISA area affecting the administration of ERISA life, disability, health, accident, and group claims.

Panel 12. Healthcare Medical Claims Fraud – From Identity to Recovery Mary Hull, RN, CCS-‐P, AHFI, UnitedHealthcare, Iselin, NJ Roberta Ferlita, ALHC, FCLS, AHFI, UnitedHealthcare, Iselin, NJ The session is designed to prepare the beginning healthcare fraud investigator or claims examiner for investigation of medical claims fraud from detection to demand. The session will also discuss the identification of a case through data mining and take you through the steps to validate the allegation, perform a thorough audit and include strategies for recovery.

MONDAY, FEBRUARY 24, 2014 CONCURRENT SESSIONS 2:45 p.m. – 4:00 p.m. Panel 13. Nomadic Claims – Masters of the Con Richard J. Marquez, CFE, DI Group, Addison, TX Sophia Aikman, Munich Re, Atlanta, GA Who are nomads? What is in a name? Learn about the culture and why they are masters at financial/ insurance frauds. The Cost of the Scams and the New Nomad. Learn how due diligence can effectively defeat their scams. Panel 14. What the Claims Professional Needs to Know about Financial Case Management Kimberly Tomaselli, CPA, FLMI, ALHC, ARA, Munich Re, Atlanta, GA John Hoffman, CPA,CFF, CITF, Nawrocki Smith LLP, Melville, NY This session will focus on what the claims professional needs to know about the financial aspects of a disability claim. We will cover the types of documents to obtain how to analyze them and why they are important to the claims decision. We will discuss frequently asked questions about the calculation of earnings and common policy provisions which require financial expertise. When should you refer a file to a CPA? Who should discuss financial information with the claimant? Understanding what to

request, why you need it and how calculations are performed will give you the knowledge needed to confidently explain and answer claimant's questions about why they need to provide financial documentation and why it is important to the claim. Panel 15. Technical Systems/Analytics Kathy Serunian, DRMS, Portland, ME This session will explore the magnitude of data points associated with disability claims, how data is used, and why data integrity is critical. From quality assurance programs to systems edits, we will explore strategies and mechanisms for maintaining accurate data and preventing financial leakage in your disability business. Panel 16. The Conundrum of Mental Illness Limitations vis a vis Subjective Symptom Disability Claims Sherril M. Colombo, Wilson Elser Moskowitz Edelman & Dicker LLP, Miami, FL This session will discuss the dichotomy of applying typical mental illness long-‐term disability policy limitation provisions to subjective symptom disability claims, such as Chronic Fatigue Syndrome, Fibromyalgia, Multiple Chemical Sensitivity Syndrome and others. The presentation will include a discussion on how the claims personnel can/should develop the administrative file when there are subjective pain complaints with potential mental illness issues. The session will also address the current status of the law where these two components come into play and overlap Panel 17. The Growing Threat of Medical Identity Fraud: A Call to Action Robin M. Slade, Medical Identity Fraud Alliance, Prosper, TX Risk, security and fraud managers from health plans, health providers, and technology and other service providers are working cooperatively alongside government strategic partners to put an end to the $80 billion annual cost of healthcare fraud and to strengthen the industry’s and their organization's position against fraud, including medical identity theft. Stolen, ransomed and even "friendly" shared patient data is at the core of the problem, compounded by fraudsters, including organized crime. The Medical Identity Fraud Alliance, founded in 2012 is about consumers as protectors of their health information and identities; the industry as innovators committed to a culture of cooperation to mitigate medical identity fraud, and regulators as leaders to guide policy, processes and decision-‐making. This session will introduce the Medical Identity Fraud Alliance (MIFA) -‐ a public/private partnership acting as the intersection between industry, government and consumers -‐ and outline its focused agenda to unite all stakeholders to jointly develop best practices and solutions for medical identity fraud. HOSPITALITY RECEPTION 5:00 p.m. – 6:30 p.m. Starlight Roof

Only Registered Attendees and Pre-‐registered Guests will be admitted to the Hospitality Receptions

TUESDAY, FEBRUARY 25, 2014 REGISTRATION 8:00 a.m. – 1:55 p.m. North Foyer – 18th Floor EXHIBITORS’ RECEPTION 8:00 a.m. – 9 a.m. Starlight Roof and Palm Roof Coffee and pastries will be available

TUESDAY, FEBRUARY 25, 2014 CONCURRENT SESSIONS 9:00 a.m. – 10:15 a.m. Panel 18. Group Insurance -‐ It's a Wonderful "Life" SueCarol Greene-‐Buckner, Esq., The Prudential Insurance Company of America, Roseland, NJ We have several topics that are germane to group life insurance that we hope will spark lively discussion from you, our attendees! No Loss/No Gain – What does that mean? What are the challenges administratively, for underwriting and for claims? Actively at work rules –the pain points when an employee leaves work due to disability and her employer changes carriers while she is out? Unclaimed Property -‐ Unclaimed Property as it pertains to group life insurance is still a controversial and challenging issueWhere are we now legislatively and administratively? Panel 19. A Closer Look Inside the Psychological IME and FCE: What Actually Goes On? Jack Spector, Ph.D, Baltimore, MD David Raptosh, MA, OTR/L, Select Physical Therapy / First Choice Rehabilitation Specialists / NovaCare Rehabilitation, Harrisburg, PA

Curious as to what transpires during an actual IME and FCE? In this session, you will watch a forensic neuoropsychologist conduct several aspects of the evaluation, as well as witness portions of an FCE conducted by an occupational therapist. An inside look. Panel 20. Decode Financial Documents -‐ How to Interpret Financials & Tax Information John M. Spatola, CPA, ABV, CFF, CVA, CFE, Nawrocki Smith LLP, Melville, NY This session will focus on the basic information which is contained in financial statements and tax documentation. We will cover what information is included on financial statements and income tax forms, what to focus on and how to decipher that information. We will discuss the different type of tax forms to request and how to obtain those forms directly from the Internal Revenue Service. We will also discuss the different types of business entities and the advantages/disadvantages of each to provide insight as to why business owners choose one entity over the other. In this session we will also share case examples of some of the financial schemes we have encountered while analyzing financial information. Panel 21. Mock Deposition Part I Edith S. Shea, Esq., Pierce Atwood LLP, Portland, ME Byrne J. Decker, Esq., Pierce Atwood LLP, Portland, ME

These back-‐to-‐back sessions will allow you to approach your next deposition with confidence. The first session will address the "dos and don'ts" of depositions, providing concrete advice that will help you to prepare for deposition; this session will help you to understand the process and will inform your approach to questions posed by the opposition. While these sessions are complementary, attendance of Part I is not a pre-‐requisite for attendance of Part II. Panel 22. STOLI On The Rocks Frank Best, Esq., Penn Mutual Life, Horsham, PA David McDowell, Esq., Edison, McDowell & Heatherington, LLP, Houston, TX The STOLI battle waged by life insurers for almost a decade has resulted in a profound impact on life insurance litigation. The current lawsuits involving hedge funds and RICO allegations, is a far cry from the initial cases that simply sought individual policy rescission on the grounds of material misrepresentations. Come hear about the effect that STOLI litigation is having on issues of rescission, financial underwriting, insurable interest, premium return and many other matters important to the life insurer.

Panel 23. Mental Health Parity – Comparing Apples to Oranges John T. Seybert, Esq., Sedgwick LLP., New York, NY This session will provide a comprehensive overview of the Mental Health Parity And Addiction Equality Act (MHPAEA) and the recently implemented regulations. We will tackle some of the more complex questions, including those issues involving quantative and non-‐quantative limitations. The session will also address the recent litigation trends, including class action suits, seeking relief for alleged violations of MHPAEA and comparable state laws.

TUESDAY, FEBRUARY 25, 2014

CONCURRENT SESSIONS 10:30 a.m. – 11:45 a.m. Panel 24. Foreign Death Claims: Reports of My Death are Greatly Exaggerated Kenton J. Coppage, Smith Moore Leatherwood LLP, Atlanta, GA Even while the world continues to shrink and becomes ever more interconnected, evaluating life insurance claims originating beyond international borders poses special challenges. This presentation focuses on meeting those challenges and defending foreign death claim decisions in the legal arena. Panel 25. Behind the Scenes of the Surveillance Assignment Michael Clarke, Archangel Investigations & Protection, Los Angeles, CA Brian Landry, Claims Bureau USA, Burlington, MA Mark Hesse, The Standard, Portland, OR

This session will focus on the logistics and execution of a surveillance assignment. More than “best practices”, the presenters will take you inside the assignment and attendees will gain a unique perspective to assist in achieving optimal results. Panel 26. E-‐Mail Etiquette, Tone and Writing Gary Blake, Ph.D., The Communication Workshop, Port Washington, NY This session will emphasize similarities and differences between letter and e-‐mail in format, organization, tone and phrasing. It will pose problematic e-‐mail situations and will challenge attendees to come up with ideas to solve each issue. Finally, the session will stress privacy issues involving e-‐mail as well as issues of e-‐mails in claims files and bad faith lawsuits. Panel 27. Mock Deposition Part II Edith S. Shea, Esq., Pierce Atwood LLP, Portland, ME Byrne J. Decker, Esq., Pierce Atwood LLP, Portland, ME The second session will present a mock deposition, demonstrating the advice in action. It will show examples of good and bad testimony. Panel 28. The Ins and Outs of Durable Medical Equipment Fraud Karen Weintraub, MA, AHFI, CPC-‐PCPMA, Healthcare Fraud Shield, Ringoes, NJ This session will explore the ins and outs of Durable Medical Equipment (DME) fraud across Medicare, Medicaid and commercial plans. Attendees will learn how to spot suspect providers, identify patterns of Fraud, Waste and Abuse, and use various techniques to successfully investigate DME Fraud.

TUESDAY, FEBRUARY 25, 2014 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 Kevin Glasgow, FLMI, FLHC Munich Re, Atlanta, GA President, International Claim Association

TUESDAY, FEBRUARY 25, 2014 CONCURRENT SESSIONS 1:45 p.m. – 3:00 p.m. Panel 29. Unclaimed Property: GRA vs Non-‐GRA – The Battle of the Decade John O’Mahony, John Hancock Life Insurance, Boston, MA Paul MacCready, Keane,

Is your company concerned about an unclaimed property audit? Are you curious about the implications of signing a GRA (Global Resolution Agreement)? Do you know the implications if your company doesn’t sign a GRA (did you even know that was an option). We will debate the pros and cons of each approach with time available for your questions. . Panel 30. “Am I So Different? – The Psychological Disability Claim: Best Practices, and What is the Peer Review and IME Expert Looking For?” Cheryl Luis, Ph.D., Hollywood, FL Daphne Moutis, Mass Mutual, Springfield, MA Join us as a Claims Director and a Forensic Neuropsychologist discuss the nuances of a mental health claim. What are best practices, what are expert Providers looking for, and how will the changes in the DSM-‐V possibly affect the assessment and management of these claims. Panel 31. Stress, What is it and how can I get rid of it? Jeff Green, PH.D, DMS, Springfield, MA This session will teach the participant the causes and mechanisms of stress. More importantly it will offer means to identify stress triggers at work and at home and provide means to reduce or remove stress. The workshop is geared for claim consultants and claim staff. The presenter has conducted this workshop to multiple audiences with positive acclaim. Participants will be encouraged to be involved and examples of experiences that create stress are welcomed for discussion. Panel 32. What! My Email’s Not Privileged?!? When Communications With Your Attorney About Claims Are Discoverable Larry Kristinik, Esq., Nelson Mullins Riley & Scarborough LLP, Columbia, SC Stephen Broer, Esq., The Guardian Life Insurance Company of America, New York, NY Not every email or phone call with your company attorney is privileged. The courts have fashioned a number of traps that can open the door to your confidential communications with counsel during the claims investigation process. Experienced in-‐house and outside counsel reveal these traps and will offer practical advice that will allow you and your company to maximize the use of the attorney-‐client privilege. The latest developments will be covered, including the fiduciary exception applicable with ERISA claims. Panel 33. Pharmaceutical Fraud Karen Weintraub, MA, AHFI, CPC-‐PCPMA, Healthcare Fraud Shield, Ringoes, NJ This session will delve into key statistics and emerging schemes surrounding prescription fraud. Attendees will learn about specific drugs that are being targeted for abuse, how to data mine for those drugs, and how to implement fraud algorithms to prevent inappropriate billing in the future. Additionally, the audience will learn about the construction of DEA numbers, how to find prescribers purchasing medications from foreign and unlicensed suppliers, and where to identify prescribers and pharmacies subject to sanctions against their license.

Notes

• The attendee registration fee includes admission to the Hospitality Receptions. However, if you bring a guest (a colleague or spouse), a $200 fee is payable for your first Pre-‐registered Guest wishing to attend the receptions. The fee covers both receptions. A $150 fee is payable for each Additional Guest, per event.

• If you have special needs, please contact Arlene Walsh at 718 497 7886 or [email protected].

• Business dress is encouraged.

• There will be a $50 late fee added to registrations received after January 31, 2014.

• There will be no refunds for cancellations received after January 31, 2014.

THE FEDERAL TAX ID NUMBER FOR THE ECC IS 20-‐8483688

Attendee Registration Fees for 2014

2 days with lunch $595 2 days without lunch $475 1 day with lunch $395 1 day without lunch $330 First Pre-‐registered guest $200 Each additional guest (per event) $150 Late fee after January 31, 2014 $ 50

Waldorf = Astoria 301 Park Avenue

New York, NY 10022-‐6897 1 877 GROUP WA (1 877 476 8792)

Hotel Rates for 2014 (Use Hotel Code ECC)

Accommodations Single/Double Deluxe Queen $295 King Bed & Double/Double Superior Room $295 King Bed Luxury Room $359

• All Room rates are subject to state and local taxes, currently 14.75%, $2.00 Occupancy tax, and $1.50 Jacob Javits Center fee per room, per night.

• A credit card is required to make a reservation. • If you need to cancel your hotel room, please do so one day prior to

arrival to avoid cancellation fee. • Hotel Check-‐in time is 3 p.m.

ECC Eastern Claims Conferenceit-mis.com/easternclaims/pdfs/ECC_2014_Invitation.pdfEastern Claims...

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