www.NJSIA.org
New Jersey Special Investigators Association, Inc.

2019 Workshops (subject to change)

Accident Investigation, Evidence Gathering and EDR Analysis                                                                   

Accident Investigation and Evidence Gathering is a one-hour seminar designed to educate participants about Vehicle Accidents, the evidence gathering process and Event Data Recorders. The presentation introduces multiple types of reported vehicle crashes including: phantom vehicles, sideswipes and rear-end crashes.  It also covers the process of gathering evidence after an accident, which includes site investigation, properly gathering and maintaining evidence, collecting witness statements, and obtaining medical documentation.  Participants will also learn about vehicle Event Data Recorders and the use of contained data in a crash investigation and how to identify situations in which a consultant is needed.

Preston L. Forchion II

Senior Consultant / ACTAR / Philadelphia

Mr. Forchion is a graduate of the United States Military Academy at West Point, New York with extensive industry experience in vehicle accident reconstruction. His experience and industry knowledge covers over 18 years of reconstruction methodology ranging from minor property damage crashes to multiple vehicle fatal collisions. Mr. Forchion is well versed in collisions involving motorcycles, bicycles, pedestrians, damage consistency, occupancy kinematics, event data recorder download and analysis.

Mr. Forchion is a retired police officer and has extensive knowledge and training in Impaired and Intoxicated Vehicle Operation (DRE) and Emergency Vehicle Operations. Additionally, Mr. Forchion is a certified FAA drone pilot and is well abreast in performing aerial site inspections for a myriad of situations.

Education and Certifications

Behavioral Science and Leadership, B.S.: United States Military Academy

Accredited Traffic Accident Reconstructionist: The Accreditation Commission for Traffic Accident Reconstruction

Part 107 Small Unmanned Aircraft Systems Pilot: Federal Aviation Administration

Adapting In-Person Interviewing Skills to the Phone Interview

This course is designed for insurance fraud investigators, licensed adjusters, case managers, and claims professionals whose duties require them to conduct telephone interviews of insureds, claimants and witnesses involved in incidents resulting in the submission of an insurance claim.

Learning Objectives:           Upon completion of this course, the participants will be able to:

  • Explain the impact of the telephone on evaluating verbal and non-verbal cues
  • Participants will learn how to prepare for and develop processes for interviewing claimants
  • Participants will fine tune listening skills and understand the purpose of an interview
  • Participants will gain knowledge on how to prepare a file for review
  • Participants will learn how to compensate for the absence of body language and nonverbal communication during a phone interview
  • Identify indicators of truthfulness and deception

Dr. Rick Wakefield is a graduate of University of Florida, Life University and John Marshall Law School.  Dr. Wakefield has held faculty positions at Yale University, Hahnemann Medical College, George Washington School of Medicine, Emory University and Life University. 

He is president of International Healthcare Consultants, Inc., a forensic consulting firm specializing in issues concerning healthcare, science, insurance and law. Dr. Wakefield has analyzed thousands of cases and conducted original research concerning causation and human factors in minor to catastrophic injuries and fatalities.  Since 1984, he has been a lecturer, teacher, moderator, expert witness, and consultant in the areas of medical billing and coding, fraud detection, injury causation, injury biomechanics & human factors, and interviewing & interrogation techniques.  Dr. Wakefield has been a consultant to, and provided training for many Federal, State, and Local Government agencies as well as industry organizations. Dr. Wakefield has provided Continuing Legal Education courses in states around the country; including being a CLE instructor for the State Bar of Georgia Insurance Law Institute. 

Analytics You can Use

Joel McCloskey and Aaron Soline of the National Insurance Crime Bureau will talk about data analysis and how to actually use that analysis.  This session will focus on making analysis actionable to the end user.  The discussion will focus on creating products and reports that are functional and understandable.  The presenters will discuss claims data analysis at a strategic and tactical level.  On the strategic level the discussion will touch on business rules models, red flag indicators, and modeling techniques.  The tactical discussion will encompass link analysis, medical billing analysis, and cell phone data record analysis.  Investigators and analysts will benefit from the tips for bringing complex analysis to the end user.

 Joel McCloskey

Joel Manages the Data Analytic’s commercial unit, mining workers compensation, general liability, commercial automobile and commercial personal property claims to identify previously unidentified entities and organized groups potentially engaged in fraudulent activity. Joel has received a Master of Public Administration (MPA) degree from Roosevelt University and has been designated a Certified Fraud Examiner (CFE) by the Association of Certified Fraud Examiners (ACFE).

________________________________________________________

Aaron Soline

Aaron Soline is a Director of Data Analytics at the National Insurance Crime Bureau (NICB).  Prior to this, Aaron was a Strategic Analyst specializing in organized fraud groups and vehicle investigations.  Aaron previously worked in contract security, managing services for multiple commercial, retail, and residential facilities in Chicago, IL and the surrounding areas.  In his current role, he is responsible for managing NICB’s team of vehicle analysts and projects, training new employees, and teaching the NICB Analyst Academies.

Aaron graduated with a dual major in Law Enforcement and Justice Administration, and Small Operations Business Management from Western Illinois University.  He later went on to obtain a Master’s of Business Administration in 2000 from Western Illinois University.  Aaron Soline has also obtained the Certified Insurance Fraud Investigator and Certified Insurance Fraud Analyst designations from IASIU.

Arson Techniques and Successful Investigations

This class is designed to instruct the attendees on the various methods people use to ignite incendiary fires besides the expected ignitable liquids. To fully determine the cause of a fire, various engineers may be required to be utilized to rule out potential items that may indicate the appearance of an accidental fire, and to confirm the finding of arson.  The input of information from the scene examination, follow up lab work and intelligence gathering can greatly assist in not only the origin and cause investigation, but in avoiding a bad faith claim being filed against the insurance company by the insured.

Kevin Reilly

Mr. Reilly has 22 years of experience in the fire service in both New Hampshire and Colorado and retired from the fire service in 2006 at the rank of Battalion Chief. For the past 10 years he has worked with Unified Investigations/ EFI Global as a Senior Investigator and Team Lead and currently holds the position of District Fire Science Principal for the Atlantic District. He has investigated over 1500 fires in his career and has extensive training in fire origin and cause determination, arson investigations, juvenile fire setters, as well as being a Certified Instructor for Emergency Response to W.M.D. / Terrorism Events and Clandestine Laboratory Identification for First Responders. Mr. Reilly also instructed fire investigation courses across the country periodically for the Public Agency Training Council. Mr. Reilly is a Certified Fire Investigator through the International Association of Arson Investigators and a Certified Fire Explosion Investigator and Certified Vehicle Fire Investigator through the National Association of Fire Investigators. Areas of investigation expertise include residential and commercial structure fires, commercial and personal vehicle fires, farm equipment fires and wildland fires.

Auto Insurance Premium Leakage – How to Detect and Deter

Personal-Lines auto insurers loose at least $29 billion a year in premium leakage. This workshop will provide a review of the evolution of premium leakage and the improvement of detection as well as forward looking trends with an emphasis on emerging technology and subject matter experts convergence, with the use of AI applications, red flag detection database engines and trending analytics.

Robert Pichler

Vice President, Operations, Technology Platforms - Fighting Fraud & Risk Monitoring Division

Robert Pichler is Vice President of Operations, a position he has held since 2009.

Mr. Pichler is responsible for the day-to-day operations, leading Service Delivery and Business Operational Excellence strategies with a best-in-class customer-centric approach. Adept at repositioning resources and leveraging technology; growing margins and revenue, and enhancing efficiencies in startup and high-growth organizations in challenging economic and political environments.

Prior to being named to this position, Mr. Pichler was Vice President of Sales and Marketing for the division. He began his career with the company in 2007.

Prior to joining CARCO, he held senior roles of increasing responsibility in Operations, Marketing, Sales, Underwriting, and Client Services for Cybersettle Inc. and Allstate Insurance. Mr. Pichler also held the role of Consultant for a privately held firm. He was responsible for the development, evaluation, and facilitation of organizational interventions on executive and organizational core competencies.

Mr. Pichler holds a Master of Arts degree in Industrial and Organizational Psychology from Hofstra University and a Bachelor of Arts in Sociology, with a minor in Business from Saint John's University.

John Butchko

Since September 2018, John has worked as a Senior Fraud Advisor for the CARCO Group, providing guidance and counsel on New Jersey Insurance fraud prevention, detection and deterrence issues.

On April 1, 2018, after 39 years of service, John retired from the State of New Jersey where he began his career with the Department of Banking and Insurance, becoming New Jersey’s first insurance fraud investigator appointed, when the Division of Insurance Fraud Prevention was established in 1983.             

Over the next fifteen years, John worked at the Division of Insurance Fraud Prevention serving as Investigator and Supervising Investigator before rising to the rank of Deputy Director in 1990. In 1998 the Division of Insurance Fraud Prevention and the Insurance Fraud Unit in the New Jersey Attorney General’s Office, Division of Criminal Justice, were merged into the newly established Office of the Insurance Fraud Prosecutor, under the authority of the New Jersey Attorney General.

John transferred to the new Office of the Insurance Fraud Prosecutor, where he served as a Special Assistant to the Prosecutor and Chief of the Liaison Section until 2010 when the Department of Banking and Insurance re-established a section to investigate insurance fraud, named the Bureau of Fraud Deterrence.

John returned to the Department of Banking and Insurance and on July 1, 2012, was appointed to the position of Chief of Investigations for the Bureau of Fraud Deterrence. In December 2016 John assumed the position of head of the Bureau and its staff of 90 Investigators, Managers, and support personnel.

John is a founding member of the New Jersey Special Investigators Association serving as its first President from 1989 – 1994 and as a member of the NJSIA Board of Directors until 2010. John was named a Life Member of NJSIA in 2012. Additionally, John was the recipient of the NJSIA Annual Achievement Award in 1993, 1995, and 1996 and the NJSIA President's Award in 2000, 2003 and 2016. John was re-elected to the NJSIA Board of Directors in January 2019.

In 2005, John received international recognition for his work in insurance fraud investigation, detection, and prosecution when he was presented with the International Association of Investigative Units Outstanding Service Award.


Automobile Finance Fraud – Automobile Straw Purchasing

The course is designed to demonstrate how auto finance fraud, used car dealer fraud, and automobile straw purchasing is the new face of auto theft.  This activity is often miscategorized by financial institutions and insurance companies as an identity theft or credit loss and is routinely considered by law enforcement as a civil matter.  The course will show clear examples of organized criminal activity, money laundering, and insurance fraud on a local, national and international scale.  The presentation will discuss many fraud related crimes with real examples from New Jersey cases involving vehicles, such as subleasing scams, title fraud, identity theft straw buyers and why they should be considered criminal offenses as opposed to civil matters.  The attendees will learn the essentials of automobile fraud/automobile loan fraud and the definition of straw buyer and the red flags when investigating these cases.  Sgt Pyrzanowski will discuss how to identify fraudulent documents such as fake pay stubs and terms used in investigating Loan Fraud with concentration on fraud in the loan application.  The course will show how loan fraud is often the foundation to insurance fraud and other financial crimes.

Jarek Pyrzanowski

Detective Sergeant Jarek Pyrzanowski has been a member of the New Jersey Division of Criminal Justice, Insurance Fraud Prosecutor’s Office since February 2000.  Prior to joining DCJ/OIFP, Sergeant Pyrzanowski worked in the Special Investigations Section of Liberty Mutual Insurance Company and as a Borough of Belmar Police Department patrol officer.  He is currently assigned to the New Jersey State Police, Auto Theft Task Force (ATTF), which is comprised of members of various law enforcement agencies tasked with investigating organized auto theft groups. Throughout his twenty-year law enforcement career, he has been assigned to various units that conduct complex investigations pertaining to automobile theft, financial crimes, criminal street gangs, drug trafficking and official misconduct.  Detective Sergeant Pyrzanowski possesses a Bachelor of Science degree in Criminal Justice from New Jersey City University.  Detective Sergeant Pyrzanowski is a certified technical investigator and has extensive knowledge of electronic surveillance techniques and tactics.  Detective Sergeant Pyrzanowski is also proficient in various cell phone forensics and vehicle infotainment extractions.   Detective Sergeant Pyrzanowski has extensive experience investigating techniques and practices utilized by individuals to commit auto theft, automobile fraud and insurance fraud.  Sergeant Pyrzanowski is the former President of the New Jersey Vehicle Theft Investigators Association and is currently on the board of directors of North East International Association of Auto Theft Investigators.  He regularly speaks at various Law Enforcement and industry seminars and is a frequent speaker at New Jersey Police Academies.

Cory Rodriguez

Detective Cory Rodriguez has been a member of the New Jersey State Police since 2007. He is currently assigned to the Interstate Theft North Unit, Auto Theft Task Force, in the Intelligence and Criminal Enterprise Section. Detective Rodriguez has experience investigating auto theft ranging from street-level auto theft to trans-national auto theft trafficking. He has been an affiant or co-affiant for two wire taps which resulted in the identification, apprehension, and prosecution of 60 targets for first degree Racketeering, Financial Facilitation, and other auto theft related offenses. Detective Rodriguez is an IAATI Level 1 and 2 Certified Investigator.   

Developments in Social Media and Cloud Data

Social media, connected device and cloud data remain valuable sources of potentially useful information in investigating claims.  What has changed over time are the means and methods used for obtaining such data.  Attend this session to learn about recent developments in obtaining, verifying and utilizing this data in making claim decisions and defending such decisions in litigation.

 Roy A. Mura, Esq

Roy Mura is the founder and managing member of the eight-lawyer firm Mura & Storm, PLLC, headquartered in Buffalo, New York. He is a 1986 law graduate of University of Buffalo School of Law and a 1983 linguistics degree graduate of SUNY at Binghamton. The author of the widely read and award-winning Coverage Counsel blog (nycoveragecounsel.blogspot.com), Mr. Mura’s practice includes insurance coverage analysis and litigation, first-party property, third-party liability, auto/UM/UIM, no-fault, fraud and arson defense work for numerous property and casualty insurers on a state-wide and regional basis. He has successfully litigated and tried numerous insurance fraud and coverage cases for insurers through trial and appeal in New York and writes and speaks regularly for insurers and adjusters nationwide on various issues relating to insurance coverage, fraud, social media research for claims and underwriting investigations, “bad faith” and the defense of first- and third-party claims. He is a member of and proudly serves as General Counsel to the New York State Chapter of the International Association of Special Investigation Units. He is also a member of the International Association of Arson Investigators, New York State Fire Investigators State Chapter No. 23, Defense Research Institute, several local claims associations and the New York State and Erie County bar associations. He has been listed in the New York Super Lawyers – Upstate Edition since 2012, and maintains the highest possible AV rating with Martindale-Hubbell. He is married, has three children, four grandchildren, and all but gave up golf several years ago to pursue his avocation for all-season fresh water fishing.

Fighting Mills Through Fighting Bills 

This presentation addresses various techniques to combat questionable billing from questionable treatment in third party matters.

  Ashley R. Lynam

Ashley R. Lynam is an experienced trial attorney with the special investigations team, defending the firm’s clients in an array of personal injury, premises liability, and property damage matters. After beginning her legal career in the Philadelphia District Attorney’s Office, Ashley brought her trial advocacy skills to Bennett Bricklin & Saltzburg, where she has successfully defended numerous jury trials in Philadelphia and its surrounding counties. Ashley also routinely speaks on issues relating to insurance litigation, regulation, coverage, and fraud, including monitoring the legal landscape for the most up-to-date developments. Ashley was named a Super Lawyer’s Rising Star in Pennsylvania in 2017 and 2018.

Ashley graduated summa cum laude from Villanova University in 2008 with a B.A. in Business Management. At Villanova University, she was the president of the nationally ranked mock trial team, a writer for The Villanovan and vice-president of the Villanova Ethics Society. Ashley was also a member of the Phi Kappa Phi National Honor Society, the Sigma Alpha Phi Honors Society, the National Scholars Honor Society and the National Society of Collegiate Scholars.

A proud “Super-Nova”, Ashley graduated from Villanova University’s School of Law where she was an executive member of the Moot Court Board and member of the Trial Advocacy Club. While in law school, she clerked for the Honorable Rayford Allen Means of the Philadelphia Court of Common Pleas and was a certified legal intern for the Chester County District Attorney’s Office.

After law school, Ashley worked at the Philadelphia District Attorney’s Office, primarily in the Family Violence & Sexual Assault Unit where she prosecuted felony-level rape, domestic violence and child physical and sexual abuse cases. She specialized in the prosecution of human trafficking cases, conducting proactive investigations into the trafficking and sexual exploitation of children while collaborating with local, state and federal agencies and coalitions. She received a certification in human trafficking training and was the keynote speaker at several events, including the Philadelphia Safety Summit for Women and Children and the Federal Women’s Program hosted by the Environmental Protection Agency. Ashley was assigned to the Major Trials Unit, where she was responsible for prosecuting non-fatal shootings, gun-point robberies and attempted murder cases. She has also handled investigations and prosecutions arising out of the Philadelphia Indicting Grand Jury with a focus on cases involving victim or witness intimidation.

Ashley is a board member of Villanova Law’s Alumni Association, an advisory board member of The Salvation Army of Greater Philadelphia, and an executive board member of Villanova Law’s Institute to Address Commercial Sexual Exploitation. A Philadelphia native and die-hard Villanova basketball fan, Ashley currently lives in Wayne with her husband, Shane, their daughters, Lilly and Violet, and their beloved dog, Dominic.

Michael Benjamin Gerstein

Michael Benjamin Gerstein is a member in the Philadelphia office of Bennett, Bricklin & Saltzburg LLC defending the firm's clients in a variety of personal injury, property damage and premises liability cases. He is a member of the Pennsylvania Bar and New Jersey Bar. Michael is an active trial attorney, having defended numerous jury trials in venues across the region including Philadelphia, Montgomery County, Bucks County and Delaware County.

Michael obtained his B.A. from Drexel University in 2004, graduating magna cum laude. While at Drexel, Michael studied history and political science and was awarded most distinguished seminar research paper by faculty. Michael spent his junior year abroad at the London School of Economics, achieving honors in the General Course program. After graduation, Michael managed a small legal services business in Philadelphia. He then attended Villanova University’s Charles Widger School of Law, graduating in 2009.

In the summer of 2008, and throughout his third year of law school, Michael clerked for the firm. During law school, he was an Executive Board member of the Villanova Law Moot Court Board, externed for the Honorable Mark I. Bernstein in the Philadelphia Court of Common Pleas of Pennsylvania, served as a teaching assistant and worked as a certified student attorney in the Villanova Civil Justice Clinic.

When he is not in the office, Michael enjoys spending time with his family and friends, reading, cycling and golfing.

Investigating Slip & Falls

This is a one-hour course that will introduce human factors terminology and human factors concepts such as the built environment; coefficient of friction; cognitive reaction time; expectation; line of sight; gait patterns; and reasonable care to name a few.  This course will discuss how human factors concepts can be used in the evaluation of personal injury events on walking surfaces, working surfaces, motor vehicle accidents, and a variety of other engineering investigations.

Jody DeMarco, P.E.

Engineering Manager

Forensic Consultants of North America

Jul 2010 – Present9 years 3 months

Mount Laurel, New Jersey

More than twenty-five years of civil and structural engineering experience, encompassing commercial and residential design and construction, roadway/highway design and construction, bridge design and construction, and site/civil design, forensic investigations, litigation support and expert testimony.

More than twenty-five years of civil and structural engineering experience, encompassing commercial and residential design and construction, roadway/highway design and construction, bridge design and construction, and site/civil design, forensic investigations, litigation support and expert testimony.

Keys, Fobs and Other Auto Theft Technology

This workshop will discuss the latest auto theft techniques, newest electronic and mechanical keys. 

Glenn Hennings is employed by Sterling Investigations.  He is retired from active law enforcement after 32 years.  Glenn is a state licensed locksmith with certifications in forensics, fire investigation and other areas.  Glenn can be contacted at: 908-576-8830 or ghennings@apgsecurity.com.


Legal Update:  Ownership Schemes and Self-Referrals

                     

Self-referral schemes continue to plague the auto insurance market in New Jersey.  This session reviews the basics of the Codey Act and discusses the amendments broadening the exceptions applicable to procedures at ambulatory surgical centers and to intra-operative monitoring.  The session then reviews the recent statutory amendment requiring full licensure for one-room surgical practices.  The session then explores how these laws apply to two common situations: referrals by interventional pain physicians to self-owned anesthesia practices to provide anesthesia during procedures; and referrals by spinal surgeons to self-owned intra-operative monitoring entities.  CLE approval is pending with the Board of Continuing Legal Education.

John Kennedy, Esq.

John Kennedy is an attorney with considerable expertise in combating insurance fraud, having spent over 10 years heading the Office of the Insurance Fraud Prosecutor’s civil and criminal enforcement efforts.  Mr. Kennedy is now in private practice where he uses his knowledge and expertise to help insurance companies recoup money lost to insurance fraud.

Before leaving OIFP, Mr. Kennedy was second-in-command of an office with a staff of 120, and a case list averaging several hundred active criminal and civil cases.  Simultaneously, Mr. Kennedy was lead prosecutor in some of the office’s most significant prosecutions, securing state prison sentences for, among others, doctors who accepted cash kickbacks for patient referrals, and an insurance producer who stole nearly $2 million from his clients.

Mr. Kennedy has prosecuted a wide range of white-collar crimes, including insurance frauds of all kinds, environmental crimes and tax frauds.  Mr. Kennedy is also an accomplished appellate advocate, having argued three cases before the New Jersey Supreme Court and dozens before the Appellate Division.

Mr. Kennedy received his J.D. from New York University School of Law, and his bachelor’s degree from Saint Peter’s College.   

New Jersey Auto Theft - Current Trends and Investigations

The audience will learn about the motivating factors for auto theft and the current auto theft trends in New Jersey.  This class focuses on luxury motor vehicle theft trends and the use of these stolen vehicles in other crimes.  We will also discuss other theft trends investigated by the New Jersey State Police Auto Theft Task Force.

Cory Rodriguez

Detective Cory Rodriguez has been a member of the New Jersey State Police since 2007. He is currently assigned to the Interstate Theft North Unit, Auto Theft Task Force, in the Intelligence and Criminal Enterprise Section. Detective Rodriguez has experience investigating auto theft ranging from street-level auto theft to trans-national auto theft trafficking. He has been an affiant or co-affiant for two wire taps which resulted in the identification, apprehension, and prosecution of 60 targets for first degree Racketeering, Financial Facilitation, and other auto theft related offenses. Detective Rodriguez is an IAATI Level 1 and 2 Certified Investigator.

Jarek Pyrzanowski

Detective Sergeant Jarek Pyrzanowski has been a member of the New Jersey Division of Criminal Justice, Insurance Fraud Prosecutor’s Office since February 2000.  Prior to joining DCJ/OIFP, Sergeant Pyrzanowski worked in the Special Investigations Section of Liberty Mutual Insurance Company and as a Borough of Belmar Police Department patrol officer.  He is currently assigned to the New Jersey State Police, Auto Theft Task Force (ATTF), which is comprised of members of various law enforcement agencies tasked with investigating organized auto theft groups. Throughout his twenty-year law enforcement career, he has been assigned to various units that conduct complex investigations pertaining to automobile theft, financial crimes, criminal street gangs, drug trafficking and official misconduct.  Detective Sergeant Pyrzanowski possesses a Bachelor of Science degree in Criminal Justice from New Jersey City University.  Detective Sergeant Pyrzanowski is a certified technical investigator and has extensive knowledge of electronic surveillance techniques and tactics.  Detective Sergeant Pyrzanowski is also proficient in various cell phone forensics and vehicle infotainment extractions.   Detective Sergeant Pyrzanowski has extensive experience investigating techniques and practices utilized by individuals to commit auto theft, automobile fraud and insurance fraud.  Sergeant Pyrzanowski is the former President of the New Jersey Vehicle Theft Investigators Association and is currently on the board of directors of North East International Association of Auto Theft Investigators.  He regularly speaks at various Law Enforcement and industry seminars and is a frequent speaker at New Jersey Police Academies.  

New Techniques – Old Fraud …

Staying one step ahead of fraudulent contractors

In this session, participants will learn about how intentional damage doesn’t just mean hitting roofing/siding to create ‘hail’ impacts.  The presentation will take the audience through an SIU investigation involving intentional “wind” damage including the value of engineers, contractors, surveillance and neighborhood canvases in developing evidence of fraud.   We will also discuss among other topics: the unorthodox contracts/ assignments used by questionable contractors and how those contracts differ from traditional construction contracts; and issues posed by reliance on on-line weather records.

James H. Cole, Esq.                               

jhcole@mdwcg.com

James focuses his practice on the investigation and litigation of Special Investigative Unit and Property Damage claims, including arson, burglaries, public adjuster represented claims, mold/ pollution and automobile thefts. Within his areas of practice, he is experienced in the bad faith and coverage issues inherent in first party/SIU investigations and litigation. Throughout his career, James has assisted with hundreds of SIU investigations; litigated hundreds of first party property lawsuits; and consulted on hundreds of property coverage issues.

James is frequently asked by clients and industry organizations to lecture on a variety of topics concerning property damage, insurance fraud and bad faith. For the past five years, he has been a featured speaker at the annual Pennsylvania Insurance Fraud conferences, and he has spoken several times at PLRB conferences, among others. An active member of the Claims & Litigation Management Alliance (CLM), James sits on the Executive Council for the CLM's Claims College, School of Property, where he has helped to develop curriculum surrounding good faith claims handling and insurance coverage topics.

James is a 1990 graduate of the Indiana University of Pennsylvania. Immediately following graduation, he worked as a claims representative with a large insurance carrier, where for eight years he was involved in the investigation and resolution of property and casualty claims. In 1995, he entered Temple University School of Law while continuing to work full time. James graduated from Temple University in 1999 with a degree of juris doctor. Thereafter, he joined Marshall Dennehey and is currently chair of the firm's SIU Litigation and Property Litigation Practice Groups.   His first hand property background, insurance industry knowledge and familiarity with property policies allows him to effectively,  efficiently and practically counsel clients on Property and SIU issues, and when necessary provide a vigorous and common sense defense tailored to the needs of a particular carrier.

NJ Legal Update and the Impact on Insurance Fraud Including Boardable Medicals 

This breakout session will focus on trends in New Jersey on both the legislative front and recent cases that will impact the Insurance Industry.  Stephen and Matt will focus on how these trends will have an impact on insurance fraud in New Jersey.  For example, the impact of recent Bills such as Senate Bill 2432.  This Bill now allows a claimant that has PIP limits lower than $250,000 (and perhaps as low as $15,000) to seek compensation for medical expenses above and beyond their PIP limits.  We will also analyze the “Bad Faith Bill” that is still pending, as well as all other recent case law that can impact insurance fraud.

Stephen Katzman

Loyola University School of Law, J.D. 1981
Boston University, B.A. cum laude, 1978

Stephen began his career as an Assistant District Attorney in New Orleans, Louisiana,

eventually becoming the Division Chief supervising approximately 30 attorneys. He also served as the homicide and sex crimes trial prosecutor.

In 1985 he was admitted to the bar in New Jersey and the U.S District Court for the District of New Jersey. Upon moving to New Jersey he joined Methfessel & Werbel, where he served as an insurance defense trial attorney specializing in fraud, defamation defense, property damage, subrogation, coverage and negligence actions. In 1989 he was admitted to practice before the U.S. Court of Appeals for the Third Circuit.

Stephen left M&W in 1989 to form the law firm of Maloney and Katzman, which then became the Law Office of Stephen R. Katzman, where he handled over 1500 property damage, fraud, fire, coverage, defamation defense, subrogation, products liability and bodily injury files over a period of 13 years. He rejoined M&W in 2002 as a member of the first-party/property team.  He and his team specialize in insurance fraud, defamation defense and insurance coverage matters.

Matthew Werbel

Tulane University School of Law, J.D. 1998
Franklin & Marshall College, B.A. 1994

Mr. Werbel joined the firm following a successful clerkship with the Honorable Edward W. Beglin, Jr., Assignment Judge of the Superior Court in Union County. At Tulane he specialized in environmental litigation and regulatory actions, receiving a certification in Environmental Law as well as a J.D.

Mr. Werbel presently represents insurance carriers, insureds, and self-insureds in the investigation and defense of both first and third-party claims.

Mr. Werbel handles cases in many areas, including environmental, fraud, first and third party coverage, inland marine, liability, and subrogation. Additionally, Mr. Werbel has successfully argued several cases before the Appellate Division including several that were approved for publication. Mr. Werbel also handles substantial subrogation claims including the early investigation of those claims.

Mr. Werbel has also presented many seminars on topics such as Mold, Bad Faith, Insurance Fraud, Unfair Claims & Settlement Practices Act, Staged First Party Claims, Additional Insured and Indemnification Claims, Collapse Claims, and Duty to Defend Negligent and Intentional Torts.

On Scene Crash Investigation for the Insurance Investigator              

This course provides a breakdown of the crash investigation from the police response through the special investigators follow up.

Chris Jacksic, West Orange Police Department

Chris Jacksic is a 25-year law enforcement veteran, with a current assignment in the West Orange Police Department, Traffic Bureau conducting fatal and near fatal crash investigations/reconstructions. He has extensive training in crash reconstruction along with additional training in pedestrian/bicycle, motorcycle and commercial vehicle crashes.

Paul Nigro, Claims Investigator Travelers Insurance

Paul Nigro is currently employed an Investigator with Travelers Insurance, he retired as at the rank of Captain with Denville Police and was previously employed as an SIU Investigator with Hertz Claims management, Computer Science Corp. (1991 – 1993) and Claims Examiner Auto Blend Unit Computer Science Corp.

P.E.A.C.E. in America ! –

A Different Approach to Investigative Interviewing

This course is designed for insurance fraud investigators, licensed adjusters, case managers, and claims professionals whose duties require them to conduct any interviews of insureds, claimants and witnesses involved in incidents resulting in the submission of an insurance claim.

Learning Objectives:  Upon completion of this course, the participants will be able to:

  • To provide the delegates with the understanding of how to professionally plan, conduct, and evaluate investigative interviews with witnesses and subjects.
  • Describe how to make investigative decisions and record the rationale
  • Understand the PEACE interview framework and its principles
  • Understand how an investigative interview is conducted
  • Understand the Cognitive Interview Model
  • Understand the Conversation Management Model

JONATHAN DAVISON

Solutions FIS® Jonathan co-ordinates a collaborative team of international an international reputation delivering scenario-based training courses, consultancy, and solutions to public and private sector organizations across the world.

Forensic Interview Solutions FIS® was founded by Jonathan in 2008 after leaving the Greater Manchester Police in the United Kingdom.

Jonathan had over 12 years Investigation and Interview experience as a Detective and in his last role with Greater Manchester Police, Jonathan was an Advanced Specialist Tier 3 Interviewer and a Qualified Trainer in the field of Investigative Interviewing.

To be eligible for this role as a Trainer the essential skills required included being a Tier 3 Specialist. In Greater Manchester Police, a Police Force with over 8000 officers, there are approximately 100 Specialists, which gives you an idea of Jonathan´s skills as an investigator and interviewer.

The role of a Tier 3 involves the ability to communicate and investigate to the highest level.

Once a qualified Trainer in Greater Manchester Police, Jonathan became 1 of 8 trainers delivering interview training to the entire force of over 8000 officers in state of the art facilities.

Since leaving the Police, Jonathan had a vision to create a team specializing in P.E.A.C.E. investigative interviewing and FIS® has developed an international reputation and footprint delivering scenario-based training courses to organizations worldwide.

As President and CEO Jonathan has developed this footprint to become the leading provider and preferred supplier of ethical investigative interviewing in the marketplace and has moved to the United States to continue this vision.

PEACE- Practical Takeaways 'Right question, Right Place, Right Time and Notetaker’

This is an interactive practical session which will hopefully assist how you gather information during your interviews which will ultimately lead to more complete, accurate, reliable information.

The object of questioning is to discover the truth about the matter under investigation, to obtain information. A knowledge of questioning technique is a necessity for effective interviewing. In this session we will look at the science behind questioning and how that impacts your interviews.

Questioning also has a direct impact on how you record information gathered during an interview. The 2nd part of the session will outline the Notetaker methodology which will assist you capture key information.

Notetaker

Notetaker system has been developed, after extensive and on-going research to improve the quality of the gathering of information and subsequent analysis by providing a system to help investigators:

Plan and prepare for interviews and gathering information;

Take notes during interviews;

Summarize the information from interviews and other sources; and

Evaluate the quality of the interviews and sources of information.

As the President and experts specializing in P.E.A.C.E. investigative interviewing who have developed CEO of Forensic Interview

JONATHAN DAVISON

Solutions FIS® Jonathan co-ordinates a collaborative team of international an international reputation delivering scenario-based training courses, consultancy, and solutions to public and private sector organizations across the world.

Forensic Interview Solutions FIS® was founded by Jonathan in 2008 after leaving the Greater Manchester Police in the United Kingdom.

Jonathan had over 12 years Investigation and Interview experience as a Detective and in his last role with Greater Manchester Police, Jonathan was an Advanced Specialist Tier 3 Interviewer and a Qualified Trainer in the field of Investigative Interviewing.

To be eligible for this role as a Trainer the essential skills required included being a Tier 3 Specialist. In Greater Manchester Police, a Police Force with over 8000 officers, there are approximately 100 Specialists, which gives you an idea of Jonathan´s skills as an investigator and interviewer.

The role of a Tier 3 involves the ability to communicate and investigate to the highest level.

Once a qualified Trainer in Greater Manchester Police, Jonathan became 1 of 8 trainers delivering interview training to the entire force of over 8000 officers in state of the art facilities.

Since leaving the Police, Jonathan had a vision to create a team specializing in P.E.A.C.E. investigative interviewing and FIS® has developed an international reputation and footprint delivering scenario-based training courses to organizations worldwide.

As President and CEO Jonathan has developed this footprint to become the leading provider and preferred supplier of ethical investigative interviewing in the marketplace and has moved to the United States to continue this vision.

PIP Investigations:  A Look Back and a Look Forward

Kenneth E. Pringle was admitted to the New Jersey and District of Columbia bars in 1983.  He graduated summa cum laude from Mount Saint Mary’s College and cum laude from Georgetown University Law Center, where he was a member of the editorial board of the Georgetown Law Journal.  He served as law clerk to the Honorable Clement F. Haynsworth, Jr., Senior Circuit Judge of the United States Court of Appeals for the Fourth Circuit.  He has been associated with the Washington, D.C. law firms of Hogan & Hartson and Ross, Dixon & Masback. 

Mr. Pringle has extensive experience in a broad range of insurance defense and coverage areas on behalf of numerous U.S. insurance companies, including the CNA Insurance Companies, Harbor Insurance Company, Chubb Insurance Company, the Allstate Insurance Company, the Prudential Property and Casualty Insurance Company, Liberty Mutual Insurance Company, Selective Insurance Company and AMICA Mutual Insurance Company.  Mr. Pringle represents the Special Investigation Units of Allstate, Prudential, Liberty Mutual, CNA, Colonial Penn Insurance Company, Bayside Insurance Company, Selective Insurance Company, AAA/Midlantic (Keystone) and USAA Casualty and Insurance Company, and has represented a number of non-marine syndicates at Lloyd’s, London in connection with insurance fraud matters ranging from fraudulent property and personal injury losses to staged deaths and accidents, to healthcare fraud.  Mr. Pringle has brought suit on behalf of his clients in New Jersey against numerous healthcare providers alleging violations of the NJ Insurance Fraud Prevention Act and the Racketeer- Influenced and Corrupt Organizations Act.  In addition, he has litigated in the state and federal courts in numerous liability areas, including employment law, comprehensive general liability, automobile liability, directors’ and officers’ liability, public officials’ liability and board of education liability.  Mr. Pringle serves as general counsel to the New Jersey Special Investigators Association, Inc.

Mr. Pringle is a past member of the Board of Trustees of Mount Saint Mary’s College, Emmitsburg, MD, and is a member of the Summit Bank Advisory Council, and has served as Mayor of the Borough of Belmar since 1990.  

Ben Hickey

Ben Hickey is one of two insurance fraud analysts for Allstate New Jersey Property and Casualty Insurance Company (ANJ). He has been employed by Allstate since 1983 and was a founding member of Allstate’s SIU in 1990. He is a graduate of Rutgers, the State University of New Jersey. He shares responsibility for Allstate New Jersey’s insurance fraud analytics, as well as for overseeing ANJ SIU litigation wherein Allstate is the plaintiff. During the time Ben has been an SIU analyst, ANJ has filed 81 separate insurance fraud lawsuits in the Garden State. Ben also acts as a liaison for ANJ to the law enforcement community and he has provided training seminars on insurance fraud issues and ongoing complex insurance fraud investigations. He has won several Allstate and industry awards, including the NJSIA Investigator of the Year Award in 2004 and shared in the NJSIA Investigation of the Year Awards in 2007, 2012 and 2014. Ben rides an old BMW K100 and is grandpa to Lucy, Alexis, Colin, Xavier and Oliver.

Lori Smith

Lori Smith is President/CEO and the owner of Pattern Analysis, Inc., a litigation support company that provides law firms, insurers, and law enforcement agencies with data analysis and expert witness reports and testimony aimed at identifying and proving patterns of medical provider fraud and abuse.  In addition to managing the expert witness services offered by Pattern, Lori also serves as a Rule 1006 summary witness, and provides data analysis, summary reports, exhibits and testimony, for a variety of complex litigation matters.  Lori graduated summa cum laude from Rutgers Law School and is licensed to practice law in NJ and NY. She also holds an MBA from Rowan University and is a Certified Fraud Examiner (CFE) and a Fraud Claims Law Specialist (FCLS). With more than 20 years’ experience, Lori’s unique combination of medical, legal, analytical, and technical knowledge enables her to offer comprehensive and innovative techniques and solutions to successfully help her clients in their fight against healthcare fraud.

So You’re about to Be Deposed (or Violently Overthrown): How Should You Prepare & What Should You Expect?

The claims professional and special investigator have done great work in investigating the reported loss and resulting claim.  Your investigation fully supports your company’s claim decision, but now the claim has gone into suit and you are about to be deposed.  How should you prepare and what should you expect?  Attend this session and avoid undermining your company’s defense by inadequately preparing for or imprecisely testifying during your deposition.

Roy A. Mura, Esq

Roy Mura is the founder and managing member of the eight-lawyer firm Mura & Storm, PLLC, headquartered in Buffalo, New York. He is a 1986 law graduate of University of Buffalo School of Law and a 1983 linguistics degree graduate of SUNY at Binghamton. The author of the widely read and award-winning Coverage Counsel blog (nycoveragecounsel.blogspot.com), Mr. Mura’s practice includes insurance coverage analysis and litigation, first-party property, third-party liability, auto/UM/UIM, no-fault, fraud and arson defense work for numerous property and casualty insurers on a state-wide and regional basis. He has successfully litigated and tried numerous insurance fraud and coverage cases for insurers through trial and appeal in New York and writes and speaks regularly for insurers and adjusters nationwide on various issues relating to insurance coverage, fraud, social media research for claims and underwriting investigations, “bad faith” and the defense of first- and third-party claims. He is a member of and proudly serves as General Counsel to the New York State Chapter of the International Association of Special Investigation Units. He is also a member of the International Association of Arson Investigators, New York State Fire Investigators State Chapter No. 23, Defense Research Institute, several local claims associations and the New York State and Erie County bar associations. He has been listed in the New York Super Lawyers – Upstate Edition since 2012, and maintains the highest possible AV rating with Martindale-Hubbell. He is married, has three children, four grandchildren, and all but gave up golf several years ago to pursue his avocation for all-season fresh water fishing.

The Data You Didn’t Know Your Cellphone and Vehicle are Storing About You

There is a vast amount of data that can be retrieved from your cellphone, as well as your vehicle’s infotainment system, such as whether you connected your cellphone to your vehicle and when, call and missed call logs, contact lists, time- and geo-stamped odometer readings, navigation history, whether your vehicle’s lights were on, and even when a vehicle’s door was opened or closed.  This data can change the playing field and help solve many questionable and fraudulent claims.

Data from infotainment downloads has been successfully used to prove an owner wrecked his vehicle when he alleged it was stolen, a vehicle was used for work when it was registered under a personal policy, and a vehicle was involved in a hit-and-run when the driver left the scene.

Learn more about this latest technology from leading expert, Dr. Dan Wolfe, and how it can be leveraged to determine the validity of suspicious claims..

DANIEL M. WOLFE, PH.D., ACTAR

2288 Second Street Pike | Penns Park, PA 18943 | 215-598-9750 | dwolfe@arcca.com

Dr. Wolfe is a forensic scientist and accident reconstructionist specializing in the reconstruction of motor vehicle, pedestrian, and bicycle collisions. He specializes in collisions involving nighttime recognition and conspicuity issues, including headlight mapping of vehicles, illumination from roadway lighting, and nighttime photography. He is certified as a BOSCH Crash Data Retrieval (CDR) technician, and is experienced in documenting evidence utilizing three-dimensional laser scanning. He is also accredited as a Traffic Accident Reconstructionist by the Accreditation Committee for Traffic Accident Reconstruction (ACTAR #3532).

The Investigative Process-

From Claim Submission to Referral to Law Enforcement

The course will take the audience on an investigative journey, beginning with the process of a claim once submitted to the Insurance Company; followed by Special Investigations review, the actions they take, the negotiation process and finally the referral to Law Enforcement. The audience will also hear a couple case examples and current schemes that illustrate the Investigative Process in its totality.

Lorraine Buckman, AHFI

Lead Investigator, Horizon-BCBSNJ Special Investigations Unit

Joined Horizon-BCBSNJ as a Senior Investigator in 2005.

34 years of Insurance experience with 27 years specific to Healthcare Fraud Investigations.

Prior to coming to work for Horizon-BCBSNJ worked as a Senior Investigator for Aetna Inc. and the former Prudential Healthcare between 1985 to 2005

Accredited Health Care Fraud Investigator 2004.

 James Howell

James Howell is a Supervisor, Investigations at Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) whose responsibilities include preventing and detecting suspected fraudulent activity. James manages a group of senior and junior level investigators tasked with developing fraud cases against providers, small group employers, and subscribers. James joined Horizon BCBSNJ as a junior level Investigator in 2005. Since that time, he has been promoted to a Senior Investigator, Lead Investigator and more recently to his current position as Supervisor, Investigations. Prior to joining Horizon BCBSNJ, James has held several positions within the healthcare insurance industry, including Customer Service Representative, Claim Examiner, Claim Resolution Analyst, and Investigator. Notable are his 26 years in the healthcare insurance industry at companies such as Prudential, Cigna Healthcare, AIG, CareFirst Blue Cross Blue Shield, and Horizon BCBSNJ. James has dedicated 15 of those years to the discovery and recovery of fraudulent dollars within various Special Investigation Units. James also has a BA in Corporate Communication and Business Administration from The College of St. Elizabeth.

The Medical Investigators Guide to the Modern SIU Claim

Part 1 and Part 2                                                                                                                                                  

These sessions serves as a contemporary update to how medical investigations should be conducted start to finish.

We will examine claims from beginning to end focusing on the coverage aspect of underwriting, application, residency issues as well as misrepresentation within the presentation of the claim.

Next, we will explore contemporary and complex medical trends including but not limited to pain management, controlled substances and usual suspect arbitration medical issues.

Finally, the presentation will conclude with a brief update of cases impacting our industry and recommendations for best practices.

Jeffrey G. Rapattoni joined MDWC&G in 2008 and is a Shareholder with the firm’s SIU Department.  Jeffrey focuses his practice on insurance fraud, bad faith and SIU related matters.  Jeffrey litigates insurance fraud and fraud-related matters throughout the state of New Jersey and has coordinated complex litigation strategy and fraud related investigations in various other states. He has extensive training and background in provider-based investigations, underwriting fraud, policy voidance, and staged accidents. Other practice areas include large loss property claims, coverage, general civil litigation, and appellate practice. He also has significant experience in large settlement negotiation, mediation, and arbitration.  As part of his practice, Jeffrey has worked with experts in the fields of cause and origin and bad faith as well as local and Federal authorities.

Jeffrey is frequently asked to lecture on a variety of insurance topics including insurance fraud and bad faith. He is a regular presenter for and on behalf of several local and national insurance organizations. He also provides legal education seminars for various clients and organizations across the country.

After graduating with a BA Degree from Villanova University in 1997, Jeffrey served as a Legislative Correspondent for United States Senator Arlen Specter in Philadelphia and Washington D.C., where he assisted in drafting legislation and conducted legal investigations. While attending Rutgers Law School, he served as a judicial extern to the Honorable Judge John A. Almeida, J.S.C. Burlington County-Civil Division, where he drafted various tentative dispositions of the Court and assisted in court-ordered mediation sessions.

Ariel Brownstein

Ariel, a shareholder in the Casualty Department, focuses his practice on insurance fraud and Special Investigation Unit (SIU) litigation with particular emphasis on large loss fraud and medical provider fraud. His practice in the area of fraud investigation consists of assessing and analyzing fraud by both medical providers and falsified claims brought by his client's insureds. In doing so, Ariel has represented a significant number of insurance carriers on these issues and has assisted in multi-million dollar high-profile medical provider fraud investigations and law suits in various states.

Moreover, Ariel has litigated on behalf of many different clients in favor of protecting the interests of insurance carriers in court seeking to disclaim coverage for fraudulent claims. He has taken numerous comprehensive Examinations Under Oath on SIU-related issues throughout New Jersey and Pennsylvania. In particular, he has assisted in several high-value and high-profile matters regarding carrier recovery of monies paid to fraudulent medical providers and fraudulent motor vehicle accidents. Furthermore, Ariel has litigated extensive insurance fraud and other personal injury protection related matters in the National Arbitration Forum (NAF)/Forthright and Superior Court for his clients.

During his career, Ariel has handled several high value cases on behalf of his clients. In one particular case, the amount sought by the Claimant was denied by the arbitrator due material misrepresentations made by the insured regarding his prior medical history and his injuries at the time of the subject loss during an Examination Under Oath, conducted by Ariel.  In another matter, Ariel successfully argued that a claimant was subject to a personal injury protection benefit limit selected by the named insured, a live-in boyfriend and the amount demanded, was denied.

Prior to joining the firm, Ariel served as a law clerk for the Honorable Richard Geiger in Cumberland County Superior Court. His responsibilities included researching criminal law precedence, reviewing memoranda and pre-trial motions, and mediating civil lawsuits.

Matthew J. Burdalski

Matt is an associate in the firm's Fraud/Special Investigation Practice Group where he focuses primarily on large loss fraud and medical provider fraud. His practice in the area of fraud investigation involves the assessment and evaluation of both medical provider fraud and fraudulent claims on the part of his clients' insureds. Matt also has experience dealing with insurance coverage disputes, representing numerous insurance carriers across multiple states for the purposes of SIU investigation, bad faith litigation and general defense litigation. In doing so, Matt has represented a significant number of insurance carriers on these issues and has assisted in high-dollar and high-profile medical provider fraud, property loss and insurance fraud matters.

During his time with the firm, Matt has taken numerous Examinations Under Oath, drafted various complex coverage opinions and litigated topics of insurance fraud including, but not limited to, medical provider fraud, large loss property investigations and bad faith. In particular, he has assisted in multiple high-profile matters regarding carrier recovery of monies paid to fraudulent medical providers and as a result of fraudulent motor vehicle accidents. He has also successfully represented his clients in matters involving policy coverage and eligibility for benefits.

Matt earned his undergraduate degree from West Chester University and went on to receive his juris doctor from Widener University, in Wilmington, Delaware, graduating cum laude and with pro bono distinction. As a law student, he took part in Widener's Environmental Law Clinic, working with clients in all aspects of complex environmental litigation, and was the recipient of the Greenwatch Award for excellence in environmental law.

Prior to joining the firm, Matt represented insurance carriers and employers in the field of workers' compensation defense litigation where he handled matters in both Pennsylvania and New Jersey. 

Tools, Fools, Cruel Rescissions and Other Cool Seminar Topics

This workshop is broken into three parts:  1) a review of online tools for SIU attorney's and investigators coupled with a discussion of emerging PIP issues (with boardable medicals);  2) rescission update in auto matters- exploring the unsettled issues; and 3) a BRIEF, layman's, pysch 101 lesson for SIU practitioners.

Gregory E. Peterson

Mr. Peterson is a partner and founding member of Dyer & Peterson. Before starting his own practice, Mr. Peterson was of counsel to the Connell Foley firm and was involved in a wide array of litigation cases, including complex commercial, breach of contract, insurance defense (including Personal Injury Protection/Forthright matters), personal injury, products liability, construction and professional liability matters.

His insurance practice focuses on all aspects of litigation and specializes in large exposure first party and fraud matters.

Early in his career, Mr. Peterson tried the matter of Bowe v. New Jersey Mfrs. Ins. Co., 367 N.J.Super 128 (App.Div.2004) and secured a successful verdict based upon a ground breaking causation theory in No Fault litigation.  In a published opinion, the Appellate Division affirmed Mr. Peterson’s defense theory, utilizing his cross-examination of plaintiff’s expert as the basis for its holding. Bowe remains the seminal case regarding causation in PIP matters and has been cited more than 7,600 times in PIP arbitration decisions.

In 2010, Mr. Peterson gained another successful outcome in Haywood v. Harris , 414 N.J. Super. 204 (App.Div.2010).  There, the Appellate panel affirmed the trial court’s revision of a jury verdict for economic loss based upon Mr. Peterson’s post-trial application. In upholding his position, the Appellate Court recommended a modification to the Model Jury Charge and verdict sheets used in Limitation on Lawsuit matters to accommodate defendant’s position, as advocated by Mr. Peterson.

In 2019, Mr. Peterson secured a groundbreaking decision in favor of automobile insurers regarding ambulatory surgery center claims in New Jersey Manufacturers Insurance Company v. Specialty Surgical Center of North Brunswick a/s/o Claire Fiore and New Jersey Manufacturers Insurance Company v. Surgicare Surgical Associates of Fair Lawn a/s/o Martino Chizzoniti, 485 N.J.Super. 63 (App.Div.2019).  The Court found that insurers would not be liable on exorbitant hosting fees for high-value spine surgery codes where CPT codes had no value listed in the ASC column of the fee schedule.  This precedent has saved insurers millions of dollars in “usual, customary and reasonable” fee exposure.

Mr. Peterson spearheads fraud investigations and has pursued numerous litigations under Jersey’s Insurance Fraud Prevention Act.   Working collaboratively with his clients, Mr. Peterson devises novel approaches to reducing his client’s exposure on false claims. 

Mr. Peterson has been named by New Jersey Monthly magazine and New Jersey Super Lawyers “Rising Star” for  2006-2007, 2009-2011, 2013, 2014 and 2015.  Mr. Peterson has been selected as 2019 New Jersey Super Lawyer.

Mr. Peterson earned his B.A. degree from the University of Notre Dame and his J.D. degree from Boston University School of Law. He is admitted to practice in New Jersey, New York, Pennsylvania, the District of Columbia, the U.S. District Court for the District of New Jersey, the U.S. Court of Appeals for the Third Circuit and the United States Supreme Court.

Underwriting Fraud; Point-of-Claim, Point-of-Sale and Dataset Availability 

Today’s high speed customer service environment presents a challenge for insurers. Along with the drive for greater process velocity, the task of making accurate policy and claim decisions is more important than ever. Technological advancements and newly available datasets have made it easier for insurers to address these challenges, and as a beneficial by-product are also helping to weed out misrepresentation and fraud. In this session, industry experts explore how the inclusion of new data sets and greater process transparency helps to better serve reputable customers by providing accurate quotes and instant loss adjustment while also protecting insurers against fraud. In this session, topics of discussion will include investigative process, speed to detection and automation, available data, evolving best practices, applicant behavior and more. 

Louis Riggio

Louis Riggio brings over 25 years of experience in the P&C Insurance and Training industries to his role as Training & Communications Manager for ISO ClaimSearch Solutions. Louis has held numerous positions within these industries over the course of his career with his longest tenure in Claims. He also leverages a diverse background in Operations, Product Development/Support and Project Management. These skills allow Louis to support and enhance the ISO ClaimSearch Solution customer experience.

Michelle Miller

Michelle spent over 21 years in the insurance industry and worked "from the ground up" through almost every department in claims.

In her former position as a Senior Intelligence Analyst, she had several responsibilities;

  • Conducted cursory investigation of suspected fraudulent claims
  • Analyzed claims for fraudulent trends using the program “Netmap”, while focusing on fraud initiatives within the company
  • Prepared detailed reports of findings with executive summaries and presented to upper management
  • Scanned internet for potential fraud cases
  • Completed special projects for fraud claims Director
  • Liaisoned to other SIU units regarding pending fraud initiatives
  • Tasked with training new analysts and developed new protocols for the Business Intelligence Unit
  • Conducted interviews of subjects of investigation

In 2013 & 2016 Michelle was Plymouth Rock President’s Award Recipient. Additionally, she received 2013, 2014, 2015 & 2016 Plymouth Rock Fraud Recognition Awards for outstanding fraud detection and investigation on multiple major case initiatives that led to substantial financial impact to the company’s bottom line. Several of these cases resulted in arrests and convictions of medical providers.

In 2019, she started her new journey with Verisk Analytics.

Using the “ Medicine” to Defend Bodily Injury Cases:

How to use SIU PIP defenses to defend BI cases in the Superior Court

We will go through a Bodily Injury case step by step from accident through treatment.

The topics will include:

Runner involvement

ER referral to Pain Management

Chiropractic

MRI

EMG/NCV

Pain Management

Surgery

Outrageous Charges for treatments/out of pocket medical expenses

Sullivan and Graber will present actual examples of PIP defenses used this year to defend BI cases.

Deposition testimony and medical records will be used to show the fraud committed by providers.


KELLY A. SHERWOOD

Kelly A. Sherwood is an associate in the Morristown law firm of Sullivan and Graber, which has provided successful representation to insurance carriers and their insureds for over 35 years.  Ms. Sherwood has spoken on several occasions for insurance carriers. 

In her three and a half years at Sullivan and Graber, Ms. Sherwood has worked on complex litigation insurance claims, and assisted insurance carriers in claim investigations.  In addition, her insurance work has included bad faith claims and litigation, examinations under oath, first party and third party coverage, general liability, homeowner’s insurance, no fault/PIP, personal injury litigation, product and premises liability, and uninsured and underinsured motorist coverage. 

Ms. Sherwood has worked on multiple sophisticated insurance fraud schemes and filed declaratory judgment to fight fraud against insurance carriers.  Kelly has recently been working on a large claim file involving an illegal kickback scheme for the referral of patients in violation of The Insurance Fraud Prevention Act, N.J.S.A. 17:33A-1, et seq. 

Prior to her work at Sullivan and Graber, Ms. Sherwood was an associate at Daggett & Kraemer, in Sparta, New Jersey from 2012 through 2016.  Ms. Sherwood was also a law clerk in the Superior Court of New Jersey, Special Civil Division for the Honorable William J. McGovern, III, J.S.C. from September 2011 through 2012.  Kelly Sherwood received her J.D. from St. John’s University School of Law, Jamaica, New York in 2011 and her Bachelor of Arts from the University of Scranton, Scranton, Pennsylvania in 2008. Ms. Sherwood is admitted in New Jersey, is a member of the Morris County Bar Association, and Secretary for the Sussex County Bar Association. 

DANYELLE H. GOLLAND

Danyelle H. Golland is an associate in the Morristown law firm of Sullivan and Graber, which has provided successful representation to insurance carriers and their insureds for over 35 years.  Ms. Golland has spoken on several occasions for insurance carriers. 

In her five years at Sullivan and Graber, Ms. Golland has worked on complex litigation insurance claims, and assisted insurance carriers in claim investigations.  In addition, her insurance work has included auto theft, bad faith claims and litigation, dram shop litigation, examinations under oath, first party and third party coverage, general liability, homeowner’s insurance, no fault/PIP, personal injury litigation, product and premises liability, and uninsured and underinsured motorist coverage.

Ms. Golland has worked on multiple sophisticated insurance fraud schemes and filed motions for summary judgment, and declaratory judgment to fight fraud against insurance carriers.  Ms. Golland has filed complex briefs in the New Jersey Supreme Court, New Jersey Appellate Division and the New Jersey Superior Court.  Danyelle has recently been working on a large claim file involving intraoperative neurologic monitoring performed by chiropractors. 

Prior to her work at Sullivan and Graber, Ms. Golland was a law clerk in the New Jersey Appellate Division for the Honorable Jerome M. St. John, J.A.D. (Ret.) and a law clerk in the Superior Court of New Jersey, Criminal Division for the Honorable Ronald S. Reisner, J.S.C. (Ret.). Danyelle Golland received her J.D. from Pace University School of Law, White Plains, New York in 2012 and her Bachelor of Arts from American University, Washington, District of Columbia in 2008. Ms. Golland is admitted in New Jersey and a member of the Morris County Bar Association

LEE BEFELER

Lee Befeler is a principal in the Morristown law firm of Sullivan and Graber, which has provided successful representation to insurance carriers and their insureds for over 35 years. In his 31 years at Sullivan and Graber, Mr. Befeler has lectured numerous times on insurance issues at the New Jersey Special Investigators Association and the New Jersey Vehicle Theft Investigators annual seminars and has prepared seminars for insurance carriers to satisfy CLE requirements. Lee Befeler is a certified R.1:40 Mediator for the New Jersey Superior Court.

Sullivan and Graber has extensive experience litigating insurance claims in Federal and State Courts in New Jersey and New York. The firm’s coverage work includes assisting insurance carries in claim investigations and the taking of examinations under oath. Sullivan and Graber also provides carriers with legal opinions on issues including, but not limited to, coverage and policy conditions such as duty to defend, bad faith claims, subrogation and indemnification.   

The firm’s insurance work includes:

  • Arbitration and mediation
  • Auto Theft
  • Arson
  • Bad faith claims and litigation
  • Business and commercial coverage
  • Dram shop litigation
  • Environmental claims, coverage and pollution exclusions
  • Examinations Under Oath
  • First Party and Third Party coverage
  • General liability
  • Homeowner’s insurance
  • No Fault/PIP
  • Personal injury and wrongful death litigation
  • Product and Premises liability
  • Professional liability
  • Subrogation
  • Uninsured and Underinsured Motorist coverage

In addition to general casualty work, Sullivan and Graber is recognized as a leader in the specialty practice of insurance fraud. The firm uses innovative techniques, advanced technology and hard work to fight fraud against insurance carriers. Sullivan and Graber pioneered the use of declaratory judgment actions to combat large fraud schemes resulting in significant savings to the insurance industry. The firm adopted the procedural tools developed in those actions to curtail fraud in POP, personal injury and property damage cases. Sullivan and Graber’s early use of injunctive relief to stay PIP suits and arbitrations pending the resolution of fraud and restitution actions in the Superior Court greatly reduced insurance carrier’s litigation costs as well as obtaining recoveries in the tens of millions of dollars for multiple insurance carriers.

Lee Befeler received his J.D. from the McGeorge School of Law, Sacramento, California in 1987. Mr. Befeler is admitted in New Jersey.                                                                                             

Vendor/Client Relations:  A Path to Successful Investigations

A successful investigation starts with the relationship between the Vendor and Client.  This workshop will focus on the best practices followed between a Vendor and Client and the importance of communication.  The presentation will have unique insight from both the Vendor as well as the Client.  Through the use of case studies, this workshop will work through best practices a Client should use when sending a case to a Vendor, identifying the steps a Vendor completes prior to starting surveillance, how this information is used during the surveillance period of the investigation, and then how the Client is provided the overall conclusion of the investigation.  The workshop will conclude with a discussion of how the development of KPI’s can be used by the Client to audit the Vendor.

Matthew Anderson

President

Matthew Anderson is the President and Founder of AIC Companies, LLC.  He established the investigative firm in 2014 with a radical approach to Surveillance and Investigative Services in the claims industry.

Graduating from Rutgers University, The State University of New Jersey, Matthew centralized his focus on Criminal Justice and Investigative Practices.  Matthew started his career as a Field Investigator in the claims industry with a regional investigative firm in 2005 investigating potentially fraudulent workers’ compensation claims.  Through almost a decade, Mr. Anderson honed his skills from the field investigator role to becoming the Lead SIU Administrator and finally the Director of Operations.

As President of AIC Companies, LLC, Matthew is now responsible for running all facets of the firm.  Matthew’s passion has been to introduce groundbreaking solutions to the investigative industry that has been languishing for years with limited innovation.  At the helm of AIC Companies, LLC, Mr. Anderson has put together an All-Star Team leading the investigative firm into the future.

Brian Freeland                                                                             

Brian Freeland founded Covert Solutions Group in 2010. He began his career in the law enforcement industry and naturally transitioned into investigating fraudulent insurance claims in 1999. Between 1999 and 2005, Mr. Freeland was employed with two nationwide investigative companies and quickly moved up the ranks earning titles such as Senior Investigator, Recruiter, Investigator Trainer, Quality Control Officer, Field Operations Manager, and Marketing and Business Development. From 2005 through 2010, while employed with a regional investigative services company, he was responsible for Business Development and Marketing, the supervision and coordination of client procedural implementation, and overseeing the day-to-day operational aspects of investigations including supervising the Special Investigations Unit (SIU) within the company.

Mr. Freeland is dedicated to staying aware of the national trends of investigative management and insurance claims investigation needs, which allows Covert Solutions Group to provide an exceptional product within this ever-changing industry.  As President of Covert Solutions Group, he remains hands-on and works closely with clients as well as his operations managers to assure the highest levels of quality and service. 

Lori Coupe

Lori Coupe is a Supervisor of Investigations within the Special Investigations Unit at NJM Insurance Group.  Lori graduated from West Chester University with a Bachelor’s Degree in Criminal Justice and a Minor in Forensic Chemistry. Lori started at NJM as an adjuster in the General Claims Department in 2006.  She became an Investigator within the SIU in 2008 where she worked as a Generalist conducting investigations focusing on Workers’ Compensation Claims, General Claims and Underwriting.   Lori has held a Supervisory Position within the SIU since 2013.

Within NJM’s SIU, Lori developed and oversees the Vendor Investigation Management Team.  This team is responsible for all Workers’ Compensation Surveillance Investigations that are assigned to an outside vendor company.  At the infancy of this team, Lori developed specific protocols regarding how the investigations would be handled and reported to NJM.   These protocols as well as established KPI’s are audited at the conclusion of each investigation.

Dan relies on his educational background in electrical engineering and physics to understand the operation and functionality of vehicle sensors such as, light detection and ranging (LiDAR), millimeter wave, infrared, and optical cameras.

Dan specializes in accident reconstruction, EDR (Black Box) imaging and analysis, pedestrian/bicycle accident analysis, human factors, and nighttime visibility/conspicuity issues.

In addition, he also consults with the National Hockey League on issues of player safety.

After receiving his B.S. in Engineering with a minor in Mathematics at James Madison University, Dr. Wolfe went on to earn his Ph.D. in Electrical and Computer Engineering at the University of Delaware, Newark.



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