August 18, 2025 • 44 mins
The digital revolution has transformed insurance fraud investigation from cassette tapes to AI algorithms, yet the foundational skills remain surprisingly human. Larry Henning, Senior Vice President of Anti-Fraud and Special Investigations at Allied Universal Services, brings 47 years of investigative expertise to this eye-opening conversation about the evolving landscape of insurance fraud detection.
"God gave you one mouth and two ears for a reason," Henning remarks, highlighting that despite technological advancements, active listening remains the most powerful tool in an investigator's arsenal. He shares a compelling story from early in his career when simply listening carefully revealed a confession that an experienced adjuster had completely missed—a moment that nearly caused him to crash his car in disbelief.
The episode explores how inconsistency across different tellings of the same story serves as the primary red flag for potential fraud. When someone reports an incident to their employer, tells friends, and describes it to medical providers, variations between these accounts warrant deeper investigation. Henning offers practical advice for claims professionals on conducting effective interviews, emphasizing the importance of following up on every person, place, thing, or event mentioned in a claimant's story.
Technology's impact on fraud investigation is examined in depth—from social media algorithms that can search hundreds of platforms simultaneously to geo-intelligence tools capable of identifying witnesses by searching posts from specific locations and timeframes. These digital advances are balanced with traditional "boots on the ground" techniques like locating security footage, creating a powerful combination for uncovering the truth.
Whether you're a claims professional seeking to sharpen your fraud detection skills or simply curious about how investigators separate fact from fiction, this episode offers valuable insights into the art and science of insurance fraud investigation. Subscribe now to hear more conversations with industry experts who are making a difference in the world of claims.
Season 9 is brought to you by Berkley Industrial Comp. This episode is hosted by Greg Hamlin and guest co-host Chris Drake.
Visit the Berkley Industrial Comp blog for more!
Got questions? Send them to marketing@berkleyindustrial.com
For music inquiries, contact Cameron Runyan at camrunyan9@gmail.com
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Greg Hamlin (00:12):
Hello everybody and welcome to Adjusted.
I'm your host, greg Hamlin,coming at you from beautiful
Birmingham, Alabama and BerkeleyIndustrial Comp.
And I wanted to start thisepisode with a fun fact.
Did you know?
According to the NationalInsurance Crime Bureau, fraud
may be involved in 10% of losses?
(00:32):
So today we're going to beexploring fraud in claims in
insurance, and with me today ismy co-host, Chris Drake.
Chris, do you want to introduceyourself for folks?
Chris Drake (00:44):
Yeah, I am in hot and steamy Indiana at this point
.
I'm a claims manager atBerkeley Industrial Comp and
I've been in the industry forabout 16, 17 years.
Greg Hamlin (00:55):
Excellent.
I don't even want to hear it.
I grew up in Indiana and Iwould take an Indiana summer
over an Alabama summer almostany day.
I took the kids to the pool theother day to cool off and
jumped in and it felt like a hottub because it's been so hot.
The pool's like as warm as itis outside.
So with us also today is ourguest, larry Henning.
(01:16):
He's a senior vice president ofanti-fraud and special
investigations at AlliedUniversal Services.
Larry, if you could say helloto everybody.
Hey, everyone, and thank youfor having me today.
Larry, if you could say helloto everybody.
Larry Henning (01:25):
Hey everyone and thank you for having me today.
I appreciate it.
Looking forward to it.
Greg Hamlin (01:30):
And Larry, where are you out of?
Larry Henning (01:31):
I am in High Point North.
Greg Hamlin (01:33):
Carolina.
I know exactly where that is.
They have a baseball team there.
They're like the rocking chairsor something.
The Rockers, yep, the Rockers.
So you're like in the furniturecapital of the world.
Larry Henning (01:44):
I absolutely am known for that and have people
from all over the world comingtwice a year to showcase their
wares.
Greg Hamlin (01:53):
So we have a fellow Berkeley company that's right
there in High Point in key riskinsurance.
So shout out to my key riskfriends, they have their office
right by that ball field they doright at the stadium itself.
So they've got a pretty coolspot.
I'm a little jealous.
Especially this time of year.
I bet it's fun to hang out andwatch a game after work.
(02:14):
So, larry, I wanted to startthis conversation talking about
the topic of fraud.
That that's where we were goingto go today.
When you were growing up, inyour career day in kindergarten,
larry, did you see yourselfending up in this special
anti-fraud specialinvestigations?
Larry Henning (02:33):
In insurance absolutely not but in
investigations and lawenforcement.
That was the only career that Ireally had ever wanted was in
investigations, so, and I'vebeen doing it now for 47 years.
Greg Hamlin (02:47):
So how did you?
How did you get into theindustry?
Larry Henning (02:50):
Well, that's a.
It's a great story.
I actually started off in lawenforcement.
I was doing an internship incollege at a law enforcement
agency in Metro Atlanta.
While I was there the chiefasked me was I interested in
being in the academy?
And I said, well, I haven'tapplied or anything.
And he put right through and intwo weeks later I was starting
(03:13):
the academy.
So I worked law enforcement forabout 13 years and I was
approached if I'd be interestedin the special investigation
unit.
Working insurance fraud had noidea what the SIU was.
We had worked some cases andpresented on insurance, but that
(03:35):
was early in the startups ofSIUs back in 1989, 1990.
From that it was an easy callhey, 1989-1990.
From that it was an easy callhey, we'll double your pay, you
won't get shot at, you won'twork nights and weekends.
So, being newly married withjust a couple small kids, that
was an easy choice to make.
Greg Hamlin (03:55):
You're like I'll take it, I'll take it.
That's wonderful.
Chris Drake (04:02):
Your life insurance carrier loves it too, for sure.
So, larry, what types of fraud?
Larry Henning (04:08):
have you seen in the industry?
Well, it really runs the gamutwhen it comes to insurance,
because of not only propertycasualty and everything that
entails, and then over on thelife, health, disability,
certainly the different variousspecialty lines.
There really is no part ofinsurance that's immune to fraud
(04:29):
, whether that's from a claimperspective, from underwriting
and unfortunately, on occasion,internal as well.
Greg Hamlin (04:37):
So you know, I've always I've spent most of my
career on the claim side andI've seen a little of some of
the others, but claims is whereI've spent most of my career.
Many insureds that I've workedwith have injured workers that
they don't care for.
Once they file a claim and theysay it's fraudulent.
And there's a big difference, Ithink, between somebody who
(04:59):
maybe is not an easy person towork with and fraud.
So, larry, from yourperspective, being in the
insurance industry, as long asyou have what are some of the
indicators that help yourecognize, maybe there's
something more to this claim andit's not just an insurer who's
frustrated with an individual,but there's something else here.
Larry Henning (05:21):
Yeah, and this really goes across any kind of
claim type.
But it's inconsistency in thestory.
When someone reports a claim,no matter what it might be and
we'll use some examples, but nomatter what it might be and they
report that claim to theinsurer.
Let's say it does involve aninjured worker, so it's workers'
(05:42):
compensation, and they reportthis to their employer.
Then they tell friends about it, they go to the doctor and they
tell the doctor about it.
Maybe they've gone to urgentcare or an ER and they've told
them the story of what happenedand why they got hurt or how
they got hurt.
And when all of those storiestend to be different that's what
(06:05):
I mean by inconsistency andwhen we don't look at that level
of detail and pay attention toit, we might miss it.
Greg Hamlin (06:14):
That's a great point.
So if and I've actually seenthis in my career where some of
those inconsistencies, maybe afull investigation wasn't done
on the front end of the claimand some of those
inconsistencies weren't figuredout until months and months
later, and then at that pointthe toothpaste is kind of out of
the tube right, it becomes alot more difficult.
(06:35):
What are some of the thingsthat an adjuster could be doing
to investigate to make sure youknow they're catching things and
they're not in one of thosereactions where nine months
later we find out the doctor'sreport doesn't match this, the
statement that was never takendoesn't match the witness
statement, all these types ofthings.
Larry Henning (06:58):
Yeah, there's several, but I always like to
start with, especially when I'mtalking to a group of adjusters
or even a group of newinvestigators.
And that's two key things.
One, listening.
My grandmother always told me,larry, they gave you one mouth.
God gave you one mouth and twoears for a reason he really
(07:20):
wants you listening more than hewants you talking.
So listening skills are huge.
If I can digress for a second,one of the very first cases when
I left law enforcement and wentover to insurance as an SIU in
the Atlanta area it was a bigfire case Chief claim officer
there in the Atlanta officebrought it to me.
(07:41):
I literally was my first day onthe job.
I looked at the file.
I said can I go out to wherethis house burned down?
And he said, yeah, it's still ascene, nothing's been touched.
It was, the fire was a coupleof weeks ago and on the way you
have to remind this goes back to1990s.
So I took the cassette tape andput it in the player in the car
(08:05):
to listen to the large lossadjusters interview on my way to
the fire scene.
And I'm listening to this tape.
The adjuster did a great job.
This was a 20-year adjuster Dida fantastic job, asked
everything I probably would haveasked and, at the end of the
(08:27):
tape, theial question.
Thank you very much.
I appreciate your help and theinformation you provided.
I have one final question.
Did you have anything to dowith the starting of the fire at
your home?
And the response on that tape?
Yes, but I really didn't have achoice.
And the next words out of theadjuster's mouth is thank you
(08:49):
very much.
Today's date is such and such atime.
It's time is such and such.
Thank you for your help.
I almost crashed the car.
I got back to the office, toldthe chief claim officer.
I said you can deny this claim.
I said I'll give you more ofthe detail, but this was an
intentionally set fire done bythe insured.
(09:11):
Well, how do you know that?
I said because he admitted toit.
So I played the tape for him.
They died laughing.
I mean, they just could not.
And I say that because oflistening Back to that.
We get so ingrained in what wethink we should be hearing.
Next, stuff goes right over ourhead and we don't hear it, even
(09:35):
though it was said.
So, listening number one, skillNumber two is, when we're
asking questions, what we reallywant to arrive at at the end of
that interview the who, what,when, where, why, how and how
much.
When you're getting the answersto those questions, you've
(09:58):
probably done a pretty darn goodinterview.
Chris Drake (10:02):
Those are both really really good points.
I think I don't know if you canput enough emphasis on active
listening, right?
I think that goes to the pointwhere you're hearing what you're
hearing, but something stilldoesn't add up, and at that
point in time you know somethingneeds to be further
investigated.
So what other tools can beutilized?
If you come up with a situationlike that and you understand
(10:24):
something just doesn't seemright, my gut seems off.
What else can you do toinvestigate the claim?
Larry Henning (10:30):
Well, what you're looking at is again back to the
.
You're identifying thoseinconsistencies.
What conflicting information doyou have?
And then what are those avenues?
Whether it be a tech tool, adocument, a record of some kind,
when can I go and find out whatthe facts are to resolve this
(10:55):
inconsistency?
And I think that's probably thebiggest thing is developing a
lead and then following thatlead.
I think one of the things thatfor investigators especially,
and certainly adjusters becauseadjusters just don't that's what
they are.
Adjusters are investigators.
They just happen to do all theinsurance process policy
(11:17):
interpretation, settlementevaluation.
They do all those extra thingsthat the SIU investigators
typically aren't doing, andthat's why it's good to rely on
those investigators and theywork in partnership with the
adjusters to get to the facts.
I think we'd all agree thatinsurance carriers hey, we just
(11:39):
want to resolve this withinformation that's accurate.
If we owe and we need to paythis claim, then great, we'll
pay it.
But if we don't owe it orthere's some provision of the
policy that excludes certaincoverages, or there's some
provision of the policy thatexcludes certain coverages or
there's certain conditions inthe policy that might exclude or
(12:00):
limit certain pieces, thenthat's what we follow.
I think those are key, butdeveloping leads, following
those leads sometimes that'sgoing out to get a medical
report could be a police reportIn a vehicle situation, whether
it be a collision and it'ssimply a auto liability bodily
injury claim or it's a worker'scomp, but it happened to be
(12:23):
because they were out in avehicle for work and got
involved in the collision.
But think of the telematics thatare in vehicles nowadays,
especially since around 2016,2017.
And prior to that and even instill vehicles, obviously on the
road today the EDR data fromthose vehicles and what it can
tell you and whether thatmatches up with the story.
(12:46):
So you take the original storyand then you look for ways to
confirm it.
I'm always a big believer in ifyou act in good faith in your
investigations, if you act ingood faith in your adjusting,
which means, hey, this is whatthe insured or this is what the
claimant told me, I'm going togo find the evidence and the
(13:09):
facts to support what they justtold me.
And if it's not there and theevidence and the information is
contrary to that, well so be it.
But you do it in the mindset ofI'm out there to find something
to support what they've told me.
Greg Hamlin (13:27):
Larry, I think that's a really good point and
you know, sometimes carriers geta bad reputation for or at
least I think a lot of theplaintiff attorneys like to run
commercials that make it soundlike insurance carriers are
always looking for ways to denyclaims, which really isn't true.
I think you pointed out areally important thing.
We want to confirm the factsand what works best is when
(13:48):
everything lines up and we canprocess the claim and move
forward and it paid out if itneeds to be paid out, or get the
person the treatment they needif it's a workers' comp claim.
But I think the good faithpiece is really important there
that you mentioned One thing forme.
You mentioned cassette tapes.
I'm old enough that I remembercassette tapes.
I made mixed tapes for mygirlfriends in middle school
(14:11):
back in the day tape recordingstuff on the radio, so I can do
that and I actually remember inthe very beginning as an
adjuster we still had cassettetapes at the very beginning of
my career.
Obviously, so much has changedin the last 20 years I don't
know like my kids today.
There's probably a recording ofalmost everything they did.
I grew up in the nineties soI'm kind of lucky that there
(14:32):
weren't phones with videos onthem of all the dumb stuff I did
.
Just lives back in the 90s.
But you know, now reallytechnology is everywhere.
How have you seen that changeinvestigations from maybe back
when you first started to now?
Larry Henning (14:49):
It has been huge in the changes.
Because I'm older, I'd like tothink, maybe wiser, certainly
more experienced, but in thevery early days there weren't
even mobile phones.
We had pagers and you got apage and then you stopped at a
pay phone and then called, tookto whatever you needed to call.
(15:12):
So it has really evolved.
But from investigator tools of,like I said, cassette tapes
through to digital recorders,and now even digital recorders
are seldom used because a lot ofthe recordings are direct to
the cloud.
There's other types of devicesthat you can use now that you
(15:34):
record and it actually producesan immediate transcript within
seconds.
Push a button and it creates asummary of what that interview
was about in a matter of 15, 20seconds and you have a pretty
detailed summary document aswell.
So that really speeds up andreally aids.
(15:54):
In the old days you took a lotof notes and that's one of the
things that you have to becareful about If you're busy
taking so many notes, you mightmiss something.
Back to the listening part thatI talked about earlier.
So technology has reallyimproved for you to be more
accurate, more detailed, withless actual manual effort to do
(16:19):
that.
You know one of the tools thatwe initiated even prior to COVID
.
I think we launched about ayear or two before COVID but
it's called InView Interview,like we're on this call.
But InView is actually asoftware that is more secure,
can't be hacked, has the dataprivacy and security features to
(16:46):
it.
But in doing that InView or theinterview, like what we're doing
today with a video, I can bringin maps, I can bring in
documents, I can bring in photoimages so I can be talking to
somebody and interviewing themanywhere and conduct a pretty
extensive interview andinvestigation virtually but
still see the person to what youcan see on camera.
(17:12):
So it may be from like theshoulders up, but it's still
pretty effective in producing itthat way.
And then when COVID hit andeverything went virtual just
think about their most specialinvestigation units, most SIUs
for insurance companies, whetherthey were with the insurer or
(17:33):
contractors such as myself mosteverything was in person.
With COVID almost everythingwent virtual for a year and a
half, two years.
And now insurers learned hey,you can actually do some really
effective investigationsvirtually and eliminate travel
time, travel costs, you know,capacity to handle more cases in
(17:56):
a shorter period of time can goup.
So there was a lot of benefitsof technology that were really
had to be hot tested, like Ilike to call it, during COVID,
because it was necessary to dothat.
Chris Drake (18:09):
Are you seeing any change to where people are doing
more in person, or is it morevirtual at this point, since
you've had such great successwith it?
Larry Henning (18:17):
It's a big mix.
Yeah, I've seen severalinsurers special investigation
units convert a significantportion of their staff to
virtual doing desktopinvestigations.
Here in my own company I haveover 500 investigators employee
investigators just here in theUS.
About 35 of those are desktoponly.
(18:40):
The rest are in the field.
But it depends on theassignment as to whether or not
it is done virtually or in thefield or a mix of both.
I'd say most SIU investigationsare a mix of both.
And then certainly thesurveillance investigators.
It's always in the field thatis not done virtually.
(19:03):
Now there's other technologynow deployed for surveillance
that is unmanned.
So you're using good techdevices to conduct that
surveillance.
Greg Hamlin (19:14):
Right, that's changed a lot.
I remember when I first startedit was always somebody
following somebody in a van, oryou know they'd have different
ways of doing it.
Now, cameras are so small thatI've seen those green utility
poles that look like they'rejust like a green utility
monster, and that there's acamera in there.
So it's a different world froma surveillance standpoint.
(19:37):
The other piece of that I'dlove you to comment on, larry,
is just how social media changedyour investigations.
You know, when I was growing up, there was no social media
where my kids you know, whetherit's they're taking pictures and
sending it through social mediaor they're hanging out in
different ways.
I think we communicate a lotdifferent than we used to.
Larry Henning (19:58):
We do.
And just think about it.
If an event or incident of anykind occurs out in public and
this doesn't mean violent oranything like that, but just it
causes a disturbance, wheresomething happens and people
take notice, what's the firstthing you see?
If you're out there as well,everybody's holding their phone
(20:21):
up recording what's going on,yeah, and it's getting posted
out to social media somewhere,and these are uninvolved people
to the event that are doing that.
So, yeah, it is greatlyenhanced the ability to find out
some information about an event, about an incident car crashes,
(20:42):
work comp type cases, reallyany type of insurance loss you
can think of.
There's the potential ofgaining valuable information
through social media.
Now, you can't always believewhat you're lying, I see, so you
have to do some authenticationand validation of what you find
(21:05):
on social media as well.
Greg Hamlin (21:07):
Yep, well, and another question I had on that,
larry.
So let's say I'm the ambitiousadjuster.
There's a lot of obviouslythere's a lot of laws around
what you can do as far as socialmedia goes, and this is why a
company like yours is important,because if someone on my staff
was to create a fake socialmedia account and then use that
(21:29):
account to try to maybe capturesomebody or catch somebody in a
lie, there's obviously someconcerns with that.
And so what are some of thethings you do when you get that
kind of referral that makes surethat when you're doing these
investigations, we're followingthe laws and we're not doing
anything that entraps people orcauses people privacy issues.
Larry Henning (21:52):
Well, and those are great questions.
Probably one of the number onething that comes up when I talk
to chief claim officers aboutsocial media is like I do not
want my adjusters and my staffout on social media because it's
a big time drain and it's a bigblack hole and they just don't
(22:13):
have time.
And I totally agree with that.
Yes, there are differentprivacy issues.
There are certain legal thingsthat you need to be cognizant of
.
Yeah, I'll use the word, eventhough it's not appropriate for
all social media, but you don'twant to have someone go out and
friend that individual you'relooking for Again, whether it's
(22:38):
using a fake account, a realaccount, it doesn't matter but
to make contact with them,especially if they're a
represented individual, if theyhave an attorney.
So the best way to enhance anddo social media and how we
operate is we use computeralgorithms.
We use algorithms to tell itthis is who we're interested in,
(23:03):
this is what we're looking for,and then the algorithms then
search.
So because it's there'sliterally hundreds and hundreds
of social media type sites thatare out there.
So using a computer to go look,I would tell adjusters probably
if there was a single piece ofinformation for us to have
(23:28):
before we started a social media, and we want quite a bit, but
the one that is really, reallyimportant is the personal email
address of that person, becausemost people set up their social
media accounts with theirpersonal email.
So that is one of the keypieces of information to look
(23:49):
for.
Yes, we want name and addressand whatever identifying
information they have as part ofthat claim.
The other thing we do with thealgorithms is we look for is
this involving an injury?
Is this involving some othertype of claim that's not injury
related?
Because we really want to lookfor things that may be relevant
(24:14):
to the loss that we'reinvestigating and that the
adjuster is looking at.
Once the computer pulls all thedata down, then we actually
have an analyst, a human being,that is now looking at it to
make that determination.
Is this or could this berelevant?
Because otherwise, almost everycase involving doing a social
(24:37):
media search, you're going tohave hundreds and hundreds and
hundreds of pages of stuffthat's worthless.
So you're looking for the linksand the data that may mean
something to the client or couldmean something, or absolutely
does mean something to theclient.
Chris Drake (24:58):
I think that's huge too, because you may have some
people that post so limitedinformation and are very, very
private, and then you haveeverybody that's going to give
you a real-time update on everysingle thing they do.
And I think you could haveinjuries where somebody is
posting about an injury fivedays before it's the weekend.
They go back in on Monday andthey report a work-related
(25:20):
accident and you can go back andpreview their social media from
five days ago and see they areactually injured.
They are not at work.
So it's awesome, it'sdefinitely an awesome tool.
And it tells me too you got to.
You got to watch that digitalfootprint.
So, greg, you better startdeleting some of your accounts
real quick.
He's going to find you.
Greg Hamlin (25:38):
I got to stop dancing.
I got to stop dancing and putmy videos up, right With my kids
.
Larry Henning (25:43):
Yeah, one of the things that's really important
it's social media related, butit's not necessarily to a person
at the time, but especially ifthe event you're interested in
occurred out in public, go backto the scenario we talked about
(26:03):
a few minutes ago.
It may not be that insured orclaimant, whoever it might be,
it may not be their social mediathat I'm really looking for,
but I don't know who's I need tolook at.
So we've got a product calledgeo intel and you're geo fencing
a physical area with GPScoordinates.
You're putting in some date andtime ranges and then you're
(26:26):
putting in the type of eventlet's say a car crash that
you're looking for and then youlet the algorithm go out and
look for any posting by anybodyinvolving a car crash between
that date and time range withinthis geo-fenced area, the GPS
(26:51):
coordinates, and then see whatit returns.
I mean, we have locatedliterally witnesses to an
accident in which everyone thatbecame known to the police said
party one was at fault.
They did this, yet the videodoesn't support it and you find
(27:13):
a witness who gives you a pieceof information and they have
video of their piece thattotally refutes what the
original belief was as to whothe at-fault party was.
So you find witnesses, you findactual video of either the
event as it occurred or theimmediate seconds afterwards,
(27:36):
because, think about it,somebody sees it, or they hear
the crash and immediately thephone goes up.
So they're really recording theimmediate after events of the
crash, not the crash itself.
But that's very helpful,because the other thing the
boots on the ground piece wouldbe for the investigator to go
out and literally look forcameras in the area.
(27:59):
I mean, we do that frequently,whether it be public cameras on
the sides of buildings, theycould be street cameras run by
the local public entity, orpotentially they're cameras on
private residences or businessesthat may capture something.
You knock on the door and tellthem what you're doing and maybe
(28:19):
they could help.
Sometimes they do and sometimesthey don't and maybe they could
help.
Greg Hamlin (28:23):
Sometimes they do and sometimes they don't.
That's a great point.
That's a great point.
And it's very rare anymore that, like you said, somebody didn't
get a video of it, whetherthat's a surveillance video that
was there for security purposes, or a door cam or somebody's
phone.
That's a great point.
One of the things I really likedthat you said earlier that I
want just to circle back on wasthe importance of I think we
(28:48):
talked a little bit abouttrusting your gut but asking,
continuing to ask follow-upquestions, and you had mentioned
like that example of theadjuster who kind of was
following a script it soundedlike and then once they finished
their script, they were doneand they didn't ask additional
questions.
And you know we have a prettyspecialized catastrophic team
and I can think of one verychallenging claim that happened,
which was very difficult, andthe injured worker story didn't
(29:10):
sit right with the adjuster Likesomething just didn't feel
right about it and it was anafter work party.
You know that was a companyevent, so this wasn't like a
normal business workers'compensation accident.
But as she took the person'sstatement, it raised some red
flags and she got hold of awitness and the witness
(29:32):
statement just didn't feel rightand so then she kept going and
there was another witness thatwas there that day that she
tracked down, and that witnesshad a completely different story
, where the person was under theinfluence and made some really
poor choices and said somethings that were pretty bad and
actually kind of caused theinjury to occur by their actions
(29:55):
, clearly became not awork-related injury, but at
first blush, if you had justtaken the one statement and the
friend who was a witness, theclaim would have been accepted.
Larry Henning (30:07):
So when do you see that gap?
And that's a great example,because you know earlier when I
talked about the who, what, when, where, why, how and how much.
There's also another aspect,and this is why interview
training is so important forclaim staff, and not just one
(30:28):
time, but probably somerefresher training every few
years as well, because eveninterviewing evolves.
But a lot of interviewing issimply common sense.
So one of the things I like totrain folks is, anytime somebody
when you're interviewing them,if they introduce a person,
place, thing or event in theirstory, you need to dive down
(30:53):
into those things to identify alittle bit more information.
And I'll use this example basedon what you were just saying.
Saying in that example,somebody may talk in their
interview and say, yeah, beforeI went to the party, I had
stopped at my brother's houseand then when I left there and
(31:13):
most I would say most peoplewould not come back who's your
brother?
Where does your brother live?
What's his address?
Your brother live, what's hisaddress?
Because it could be that smalldetail that later and you later
on you go find out you talk to.
I haven't seen my brother intwo weeks.
I don't know what the heck he'stalking about stop.
So why would he provideinformation?
(31:37):
That's not true?
That doesn't appear to berelevant to our story.
Now it takes more inquiries.
Okay, why was that brought upand why might it be relevant?
So it's when they introduce.
It could be my friend was inthe room and then they left.
When this occurred, whatever theevent was, and a lot of people
(32:01):
would never go back.
They think in their mind well,my friend, the person was not in
the room when the event ofCasey's Head, my friend left the
room and they would never go tofind out who is my friend.
Because that person potentiallywill have important and
(32:22):
relevant information.
That's material to that claim,because maybe they were there,
maybe they weren't, but if theywere, maybe they didn't quite
leave the room as fast as theother person thought and they
actually saw what happened.
So those are examples of divingdown into the person, place,
(32:45):
place, thing or event in thestory, get more detail.
It's a lot easier to get it upfront than to come back and get
it later.
And with that said and I knowthis is probably quite a bit
about interviewing, but probablyone of the last things I made a
practice of early on in aninterview would be.
(33:05):
Hey, Greg, I really appreciateyour time and you gave me some
great information and it'sreally going to help us make an
informed decision.
More than likely I forgotsomething, so would it be OK if
I reach back out and did afollow up and maybe ask the
question that later on I forgotI should have asked?
I don't think in my career I'veever had anybody tell me no,
(33:30):
and so when I do call back, it'snot a surprise, it's not a
shock.
They're more at ease and Iusually am able to get the
additional information I'mlooking for without any trouble.
Greg Hamlin (33:43):
It's a good point and I think getting the details
is so important when we'reinvestigating claims and then
knowing when to make thatreferral to whether that's to a
company like you.
Now, in some cases there needsto be a referral made to the
state and I think that can beconfusing for adjusters to know
every state's different.
Larry, when do we let the stateknow that we think, wait a
(34:07):
minute, this is, I mean, this issomething they need to be
notified of reportingrequirement when fraud is
suspected.
Larry Henning (34:22):
Most of the state statutes are.
If you put them all side byside, most of them read very,
very similar and the thresholdfor reporting in most states is
reasonable suspicion.
I like to tell groups when Italk with them hey, there's 20
(34:47):
people in the room If I tell astory on a claim and give the
red flags as to why I'msuspicious about this particular
claim and either everyone orthe majority of people in the
room agree, yeah, I'd besuspicious of that too.
You just met the threshold forreporting in most states.
You have the state of Wisconsin.
There's laws a little different.
It says you must have evidenceof fraud to be required to
(35:11):
report.
In the state of Wisconsin it'svoluntary to report it if it's a
reasonable suspicion, but it'srequired if there's evidence.
Again, most states it's justreasonable suspicion and that
makes it required.
And then you have the state ofCalifornia, whose actual statute
still says reasonable suspicion, but they have interpreted
(35:36):
their own law to now say theremust be evidence of a material
misrepresentation.
So that's the languageCalifornia uses now is material
misrepresentation and evidenceof that material
misrepresentation and then it'srequired in the state of
California.
(35:57):
It's unfortunate, you'veprobably seen it in industry but
Illinois just came out andreinterpreted their statute
saying there's no mandatory atall to report to the state.
It's all voluntary if you wantto.
The law didn't change.
They didn't change the statute,but the Department of Insurance
(36:20):
changed their interpretation tonow it's totally voluntary in
the state of Illinois and it'sunfortunate.
I think there's some industrygroups that are trying to make
some inroads to the statelegislature and some other
groups to try to get back towhere it's a required action
like most other states.
Greg Hamlin (36:43):
That can be.
I mean, and when you make thosereferrals, how often does the
state?
And I know it's probablydifferent from state to state,
but I mean, do you see the stateactually take action on very
many things?
Or are there sometimes you knowyou're doing the steps, you're
following the protocol, and thenyou don't hear back or maybe
they don't do something.
Or have you seen cases wherethey get involved and they
(37:04):
actually start to press chargesat a state level?
Larry Henning (37:08):
They do, and think of it this way.
You have, of course, hundredsand hundreds and hundreds of
insurers out there.
So you have thousands andthousands of claim staff,
underwriting staff, others, butthe vast majority of referrals
are in fact from claims by farnumber one.
Then you've got third-partyclaims administrators, you've
(37:30):
got MGAs, mgus, you've got allthese industry people who now
have some requirements to reportand they do so.
The states get inundated inmany cases with the referrals.
So the states get inundated inmany cases with the referrals.
So many of these states havecreated their own databases.
To me it's reasonable If, all ofa sudden, the state gets a
(37:51):
referral on Larry from carrier B, from carrier C, all of a
sudden five or six differentcarriers all report Larry
involved in a suspect claiminvolving an injury in the last
90 days, the state's going to gohmm, I think we're going to dig
(38:13):
into this one, because nowwe've got the same Larry at the
same address, with the same dateof birth, filing an injury
claim with six differentinsurers in 90 days.
I think that would make all ofus go hmm, something's here.
I'm aware of one state that isjust starting a pilot of using
(38:35):
some rules-based type technologyfraud detection technology to
help them with all the datathat's coming in from all the
different carriers.
But using some rule-based frauddetection technology to assist
them in identifying the cases inwhich they should actually open
(38:58):
a case and assign to one oftheir investigators Makes
perfect sense to me.
A lot of insurers at my companywe use fraud detection
technology, the clients andtheir data and then we see the
rule triggers a referral.
The SIU triages that referral.
Is this a false positive or isthis an actual case that should
(39:22):
be investigated?
And then proceed from there.
And by doing that triage youstart training the model as to
what's really a good rule andwhat's accurate and what kind of
rule.
Maybe the rule needs to betweaked some.
Maybe the weights of thoserules, maybe the weights of
(39:46):
those rules.
And there's a lot of differenttech tools out there in the
industry available that areeither predictive model or
rules-based, and a lot of AI isbeing generated with it now as
well.
Greg Hamlin (39:53):
A whole new frontier.
It's a whole new frontier.
We started talking about AI.
Larry Henning (39:58):
It is.
It changes drastically, almostweekly.
Is there something new comingout?
Greg Hamlin (40:08):
It does, it does.
My kids are going to grow up ina very different world.
I know that much Just seeinghow that's working Well, larry,
I really enjoyed having you onthis episode.
One thing that I've tried tomake a habit of is putting good
vibes back out in the universe.
I felt like there's so muchnegativity, and so one of the
things I've focused on in my ownpersonal life is trying to be
(40:31):
more grateful, because I thinkit's easy to forget how
wonderful life is, and so one ofthe things I've been asking
each of our guests over the lastseveral years is to share
something they're grateful for.
So it could be anything youwant, but something that, to you
today, you're grateful for.
Larry Henning (40:48):
You know, I think everybody would probably have a
very common thing, and that isfamily and friends.
You know my faith.
All of those things matter agreat deal.
My most recent thing and I'lluse as an example is in February
.
I was fortunate to gatherfamily and friends from all over
the country for my mom's 90thbirthday.
(41:09):
That's great Was still living inher own home down in Florida
and doing well, yeah, couldn'tdrive anymore, do any of those
things, but she was gettingaround and playing games on her
phone and she'd FaceTime you.
She was really active with thatand she'd FaceTime you, and so
she was really active with thatand she suddenly passed in March
.
I'm sorry, but by having thatexperience, with everybody
(41:34):
gathered together in February, Iwas very grateful that that
happened.
That's my most recent thing.
Greg Hamlin (41:43):
No, that's wonderful.
I had the opportunity.
So before I, ever after Igraduated from high school and
before I went to college, Ispent a couple of years out West
on the Navajo reservation as amissionary and my mission
president was a huge influenceon me as a young as a young man
and recently went into hospiceand he because he's kind of a he
(42:05):
was a tough guy.
He said I'm going out on my ownterms, I'm inviting everybody
to a party to say goodbye, andliterally from all over, we, we
flew out to see him and he has.
He's still in hospice.
This was a couple of months ago, but I'm so grateful that we
had that opportunity.
It was like a really awesomereunion and there was so much
(42:26):
love there of and it was awesomejust to see like this has been
25 years.
But look at all these peoplewho have kids, grandkids, that
have all been impacted by thisperson and and the kind of life
he lived.
So I love that.
Larry Henning (42:41):
Greg, you talked earlier with your kids, and I'm
fortunate that I have fivegrandkids and so you'll have
those down the road.
That's right.
Greg Hamlin (42:50):
Hopefully not too soon, but yes but hey, grandkids
are awesome, Absolutely awesome.
I can't wait.
I can't wait.
I'll never see my wife again.
I know that.
So once they come, that'll bethat.
So she'll be like I don't wait,I'll never see my wife again.
I know that.
So once they come, that'll bethat.
So she'll be like I don't careif you retire tonight, I'm going
to be gone chasing them.
So well, larry, I've certainlyenjoyed meeting with you.
(43:12):
We will remind our listeners,if you like the episode, to go
ahead and get us on your podcastplatform, and we'd love it if
you give us five star rating andleave some comments and
feedback so other people canfind this episode and also just
remind our listeners to do right, think differently and don't
(43:32):
forget to care.
And we will continue releasingepisodes every two weeks, like
we have for almost the last fiveyears.
So we hope you continue tofollow and share this with your
friends.
Thanks Larry, thanks Greg.
Larry Henning (43:44):
Thanks Chris, appreciate it guys.
Thanks Larry.
Hello everybody and welcome to Adjusted.
I'm your host, greg Hamlin,coming at you from beautiful
Birmingham, Alabama and BerkeleyIndustrial Comp.
And I wanted to start thisepisode with a fun fact.
Did you know?
According to the NationalInsurance Crime Bureau, fraud
may be involved in 10% of losses?
(00:32):
So today we're going to beexploring fraud in claims in
insurance, and with me today ismy co-host, Chris Drake.
Chris, do you want to introduceyourself for folks?
Chris Drake (00:44):
Yeah, I am in hot and steamy Indiana at this point
.
I'm a claims manager atBerkeley Industrial Comp and
I've been in the industry forabout 16, 17 years.
Greg Hamlin (00:55):
Excellent.
I don't even want to hear it.
I grew up in Indiana and Iwould take an Indiana summer
over an Alabama summer almostany day.
I took the kids to the pool theother day to cool off and
jumped in and it felt like a hottub because it's been so hot.
The pool's like as warm as itis outside.
So with us also today is ourguest, larry Henning.
(01:16):
He's a senior vice president ofanti-fraud and special
investigations at AlliedUniversal Services.
Larry, if you could say helloto everybody.
Hey, everyone, and thank youfor having me today.
Larry, if you could say helloto everybody.
Larry Henning (01:25):
Hey everyone and thank you for having me today.
I appreciate it.
Looking forward to it.
Greg Hamlin (01:30):
And Larry, where are you out of?
Larry Henning (01:31):
I am in High Point North.
Greg Hamlin (01:33):
Carolina.
I know exactly where that is.
They have a baseball team there.
They're like the rocking chairsor something.
The Rockers, yep, the Rockers.
So you're like in the furniturecapital of the world.
Larry Henning (01:44):
I absolutely am known for that and have people
from all over the world comingtwice a year to showcase their
wares.
Greg Hamlin (01:53):
So we have a fellow Berkeley company that's right
there in High Point in key riskinsurance.
So shout out to my key riskfriends, they have their office
right by that ball field they doright at the stadium itself.
So they've got a pretty coolspot.
I'm a little jealous.
Especially this time of year.
I bet it's fun to hang out andwatch a game after work.
(02:14):
So, larry, I wanted to startthis conversation talking about
the topic of fraud.
That that's where we were goingto go today.
When you were growing up, inyour career day in kindergarten,
larry, did you see yourselfending up in this special
anti-fraud specialinvestigations?
Larry Henning (02:33):
In insurance absolutely not but in
investigations and lawenforcement.
That was the only career that Ireally had ever wanted was in
investigations, so, and I'vebeen doing it now for 47 years.
Greg Hamlin (02:47):
So how did you?
How did you get into theindustry?
Larry Henning (02:50):
Well, that's a.
It's a great story.
I actually started off in lawenforcement.
I was doing an internship incollege at a law enforcement
agency in Metro Atlanta.
While I was there the chiefasked me was I interested in
being in the academy?
And I said, well, I haven'tapplied or anything.
And he put right through and intwo weeks later I was starting
(03:13):
the academy.
So I worked law enforcement forabout 13 years and I was
approached if I'd be interestedin the special investigation
unit.
Working insurance fraud had noidea what the SIU was.
We had worked some cases andpresented on insurance, but that
(03:35):
was early in the startups ofSIUs back in 1989, 1990.
From that it was an easy callhey, 1989-1990.
From that it was an easy callhey, we'll double your pay, you
won't get shot at, you won'twork nights and weekends.
So, being newly married withjust a couple small kids, that
was an easy choice to make.
Greg Hamlin (03:55):
You're like I'll take it, I'll take it.
That's wonderful.
Chris Drake (04:02):
Your life insurance carrier loves it too, for sure.
So, larry, what types of fraud?
Larry Henning (04:08):
have you seen in the industry?
Well, it really runs the gamutwhen it comes to insurance,
because of not only propertycasualty and everything that
entails, and then over on thelife, health, disability,
certainly the different variousspecialty lines.
There really is no part ofinsurance that's immune to fraud
(04:29):
, whether that's from a claimperspective, from underwriting
and unfortunately, on occasion,internal as well.
Greg Hamlin (04:37):
So you know, I've always I've spent most of my
career on the claim side andI've seen a little of some of
the others, but claims is whereI've spent most of my career.
Many insureds that I've workedwith have injured workers that
they don't care for.
Once they file a claim and theysay it's fraudulent.
And there's a big difference, Ithink, between somebody who
(04:59):
maybe is not an easy person towork with and fraud.
So, larry, from yourperspective, being in the
insurance industry, as long asyou have what are some of the
indicators that help yourecognize, maybe there's
something more to this claim andit's not just an insurer who's
frustrated with an individual,but there's something else here.
Larry Henning (05:21):
Yeah, and this really goes across any kind of
claim type.
But it's inconsistency in thestory.
When someone reports a claim,no matter what it might be and
we'll use some examples, but nomatter what it might be and they
report that claim to theinsurer.
Let's say it does involve aninjured worker, so it's workers'
(05:42):
compensation, and they reportthis to their employer.
Then they tell friends about it, they go to the doctor and they
tell the doctor about it.
Maybe they've gone to urgentcare or an ER and they've told
them the story of what happenedand why they got hurt or how
they got hurt.
And when all of those storiestend to be different that's what
(06:05):
I mean by inconsistency andwhen we don't look at that level
of detail and pay attention toit, we might miss it.
Greg Hamlin (06:14):
That's a great point.
So if and I've actually seenthis in my career where some of
those inconsistencies, maybe afull investigation wasn't done
on the front end of the claimand some of those
inconsistencies weren't figuredout until months and months
later, and then at that pointthe toothpaste is kind of out of
the tube right, it becomes alot more difficult.
(06:35):
What are some of the thingsthat an adjuster could be doing
to investigate to make sure youknow they're catching things and
they're not in one of thosereactions where nine months
later we find out the doctor'sreport doesn't match this, the
statement that was never takendoesn't match the witness
statement, all these types ofthings.
Larry Henning (06:58):
Yeah, there's several, but I always like to
start with, especially when I'mtalking to a group of adjusters
or even a group of newinvestigators.
And that's two key things.
One, listening.
My grandmother always told me,larry, they gave you one mouth.
God gave you one mouth and twoears for a reason he really
(07:20):
wants you listening more than hewants you talking.
So listening skills are huge.
If I can digress for a second,one of the very first cases when
I left law enforcement and wentover to insurance as an SIU in
the Atlanta area it was a bigfire case Chief claim officer
there in the Atlanta officebrought it to me.
(07:41):
I literally was my first day onthe job.
I looked at the file.
I said can I go out to wherethis house burned down?
And he said, yeah, it's still ascene, nothing's been touched.
It was, the fire was a coupleof weeks ago and on the way you
have to remind this goes back to1990s.
So I took the cassette tape andput it in the player in the car
(08:05):
to listen to the large lossadjusters interview on my way to
the fire scene.
And I'm listening to this tape.
The adjuster did a great job.
This was a 20-year adjuster Dida fantastic job, asked
everything I probably would haveasked and, at the end of the
(08:27):
tape, theial question.
Thank you very much.
I appreciate your help and theinformation you provided.
I have one final question.
Did you have anything to dowith the starting of the fire at
your home?
And the response on that tape?
Yes, but I really didn't have achoice.
And the next words out of theadjuster's mouth is thank you
(08:49):
very much.
Today's date is such and such atime.
It's time is such and such.
Thank you for your help.
I almost crashed the car.
I got back to the office, toldthe chief claim officer.
I said you can deny this claim.
I said I'll give you more ofthe detail, but this was an
intentionally set fire done bythe insured.
(09:11):
Well, how do you know that?
I said because he admitted toit.
So I played the tape for him.
They died laughing.
I mean, they just could not.
And I say that because oflistening Back to that.
We get so ingrained in what wethink we should be hearing.
Next, stuff goes right over ourhead and we don't hear it, even
(09:35):
though it was said.
So, listening number one, skillNumber two is, when we're
asking questions, what we reallywant to arrive at at the end of
that interview the who, what,when, where, why, how and how
much.
When you're getting the answersto those questions, you've
(09:58):
probably done a pretty darn goodinterview.
Chris Drake (10:02):
Those are both really really good points.
I think I don't know if you canput enough emphasis on active
listening, right?
I think that goes to the pointwhere you're hearing what you're
hearing, but something stilldoesn't add up, and at that
point in time you know somethingneeds to be further
investigated.
So what other tools can beutilized?
If you come up with a situationlike that and you understand
(10:24):
something just doesn't seemright, my gut seems off.
What else can you do toinvestigate the claim?
Larry Henning (10:30):
Well, what you're looking at is again back to the
.
You're identifying thoseinconsistencies.
What conflicting information doyou have?
And then what are those avenues?
Whether it be a tech tool, adocument, a record of some kind,
when can I go and find out whatthe facts are to resolve this
(10:55):
inconsistency?
And I think that's probably thebiggest thing is developing a
lead and then following thatlead.
I think one of the things thatfor investigators especially,
and certainly adjusters becauseadjusters just don't that's what
they are.
Adjusters are investigators.
They just happen to do all theinsurance process policy
(11:17):
interpretation, settlementevaluation.
They do all those extra thingsthat the SIU investigators
typically aren't doing, andthat's why it's good to rely on
those investigators and theywork in partnership with the
adjusters to get to the facts.
I think we'd all agree thatinsurance carriers hey, we just
(11:39):
want to resolve this withinformation that's accurate.
If we owe and we need to paythis claim, then great, we'll
pay it.
But if we don't owe it orthere's some provision of the
policy that excludes certaincoverages, or there's some
provision of the policy thatexcludes certain coverages or
there's certain conditions inthe policy that might exclude or
(12:00):
limit certain pieces, thenthat's what we follow.
I think those are key, butdeveloping leads, following
those leads sometimes that'sgoing out to get a medical
report could be a police reportIn a vehicle situation, whether
it be a collision and it'ssimply a auto liability bodily
injury claim or it's a worker'scomp, but it happened to be
(12:23):
because they were out in avehicle for work and got
involved in the collision.
But think of the telematics thatare in vehicles nowadays,
especially since around 2016,2017.
And prior to that and even instill vehicles, obviously on the
road today the EDR data fromthose vehicles and what it can
tell you and whether thatmatches up with the story.
(12:46):
So you take the original storyand then you look for ways to
confirm it.
I'm always a big believer in ifyou act in good faith in your
investigations, if you act ingood faith in your adjusting,
which means, hey, this is whatthe insured or this is what the
claimant told me, I'm going togo find the evidence and the
(13:09):
facts to support what they justtold me.
And if it's not there and theevidence and the information is
contrary to that, well so be it.
But you do it in the mindset ofI'm out there to find something
to support what they've told me.
Greg Hamlin (13:27):
Larry, I think that's a really good point and
you know, sometimes carriers geta bad reputation for or at
least I think a lot of theplaintiff attorneys like to run
commercials that make it soundlike insurance carriers are
always looking for ways to denyclaims, which really isn't true.
I think you pointed out areally important thing.
We want to confirm the factsand what works best is when
(13:48):
everything lines up and we canprocess the claim and move
forward and it paid out if itneeds to be paid out, or get the
person the treatment they needif it's a workers' comp claim.
But I think the good faithpiece is really important there
that you mentioned One thing forme.
You mentioned cassette tapes.
I'm old enough that I remembercassette tapes.
I made mixed tapes for mygirlfriends in middle school
(14:11):
back in the day tape recordingstuff on the radio, so I can do
that and I actually remember inthe very beginning as an
adjuster we still had cassettetapes at the very beginning of
my career.
Obviously, so much has changedin the last 20 years I don't
know like my kids today.
There's probably a recording ofalmost everything they did.
I grew up in the nineties soI'm kind of lucky that there
(14:32):
weren't phones with videos onthem of all the dumb stuff I did
.
Just lives back in the 90s.
But you know, now reallytechnology is everywhere.
How have you seen that changeinvestigations from maybe back
when you first started to now?
Larry Henning (14:49):
It has been huge in the changes.
Because I'm older, I'd like tothink, maybe wiser, certainly
more experienced, but in thevery early days there weren't
even mobile phones.
We had pagers and you got apage and then you stopped at a
pay phone and then called, tookto whatever you needed to call.
(15:12):
So it has really evolved.
But from investigator tools of,like I said, cassette tapes
through to digital recorders,and now even digital recorders
are seldom used because a lot ofthe recordings are direct to
the cloud.
There's other types of devicesthat you can use now that you
(15:34):
record and it actually producesan immediate transcript within
seconds.
Push a button and it creates asummary of what that interview
was about in a matter of 15, 20seconds and you have a pretty
detailed summary document aswell.
So that really speeds up andreally aids.
(15:54):
In the old days you took a lotof notes and that's one of the
things that you have to becareful about If you're busy
taking so many notes, you mightmiss something.
Back to the listening part thatI talked about earlier.
So technology has reallyimproved for you to be more
accurate, more detailed, withless actual manual effort to do
(16:19):
that.
You know one of the tools thatwe initiated even prior to COVID
.
I think we launched about ayear or two before COVID but
it's called InView Interview,like we're on this call.
But InView is actually asoftware that is more secure,
can't be hacked, has the dataprivacy and security features to
(16:46):
it.
But in doing that InView or theinterview, like what we're doing
today with a video, I can bringin maps, I can bring in
documents, I can bring in photoimages so I can be talking to
somebody and interviewing themanywhere and conduct a pretty
extensive interview andinvestigation virtually but
still see the person to what youcan see on camera.
(17:12):
So it may be from like theshoulders up, but it's still
pretty effective in producing itthat way.
And then when COVID hit andeverything went virtual just
think about their most specialinvestigation units, most SIUs
for insurance companies, whetherthey were with the insurer or
(17:33):
contractors such as myself mosteverything was in person.
With COVID almost everythingwent virtual for a year and a
half, two years.
And now insurers learned hey,you can actually do some really
effective investigationsvirtually and eliminate travel
time, travel costs, you know,capacity to handle more cases in
(17:56):
a shorter period of time can goup.
So there was a lot of benefitsof technology that were really
had to be hot tested, like Ilike to call it, during COVID,
because it was necessary to dothat.
Chris Drake (18:09):
Are you seeing any change to where people are doing
more in person, or is it morevirtual at this point, since
you've had such great successwith it?
Larry Henning (18:17):
It's a big mix.
Yeah, I've seen severalinsurers special investigation
units convert a significantportion of their staff to
virtual doing desktopinvestigations.
Here in my own company I haveover 500 investigators employee
investigators just here in theUS.
About 35 of those are desktoponly.
(18:40):
The rest are in the field.
But it depends on theassignment as to whether or not
it is done virtually or in thefield or a mix of both.
I'd say most SIU investigationsare a mix of both.
And then certainly thesurveillance investigators.
It's always in the field thatis not done virtually.
(19:03):
Now there's other technologynow deployed for surveillance
that is unmanned.
So you're using good techdevices to conduct that
surveillance.
Greg Hamlin (19:14):
Right, that's changed a lot.
I remember when I first startedit was always somebody
following somebody in a van, oryou know they'd have different
ways of doing it.
Now, cameras are so small thatI've seen those green utility
poles that look like they'rejust like a green utility
monster, and that there's acamera in there.
So it's a different world froma surveillance standpoint.
(19:37):
The other piece of that I'dlove you to comment on, larry,
is just how social media changedyour investigations.
You know, when I was growing up, there was no social media
where my kids you know, whetherit's they're taking pictures and
sending it through social mediaor they're hanging out in
different ways.
I think we communicate a lotdifferent than we used to.
Larry Henning (19:58):
We do.
And just think about it.
If an event or incident of anykind occurs out in public and
this doesn't mean violent oranything like that, but just it
causes a disturbance, wheresomething happens and people
take notice, what's the firstthing you see?
If you're out there as well,everybody's holding their phone
(20:21):
up recording what's going on,yeah, and it's getting posted
out to social media somewhere,and these are uninvolved people
to the event that are doing that.
So, yeah, it is greatlyenhanced the ability to find out
some information about an event, about an incident car crashes,
(20:42):
work comp type cases, reallyany type of insurance loss you
can think of.
There's the potential ofgaining valuable information
through social media.
Now, you can't always believewhat you're lying, I see, so you
have to do some authenticationand validation of what you find
(21:05):
on social media as well.
Greg Hamlin (21:07):
Yep, well, and another question I had on that,
larry.
So let's say I'm the ambitiousadjuster.
There's a lot of obviouslythere's a lot of laws around
what you can do as far as socialmedia goes, and this is why a
company like yours is important,because if someone on my staff
was to create a fake socialmedia account and then use that
(21:29):
account to try to maybe capturesomebody or catch somebody in a
lie, there's obviously someconcerns with that.
And so what are some of thethings you do when you get that
kind of referral that makes surethat when you're doing these
investigations, we're followingthe laws and we're not doing
anything that entraps people orcauses people privacy issues.
Larry Henning (21:52):
Well, and those are great questions.
Probably one of the number onething that comes up when I talk
to chief claim officers aboutsocial media is like I do not
want my adjusters and my staffout on social media because it's
a big time drain and it's a bigblack hole and they just don't
(22:13):
have time.
And I totally agree with that.
Yes, there are differentprivacy issues.
There are certain legal thingsthat you need to be cognizant of
.
Yeah, I'll use the word, eventhough it's not appropriate for
all social media, but you don'twant to have someone go out and
friend that individual you'relooking for Again, whether it's
(22:38):
using a fake account, a realaccount, it doesn't matter but
to make contact with them,especially if they're a
represented individual, if theyhave an attorney.
So the best way to enhance anddo social media and how we
operate is we use computeralgorithms.
We use algorithms to tell itthis is who we're interested in,
(23:03):
this is what we're looking for,and then the algorithms then
search.
So because it's there'sliterally hundreds and hundreds
of social media type sites thatare out there.
So using a computer to go look,I would tell adjusters probably
if there was a single piece ofinformation for us to have
(23:28):
before we started a social media, and we want quite a bit, but
the one that is really, reallyimportant is the personal email
address of that person, becausemost people set up their social
media accounts with theirpersonal email.
So that is one of the keypieces of information to look
(23:49):
for.
Yes, we want name and addressand whatever identifying
information they have as part ofthat claim.
The other thing we do with thealgorithms is we look for is
this involving an injury?
Is this involving some othertype of claim that's not injury
related?
Because we really want to lookfor things that may be relevant
(24:14):
to the loss that we'reinvestigating and that the
adjuster is looking at.
Once the computer pulls all thedata down, then we actually
have an analyst, a human being,that is now looking at it to
make that determination.
Is this or could this berelevant?
Because otherwise, almost everycase involving doing a social
(24:37):
media search, you're going tohave hundreds and hundreds and
hundreds of pages of stuffthat's worthless.
So you're looking for the linksand the data that may mean
something to the client or couldmean something, or absolutely
does mean something to theclient.
Chris Drake (24:58):
I think that's huge too, because you may have some
people that post so limitedinformation and are very, very
private, and then you haveeverybody that's going to give
you a real-time update on everysingle thing they do.
And I think you could haveinjuries where somebody is
posting about an injury fivedays before it's the weekend.
They go back in on Monday andthey report a work-related
(25:20):
accident and you can go back andpreview their social media from
five days ago and see they areactually injured.
They are not at work.
So it's awesome, it'sdefinitely an awesome tool.
And it tells me too you got to.
You got to watch that digitalfootprint.
So, greg, you better startdeleting some of your accounts
real quick.
He's going to find you.
Greg Hamlin (25:38):
I got to stop dancing.
I got to stop dancing and putmy videos up, right With my kids
.
Larry Henning (25:43):
Yeah, one of the things that's really important
it's social media related, butit's not necessarily to a person
at the time, but especially ifthe event you're interested in
occurred out in public, go backto the scenario we talked about
(26:03):
a few minutes ago.
It may not be that insured orclaimant, whoever it might be,
it may not be their social mediathat I'm really looking for,
but I don't know who's I need tolook at.
So we've got a product calledgeo intel and you're geo fencing
a physical area with GPScoordinates.
You're putting in some date andtime ranges and then you're
(26:26):
putting in the type of eventlet's say a car crash that
you're looking for and then youlet the algorithm go out and
look for any posting by anybodyinvolving a car crash between
that date and time range withinthis geo-fenced area, the GPS
(26:51):
coordinates, and then see whatit returns.
I mean, we have locatedliterally witnesses to an
accident in which everyone thatbecame known to the police said
party one was at fault.
They did this, yet the videodoesn't support it and you find
(27:13):
a witness who gives you a pieceof information and they have
video of their piece thattotally refutes what the
original belief was as to whothe at-fault party was.
So you find witnesses, you findactual video of either the
event as it occurred or theimmediate seconds afterwards,
(27:36):
because, think about it,somebody sees it, or they hear
the crash and immediately thephone goes up.
So they're really recording theimmediate after events of the
crash, not the crash itself.
But that's very helpful,because the other thing the
boots on the ground piece wouldbe for the investigator to go
out and literally look forcameras in the area.
(27:59):
I mean, we do that frequently,whether it be public cameras on
the sides of buildings, theycould be street cameras run by
the local public entity, orpotentially they're cameras on
private residences or businessesthat may capture something.
You knock on the door and tellthem what you're doing and maybe
(28:19):
they could help.
Sometimes they do and sometimesthey don't and maybe they could
help.
Greg Hamlin (28:23):
Sometimes they do and sometimes they don't.
That's a great point.
That's a great point.
And it's very rare anymore that, like you said, somebody didn't
get a video of it, whetherthat's a surveillance video that
was there for security purposes, or a door cam or somebody's
phone.
That's a great point.
One of the things I really likedthat you said earlier that I
want just to circle back on wasthe importance of I think we
(28:48):
talked a little bit abouttrusting your gut but asking,
continuing to ask follow-upquestions, and you had mentioned
like that example of theadjuster who kind of was
following a script it soundedlike and then once they finished
their script, they were doneand they didn't ask additional
questions.
And you know we have a prettyspecialized catastrophic team
and I can think of one verychallenging claim that happened,
which was very difficult, andthe injured worker story didn't
(29:10):
sit right with the adjuster Likesomething just didn't feel
right about it and it was anafter work party.
You know that was a companyevent, so this wasn't like a
normal business workers'compensation accident.
But as she took the person'sstatement, it raised some red
flags and she got hold of awitness and the witness
(29:32):
statement just didn't feel rightand so then she kept going and
there was another witness thatwas there that day that she
tracked down, and that witnesshad a completely different story
, where the person was under theinfluence and made some really
poor choices and said somethings that were pretty bad and
actually kind of caused theinjury to occur by their actions
(29:55):
, clearly became not awork-related injury, but at
first blush, if you had justtaken the one statement and the
friend who was a witness, theclaim would have been accepted.
Larry Henning (30:07):
So when do you see that gap?
And that's a great example,because you know earlier when I
talked about the who, what, when, where, why, how and how much.
There's also another aspect,and this is why interview
training is so important forclaim staff, and not just one
(30:28):
time, but probably somerefresher training every few
years as well, because eveninterviewing evolves.
But a lot of interviewing issimply common sense.
So one of the things I like totrain folks is, anytime somebody
when you're interviewing them,if they introduce a person,
place, thing or event in theirstory, you need to dive down
(30:53):
into those things to identify alittle bit more information.
And I'll use this example basedon what you were just saying.
Saying in that example,somebody may talk in their
interview and say, yeah, beforeI went to the party, I had
stopped at my brother's houseand then when I left there and
(31:13):
most I would say most peoplewould not come back who's your
brother?
Where does your brother live?
What's his address?
Your brother live, what's hisaddress?
Because it could be that smalldetail that later and you later
on you go find out you talk to.
I haven't seen my brother intwo weeks.
I don't know what the heck he'stalking about stop.
So why would he provideinformation?
(31:37):
That's not true?
That doesn't appear to berelevant to our story.
Now it takes more inquiries.
Okay, why was that brought upand why might it be relevant?
So it's when they introduce.
It could be my friend was inthe room and then they left.
When this occurred, whatever theevent was, and a lot of people
(32:01):
would never go back.
They think in their mind well,my friend, the person was not in
the room when the event ofCasey's Head, my friend left the
room and they would never go tofind out who is my friend.
Because that person potentiallywill have important and
(32:22):
relevant information.
That's material to that claim,because maybe they were there,
maybe they weren't, but if theywere, maybe they didn't quite
leave the room as fast as theother person thought and they
actually saw what happened.
So those are examples of divingdown into the person, place,
(32:45):
place, thing or event in thestory, get more detail.
It's a lot easier to get it upfront than to come back and get
it later.
And with that said and I knowthis is probably quite a bit
about interviewing, but probablyone of the last things I made a
practice of early on in aninterview would be.
(33:05):
Hey, Greg, I really appreciateyour time and you gave me some
great information and it'sreally going to help us make an
informed decision.
More than likely I forgotsomething, so would it be OK if
I reach back out and did afollow up and maybe ask the
question that later on I forgotI should have asked?
I don't think in my career I'veever had anybody tell me no,
(33:30):
and so when I do call back, it'snot a surprise, it's not a
shock.
They're more at ease and Iusually am able to get the
additional information I'mlooking for without any trouble.
Greg Hamlin (33:43):
It's a good point and I think getting the details
is so important when we'reinvestigating claims and then
knowing when to make thatreferral to whether that's to a
company like you.
Now, in some cases there needsto be a referral made to the
state and I think that can beconfusing for adjusters to know
every state's different.
Larry, when do we let the stateknow that we think, wait a
(34:07):
minute, this is, I mean, this issomething they need to be
notified of reportingrequirement when fraud is
suspected.
Larry Henning (34:22):
Most of the state statutes are.
If you put them all side byside, most of them read very,
very similar and the thresholdfor reporting in most states is
reasonable suspicion.
I like to tell groups when Italk with them hey, there's 20
(34:47):
people in the room If I tell astory on a claim and give the
red flags as to why I'msuspicious about this particular
claim and either everyone orthe majority of people in the
room agree, yeah, I'd besuspicious of that too.
You just met the threshold forreporting in most states.
You have the state of Wisconsin.
There's laws a little different.
It says you must have evidenceof fraud to be required to
(35:11):
report.
In the state of Wisconsin it'svoluntary to report it if it's a
reasonable suspicion, but it'srequired if there's evidence.
Again, most states it's justreasonable suspicion and that
makes it required.
And then you have the state ofCalifornia, whose actual statute
still says reasonable suspicion, but they have interpreted
(35:36):
their own law to now say theremust be evidence of a material
misrepresentation.
So that's the languageCalifornia uses now is material
misrepresentation and evidenceof that material
misrepresentation and then it'srequired in the state of
California.
(35:57):
It's unfortunate, you'veprobably seen it in industry but
Illinois just came out andreinterpreted their statute
saying there's no mandatory atall to report to the state.
It's all voluntary if you wantto.
The law didn't change.
They didn't change the statute,but the Department of Insurance
(36:20):
changed their interpretation tonow it's totally voluntary in
the state of Illinois and it'sunfortunate.
I think there's some industrygroups that are trying to make
some inroads to the statelegislature and some other
groups to try to get back towhere it's a required action
like most other states.
Greg Hamlin (36:43):
That can be.
I mean, and when you make thosereferrals, how often does the
state?
And I know it's probablydifferent from state to state,
but I mean, do you see the stateactually take action on very
many things?
Or are there sometimes you knowyou're doing the steps, you're
following the protocol, and thenyou don't hear back or maybe
they don't do something.
Or have you seen cases wherethey get involved and they
(37:04):
actually start to press chargesat a state level?
Larry Henning (37:08):
They do, and think of it this way.
You have, of course, hundredsand hundreds and hundreds of
insurers out there.
So you have thousands andthousands of claim staff,
underwriting staff, others, butthe vast majority of referrals
are in fact from claims by farnumber one.
Then you've got third-partyclaims administrators, you've
(37:30):
got MGAs, mgus, you've got allthese industry people who now
have some requirements to reportand they do so.
The states get inundated inmany cases with the referrals.
So the states get inundated inmany cases with the referrals.
So many of these states havecreated their own databases.
To me it's reasonable If, all ofa sudden, the state gets a
(37:51):
referral on Larry from carrier B, from carrier C, all of a
sudden five or six differentcarriers all report Larry
involved in a suspect claiminvolving an injury in the last
90 days, the state's going to gohmm, I think we're going to dig
(38:13):
into this one, because nowwe've got the same Larry at the
same address, with the same dateof birth, filing an injury
claim with six differentinsurers in 90 days.
I think that would make all ofus go hmm, something's here.
I'm aware of one state that isjust starting a pilot of using
(38:35):
some rules-based type technologyfraud detection technology to
help them with all the datathat's coming in from all the
different carriers.
But using some rule-based frauddetection technology to assist
them in identifying the cases inwhich they should actually open
(38:58):
a case and assign to one oftheir investigators Makes
perfect sense to me.
A lot of insurers at my companywe use fraud detection
technology, the clients andtheir data and then we see the
rule triggers a referral.
The SIU triages that referral.
Is this a false positive or isthis an actual case that should
(39:22):
be investigated?
And then proceed from there.
And by doing that triage youstart training the model as to
what's really a good rule andwhat's accurate and what kind of
rule.
Maybe the rule needs to betweaked some.
Maybe the weights of thoserules, maybe the weights of
(39:46):
those rules.
And there's a lot of differenttech tools out there in the
industry available that areeither predictive model or
rules-based, and a lot of AI isbeing generated with it now as
well.
Greg Hamlin (39:53):
A whole new frontier.
It's a whole new frontier.
We started talking about AI.
Larry Henning (39:58):
It is.
It changes drastically, almostweekly.
Is there something new comingout?
Greg Hamlin (40:08):
It does, it does.
My kids are going to grow up ina very different world.
I know that much Just seeinghow that's working Well, larry,
I really enjoyed having you onthis episode.
One thing that I've tried tomake a habit of is putting good
vibes back out in the universe.
I felt like there's so muchnegativity, and so one of the
things I've focused on in my ownpersonal life is trying to be
(40:31):
more grateful, because I thinkit's easy to forget how
wonderful life is, and so one ofthe things I've been asking
each of our guests over the lastseveral years is to share
something they're grateful for.
So it could be anything youwant, but something that, to you
today, you're grateful for.
Larry Henning (40:48):
You know, I think everybody would probably have a
very common thing, and that isfamily and friends.
You know my faith.
All of those things matter agreat deal.
My most recent thing and I'lluse as an example is in February
.
I was fortunate to gatherfamily and friends from all over
the country for my mom's 90thbirthday.
(41:09):
That's great Was still living inher own home down in Florida
and doing well, yeah, couldn'tdrive anymore, do any of those
things, but she was gettingaround and playing games on her
phone and she'd FaceTime you.
She was really active with thatand she'd FaceTime you, and so
she was really active with thatand she suddenly passed in March
.
I'm sorry, but by having thatexperience, with everybody
(41:34):
gathered together in February, Iwas very grateful that that
happened.
That's my most recent thing.
Greg Hamlin (41:43):
No, that's wonderful.
I had the opportunity.
So before I, ever after Igraduated from high school and
before I went to college, Ispent a couple of years out West
on the Navajo reservation as amissionary and my mission
president was a huge influenceon me as a young as a young man
and recently went into hospiceand he because he's kind of a he
(42:05):
was a tough guy.
He said I'm going out on my ownterms, I'm inviting everybody
to a party to say goodbye, andliterally from all over, we, we
flew out to see him and he has.
He's still in hospice.
This was a couple of months ago, but I'm so grateful that we
had that opportunity.
It was like a really awesomereunion and there was so much
(42:26):
love there of and it was awesomejust to see like this has been
25 years.
But look at all these peoplewho have kids, grandkids, that
have all been impacted by thisperson and and the kind of life
he lived.
So I love that.
Larry Henning (42:41):
Greg, you talked earlier with your kids, and I'm
fortunate that I have fivegrandkids and so you'll have
those down the road.
That's right.
Greg Hamlin (42:50):
Hopefully not too soon, but yes but hey, grandkids
are awesome, Absolutely awesome.
I can't wait.
I can't wait.
I'll never see my wife again.
I know that.
So once they come, that'll bethat.
So she'll be like I don't wait,I'll never see my wife again.
I know that.
So once they come, that'll bethat.
So she'll be like I don't careif you retire tonight, I'm going
to be gone chasing them.
So well, larry, I've certainlyenjoyed meeting with you.
(43:12):
We will remind our listeners,if you like the episode, to go
ahead and get us on your podcastplatform, and we'd love it if
you give us five star rating andleave some comments and
feedback so other people canfind this episode and also just
remind our listeners to do right, think differently and don't
(43:32):
forget to care.
And we will continue releasingepisodes every two weeks, like
we have for almost the last fiveyears.
So we hope you continue tofollow and share this with your
friends.
Thanks Larry, thanks Greg.
Larry Henning (43:44):
Thanks Chris, appreciate it guys.
Thanks Larry.
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