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

2022 Workshops

(Subject to Change)

2022 NJSIA Seminar Booklet.pdf

Auto Theft Trends

                                                                     

This workshop will discuss stats, trends, and where we are failing in respects to auto theft prevention (victims, law enforcement, the court system, insurance companies), and what needs to be done to correct the explosion of car thefts.

Cory Rodriguez

Detective Sergeant Cory Rodriguez is assigned to the New Jersey State Police, Motor Vehicle Crimes North Unit, Auto Theft Task Force.  He has been a member of the New Jersey State Police for over 15 years. DSG Rodriguez has attended the New York Police Department Auto Crimes School, Interpol's Project Formatrain, is an IAATI Certified Vehicle Crime Specialist, a certified Berla vehicle forensics investigator, and a Certified Fraud Examiner.  DSG Rodriguez is a member of the International Association of Chiefs of Police Vehicle Crimes Committee and the NMVTIS Law Enforcement Sub-Committee. He is also 1st Vice President of the Northeast Chapter of the International Association of Auto Theft Investigators.

Ross Soares

Detective Ross Soares is assigned to the New Jersey State Police, Motor Vehicle Crimes North Unit, Auto Theft Task Force. He has been a member of the New Jersey State Police for 7 years. Det. Soares has attended the New York Police Department Auto Crimes School and is an IAATI Certified Vehicle Crime Specialist. Det. Soares is a member of the International Association of Auto Theft Investigators.

Biomechanical Expert Witness Presentation 


Kevin Toosi MD, Ph.D. 

Dr. Toosi will educate and explain in detail Biomechanics -what it is; how it’s used and applied within personal injury litigation; human anatomy and physiology; identify fraudulent injuries; mechanisms, forces applied within a particular accident and how to utilize Biomechanics in court.

Kevin Toosi MD, Ph.D.


Kevin Toosi, MD, Ph.D., is a Doctor of Philosophy in Bioengineering as well as a Medical Doctor. Dr. Toosi has handled over 1000 cases involving automobile, pedestrian, slip and falls, general liability and premises liability which involve the application of Biomechanics in determining whether the forces and injury mechanisms were present in the subject incident to have caused the alleged injuries. Dr. Toosi is also an Adjunct Professor of Biomechanics at the University of Pittsburgh. Dr. Toosi has over 18 years as an Expert Witness in Biomechanics and has testified in over 200 cases across the U.S.

Bridging the CX and SIU Gap Through Analytics  

                                                                                                                                                

For years now the insurance industry has moved to enhance the Customer Experience (CX) by optimizing and streamlining the entire insurance and insurer-policyholder relationship process. These optimization efforts have led to quicker electronic web-based application processes and also low-touch or no-touch claims handling. Many in the SIU realm have viewed these changes negatively arguing that this puts anti-fraud efforts at a disadvantage and makes it harder to catch fraud due to the elimination of documentation requirements and human interactions in the insurance processes that have historically been critical to identifying suspicious claims and policies for investigation. In this session we will break down a counter argument to this negative viewpoint on CX changes in the industry and highlight how the very tools that enable these new streamlined customer interactions can be leveraged to surface potential fraud and areas for investigation. We will discuss how data analysis can help to identify suspicious networks and anomalies in electronic customer interactions through some key data points such as:

  • ·        IP Addresses
  • ·        Geo Data
  • ·        Device Data
  • ·        User Data
  • ·        Google IDs
  • ·        Behavioral Data

This data can not only highlight potential fraud but can also allow analysts to identify other threats such as cyber-attacks. As SIUs continue to adapt to these industry changes it is important that they also push to have a seat at the CX table to ensure technology and data decisions at an enterprise level can also be utilized to strengthen anti-fraud efforts. In this session we will discuss how SIUs can be better prepared and positioned for industry changes by pushing to have “Data” people in SIU leadership roles.

Mike Bento


Mike Bento is an Administrator overseeing the SIU Data Analytics, PIP and Medical Fraud Teams at NJM Insurance Group. He has 12 years of insurance industry experience with NJM, 9 of which have been in the SIU where he has worked as both a field investigator and data analyst before working in supervisory roles. Since 2017, Mike has led the Data Analytics group in its anti-fraud efforts by leveraging data analysis and intelligence gathering. The team is responsible for conducting data mining efforts to explore anomalies, as well as statistical analyses to identify patterns and trends related to fraudulent policies and claims in all lines of business at NJM. Mike holds both a Bachelor of Science degree and a Master of Science degree from the New Jersey Institute of Technology.

Loni Hand

Founder of Civility Solutions, LLC, Loni Hand is a visionary executive leader with extensive experience as a corporate attorney with a proven record of increasing organizational effectiveness and driving business value. Experience includes enterprise level responsibility for privacy and security; anti-fraud strategy and operations; and corporate anti-discrimination and harassment program. As Chief Privacy Officer, Loni advanced the corporate cyber security program, governance processes, and strategic objectives. As SIU Director & Counsel, Loni transformed NJM’s Special Investigations Unit into a regionally-recognized award-winning premier insurance fraud investigation organization. In re-envisioning the enterprise anti-discrimination and harassment program, she shifted the focus from traditional legal “do’s and don’ts” to civility-driven, scenario-based training. With strong skills in human development and cross-organizational leadership, she is able to communicate effectively at all levels from Board and Audit Committee to individual contributor. She is recognized as being capable of driving results and executing on key objectives with superior outcomes using a collaborative, emotionally intelligent style.

After earning a JD from Seton Hall Law School and an LL.M in Trial Advocacy from Temple University, Beasley School of Law, Loni served as an adjunct professor in trial advocacy. She is a Certified Insurance Fraud Investigator (CIFI) and Chartered Property Casualty Underwriter (CPCU).

Loni serves on the Board of Trustees of the New Jersey Special Investigators Association and lectures at national insurance fraud seminars and conferences.

As a former Assistant Prosecutor and Director of the Mercer County Prosecutor’s Office Child Abuse and Sexual Assault Unit, Loni remains committed to supporting and protecting children in our community. Loni sits on the Mercer County Commission for Abused, Neglected and Missing Children and serves as member of the Board of Trustees of PEI Kids.

Catastrophic Claims Investigations & SIU


Joey Cox

 Purpose:  To present to the insurance professional a systematic approach to managing Catastrophe Team Operations while focusing on the identification, detection and investigation of insurance related fraud that may be associated with these type losses. 

Joey Cox is currently employed as a Senior Investigator with Metropolitan Life Insurance Company’s Legal Division, Special Investigation Unit.   He has a forty-year history in conducting civil and criminal investigations as well as the management of investigative staff on a national level within the public and private sectors. He has served over eighteen years in the criminal investigative field where eight years were with the Criminal Investigations Division of the North Carolina Department of Insurance.

Mr. Cox has received numerous achievement awards and has completed his General, Intermediate, and Advance Law Enforcement certifications through the NC Department of Justice where he successfully completed certification in the Police Law Institute.

While serving as a Regional Manager with MetLife Auto & Home SIU, Mr. Cox developed, coordinated, and successfully implemented numerous programs throughout his career that includes a Vendor Management/Due Diligence Program, SIU Catastrophe Fraud Management Program, Fire Investigative Response Teams, Evidence Care, Control and Custody Programs, Underwriting/Risk Assessment Programs, as well as Fraud Management, Compliance and Predictive Modeling Programs profiling fraud and financial crimes and criminal behavior within corporate arena.

Mr. Cox has been certified as an instructor in several states through the Department of Insurance and NC Justice Academy where he continues to provide continuing education and training throughout the nation to various corporations, state, local, and federal law enforcement agencies.  He actively participates in several support organizations and groups focusing on fraud awareness, training and education and is currently serving on the CIFI Board & Continuing Education committees with the International Association of Special Investigation Units (IASIU).

Damage Analysis for Consistency and Detection of Fraud

Michael Price

This workshop is designed to assist participants with the determination of consistency between claimed damage and accident scenarios.  This course covers phantom vehicle claims, comparison between wall impact damage and vehicle impact damage, determining if the damage between two vehicles is consistent, and identifying pole or tree impacts versus vehicle impacts.  This course also provides information on multi-vehicle in-line collisions and the use of current vehicle technology to assist with the determination of consistency or fraud.

Michael Price

Michael Price, ACTAR                                    

Senior Consultant

Philadelphia, PA

Michael Price is a Transportation Consultant and ACTAR-accredited vehicle accident reconstructionist. His professional experience includes more than 25 years as a member of the Baltimore Police Department, eight of which include extensive experience as a K9 handler, and 13 as a crash reconstructionist. Throughout his career, he has investigated and reconstructed hundreds of collisions involving commercial and passenger vehicles, motorcycles, and pedestrians. As a forensic consultant, Mr. Price provides Rimkus clients in the northeast United States with vehicle crash analyses to determine cause and critical factors affecting the dynamics of collisions. He also performs inspections of the components of motor vehicles, motorcycles, seatbelts, and child safety seats. He has extensive training in crash scene mapping using a Total Station and hand measurements. Mr. Price has certifications in RADAR, LIDAR, and as a Bosch crash data retrieval technician and analyst. He holds an A.A. in criminal justice from Essex Community College.

Documenting Digital Evidence with Screenshots

Richard Frawley

This workshop discusses how to properly document mobile device evidence with screenshots to capture user and device specific evidence screenshots are used to document evidence or items of relevance on mobile devices every day.

Join Rich Frawley, Director of Digital Forensics Training at ADF Solutions, as he discusses the current state of acquiring data from mobile devices and how to properly document screenshots when acquiring application or device specific data. Investigators and examiners will walk away knowing screenshot basics, when screenshots should be employed, best practices, chain of custody, and how to make sure your evidence is reliable.

This is a beginner level session good for front line investigators, examiners, prosecutors, and anyone involved in the processing and reporting of mobile evidence.

ADF SOLUTIONS
11654 Plaza America Drive #501

Reston, VA 20190 USA

Phone:  301-312-6578

INFO@ADFSOLUTIONS.COM


Richard Frawley

Richard Frawley is the Director of Training with ADF Solutions and is responsible for all training content globally. Richard started with ADF in 2016 as a Digital Forensic Specialist and quickly took charge of creating the content to build confidence in the use of the ADF suite of tools. Richard has successfully transformed the in-person classes of old to a dynamic online and virtual experience. Richard spent 22 years in Law Enforcement as a Certified Forensic Computer Examiner and Cybercrime investigator before retiring and joining ADF Solutions.

Electric Bicycles, Low-Speed Electric Bicycles, Motorized Bicycles, and Complex Coverage Questions

Douglas M. Alba, Esq.

Nicolas Hamm           

More than 39 states have legalized the use of low-speed electric bicycles to some degree. Most states do not require the operator to be licensed or the bike to be registered or insured. New Jersey joined that group on May 14, 2019, and in less than 2 years the New Jersey Property-Liability Insurance Guaranty Association is seeing claims involving "electric bicycles" that are approaching 10% of the total new claims received under the Unsatisfied Claims & Judgment Fund. Understanding the legal requirements and the nuances of the different classifications and categories of low-speed electric bicycles, electric bicycles, motorized bicycles, and motorized and/or low speed electric scooters is sometimes difficult but necessary in determining if and where coverage may be found.

Electric powered transportation is not new. In fact, electric cars have existed since at least 1834, long before gasoline cars were invented, but the explosion in the use of and legalization of low-speed Electric bicycles and low speed electric scooters is only a few years old. This is likely due to several factors including the Green Movement, the reduced cost yet increased efficiency of battery power and possibly even COVID-19, because people in urban environments wanted to avoid crowded public transportation. Most insurance policies have not addressed the issue directly and few insurance companies are even aware that this could be an issue. Many police accident (crash) reports do not designate or have a place to identify if the  bicycle and/or scooter being operated by an involved person was powered by a battery or not. Additionally, many police officers do not understand the difference between a low-speed electric bicycle, which is likely legal in most states, and an electric bicycle or motorized bicycle that must be registered and insured and the driver licensed in most states. This is a new and burgeoning type of transportation, yet largely unregulated or supervised, that is poised to show continued and explosive growth.

By reviewing some definitions found in the enabling legislation and New Jersey statutes, providing a few case studies, and recommending methods of investigations, this presentation hopes to make you aware of this new and developing trend that we believe will become more common as the cost of batteries decreases and the amount of stored power in these batteries increase. Our goal is to increase your awareness and provide some knowledge as to how SIU can assist in investigating these claims and providing relevant information to the claims unit.



Kennedy Vuernick, LLC

The Meadows Office Complex

301 Route 17 North, Suite 800

Rutherford, NJ 07070                                                                      

E-Mail:    dalba@kvlawllc.com

Website: http://www.kvlawllc.com 

Tel: 201-636-9980  

Direct: 201-636-9987

Fax: 201-636-9990  

Douglas M Alba, Esq., Partner Kennedy Vuernick, LLC

Mr. Alba began his prestigious litigation career as a Deputy Attorney General in the Division of Law with the New Jersey Office of the Attorney General. As a Deputy Attorney General, Mr. Alba litigated civil fraud cases on behalf of the Medicaid program. He also served as Counsel to the New Jersey Spinal Cord Injury Commission, the Board of Nursing Home Administrators and the Department of Human Services’ HIPAA Compliance Committee.

During more than 18 years in private practice, Mr. Alba has represented insurance carriers in some of the most significant civil prosecutions under the Insurance Fraud Prevention Act. As recently as 2019, Mr. Alba was part of a litigation team that presided over a favorable jury trial verdict finding that numerous medical providers violated the Insurance Fraud Prevention Act. Additionally, in 2018, Mr. Alba obtained numerous favorable summary judgment decisions which held that: a chiropractor violated the Insurance Fraud Prevention Act; medical doctors violated the Codey Act; and medical doctors violated the Board of Medical Examiners’ regulations.      

Nicolas Hamm


Nick has over 45 years of investigative experience with more than 20 in the Special Investigation Units for insurance carriers following his 26-year career in law enforcement. He has conducted Complex-Major Case Investigations, managed a team of Complex-Major Case SIU Investigators across the country and for the past 10 years worked as the Director of Investigations for the New Jersey Property-Liability Insurance Guaranty Association where he built their SIU from scratch.
Immediately upon entering his second career in SIU, he realized he needed educate himself in the area of insurance and insurance fraud and he joined multiple fraud fighting organizations such as New Jersey Special Investigators Association and the International Association of Special Investigation Units where he continues to attend local and national training events. He also obtained The Chartered Property Casualty Underwriter, Associate in Claims, Associate in Management and Certified Insurance Fraud Investigator designations. One of the most gratifying aspects during his career continues to be teaching, mentoring then watching new talent succeed. This is especially true with the current SIU team at the New Jersey Property-Liability Insurance Guaranty Association.

Nick is married with two adult daughters and two active grandchildren and lives in north-central New Jersey. He enjoys fishing, hunting, and other outdoor activities when not working.

Electronic Vehicle Data: What a vehicle can tell you about the accident? 

Joseph Teitelman  

Electronic vehicle data has been a critical tool for accident investigators and reconstructionists since the first commercially accessible event data was introduced in 1994 by General Motors. With the ever-increasing amount of technology being implemented into new vehicles, the future of electronic vehicle data stretches far beyond the traditional “black box”. Collision reconstructionists are able to access more information than ever before from a multitude of computers located within the modern vehicle. ARCCA’s accident reconstruction experts are industry leaders when it comes to accessing and utilizing electronic vehicle data. Information imaged from event data recorders (EDR), infotainment/telematics units, and advanced vehicle data related to driver assistance systems will be explored and the many roles that this data can play in an investigation with be demonstrated.



Joseph M. Teitelman, B.S.M.E., ACTAR 

Mr. Teitelman is a Senior Accident Reconstructionist. His work includes the investigation and analysis of motor vehicle, pedestrian, and bicycle collisions. In addition to accident reconstruction, he is also certified and proficient in EDR (Black box) imaging and analysis, 3-D Laser Scanning, sightline analyses, scene documentation/diagramming and forensic video analyses. He performs vehicle, site, and evidence inspections and also investigates enhanced damages, staged collisions, and phantom vehicle incidents. He has training and experience with highly autonomous vehicles and advanced driver assistance systems (ADAS) and is certified as a BOSCH Crash Data Retrieval (CDR) technician. Mr. Teitelman is a certified pilot of Unmanned Aircraft Systems (UAS) by the Federal Aviation Administration and is experienced in the utilization of aerial photogrammetry in accident reconstruction.

He is also accredited as a Traffic Accident Reconstructionist (ACTAR #3858) and is an active researcher in the field of accident reconstruction whose peer-reviewed work has been published by the Society of Automotive Engineers (SAE). Mr. Teitelman earned his Bachelor of Science in Mechanical Engineering at Temple University, where he was a presidential scholar and a member of Temple University’s Honors Program. As an engineering student, he participated in collaboration with the Temple Robotics club in the NASA Robotic Mining Competition.

Highway Robbery: Combating Questionable Tow Bills

Adam J. Brand, Esq.

Inflation and fabrication of tow, recovery and hazmat invoices has become big business. With increasing frequency, towers are holding everything from heavy equipment to automobiles hostage while demanding payment of unreasonable invoices. Storage continues to accrue and insurers are regularly confronted with difficult choices to pay or fight. This presentation will outline ways in which to identify suspect recoveries and inflated/fraudulent invoices and provide strategies to investigate, mitigate and litigate these disputes.

Adam J. Brand, Esq.


Adam J. Brand, founder and managing partner of Brand & Tapply, LLC, represents insurance clientele in all phases of first and third-party coverage and litigation. Brand & Tapply, LLC specializes in combating suspect claims nationwide in virtually all lines of insurance. Mr. Brand has extensive trial experience before state and federal courts in complex coverage litigation, automobile, commercial and homeowner fraud and arson cases, as well as medical provider, bad faith and extra-contractual liability matters. Mr. Brand is actively involved in the insurance industry’s education efforts and has served as a panelist and lecturer at seminars and conferences sponsored by international, national and local insurance organizations.

Homeowner Claims-Fraudster Style:

The use of EUOs to Ferret out Fraud

                                                                                                                                     

The class will provide a brief history of the court decisions that established the right of an insurance carrier to conduct an EUO of its insured, including the information and documentation that it is entitled to obtain.

An analysis of 3 or 4 recent matters wherein the use of an EUO revealed evidence that either supported the carrier's denial of the claim or confirmed the facts of the claim as presented by insureds will be discussed. The claims that will be analyze will be homeowner claims involving a theft loss, a fire loss and a water damage loss as well as a collision loss to a vehicle. This portion of the class will be interactive.

Michael A. Soriano

Michael A. Soriano, a founding partner, focuses his practice on defense litigation involving matters of fraud, general liability and insurance coverage analysis. He has infused his 30 years of experience into successfully trying cases to verdict that involve homeowners such jewelry claims, roof damage, asbestos claims, fire losses and inventory fraud.

Prior to joining Bruno, Gerbino, Soriano & Aitken, LLP, Mr. Soriano was a senior associate with a law firm concentrating in the defense of cases involving suspected arson, fraud and exaggerated damages. 

When he is not in court, the New York native participates in a variety of seminars for claims professionals and special investigative personnel on topics including: The Conducting and Use of Examinations Under Oath, First Party Punitive Damages, Proof of Loss Defenses in Matters of Suspected Property Damage Fraud and Investigations of Suspected Staged Accidents.

With a Juris Doctor degree from Hofstra University School of Law and a bachelor’s degree in English from Hofstra University, he is admitted to practice in the State of New York and the United States District Court for the Eastern District of New York. He is also a member of the New York State and Suffolk County Bar Associations.

Richard C. Aitken

Richard C. Aitken’s practice includes the representation of national automobile insurance carriers in all aspects of coverages, involving matters of vehicular negligence, premise liability, no-fault coverage, insurance fraud, uninsured motorist claims, and underinsured motorist claims and coverage analysis.

Mr. Aitken has litigated more than a hundred declaratory judgment actions on behalf of carriers regarding staged and/or caused motor vehicle accidents; material misrepresentation in the procurement of the policy of insurance; and fraudulently incorporated medical providers resulting in significant savings for the insurance industry.

One standout was when he successfully defended MetLife, Inc. and Metropolitan Property in the matter of MARK SHAPIRO v. ANTHONY TARDALO, THE NATIONAL INSURANCE CRIME BUREAU, ET AL (Supreme Court New York County index # 157718/16). In this case, Dr. Shapiro sought millions of dollars in compensation after the federal government indicted, arrested, and prosecuted him along with dozens of alleged criminal co-conspirators in 2012 for insurance fraud. 

One of his other passions is education. When not in court, Mr. Aitken regularly leads seminars and training for insurance carriers on all aspects of insurance law. He has successfully assisted a national carrier implement an examination under oath protocol of suspect medical providers and claimants and has also provided seminars at the National Insurance Crime Bureau.

Prior to joining BGSA, Mr. Aitken was an associate with a small general practice firm where he concentrated in criminal defense, plaintiff’s negligence, and family law. He was responsible for handling all aspects of these matters from the inception through trial.

With a bachelor’s and J.D. from Ohio University and the Jacob D. Fuschberg School of Law, respectively, Mr. Aitken is admitted to practice in New York and the United States District Court for the Eastern and Southern Districts of New York. He is also a member of the New York State Bar Association.

Outside of law, he coaches soccer, basketball, and lacrosse for the youth sports leagues in his community in support of his two daughters.

How Data Analytics Uncovered an Unlicensed Provider Charging Insurers for…..Working Out?

Karen Weintruab

What does working out have to do with healthcare fraud?

After tackling the types of data methods to data analytics, investigators and analysts are tasked with assessing what’s a viable lead and the next steps in the process. Learn about how data analytics uncovered an unlicensed provider who was merely performing Personal Training services and billing as if they were a licensed provider providing medical services. The case incorporated data analysis, interviews, medical records, social media research, regulatory agency referral and investigation and more.


Karen Weintraub

With 25 years of data and 20 years of healthcare experience, Ms. Weintraub is currently responsible for the design and development of the company’s healthcare fraud detection software products and services. She provides subject matter expertise on system design and workflow, business rule development, data mining and fraud outlier algorithms as well as SIU policies and procedures. Prior to joining Healthcare Fraud Shield, managed SIUs on various healthcare investigations for all commercial, Medicaid and Medicare business and claims of fraudulent activity. Ms. Weintraub received a BA in Criminal Justice from the University of Delaware and an MA in Criminal Justice from Rutgers University. Ms. Weintraub is a Certified Professional Coder for Payers (CPC-P), a Certified Professional Medical Auditor (CPMA) from the American Academy of Professional Coders and the founder of a local NJ AAPC chapter. She is also an Accredited Healthcare Fraud Investigator (AHFI) from the National Healthcare Anti-Fraud Association (NHCAA). Ms. Weintraub previously taught CPT Coding, Fraud & Audits, and Medical Billing, Laws and Ethics at Mercer County Community College.

Insurance Fraud Trivia

Lee Befeler, Esq.

Daniel Johns

Do you consider yourself knowledgeable in the category of Insurance Fraud?  The question is, how much do you really know?  Come challenge your peers and join us for a fun test of your general knowledge while being educated about what you may not know.  This class is for everyone, no matter what line of insurance you work in.  Questions consist of general insurance and insurance fraud for property and casualty, workers compensation, health and NJ Legislation PLUS, it wouldn’t be trivia without some random fun off beat questions to keep everyone on their toes.  At the end, participants with the most points will have a chance to spin for their token prize, Atlantic City style.    

JAMES F. SULLIVAN*

GORDON S. GRABER* Ñ à

LEE SCOTT BEFELER Ñ

DANYELLE  H. GOLLAND

* Certified by the Supreme Court

    of NJ as a Civil Trial Attorney

Ñ Rule 1:40 Qualified Mediator

à Also admitted in NY

SULLIVAN AND GRABER

ATTORNEYS AT LAW

60 MAPLE AVENUE

P.O. BOX  912

MORRISTOWN, N.J. 07963-0912

TELEPHONE (973) 540-0877

FAX (973) 540-8019

www.sullivangraberlaw.com

NEW YORK OFFICE

5 Columbus Circle, 11th Floor
New York, NY 10019

(212) 835-9462 

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.

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

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.

Danielle Johns


Danielle Johns is currently a SIU Supervisor at NJ Manufactures Insurance Group, overseeing the medical investigations team.  She has been an insurance fraud investigator for the past 25 years in the private sector handling property and casualty case investigations inclusive of both personal and commercial lines of insurance.  Danielle’s expertise includes areas of personal injury protection claims, global medical provider investigations, workers compensation and premium fraud, rate evasion, thefts, and general liability.  She has experience with data analytics programs such as Netmap.  Danielle did serve on the board of directors for the New Jersey Vehicle Theft Investigators Association for several years, including serving as an Officer as Treasurer and Vice President.  Danielle also worked as the Investigating Manager at the Bureau of Fraud Deterrence managing the Major Fraud Unit.

Legal Trends in Fighting Fraud

                                                                                                                                  

Jeffrey G. Rapattoni, Esq.

Adam J. Brand, Esq.

Frank Sztuk (moderator)

Matthew Werbel, Esq.

The ever-changing landscape in litigation and regulation can be challenging for fraud fighters. Hear from leading fraud defense attorneys who are on the front line in the fraud fight on the current and emerging legal issues affecting the SIU Professionals.

Jeffrey G. Rapattoni, Esq.



Attorney at Law

15000 Midlantic Drive, Suite 200, P.O. Box 5429, Mount Laurel, NJ 08054
Direct: (856) 414-6076 | Cell: (856) 981-4156 | Main: (856) 414-6000 | Fax: (856) 414-6077

jgrapattoni@mdwcg.com

Jeffrey joined Marshall Dennehey in 2008 and serves as the chair of the firm’s PIP Litigation Practice Group, co-chair of the firm's Fraud/Special Investigation Practice Group and is a member of the Board of Directors. He focuses his practice on insurance fraud, bad faith and SIU related matters working with carriers both in the US and internationally.

Jeffrey litigates insurance fraud and fraud-related matters throughout the state of New Jersey and many other jurisdictions. He acts as national coordinating counsel to several insurance companies and helps clients develop strategies for defending complex litigation related to medical provider fraud, PIP and other emerging insurance issues. In addition, Jeffrey frequently consults with insurance carriers across the country to help integrate internal analytical platforms, create risk management protocol and conduct fraud-related investigations.

Francis X. (Frank) Sztuk


Frank is the Senior Vice President/Investigative Services for the Delta Group.  He came to Delta after a rewarding 36-year career with the Hanover Insurance Company, where he developed the Special Investigation Unit Program at that company.  He retired as the National SIU Strategist, responsible for oversight of one of the leading anti-fraud programs in the industry.  He served on many boards and councils in his career, most notable being the immediate past-Chair of the Massachusetts Insurance Fraud Bureau.  He is also a former Chair of the national Coalition Against Insurance Fraud as well as the NY Alliance Against Insurance Fraud, where he still chairs the Public Outreach Committee of that organization.  He sat on the NJ Insurance Commissioner’s Fraud Advisory Board and the NJ Insurance Council Anti-Fraud Committee.  He has lectured both nationally and internationally on the subject of insurance fraud and continues to present at various programs such as the ISO/NICB Insurance Fraud Management Conference and the IASIU annual fraud conference.  Frank is a lifelong resident of New Jersey, where he lives with his wife, Angela.

Adam J. Brand, Esq.

Adam J. Brand, founder and managing partner of Brand & Tapply, LLC, represents insurance clientele in all phases of first and third-party coverage and litigation. Brand & Tapply, LLC specializes in combating suspect claims nationwide in virtually all lines of insurance. Mr. Brand has extensive trial experience before state and federal courts in complex coverage litigation, automobile, commercial and homeowner fraud and arson cases, as well as medical provider, bad faith and extra-contractual liability matters. Mr. Brand is actively involved in the insurance industry’s education efforts and has served as a panelist and lecturer at seminars and conferences sponsored by international, national and local insurance organizations.

Matthew Werbel, Esq.


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.

Medical Street Fraud

Lt. Jarek Pryzanowski

Today’s street Gangs are no longer just focusing on drugs and violence.  The new trend among the street gangs is Fraud.  The course will provide case debriefs on real medical fraud investigations and clarify the nexus between white-collar crime and the street crime underworld.  It will also educate attendees how the rapidly expanding realm of cyber-crime is resulting in increased criminal activity in the areas of medical fraud and street fraud investigations.  Many real world and clear examples of organized criminal activity, money laundering, theft and fraud on a local, national and international scale will be discussed in this course.

Jarek Pyrzanowski


Lieutenant Pyrzanowski currently oversees a specialized unit investigating medical fraud and prescription drug fraud for the NJ Division of Criminal Justice. He was formerly assigned to the NJSP Auto Theft Task Force and is recognized as a subject matter expert in the areas of Vehicle Theft and Vehicle Finance Fraud. Before joining DCJ/OIFP, he worked in the Special Investigations Section of Liberty Mutual Insurance Company and as a Borough of Belmar Police Department patrol officer. Throughout his twenty-five-year law enforcement career, he has been assigned to various units that conduct complex investigations pertaining to automobile crimes, financial crimes, criminal street gang crimes, drug trafficking, complex fraud investigations, and Official misconduct.  He is a certified technical investigator and has extensive knowledge of electronic surveillance techniques and tactics.  He is also proficient in various cell phone forensics, vehicle infotainment extractions and analysis.     He was the President of the New Jersey Vehicle Theft Investigators Association and is currently the 4th Vice President of the 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. Lieutenant Pyrzanowski’s Auto and Medical Fraud investigation experience, two seemingly unrelated fields, fit together in a complex criminal investigation world. 

Peer-to Peer rentals:  strategies to address coverage and liability issues.

Matthew Werbel, Esq.

Richard Nelke, Esq.

Peer-to-Peer rentals:  strategies  to address coverage and liability issues:  This session will focus on the developing trend where insureds are utilizing rental apps to allow others to use their vehicle for a fee or when an insured is in an accident while using a rented vehicle through the app.  We will address the growing trend and the implications with regard to coverage.  Is there coverage?  Does the app provide coverage, and if so to what extend?  Does it depend who is making the claim and what type of coverage?  We will also focus on issues pertaining to liability exposure to an insured involving these vehicles.  Lastly we will touch upon potential legislation and strategies to resolve any uncertainty when accidents happen with peer-to-peer rentals.

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.

Methfessel & Werbel, P.C.

2025 Lincoln Highway, Suite 200

Edison, New Jersey 08818

Ph. 732-248-4200

www.methwerblaw.com

Richard A. Nelke

Pace University School of Law, J.D. 1999

Seton Hall University, B.A. 1996

Admitted to the New Jersey Bar, 1999

Admitted to the New York and Washington D.C. bars, 2000

After graduation, Mr. Nelke obtained a clerkship with the Honorable Mark M. Russello, Bergen County Superior Court.

Following his successful clerkship, Mr. Nelke worked for a defense firm representing insurance carriers, insureds and self-insureds in the investigation and litigation of both first and third-party claims in New Jersey and New York. For 11 years he managed and supervised a litigation practice group, defended insureds and insurers in jury and bench trials across the state and specialized in the investigation and prosecution of fraud claims.

Run the Jewels - Make the Claim! Unlocking the Schemes of Personal Articles Policy Losses                                                                  

Michael Benjamin Gerstein, Esq.

Nicole Hatton, Esq.

This presentation addresses fraud associated with personal property losses, inclusive of mysterious disappearances and theft - “run the jewels” is slang for “hand over the jewelry, or else!”  We will cover appraisal considerations and the scope of claims that are on the rise today.  We will also discuss claim handling considerations associated with the typical insurance policies at issue with such losses.  Finally, we will play a “squid game” with participants – can you spot counterfeit jewelry and handbags before you’re eliminated?


Michael Benjamin Gerstein

Michael Benjamin Gerstein is a member of the firm’s Special Investigations and Fraud team.  Michael's practice is concentrated 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.  Michael also prepares insurance coverage opinion letters for insurers in both Pennsylvania and New Jersey,

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.

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

Nicole Hatton

Nicole Hatton is an associate with the firm’s Special Investigations and Fraud team and is admitted to practice law in the courts of Pennsylvania and New Jersey.

Nicole graduated from the University of Delaware in 2012, with a Bachelor’s degree in Criminal Justice and Art History.  She earned her Juris Doctor from Rutgers Law School - Camden.  While in law school, she participated in the Domestic Violence Clinic.  Upon graduation from law school, she worked for a boutique real estate law firm in Marlton, New Jersey. 

Prior to joining Bennett, Bricklin & Saltzburg, LLC, Nicole worked at a general practice firm in Oxford, PA, where she represented clients in a variety of matters including family law, DUIs, minor criminal matters, personal injury, estate planning, and real estate.  She now defends the firm's clients in a variety of personal injury, property damage and premises liability cases in addition to opining on a variety of coverage considerations.

Nicole lives in Downingtown with her husband, two babies and two dogs.  In her free time, she enjoys traveling, cycling, running, and spending time with family and friends.

Recent PIP Developments - 2022

Ken Pringle, Esq.

Gauri Shah, Esq.

Lori Smith, Esq. Pattern Analysis, Inc.

                                                                                                                               

The class will provide updates on Referral Network Schemes, including the continuing trend of chiropractic offices being absorbed by multi-specialty medical practices.   We will also discuss recent Contract-Surgeon Kickback Schemes and the structure of Intra-Operative Neuromonitoring (“IONM”) arrangements.  Practical investigation and intervention tips and legal strategies will be discussed.

 

Ken Pringle, Esq.                                      

Pringle, Quinn, Anzano, P.C.

Belmar Office:

701 Seventh Avenue

Belmar, NJ  07719

Telephone:  732-280-2400



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.  He is married to Kathleen Ellis; they reside in Belmar with their two children, Emily and K.J.

Gauri Shirali Shah was admitted to the New Jersey Bar as well as the United States District Court for the District of New Jersey in 1991.  She was admitted to the New York Bar in 1996.  Ms. Shah graduated with a BA degree in Economics from Rutgers University in 1988 and received her Juris Doctor from Rutgers Law School -Newark in 1991.  While at Rutgers

School of Law – Newark, Ms. Shah was the Notes and Comments Editor for the Women’s Rights Law Reporter and handled matters for the Urban Legal Clinic.

Ms. Shah was previously a Deputy Attorney General with the New Jersey Division of Law from 1991 through 1998.  During that time, Ms. Shah represented the Department of Environmental Protection in land use and air pollution enforcement matters in various forums including the Office of Administrative Law, Superior Court – Chancery Division and the Appellate Division.  She also provided counsel on diverse environmental issues to the Commissioner of the Department.  During her tenure at the Division of Law, Ms. Shah also represented State Departments and Entities in tort claims brought against them under the New Jersey Tort Claims Act, FELA and Section 1983 of the Civil Rights Act in both the State and Federal Courts.

Ms. Shah has also served as an associate attorney with the law Firm of Denoia and Tambasco in Toms River, New Jersey, where she handled civil defense of professional negligence actions and general litigation matters.  Ms. Shah has also served as counsel on criminal appeal matters for the New Jersey Public Defenders Office, Appellate Section.

Since joining Pringle Quinn Anzano in July 2002, Ms. Shah has specialized in the Firm’s insurance fraud practice with an emphasis on matters involving medical provider fraud. She also represents health care providers in transactional matters, and provides legal counsel to health care practitioners in the area of regulatory compliance with State and Federal health care laws and professional licensing board rules and regulations.

Lori Smith, Esq.


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.

900 Haddon Ave
Suite 210
Collingswood, NJ 08108
856-854-2100
FightFraud@patternanalysis.com

Regional Roundtable

As the industry comes out of Covid, the investigative landscape has changed.  Not every change is good, however.  We are seeing companies reducing SIU staff, cutting SIU budgets, taking investigators off the road, etc.  What is beyond 2022?  What does the fraud fighting profession need to look like in the future?  What changes can be made to keep the emphasis on good investigation?  What changes need to be thrown out to assure that the public is protected from this crime. This panel of experts will discuss the future of fraud fighting and control and will look to create a vision of where the industry needs to focus deterrence and investigation.

Vincent F. Gerbino


Vincent F. Gerbino is a founding partner, with 30+ years of experience, extensive litigation skills and a teamwork approach when addressing every case or special project. This approach was recognized when he received a prestigious 2020 award from International Advisory Experts for his excellence in premises liability law. In 2022 he spearheaded the effort to get his firm selected as one of only 10 members of the Coalition Against Insurance Fraud in the nation. The firm was chosen because of the team’s proven skill and commitment to fighting insurance fraud.

He leads multi-faceted investigations on behalf of insurance clients and routinely conducts Examinations Under Oath of claimants and medical providers. Mr. Gerbino has been an integral part of litigating numerous affirmative litigation suits to conclusion with positive recoveries for his carrier clients.

His strong trial skills were put to the test in 2009 when Mr. Gerbino served as lead counsel for several insurance carriers in a $28 million insurance fraud case against a doctor who was wrongly paid monies under the “New York No-Fault Law.” The case, which was decided by a jury in favor of the insurance carriers, remains the only jury verdict on the issue of fraudulent incorporation. In June 2019 the New York Court of Appeals unanimously reaffirmed the 2009 decision.

Throughout his career, Mr. Gerbino has been recognized as a leader in his field. In 2017 he received designation as a Certified Litigation Management Professional (CLMP) from the Claims & Litigation Management Alliance (CLM).

Mr. Gerbino is frequently called on to offer his insight into relevant issues affecting the insurance industry, particularly pain management. He spoke at the CLM Focus event in November 2020 in a virtual presentation called "How to Manage the Wealth in Pain Management.” Also that year, he blended his passions for law and education to teach for The School of Casualty Claims for the CLM Alliance (Claims and Litigation Management Alliance) Claims College.

Mr. Gerbino has served on numerous panel discussions, presented at conferences and has published articles including his most recent “Telehealth: A new fraud frontier or a welcome expansion of Technology” for CLM Magazine as well as others including “Closing the Door on Pain Management Abuse,” “You Won, Now Try and Collect” and “Beyond the Insured: Uncovering Misrepresentations in Insurance Applications” in CLM’s Claims Management. In 2018 he published a white paper, “The Use and Abuse of Pain Management in Accident Cases.”

Mr. Gerbino is licensed to practice law in New York, New Jersey, the District of Columbia and the U.S. District Courts for the Southern, Eastern and Western Districts of New York and the U.S. District Court for the District of New Jersey. He is a member of the New York State and District of Columbia Bar Associations.

Mr. Gerbino graduated from New York University in 1985 with a bachelor’s degree in political science. He received a Juris Doctor Degree from St. John’s University School of Law in 1988.  He is also a member of Vistage, the world's leading advisory and executive coaching organization.

Andrea Fury


Andrea Fury

Claim Specialist-SIU

CIFI, PLCS, FCLS                                         

Andrea Fury has been associated with State Farm Insurance since 1992 serving in a SIU capacity since 1996. Her primary focus in managing complex first party property damage field investigations for Auto and Homeowners claims. Her specialties include investigating building and vehicle arson, theft/vandalism, mysterious disappearance, water damage, public adjuster/vendor fraud and commercial liability slip/falls.

Ms. Fury currently serves as the Chairperson of the Board of Directors-Pennsylvania Insurance Fraud Prevention Authority and Chapter President of Delaware Valley Chapter of International Association of Special Investigative Units.  

610-357-5395

Andrea.fury.c49e@statefarm.com

Francis X. (Frank) Sztuk