(Subject to Change)
Gregory Peterson, Esq. - Dyer & Peterson
The key topics of this course include the use of AI: LLMS for you and me/industry use. We will delve into the world of ghost brokers and premium avoidance. This course will address lawyer ethics in the SIU: some things you may not know. And finally, we will discuss the “cutting edge concepts” in spine surgery coding.
Gregory E. Peterson
Mr. Peterson is a partner and founding member of Dyer & Peterson. Before starting his own practice, Mr. Peterson was of counsel to the Connell Foley firm and was involved in a wide array of litigation cases, including complex commercial, breach of contract, insurance defense (including Personal Injury Protection/Forthright matters), personal injury, products liability, construction, and professional liability matters.
His insurance practice focuses on all aspects of litigation and specializes in large exposure first party and fraud matters.
Early in his career, Mr. Peterson tried the matter of Bowe v. New Jersey Mfrs. Ins. Co., 367 N.J. Super. 128 (App.Div.2004) and secured a successful verdict based upon a ground breaking causation theory in No Fault litigation. In a published opinion, the Appellate Division affirmed Mr. Peterson’s defense theory, utilizing his cross-examination of plaintiff’s expert as the basis for its holding. Bowe remains the seminal case regarding causation in PIP matters and has been cited more than 7,600 times in PIP arbitration decisions.
In 2010, Mr. Peterson gained another successful outcome in Haywood v. Harris , 414 N.J. Super. 204 (App.Div.2010). There, the Appellate panel affirmed the trial court’s revision of a jury verdict for economic loss based upon Mr. Peterson’s post-trial application. In upholding his position, the Appellate Court recommended a modification to the Model Jury Charge and verdict sheets used in Limitation on Lawsuit matters to accommodate defendant’s position, as advocated by Mr. Peterson.
On January 29, 2019, Mr. Peterson prevailed by the Appellate Division in the matters of New Jersey Manufacturers Insurance Company v. Specialty Surgical Center of North Brunswick a/s/o Claire Fiore and Surgicare Surgical Associates of Fair Lawn a/s/o Martino Chizzoniti.
The Court considered the critical issue of whether high-billing ambulatory surgery center could be paid by a no-fault insurer for surgical codes without a value listed in PIP. From a jurisdictional standpoint, the Court noted "no published cases have addressed the issue before us; in light of the absence of needed precedent, public policy favors review of the instant matter".
The decisions have been cited in countless matters to curb insurer liability and keep insurance rates low for the public.
Mr. Peterson spearheads fraud investigations and has pursued numerous litigations under Jersey’s Insurance Fraud Prevention Act. Working collaboratively with his clients, Mr. Peterson devises novel approaches to reducing his client’s exposure on false claims.
Michael Benjamin Gerstein, Esq. -Bennett, Bricklin & Saltzburg LLC
This presentation will address select cases and fact patterns involving real claims that have gone to trial and/or arbitration involving suspicious and/or staged slip-and-fall and trip-and-fall fact patterns. I will cover the types of discovery used to investigate these “falls,” the impact of liability experts, and trial strategy considerations.
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.
Exposing Body Shop Secret
Dirty Tricks and Enhanced
Christopher Borelli- Borelli Collision Analysis, LLC
This workshop will discuss identifying inconsistent, unrelated, and enhanced damage. Also, information regarding some of the technology that can be used to help identify if a loss occurred as reported will be discussed.
Christopher Borelli is the founder and owner of Borelli Collision Analysis. A Mechanical Engineer (BSME) and an ACTAR accredited Accident Reconstructionist, he has been reconstructing collision losses for 30 years. Mr. Borelli received his primary education in accident reconstruction from Northwestern University in Chicago, Illinois, and receives continuing education at various universities and related associations around the country.
Primarily focusing on analyzing damage for potential automobile insurance fraud claims, he has been able to apply engineering and accident reconstruction principles, along with the latest accident reconstruction technology, to analyze thousands of collision losses from across the country. Mr. Borelli has provided expert testimony for trials and arbitrations in Massachusetts, Rhode Island, and Connecticut.
Borelli Collision Analysis, LLC
Dr. John Robinton
This one-hour session will provide an overview of the principles of EMG and nerve conduction study. There will be a discussion regarding qualifications required to perform a quality study which contrasts significantly with factors that allow any licensed physician independent of qualifications to perform studies. An introduction to topics regarding fraud and abuse in EMG cases will be presented. As part of the discussion, Dr. Robinton will highlight trends he’s seen over the last 15 years regarding fraud and abuse in NY and NJ. Surprisingly, despite widespread fraud within the field of EMG and nerve conduction studies, because of issues regarding confidentiality, very little appears in the public space regarding this topic
Dr. John Robinton
Dr. Robinton is a board-certified neurologist who is additionally board certified in EMG and neurophysiology. He is one of three practicing physicians in the State who are board certified in neurophysiology, EMG, and supervises an EMG laboratory within the State that is accredited with exemplary status. He served as the President of the New Jersey EMG Association and on the Professional Standards Committee of the AANEM, the primary educational organization in the world dealing with issues concerning EMG standards. Dr. Robinton has been interested in the field of fraud and abuse in EMG for the past 15 years collaborating with nearly all of the major insurance companies within the States of New Jersey and New York. He has served as an expert for the State of New Jersey and federal government on a number of occasions. He has chaired a special interest group at the National AANEM Meeting concerning issues related to fraud and abuse in EMG and nerve conduction studies. He has practiced neurology in Montclair, New Jersey since 1985.
Joe Bottino- SHIFT Technology
Alicia Holmes- SHIFT Technology
The use of artificial intelligence (AI) in fighting insurance fraud is at an all-time high and carriers are seeing significant success. With external data integration, deep data trends and insights, improvements in processes and efficiencies, and advanced network detection, fraud detection within SIU’s has undergone drastic transformation. Join Alicia Holmes and Joe Bottino from Shift Technology for a look inside optimal fraud detection and the impacts of AI on your business.
Alicia Holmes - Senior Solution Consultant, SIU & Claims. Alicia Holmes is an SIU and Claims Solution Consultant at Shift Technology and specializes in fraud detection. Prior to joining Shift, Alicia spent close to 25 years at State Farm where she managed SIU, Major Case and Complex PIP teams. Alicia also sits on the Government Affairs Committee at the Coalition Against Insurance Fraud, and is passionate about strategies to identify fraud faster and making an impact on the industry.
Joe Bottino - Account Executive. Joe is Shift Technology's NJ based account executive, working with our customers to ensure they realize maximum return from their investment with Shift. Joe has been working in the automation space for 15 years, helping customers match their business objectives with the right technologies.
Investigating Common Interventional Pain Management Procedures
Matthew J.Burdalski, Esq.- Marshall Dennehey
Ariel C. Brownstein, Esq. - Marshall Dennehey
The presentation would center around investigating common interventional pain management procedures from an SIU perspective – what to look for in the pain management records and how to ask the right questions to a patient during a recorded statement/Examination Under Oath.
Matthew J. Burdalski, Esq.
15000 Midlantic Drive, Suite 200, P.O. Box 5429, Mount Laurel, NJ 08054
Matt is a shareholder in the firm's Fraud/Special Investigation Practice Group where he focuses primarily on large loss fraud and medical provider fraud. His practice in the area of fraud investigation involves the assessment and evaluation of both medical provider fraud and fraudulent claims on the part of his clients' insureds. Matt also has experience dealing with insurance coverage disputes, representing numerous insurance carriers across multiple states for the purposes of SIU investigation, bad faith litigation and general defense litigation. In doing so, Matt has represented a significant number of insurance carriers on these issues and has assisted in high-dollar and high-profile medical provider fraud, property loss and insurance fraud matters.
During his time with the firm, Matt has taken numerous Examinations Under Oath, drafted various complex coverage opinions and litigated topics of insurance fraud including, but not limited to, medical provider fraud, large loss property investigations and bad faith. In particular, he has assisted in multiple high-profile matters regarding carrier recovery of monies paid to fraudulent medical providers and as a result of fraudulent motor vehicle accidents. He has also successfully represented his clients in matters involving policy coverage and eligibility for benefits.
Matt earned his undergraduate degree from West Chester University and went on to receive his juris doctor from Widener University, in Wilmington, Delaware, graduating cum laude and with pro bono distinction. As a law student, he took part in Widener's Environmental Law Clinic, working with clients in all aspects of complex environmental litigation, and was the recipient of the Greenwatch Award for excellence in environmental law.
Prior to joining the firm, Matt represented insurance carriers and employers in the field of workers' compensation defense litigation where he handled matters in both Pennsylvania and New Jersey.
Ariel C. Brownstein, Esq.
15000 Midlantic Drive, Suite 200, P.O. Box 5429, Mount Laurel, NJ 08054
Direct: (856) 414-6075
Ariel, a shareholder in the Casualty Department, focuses his practice on insurance fraud and Special Investigation Unit (SIU) litigation with particular emphasis on large loss fraud and medical provider fraud. His practice in the area of fraud investigation consists of assessing and analyzing fraud by both medical providers and falsified claims brought by his client's insureds. In doing so, Ariel has represented a significant number of insurance carriers on these issues and has assisted in multi-million dollar high-profile medical provider fraud investigations and law suits in various states.
Moreover, Ariel has litigated on behalf of many different clients in favor of protecting the interests of insurance carriers in court seeking to disclaim coverage for fraudulent claims. He has taken numerous comprehensive Examinations Under Oath on SIU-related issues throughout New Jersey and Pennsylvania. In particular, he has assisted in several high-value and high-profile matters regarding carrier recovery of monies paid to fraudulent medical providers and fraudulent motor vehicle accidents. Furthermore, Ariel has litigated extensive insurance fraud and other personal injury protection related matters in the National Arbitration Forum (NAF)/Forthright and Superior Court for his clients.
During his career, Ariel has handled several high value cases on behalf of his clients. In one particular case, the amount sought by the Claimant was denied by the arbitrator due material misrepresentations made by the insured regarding his prior medical history and his injuries at the time of the subject loss during an Examination Under Oath, conducted by Ariel. In another matter, Ariel successfully argued that a claimant was subject to a personal injury protection benefit limit selected by the named insured, a live-in boyfriend and the amount demanded, was denied.
Prior to joining the firm, Ariel served as a law clerk for the Honorable Richard Geiger in Cumberland County Superior Court. His responsibilities included researching criminal law precedence, reviewing memoranda and pre-trial motions, and mediating civil lawsuits.
Jason Bayley, P.Eng. -Collision Sciences
This course will teach you how to retrieve and analyze data from Event Data Recorders (EDRs), which are devices installed in some vehicles to record information related to traffic collisions. You will learn about the types of data that EDRs can record, such as vehicle speed, driver inputs, restraint use, and crash severity. You will also learn how to use specialized tools and software to access and interpret the EDR data in a readable format. This course will help you understand the role and value of EDR data in crash investigation.
Jason is currently the CEO of Collision Sciences, a forensic tech company, with the capability of coordinating crash data evidence preservation for any motor vehicle loss globally. Collision Sciences has directed the development of new technologies for crash data evidence preservation and analysis so insurance investigators can easily and economically obtain a Crash Data Report from a damaged vehicle.
Jason Bayley, P.Eng.
Collision Sciences | CEO & Founder
M: +1 905 599 9899
Richard E. Vuernick, Esq.- Kennedy Vuernick, LLC
This presentation discusses recent case developments in the False Claims Act (“FCA”) area. A review of basic FCA concepts assists participants in understanding how to assemble the evidence for a potential FCA matter. Finally, we explore a few health care frauds SIUs may explore as they investigate and civilly prosecute health care fraud.
Kennedy Vuernick, LLC
The Meadows Office Complex
301 Route 17 North, Suite 800
Rutherford, NJ 07070
Richard E. Vuernick, Esq.
Richard Vuernick is an attorney with considerable expertise in combating insurance fraud, having spent over 25 years in the public and private sectors prosecuting cases. Following his service as a deputy attorney general in the New Jersey Office of the Insurance Fraud Prosecutor, Mr. Vuernick has used his knowledge and expertise in the private sector to help insurance companies recoup money lost to insurance fraud.
Mr. Vuernick has also prosecuted cases under the New Jersey and federal False Claims Acts to recover money on behalf of governmental entities. He represented an insurance company and assisted New Jersey to recoup $718,000 for the state’s Charity Care Fund. He has helped recover fraudulently spent funds from a worldwide biotechnology company, as well as a local pharmacy. Recently, he represented a whistleblower to recover funds from a physician who improperly obtained funds from Medicare recipients.
Mr. Vuernick also receives appointments from New Jersey’s Chancery courts as an independent financial monitor.
Mr. Vuernick began his legal career as a consumer advocate in Washington, D.C., where he lobbied Congress and federal administrative agencies on various legal reform issues. He received his bachelor’s degree from Vassar College and his J.D. from Western New England University School of Law.
Forensic Investigations of Fraud
Dr. Joseph Geissler- ARCCA, Inc.
ARCCA, Inc. specializes in forensic investigations that scientifically analyze the physical evidence of various events including motor vehicle collisions, slips, trips, or falls, and falling objects scenarios. This presentation will explore the tools, equipment, and methods our engineers use to properly perform their investigations. A special emphasis will be placed on explaining some of the unique identifiers associated with fraudulent claims. We will also cover numerous real-world situations so that the audience can develop their own strategies for proper identification of nefarious acts.
Joseph R. Geissler, PH.D.
Dr. Geissler is a Senior Biomechanist and his academic background in biomedical engineering, as well as his professional experience in crashworthiness, serve as the cornerstone for his expertise in accident reconstruction and injury mechanism analysis. Dr. Geissler utilizes these skills to quantify the severity and impact mechanics of vehicular collisions, slips, trips, falls, and other loading scenarios and to evaluate the human kinematic responses to these events while also investigating potential injury mechanisms and associated injury tolerances. During his time as a graduate student, Dr. Geissler designed and conducted various orthopaedic research studies focused on investigating potential underlying mechanisms of atypical bone fractures that are associated with long-term bisphosphonate therapy.
Dr. Geissler has completed coursework that included statics and dynamics, advanced biomechanics, orthopaedic biomechanics, computational biomechanics, and tissue engineering, and his work has been recognized by the orthopaedic community through multiple presentations at annual society conference proceedings.
Dr. Geissler also performs scientific testing of sports equipment to evaluate performance and proposes new designs that mitigate trauma and injury.
More and more SIUs are finding themselves fighting against an enemy that they cannot see. In this session we will demonstrate why network analytics is the great equalizer for SIUs to level the playing field and bring the fraudsters into focus. As the industry continues to optimize and streamline the entire insurance and insurer-policyholder relationship process, fraudsters have become more creative and discovered new ways to remain hidden. While electronic web-based application processes and low-touch/no-touch claims handling have provided much needed enhancements to the customer experience it has not been without its gaps that SIUs need to be prepared to find and combat. Through network analytics, investigators and analysts can better identify organized rings of activity from single policy and claim events to larger webs of connected data points. This session will cover methods to leverage network analytics from the application stage all the way to a claim to connect the dots and enhance investigations. We will discuss how to approach organized network investigations in ways that encompass an enterprise-wide approach with stakeholder involvement from Underwriting, Claims, Legal and Financial Operations to better combat and stop the fraudulent activity. The presentation will include real examples within the past year of network analytics-led investigations that uncovered the following types of activity:
Mike Bento is an Administrator overseeing the SIU Data Analytics, PIP and Medical Fraud Teams at NJM Insurance Group. He has 13 years of insurance industry experience with NJM, 10 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.
Matthew Werbel, Esq.- Methfessel & Werbel, P.C.
Richard Nelke, Esq. - Methfessel & Werbel, P.C.
A discussion of current trends where contractors are enhancing damage/creating damage that didn’t exist. This session will also address the increased involvement of contractors in claims, including contractors seemingly performing similar services as public adjusters. Additionally, we will discuss dealing with difficult contractors and restoration companies when they try to control the claim process or perform repairs before the insurance carrier has an opportunity to inspect. Lastly, we will address the increased frequency of assignment of benefits with contractors and restoration companies.”.
Tulane University School of Law, J.D. 1998
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.