Law of Claims Fraud Investigation and Defense

Organization

American Educational Institute, Inc. (AEI)

Credit Course Categories:

Descriptions and credit recommendations for all evaluated learning experiences

Advanced Legal Issues in Fraud Investigation and Defense (515)

Length:

Approximately 19 hours of structured independent study.

Dates:

May 2004 - Present.

Objectives:

Upon successful completion of the course, students will be able to identify and discuss advanced legal issues and investigation techniques in insurance fraud.

Instruction:

Major topics are: defamation; using information; hearsay; and surveillance. In addition to AEI produced textbook, students receive actual court decisions, which relate to the subject matter and present real-life court opinions that illustrate how courts have ruled in the past and are likely to rule in the future on important issues in claims. A proctored examination is administered for both levels of the credit recommendation. Scenario and case study-based questions, built around actual claims situations, challenge students to analyze and solve problems using applicable principles of claims law that parallel their own claim files. To broaden students' knowledge of the subject, graded exams are returned with helpful comments that provide a written explanation of why each answer is correct or incorrect. For the graduate level credit recommendation, students also prepare and submit an appropriate graduate level research project on a pre-approved topic or issue, in accordance with AEI's specific guidelines.

Credit recommendation:

In the upper division baccalaureate degree category OR in the graduate degree category, 1 semester hour in Insurance, Insurance Law or Business Law (5/10) (5/15 revalidation) (6/20 revalidation). NOTE: Courses 513, 514, and 515 or 516 constitute 3 semester hours in Insurance Fraud. NOTE: Courses 510, 512, 515 or 516 constitute 3 semester hours in Insurance Fraud.

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Auto Insurance Fraud (516)

Length:

Approximately 15 hours of structured independent study.

Dates:

May 2004 - Present.

Objectives:

Upon successful completion of the course, students will be able to identify and discuss legal issues and investigation techniques applicable to auto insurance fraud.

Instruction:

Major topics are: auto theft; auto fraud schemes; auto fires and physical damage. In addition to AEI produced textbook, students receive actual court decisions, which relate to the subject matter and present real-life court opinions that illustrate how courts have ruled in the past and are likely to rule in the future on important issues in claims. A proctored examination is administered for both levels of the credit recommendation. Scenario and case study-based questions, built around actual claims situations, challenge students to analyze and solve problems using applicable principles of claims law that parallel their own claim files. To broaden students' knowledge of the subject, graded exams are returned with helpful comments that provide a written explanation of why each answer is correct or incorrect. For the graduate level credit recommendation, students also prepare and submit an appropriate graduate level research project on a pre-approved topic or issue, in accordance with AEI's specific guidelines.

Credit recommendation:

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Avoiding Bad Faith and Civil Liability in Handling Suspicious Claims (514)

Length:

Approximately 18 hours of structured independent study.

Dates:

May 2004 - Present.

Objectives:

Upon successful completion of the course, students will be able to discuss how to avoid the imposition of liability during the investigation of fraudulent claims.

Instruction:

Major topics are: first and third party bad faith claims. In addition to AEI produced textbook, students receive actual court decisions, which relate to the subject matter and present real-life court opinions that illustrate how courts have ruled in the past and are likely to rule in the future on important issues in claims. A proctored examination is administered for both levels of the credit recommendation. Scenario and case study-based questions, built around actual claims situations, challenge students to analyze and solve problems using applicable principles of claims law that parallel their own claim files. To broaden students' knowledge of the subject, graded exams are returned with helpful comments that provide a written explanation of why each answer is correct or incorrect. For the graduate level credit recommendation, students also prepare and submit an appropriate graduate level research project on a pre-approved topic or issue, in accordance with AEI's specific guidelines.

Credit recommendation:

In the upper division baccalaureate degree category OR in the graduate degree category, 1 semester hour in Insurance, Insurance Law or Business Law (5/10) (5/15 revalidation) (6/20 revalidation). NOTE: Courses 513 and 514 constitute 2 semester hours in Handling Suspicious Insurance Claims. NOTE: Courses 513, 514, and 515 or 516 constitute 3 semester hours in Insurance Fraud.

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Handling Suspicious Claims: The Policy and Its Requirements (513)

Length:

Approximately 17 hours of structured independent study.

Dates:

May 2004 - Present.

Objectives:

Upon successful completion of the course, students will be able to identify and interpret applicable policy language to guide the handling of fraudulent claims.

Instruction:

Major topics are: policy conditions, exclusions; insurer's remedies. In addition to AEI produced textbook, students receive actual court decisions, which relate to the subject matter and present real-life court opinions that illustrate how courts have ruled in the past and are likely to rule in the future on important issues in claims. A proctored examination is administered for both levels of the credit recommendation. Scenario and case study-based questions, built around actual claims situations, challenge students to analyze and solve problems using applicable principles of claims law that parallel their own claim files. To broaden students' knowledge of the subject, graded exams are returned with helpful comments that provide a written explanation of why each answer is correct or incorrect. For the graduate level credit recommendation, students also prepare and submit an appropriate graduate level research project on a pre-approved topic or issue, in accordance with AEI's specific guidelines.

Credit recommendation:

In the upper division baccalaureate degree category OR in the graduate degree category, 1 semester hour in Insurance, Insurance Law or Business Law (5/10) (5/15 revalidation) (6/20 revalidation). NOTE: Courses 513 and 514 constitute 2 semester hours in Handling Suspicious Insurance Claims. NOTE: Courses 513, 514, and 515 or 516 constitute 3 semester hours in Insurance Fraud.

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Proving Fraud (512)

Length:

Approximately 16 hours of structured independent study.

Dates:

May 2004 - Present.

Objectives:

Upon successful completion of the course, students will be able to discuss the issues involved in how to legally prove fraud and identify the relevant forms of evidence in investigating fraud claims.

Instruction:

Major topics are: burden of proof; prior, subsequent incidents; constitutional issues. In addition to AEI produced textbook, students receive actual court decisions, which relate to the subject matter and present real-life court opinions that illustrate how courts have ruled in the past and are likely to rule in the future on important issues in claims. A proctored examination is administered for both levels of the credit recommendation. Scenario and case study-based questions, built around actual claims situations, challenge students to analyze and solve problems using applicable principles of claims law that parallel their own claim files. To broaden students' knowledge of the subject, graded exams are returned with helpful comments that provide a written explanation of why each answer is correct or incorrect. For the graduate level credit recommendation, students also prepare and submit an appropriate graduate level research project on a pre-approved topic or issue, in accordance with AEI's specific guidelines.

Credit recommendation:

In the upper division baccalaureate degree category OR in the graduate degree category, 1 semester hour in Insurance, Insurance Law, Legal Environment or Business Law (5/10) (5/15 revalidation) (6/20 revalidation). NOTE: Courses 510 and 512 constitute 2 semester hours in Insurance Fraud. NOTE: Courses 510, 512, 515 or 516 constitute 3 semester hours in Insurance Fraud.

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Recognizing Fraud (510)

Length:

Approximately 14 hours of structured independent study.

Dates:

May 2004 - Present.

Objectives:

Upon successful completion of the course, students will be able to recognize the element of fraud, misrepresentation, concealment, false swearing and arson and how these elements relate to claims; and identify and understand fraudulent claims and begin to take the steps necessary to deal with them.

Instruction:

Major topics are: identifying fraud; concealment; misrepresentation. In addition to AEI produced textbook, students receive actual court decisions, which relate to the subject matter and present real-life court opinions that illustrate how courts have ruled in the past and are likely to rule in the future on important issues in claims. A proctored examination is administered for both levels of the credit recommendation. Scenario and case study-based questions, built around actual claims situations, challenge students to analyze and solve problems using applicable principles of claims law that parallel their own claim files. To broaden students' knowledge of the subject, graded exams are returned with helpful comments that provide a written explanation of why each answer is correct or incorrect. For the graduate level credit recommendation, students also prepare and submit an appropriate graduate level research project on a pre-approved topic or issue, in accordance with AEI's specific guidelines.

Credit recommendation:

In the upper division baccalaureate degree category OR in the graduate degree category, 1 semester hour in Recognizing Fraud, Insurance, Insurance Law or Business Law (5/10) (5/15 revalidation) (6/20 revalidation). NOTE: Courses 510 and 512 constitute 2 semester hours in Insurance Fraud. NOTE: Courses 510, 512, 515 or 516 constitute 3 semester hours in Insurance Fraud.

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Special Investigation (511)

Length:

Approximately 18 hours of structured independent study.

Dates:

May 2004 - Present.

Objectives:

Upon successful completion of the course, students will be able to: discuss the role of the Special Investigative Unit in dealing with fraudulent claims; manage information to avoid defamation; and use information to investigate fraud.

Instruction:

Major topics are: special investigation techniques; fraud reporting. In addition to AEI produced textbook, students receive actual court decisions, which relate to the subject matter and present real-life court opinions that illustrate how courts have ruled in the past and are likely to rule in the future on important issues in claims. A proctored examination is administered for both levels of the credit recommendation. Scenario and case study-based questions, built around actual claims situations, challenge students to analyze and solve problems using applicable principles of claims law that parallel their own claim files. To broaden students' knowledge of the subject, graded exams are returned with helpful comments that provide a written explanation of why each answer is correct or incorrect. For the graduate level credit recommendation, students also prepare and submit an appropriate graduate level research project on a pre-approved topic or issue, in accordance with AEI's specific guidelines.

Credit recommendation:

In the upper division baccalaureate degree category OR in the graduate degree category, 1 semester hour in Insurance Law or Investigating Fraudulent Claims (5/10) (5/15 revalidation) (6/20 revalidation).

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