Pennsylvania




Expert No. 3560

Insurance Policy, Claim & Administrative Expert & Insurance Standard of Care, Protocols & Procedures Specialist

Professional Profile

Education, Training, Hand-on Experience, Accomplishments:

SME (Subject Matter Expert) and Technical Administrative Expert on and within the following Insurance Products and Coverage's: Life Insurance Claims, Life Insurance Policies and Life Insurance Underwriting and Administrative matters, Life Insurance Claims Handling, Bad Faith in all Life Insurance matters, Unfair Trade and Unfair Claim Settlement practices in the Life Insurance Industry, Accidental death benefit claims and matters for Individual and Group Life Insurance matters, Defined benefit Pension matters and  Contestable death Claims , Life Policy Rescissions and Stranger Owned./Investor and 3rd Party Owned Life Insurance transactions.

Advanced Professional Industry Education
 
ALHC - Insurance Insider Designation - (Associate, Life & Health Claim Administration)-International Professional Designation from the International Claim Association (an International and Global Association) in Washington, D.C., (Specializing in the investigation, administration and adjudication of Life and Health Insurance Law, Medical aspects of Claims, Claim Administration, Underwriting Protocols and Procedures, Claim Department Operations and Operations of how Life Insurance Companies operate in the Economy, Rules, Regulations and Protocol issues Expert in Claim Handling and Claim Department Operations, Bad FAITH Expert, Contestable Claim and Contestable Policy Investigations and Protocol, Policy Rescissions, and the Economic & Benefit Administration and Adjudication and Policy and Procedural aspects of Group Life and Individual Life Insurance & Benefit matters, Employee Benefits and all Group Life/Employer Sponsored Life Insurance coverage's and Individual Life Insurance policies, Disability Policies and Disability Claim Administration claim matters, Reinsurance matters, Accidental Death cases, Life Insurance claims and all Life Policy matters, and all aspects of suspicious death cases, homicide cases, drowning death cases, drug-related death cases, and cases of a claimant claiming living or accelerated benefits from a life insurance policy. 

Unique Hands-on and Practical Life Insurance Policy Interpretation, Administration and Claim Handling and Claim Adjudication Experience.

I am an Insurance Policy, Claim, Administrative and Adjudicative Expert and Life Insurance Protocols and Procedures Specialist who has actually processed, administered and adjudicated thousands of claims for Life Insurance Benefits, who is also an Expert and has extensive knowledge and experience in dealing with and knowing Rules and Regulations regarding Unfair Claim Settlement Practices and Unfair Trade Practices.

Nationally Recognized as an Insurance Claim, Policy and Administrative Expert and Insurance Protocol and Procedures Specialist and one of the Best Insurance Experts and Special Investigators in the World by AM BEST COMPANY-AM BEST recommended.

Deposition and Testifying at Deposition Experience as an Expert Witness-Can write detailed Expert Witness Reports and break down and plainly explain difficult and technical industry concepts, terminology, jargon, procedures and protocols so that a Jury and Judge can understand.

Administered, Examined, Investigated, Adjudicated and Settled over 2, 500 Claims for Life Insurance and Accidental death benefits, and reviewed, examined, analyzed and interpreted over several hundred Life Insurance Contracts and Policies throughout career. In Addition, have a thorough understanding of the entire Underwriting and Risk Selection Process, as well as Best Practices and Proper Protocols and Procedures, as well as procedure for Contestable death claim Investigations, Rescission of Life Insurance Policies, and Claim and Policy Administration. 

Worldwide Listing Recognition and Publications

Available Upon Request

Special Business and Industry Accomplishments

From 2004 - Present

Created and Developed 10 Course Continuing Education Curriculum for Certified Public Accountants at Community College of Philadelphia's Center for Business and Industry covering the Pension System, Life Insurance Regulations, Policies and Procedures, ERISA rules and regulations, Life Insurance Policies and Contracts, Medicare and Medicaid Procedures, The Deficit Reduction Act of 2005 and its impact on Medicaid and Medicare, Viatical Settlement Contracts and Agreements, and a course on Ethics in Business, Governmental Affairs and the Financial World.

Special and Specific Areas of Expertise in the Insurance Industry

(A reference for the Legal, Business and Corporate Community, Insurance Companies, and the Legal Community- See Codes and Topics of Expertise and Advanced Knowledge & Capabilities Below):

Expertise Below pertains to all Life Insurance matters, Accident and Health Insurance matters and issues, Universal & Proper Agent, Broker and Producer Fiduciary Responsibilities and Standard of Care within Insurance Industry, Fair and Proper Trade and Business Practice by Agents. Brokers, and Producer's, Accidental Death benefits matters, ERISA practices, procedures and protocol. Pension matters, Plan Administrator Fiduciary Duties, Annuity matters, and Health, Disability, and Medical Insurance coverage matters and issues, and Healthcare Provider Fraud.

Beneficial Interest Contract Protocols and Procedures, Stranger Owned/Stranger Originated Policy and Contract issues, Investor Owned and Speculative Life Insurance transactions, Life Settlement Contractual issues, Viatical Settlement Contractual issues, Living benefit and Accelerated Death benefit issues, Proper Underwriting protocols and procedures for Life Policies, Bad Faith, Customs and Practice, Risk Management Best Practices and Procedures, Superior and Advanced Customer and Client Service Skills Claim Administration and Adjudication, Employee Benefits, Claim Settlement Procedures and Practices, ERISA procedures, Life Insurance Claims, Accidental Death benefit claims and procedures, Pension Procedures and Practices, Pension Benefits, Fiduciary Responsibilities of Pension Plan Administrators, Employee Benefit issues, Disability Claim and Disability Policy Best Practices and Protocols, Unfair Claim Settlement Practices by Insurance Companies for Life Insurance Claims and Disability Claims, Unfair Trade Practices by Insurance Companies, Insurance Agent, Broker & Producer Fiduciary Responsibilities, & Agent, Broker & Producer Standard of Care, Proper Underwriting Procedures and Practices by Insurance Companies, Contestable Claim Procedures and Contestable Investigation Rules, Regulations and Procedures that Insurance Companies Must Follow and Adhere to when a death occurs within the 2-year
Contestable Period of a Life Insurance Policy, Underwriting Expert, Pension Plan Fiduciary Responsibilities, ERISA procedures and ERISA administration rules and regulations, Risk Classification Expert, Insurance Claims Expert, Insurance Fraud Expert.

Expert Special Investigator, Trainer, Educator, Investigator, Troubleshooter, and Lecturer to Groups, Organizations, Businesses, Individuals and Families on matters of Economics, Financial and Benefit matters, Estate Planning and Estate Creation, Group Economic Development and Advancement, Group Insurance, Pensions, Annuities, Health Insurance concerns, Business Ethics, Business Administration, Business practices and procedures in Corporate and Government Institutions nationwide.

Expert in the investigation, detection and deterrence of fraud and corruption, as well as being an expert in the Benefit and Policy administration of Corporate Financial & Economic Affairs, Government benefit matters, Corporate Owned Life Insurance, Group Life and Individual Life Insurance, and Accidental Death benefits, Pensions and Annuities, Individual and Group Economic concerns for families, individuals, businesses and organizations.

Skilled expert in conducting Special Insurance Fraud, Corruption, Collusion, and Malfeasance investigations and preparing detailed special investigative reports for clients.

Created and Developed 10-course CE (Continuing Education) Curriculum for Insurance and Financial professionals, Legal Professionals, and CPA'S at local Philadelphia Community College. (Curriculum taught to CPA's at CCP).

Created, Developed and taught Courses on the Economics of Life Insurance and Pensions in the Economy to CPA'S (Certified Public Accountants) at local Philadelphia Community College.
Created and Developed a course entitled "Ethics in Business, Governmental Affairs & the Financial World" for CPA'S at local Philadelphia Community College.

Skilled Insurance Claims Expert.

Additional Industry Accomplishments, Certificates, Awards & Education received Throughout Career

CFS-(Certified Fraud Specialist)-Obtained Advanced Professional Designation from the Association of Certified Fraud Specialists in Sacramento, CA.(Obtained in March of 2004). Skilled expert and specialist in the investigation, prevention, detection, and deterrence of fraud and corruption in the areas of  Corporate & Government Economic, Financial, and policy and procedural matters, Estate administration, Life Insurance & Accidental Death benefit matters & Estate Settlement Matters, Disability Claim matters, Underwriting Procedures and Protocols, Pension benefit matters, and Corporate and Governmental Benefit policies and procedures fraud, and unfair business practices and procedures.                 

Skilled Expert as an Economic, Financial & Benefits Educator, Trainer, Lecturer, Advisor, Consultant & Special Investigator for Individuals, Families, Businesses, Groups and Organizations.

Obtained Associate Member Designee certificate from the ASSOCIATION OF CERTIFIED FRAUD EXAMINERS, and International and Global organization (Specializing in the detection and deterrence of fraud and white-collar crime in the areas of   Corporate, Government  Benefit and Insurance matters), July 1999.

Obtained Broker License in Life Accident, and Health Insurance for and within the state of Pennsylvania, 1997.

Attended Temple University, Real Estate Institute (Received Real Estate Certificate), 1995.

Attended Temple University, Risk Management and Insurance and Business Administration program, from 1985-1990.

State Farm Automobile Insurance Company in Concordville, PA (Summer of 1990, awarded and chosen for prestigious summer internship program.

Employment and Special Expert/Executive Duties undertaken since 2002 are listed below:

9/2002-Present- Independent Expert Insurance Contract & Claim Consultant to Attorneys.- Insurance & Benefits Instructor, Educator & Trainer to Insurance Agents, Financial professionals, CPA’S and business persons and employees in Corporate America who deal with Insurance products.

2011
Present-Current Instructor and Educator - Conducting Continuing Education Workshops and Seminars for Insurance, Financial, and Legal Professionals. Courses developed and created for these professionals by Expert 3560 include courses on both Healthcare Reform of 2010 and Wall Street Consumer Protection and Reform.

2008-Present
Current Pre-Licensing and Continuing Education Instructor for Express Education, and Educational Institution providing and teaching Classes for persons who are attempting to obtain and Insurance Producer License, and students who need their required Continuing Education Credits to maintain their Insurance license. I am an Expert in Life Insurance matters, Claims and Procedures from the Underwriting Process all the way to the Claim Adjudication Process.

2004-Present
Educator and Instructor to CPA's (Certified Public Accountants) for CCP (Community College of Philadelphia, PA)-have created, developed and taught as a Subject Matter Expert (SME) on TOPICS such as the Key Elements with respect to Unfair Trade Practices and Unfair Claim Settlement Practices as promulgated and directed by the NAIC, Stranger Owned/Investor Owned Life Insurance transactions, Contestable Investigations and the Life Insurance Policy and Life Insurance Policy Rescissions

Past Instructor for A.D. Banker (2003-2007) and Company educating teaching and training Corporate CEO'S, Attorney's, Senior      Management, Underwriters, Sales and Marketing staff, and Agents and Brokers in the areas of COLI (Corporate Owned Life Insurance), Business ethics in the Insurance, Financial, & Economic world, fraud training, and product knowledge training in economics and benefits.  In addition, providing training in Group Life Insurance coverage's, policy provisions, and new group life products from the group life application process to the claim settlement process. In addition, educating working professionals on FMLA, COBRA and HIPAA coverage's & benefits.

Currently conducting extensive Fraud and corruption training in the Life Insurance and Accidental Death benefits marketplace to company executives and benefit personnel. In addition, teaching Ethical Responsibility, Employee Benefit and retirement planning and Financial planning through the use of Individual and Group Life Insurance, Pensions, Annuities and Estate Education.

Currently conduct Benefit Seminars and Workshops to Community Groups and Employees of small, medium and large Companies so that they understand their group benefits, in particular the group life insurance benefits and Pension matters , as well as Health care concerns and proper beneficiary designation procedures.

Advisor and Consultant to small, medium and large employers and businesses on Executive Compensation, the Development and Implementation of Regulatory, Compliance and Administration Programs, employee relations and development, and designing group benefit plans. In addition, have also created, developed, designed, and implemented benefit plans in order  to maximize the value of employer group benefits.

Regular trainer and educator to Sales Agents and Brokers to foster better understanding of the Group Life product, the Long-Term Care product, FMLA, COBRA and HIPAA benefits Pensions and Annuities, and proper Ethical responsibility and proper client service.

Train and Educate CEO'S, Senior Management, Claim Administrators, Underwriters, and Sales and Marketing staff in areas of detection and deterrence of Policyholder and insurance fraud in the group life market, as well as Educate in areas of Economics, Pensions, and Corporate and Government Policy and Procedures in administration of economic affairs and benefits.

Expert in Claim, Policy, and Benefit Administration procedures for Life Insurance, Accidental Death benefit matters, Pensions and Annuities, and Corporate and Government Business affairs..

Expert Insurance, Economic and Benefits Advisor and Consultant to insurance agents, brokers, financial advisors, attorney's, business owners, and company executives in helping them understand how these Economic matters are administered.

12/96 – 8/2002
Reliance Standard Life Insurance Company
Position- Life Insurance & Accidental Death Claims Examiner

Responsible For the investigation, evaluation, and adjudication of Life Insurance Claims(from Life insurance Claims of several thousand dollars to Life Insurance Claims in excess of A Half-Million Dollars in accordance and compliance with each States Insurance Department  Insurance Rules and Regulations, Life Insurance Law, Best Practices and Proper Standard of Care, and in accordance with Insurance Policy provisions for hundreds of corporations, companies and firms within the jurisdiction of the United States of America.

Providing and educating beneficiary's with intricate, lucid explanations of all settlement options in the Life Insurance policy and Pension and Estate Settlement process to include all interest rate and beneficiary issues

Conducting and moderating training sessions and workshops with underwriters, agents and brokers on the Life insurance contract and Pension and Estate Administration how it really works at the time of insured's unfortunate demise to help improve the risk management and selection process for underwriter, as well as to improve service to clients for the agents and brokers. In addition, skilled expert in investigating and uncovering Life Insurance and Accidental Death benefit and Pension administration Fraud.

Educating policyholders on Life insurance policy provisions, options, and riders, such as how the Family Medical Leave Act of  1993 is implemented as used in the Life Insurance contract, as well as rules and regulations that affect the Life estate claim for benefits in an Accelerated (living) Benefit rider claim.

Skilled in the Knowledge and application of Rules, Regulations and Procedures with respect to Pension rights, Benefits rights and Insurance rights under ERISA (The Employee Retirement Income Security Act of 1974, as amended) and the Department of Labor Pension and Health and Welfare Benefits Administration.

Skilled in the Knowledge and Application of the Rules, Regulations and Procedures of the (PBGC)-Pension Benefit Guaranty Corporation, as well as Health Insurance benefits under COBRA(Consolidated Omnibus Budget Reconciliation Act OF 1986). Knowledge of all aspects of the administration of HIPAA benefits(Health insurance Portability and Accountability Act of 1996)

Applying applicable ERISA laws in the adjudication of Life Insurance claims.

Skilled expert in the interpretation, adjudication and settlement of Life insurance Benefits contracts involving Basic Group Life, Accidental Risk Coverage, Voluntary Accidental Risk Coverage, Voluntary Group term & Voluntary Accidental Risk Coverage and all individual (WHOLE LIFE) coverage's, and all coverage's regarding employer trust arrangements.

Assisted in Editing and reviewing 5 volume company wide Life Insurance Estate claim reference manual at the request of management.

Administered and Adjudicated Life Insurance claims for non employer-employee groups, including trusts, unions, and partnerships.

Provide claim filing instructions to Policyholders and Insured's to aid in the claim administration process.

Knowledge of NAIC (National Association of Insurance Commissioner Guidelines).

Received the "Achieving Extraordinary Customer and Client Relations Award" during tenure as Administrator.

Served as "Critical Incident Troubleshooter" for all Group New Business accounts (i. e Non-profit, For-profit and Trust arrangements)  in charge of working with Human Resource departments and Benefits departments in all employee benefit consulting and problem and resolution issues.

3/94 -12/96
WHYY-TV 12
Fund Raising Representative & Team Leader

Received "Top Fundraising and Sales Producer" award a record 25 times and 8 consecutive months.

-Consistently maintained the highest percentage of revenue generated over a two year period.
-Implemented innovative strategies for increasing membership.
-Developed new script and marketing techniques to communicate to prospective members.
-Was elected team leader and captain to manage 15 employees by fellow associates due to proven leadership ability and superior training skills that produce vast revenues.
-Singularly secured over a half million dollars in net revenue in two and a half years of dedicated service.
-Systems Used: Windows Millennium Edition, Windows XP, Microsoft Office 2000, Microsoft Word,  PowerPoint, Hewlett Packard Hardware System

1990-1993
Served as Director of the Individual Disability Claims Department for an insurance company in Philadelphia (Life & Health Insurance Company of America) in Downtown Philadelphia.

Responsible for the investigation and adjudication of individual disability claims where 70% of the claimants lived and worked in the state of California

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