FRAUD POLICY
Revision Date
Last modified: November 2, 2021
INTRODUCTION
USLI recognizes that fraud exists in the insurance industry. As such, it is the policy and mission of the company to strive to detect and prevent insurance fraud through the employment of an effective and diligent Anti-Fraud Plan. As part of the company’s management process, USLI claim staff will endeavor to thoroughly review each claim with the specific goal of identifying those claims exhibiting fraud related indicators, red flag events and situations or behavior indicative of fraud schemes. Those identified will be directed for specialized handling.
ANTI-FRAUD PLAN
The purpose and goal of our Anti-Fraud Plan is to educate, detect, investigate and deter insurance fraud thereby helping to reducing insurance costs.
FRAUD INVESTIGATION AND TRAINING
The company has a Special Investigations Unit (S.I.U.) that is responsible for the review and disposition of all suspected fraudulent insurance acts. The S.I.U. also provides training to employees and appointed producers in detecting, investigating and referring cases of suspected transactional and claim fraud. If you are interested in assisting USLI in its anti-fraud efforts and would like to receive more information or training on how to detect and handle cases of suspected fraud, please contact one of the members of our S.I.U. listed below.
S.I.U. REVIEW COMMITTEE
Lauren Reiley
Executive Vice President, General Counsel, Chief Compliance Officer
1190 Devon Park Drive, Wayne, PA 19087-2191
(610) 225-2224
lreiley@usli.com
Jim Scalise
Executive Vice President, Chief Claims Officer
1190 Devon Park Drive, Wayne, PA 19087-2191
(610) 225-2551
jscalise@usli.com
SPECIAL INVESTIGATION UNIT (S.I.U.)
The company has an S.I.U. composed of a three person Anti-Fraud Review Committee responsible for the review and disposition of all suspected fraudulent insurance acts, a two person Anti-Fraud team responsible for the detection, evaluation, investigation and reporting to state fraud bureaus, and a Legal & Compliance Team to provide assistance in the company’s anti-fraud efforts.
POSITION
Insurance fraud will not be condoned by USLI. Our personnel are dedicated to the prevention of insurance fraud and will aggressively review, analyze, monitor, investigate and seek prosecution of fraudulent insurance acts to the fullest extent of the law. These acts include but are not limited to: Application Fraud, Certificate of Insurance Fraud, Fraudulent Insurance Claims and the Understating Rating Exposures such as Sales, Payroll, etc. Further, we will comply with state statutes with respect to the reporting, investigation, and preparation of Anti-Fraud Plans.
REPORTING
Suspected fraudulent insurance acts must be reported to the respective State Fraud Bureau where applicable. Those acts involving USLI should be referred to the company using the sample referral form.
All suspected fraudulent insurance act referrals including supporting documentation should be forwarded to:
Chief Compliance Officer
USLI
1190 Devon Park Drive, Wayne, PA 19087