4. 5) 1. S tate Fa rm. State Farm,.. 6) ( ),,,,.., 5) Best Practice & Template(2001.12)., Best Practice & Template (2001.11.13 11.21) ( ). 6), (http :/ / www.statefarm.com).
5. < -1> State Fa rm Data (S IU) ( ) State Farm (SIU : Sp ecial Investigation Unit, SIU ), 190, 1,400 7). SIU (Con su m er Frau d), (In su rer Frau d), (Agency Frau d), (Application Frau d). 8) State Farm. (Cons ume r fra ud), 7) 3~3.5%. 8) State Farm SIU 2000 8.
6 21,,,,,, (Ins ure r fra ud),,,. 1) (Frau d in dicator). State Farm, (NICB : National Insurance Crim e Bureau). 9) N ICB. 9) NICB (objectivity).,
7 (Indicators of Prop erty Frau d) (Indicators of Casu alty Frau d nom adic) (Indicators of Workers' Comp en sation Frau d) (In dicators of Vehicle Th eft Frau d) (Indicators of Catastrop he Frau d) Indicators of Rental Frau d (Indicators of Application Frau d) (Indicators of Workers' Compensation Premium Fraud) Indicators of N om adic Grou p Activity 2) State Farm SIU (Tool Box). ( )..,, (Scorin g System ). 10), SIU,. ISO N ICB. 10),..
8,.., (factor).,. 3) (S IU) 11) SIU,,., SIU, (referral criteria). SIU. 12),,. 13) 11) SIU,,, 1999.11. 12) ( cost information).. 13) What to do In Case of Accident or Loss : cooperate with us in the investigation, or settlement or defense of any claim or suit ; promptly send u s copies of any notices or legal p apers received in connection with the accident or loss ; submit a sw orn proof of loss when required by u s ;
9 State Farm SIU.,. SIU.., SIU. SIU ( ),. SIU (recovery)., (crim inal investigation),., SIU.. State Farm SIU 1993 131 (arson dogs). (h otline). (N ICB), Task Force,. do whatever else is required in the Section of the policy which provides coverage for the loss, dam age or injury.
10, State Farm..,. (,, 3 ),,,,, Social Secu rity Card. ( ),.,,..,.,,. (Medicare), (Medicare Frau d Hotlin e).,.,.. State Farm (CAIF), (N ICB), (N HCAA) 14)
11. 2. Chubb. Chubb (a philosophy of zero tolerance).,,.,..,. ( ),,,.,,,. 14) (NH CAA : N ational Health Care Anti-Frau d Association) 1985,,,,.,,,.
12. 1) S IU Chubb SIU SIU 7. Sp ecial In dex (IFB),, ( ). (red flags) SIU, PILR Unfair Claim s Acts ( ) SIU SIU < -2>
13. < -2> Chubb S IU (Fraud Indicato r) ( ) ( ) (C la ima nt) / (Re co mme ndation)
14 2) S IU Chubb SIU...,,,... Chubb Service Stand ard, (public relations)..,,..,, ( ).,...
15..,, 3... 3 1)., S.C.A.M. 15). (,, ) S.C.A.M., N ICB, CIB form. (Frau d Comm ittee) W/ S n otes n on-view able. 15) Chubb SIU S.C.A.M..
16 2) S.C.A.M. (adju ster) (frau d coordin ator).. 2 ( / ). (casu alty sup ervisor),,,. (branch claim m an ager). 3) 3 ( : UM, PIP).,. (m anaging director) 1. (exam iner). (Zone office), (sp ecific diary system ). 3, 1 PIP (p ersonal injury protection), UM (uninsured m otor)..
17 < -3> Chubb / 4) (bodily inju ry),,. (outside investigation),,, (surveillance).,,. ( ), (investigator) (examiner).,., (adju stm ent),.
18 5) (rese rving).,. 6) (s ettle me nt),., S.C.A.M.... 7),,,... 8)..
19 3. Co untry. Country Insurance and Fin ancial Services( Country ),, ( ). Country.,,,. SIU. (Op tim ize referrals from field offices) (Development maintenance contracts with law enforcement) ( ) (Assist field claim s offices w ith in vestigation an d settlem ent of claim s) (Prom ote frau d aw aren ess throu gh out the Comp any) (Provide frau d training to field offices)
20 < -4> Country S IU ( ) S IU ( ). 1) S IU SIU (Director of Corp orate Com pliance). Country, SIU. SIU ( ). SIU. SIU SIU.. SIU SIU. SIU (Unfair Claim s Practice Act).
21 SIU. /, N ICB (IFB) Country SIU, (Director) SIU (SIU Sup ervisors), SIU (Consultant) (Sp ecialist), SIU SIU (Senior Com pliance Attorn ey). SIU,,,,,,.
22 < -5> Country S IU D irector of Corporate Insurance Com pliance SIU Su p erv isor Sen ior A ttorn ey Sup p ort A ssistan t SIU Sup erv isor SIU Consultant SIU Consultant SIU Consultant SIU Specialist 2) S IU SIU,. SIU.,,,,, SIU
23, SIU. Country SIU., ( )., SIU ( )., ( ).,, (N ICB),, ( ).,. SIU ( )., ( ). Country SIU. Country SIU, SIU (Sp ecialist) SIU (Sup ervisor),.
24 < -1> S IU S IU ( ) ( ) SIU SIU (, ). SIU ( ) (u p d ated) OAL em ail (rep ortin g),,,, ( ), SIU ( ) ride alongs DB SIU, DB (subrogation), (surveillance) (ven d or) ( ) ( ), IASIU, N ICB,,
25 < -2> S IU ( ) ( ) SIU,, OAL SI SIU monitor SIU,.,, SIU. SIU, N ICB, SIU IASIU, N ICB,, SIU 3) SIU,,.,, SIU. ( )
26 SIU N ICB, PILR Ind ex Bureau,..,.,. Country SIU. SIU (Director). Prop erty Insurance Loss Register (PILR) INDEX N ational Insurance Crim e Bureau (N ICB) Insurance Service Office(ISO) - Claim search Au totrackxp/ Choicep oint Internet Website for variou s resources Credit Bu reau Medical Insurance Bureau (MIB) SIU, SIU ( ).
27. SIU.. 1) S IU, SIU. SIU SIU SIU SIU SIU 2) S IU SIU
28 SIU SIU SIU ( ) SIU. SIU,.. 1) SIU,. SIU., N ICB. SIU.. 2) SIU,. SIU. SIU. SIU
29,,. SIU N ICB, PILR, In dex Bureau, IASIU. 3) (in-h ou se). ( ), SIU. 4),., SIU,., SIU,,,.,, SIU,.,, (objective, unbiased and tim ely m ann er).,
30. < -6> S IU SIU CONS. / SPEC. (SIU CONS. / SPEC.) ( ) S IU ( ) ( ) ( )
31 5) SIU (Sp ecial Investigator : SI) 2. OAL.. OAL 7. OAL. SIU., OAL. OAL. SIU OAL.. SIU.
32 6) S IU SIU, SID (SID Assignm ent Form)., SIUSUPV, SIU. SIU.., SIU,. SIU (Director),. N ICB, (AEI Claim s Frau d Investigation and Defense ),. IAAI(International Association of Arson Investigators) IAAI State Chapter in SI geographical area
33 IASIU (International Association of Sp ecial Investigation Units) IASIU State Chapters in SI geographical area N ICB SIU m eeting, regional anti-frau d association s SIU ( ). SIU.,.,.,, ( ).
34 < -3> S ID ASS IGNMENT FORM CO M PLETE TH E EM A IL FO RM A N D "SEN D TO SIU SU PV " SID A SSIG N M EN T FO RM Claim N o. : SID Assignm ent N o. : : : : : : : : : : : : Soc. Sec. # : Claim s Handler : : ( ) Prop erty ( ) Au to ( ) Comm ercial ( ) W / C ( ) Oth er ( ) Fire ( ) Th eft ( ) BI ( ) Med ( ) Su bro ( ) Other (Reason for Referral : In dicators) : SIU? ( ) Yes ( ) N o Yes? ( ) (Referred by) : : : : SID : SI.
35. Country,.,, 1,,,...,.. 1),...,., ( )..
36 ( ). 2) (PFTA). PFTA PFTA..... PFTA..., 1., ( ),.,..
37.,..,,. Country.....,,. Country.,.,.. ( ). ( )
38.,. Country,.,. 3) Country,.,., 5. ( ).. 4) Country. (Privacy Law )'.,,.. MIS. ( ), ID.
39 ( )..., ( ) (MIS ).,.. MIS.. (,,, ) MIS. MIS. ( ).. LAN ID.. 4.,,,,,
40., State Farm (SIU),,, (hotline),., Chubb Country SIU,,,,,,,.,..,,.,., SIU,.,.