TSI DEFACTO by hilen


									                                                                                                                            September 2002

       TSI Solutions                                                                                                        Volume 1, Issue 5


                                          TSI PARTNERING COMPANIES
                                                  THANK TSI
Inside this issue:                                                                                                  TSI & Insurers… Partners in
                                                                                                                    combating insurance fraud
                                          ...For Helping them Contain Low Impact
                                       Opportunistic, Exaggerated or Staged PD and AB
TSI Partnering
Companies thank
TSI                                                                                   turned out to be many difficult opportunistic and exag-
                         WHAT ARE OUR CUSTOMERS SAYING ABOUT
Industry Wide TSI        US?                                                          gerated low impact/injury accident benefit claims…
Program is               Here are 5 communications from our many satisfied            ...savings in this area were significant and conserva-
Needed Now!              customers that are all among the top 30 writers of auto      tively were estimated to be in excess of $100,000.
Meet our Team            insurance in Canada…..                                       Your efforts were a large part of making that happen”
                         “The subject of this communication is to thank you and                                                   AB Supervisor
                         commend your company’s endeavours in regard to
Who is TSI?              Fraudulent Motor Vehicle Investigations that span the        Another customer said:
                         last fiscal year…                                            “...we feel we have a successful partnership with your
                         Our joint impact on savings related to these file con-       firm and are very satisfied with the experience, exper-
                         cerns resulted in savings reaching the two million dollar    tise and results of your investigators. Your investigators
                         mark. Your efforts were a large part of making that          are thorough, and your reports are concise, yet com-
                         happen…”                                                     plete. As well, we have found your fees to be reason-
                                                            National SIU Manager
                                                                                      With your assistance, we were better able to address
                         Another customer said:                                       our core values and protect the interests of our company
                         “As you know, over the past year we have attempted to        and its stakeholders by not paying or overpaying cer-
                                                                                      tain claims.
 Combating AB            aggressively manage and investigate our fraud files,
                         especially those involving staged accidents.                 We look forward to our continuing relationship.”
 Fraud requires
 TEAMWORK.               We have enjoyed very good results with TSI and our                                                      Claim Manager
                         Examiners have reported prompt service and thorough
 ● Appraisers            and objective reporting on claims under investigation.       One more customer said:

 ● Physical Damage       Late last year we argued an accident was staged at F.S.      “...you guys are doing a great
                         C.O. and the Arbitrator accepted our position based on       job over there. I like the
 ● Accident Benefits     a TSI report and oral evidence. Insofar as we can deter-     confirmation sheets you are
                         mine, this was the first successful staged accident denial   sending. Also, your reports are
 ● TSI Solutions Inc.                                                                 coming so quickly. It's great!!
                         heard by F.S.C.O.
                                                                                      My claims advisors are thrilled!!”
 ● Legal Counsel         We now have approximately 15 staged accident investi-                           SIU Investigator
                         gations which have resulted in proper denials to all
    Together             parties. On a conservative basis, the savings are con-
                         I would be prepared to recommend TSI Solutions Inc. to
    Accomplishes         any prospective clients…”
                                                          Branch Claims Manager
                         Another TSI customer said:
                         “We were reviewing the claims support services per-
                         formed by TSI for our Company over the past year and
                         wanted to thank TSI for helping us investigate what
                                DEFACTO                                             Volume 1, Issue 5
                                                                                                                                      Page 2

The industry has been trying to respond to the worst ever On-               tated and opportunistic fraud were highest in Ontario…
tario auto financial results, partly caused by the proliferation of    The Insurance Bureau of Canada says…
improper claims:
  1. By increasing premiums, but these increases are not com-            • Second quarter premium growth outpaced expense growth, but
     ing fast enough or are large enough;                                   not claims growth;

  2. By focusing on a standard invoice and other actions re-             • Preliminary data indicates the loss ratio for Ontario auto in-
     specting health care providers, but this will not stop pay-            surers increased to 94% for the year ending June 30, 2002… an
     ments to claimants and providers that should never have                alarming deterioration;
     been made in the first place;
                                                                         • The growing predominance of physiotherapy likely reflects the
  3. By recognizing fraud in the system, but applying inade-                rising cost of whiplash injury claims. Whiplash injuries are
     quate resources given how extensive the fraud problem                  defined as a combination of soft tissue head injury claims and
     really is;                                                             soft tissue upper body injury claims. As a proportion of total
  4. By lobbying for legislative change… BUT these changes                  AB medical claims, whiplash claims increased from 54% in
     will take time;                                                        1995 to 68% in 2000;

  5. By investigating certain complex organized ring activities,         • The composition of automobile claims costs is changing. While
     hoping to collapse them, and while this process is very                accident frequency is generally going down, severity is going
     necessary, it will deal only with the tip of the iceberg and           up. A rise in the number of bodily injury claims being filed
     will take a long time before it actually helps companies               suggests that while the number of accidents are going down,
     improve their bottom lines;                                            those who are involved in the remainder are now more likely to
  6. By having endless industry wide fraud detection technol-               claim for injuries than in the past.
     ogy discussions while the available technology and proc-          PREMEDITATED OR OPPORTUNISTIC FRAUD WAS OBSERVED
     esses still are not in place.                                     IN 33.6% OF ALL ACCIDENT BENEFIT CLAIMS — NO WONDER
While the above actions are being discussed and taken, the evi-        THE COMPOSTION OF AUTOMOBILE CLAIMS COSTS IS
dence is overwhelming to support the RIGHT NOW investiga-              CHANGING AND SEVERITY IS GOING UP!
tion on a file-by-file basis of all auto low-impact (under $3000)
vehicle damage) soft tissue injury claims utilizing experienced
auto collision and reconstruction experts, like TSI.                   TSI’S INVESTIGATIVE TEAM CAN CHANGE THIS RIGHT NOW
Other No-Fault jurisdictions in the US have experienced exactly        FOR YOU…
the same problems as we have in Ontario. To make it worse, in                                ...Just as we have for our other customers!
the GTA, the police don’t come to the collision scene when mi-
nor injuries are alleged, so there doesn’t even have to be a
“staged collision”. All that is needed is minor car damage and a          _______________________________________________
Ministry of Transportation form completed at a CRC.
TSI has proven over and over in investigating more than 500 of
these types of claims that investigative action is hugely cost bene-
Insurers will be better able to contain exaggerated, opportunis-
tic or staged accidents, one at a time, RIGHT NOW.
At the same time, if ALL auto insurers got really serious about
this and systematically reported claims TSI found to be exagger-
ated, opportunistic or staged to the Investigative Services Divi-
sion (ISD) of the IBC, it would greatly assist the ISD in the in-
vestigation of organized ring activity.
Remember the facts about AB fraud and insurer financial
Canadian Coalition Against Insurance Fraud 2001 Personal In-
jury Fraud Research Findings

  • Premeditated or opportunistic fraud was observed in
      33.6% of all accident benefit claims and 26.6% of all bod-
                                                                       Did These Vehicles Collide? Is There a Mechanism for Injury?
      ily injury claims;
                                                                                       TSI HAS THE ANSWERS!
  • The number and dollar amounts of claims with premedi-
                                 DEFACTO                                                        Volume 1, Issue 5

                                                                                                                                                       Page 3

                                                  Meet our Investigative Team!

                             LEVEL IV COLLISION RECONSTRUCTIONISTS                                Rick Hawkyard: Rick spent 14 years with Metropolitan To-
                                                                                                  ronto Police, where he worked in the Criminal Investigation
                             Rob Seaton: Lead reconstructionist. Rob served 23 years as a         Bureau; was a forensic photographer; and a Special Accident
                             police officer specializing in collision investigation and re-       Investigator. He has investigated in excess of 4000 collisions,
                             construction. He was the sergeant in charge of the OPP’s             hundreds of those involving fatalities. Rick was also a Special
Let the TSI Team Join Your   reconstruction program. Rob has taught collision reconstruc-         Investigator and Senior Claims Specialist with Canadian Gen-
Team to Fight Exaggerated    tion at the Ontario Police Academy and the Canadian Police           eral Insurance and is a Certified Fraud Examiner and Certified
          Claims             College. He is also a consultant to the Provincial SIU on colli-     Fire and Explosion Investigator.
                             sions involving Police vehicles.

                             Gary Carty: Collision reconstructionist. Gary brings 21 years        OTHER INVESTIGATORS
                             experience as a police collision investigator and reconstruc-
                             tionist. He has investigated more than 1500 collisions. He has       Lee Thistle: Lee is a former Peel Regional Police officer,
                             also served as a collision reconstructionist where he was re-        having reached the rank of Detective. He is recognized as a
                             sponsible for the investigation of more than 100 fatal and life      pioneer in fraud prevention in the insurance industry. While
                             threatening collisions.                                              with the ICPB, he was awarded the Doug Hiron Memorial
                                                                                                  Award, in recognition for excellence in insurance fraud inves-
                             Ian Woodworth: Collision reconstructionist. Ian brings 16            tigation. He established and managed two successful SIU’s.
                             years experience as a collision investigator and reconstruc-         Lee specializes in large loss fires and is a Certified Fraud
                             tionist. He has investigated hundreds of collisions as a colli-      Examiner and Certified Fire and Explosion Investigator.
                             sion reconstructionist, including over a hundred collisions
                             involving fatalities.                                                Jim Marchment: Jim spent 30 years with the Peel Regional
                                                                                                  Police Force and has experience with collision investigation
                             Jeffrey Lavigne: Collision reconstructionist. Jeff brings 20         and fraud.
                             years experience as a police collision investigator and recon-
                             structionist. During his 20 year career, he has investigated         Stan Swann: Stan was with the Royal Canadian Mounted
                             hundreds of hit and run collisions, and collisions involving         Police, focusing on commercial crime, for 23 years. Before
                             serious bodily injury or fatality. Jeff is an expert in scene        coming to TSI, Stan managed Zurich Canada’s Investigative
                             photography.                                                         Services Unit. Stan specializes in fidelity, property and mu-
                                                                                                  nicipal liability claims. Stan has recently achieved his CIP
                             LEVEL III COLLISION ANALYSTS                                         designation. Stan is also a Certified Fraud Examiner and a
                                                                                                  Canadian Certified Fire Investigator, Level C.
                             Ian Harrison: Ian spent 28 years with Toronto Police Ser-
                             vice. In his career, he has investigated over 2.500 collisions.      Glenn Lumber: Glenn is a former Peel Regional Police Offi-
                             He has also investigated hundreds of traffic collisions involv-      cer. He has experience in insurance fraud investigations,
                             ing serious injury or fatality.                                      WSIB investigations and is a surveillance specialist.

                             William Kristy: Bill brings 14 years experience as a police
                             collision investigator and collision analyst. He has investi-
                             gated thousands of motor vehicle collisions, including 25
                             involving serious injury or fatality. He will become a Level
                             IV Reconstructionist in November, 2002.


                             Al Jenkins: Al spent 17 years with Metropolitan Toronto
                             Police, we he primarily investigated collisions. He has
                             investigated thousands of collisions in his career, both as a
                             police officer and on his own, many of those involving
                             serious injury, pedestrians and fatality. He is also the in-
                             vestigator responsible for the FSCO decision mentioned
                             earlier in this issue.
                         DEFACTO                                        Volume 1, Issue 5

                                                                                                              Page 4

TSI Solutions
                                             Who is TSI?
        In 1999, Jim Jasper, Mark Ed-        port, but also through our various   effective SIU’s at 2 major P&C
        wards and Lee Thistle, leaders in    training programs and our new        carriers.
        Canada in the Property & Casu-       claims best practices tool, “TSI     Mark Edwards, President, has 25
        alty and Life & Health insurance     Claims Scorecard 1000”. This tool    years experience in the Life &
        industries in the creation of best   objectively and systemically iden-   Health and P&C industry from
        claims practices, fraud control      tifies and prioritizes improvement   the perspective of VP, General
        and legal management programs,       opportunities and benchmarks         Counsel & Corporate Secretary,
        came together to form TSI Solu-      claims and management practices      VP Claims and Director. He is a
        tions Inc.                           against outside standards.           change and performance manage-
        TSI will help private and public     TSI has shown that our approach      ment leader in best practices
        insurers implement solutions to      preserves good broker relation-      claims.
        improve overall performance and      ships and good faith at the same     Jim Jasper, Chairman & Treas-
        efficiency and in particular, re-    time - we are committed to doing     urer, has 35 years in the P&C in-
        duce unnecessary claims loss and     this as we help investigate oppor-   dustry in the US and Canada. He
        expense leakage.                     tunistic personal injury claims      is a change management specialist
        One of our primary objectives is     and apply its Kinematics Pro-        with more than 125 General Man-
        to strengthen fraud recognition      gram.                                agement Consulting projects to
        and investigation programs of in-    Lee Thistle, C.O.O., is recognized   the P&C industry.
        surers.                              as a pioneer and leader in fraud     Our team also includes CFEs,
        We do this not only through pro-     prevention and investigation in      Certified Fire and Explosion In-
        viding claims investigation sup-     Canada, with more than 30 years’     vestigators and Level III and
                                             experience. He has established two

                                       TSI SOLUTIONS INC.
             10 Kingsbridge Garden Circle, Suite 704, Mississauga, Ontario, L5R 3K6
                          Phone: (905) 502-3480 Fax: (905) 502-3468
                               E-mail: qanda@tsisolutionsinc.com
                        Visit us on the Web at: www.tsisolutionsinc.com

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