A Speaker Ready Lounge on the Convention Level is where speakers can check in with staff, review slides, and ask questions related to their presentation.

Check in and pick up your badge.

Join us for a pre-conference meet-up, where you can connect with other attendees from your section and play some trivia. This is open to all groups.

Moderators:

Sheila Burns, Director, Health & Disability Policy, CLHIA

Shannon DeLenardo, Director, Anti-Fraud, CLHIA

This session is sponsored by:

Welcome to Charlottetown and the CLHIA's Claims and Anti-Fraud Conference! Join us at our opening general session hosted by our Conference Chair where you will get to hear an engaging conversation between CLHIA and Medavie Blue Cross, on the latest topics impacting our industry. Plus, get ready to hear from the determined, Unstoppable Tracy - she will move and motivate you with her extraordinary personal story as a 4-way amputee and her lim(b)itless success. 

Host: Virginie Stanert, Blue Cross Life & Conference Chair 

Keynote speaker introduction by: Dr. Ayla Azad, CEO of the Canadian Chiropractic Association

This session is sponsored by:

Join Mallory and Lisa to learn about updates in the world of denturism

Moderator: Sheila Burns 

Discussion about beliefs versus reality of Snowbirds Emergency Travel Insurance.

Moderator: Pierre and Richelle Feddema

With the increased costs of litigation, it is important to apply best practices when preparing for and participating in a mediation in order to achieve the best outcome. During this interactive workshop, an experienced mediator, Dana Hirsh and a top litigator, Kevin Cooke will cover best practices. There will also be an opportunity for the attendees to participate in the discussion.

Moderator: Joanne Wedgewood

This session will provide a brief overview on incident and diagnosis of concussion including what specialties should be making the diagnosis, ongoing treatment considerations, and expected recovery. Discussion will also include a review of co-morbid considerations in cases where the recovery is not following the expected timeline as well as appropriate timing for Independent Examinations and type of examination(s) to consider based on the file material.

Moderator: Chantal Lafreniere

Join your colleagues for a discussion on investigating fraud in life insurance at underwriting and claim time.

Moderators: Alain Maille, Mathieu Cote and Yolla Fadlallah

An overview of a complex fraud ring involving plan members, providers and clinics around the GTA.

Moderator: Colin Darmon

Join your colleagues for a discussion on claim topics relating to health, dental and electronic claims.

Moderators: Sheila Burns and Richelle Feddema

The Canadian Dental Care Plan (CDCP) should be designed to increase access to care for nine million uninsured Canadians. But what about the danger facing third-party dental benefits? In this session, we will discuss the de-insurance risk under the CDCP, its implications on the dental, health care and insurance professions, and what we can do to safeguard existing benefits. 

Moderator: Janet Deacon

A panel discussion with industry experts who are using digital medical record requests. You’ll learn about the efficiencies gained and the positive outcomes for insurers, plan members and physicians.

Panelists: David Scollard and Jen Robertson

Moderator: Jinny Seo

Join your colleagues for a discussion on disability claims topics.

Moderators: Christine Cloutier and Joanne Wedgewood

In this session, Lea and Jacques will present the latest litigation decisions from Life and CI claims cases.

Moderator: Mathieu Côté

A session to gain knowledge of how dental fraud happens, who commits it and how to detect and prevent it. The presenter will demonstrate the power of analytics used in the detection of fraud and abuse and dive into case studies using real examples of fraud investigations.

Moderator: Shelley Frohlich

Help us kick off the conference and the opening of the Exhibit Hall. Visit with over 40 companies and associations with expertise or experience in a variety of different disciplines, from healthcare consulting and software to audit and investigations—plus much more. Remember to collect points with each exhibitor for the Conference Challenge and enter into a booth draw with participating companies.

 This reception is sponsored by:

  and     

A Speaker Ready Lounge on the Convention Level is where speakers can check in with staff, review slides, and ask questions related to their presentation.

Enjoy breakfast while attending a Sunrise Session. See the schedule for session room allocations.

Seating is also available in the Hillsborough Room.

Generative Artificial Intelligence (GAI) technologies like ChatGPT are exploding in use across the health care space. Providers, payers, and government organizations are rushing to determine how to implement GAI to substantially reduce human time spent on tasks such as document generation, claim system billing, and beneficiary communications. While GAI holds great promise to be transformative for healthcare, the downside is this new technology is also being wielded by fraudsters: from generating fake medical records and diagnostic images in mere seconds to enhanced schemes to steal or fabricate patient identities. Those responsible for payment integrity and stopping fraud, waste, and abuse will need to quickly evolve strategies to keep up. Join us as we discuss these threats and practical methods to detect potential AI generated content.

Moderator: Marlene Ivay

Dr. Azad will provide the newest research on the connections between early intervention, pain management and workplace health.

Moderator: Alain Maille

With custom foot orthotic claims continuing to be time-consuming to adjudicate, the Pedorthic Association of Canada would like to suggest ways to enhance the process.
Improving the client experience and ensuring members receive the highest level of care by consistently listing qualified providers in policy and making it easier for members to find approved providers. We have created checklists and questions to help insurers determine the eligibility for custom orthotics to help streamline the administrative process. Review the terminology used throughout the assessment and treatment services to understand better the Pedorthic journey and how it relates to claim submission.

Moderator: Janet Deacon

Learn how AI-powered software is transforming claims handling and what it means for claims examiners and adjusters. This cutting-edge technology is reshaping the role, placing greater emphasis on providing timely support to claimants. Designed to complement claims examiner and adjuster expertise, this category of software simplifies routine tasks, enabling claims professionals to prioritize compassion and the claimant experience. Innovative carriers are striving to create a claims management process that is fast, fair, and
frictionless. Let us show you how AI can be your trusted ally, monitoring claims and pinpointing those requiring action or expert judgment, ensuring examiners are spending time helping claimants recover and return to work, rather than poring over claim files. Seize this opportunity to embrace the future of claims.

Moderator: Jinny Seo

This session will provide insight on advances in precision medicine and companion diagnostics

Moderator: Jinny Seo

Join your colleagues for a discussion on travel insurance claims.

Moderator: Richelle Feddema

Ever feel overwhelmed telling a claimant their claim is declined? Come to this workshop to learn how to make these difficult decisions and tell the claimant. We will also explore how training and coaching can support case managers in learning these skills.

Moderator: Chantal Lafreniere

Allison will provide insight into the CPP Disability application, appeal and tribunal process from her perspective helping claimants navigate through the process.

Moderator: Virginie Stanert

Do you have pending claims that you revisit periodically to ensure you made reasonable effort in locating the beneficiary? Do you ever wonder if you’ve done your due diligence? If the answer is yes, then this workshop on unclaimed property by Anny Duval and Paul Marquez is not to be missed.  
 
Anny will cover the applicable laws in several provinces, Section 72.1 of the Insurers Act in Quebec, and BC’s requirement to undertake reasonable effort to locate policyholders. Paulwill give you tips in locating beneficiaries/policyholders. He’ll also share success stories in locating persons who may not be an active part of society, have a new identity, or have moved to a foreign location

Moderator: Yolla Fadlallah

This session will guide you through these three processes with a focus on the investigative portion, including a case study.

Moderator: Tonya Seip 

During this 45-minute break, enjoy refreshments and connect with more Exhibitors. Remember to collect codes from exhibitor reps for the Conference Challenge!

Information on independent dental hygienists' scope of practice, and how they bill procedures to insurance companies. I will also touch on requests we have received both as an association (PEIDHA) and from clients as an independent practitioner.

Moderator: Richelle Feddema

THE INAUGURAL Private Drug Plan Leadership: Vaccine Coverage Report Card was developed to highlight those benefits providers with modernized drug plan policies that include vaccines as a standard inclusion, rather than leaving the drug plan decision in the hands of the plan sponsor or benefits advisor. The World Health Organization (WHO) states that immunization is the foundation of the primary health care system and an indisputable human right. It’s also one of the best health investments money can buy. However, research conducted by Mapol has shown 32 percent of private payer plan members do not have coverage for vaccines, and 31 percent of private payer vaccine prescription claims are rejected, leaving plan members with insufficient coverage and unnecessary out-of-pocket costs.

Moderator: Chantal Lafreniere

AI, Machine Learning, and Automation - OH MY! We all heard of them, but how do we capitalize on them? Join subject-matter expert Carl Capato of FastTrack as he unveils how these innovative technologies and more are elevating the disability claims journey into the future, adding valuable efficiencies to claim handling operations and bettering adjudication outcomes. Together we will pinpoint critical best practices–with new and existing disability claims in focus–that will provide much-needed boosts in the areas of claim triaging, claim task recommendations, RTW opportunities and settlements, touching the right claims at the right time, and more. Join us!

Moderator: Christine Cloutier

An estimated 200,000 concussions occur annually in Canada.  There is growing public awareness and government attention to concussion-associated short-and-long-term effects on physical, cognitive, emotional and sleep health. If untreated or mismanaged, a concussion can impair quality of life beyond acute symptomology and increase the risk of repeat injury. Ontario is the only province with concussion legislation, currently. Ontario Athletic Therapists, AT-ON ATs are on the frontline of concussion care as a result of their training and point of injury role in most sports activities and teams. AT clinical practices are seeing growing numbers of patients with MVA and other injury-related concussions. This session brings a one-stop overview of all you need to know about Concussion from the established care management framework through mechanics of care and treatment breakthroughs. Athletic Therapists are ready to share the benefit of their training, knowledge and hands-on care experience with Return to Play, Return to Learn and Return to Work effectively.

Moderator: Virginie Stanert

Beginning with the essential elements of the pathology report, this lecture will discuss the different ways a diagnosis of cancer can by confirmed. The role of ICD classification and WHO coding will be reviewed and an update on liquid biopsies of different sorts will be provided.

Moderator: William Chartrand

In this session, we’ll explore disability fraud including a discussion of what disability fraud is, case examples, what educating stakeholders could look like and technology in disability fraud.

Moderator: Marlene Ivay

Tour around the Exhibit Hall and enjoy lunch with colleagues!

This lunch is sponsored by:

Enjoy lunch with your colleagues for a French discussion on all claim topics. AOPQ will give a special presentation on orthopedic shoes and why they may be prescribed with a foot orthotic.

Special presentation by AOPQ on orthopedic shoes and why they may be prescribed with a foot orthotic.

Moderators: Julie Dompierre and William Chartrand

After lunch, join us for coffee and dessert for a special plenary featuring guest speaker Elyssa Del Valle, M.D., Chief Medical Officer Americas, Life & Health Products, Swiss Re 

Host: Jinny Seo, Swiss Re & Conference Committee Member

Session Introduction: Tom Wriggins, Sr. Manager, Global Lead Health Care Fraud & Compliance, SAS

This session is sponsored by:

Join us to explore how AI and advanced imaging technologies of the eye are reshaping healthcare. Discover how early disease detection can potentially reduce long-term costs for insurers, and learn about the future of preventive care.

Moderator: Sheila Burns 

In this session, Warren will describe the key considerations for Canadian LGBTQ+ travelers as they face discrimination and safety risks in some parts of the world.  

Moderator: Janet Deacon

Following a COVID-19 illness, many people report persistent symptoms that impact their everyday function and ability to return to work.  As a result, we are seeing more clients on claim related to Long COVID or Post-Covid Condition (“Long Haulers”).  Through Lifemark’s Post Covid Rehab Program, a common issue reported is "brain fog", or  cognitive challenges with memory and concentration, as well as fatigue.  In this session, we will discuss current assessment and treatment options as well as return to work considerations for those clients struggling with the cognitive and fatigue issues related to Long COVID diagnosis. 

Moderator: Christine Cloutier

Join us in a discussion focused on mental health strategies and the importance of the right care at the right time. Gain insights into current statistics, navigate ongoing barriers, and explore effective solutions, emphasizing the pivotal role of timely support. Be part of the conversation shaping a proactive approach to mental health care.

Moderator: Chantal Lafreniere

This workshop is about sharing claims and underwriting experiences and perspectives. Join our panel experts who will chat about their experience in responding to clients’ expectations of personalization, simplicity, and flexibility. We’ll chat about how this is affecting the way we underwrite new business and manage claims.  Please be prepared to join in as we explore ways to continue our collaboration to elevate our own experiences while meeting our clients’ expectations.

Moderators: Julie Dompierre and Yolla Fadlallah

Due mainly to the proliferation of wrongful convictions related to false confessions, investigative interviewing has been closely scrutinized in recent years.  Significant and unprecedented research has assisted us in determining which interview approaches are most effective in obtaining truthful, voluntary and impactful statements, even from those who may present as confrontational or unwilling to speak to investigators. We will discuss the research and training that has shown that a rapport focused interview approach is far more effective and reliable than traditional methods.

Moderator: Colin Darmon

Refresh, catch up on work, or chat with colleagues before the Exhibit Hall Closing Reception. 

Host: Virginie Stanert, Blue Cross Life & Conference Chair 

Charity speaker: Dean Constable, Executive Director, REACH Foundation 

This reception is sponsored by:

Join us for a not-to-be-missed East Coast-style party along Charlottetown’s waterfront at one of Charlottetown's most iconic venues, Peake’s Quay. Experience a night of friendly hospitality, entertainment, and local cuisine while fostering new connections with fellow attendees. 

Please note, this event has reached capacity. Access is included with a full conference pass and exhibitors who have already purchased the special event ticket.

This special event is sponsored by:

 A Speaker Ready Lounge on the Convention Level is where speakers can check in with staff, review slides, and ask questions related to their presentation.

Enjoy breakfast while attending a Sunrise Session. See the schedule for session room allocations.

Seating is also available in the Rustico room.

When it comes to AI for insurance investigators, how can you better understand how AI decisions are made and build trust in these tools?

In this session, Shift Technology investigative and AI experts will:

- Provide clear definitions and use cases of AI with CLHIA’s fraud detection effort

- Outline the benefits of AI-powered techniques for investigators

- Discuss Shift’s philosophy and strategies  in place for ethical, accurate AI-powered decisions

Understand, trust and unlock the benefits that AI-powered techniques bring to investigators and amplify your investigative teams.

Moderator: Rita

Virtual care is increasingly commonplace. Kintec’s Anywhere program is an industry leading initiative to address the public health need for better access to pedorthic services. This talk reviews the development steps and evidenced-based approach to patient monitoring that will pioneer non-fraudulent virtual care in the pedorthic setting. 

Moderator: Mathieu Cote

Untreated sleep apnea leads to cognitive decline, accidents, expensive comorbidities, and increased insurance claims. VitalAire’s value-based healthcare approach prioritizes patient outcomes and cost controls. Emphasizing PAP therapy and adherence can reduce disability claims, enhance productivity, lower absenteeism, and foster a healthier, more engaged workforce, benefiting employers, employees, and society. 

Moderator: Alain Maille

Techniques for interviewing and evidence gathering in preparation for potential litigation.

Moderator: Shannon DeLenardo

As advancements and understanding in healthcare evolve at an increasing rate, individuals, providers, researchers, insurers and plan sponsors ask themselves “Can this be covered?”. There is a myriad of factors that influence that decision, based on responses to some standard questions.  This presentation will highlight some of those important questions that can help prepare potential providers, plan sponsors or insurers to gather their thoughts on the benefit. Questions such as What is the benefit? What condition does it treat or prevent? Who would be the right user? Who is the right provider? Etc. The session is meant to help various stakeholders in understanding basic considerations to allow for more efficient and informed decision making.

Moderator: Richelle Feddema

In this session, Elliott will look at the potential and current uses of artificial intelligence (AI) by insurers and industry partners, in the travel insurance space. He will examine potential process enhancements by AI that can include sales, claims adjudication and anti-fraud, amongst others. How will this impact jobs in the travel insurance industry?
Elliott will also touch upon health telematics that are having an impact on the industry, including health connected devices such as prescriptions and medical supplies/equipment. 
“AI is going to become so commonplace in every facet of business for us”. Learn how to anticipate, deploy and manage AI and tech within your travel business.

Moderator: Sheila Burns 

Administrative demands are placing an increasing burden on physician practice. Navigation of e-health systems with limited interoperability, redundant forms, and business management may be contributors. In 2018, Doctors Nova Scotia (DNS) began to engage government on the need to reduce unnecessary administrative burden as a key cause of burnout and a major contributor to an unsustainable and unfulfilled workforce, leading to a collaborative workplan shaped with the Office of Regulatory Affairs and Service Effectiveness (ORASE). 

The province of Nova Scotia set a goal of reducing 50,000 hours of unnecessary physician administrative burden by the end of 2023, which has since been increased to 400,000 hours by the end of 2024. Nova Scotia is currently leading the country on this initiative and continues to act as advisors for others hoping to see movement on this file.  

In this session Doctors NS will share the good and the bad when it comes to reducing physician administrative burden as they talk about their experience on the receiving end of the insurance medical requests and how the industry could help to make sure that this necessary process is simplified and effective. 

Moderator: Virginie Stanerta

How can we judge the severity of these soft factors and provide an appropriate path to recovery? When we do, how do we deliver the right intervention to the right individual at the right time? Dr. Kertay and Ian will provide perspectives on how we combine data analytics and an understanding of the full clinical spectrum to address this tough issue. And, an insurer guest speaker will provide their perspective on this topic.

Moderator: Joanne Wedgewood

Come join us in a lively discussion about critical illness development, medical advancements, and claims challenges.  

How did the product development of CI change over time? What is the impact of medical advancements on existing products and claims management?  

We will chat about claim challenges and the role of claims professionals in shaping the future of CI. We will also discuss how the product continues to evolve in Canada and other markets. How we can meet our clients’ needs and learn from our experience. Be prepared to engage in case studies. 

Have you ever wondered what would happen if your company were sued after a delisting? This informative session will simulate a civil trial. You’ll have a chance to see a plaintiff and defendant lawyer cross examine our amateur actors playing the parts of the practitioner, insurance investigator, and third-party investigator. 

Moderator: Joanne Bradley

Innovations in assessments and techniques in orthotics.

Moderator: Janet Deacon

This session will provide an update on drug trends across private drug plans in Canada and an overview of the pharmaceutical marketplace.

Moderator: Alain Maille

The findings highlight insurers’ activities regarding mental health initiatives and provide an overview of new developments globally and by region. This session offers a global perspective on how leading life and health insurers are positioning mental health within their strategic priorities, including within claims, underwriting, and product and proposition development.

Moderator: Virginie Stanert

Join your colleagues for a discussion on Disability litigation claims.

Moderators: Christine Cloutier and Joanne Wedgewood

Join your colleagues for a discussion on Critical Illness claims and challenges with evaluating old CI policies. 

Moderators: William Chartrand and Julie Dompierre

Join your colleagues for the finale of the mock trial.

Moderator: Joanne Bradley

Join us for lunch at our final plenary and hear from keynote speaker Jesse Hirsh, Futurist & Digital Strategist. We will close the conference with a few special announcements following our keynote speaker.

Host: Joanne Wedgewood, Blue Cross & Conference Committee Member

Keynote introduction: Allison Schmidt, CEO of the Disability Claims Advocacy Clinic

This session is sponsored by: