Health Insurance Expert Witnesses: 14

François Sestier, MD, PhD, FRCPC, FACC, DBIM, CIME, is a Cardiologist and Life Expectancy Calculation expert. He has over 40 years of experience in the field of medicine, 29 years as an Adult Cardiologist in the cath lab and 30 years as an Insurance Medical Officer.

Education - Dr. Sestier graduated from medical school in Nancy, France, 1967, where he obtained certification in Cardiology, Pneumology, Occupational Medicine, and Aeronautical Medicine. In Canada, since 1973, he obtained a Quebec certification in cardiology (CSPQ), and a fellowship in cardiology of the Royal College of Physicians and Surgeons (FRCPc). Dr. Sestier also obtained a PhD in Experimental Medicine (McGill, 1977).

Experience - Dr. Sestier has been a staff cardiologist at CHUM, Montreal, medical director of Quebec Blue Cross since 1985 and medical director of PartnerRe since 20219. He received certifications from the American Board of Insurance Medicine (1995) and the American Board of Independent Medical Examiners (2011). As a medical officer for various insurance companies, he has reviewed thousands of applications for life Insurance, giving advice on the Mortality and Life Expectancy associated with the applicant's medical conditions.

Dr. Sestier - Life Expectancy Calculation

Litigation Support - Dr. Sestier's medico-legal advice is available to counsel representing both Plaintiff and Defense. He has performed life expectancy calculations for litigation purposes on topics as diverse as traumatology, traumatic brain injury, cognitive impairment, spinal cord injury, morbid obesity, diabetes, many different cardio-vascular pathologies, sudden death, stroke, cerebral palsy, multiple sclerosis, epilepsy, asthma, chronic obstructive lung disease, sleep apnea, liver cirrhosis, hepatitis B and C, and all kinds of cancers. He follows the actuarial methodology proposed by the American Academy of Insurance Medicine for his LE calculations. 

Areas of Litigation Expertise:

Disability Assessment Permanent Disability Eligibility Medical Liability Insurance Médicine Life Insurance

Health Insurance Travel Insurance Critical Illness Insurance Life Expectancy Calculations Work-Life Expectancy calculation

Book chapter: Vachon P and Sestier F: Life expectancy calculation. In Life Care Planning, PMR clinics of North America, M. Lacerte and C. Johnson, ed., Elsevier publ. New York, August 2013, pp 539-551.

Recent Publication: https://www.canadianlawyermag.com/news/opinion/ethical-issues-are-too-often-ignored-by-medical-experts/275898

View Dr. Sestier's Consulting Profile.

Heather Schwartz Sanderson is nationally recognized as one of the foremost and cutting-edge legal experts in Medicare Secondary Payer Compliance. An avid blogger and national speaker, Heather is a regularly published author and national speaker on MSP compliance. Her articles have been featured in publications such Risk & Insurance, Workerscompensation.com, Defense Research Institute (DRI), and Claims and Litigation Management (CLM) Alliance Magazine.

Since the inception of her career, Heather Schwartz Sanderson, Esq. has been passionately devoted to providing simple and straightforward Medicare Secondary Payer (MSP) compliance solutions, legal strategy, as well as MSP education to the insurance and legal communities.

Heather has 12+ years of dedicated experience in MSP compliance, and has often been referred to as one of the foremost experts in the country on MSP. Prior to launching Sanderson Firm PLLC, Heather served as Chief Legal Officer for Franco Signor for 6 years, a leading national MSP services provider, until its ultimate acquisition by ISO CP in 2020. Prior to her tenure as CLO at Franco Signor, Heather previously served as both Corporate Counsel for Optum as well as Staff Counsel for ExamWorks Compliance Solutions.

Litigation Support - Over the last decade, Heather has served as an MSP expert both in Federal class action litigation as well as in litigated matters at the state level. Heather is an award-winning blogger and national speaker on MSP compliance, and a recipient of a 2018 Business Insurance Break Out Award. She serves an Ambassador for the Women to Watch Foundation, a 501(c)(3) entity serving humanitarian initiatives for women. 

Heather has been an active proponent in Washington D.C. for MSP legislative reform since 2011 and is proud of the industry’s accomplishment of the passage of both SMART Act (2013) and PAID Act (2020). 

Daryll W. Martin, JD, MBA has a unique professional experience as a Lawyer, Insurance Broker, and Insurance Brokerage Executive. Mr Martin has over 30 years of insurance experience, serving nearly half of that time as corporate counsel for two international brokers, and the other half of that time as a senior insurance brokerage executive. 

Broad Coverage Experience: Property & Casualty; Employee Benefits / Life & Health (qualified and non-qualified); D&O / Employment Practices Liability / Fiduciary; Property / Business Interruption / Boiler & Machinery / Inland & Ocean Marine; Casualty: General Liability / Professional Liability / Workers Compensation / Umbrella / Excess. 

Broad Brokerage Customer Industry Experience: Construction; Energy; Transportation; Manufacturing; Financial Institutions; Health Care; Public Entity / Not For Profit; and, Technology 

Extensive Insurance Industry Operational Experience: Executive officer of nationally ranked insurance brokers; Managed and handled a variety of international, national, and middle market accounts; Self Insurance / Large Retentions / Alternative Risk Transfer Vehicles; Foreign Placements; Wholesale Brokerage; Insurance Underwriting; Reinsurance; Technical Services / Loss Control / Actuarial/Risk Management Consulting; Actuary Services / Actuary Liability; Insurer Solvency / Market Security; Finance and Accounting; Mergers & Acquisitions; Insurance Sales; Client Service Standards; Technology Infrastructure; Human Resource Management; and, Insurer / Broker Relationship Management. 

Areas of Expertise:

Bad Faith Business / Employment Insurance Insurance Insurance Agency Insurance Agent / Broker

Insurance Customs & Practices Insurance Excess & Surplus Lines Life Insurance Property & Casualty Insurance Risk Management

Thank you for viewing my profile.  Please click this link to view my CV.

2020 07 21 Michael F Arrigo Expert CV and Supplemental Material WATERMARK NOT RETAINED.pdf

Please view a ruling published in Westlaw by U.S. District Judge Ronald S. Lew pertaining to my expert qualifications here:

United States v Pacific Health Corporation.pdf

For more about me, please click here:

https://noworldborders.com/expert-witness/ 

I am the Managing Partner, Healthcare Practice for our firm.  We work with health systems, health IT companies, and health plans. My recent retentions by the U.S. Department of Justice (DOJ). Drug pricing, patent infringement, medical coding and billing, and Qui Tam False Claims Act and fraud case specialties. He has in-depth experience in HIPAA mandates, the HITECH Act and Patient Protection and Affordable Care Act (PPACA) and is a published author and regular speaker. He consults to clients including Health IT investors, Health IT companies, and health plans and hospital systems in matters regarding HIPAA Privacy Rule, HIPAA Security Rule, HIPAA Breaches, Revenue Cycle Management

Hospital liens in personal injury cases without considering insurance as a collateral source

Medicare fraud, Medicare damages, Managed Medicaid, capitation, rate setting. Federally Qualified Health Centers (FQHC)

• Meaningful Use of Electronic Health Care Records
• Quality Measures for Medicare Advantage Hospital Value-Based Purchasing
• Medicare Advantage HEDIS 5-Star Ratings for Health Plans Mr. Arrigo was recently quoted in the Wall Street Journal Venture Capital Dispatch regarding medical coding standards and Wall Street Journal Health Blog regarding venture-backed information-technology companies that serve hospitals and health insurers.

Related posts :

Medical Billing Expert Witness

https://noworldborders.com/expert-witness/medical-billing-expert-witness/

HIPAA Expert Witness

https://noworldborders.com/expert-witness/hipaa-privacy-and-security/hipaa-expert-witness/ 

Healthcare Intellectual and Property, particularly pertaining to insurance claims processing, medical coding, medical billing and information privacy:

https://noworldborders.com/expert-witness/healthcare-patent-expert-witness/ 

Milliman’s Tampa Office provides Health Insurance, Health Care and Employee Benefit Consulting to law firms, insurance companies, hospitals, HMO’s, Blue Cross/Blue Shield plans, employers and government agencies. Our staff is experienced with medical, dental, long-term care, Medicare supplement & critical illness.

We assist clients nationwide with forensic actuarial work, rate filings, regulatory compliance, reserve projections, valuations, employee benefit analysis and design, mergers and acquisitions, demutualizations, claim cost analysis, and utilization management programs.

These health care services are used in litigation relating to:

• Pricing & Underwriting
• Senior Services
• Contract Development and Negotiations
• New Plan Design

Mary Wickens, JD, CFE, CHC has over 35 years experience in the Healthcare Insurance, Managed Care, and Compliance Industry. Her experience includes advising and counseling health care providers, insurers, government contractors, and others in compliance, ethics, fraud and abuse, Medicare, Medicaid and Federal Employees Plan, managed care, and other matters. 

Background Experience - Ms. Wickens is a former compliance officer for a major health insurer and former legal and compliance specialist for a CMS Medicare Program Safeguard Contractor. Also a former operations director for government programs (Medicare Part C, Medi-gap, and FEHBP) for a major HMO, she is experienced with government audits and investigations, commercial audits, as well as self-reporting and internal investigations. 

Ms. Wickens has decades of experience as in house counsel to HMOs and health insurers. She has drafted, developed, negotiated, and implemented numerous healthcare provider-payor contracts, and developed and implemented codes of conduct, ethics programs, compliance programs and numerous corrective action plans. 

Litigation Support - Mary Wickens provides litigation support, including skilled expert services, reports and testimony in federal False Claims Act cases, arbitrations, and provider-payer disputes. She is an experienced testifying expert, responsive to the needs of counsel, with excellent report writing skills. Ms. Wickens' services are available to counsel representing both plaintiff and defendant. Areas of Expertise:

Medicare False Claims Act (FCA) Health Insurance HMO Medicare Advantage Provider / Payor Disputes Claims Audits and Appeals Federal Employees Health Benefits Plans (FEHBP)

Medicare Part D Government Audits DME Home Health Care Hospice Managed Care Contracting Anti-Kickback Compliance Self-disclosures

View Mary Wickens' Consulting Profile.

Maurice Lieberman, CLU, ChFC, RHU, LUTCF, has over 40 years of experience specializing in Insurance and Financial Planning.

Mr. Lieberman holds three professional designations from the American College, Chartered Life Underwriter, Chartered Financial Consultant, and Registered Health Underwriter. He is a Life Insurance Training Council Fellow, and a member of the American College of Financial Services Professionals, Forensic Expert Witness Association, and the American College of Forensic Examiners International.

Background Experience - Mr. Lieberman started as an insurance agent for Metropolitan Life and then advanced in his career to manage brokers. He successfully built agencies for Aetna, and Principal Financial Group. He was later promoted to Regional Director for New England Financial, and CSAA Life. Over the years he mentored hundreds of insurance agents, brokers, financial planners and agency managers to build their own successful careers and agencies. He was also a member of the Million Dollar Round Table and utilized his selling and management experience to train insurance agents, brokers and financial planners in advanced areas of estate, business insurance, and financial planning.

Litigation Support - . Mr. Lieberman has utilized his financial planning and insurance industry knowledge to consult with attorneys for over the past 12 years. He consults with attorneys and assists council in trial preparation regarding issues of life insurance and annuity coverage analysis, coverage disputes, and company practices. He has been called upon to be an expert witness in insurance litigation cases for both plaintiff and defendant.

Areas of Expertise:

Life Insurance Coverage Analysis Annuity Coverage Analysis Coverage Disputes Company Practices Life Insurance Products and Services

Contract Analysis Regulations Compliance Best Practice Principles Life Insurance Underwriting Procedures

View Maurice Lieberman's Consulting Profile.

Mitchell L. Lathrop, has over 50 years of experience in the practice of law, and specialized knowledge in Insurance, Reinsurance, and Lawyers' Professional Responsibility. For the past 30 years, Mr. Lathrop has served as a Mediator, Arbitrator and Expert Witness in his fields of expertise. A seasoned trial lawyer, he brings his many years of practice to alternative dispute resolution. Mr. Lathrop is admitted to practice in California, New York and the District of Columbia, as well as before the U.S. Supreme Court and the U.S. Courts of Appeals for the Second, Fifth, Ninth, Tenth, District of Columbia and Federal Circuits. Mr. Lathrop is a former Presiding Referee of the California State Bar Court. He serves on the National Panel of the American Arbitration Association and is a Distinguished Neutral of the International Institute for Conflict Prevention and Resolution (CPR), as well as a member of the London Court of International Arbitration. He is the author of "Insurance Coverage for Environmental Claims," published by Lexis-Nexis Matthew Bender. He has qualified as an expert in insurance and legal malpractice in both state and federal courts. Areas of Expertise:

• Insurance bad faith and standard of care and conduct
• Reinsurance Law - Property and Casualty insurance
• Treaty and Facultative Reinsurance
• Environmental Insurance
• Complex insurance coverage Issues
• Lawyers' Professional Responsibility

For 34 years, Steven Plitt has represented policyholders / insureds in litigation and trial as well as representing insurance companies in Insurance Coverage and Bad Faith matters. During his career, he has reviewed thousands of claim files from more than 100 insurance companies. He has regularly consulted with all levels of claim department management from claim adjusters, supervisors, branch claim managers, claim-legal personnel and executive level insurance company management.

Mr. Plitt has also consulted with underwriting departments and participated with insurance company product development units and claims-legal to draft insurance policy language. He has reviewed and analyzed a broad spectrum of testimony from claims adjusters, claims management, claims attorneys, underwriters and other insurance company management as well as other insurance experts. He has reviewed an extensive variety of claims manuals, claims guidelines and other claims directives and practices.

Mr. Plitt is a nationally recognized expert witness in insurance claim handling and bad faith cases and has been retained as an expert in hundreds of cases nationally. He has qualified in both state and Federal Courts as a claims handling and insurance expert. He is currently an Adjunct Professor of Law at the University of Arizona where he teaches insurance law.

Areas of Expertise:

Insurance Extra-contractual Bad Faith Claims / Breach of Contract Claims Claims Handling Practices Unfair Claims Practices Policy Interpretation Coverage Denials

Property & Casualty Insurance Personal & Commercial Lines Surplus Lines Excess & Umbrella Insurance Insurance Agent / Broker Errors & Omissions Miscellaneous Coverage

Mr. Plitt has an LL.M. in Insurance from the University of Connecticut. He is the current successor author to COUCH ON INSURANCE 3D where he and his team are rewriting and revising the entire treatise. He has written other books on insurance law. He has published in excess of 320 law reviews and other professional publications on insurance law in addition to his books. Mr. Plitt has been cited by the Supreme Courts in 32 states, the Intermediate Appellate Courts in 23 states, 10 of the Federal Circuit Courts of Appeal, 54 Federal District Courts, the Federal Court of Claims and Federal Bankruptcy Court. Mr. Plitt has been cited in the Code of Federal Regulations. Mr. Plitt has also been cited in 91 scholarly articles.

Steven Plitt has been continuously listed as a top 50 lawyer in Arizona (2007-2014) by SOUTHWEST SUPER LAWYERS®, has been listed in BEST LAWYERS® since 2007 (insurance), and was named the Insurance Lawyer of the Year by BEST LAWYERS® in 2012 for Phoenix. He is a Fellow in the American College of Coverage and Extracontractual Counsel and a Member of the American Law Institute where he is a consultive member on the development of the RESTATEMENT OF LIABILITY INSURANCE.

HLN offers Peer-reviewed methodologies and Appellate court proven testimony by experienced professionals who have provided consulting services and conducted audits and investigations for hundreds of hospitals, physicians and other healthcare providers nationwide. HLN's experts have provided expert testimony in administrative and regulatory proceedings, as well as in state and federal courts for civil and criminal cases, for plaintiffs and defendants.

HLN provides experts in: medical billing, reasonableness of charges, reasonable value of medical services, Medicare & Medicaid reimbursement and compliance, clinical documentation, medical record coding, economic damages, insurance disputes, lost profits and false claims. HLN's founder co-authored two editions of the AMA's best selling Mastering the Reimbursement Process book. 

HLN's Consultants include:

Certified Public Accountants (CPA)  Certified Coding Specialists (CCS and CCS-P) Certified in Financial Forensics (CFF)  Certified in Healthcare Compliance (CHC)  Certified Fraud Examiner (CFE)  Certified Healthcare Chart Auditor (CHCA)  Certified Professional Coder (CPC and CPC-H)  Licensed Insurance Agents RN, MD, DO and DCs Financial Analysts Statisticians

Guy O. Kornblum has specialized as a Trial and Appellate Lawyer for 40 years. He has handled over 4,000 litigated matters to conclusion and has several million dollar cases to his credit. Mr. Kornblum has represented hundreds of clients, small businesses, individuals, and large Fortune 500 corporations during his 40 plus years of practice. He is highly regarded for his courtroom and appellate skills, and his representation of his clients in mediations, where he has a strong track record of successful settlements.

Litigation Support - Mr. Kornblum serves as a mediator and expert witness and has qualified as an expert in federal and state court. His testimony on insurance claims handling was cited by a California Court of Appeal in upholding a jury verdict in favor of a plaintiff in an insurance bad faith case.

Expertise Includes:

• Insurance Company Claims Practices - personal and commercial, property and casualty, employment coverage, director‘s and officer‘s coverage, professional liability coverage, general commercial coverage, life, health and disability insurance, bad faith, serious personal injury, professional liability, real estate, employment matters, and fraud claims involving employee welfare benefit plans, wrongful death, and actions claiming punitive damages
• Standard of Care in Legal Malpractice Cases Involving Civil Litigation Issues
• Case Settlement Value

Mr. Kornblum is Certified in Civil Trial Advocacy and Civil Pretrial Practice Advocacy by the prestigious National Board of Trial Advocacy, and is a Fellow, American College of Board Certified Attorneys. He is also a Life Member of the Multi-Million Dollar and Million Dollar Advocate’s Forum, for those attorneys who have achieved multi-million dollar awards or settlements for their clients. Mr. Kornblum is also a Charter Fellow in the Litigation Counsel of America Trial Lawyer Honorary, a Platinum Member of The Verdict Club, recognizing his “professional excellence in litigation,” and a Legends Society “Top Lawyer” in the personal injury field, and a Silver Member of the Elite Lawyers of America. He has been selected as a Super Lawyer each year since 2006.

View Guy Kornblum's Consulting Profile.

Vera Dolan is an epidemiologist with over 30 years of experience in the life and health insurance industries. She is one of the leading mortality experts in the life insurance industry. She writes underwriting manuals and policy and procedure manuals for life and health insurance companies.

Vera has testified in both state and federal court, and has been retained in over 150 cases since 2006 for plaintiffs and defense on an equal basis. She is very credible testifying in deposition and on the stand.

* Life expectancies that are personalized and accurate to the standards of the life insurance and life settlement industries. Addresses the cases when life expectancies that are simply taken from a life table or estimated by a doctor, actuary or biostatistician are too long, too short, insufficient or not credible. Addresses the cases when a complete insight into the individual's medical conditions and/or personal history of high-risk behaviors is needed to assist the judge or jury in their decision. This information often decides the case, see article for details.

* Expert in bad faith/wrongful denial of life/health insurance claims.

* Expert in life/health insurance underwriting material misrepresentation.

* Expert in medical risk assessment and underwriting issues.

* Expert in life insurance underwriting policies and procedures.

* Expert in epidemiology. Previous cases include infectious diseases, occupational and environmental exposures, pesticides and tobacco.

* Approved life expectancy expert with the U.S. Department of Justice.

* Active consultant to the life insurance industry conducting cohort mortality studies, and writing underwriting and policy and procedure manuals.

* Over 100 articles published on mortality research and underwriting.

* Friendly, clear, concise, objective and quantitative.

* There is no charge for the initial phone consultation.

* There is no charge for travel time.

Wayne Citron has 45 years of experience as an expert in Forensic Reconstruction of Insurance Transactions. He is an insurance expert and consultant.

Litigation Support - Wayne Citron specializes in policy interpretation of the rules, laws, and regulations governing insurance and financial matters. His services are available to attorneys representing plaintiff and defendant and include effective reports, affidavits, depositions, and testimony as needed.

Areas of Expertise:

Insurance Bad Faith Insurance Customs and Practices Insurance Health / HMO / Disability

Insurance - Life & Annuities Property / Casualty Insurance Insurance Agents & Brokers - Standard of Care

Mr. Citron established the Citron Agency and CMC Advisors Inc. in 1972, where his duties included executive and managerial responsibilities, sales, service, compliance with all insurance matters as well as securities laws and regulations. Both firms are leaders in life, health, disability and property and casualty insurance.

Mr. Citron is an expert in all forms of insurance, including:

Life Insurance Health Insurance Property and casualty Insurance Disability Insurance Annuities Retirement, IRAs & Pensions

Flood Insurance Broker Malpractice / Bad Faith Profit Sharing Group Coverage Self-insurance Insurance Laws / Regulations

Mr. Citron has served as an instructor for Prudential Insurance Company Brooklyn Agency (1973) educating personnel in general insurance matters, underwriting, and insurance law. He has worked with companies including Prudential Insurance Company, United States Life Insurance Company, North American Company for Life and Health Insurance, American General Life Insurance Company, William Penn Life Insurance Company, American Life Insurance Company, Chubb Insurance Company, Travelers Insurance Company, Mass Mutual Insurance Company, John Hancock Insurance Company, and American International Group (AIG), among other.

View CMC Advisors' Consulting Profile.

Peter J. Bondy FSA, MAAA, has more than 45 years of experience as an Actuary and a Financial Services Professional. He has served as a corporate executive, as a corporate director, and as a consultant domestically and internationally. Mr. Bondy has extensive experience with insurance company and reinsurer matters and practices ranging from basic business practices to matters involving financial projections and valuations as well as sales practices. He has served on corporate boards and brings a broad understanding of the issues involved. A published author, Mr. Bondy has delivered lectures and spoken frequently around the country. He is fluent in English and Spanish, his first language.

Litigation Support - Having had experience with many complex projects throughout his career, Mr. Bondy is able to serve as an expert consultant or as an expert witness for complex matters and issues regarding annuities, insurance, reinsurance, emerging mortality, experience issues, and corporate matters. He provides a broad range of litigation support services to attorneys representing both plaintiff and defendant.

Areas of Expertise

• Actuary / Actuarial
• Reinsurance
• Economic Loss
• Joint Marital Property
• Valuation of Streams of Contingent Future Payments
• Usufruct Arrangements
• Private Annuities
• Insurance : Life / Health / Annuities / Disability
• Life Settlements / Structured Settlement Annuities
• Appraisal and Performance Evaluation of: Life Insurance / Life Settlement Transactions / Annuity Benefits / Retirement Benefits