Insurance Fraud Quiz

What is Fraud?
According to Missouri Statute §375.991 RSMo., a person commits a "fraudulent insurance act" if he or she knowingly makes a statement or written document for a claim or insurance application which that person knows to contain material false information or conceals information concerning a material fact.
What is a policy dispute?
A policy dispute can be many things. You may have a policy dispute if it is questionable that you had coverage at the time of an accident. A policy dispute could be a disagreement about how an insurance company handles your claim (Mo. Reg. 20 CSR 100). Or, a policy dispute could be if your claim is denied because of a misrepresentation that is not material to the loss covered on the policy (§376.580 RSMo).
This quiz is developed for example purposes only. The questions and answers in this quiz are not to be construed as an opinion or position taken by the Missouri Department of Insurance. If you believe that you have a claim that should be paid, you may wish to ask the Consumer Affairs Section of the Missouri Department of Insurance for assistance by calling 1-800-726-7390 or check us out on line.

Question 1:

The insured, Alex, was three months late on his monthly car payment when his car was stolen. Alex told the lien holder, River Bend Savings & Loan that he was out of town when the theft occurred, but later he told the claim adjuster for the insurance company that he was working at his second job at that time. No broken glass was found at the insured's apartment where the vehicle was parked. Alex's car was recovered in a burnt condition. The door locks did not appear damaged, the radio was in the vehicle, the wheels and tires were still attached, and no other parts appeared to be missing.

Answer 1:

Question 2:

Kim filed a claim stating that she fell on her neighbor's back porch on January 12, 2003 due to snow and ice. She hurt her left shoulder. When the insurance company reviewed her medical records, they found a note stating that the original injury happened before Thanksgiving 2002, when she fell at a roller skating rink. The doctor for the insurance company confirmed what the note indicated.

Answer 2:

Question 3:

Greg, a 9-year-old boy, slipped and fell at a local restaurant. Greg's mom, Carol, says that Greg fell because an employee was mopping the floor and tripped her son with a mop. When the insurance company interviewed five witnesses, they all indicated that Greg was running and tripped on his own shoelaces and that there were no employees near him. Carol could not come up with any witnesses that could tell the same side of her story.

Answer 3:

Question 4:

Brandon made a claim to the insurance company that while at a fast food restaurant, he fell and broke his left hand. After the insurance company conducted its investigation, they denied the claim because Brandon had been in a fight the night before and injured his hand when he punched someone.

Answer 4:

Question 5:

Tammy filed a claim with her auto insurance company for hail damage two moths ago. The auto insurance company asked for proof of loss and specifically asked her to take pictures and mail them in. Tammy refused to take pictures because she felt that a claim adjuster should view her car and write her a check on the spot without questions asked. Her claim was denied due to lack of cooperation.

Answer 5: