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:

Mr. Grantham submitted a claim for furniture items that were stolen from his apartment. He had sold the same property that he claimed were stolen. Mr. Grantham did not pursue the claim after the Big River Insurance Company advised him of their knowledge of his sale of the property. Claim Closed.

Answer 1:

Question 2:

Shawn Knight purchased a vehicle at a pawnshop. He had extensive repairs preformed on the car and also went back a second time for additional work. He took the car home after the work was completed but then called the shop owner wanting to know if the car was ready to be picked up. The shop owner thought he already came and picked up the vehicle. Since the shop owner could not find the car, he reported it stolen. Mr. Knight called back to say that his brother took the car because he thought the repair work cost too much. A few days later Mr. Knight reported the vehicle stolen from his mom's apartment. Mr. Knight would not answer the insurance company's questions in the E.U.O. (Examination Under Oath).

Answer 2:

Question 3:

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 3:

Question 4:

Amy has an Actual Cash Value policy and sustained roof damage to her home that was caused by a tornado. Amy filed a claim for a new roof, but the claim was denied because her roof was 35 years old and never had any repairs to it. Amy filed a complaint with the Missouri Department of Insurance because her policy covers roof replacement caused by weather damage.

Answer 4:

Question 5:

Todd applied for coverage on March 11th to Country Auto Insurance Company. The Country Auto Insurance Company agent forgot to ask about all the members of Todd's household. When Country Auto Insurance ran a standard application investigation, the company found that his stepdaughter lives part time in the house and she had a revoked status of her driver's license. The agent went back and advised Todd that he forgot to ask about other drivers in the house and he will need to exclude his stepdaughter from driving any of his cars since she has access to the vehicles part of the time.

Answer 5: