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:

Richard North owns a 1998 Pontiac Grand Am and insures it with Green Belt Insurance Company. He reported that his car was stolen, set on fire and completely burnt. The fire marshal determined that there was evidence of Mr. North's involvement with the fire. Just days before his Grand Am was stolen, the bank (lien holder) for Mr. North repossessed one of two vehicles he owns. Two years ago, Mr. North had a 1997 Ford Truck stolen that was insured by a different insurance company. At that time, Mr. North purchased insurance on the 1997 Ford on April 20 and then it was reported stolen on June 1.

Answer 1:

Question 2:

Stacie applied for auto insurance coverage to Country Auto Insurance Company. When the agent asked for information about all drivers in the home, Stacie failed to disclose information about her son. According to the underwriting standards of Country Auto Insurance Company, her son's membership in Stacie's household caused the household ineligible for coverage due to the revoked status of his driver's license. Stacie also did not tell the company that she had an accident two months ago and that her husband had a speeding ticket a year back.

Answer 2:

Question 3:

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 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:

Kevin fell on Gloria's front porch on 2/15/03 due to ice and snow, and injured his right shoulder. When asked for proof of his loss, Kevin gave the insurance company permission to ask his doctor for a copy of his medical records. After a review of Kevin's medical records the company found a note that indicated Kevin also fell in January of 1999. The March 2003 doctor's records indicate that the current injury was fully caused by the February 2003 fall. The insurance company is asking Kevin to see one of their doctors to verify what his doctor has determined. The insurance company's doctor may or may not agree with Kevin's doctor.

Answer 5: