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:

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 1:

Question 2:

Josh damaged a sewer line when he was digging a trench for an electrical line to his house. This caused the sewer to back up in the house. Josh filed a claim stating that all of the items in his basement needed to be replaced. After the Rock Solid Property & Casualty Insurance Company investigated, it appears that only half of the items in his basement had sewer damage and the rest of his stuff was fine. Rock Solid Insurance Company advised Josh about their investigative findings and negotiated the claim. Rock Solid Insurance saved $20,250 by not paying for all of Josh's things.

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:

Janet completed an application for credit life insurance for the loan on her new car. She was asked if she had any pre-existing health conditions for heart attacks. She said no. Janet died from a heart attack 6 months later. The autopsy indicated that Janet had a small heart attack one year ago, but may have thought it was indigestion or heart burn at that time. If she would have seen the doctor for her problem a year ago, the doctor might have diagnosed her with heart disease.

Answer 4:

Question 5:

Mr. Harris purchases insurance coverage for his car at 10:00 A.M. on September 1 from KC Auto Insurance Company. He stated to his agent and on his application that there is no damage to the car and no prior accidents. Mr. Harris called the insurance company at 10:30 A.M. and said that he was in an accident at 10:15 A.M. while leaving the parking lot of the insurance agent. The check that Mr. Harris wrote for the insurance coverage unfortunately bounced and was sent back to the company as an 'insufficient funds' transaction.

Answer 5: