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:

Mrs. Peppers submitted a repair invoice for $300, when she only paid the repair shop $150. Trusty Auto Insurance Company obtained a copy of the repair bill and a copy of Mrs. Peppers check to verify the amount of the payment.

Answer 1:

Question 2:

Jake Donaldson alleges that he cut his gum on a piece of glass, which was found in his grilled chicken sandwich on April 23. After six months of requests, Protection Casualty Company has not received medical records to substantiate Mr. Donaldson's claim. Prior to leaving the restaurant on April 23, one of the members of the group with Jake at the time said to the shift manager, "don't worry, he does this all the time to try and get free food".

Answer 2:

Question 3:

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 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:

Mrs. Court took out a life insurance policy on Jim, 20 years ago, when he was 3. Jim has a condition that leaves him unable to independently take care of himself as an adult. Jim lives with his parents who have P.O.A. (Power Of Attorney) over his affairs. Mrs. Court called the insurance company to change his beneficiary to Jim's Estate. The insurance company refused to process the paperwork until Mrs. Court furnished a copy of the POA.

Answer 5: