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:

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 2:

Question 3:

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 3:

Question 4:

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 4:

Question 5:

Anna rented an apartment and had renters insurance for the things she owns in the apartment. Anna had a fire in the apartment and lost everything. The landlord told Anna that she would have to pay for every thing because the fire was her fault. On her claim form were items such as clothes, doors, hats, bathroom mirrors, furniture, and carpet. Anna was not paid for the doors, bathroom mirrors, and carpet.

Answer 5: