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. Fair signed an application for life insurance on May 31, 2002. The Life Insurance Company issued the policy on June 28, 2002. Mr. Fair died due to a heart attack on October 4, 2002. When The Life Insurance Company received the claim for the policy benefits, they conducted a standard investigation into Mr. Fair's health records. The Life Insurance Company found that Mr. Fair had a very extensive heart history and knew about his condition when he applied for insurance coverage. Based on the review of his health history, The Life Insurance Company would not have issued the policy if they had known about Mr. Fair's condition at the time of the application. Since Mr. Fair lied about his health history, The Life Insurance Company refunded all of the premiums that were paid into the policy.

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:

Independent Agent Dan Bauer applied to become an agent with Reliable Investment Life & Annuity Assurance Company. He also applied for life insurance at the same time. He failed to tell the company that he had a serious medical condition and had treatment for it twice each year since May 2000.

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:

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: