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:

Brenda Jones was injured when she slipped on the ice in front of her neighbor's house. She was treated for back pain by Dr. Douglas Jones. Dr. Jones says that he and Brenda are not related. Information gathered during the claim process indicates that both people have used the same address sometime in the past 5 years. Also, a previous claim by Brenda indicates that she had a similar injury and was treated by the same Dr. Douglas Jones.

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:

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 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: