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:

Freedom Life Insurance Company did not pay any claim money or suffer a loss. Mr. Farmer passed away on July 1, 2002. On that same date, Freedom Life Insurance Company received a Change Of Beneficiary form with Mr. Farmer's signature. Due to Mr. Farmer's history of illness, the Change Of Beneficiary form was forwarded to the Document Investigations Unit of Freedom Life. The investigations unit determined that Mr. Farmer's mother, Betty, had forged her son's signature. Betty now states that her son intended to change the beneficiary of his policy and also says that she had authorization to make changes for her son. Though, she cannot produce any documents that certify her authorization.

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:

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:

Tammy filed a claim with her auto insurance company for hail damage two moths ago. The auto insurance company asked for proof of loss and specifically asked her to take pictures and mail them in. Tammy refused to take pictures because she felt that a claim adjuster should view her car and write her a check on the spot without questions asked. Her claim was denied due to lack of cooperation.

Answer 4:

Question 5:

Mr. Townsend submitted a claim for furniture items that were stolen from his apartment. He intended to sell them at his garage sale in a week. He told all of his friends about his garage sale and invited them to see his furniture two weeks before the garage sale. From the information available to the investigators, it appears that Mr. Townsend's apartment was broken into and that he may be the victim of random burglars.

Answer 5: