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:

On October 31, Julia reported to her insurance company that she had an accident earlier that morning. The police report and the tow truck bill indicate that the date of loss (accident) happened on October 27. The effective date of her auto insurance policy was on October 29.

Answer 2:

Question 3:

Stacie applied for auto insurance coverage to Country Auto Insurance Company. When the agent asked for information about all drivers in the home, Stacie failed to disclose information about her son. According to the underwriting standards of Country Auto Insurance Company, her son's membership in Stacie's household caused the household ineligible for coverage due to the revoked status of his driver's license. Stacie also did not tell the company that she had an accident two months ago and that her husband had a speeding ticket a year back.

Answer 3:

Question 4:

Bob's home caught fire on January 1. The St. Louis fire investigator classified the fire as accidental due to a short circuit in the garage. A Cause & Origin Examination of the collapsed structure was conducted at the request of Bob's insurance company. There were positive identifiers for accelerants on both floors of the house. Also, the remains of the house were dug out to assist with the evaluation of the $300,000 claim for the contents of Bob's house. At the bottom of the basement stairs was a red plastic container containing a liquid with an odor similar to gasoline. After an interview with Bob's in-laws, it appears that half of his furniture is being kept at Bob's brother's house in Kansas City.

Answer 4:

Question 5:

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 5: