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:

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 1:

Question 2:

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 2:

Question 3:

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 3:

Question 4:

Brandon made a claim to the insurance company that while at a fast food restaurant, he fell and broke his left hand. After the insurance company conducted its investigation, they denied the claim because Brandon had been in a fight the night before and injured his hand when he punched someone.

Answer 4:

Question 5:

Dianne submitted a claim for disability insurance benefits, and she was paid $4,862.38 in disability proceeds. During the disability claim investigation, surveillance, and an interview with Dianne, the insurance company found out that she had been running her own in-home day care. Dianne reimbursed the insurance company for all of the proceeds that she had been paid.

Answer 5: