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:

The insured, Alex, was three months late on his monthly car payment when his car was stolen. Alex told the lien holder, River Bend Savings & Loan that he was out of town when the theft occurred, but later he told the claim adjuster for the insurance company that he was working at his second job at that time. No broken glass was found at the insured's apartment where the vehicle was parked. Alex's car was recovered in a burnt condition. The door locks did not appear damaged, the radio was in the vehicle, the wheels and tires were still attached, and no other parts appeared to be missing.

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:

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 4:

Question 5:

Anna rented an apartment and had renters insurance for the things she owns in the apartment. Anna had a fire in the apartment and lost everything. The landlord told Anna that she would have to pay for every thing because the fire was her fault. On her claim form were items such as clothes, doors, hats, bathroom mirrors, furniture, and carpet. Anna was not paid for the doors, bathroom mirrors, and carpet.

Answer 5: