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:

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 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:

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:

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: