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:

Shawn Knight purchased a vehicle at a pawnshop. He had extensive repairs preformed on the car and also went back a second time for additional work. He took the car home after the work was completed but then called the shop owner wanting to know if the car was ready to be picked up. The shop owner thought he already came and picked up the vehicle. Since the shop owner could not find the car, he reported it stolen. Mr. Knight called back to say that his brother took the car because he thought the repair work cost too much. A few days later Mr. Knight reported the vehicle stolen from his mom's apartment. Mr. Knight would not answer the insurance company's questions in the E.U.O. (Examination Under Oath).

Answer 1:

Question 2:

Mr. Harrison damaged his vehicle at 9:00 A.M on September 1. Mr. Harris purchased insurance coverage for that same car at 10:00 A.M. on September 1, stating that there was no damage to the car and no prior losses (accidents or damage). Mr. Harris then reported that his car was damaged at 9:00 A.M on September 2.

Answer 2:

Question 3:

Kim filed a claim stating that she fell on her neighbor's back porch on January 12, 2003 due to snow and ice. She hurt her left shoulder. When the insurance company reviewed her medical records, they found a note stating that the original injury happened before Thanksgiving 2002, when she fell at a roller skating rink. The doctor for the insurance company confirmed what the note indicated.

Answer 3:

Question 4:

Todd applied for coverage on March 11th to Country Auto Insurance Company. The Country Auto Insurance Company agent forgot to ask about all the members of Todd's household. When Country Auto Insurance ran a standard application investigation, the company found that his stepdaughter lives part time in the house and she had a revoked status of her driver's license. The agent went back and advised Todd that he forgot to ask about other drivers in the house and he will need to exclude his stepdaughter from driving any of his cars since she has access to the vehicles part of the time.

Answer 4:

Question 5:

Kevin fell on Gloria's front porch on 2/15/03 due to ice and snow, and injured his right shoulder. When asked for proof of his loss, Kevin gave the insurance company permission to ask his doctor for a copy of his medical records. After a review of Kevin's medical records the company found a note that indicated Kevin also fell in January of 1999. The March 2003 doctor's records indicate that the current injury was fully caused by the February 2003 fall. The insurance company is asking Kevin to see one of their doctors to verify what his doctor has determined. The insurance company's doctor may or may not agree with Kevin's doctor.

Answer 5: