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:

Mr. Grantham submitted a claim for furniture items that were stolen from his apartment. He had sold the same property that he claimed were stolen. Mr. Grantham did not pursue the claim after the Big River Insurance Company advised him of their knowledge of his sale of the property. Claim Closed.

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:

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 3:

Question 4:

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 4:

Question 5:

Mr. Harris purchases insurance coverage for his car at 10:00 A.M. on September 1 from KC Auto Insurance Company. He stated to his agent and on his application that there is no damage to the car and no prior accidents. Mr. Harris called the insurance company at 10:30 A.M. and said that he was in an accident at 10:15 A.M. while leaving the parking lot of the insurance agent. The check that Mr. Harris wrote for the insurance coverage unfortunately bounced and was sent back to the company as an 'insufficient funds' transaction.

Answer 5: