Insurance Fraud Questions

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:

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 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:

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 4:

Question 5:

Independent Agent Dan Bauer applied to become an agent with Reliable Investment Life & Annuity Assurance Company. He also applied for life insurance at the same time. He failed to tell the company that he had a serious medical condition and had treatment for it twice each year since May 2000.

Answer 5: