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:

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 1:

Question 2:

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 2:

Question 3:

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 3:

Question 4:

Mr. Townsend submitted a claim for furniture items that were stolen from his apartment. He intended to sell them at his garage sale in a week. He told all of his friends about his garage sale and invited them to see his furniture two weeks before the garage sale. From the information available to the investigators, it appears that Mr. Townsend's apartment was broken into and that he may be the victim of random burglars.

Answer 4:

Question 5:

One day Ricky simply decided that paying for car insurance was not for him. He wasn�t going to do it any more. He let his auto insurance cancel but still needed to get his license plates renewed because he knew that the police will stop you if you don�t have the current sticker on your plates. The Revenue License office would not renew Ricky�s plates without a current Insurance ID card. So Ricky quickly went to his card, got the old one out of is glove box and carefully penned in the current date so he could get license plates.

Answer 5: