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:

Stacie applied for auto insurance coverage to Country Auto Insurance Company. When the agent asked for information about all drivers in the home, Stacie failed to disclose information about her son. According to the underwriting standards of Country Auto Insurance Company, her son's membership in Stacie's household caused the household ineligible for coverage due to the revoked status of his driver's license. Stacie also did not tell the company that she had an accident two months ago and that her husband had a speeding ticket a year back.

Answer 1:

Question 2:

Janet completed an application for credit life insurance for the loan on her new car. She was asked if she had any pre-existing health conditions for heart attacks. She said no. Janet died from a heart attack 6 months later. The autopsy indicated that Janet had a small heart attack one year ago, but may have thought it was indigestion or heart burn at that time. If she would have seen the doctor for her problem a year ago, the doctor might have diagnosed her with heart disease.

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:

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 4:

Question 5:

Angela needs to make a few bucks quickly. She works at a one-hour photo shop after school. She has made a few fake ID�s in the past so that her friends can get into the R rated movies. She�s become very good at it too. Since she thinks no one gets hurt by sneaking into R rated movies, what damage has been done? � Right? But, Angela needs to make extra money fast for next weekend�s shopping trip to St. Louis. Why not try her hand at Insurance ID cards? Those little paper proof of insurance cards are easy to fake and Angela can whip out a dozen in no time with her scanner, Picture Shop editing program, and a color printer with good paper!

Answer 5: