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:

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 1:

Question 2:

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 2:

Question 3:

Amy has an Actual Cash Value policy and sustained roof damage to her home that was caused by a tornado. Amy filed a claim for a new roof, but the claim was denied because her roof was 35 years old and never had any repairs to it. Amy filed a complaint with the Missouri Department of Insurance because her policy covers roof replacement caused by weather damage.

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:

Mrs. Court took out a life insurance policy on Jim, 20 years ago, when he was 3. Jim has a condition that leaves him unable to independently take care of himself as an adult. Jim lives with his parents who have P.O.A. (Power Of Attorney) over his affairs. Mrs. Court called the insurance company to change his beneficiary to Jim's Estate. The insurance company refused to process the paperwork until Mrs. Court furnished a copy of the POA.

Answer 5: