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:

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:

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 3:

Question 4:

Jake Donaldson alleges that he cut his gum on a piece of glass, which was found in his grilled chicken sandwich on April 23. After six months of requests, Protection Casualty Company has not received medical records to substantiate Mr. Donaldson's claim. Prior to leaving the restaurant on April 23, one of the members of the group with Jake at the time said to the shift manager, "don't worry, he does this all the time to try and get free food".

Answer 4:

Question 5:

Tammy filed a claim with her auto insurance company for hail damage two moths ago. The auto insurance company asked for proof of loss and specifically asked her to take pictures and mail them in. Tammy refused to take pictures because she felt that a claim adjuster should view her car and write her a check on the spot without questions asked. Her claim was denied due to lack of cooperation.

Answer 5: