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:

Richard North owns a 1998 Pontiac Grand Am and insures it with Green Belt Insurance Company. He reported that his car was stolen, set on fire and completely burnt. The fire marshal determined that there was evidence of Mr. North's involvement with the fire. Just days before his Grand Am was stolen, the bank (lien holder) for Mr. North repossessed one of two vehicles he owns. Two years ago, Mr. North had a 1997 Ford Truck stolen that was insured by a different insurance company. At that time, Mr. North purchased insurance on the 1997 Ford on April 20 and then it was reported stolen on June 1.

Answer 1:

Question 2:

Bob's home caught fire on January 1. The St. Louis fire investigator classified the fire as accidental due to a short circuit in the garage. A Cause & Origin Examination of the collapsed structure was conducted at the request of Bob's insurance company. There were positive identifiers for accelerants on both floors of the house. Also, the remains of the house were dug out to assist with the evaluation of the $300,000 claim for the contents of Bob's house. At the bottom of the basement stairs was a red plastic container containing a liquid with an odor similar to gasoline. After an interview with Bob's in-laws, it appears that half of his furniture is being kept at Bob's brother's house in Kansas City.

Answer 2:

Question 3:

Mr. Fair signed an application for life insurance on May 31, 2002. The Life Insurance Company issued the policy on June 28, 2002. Mr. Fair died due to a heart attack on October 4, 2002. When The Life Insurance Company received the claim for the policy benefits, they conducted a standard investigation into Mr. Fair's health records. The Life Insurance Company found that Mr. Fair had a very extensive heart history and knew about his condition when he applied for insurance coverage. Based on the review of his health history, The Life Insurance Company would not have issued the policy if they had known about Mr. Fair's condition at the time of the application. Since Mr. Fair lied about his health history, The Life Insurance Company refunded all of the premiums that were paid into the policy.

Answer 3:

Question 4:

Kim filed a claim stating that she fell on her neighbor's back porch on January 12, 2003 due to snow and ice. She hurt her left shoulder. When the insurance company reviewed her medical records, they found a note stating that the original injury happened before Thanksgiving 2002, when she fell at a roller skating rink. The doctor for the insurance company confirmed what the note indicated.

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: