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:

Mr. Grantham submitted a claim for furniture items that were stolen from his apartment. He had sold the same property that he claimed were stolen. Mr. Grantham did not pursue the claim after the Big River Insurance Company advised him of their knowledge of his sale of the property. Claim Closed.

Answer 1:

Question 2:

Mrs. Peppers submitted a repair invoice for $300, when she only paid the repair shop $150. Trusty Auto Insurance Company obtained a copy of the repair bill and a copy of Mrs. Peppers check to verify the amount of the payment.

Answer 2:

Question 3:

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 3:

Question 4:

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 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: