Insurance Fraud Flashcards
Elizabeth, a grocery store cashier, slips on a wet floor and falls while at work. She is unharmed but pretends to suffer an injury from the fall. She files a claim against the store’s workers’ compensation insurance policy and collects payments from the insurance carrier. She also misses several weeks of work even though she is fully capable of working. Under which category of workers’ compensation schemes does Elizabeth’s scheme fall?
A. Premium fraud
B. Claimant fraud
C. Organized fraud
D. Agent fraud
B. Claimant fraud
Which of the following is NOT a potential indicator of insurance fraud?
A. An insured can provide the insurance company with documentation for claims involving expensive property.
B. A claim for a burglary loss includes large, bulky property.
C. A claim is made shortly after a change in policy coverage.
D. An insured previously asked an insurance agent hypothetical questions about details similar to those involved in the claim.
A. An insured can provide the insurance company with documentation for claims involving expensive property.
Jeremy is involved in an automobile accident but does not have insurance. To be reimbursed for the damages, he gets insurance, waits a short time, and then reports the vehicle as having been in an accident. He has committed an insurance scam known as _____________.
A. Past posting
B. Ditching
C. Churning
D. None of the above
A. Past posting
An address similarity report can help detect insurance fraud by showing a payment defalcation or funds that might have been fraudulently sent to which of the following parties?
A. Another insurance company
B. A fictitious payee
C. A broker
D. All of the above
D. All of the above
Workers’ compensation schemes are generally broken into four categories. Which of the following is NOT one of these categories?
A. Premium fraud
B. Claimant fraud
C. Agent fraud
D. Double duty fraud
D. Double duty fraud
Janice, a Certified Fraud Examiner (CFE) for a major insurance company, has received an anonymous tip that an employee in the claims department is processing claims for their own benefit during nonworking hours. To gather information about the validity of this tip, Janice should look at which of the following reports?
A. Exception report
B. Manual override report
C. Address similarity report
D. All of the above
D. All of the above
Insurance agent/broker fraud includes which of the following?
A. Fictitious death claims
B. Premium theft
C. Fictitious payees
D. All of the above
D. All of the above
Which of the following is the BEST definition of the automobile insurance scheme known as ditching?
A. An insured falsely reports a vehicle as stolen to collect on an insurance policy.
B. An insured has two insurance policies in place and files claims with both.
C. An agent inflates their commissions by pressuring customers to unnecessarily replace existing policies for new ones.
D. An agent collects a customer’s premium but does not remit the payment to the insurance company.
Submit
A. An insured falsely reports a vehicle as stolen to collect on an insurance policy.
All the following are red flags of fraudulent insurance claims EXCEPT:
A. A fire loss claim does not include family heirlooms or other sentimental items.
B. A claim is made soon after the insurance policy commences.
C. A theft claim includes a lot of recently purchased property without proof of purchase.
D. The insured has not made many insurance claims in the past.
D. The insured has not made many insurance claims in the past.
Which of the following is TRUE concerning the different types of workers’ compensation fraud schemes?
A. In premium fraud, an employer might understate the amount of the payroll for higher-risk classifications to get a lower-cost premium
B. In an organized fraud scheme, a lawyer, a capper, a doctor, and the claimant often collude to defraud the insurance company
C. In an agent fraud scheme, agents sometimes issue certificates of coverage to the insured customer while pilfering the premium
D. All of the above
D. All of the above
__________ is the term used for including additional coverages in an insurance policy without the insured’s knowledge.
A. Sliding
B. Churning
C. Twisting
D. None of the above
A. Sliding
An address similarity report is an electronic insurance fraud detection tool that compares multiple payments going to the same address.
A. True
B. False
True
