Studies 1 & 2

Question 1

Three basic elements required to qualify an even as insurance fraud.

Answer 1

a) Acts or omissions - false or misleading statements or suppression of the truth.
b) The illegal benefit - Insurance protection, payment of claims which would not be obtained without deception.
c) With a view to: Fraudulent intent of the person committing the fraud. See Mens Res - Guilty Mind

Question 2

“The guilty mind”. Differentiates a mere mistake from the commission of an act to defraud.

Answer 2

Mens Rea

Question 3

How is fraud defines by the criminal law?

Answer 3

Dishonesty and Deprivation - the use of deceit, trickery or a breach of confidence to gain an unfair or dishonest advantage.

Question 4

Obtaining something illegally or by deceit is…

Answer 4

Dishonesty

Question 5

Taking something away so that the economic benefits flow not to the rightful recipient but to a criminal perpetrating a crime.

Answer 5

Deprivation

Question 6

10 activities the Criminal Code specifies as fraudulent activity.

Answer 6

a) Arson
b) Bribery
c) Criminal breach of trust
d) Fabricating evidence
e) Forgery or making a false document.
f) Fraudulent concealment
g) Fraudulently destroying or falsifying documents of title.
h) Impersonation
i) Making false statement by affidavit
j) Misappropriating money

Question 7

Incorrect or missing information about a material fact that is offered, or not, by an applicant or insured with or without the intent to mislead is…

Answer 7

Misrepresentation

Question 8

This word is defined when the insured interprets contract wording with ambiguity meaning, the insured believes there is coverage offered when the actual working is supposed to offer no coverage or limited.

Answer 8

Contra Proferentem

Question 9

What is meeting of the minds?

Answer 9

1 of 5 legal requirements for parties to enter into a contract. Occurs prior to the agreement of said contract.

Question 10

What does pro rata mean?

Answer 10

Prorated policy premium returned to the insured when a policy is canceled.

Question 11

_ _ _ _ - when the entire policy premium is given back to the insured. Hint Ab Inito

Answer 11

Voided - when a policy is voided from the beginning is is “voided ab inito”.

Question 12

_ _ _ _ - One month premium is returned or pro rata.

Answer 12

Canceled policy.

Question 13

What are three things considered “bad faith”.

Answer 13

a) Design to deceive or mislead another.
b) Conscious wrong doing
c) Constructive fraud.

Question 14

_ _ _ _ - This is the fee for the wrong doing.

Answer 14

Punitive damages

Question 15

_ _ _ _ - When good faith is not extended to the insured…this fee is collected.

Answer 15

Exemplary damages.

Question 16

What are the two types of evidence?

Answer 16

a) Direct evidence

b) Circumstantial evidence

Question 17

Define direct evidence

Answer 17

Proves the fact in issue without the need to infer or make presumptions.

Question 18

Define Circumstantial evidence

Answer 18

Based on making inferences from connected facts.

Question 19

_ _ _ _ - This is a testimony given under oat in court.

Answer 19

Viva Voice

Question 20

_ _ _ _ - This is the destruction of evidence prior to the presentation. Also an alteration of a policy by a party other than the insured or insurer without consent prior to trial.

Answer 20

Spoliation

Question 21

_ _ _ - this is a bar created when someone by his action, or lack of it, indicated that he will not exercise a right he has. He stops himself from exercising his right later. Telling an insured there is coverage OTP, but later telling them the coverage never existed

Answer 21

Estopple

Question 22

Damages designed to compensate the plaintiff for suffering intangible damages such as humiliation and distress as a result of the defendants actions.

Answer 22

Aggravated damages

Question 23

The standard by which a claim must be proven to prevail.

Answer 23

Burden of proof