ACE Fraud Detection & Prevention 2

Question 1

Which ACORD form field is most commonly manipulated in staged auto accident fraud schemes?

Accepted Answer

Vehicle identification number (VIN)

Answer

Date of loss

Answer

Policy inception date

Answer

Agent code

Question 2

In the context of ACORD data standards, what is a 'soft fraud' indicator in property claims?

Accepted Answer

Slightly inflating the value of legitimately damaged items

Answer

Filing a claim for a loss that never occurred

Answer

Using a false identity to obtain a policy

Answer

Burning property to collect insurance proceeds

Question 3

Which data element in ACORD's AL3 standard is critical for detecting policy stacking fraud in auto insurance?

Accepted Answer

Vehicle use code

Answer

Named insured tax ID

Answer

Prior carrier code

Answer

Multi-car discount flag

Question 4

What is the primary purpose of the NAIC's Special Investigations Unit (SIU) data call?

Accepted Answer

Collecting standardized fraud referral data across insurers

Answer

Setting premium rates for high-risk policyholders

Answer

Licensing fraud investigators in all 50 states

Answer

Maintaining a national database of convicted insurance fraudsters

Question 5

Under the ISO ClaimSearch system, what triggers an automatic cross-match alert for a claimant?

Accepted Answer

Matching name, SSN, or vehicle data against prior claims in the database

Answer

Filing more than one claim per policy period

Answer

Claiming injuries without a police report

Answer

Switching insurers within 30 days of a loss

Question 6

Which red flag is MOST indicative of medical provider fraud in workers' compensation claims?

Accepted Answer

Billing for procedures not supported by the diagnosis code

Answer

Claims filed on Mondays

Answer

Claimant returning to work sooner than expected

Answer

Multiple claims from one employer within a year

Question 7

What role does ACORD's XML framework play in real-time fraud detection?

Accepted Answer

It enables structured, machine-readable data exchange that feeds analytics and fraud scoring engines

Answer

It encrypts all policy data to prevent data breaches

Answer

It mandates SIU referrals within 48 hours of claim intake

Answer

It generates automatic fraud scores for each new policy