Fraud Detection and Prevention in Auto Claims Flashcards
6 cards from real CAIA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Fraud Detection and Prevention in Auto Claims flashcards as text
Which of the following is a common red flag indicator of a staged auto accident?
Answer: Multiple claimants with the same attorney
Multiple claimants represented by the same attorney is a classic indicator of a staged accident ring.
What type of auto insurance fraud involves a policyholder intentionally causing damage to their own vehicle to collect a claim?
Answer: Owner give-up fraud
Owner give-up fraud occurs when a policyholder deliberately destroys or abandons their own vehicle to collect insurance proceeds.
An adjuster notices the claimant's medical bills were submitted from a clinic that opened one week after the reported accident. This is most indicative of:
Answer: Possible medical billing fraud
A medical facility opening immediately before or after an accident and submitting related bills is a strong indicator of fraudulent billing schemes.
Which database is commonly used by U.S. insurance adjusters to detect prior claim histories and potential fraud patterns?
Answer: ISO ClaimSearch
ISO ClaimSearch is an industry-wide database that allows insurers to check a claimant's prior claim history across multiple carriers.
What is 'soft fraud' in the context of auto insurance claims?
Answer: Exaggerating a legitimate claim to recover more money
Soft fraud, also called opportunistic fraud, involves padding or exaggerating a real claim rather than inventing a fictitious one.
When an adjuster suspects fraud, the appropriate first step is to:
Answer: Document suspicions and refer to the Special Investigations Unit (SIU)
Suspected fraud should be documented and escalated to the carrier's Special Investigations Unit (SIU), which is trained to conduct fraud investigations.