Fraud Detection & Prevention Flashcards
7 cards from real CALA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Fraud Detection & Prevention flashcards as text
A 'swoop and squat' staged accident typically involves which scenario?
Answer: One vehicle cutting off another, causing a deliberate rear-end collision to collect liability damages
In a swoop and squat, one vehicle cuts in front of another and brakes suddenly, engineering a rear-end collision in which the following driver appears at fault.
Which red flag is most associated with 'claim padding' in a homeowners contents claim?
Answer: Claimed items include new high-value electronics with no proof of ownership
Claiming new high-value electronics without receipts, photos, or other proof of ownership is a classic indicator of contents claim padding.
What is the primary purpose of an Examination Under Oath (EUO) in the fraud investigation context?
Answer: To formally obtain sworn testimony from the insured to verify claim facts and detect inconsistencies
An EUO compels the insured to provide sworn testimony about the claim under penalty of perjury, making it a powerful tool to detect material misrepresentations.
When a claimant hires an attorney immediately after a minor fender-bender with no visible injuries at the scene, this is best classified as:
Answer: A potential fraud indicator that warrants closer claim review
Immediate attorney retention after a minor accident with no visible injuries is a recognized fraud indicator, though it alone does not prove fraud.
Which of the following best describes the role of the National Insurance Crime Bureau (NICB)?
Answer: A nonprofit organization that partners with insurers and law enforcement to detect and prevent insurance fraud
The NICB is a nonprofit that works collaboratively with member insurers and law enforcement agencies to investigate and combat insurance crime.
A claimant submits the same medical bill to both their health insurer and their auto liability insurer. This is known as:
Answer: Double-dipping or duplicate billing fraud
Submitting the same expense to multiple insurers to receive overlapping reimbursements is double-dipping, a common form of soft fraud.
Which approach is considered best practice when an adjuster first suspects fraud but lacks conclusive evidence?
Answer: Continue handling the claim normally while referring it to SIU and documenting all concerns
Best practice is to continue good-faith claim handling while simultaneously referring to SIU and documenting red flags, avoiding premature denial or accusation.