CALA Fraud Detection & Prevention 2

Question 1

A claimant reports a burglary but cannot provide receipts or photos of the stolen items. Which investigative step is most appropriate?

Accepted Answer

Request a recorded statement and supporting documentation

Answer

Requesting a recorded statement and supporting documentation is standard practice to verify ownership and the legitimacy of a burglary claim.

Question 2

Which pattern most strongly suggests organized auto insurance fraud in a staged accident ring?

Accepted Answer

Multiple claimants from the same household involved in separate minor accidents

Answer

Multiple claimants from the same household appearing in separate minor accidents is a hallmark indicator of organized staged accident fraud rings.

Question 3

Under the Insurance Fraud Prevention Act framework, insurers are generally required to report suspected fraud to which entity?

Accepted Answer

The state Department of Insurance fraud division

Answer

Most states require insurers to report suspected fraud to the state Department of Insurance fraud division, though NICB reporting may also be required.

Question 4

A contractor submits invoices for roof repairs that appear inconsistent with a property's pre-loss condition. What is this an example of?

Accepted Answer

Hard fraud involving an inflated claim

Answer

Submitting inflated invoices for repairs exceeding actual damage is a form of hard fraud, typically involving deliberate material misrepresentation.

Question 5

Which of the following best defines 'premium fraud' in the insurance context?

Accepted Answer

Misrepresenting risk characteristics to obtain lower premiums

Answer

Premium fraud involves misrepresenting material facts about the insured risk—such as garaging location or driver history—to secure a lower premium.

(CALA) Certified All-Lines Adjuster Practice Test

(CALA) Certified All-Lines Adjuster Practice Test

CALA Fraud Detection & Prevention 2