CALA Fraud Detection & Prevention 3

Question 1

A claimant alleges total theft of a vehicle, but GPS data from the insured vehicle shows it parked at the claimant's workplace during the alleged theft window. This is an example of:

Accepted Answer

Hard fraud—fabrication of a loss

Answer

Fabricating a theft that never occurred using false statements is hard fraud, and GPS data is direct digital evidence contradicting the claim.

Question 2

When an SIU investigator conducts surveillance on a disability claimant, which legal principle must guide the investigation?

Accepted Answer

Surveillance is permissible only in public spaces where there is no reasonable expectation of privacy

Answer

Surveillance must be conducted only in public areas where there is no reasonable expectation of privacy to comply with privacy laws and avoid evidence suppression.

Question 3

Which of the following is a 'soft fraud' scenario?

Accepted Answer

Adding pre-existing damage to a legitimate storm damage claim

Answer

Soft fraud involves exaggerating or embellishing a legitimate claim—such as adding pre-existing damage—rather than fabricating a loss entirely.

Question 4

A homeowner files a claim for water damage and lists a 75-inch television as damaged. The adjuster finds an older 40-inch TV during inspection. Which fraud indicator is present?

Accepted Answer

Misrepresentation of damaged property value

Answer

Listing a higher-value item than what actually existed is misrepresentation of property, a common contents fraud technique.

Question 5

The Coalition Against Insurance Fraud (CAIF) primarily serves what function?

Accepted Answer

Advocating for anti-fraud laws and coordinating public awareness campaigns

Answer

The CAIF is a nonprofit alliance that advocates for stronger fraud laws and promotes public awareness about the costs of insurance fraud.

(CALA) Certified All-Lines Adjuster Practice Test

(CALA) Certified All-Lines Adjuster Practice Test

CALA Fraud Detection & Prevention 3