CALA Risk Management & Fraud Prevention in Claims Handling 2

Question 1

Which red flag most strongly suggests a staged collision between two cooperating drivers?

Accepted Answer

Both vehicles show damage inconsistent with the described impact angle

Answer

Both drivers use the same body shop

Answer

The at-fault driver immediately admits liability

Answer

The claimant has prior claims with the same insurer

Question 2

A claimant submits repair invoices totaling $8,400 but the adjuster's appraisal is $3,200. What is this discrepancy most likely called?

Accepted Answer

Inflated repair fraud

Answer

Supplemental claim

Answer

Betterment dispute

Answer

Comparative negligence offset

Question 3

What does the term 'sliding' mean in the context of insurance fraud?

Accepted Answer

Adding unauthorized coverages to a policy without the insured's knowledge

Answer

Delaying settlement to reduce payout

Answer

Shifting liability to a third party

Answer

Reducing stated deductibles after a loss

Question 4

Under the ISO ClaimSearch database, what is the primary purpose of cross-referencing a claimant's prior claims history?

Accepted Answer

To identify patterns of suspicious or repeated claims

Answer

To determine subrogation potential

Answer

To verify the claimant's current coverage limits

Answer

To calculate accurate diminished value

Question 5

An adjuster notices a vehicle was reported stolen two days after the insured defaulted on auto loan payments. Which fraud category does this most likely represent?

Accepted Answer

Hard fraud (owner give-up)

Answer

Opportunistic fraud

Answer

Soft fraud (premium evasion)

Answer

Third-party liability fraud

Question 6

Which method is MOST effective for detecting phantom passenger fraud in an auto accident claim?

Accepted Answer

Obtaining recorded statements from each alleged occupant separately

Answer

Reviewing the vehicle's service history

Answer

Inspecting airbag deployment data

Answer

Requesting the insured's credit report

Question 7

A body shop bills for OEM parts but installs aftermarket parts and keeps the price difference. This scheme is known as:

Accepted Answer

Parts substitution fraud

Answer

Betterment padding

Answer

Short-pay fraud

Answer

Labor rate churning