CCA CCA Fraud Detection and Prevention 1

Question 1

Which type of insurance fraud involves a policyholder exaggerating an otherwise legitimate claim?

Accepted Answer

Both B and C

Answer

Hard fraud

Answer

Soft fraud

Answer

Opportunistic fraud

Question 2

A 'staged accident' is an example of which type of insurance fraud?

Accepted Answer

Hard fraud

Answer

Soft fraud

Answer

Premium evasion

Answer

Medical billing fraud

Question 3

Which of the following is a common red flag for auto insurance fraud?

Accepted Answer

Policy purchased shortly before the reported loss

Answer

Claim filed on the same day as the accident

Answer

Multiple witnesses at the accident scene

Answer

Vehicle photographed at the scene by police

Question 4

What organization in the US serves as the primary repository for insurance fraud information shared among insurers?

Accepted Answer

NICB (National Insurance Crime Bureau)

Answer

NAIC

Answer

ISO/Verisk

Answer

FBI

Question 5

A claimant submits medical bills for treatment on a date when records show they were out of the country. This is best described as:

Accepted Answer

Medical billing fraud / hard fraud

Answer

Soft fraud through exaggeration

Answer

Premium evasion

Answer

Material misrepresentation at policy inception

Question 6

When an adjuster suspects fraud, the FIRST action they should typically take is:

Accepted Answer

Document the red flags and refer the file to the Special Investigations Unit (SIU)

Answer

Deny the claim immediately

Answer

Alert law enforcement without telling the insurer

Answer

Contact the claimant to confront them about the suspicion