CCA Fraud Detection and Prevention Flashcards
6 cards from real CCA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 CCA Fraud Detection and Prevention flashcards as text
Which type of insurance fraud involves a policyholder exaggerating an otherwise legitimate claim?
Answer: Both B and C
Soft fraud (also called opportunistic fraud) occurs when a policyholder inflates a genuine claim, such as adding extra items to a theft loss or exaggerating injury severity.
A 'staged accident' is an example of which type of insurance fraud?
Answer: Hard fraud
Hard fraud involves deliberately causing or fabricating a loss, such as staging a car accident, to collect insurance proceeds.
Which of the following is a common red flag for auto insurance fraud?
Answer: Policy purchased shortly before the reported loss
Purchasing a policy shortly before a reported loss is a classic fraud indicator, suggesting the 'loss' may have been pre-planned.
What organization in the US serves as the primary repository for insurance fraud information shared among insurers?
Answer: NICB (National Insurance Crime Bureau)
The NICB is a non-profit organization funded by insurers that works with law enforcement to detect and prevent insurance fraud and vehicle theft.
A claimant submits medical bills for treatment on a date when records show they were out of the country. This is best described as:
Answer: Medical billing fraud / hard fraud
Submitting bills for treatment that never occurred is a form of hard fraud — in this case, medical billing fraud involving fabricated records.
When an adjuster suspects fraud, the FIRST action they should typically take is:
Answer: Document the red flags and refer the file to the Special Investigations Unit (SIU)
Adjusters should document suspicious indicators and refer the claim to the insurer's Special Investigations Unit (SIU) rather than acting unilaterally or confronting the claimant.