CCP SIU Referral & Fraud Indicators 2

Question 1

A claimant reports a vehicle theft but the GPS data shows the vehicle was stationary at a different location than reported. What fraud indicator does this represent?

Accepted Answer

Physical evidence inconsistency

Answer

When physical or electronic evidence contradicts the claimant's account, it is a classic physical evidence inconsistency fraud indicator requiring SIU referral.

Question 2

Which of the following is the MOST significant red flag when a medical provider submits bills for a claimant?

Accepted Answer

Billing for services on dates the claimant was hospitalized elsewhere

Answer

Billing for services rendered on dates when the patient was provably elsewhere indicates phantom billing fraud.

Question 3

A newly purchased policy is followed within days by a large theft claim. This scenario most closely resembles which fraud scheme?

Accepted Answer

Policy inception fraud

Answer

Policy inception fraud occurs when a policy is obtained specifically to file an immediate fraudulent claim.

Question 4

When an SIU investigation is opened, what obligation does the insurer generally have under most state regulations?

Accepted Answer

Report fraud findings to the state insurance fraud bureau within a specified timeframe

Answer

Most states mandate that insurers report suspected fraud to the state insurance fraud bureau or DOI within a specific period after discovery.

Question 5

A claimant's recorded statement contains inconsistencies about how the accident occurred. Which action should the adjuster take FIRST?

Accepted Answer

Document the inconsistencies and consider an SIU referral

Answer

The adjuster should document all inconsistencies and evaluate whether they rise to the level requiring an SIU referral per company guidelines.

(CCP) Certified Claims Professional Practice Test

(CCP) Certified Claims Professional Practice Test

CCP SIU Referral & Fraud Indicators 2