CCP SIU Referral & Fraud Indicators 3

Question 1

A homeowner files a claim for fire damage and the fire investigator determines the fire's origin was incendiary. Which factor would MOST strengthen a fraud referral?

Accepted Answer

The homeowner had significantly increased the policy limits 60 days before the fire

Answer

Substantially increasing coverage shortly before a suspicious loss is a key fraud indicator, especially when combined with an incendiary origin finding.

Question 2

Which type of fraud involves a legitimate accident but exaggerated injury claims or inflated repair estimates?

Accepted Answer

Soft fraud

Answer

Soft fraud involves opportunistic exaggeration of a real claim, such as inflating damages or overstating injuries after an actual accident.

Question 3

An injured worker's social media posts show them playing sports the week after claiming total disability. This is primarily an indicator of:

Accepted Answer

Malingering or workers' compensation fraud

Answer

Social media activity inconsistent with claimed disability is a strong indicator of malingering or workers' compensation fraud warranting SIU referral.

Question 4

Under the ISO ClaimSearch system, what primary function does the database serve in fraud detection?

Accepted Answer

It identifies patterns of prior claims across multiple insurers

Answer

ISO ClaimSearch cross-references claims data across insurers to reveal suspicious claim histories or patterns that a single insurer would not see alone.

Question 5

A claimant reports a jewelry theft but cannot provide any purchase receipts, photos, or appraisals for the claimed items. This lack of documentation is:

Accepted Answer

A fraud indicator that may warrant further investigation

Answer

Inability to substantiate high-value items is a fraud indicator that warrants additional investigation but alone does not prove fraud.

(CCP) Certified Claims Professional Practice Test

(CCP) Certified Claims Professional Practice Test

CCP SIU Referral & Fraud Indicators 3