Insurance Fraud Investigation Flashcards
7 cards from real CFS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Insurance Fraud Investigation flashcards as text
An insured files a claim for a vehicle stolen from a mall parking lot, but surveillance footage shows the vehicle leaving with the insured driving. This is BEST classified as:
Answer: Hard fraud
Hard fraud involves deliberately staging or fabricating a loss, such as a false stolen vehicle report.
Which red flag is MOST associated with a staged slip-and-fall claim at a retail store?
Answer: Incident occurs near closing time with few witnesses
Staged slip-and-fall incidents often occur when witness presence is minimal, such as near closing time.
In workers' compensation fraud, a 'double-dipping' scheme refers to:
Answer: Claiming benefits from two separate employers simultaneously
Double-dipping occurs when a claimant collects workers' compensation benefits while also working for another employer.
Which investigative technique is MOST effective for detecting workers' compensation claimants who are secretly working while collecting disability benefits?
Answer: Social media analysis
Social media often reveals claimants engaging in physical activities or employment inconsistent with their claimed disability.
A property insurer discovers that a policyholder increased dwelling coverage significantly three months before filing a total-loss fire claim. This pattern PRIMARILY suggests:
Answer: Pre-planned arson fraud
Rapidly increasing coverage shortly before a major loss is a classic red flag for pre-planned arson or intentional destruction.
Which organization maintains the ISO ClaimSearch database used by insurers to detect prior claims?
Answer: Verisk Analytics
ISO ClaimSearch is a product of Verisk Analytics, providing insurers access to a national claims history database.
When investigating a suspicious homeowner's claim, an SIU investigator interviews neighbors and discovers the insured moved out weeks before the reported burglary. This is MOST relevant to establishing:
Answer: Motive and opportunity for fraud
Evidence that the insured vacated the property before the reported loss helps establish both motive (financial distress) and opportunity for the fraud.