CFS Insurance Fraud Investigation 2

Question 1

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:

Accepted Answer

Hard fraud

Answer

Hard fraud involves deliberately staging or fabricating a loss, such as a false stolen vehicle report.

Question 2

Which red flag is MOST associated with a staged slip-and-fall claim at a retail store?

Accepted Answer

Incident occurs near closing time with few witnesses

Answer

Staged slip-and-fall incidents often occur when witness presence is minimal, such as near closing time.

Question 3

In workers' compensation fraud, a 'double-dipping' scheme refers to:

Accepted Answer

Claiming benefits from two separate employers simultaneously

Answer

Double-dipping occurs when a claimant collects workers' compensation benefits while also working for another employer.

Question 4

Which investigative technique is MOST effective for detecting workers' compensation claimants who are secretly working while collecting disability benefits?

Accepted Answer

Social media analysis

Answer

Social media often reveals claimants engaging in physical activities or employment inconsistent with their claimed disability.

Question 5

A property insurer discovers that a policyholder increased dwelling coverage significantly three months before filing a total-loss fire claim. This pattern PRIMARILY suggests:

Accepted Answer

Pre-planned arson fraud

Answer

Rapidly increasing coverage shortly before a major loss is a classic red flag for pre-planned arson or intentional destruction.

(CFS) Certified Fraud Specialist Practice Test

(CFS) Certified Fraud Specialist Practice Test

CFS Insurance Fraud Investigation 2