CCA CCA Fraud Detection and Prevention

Question 1

Which type of insurance fraud involves a policyholder exaggerating an otherwise legitimate claim?

Accepted Answer

Both B and C

Answer

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.

Question 2

A 'staged accident' is an example of which type of insurance fraud?

Accepted Answer

Hard fraud

Answer

Hard fraud involves deliberately causing or fabricating a loss, such as staging a car accident, to collect insurance proceeds.

Question 3

Which of the following is a common red flag for auto insurance fraud?

Accepted Answer

Policy purchased shortly before the reported loss

Answer

Purchasing a policy shortly before a reported loss is a classic fraud indicator, suggesting the 'loss' may have been pre-planned.

Question 4

What organization in the US serves as the primary repository for insurance fraud information shared among insurers?

Accepted Answer

NICB (National Insurance Crime Bureau)

Answer

The NICB is a non-profit organization funded by insurers that works with law enforcement to detect and prevent insurance fraud and vehicle theft.

Question 5

A claimant submits medical bills for treatment on a date when records show they were out of the country. This is best described as:

Accepted Answer

Medical billing fraud / hard fraud

Answer

Submitting bills for treatment that never occurred is a form of hard fraud — in this case, medical billing fraud involving fabricated records.

(CCA) Certified Claims Adjuster Practice Test

(CCA) Certified Claims Adjuster Practice Test

CCA CCA Fraud Detection and Prevention