STUDY ONE - WHAT IS INSURANCE FRAUD?
A bar created when someone by his action, or lack of indicates he won't exercise a right he has stopping his right exercise it later
What is an Estoppel?
What is a Realist?
The eyes and ears of the insurer
What is a broker?
Getting to know the client, determining insurance needs, giving advise on insurance protection, obtaining instructions from the client, providing quotes on policies to the client
What are basic functions of selling insurance?
Insurer is extremely busy, a specialized type of knowledge is needed, a claim has occurred in a far away area
What are reasons an insurer might choose an independent adjuster?
Acts or omissions, an illegal benefit, fraudulent intent
What are the 3 basic elements required to qualify an event as insurance fraud?
Fraud that occurs when someone increases or "pads" a legitimate claim
What is Opportunistic fraud?
A person whose job it is to make sure that business meets the insurer's current appetite and whose responsibility it is to accept or reject business
What is an Underwriter?
Careless attitudes towards security and loss prevention
What is Alibaba?
The highest standard of integrity required on the part of the insurer and insured
What is Utmost Good Faith?
Staging an accident or committing arson to claim insurance money
What is Pre-meditated fraud?
Adjust claims promptly, protect the insured's confidential information and fully disclose information material to the insured's policy coverage, rights and obligations
What are adjuster's duties to insureds?
A vehicle that does not exist or is already wrecked
What is a Phantom vehicle?
Something an insurer is required to provide to a policy holder in a claims situation in order to comply with insurance acts in the various provinces
What is a blank proof of loss form?
Money designed to compensate a plaintiff for suffering intangible damages such as humiliation and distress
What is Aggravated Damages?
Someone who has the least tolerance of insurance fraud and advocates severe punishment
What is a Moralist?
One who represents an insured in the claim settlement process
What is a Public Adjuster?
An item is expensive to replace, an item is subject to low limits of insurance on standard policy, an item is only insured for certain limited perils or an item is completely excluded on standard property forms
What are reasons for scheduling items on a policy?
An investigative interview where the known facts are matched to a particular suspect for the purpose of obtaining a confession
What is an Interrogation?
Treating insureds fairly and with dignity, conducting a thorough investigation before taking action and considering any alternative measures to handle a claim
What are strategies for preventing bad faith lawsuits?
Promoting fraud awareness, teamwork, communication skills, consumer hotlines, detection strategies, rewards, training, data banks etc
What are Strategies to restrict fraud?
Integrity, competence, conscientious & quality of service, financial reliability, privacy
What are some common themes of Broker Codes of Ethics?
An official mark that is present on jewellery etc indicating a standard of purity
What is a Hallmark?
Pre-test interview, collection of data, analysis of data
What are the three stages of a polygraph test?