Fraud Detection and Prevention in Auto Claims Flashcards
6 cards from real CAIA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Fraud Detection and Prevention in Auto Claims flashcards as text
Which of the following best describes a 'swoop and squat' staged accident scheme?
Answer: One vehicle cuts off another causing it to brake suddenly while a rear vehicle collides
In a swoop and squat, a 'squatter' vehicle cuts in front of a target car and brakes suddenly, causing the target to rear-end them while a second vehicle blocks escape.
Which physical evidence inconsistency most strongly suggests a fraudulent rear-end collision claim?
Answer: Damage patterns inconsistent with the described impact speed
When the physical damage pattern does not match the physics of the described collision, it indicates the damage may have occurred differently than claimed.
What is the role of the National Insurance Crime Bureau (NICB) in auto fraud investigations?
Answer: It provides a federal database and investigative resources to combat insurance fraud
The NICB is a non-profit organization that partners with insurers and law enforcement to investigate and prevent insurance fraud and vehicle theft.
An adjuster reviews social media and finds the claimant posting photos of strenuous physical activity days after claiming a disabling back injury. This evidence is best used to:
Answer: Support referral to the SIU and potential fraud investigation
Social media evidence of activity inconsistent with claimed injuries supports an SIU referral and is documented in the claim file as a material inconsistency.
Which of the following is considered 'hard fraud' in auto insurance?
Answer: Reporting a stolen vehicle that was actually sold
Hard fraud involves deliberately fabricating an entirely false event, such as reporting a vehicle as stolen when it was actually sold or hidden.
State insurance fraud statutes in the U.S. typically classify insurance fraud as:
Answer: A criminal offense that may be a felony depending on the dollar amount
Most states classify insurance fraud as a criminal offense, and when the fraudulent amount exceeds a threshold, it is elevated to a felony charge.