CAIA Fraud Detection and Prevention in Auto Claims

Question 1

Which of the following is a common red flag indicator of a staged auto accident?

Accepted Answer

Multiple claimants with the same attorney

Answer

Minor vehicle damage with only one claimant

Answer

Claim filed within 24 hours of the accident

Answer

Vehicle has a clean title history

Question 2

What type of auto insurance fraud involves a policyholder intentionally causing damage to their own vehicle to collect a claim?

Accepted Answer

Owner give-up fraud

Answer

Opportunistic fraud

Answer

Soft fraud

Answer

Staged collision fraud

Question 3

An adjuster notices the claimant's medical bills were submitted from a clinic that opened one week after the reported accident. This is most indicative of:

Accepted Answer

Possible medical billing fraud

Answer

A legitimate new medical facility

Answer

Delayed treatment patterns

Answer

An unrelated injury claim

Question 4

Which database is commonly used by U.S. insurance adjusters to detect prior claim histories and potential fraud patterns?

Accepted Answer

ISO ClaimSearch

Answer

CARFAX

Answer

NICB WatchFile

Answer

CLUE report

Question 5

What is 'soft fraud' in the context of auto insurance claims?

Accepted Answer

Exaggerating a legitimate claim to recover more money

Answer

Fabricating an entirely false accident

Answer

Filing claims under a stolen identity

Answer

Colluding with a repair shop to inflate estimates

Question 6

When an adjuster suspects fraud, the appropriate first step is to:

Accepted Answer

Document suspicions and refer to the Special Investigations Unit (SIU)

Answer

Deny the claim immediately

Answer

Confront the claimant directly

Answer

Close the file and report to state police