IC39 - Fraud Risk Management In Insurance - 2
IC39 - Fraud Risk Management In Insurance - 2
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Q 1. General damages in a personal injury claim refer to which of the following types of expenses?
Medical expenses incurred for the injury.
Loss of earnings due to the injury.
Property damage expenses.
Loss of enjoyment, loss of amenities, loss of reduced life, loss of recreational ability, et cetera.
Funeral expenses.
Q 2. How do money launderers utilize various entities for money laundering?
By exclusively targeting institutions within their own country.
By engaging in global money laundering operations, involving institutions in different countries.
By investing in legitimate businesses to integrate funds.
By avoiding any interactions with financial institutions.
By collaborating with law enforcement agencies.
Q 3. Please note that the options provided are examples and can be customized based on your specific requirements or industry. Who is involved in external fraud?
Employees and insiders
Collaborative groups
Competitors within the industry
External individuals or entities
Hackers and cybercriminals
Q 4. What is the term used for unnecessary medical procedures performed at hospitals, which can be subject to claims?
Inflated medical expenses
Medical malpractice
Negligent healthcare
Unsubstantiated treatments
Fraudulent billing
Q 5. What are the two broad categories of policies issued in engineering insurance?
Comprehensive insurance policy and specialized insurance policy.
All-risk insurance policy and specific-risk insurance policy.
Construction phase insurance policy and operational phase insurance policy.
Standard insurance policy and customized insurance policy.
Pre-loss insurance policy and post-loss insurance policy.
Q 6. Factors to be examined while underwriting an individual health insurance policy include:
Age, Occupation, Family size, Lifestyle
Number of family members, Sum insured, Income,
Past insurance details
Past medical history
All of the above
Q 7. Exaggeration of a claim amount in marine insurance refers to:
The insured knowingly exaggerates the claim amount to seek higher compensation for legitimate losses.
The insured unintentionally provided incorrect details in the claim form.
The insured claiming for items that were not lost or damaged during transit.
The insured withdrew a genuine claim due to insufficient evidence.
The insured claims for losses caused by excluded perils in the insurance policy.
Q 8. What percentage of the property and casualty insurance market is represented by the member companies of the Insurance Bureau of Canada (IBC)?
50%
70%
90%
100%
85%
Q 9. Which of the following is an example of underwriting fraud in insurance?
Not furnishing the required information by the insured
Furnishing improper or wrong information by the insured
Both A and B
Not furnishing minor details
Not attending the underwriting process
Q 10. What does the insured try to exploit all the insurance contracts for when they deliberately report a claim to all insurers after entering into two or more insurance contracts for the same subject matter?
Monetary compensation
Exclusion of coverage
Additional coverage
Legal representation
Policy renewal options
Q 11. What are some examples of common frauds that may occur in the context of livestock insurance?
Honest reporting of animal health and conditions.
Accurate submission of feeding and production records.
Providing timely notice of any changes in livestock ownership.
Deliberate overstatement of animal value to claim higher compensation.
Immediate disposal of the animal carcasses with the insurer's permission.
Q 12. Intermediaries like Insurance agents and brokers mis-sell products because..
S.l products with High commission
Lack of knowledge of the product
Knowledge is limited to only some products
All of the above.
Both a & c only
Q 13. What is the primary purpose of submitting a final report?
To summarize the investigator's personal opinions
To create confusion by presenting multiple conclusions
To highlight gaps in the evidence for further investigation
To provide a detailed account of unrelated incidents
To present a definitive conclusion on the cause of the incident while eliminating other potential causes
Q 14. What type of situation arises when a loss occurs due to a peril that is not covered or explicitly excluded in the insurance policy, and the claimant requests compensation by misrepresenting a peril that is covered under the policy while concealing the actual cause of loss?
Non-disclosure fraud
Misrepresentation deception
Excluded peril claim
Peril manipulation scam
Concealed loss request
Q 15. Is exaggeration of the quantum of loss allowed in engineering insurance?
Yes, exaggeration of loss is allowed in engineering insurance.
Yes, exaggeration of loss is allowed in any type of insurance.
No, exaggeration of loss is prohibited in engineering insurance.
No, exaggeration of loss is allowed in certain types of insurance.
No, exaggeration of loss is allowed in any insurance.