IC39 - Fraud Risk Management In Insurance - 6

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Q 1. When does insurable interest typically need to exist in most insurance contracts?

At the time of buying an insurance policy

At the time of the occurrence of loss

Both at the time of buying an insurance policy and the occurrence of loss

Either at the time of buying an insurance policy or the occurrence of loss

Insurable interest is not a requirement in most insurance contracts

Q 2. In a study conducted by the IRS on 8000 insurance proposal forms, it was found that what percentage of people did not disclose their full claims history?

3%

6%

9%

12%

15%

Q 3. What is the primary objective of Live stock insurance?

To provide health insurance for animals

To protect endangered species

To compensate farmers for losses related to livestock

To offer liability coverage for pet owners

To promote animal welfare and conservation

Q 4. Which type of insurance plan combines features of both a term assurance plan and a pure endowment plan?

Whole life insurance plan

Universal life insurance plan

Variable life insurance plan

Limited payment life insurance plan

Joint life insurance plan

Q 5. What approach should an insurer adopt when considering entering into a contract with a customer in relation to their identity and background?

Perform a credit check.

Seek a character reference.

Consult with local authorities.

Conduct a background check for criminal history and terrorism links.

Verify educational qualifications.

Q 6. What are fraudulent activities commonly associated with health insurance policies?

False advertising of health insurance plans

Delayed claim processing for legitimate medical expenses

Offering discounts on health insurance premiums

Fraudulent reimbursement of claims from non-existing hospitals and non-existing patients

Providing additional coverage for policyholders'' family members

Q 7. What condition must be met for a group health insurance policy to be valid as per IRDAI regulations?

The group must consist of at least 100 members.

The group composition must match the definition stipulated by IRDAI.

The group members must all belong to the same family.

The group health insurance policy must be renewed annually.

The group health insurance policy must cover only specific diseases.

Q 8. At the inception of an insurance policy, misrepresentation made by the insured can be:

Deliberate only

Inadvertent only

Either deliberate or inadvertent

Neither deliberate nor inadvertent

Applicable only to certain types of insurance policies

Q 9. Who typically carries out mortgage frauds targeting distressed homeowners?

Homeowners in distress seeking financial assistance

Government agencies providing mortgage relief programs

Real estate and mortgage professionals misusing their specialized knowledge

Banks and lending institutions offering mortgage loans

Non-profit organizations dedicated to assisting homeowners

Q 10. What is the nature of the health insurance fraud when a person who is admitted to the hospital for treatment of a genuine sickness does not have a health insurance policy, so a person from his relatives who has an insurance policy is identified and the documentation of the claim is done in his name with his consent?

False hospitalization

Change of disease or diagnosis

Fake accident claim

Change of person or insured

Exaggeration of cost

Q 11. According to Section 45(2) of the Insurance Act 2015, within what time frame can a policy of life insurance be called into question on the grounds of fraud?

Within 1 year from the date of issuance of the policy

Within 2 years from the date of commencement of the risk

Within 3 years from the date of revival of the policy

Within 3 years from the date of issuance of the policy or date of commencement of the risk or date of revival of the policy, whichever is later

Within 5 years from the date of issuance of the policy

Q 12. The definition of "family" is explained in:

Insurance Regulatory and Development Authority of India (IRDAI) guidelines

Policy Terms and Conditions

Policy Terms and Conditions

Insurance Certificate

Customer Support Documents

Q 13. Which of the following practices is considered a type of money laundering involving trade transactions?

Offshore investments in legitimate businesses.

Over-invoicing and under-invoicing of goods and services.

Transparent reporting of financial transactions.

Direct deposits into personal bank accounts.

Charitable donations to recognized organizations.

Q 14. "Phantom Policy" means....

An insurance policy that covers only supernatural occurrences.

A policy that provides coverage for fictional events and scenarios.

An insurance policy with extremely high premiums and low coverage limits.

A non-existent policy that is fraudulently sold to unsuspecting individuals.

An insurance policy that offers comprehensive coverage for a wide range of risks.

Q 15. What is the recommended procedure for making payments in the context of life insurance, ensuring the legitimacy of the beneficiary?

Making payments in cash

Making payments through bank transfers

Making payments through money orders

Making payments through account pay cheques after due beneficiary verification

Making payments through electronic wallets


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