C39
Exam
/
Review
/
Exam Questions With Correct Answers
/ / / / /
Insurance /Fraud /- /verified /answer(s)-
✔✔any /act /or /omission /with /a /view /to /illegally /obtaining /an /insurance /benefit.
3 /basic /elements /to /qualify /as /insurance /fraud /- /verified /answer(s)-
✔✔1. /Acts /or /omissions /(false /or /misleading /statements)
2. /Illegal /benefit /(payment /of /claim /obtained /through /deception)
3. /"With /a /view /to" /(fraudulent /intent)
Mens /Rea /- /verified /answer(s)-✔✔Guilty /mind; /the /intention /to /commit /a /crime
Case /: /R. /V. /Olin, /Hudson /and /Hartnett /(1978) /- /verified /answer(s)-
✔✔- /Prosecution /of /corporate /fraud /
- /set /definition /for /fraud /
- /2 /elements /identified /
/ 1. /Dishonesty /
/ 2. /Deprivation
Fraudulent /activities /found /in /Criminal /Code /- /verified /answer(s)-✔✔Arson
Bribery
Criminal /breach /of /trust
,Fabricating /evidence /
Forgery, /false /documents /
Fraudulent /concealment /
Fraudulently /destroying /documents, /falsifying /documents /
Impersonation /
Making /false /statement /
Misappropriating /money
7 /Stat /Conditions /- /specifically /with /regards /to /fraud /protection /- /verified /answer(s)-
✔✔1. /Misrepresentation /- /incorrect /or /missing /info /about /material /fact
2. /Material /Change /- /reported /when /change /occurs /
3. /Termination- /sets /out /terms /of /cancellation /
4. /Requirements /after /Loss /- /insurers /right /to /further /info /after /loss
5. /Fraud /- /POL /provided /
6. /Entry, /Control, /Abandonment /or /salvage /- /insurers /right /to /enter /property
7. /Notice /to /police
Waiver /- /verified /answer(s)-
✔✔The /intentional /and /voluntary /relinquishment /of /a /known /right
Estoppel /- /verified /answer(s)-
✔✔A
/bar
/created
/when
/someone /by /their /action /or /lack /of /action /indicates /they /will /not /exercise /a /right /they /have
Non-waiver /agreement /- /verified /answer(s)-✔✔Signed /by /insurer /after /loss
,Agrees
/that
/the
/investigation
/and /determination /of /the /amount /of /damage /cannot /be /construed /as /admission /of /liability /
Used /when /insurer /is /in /violation /of /policy /
Allows /adjuster /to /continue /investigation /without /promise /to /cover /loss
Reservation /of /rights /letter /- /verified /answer(s)-
✔✔Notification /to /insured /that /coverage /for /claim /may /not /apply
Used /when /insured /does /not /sign /the /non-waiver
Bad /Faith /- /verified /answer(s)-✔✔Design /to /deceive /or /mislead
Conscious /wrong /doing
Constructive /fraud
Good /Faith /- /verified /answer(s)-
✔✔A
/state /of /Mind /- /honest /belief, /absence /of /malice /and /absence /of /design /to /defraud /or /to /seek
/an /unconscionable /advantage
Insurers /must /act /in /good /faith
Insurers /may /expose /themselves /to /bad /faith /claims /should /they: /- /verified /answer(s)-
✔✔Fail /to /investigate /properly /
Intentionally /offer /an /amount /lower /than /what /is /reasonable /
Fail /to /settle /within /a /reasonable /amount /of /time
Unreasonably /deny /claim
Unfounded /allegations /
, Ignore /evidence
Punitive /Damages /- /verified /answer(s)-
✔✔Damages /awarded /in /excess /of /those /required /to /compensate /for /wrong /doing
Used /to /punish /the /defendant /
Also /known /as /Exemplary /Damages
Example /Case /: /Labelle /vs /Guardian /Insurance, /insured /awarded /$10,000 /in /punitive /damages
Aggravated /damages /- /verified /answer(s)-
✔✔Compensate /for /pain /and /suffering, /humiliation /or /distress
Example
/Case /: /Warrington /vs /Great /West /Life /- /court /of /appeal /upheld /$10,000for /mental /distress
Strategies /for /preventing /Bad /Faith /- /verified /answer(s)-✔✔-
Treat /insureds /fairly /and /with /dignity /
-conduct /a /thorough /investigation /before /taking /action /
-consider /alternative /measures /to /handle /claim
Burden /of /Proof /- /verified /answer(s)-
✔✔Standard /by /which /a /claim /must /be /proven /to /prevail
Standard /of /proof /- /verified /answer(s)-✔✔Test /to /establish /whether /a /party /has /succeeded /in
/proving /a /fact /in /issue
Exam
/
Review
/
Exam Questions With Correct Answers
/ / / / /
Insurance /Fraud /- /verified /answer(s)-
✔✔any /act /or /omission /with /a /view /to /illegally /obtaining /an /insurance /benefit.
3 /basic /elements /to /qualify /as /insurance /fraud /- /verified /answer(s)-
✔✔1. /Acts /or /omissions /(false /or /misleading /statements)
2. /Illegal /benefit /(payment /of /claim /obtained /through /deception)
3. /"With /a /view /to" /(fraudulent /intent)
Mens /Rea /- /verified /answer(s)-✔✔Guilty /mind; /the /intention /to /commit /a /crime
Case /: /R. /V. /Olin, /Hudson /and /Hartnett /(1978) /- /verified /answer(s)-
✔✔- /Prosecution /of /corporate /fraud /
- /set /definition /for /fraud /
- /2 /elements /identified /
/ 1. /Dishonesty /
/ 2. /Deprivation
Fraudulent /activities /found /in /Criminal /Code /- /verified /answer(s)-✔✔Arson
Bribery
Criminal /breach /of /trust
,Fabricating /evidence /
Forgery, /false /documents /
Fraudulent /concealment /
Fraudulently /destroying /documents, /falsifying /documents /
Impersonation /
Making /false /statement /
Misappropriating /money
7 /Stat /Conditions /- /specifically /with /regards /to /fraud /protection /- /verified /answer(s)-
✔✔1. /Misrepresentation /- /incorrect /or /missing /info /about /material /fact
2. /Material /Change /- /reported /when /change /occurs /
3. /Termination- /sets /out /terms /of /cancellation /
4. /Requirements /after /Loss /- /insurers /right /to /further /info /after /loss
5. /Fraud /- /POL /provided /
6. /Entry, /Control, /Abandonment /or /salvage /- /insurers /right /to /enter /property
7. /Notice /to /police
Waiver /- /verified /answer(s)-
✔✔The /intentional /and /voluntary /relinquishment /of /a /known /right
Estoppel /- /verified /answer(s)-
✔✔A
/bar
/created
/when
/someone /by /their /action /or /lack /of /action /indicates /they /will /not /exercise /a /right /they /have
Non-waiver /agreement /- /verified /answer(s)-✔✔Signed /by /insurer /after /loss
,Agrees
/that
/the
/investigation
/and /determination /of /the /amount /of /damage /cannot /be /construed /as /admission /of /liability /
Used /when /insurer /is /in /violation /of /policy /
Allows /adjuster /to /continue /investigation /without /promise /to /cover /loss
Reservation /of /rights /letter /- /verified /answer(s)-
✔✔Notification /to /insured /that /coverage /for /claim /may /not /apply
Used /when /insured /does /not /sign /the /non-waiver
Bad /Faith /- /verified /answer(s)-✔✔Design /to /deceive /or /mislead
Conscious /wrong /doing
Constructive /fraud
Good /Faith /- /verified /answer(s)-
✔✔A
/state /of /Mind /- /honest /belief, /absence /of /malice /and /absence /of /design /to /defraud /or /to /seek
/an /unconscionable /advantage
Insurers /must /act /in /good /faith
Insurers /may /expose /themselves /to /bad /faith /claims /should /they: /- /verified /answer(s)-
✔✔Fail /to /investigate /properly /
Intentionally /offer /an /amount /lower /than /what /is /reasonable /
Fail /to /settle /within /a /reasonable /amount /of /time
Unreasonably /deny /claim
Unfounded /allegations /
, Ignore /evidence
Punitive /Damages /- /verified /answer(s)-
✔✔Damages /awarded /in /excess /of /those /required /to /compensate /for /wrong /doing
Used /to /punish /the /defendant /
Also /known /as /Exemplary /Damages
Example /Case /: /Labelle /vs /Guardian /Insurance, /insured /awarded /$10,000 /in /punitive /damages
Aggravated /damages /- /verified /answer(s)-
✔✔Compensate /for /pain /and /suffering, /humiliation /or /distress
Example
/Case /: /Warrington /vs /Great /West /Life /- /court /of /appeal /upheld /$10,000for /mental /distress
Strategies /for /preventing /Bad /Faith /- /verified /answer(s)-✔✔-
Treat /insureds /fairly /and /with /dignity /
-conduct /a /thorough /investigation /before /taking /action /
-consider /alternative /measures /to /handle /claim
Burden /of /Proof /- /verified /answer(s)-
✔✔Standard /by /which /a /claim /must /be /proven /to /prevail
Standard /of /proof /- /verified /answer(s)-✔✔Test /to /establish /whether /a /party /has /succeeded /in
/proving /a /fact /in /issue
