INSURANCE FRAUD
1-Complete the following email from a policyholder to an insurance company :
obligations //stated // litigation // disclose // submitted //
deny // determined // withhold // good faith // court
Dear Warren &Crane Inc.,
I am very disappointed in your decision to .. deny ...... my recent claim regarding the
damage to my vehicle.
I entered this agreement in.... good faith..., and I fully expected your company to fulfill its....
obligations......
According to your email, I failed to .... disclose......material information about the cause of the
damage. This is not true! As I clearly.... stated ........, I did not know the cause of the damage,
so I described my observations as best as I could. Later, the police investigator examined the
vehicle and ... determined.....the cause . But by that point, I had already .. submitted..... my
claim. I did not intend to . withhold......information, and I believe your company should
understand that.
If this matter is not reviewed promptly, I will pursue... litigation .... However, I would prefer
to settle this outside of..... court.........
Kimberly Thomson
2-Classify the following examples according to whether they are considered SOFT fraud
or Hard fraud:
-Committing an arson
– Exaggerating the amount of damage that occurred to one’s property
–Omitting conditions on a medical claim
– faking an accident
- Billing for a higher-rated exam, when a minor exam was performed
– Exaggerating the value of one’s property
- Claiming you had very expensive art that was destroyed when your home was burglarized.
( In reality your home was burglarized but your art collection really consisted of prints)
- Faking your own death
Soft Fraud Hard Fraud
-Committing an arson
– Exaggerating the amount of damage that occurred to one’s property – faking an accident
–Omitting conditions on a medical claim - Faking your own death
- Billing for a higher-rated exam, when a minor exam was performed
– Exaggerating the value of one’s property
Claiming you had very expensive art that was destroyed when your home was
burglarized.( In reality your home was burglarized but your art collection really
consisted of prints)
2- Insert the missing sentences in the following email :
a. . of soft fraud in this case
b. . I recommend approving her claim
c. . the claimant was attempting insurance
d. According to the claim, the claimant’s home was burglarized
e. It was definitely a red flag
Hi Ken,
I finished the investigation on that suspicious claim you sent me.1.........D..........., and the
burglars stole several household electronics. I know you were suspicious 2......A....... And I
know you were right to refer the case to us. The amounts that the claimant listed for her
electronics seemed unusually high.3.....E............
However, I do not believe 4....C.........fraud . I contacted her, and she was able to produce
receipts for most of the products.5........B..........
Let me know if you have further questions about my investigation.
Fiona
4-Complete the definition of hard and soft fraud : you are helped with the first letter :
a- ...SOFT......fraud : generally occurs with fundamentally legitimate..... claim . In these
cases, the claimant............... omits or exagerates.................. information to get more.. out of
a claim than he or she should.
b- ...HARD... fraud : is more deceitful. It involves staging..... an event specially to
claim.....on the insurance. In these cases a [Link]....... deliberately creates...... the events
that lead to the claim.