This course explains the facts of insurance fraud, the elements of the tort of insurance fraud, the elements of the crime of insurance fraud, and how it affects the insured, the insurer, and the property owners.  The course discusses the effect fraud has on the insurance industry and how insurance professionals have been compelled, by statute, to thoroughly investigate suspected fraud.  The course also explains how investigations are conducted, what facts lead an insurer to suspect that an insurance fraud is being attempted, and what the insured can expect from an insurer if it suspects fraud – whether in good faith or not. 

The course covers the following:

  1. What is insurance fraud?
  2. Insurance fraud and the tort of bad faith.
  3. Insurance fraud and the evidence of good faith and fair dealing.
  4. The red flags of fraud.
  5. The tort of insurance fraud.
  6. The crime of insurance fraud.
  7. Obligations of insurers when insurance fraud is suspected.
Learning Objectives
  • The student will learn about the elements of the tort and crime of insurance fraud.
  • The student will be able to:
  • Explore the various types of insurance fraud faced by an insurer.
  • Understand the state laws requiring insurers to investigate fraud.
  • Identify the facts that cause an insurer to conduct a thorough fraud investigation.
  • Identify how a fraud investigation will delay resolution of a claim.
  • Identify the duties of the insured when fraud is suspected or indicated.
Last updated/reviewed: August 26, 2023

Included In Certifications

This course is included in the following Certification Programs:

16 CoursesCorporate Property Insurance Certification

  1. Introduction: Excellence in Claims Handling
  2. How to Acquire a First-Party Property Insurance Policy
  3. How to Read and Understand an Insurance Policy
  4. The Necessity of an Honest and Complete Insurance Application
  5. The Basics of the Law of Contracts for the Insurance Professional
  6. Ethics for the Insurance Professional
  7. What is the Problem with Fraud?
  8. Interviewing Techniques for the Insurance Professional
  9. Investigation of a First-Party Property Insurance Claim
  10. The Creation of a Scope, Statement, and Proof of Loss
  11. The Duties of an Insured Presenting a First-Party Property Claim
  12. The Insurance Examination under Oath (EUO)
  13. Insurance Fraud Prevention
  14. Compliance with Special Investigation Unit Regulations
  15. Compliance with Good Faith Settlement Practices Regulations
  16. The Obligations of a Public Insurance Adjuster
Prerequisites
Course Complexity: Intermediate

No Advanced Preparation or Prerequisites are needed for this course. However, it is recommended to take the other courses in the series prior to completing this one.

Education Provider Information
Company: Illumeo, Inc., 75 East Santa Clara St., Suite 1215, San Jose, CA 95113
Contact: For more information regarding this course, including complaint and cancellation policies, please contact our offices at (408) 400- 3993 or send an e-mail to .
Instructor for this course
  Course Overview CPE
Course Syllabus
INTRODUCTION AND OVERVIEW
  Introduction to What is the Problem with Fraud5:25
  Insurance Fraud & the Tort of Bad Faith8:01
  The Obligation to Report Suspected Fraud11:29
  Insurers Must Have an Anti-Fraud Program10:53
  Some Examples: Ferris Abou Assaly and Levon Sogomonian11:14
  Some Examples: Levon Sogomonian (Continued) and Petar Misic9:52
  Some Examples: Petar Misic (Continued) and W.P. Cheng10:12
CONTINUOUS PLAY
  What is the Problem with Fraud1:07:09
SUPPORTING MATERIALS
  Slides: What is the Problem with FraudPDF
  What is the Problem with Fraud GlossaryPDF
REVIEW AND TEST
  REVIEW QUESTIONSquiz
 FINAL EXAMexam