Suspected Insurance Fraud definition

Suspected Insurance Fraud means any misrepresentation of fact or omission of fact pertaining to a transaction of insurance including claims, premium and application fraud. These facts may include but are not limited to evidence of doctoring, altering or destroying forms, prior history of the claimant, policy holder, applicant or provider, receipts, estimates, explanations of benefits (EOB), medical evaluations or billings, medical provider notes, police and/or investigative reports, relevant discrepancies in written or oral statements and examinations under oath (EUO), unusual policy activity and falsified or untruthful application for insurance. An identifiable pattern in a claim history may also suggest the possibility of suspected fraudulent claims activity. A claim may contain evidence of suspected insurance fraud regardless of the payment status.
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Suspected Insurance Fraud means any misrepresentation of fact or omission of fact pertaining to a
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Suspected Insurance Fraud means any misrepresentation of fact or omission of fact pertaining to a transaction of insurance including claims, premium and application fraud. These facts may include but are
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Examples of Suspected Insurance Fraud in a sentence

  • Compliance with State Regulations California Statute - 10 CCR § 2698.35 Detecting Suspected Insurance Fraud.

  • The "Uniform Suspected Insurance Fraud Reporting Form," 7/2019, this form allows anyone who has knowledge or suspicion of fraudulent insurance activities to report to the Department.


More Definitions of Suspected Insurance Fraud

Suspected Insurance Fraud means having knowledge or a belief that insurance fraud is being or has been committed.
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Suspected Insurance Fraud means includes any misrepresentation of fact or omission of fact
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Related to Suspected Insurance Fraud

  • D&O Liability Insurance Policies means all insurance policies (including any “tail policy”) of any of the Debtors for liability of any current or former directors, managers, officers, and members.

  • Named Insured means the person or organization named in Item 1 of the Declarations.

  • Insurance Policy With respect to any Mortgage Loan included in the Trust Fund, any insurance policy, including all riders and endorsements thereto in effect, including any replacement policy or policies for any Insurance Policies.

  • Professional liability insurance means insurance against legal liability incident to the practice of a profession and provision of a professional service.

  • Insurance Provider s Tender” means the completed Tendering Document submitted by the Insurance Provider to the Procuring Entity

  • Policy means Related Party Transaction Policy.

  • Insurance carrier means every insurance carrier duly

  • Insurance Policies has the meaning set forth in Section 3.16.

  • Policy or This Policy means, “Nomination and Remuneration Policy.”

  • Medical malpractice insurance means insurance against legal liability incident to the practice and provision of a medical service other than the practice and provision of a dental service.

  • Covered policy means a policy of commercial risk insurance, professional liability insurance or public entity insurance.

  • Hazard Insurance A fire and casualty extended coverage insurance policy insuring against loss or damage from fire and other perils covered within the scope of standard extended hazard coverage naming the Servicer, its successors and assigns, as a mortgagee under a standard mortgagee clause, together with all riders and endorsements thereto.