Which statement describes claimant fraud?

• A. Misrepresenting the circumstances of any injury or fabricating that an injury occurred
• B. Underreporting injuries
• C. Failing to seek medical treatment
• D. Filing duplicates

Answer: (A)

Claimant fraud happens when someone purposefully deceives the insurer to obtain benefits. Misrepresenting the circumstances of an injury or fabricating that an injury occurred involves deliberate falsehoods about what happened, which is exactly the kind of deceptive action that defines fraud. Intent to mislead for gain is what makes this option stand out as fraud. In contrast, underreporting injuries or not seeking medical treatment can occur for various reasons and don’t inherently involve lying to get benefits. Filing duplicates can be improper, but fraud centers on intentional deception, and misrepresenting or fabricating an injury is the clearest example of that.