this often happens to vehicles when an insured can no longer pay the loan they either ditch a vehicle or hire someone to steal it, only to later report the vehicle as stolen and file a claim.
Insurance Encyclopedia
Fallen Building Clause
A provision found in some Fire Insurance policies which stipulates that if any material part of the building which is insured falls or collapses from causes other than from Fire or Explosion, the Fire Insurance becomes void.
Fallen building clause (Property Insurance)
A clause in a property insurance policy stipulating that if a portion of a building collapses for any reason other than fire or explosion, the fire insurance is voided.
False Claims Act (FCA)
Federal legislation that regulates civil action for filing of a false or inaccurate claim for payment, knowingly using a false record or statement to obtain payment on a false or fraudulent claim paid by the government, and conspiring to defraud the government by getting a false or fraudulent claim allowed or paid. Under this act, any person who knowingly presents or causes to be presented a false or fraudulent claim to the government for payment or approval is liable. This law covers all types of government payments, not just medical insurance claims.
False Imprisonment
The illegal and unlawful confinement of another within boundaries fixed by the defendant without legal justification and with the intention that the act or breach of duty shall result in such confinement.
False negatives
Occur when the patient’s medical record contains evidence of a service that does not exist in the encounter data. This is the most common problem in partially or fully managed care capitated plans because the provider does not need to submit an encounter in order to receive payment for the service and therefore may have a weaker incentive to conform to data collection standards.
False positives
Occur when the encounter data contain evidence of a medical service that is not documented in the patient’s medical record. If we assume that the medical record contains complete information on the patient’s medical history, a false positive may be considered a fraudulent service. In a fully managed care capitated environment, however, the provider would receive no additional reimbursement for the submission of a false-positive encounter.
False Pretense
Refers to any untrue statements or representations made with the intention of obtaining property or money.
FALSE PRETENSE, TRICK, AND DEVICE
Garage liability for automobile dealers excludes losses resulting from fraudulent acts committed by customers or potential customers. For example, suppose a customer goes to a dealership and wants to test drive a car. The salesperson allows the customer to drive the car alone and the customer steals the auto and drives to another state. Under the exclusion in the garage policy, the dealer has no coverage for the value of the car.A false pretense, trick, and device endorsement removes this exclusion. It also covers such possible losses as a dealer taking a car in trade to which the customer did not have legal title. The coverage is designed for automobile dealers but is also purchased by other entities that occasionally engage in the selling of automobiles such as banks and credit unions. (See Garage Liability).
False swearing
If the insured lies under oath the policy is void whether the lie is in a proof of loss or at an examination under oath. The lie could be on the proof of loss statement, statements made to the carrier about the claim, statements made in the examination under oath, statements made on the application that the insured knows to be false. The difference between fraud and false swearing is that since false swearing involves a false statement made under oath, it is harder for the person to back off from the false statements when confronted.