The number of questionable claims (QCs) filed during the 2011 first half increased 4.5 percent compared to the previous year, according to a recent National Insurance Crime Bureau (NICB) analysis.

The report takes into account a total of six referral-reason categories—property, casualty, commercial, workers' compensation, vehicle and miscellaneous—for the first half of 2009, 2010 and 2011.

The QC terminology denotes claims that NICB-member insurers submit to the Des Plaines, Ill.-based not-for-profit organization for closer review and investigation based on one or more indicators of possible fraud.

From January to June of this year, 48,887 QCs were logged, compared to 46,766 for the first half of 2010 and 41,309 in 2009. This translates to a 4.5-percent increase between 2011 and 2010 and a two-year increase of 18.3 percent.

Inflated damages top the list of property-referral reasons, with a 10-percent increase from the 2010 first half to the same time period in 2011.

Perhaps most troubling, the number of medical-related referrals in the workers' comp category and vehicle hail-damage referrals both showed a steep upswing.

Under workers' comp, for instance, just two referral reasons combined for a 445-percent increase from the 2010 first half—inflated medical billing and duplicate billing, at 245 percent and 200 percent, respectively.

Hail-damage vehicle referrals surged 109 percent, when comparing the first half of 2010 to that of 2011.

Special Reports /

NICB: Questionable Claims Up In 2011 First Half

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