Filed Under:Claims, Investigative & Forensics

Uptick in Medical-Related and Vehicle Hail Damage Referrals

The number of questionable claims (QCs) filed during the first half of 2011 increased 4.5 percent when compared to the previous year, according to the NICB’s findings released last month.

This particular yearly 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. One claim may contain as many as seven different referral reasons.

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

As for property-related referrals, NICB reported a surge in all categories, with the exceptions of suspicious theft/loss (non-vehicle) and fire/arson. Inflated damages topped the list of property referral reasons, with a 10-percent increase from the first half of 2010 to the same time period in 2011.

Perhaps most troubling, the number of medical-related referrals in the workers’ comp category, as well as vehicle hail damage claims both showed a steep upswing. Under workers’ comp, for instance, just two referral reasons combined for a whopping 445-percent increase from the first half of 2010—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.

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