Filed Under:Claims, Investigative & Forensics

NICB Reports 7-Percent Uptick in 3Q Suspicious Claims

Workers’ Comp, Casualty Claims Lead Increase

Apparently, forms like this are not always filled out honestly.
Apparently, forms like this are not always filled out honestly.

Suspicious claims activity appears to be climbing each year, the National Insurance Crime Bureau (NICB) asserts in its most recent analysis.

The Des Plaines, Ill. non-profit organization examined all questionable claims submitted by its member companies for the first three quarters of 2009, 2010, and 2011. A thorough assessment revealed a 7 percent increase overall. This is slightly more troubling than the 4.5-percent spike reported for the first half of this year.

Once received, an incoming claim displaying at least one possible indicator of fraud is categorized according to type—such as property, casualty, commercial, workers’ compensation, vehicle, and miscellaneous. Each claim can contain as many as seven referral reasons (or possible indicators) that warrant further investigation.

A total of 74,944 questionable claims were logged during the first nine months of 2011, which accounts for the aforementioned increase of seven percent, when NICB factored in the 62,341 and 70,295 QCs submitted during the same periods in 2009 and 2010, respectively.

The questionable claims submitted by NICB member insurance companies contained a total of 142,316 referral reasons. Referrals under workers’ compensation and casualty policies posted noticeable gains, while property and commercial policies saw only slight decreases. Although vehicle claims remained flat, referrals related to “hail damage” claims soared 103 percent compared to the NICB’s 2010 findings. 

More than 1,100 p&c insurers and self-insured organizations support NICB’s ongoing mission to identify and deter fraudulent activity. These members wrote more than $319 billion in insurance premiums in 2010, or about 80 percent of the nation’s p&c insurance. That figure includes more than 94 percent ($152 billion) of the nation’s personal auto insurance.

For more information or to access the full report, click here.

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