NU Online News Service, Aug. 24, 3:32 p.m. EDT

WASHINGTON--Insurance crime experts are warning that "slip and fall" claims are soaring, and as a result, such claims are coming under greater scrutiny for potential fraud by both insurers and investigators.

The Des Plaines, Ill.-based National Insurance Crime Bureau (NICB) said today that an analysis of questionable slip and fall claims submitted by NICB member companies showed a 57 percent increase in the number of referrals over the past two and a half years.

That has led the NICB to increase its focus on commercial fraud, with slip and fall and workers' compensation fraud cases being priorities for many NICB member companies, according to Joe Wehrle, NICB president and chief executive officer.

One concern is that many retailers are self-insured, and they look at slips and falls as a cost of doing business. They'll write a check without investigating, Mr. Wehrle said.

"Based on what companies have told us, we think that adds up to millions of dollars in unwarranted payouts," he said.

"We're reaching out to these companies and urging them to join us in fighting commercial fraud," he said.

The number of slip and fall questionable claims submitted to NICB went from 325 in the 2008 first quarter to a high of 565 in the 2009 fourth quarter.

In the 2010 first half, there were 997 slip and fall claims referred to NICB for further analysis, Mr. Wehrle said.

New York, Los Angeles, Philadelphia, Las Vegas and Chicago were the five cities with the most questionable claims for slips and falls, and California, Florida, New York, Illinois and Texas were the top five states, he said.

More than 4,600 questionable claims were received in 2008, 2009 and the first half of 2010, according to the NICB, and most were tied to commercial policies.

"While many people have legitimate accidents in stores and businesses across the country, we've seen a growing number of cases that have some indication of potential fraud," Mr. Wehrle said.

"Our agents, working with insurance company investigators and law enforcement, are busy identifying and targeting organized criminal rings that make a good living staging slip and fall accidents," he said.

"They come into an area and hit several retailers, grocers or other businesses with sophisticated schemes and professional execution," he explained.

"They hope to collect a quick payout and move on before anyone realizes what's going on," he said.

"A typical slip and fall case may involve two people going into a big box store or retailer and splitting up," Mr. Wehrle said.

The first person goes down an aisle while the other keeps a lookout, he said.

"When the coast is clear, he or she pulls out a small bottle of liquid, pours it on the floor and then pretends to fall on the floor," he said. "The partner runs to assist and tells everyone that he witnessed the fall," he said.

"Fortunately, we've worked with insurers to raise the awareness level and urged companies to analyze claims before they pay," Mr. Wehrle said.

Special Reports /

NICB Data Shows Increase In Slip And Fall Fraud Schemes

Related Stories

Recommended For You