The National Insurance Crime Bureau this week released a three-year nationwide analysis of questionable claims. Questionable claims are analyzed by loss state, loss city, core-based statistical area, policy type, loss type and referral reasons. The report covers the claims referred to NICB by its member insurance companies from Jan. 1, 2008 through Dec. 31, 2010.
Questionable claims (QCs) are those claims that NICB member insurance companies refer to NICB for closer review and investigation based upon one or more indicators of possible fraud. In 2008, a total of 74,676 QCs were referred. The number increased to 85,018 in 2009 and to 91,730 in 2010 - a 23 percent increase from 2008.
Just five states - California, Florida, Texas, New York and Michigan - generated 49 percent of all QCs during this period. As for cities generating the most QCs, they were New York, Los Angeles, Houston, Tampa and Detroit. Florida is unique in that it has three cities in the top ten for QCs-Tampa, Miami and Orlando. Florida is also the only state where NICB operates two Major Medical Fraud Task Forces.
When analyzed by core-based statistical areas, the top five are Los Angeles-Long Beach-Santa Ana, Calif.; New York-Northern New Jersey-Long Island, N.Y., N.J., Pa.; Miami-Fort Lauderdale-Pompano Beach, Fla.; Detroit-Warren-Livonia, Mich.; and Chicago-Naperville-Joliet, Ill., Ind., Wis.
Personal automobile was the policy type with the most QCs for all three years while faked/exaggerated injury and questionable vehicle theft were the QC referral reasons most cited for all three years.
Reprinted from the Michigan Association of Insurance Agents - Executive Update July 2011