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National Insurance Crime Bureau releases latest “questionable” claims numbers


November 18, 2013   by Canadian Underwriter


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The National Insurance Crime Bureau, based in Des Plaines, Ill., reported Monday a 21% year-to-year increase in the number of questionable auto claims referred to the organization for unperformed repairs, while the number of questionable commercial claims dropped 13% from the first nine months of 2012 to the first nine months of 2013.

NICB released those statistics with its third-quarter 2013 questionable claims referral reason analysis. NICB’s questionable claims database is comprised of claims referred by NICB member companies for closer review and investigation based on indicators of possible fraud. In some cases, a carrier will refer one claim for multiple reasons – up to seven.

During the first three quarters of 2011, 74,944 questionable claims were referred to NICB. That number increased to 87,684 in 2012 and then again to 93,053 in the first nine months of 2013.

questionable insurance claims

Total vehicle referrals were 32,698 in the first nine months of 2013, up 4% from the same period of 2012.

There were 1,596 in the “unperformed repairs” category in the first nine months of 2011. That figure increased 28%, to 2,045, during the same period in 2012 and then another 21% – to 2,477 – during the first nine months of 2013.

During the first three quarters of this year, NICB received 9,210 reports from members of questionable vehicle theft, down 1% from 9,329 in 2012. In the “faked damage” referral category, NICB received 5,765 questionable claims during the first three quarters of this year, up 2% from 5,652 in the same period of 2012.

In commercial claims there was a 13% decrease year over year (from 1,782 in 2012 to 1,556 in 2013) in questionable claims reported during the first nine months of the year. That category had 11 different referral reasons. For example, there were 492 commercial claims with slip and fall listed as a referral reason, down 16% year over year from 585 in 12. Those in the “construction/farm/heavy Equipment (not theft)” referral category had the highest percentage increase – 53% – year over year. But the total number only increased by nine, from 17 in the first three quarters of 2012 to 26 in the same period this year.

NICB, which has more than 1,100 members (including P&C carriers and self-insured organizations), aims to prevent and detect insurance fraud and vehicle theft through data analytics, investigations, training, legislative advocacy and public awareness.

The volume of referrals “can increase or decrease over a given period of time and may be caused by a number of factors, including better reporting by the industry and an increase or decrease in fraudulent activity, etc.,” NIBC noted.


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