Questionable claims in the U.S. up since 2010, report says

Questionable claims are up in the United States, reaching a new record in 2012, notes the National Insurance Crime Bureau in a new report.

Questionable claims are those claims that NICB member insurance companies refer to NICB for closer review and investigation based on one or more indicators of possible fraud. A single claim may contain up to seven referral reasons, NICB notes.

Over the period from 2010 to 2012, there was a 26.7% increase in QCs referred to NICB, going from 91,797 in 2010 to 116,268 in 2012. In 2011, the total was 100,450.

Last year’s numbers are a new record, NICB says, but last years QCs are still only 0.2% of all claims processed, it notes. “While QCs are by definition suspicious, at the time of referral they have not been identified as definitive acts of fraud,” the bureau adds.

The report looks at six referral reason categories of claims: property, casualty, commercial, workers’ compensation, vehicle and miscellaneous referred in 2012, with those referred in 2010 and 2011.

“Within the property category, ‘suspicious disappearance/loss of jewelry’ had the highest percent change—up 86%, while ‘suspicious theft/loss (not vehicle)’ had the highest increase in volume to 10,680 in 2012 from 7,152 reached in 2011,” NICB says.

“In the vehicle category, ‘hail damage’ with 1,505 referrals and ‘suspicious hit while parked’ with 5,006 referrals were the top two referral reasons,” it notes.

The top five states generating the most QCs in 2012 were: California, Florida, Texas, New York, and Maryland.