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NICB: Upswing in Suspicious Claims, Medical A Concern

Questionable claims in the first quarters of 2009-2011 have been on the rise, with the most notable increase in medical-related claims.

By Christina Bramlet | Updated on May 31, 2011
Those spearheading the fight against insurance fraud report that the past few years began with an influx of suspicious cases. During the first quarters of 2009-2011, the number of questionable claims (QC) referred to the National Insurance Crime Bureau (NICB) for further investigation increased 23 percent, with the most significant uptick in medical-related claims.

That’s according to the Des Plaines, Ill.-based organization’s first-quarter 2011 ForeCast report, which analyzes referrals submitted by its more than 1,100 property and casualty (P&C) insurers and self-insured member organizations. In the report, NICB showed that the first quarter of 2009 brought in a total of 19,967 QCs, compared with 24,497 received in the first quarter of 2011—for a 23 percent overall increase.

NICB categorizes suspicious claims as property, casualty, commercial, workers’ compensation, vehicle, and miscellaneous. The 1Q report findings indicated that property QCs were up 3 percent, while casualty and commercial QCs rose by 25 percent and 21 percent, respectively. Workers’ compensation QCs increased 24 percent, and there was a 25-percent swell in miscellaneous claims.

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