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NICB: Questionable WC Claims On the Rise

Even as the overall number of workers compensation claims wanes, the suspicious onesor those designated questionable claims (QCs)are actually increasing, according to the National Insurance Crime Bureau (NICB). When the Des Plaines, Ill.-based not-for-profit organization examined referrals dating from Jan. 1, 2011 through June 30, 2013, it found that medical...

By Arthur D. Postal | Updated on November 01, 2013

Even as the overall number of workers’ compensation claims wanes, the suspicious ones—or those designated “questionable claims” (QCs)—are actually increasing, according to the National Insurance Crime Bureau (NICB). When the Des Plaines, Ill.-based not-for-profit organization examined referrals dating from Jan. 1, 2011 through June 30, 2013, it found that medical loss claims were the largest source of questionable claims.

In 2011, a total of 3,349,925 workers’ comp claims were found in the Insurance Services Office (ISO) ClaimSearch database, NICB indicated. That number decreased to 3,244,679 in 2012 and is on track to decrease again in 2013 based on the 1,498,725 claims received in the first half of 2013. However, QCs are not following this downward trend.

In 2011, 3,474 questionable workers’ comp claims were referred to NICB. That number increased to 4,460 in 2012—a 28 percent rise, the report said. Questionable workers comp claims accounted for 3.5 percent of the total 100,201 questionable claims submitted in 2011 and increased to 3.8 percent of the 116,171 total claims in 2012.

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