NICB Reports 4.5 Percent Rise in 2011 Questionable Claims

September 15, 2011

There was a 4.5 percent increase in questionable claims (QC) this year compared with 2010, according to the The National Insurance Crime Bureau (NICB) report released today.

The report noted a 18.3 percent increase when compared with the first half of 2009.

During the first half of 2009, a total of 41,309 QCs were referred. That number increased to 46,766 in 2010 and to 48,887 in the first half of 2011.

Medical-related and vehicle hail damage referrals generated significant QCs. Under workers’ compensation, two referral reasons—”inflated medical billing’ and ‘duplicate billing’ combined for a 445 percent change increase from the first half of 2010.

The report examined six referral reason categories of claims—property, casualty, commercial, workers’ compensation, vehicle and miscellaneous—for the first half of 2009, 2010 and 2011.

Questionable claims are claims that NICB member insurance companies refer to NICB for closer review and investigation based on one or more indicators of possible fraud.

Source: NICB

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