There was a 26.7 percent increase in questionable claims (QC) referred to National Insurance Crime Bureau (NICB) between 2010 and 2012, going from 91,797 in 2010 to 116,268 in 2012—a new record. In 2011, the total was 100,450, according to the NICB’s 2012 referral reason analysis.
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.
The report examines 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 percent, while “suspicious theft/loss (not vehicle)” had the highest increase in volume to 10,680 in 2012 from 7,152 reached in 2011. 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.
In 2012, the top five states generating the most QCs were: California (21,935), Florida (10,693), Texas (10,368), New York (9,059) and Maryland (4,296).
Although there have been year-to-year increases in QCs, they represent a small percentage of the overall claims processed. Each year over 56 million claims are processed, making 2012 QCs just 0.20 percent of total claims. Moreover, while QCs are by definition suspicious, at the time of referral they have not been identified as definitive acts of fraud.
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