Questionable claims are those claims that NICB member insurance companies refer to NICB for closer review and investigation based upon one or more indicators of possible fraud. In 2008, a total of 74,676 QCs were referred. The number increased to 85,018 in 2009 and to 91,730 in 2010-a 23 percent increase from 2008.
Just five states -- California, Florida, Texas, New York and Michigan -- generated 49 percent of all QCs during this period. As for cities generating the most QCs, they were New York, Los Angeles, Houston, Tampa and Detroit. Florida is unique in that it has three cities in the top ten for QCs-Tampa, Miami and Orlando. Florida is also the only state where NICB operates two Major Medical Fraud Task Forces.
When analyzed by core based statistical areas, the top five are Los Angeles-Long Beach-Santa Ana, Calif.; New York-Northern New Jersey-Long Island, N.Y., N.J., Pa.; Miami-Fort Lauderdale-Pompano Beach, Fla.; Detroit-Warren-Livonia, Mich.; and Chicago-Naperville-Joliet, Ill., Ind., Wis.
Personal automobile was the policy type with the most QCs for all three years while faked/exaggerated injury and questionable vehicle theft were the QC referral reasons most cited for all three years.
About the National Insurance Crime Bureau:
Headquartered in Des Plaines, Ill., the NICB is the nation's leading not-for-profit organization exclusively dedicated to preventing, detecting and defeating insurance fraud and vehicle theft through data analytics, investigations, training, legislative advocacy and public awareness. The NICB is supported by nearly 1,100 property and casualty insurance companies and self-insured organizations. NICB member companies wrote about $320 billion in insurance premiums in 2010, or approximately 80 percent of the nation's property/casualty insurance. That includes 94 percent ($152 billion) of the nation's personal auto insurance. To learn more visit www.nicb.org.