The National Insurance Crime Bureau today released its third quarter 2011 questionable claims (QC) referral reason analysis. The report examines six referral reason categories of claims—property, casualty, commercial, workers' compensation, vehicle and miscellaneous—for the third quarter 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. A single claim may contain up to seven referral reasons.
During the first three quarters of 2009, a total of 62,341 QCs were referred. That number increased to 70,295 during the same period in 2010 and to 74,944 through the third quarter of 2011. Overall, there was a 7 percent increase in QCs through three quarters of 2011 compared with the same period in 2010, and a 20 percent increase when compared with the same period of 2009.
Referrals under workers' compensation and casualty policies posted gains while property and commercial policies saw slight decreases. Vehicle claims were flat overall; however, the vehicle referral reason "hail damage" increased 103 percent from the third quarter of 2010.