NICB Reports 10 Percent Rise in New York Suspicious Claims Since 2008

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Apr 13, 2011, 09:00 ET

Faked/Exaggerated Injuries and Excessive Treatment Lead Increase

DES PLAINES, Ill., April 13, 2011 /PRNewswire-USNewswire/ -- The National Insurance Crime Bureau (NICB) today released its 2010 questionable claims (QC) referral reason analysis for New York. The report examines QCs associated with New York and referred to NICB from January 1, 2008, through December 31, 2010.

In 2008, a total of 6,378 New York QCs were referred to NICB from its member insurance companies compared with 6,726 in 2009 and 7,026 in 2010. That represents a 10 percent increase in 2010 from 2008 numbers. 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 full report is at: http://www.nicb.org/File%20Library/Public%20Affairs/NY-QCs08-10.pdf

In response to escalating incidents of fraud associated with medical claims, NICB opened its first Major Medical Fraud Task Force in New York in 2002. This focus has proven quite effective in targeting insurance fraud activity and has since been replicated in six other cities across the nation. Statistics in today's report show a continuing need for NICB's laser focus on insurance fraud in New York, particularly New York City.

Of New York's 7,026 QCs reported in 2010, 4,016 of them—57 percent—were from New York City alone. The rest were scattered around the state with the next highest number—145—originating from Buffalo.

With respect to referral reasons, most were for "faked/exaggerated injury" followed by "excessive treatment" and "staged/caused accident."

Under policy type, "personal automobile" was the single most cited policy generating 5,838 QCs in 2010—83 percent of all New York QCs in 2010. Viewed another way, in the three years covered by this report, a total of 20,130 QCs came from New York and 16,009—80 percent—were personal automobile policy types.

“One of the most important things that can be done to fight fraud in New York is to support the passage of S.2816 sponsored by Senator James Seward. This bill would deliver comprehensive reform to New York’s no-fault system while preventing much of the fraud we see conducted by illegitimate clinics and their patients—receiving treatments for non-existent injuries sustained during phony accidents,” said Joe Wehrle, NICB president and chief executive officer.

Anyone with information concerning vehicle theft and insurance fraud can report it anonymously by calling toll-free 1-800-TEL-NICB (1-800-835-6422), texting keyword "fraud" to TIP411 (847411) or by visiting our web site at www.nicb.org.

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 more than 1,100 property and casualty insurance companies and self-insured organizations. NICB member companies wrote over $317 billion in insurance premiums in 2010, or approximately 80 percent of the nation's property/casualty insurance. That includes more than 93 percent ($151 billion) of the nation's personal auto insurance. To learn more visit www.nicb.org.

SOURCE National Insurance Crime Bureau