NICB Says Many Slip and Fall Claims Getting a Second Look

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Aug 24, 2010, 09:00 ET

Businesses Frequently Pay Without Investigating

DES PLAINES, Ill., Aug. 24 /PRNewswire-USNewswire/ -- The National Insurance Crime Bureau (NICB) said today that "slip and fall" claims targeting businesses and their insurance companies are beginning to be scrutinized more carefully for potential fraud.

An analysis of questionable slip and fall claims submitted by NICB member companies showed a 57 percent increase in the number of referrals over the past two and a half years. More than 4,600 questionable claims were received in 2008, 2009 and the first half of 2010. Most of those claims were tied to commercial policies.

"While many people have legitimate accidents in stores and businesses across the country, we've seen a growing number of cases that have some indication of potential fraud," said Joe Wehrle, NICB president and chief executive officer. "Our agents, working with insurance company investigators and law enforcement, are busy identifying and targeting organized criminal rings that make a good living staging slip and fall accidents.

"They come into an area and hit several retailers, grocers, or other businesses with sophisticated schemes and professional execution. They hope to collect a quick payout and move on before anyone realizes what's going on.

"A typical slip and fall case may involve two people going into a big box store or retailer, and splitting up. The first person goes down an aisle while the other keeps a lookout. When the coast is clear, he or she pulls out a small bottle of liquid, pours it on the floor and then pretends to fall on the floor. The partner runs to assist and tells everyone that he witnessed the fall.

"Fortunately, we've worked with insurers to raise the awareness level and urged companies to analyze claims before they pay. The bad news is, many retailers are self-insured and they look at this as a cost of doing business – they'll write a check without investigating. Based on what companies have told us, we think that adds up to millions of dollars in unwarranted payouts. We're reaching out to these companies and urging them to join us in fighting commercial fraud."

Wehrle said the NICB has increased its focus on commercial fraud, and slip and falls and workers' compensation fraud are cases that are priorities for many of its member companies who write commercial policies.

The number of slip and fall questionable claims submitted to NICB went from 325 in the first quarter of 2008 to a high of 565 in the fourth quarter of 2009. In the first half of 2010, there were 997 slip and fall claims referred to NICB for further analysis.

New York, Los Angeles, Philadelphia, Las Vegas and Chicago were the five cities with the most questionable claims for slip and falls, and California, Florida, New York, Illinois and Texas were the top five states.

The full ForeCAST(SM) report is available here:

www.nicb.org//File%20Library/Public%20Affairs/Slip-and-Fall-Report2010.pdf.

Anyone with information concerning insurance fraud can report it anonymously by calling toll-free 1-800-TEL-NICB (1-800-835-6422), or by visiting our Web site www.nicb.org. You may also text your information to TIP411, keyword "FRAUD" and remain anonymous if you so desire.

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 information analysis, 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 over $319 billion in insurance premiums in 2009, or more than 78 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