Uptick in Medical-related and
Vehicle Hail Damage referrals
The number of questionable claims (QCs) filed during the first half of 2011 in- creased 4. 5 percent when
compared to the previous year, according to the NICB’s findings released last
This particular yearly report takes
into account a total of six referral reason categories—property, casualty,
commercial, workers’ compensation,
vehicle, and miscellaneous—for the
first half of 2009, 2010, and 2011. The
“QC” terminology denotes claims that
NICB member insurers submit to the
Des Plaines, Ill.-based not-for-profit
organization for closer review and investigation based on one or more indicators of possible fraud. One claim may
contain as many as seven different referral reasons.
From January to June of this year,
48,887 QCs were logged, compared to
46,766 for the first half of 2010. For the
same period in 2009, the number of
suspicious claims requiring investiga-
tion totaled 41,309. This translates to a
4.5-percent increase between 2011 and
2010, and a two-year increase of 18. 3
QC Referral Reasons –
First Half 2009, 2010, 2011
A Overall, workers’ compensation referral
reasons increased by 18% from the
first half of 2010 to the first half of
2011 after a 7% decrease from 2009
A “Inflated medical billing” increased a
whopping 245% from the first half of
2010 to the first half of 2011.
A Hail damage topped the list of vehicle
referral reasons, with the largest
percentage increase—109% from the
first half of 2010 to the first half of
A Auto glass fraud showed the largest
percentage decrease, with -67%.
A Questionable vehicle theft showed a
significant numeric decrease of 571
fewer referrals from the first half of
2010 to the same period in 2011.
Source: The National Insurance Crime Bureau
use the system. Some questions are now being asked earlier rather
than later if these claims are being referred directly to the SIU, and
some companies grant all employees access to the system. This is
beneficial if the employee receiving the initial claim call is not that
experienced—he or she will know what basic questions to ask.
Does this compare to systems some insurers may already
have in place?
I have a feeling that some companies have their own version of this
that they’ve devoted a great deal of time to perfecting them over the
years. Some insurers may have just started thinking about creating
a similar system, but if they’re members, then the use of our system
is already being paid for. Companies can compare systems to find
out which one they would prefer to use. We don’t tell members what
they have to do, we just say, “Here’s another benefit of membership
that you can take advantage of.”
tell me about the webinars that the Nicb will be offering.
We came up with the idea for webinars because we wanted to offer
training at a time and place that works best for those receiving the
training. It can be difficult for companies to send a large number
of employees to another location for training, especially financially.
We really wanted to take advantage of new technologies and mobile webinar training because of the convenience. We know we
can’t do three-hour sessions, but maybe we can explore the five to
15 minute time frame. For example, we could have a five-minute session on the analysis of vehicle identification numbers (VINs). Maybe
there would be one on medical bill review.
How will this transform the training Nicb offers?
Each year, we train about 14,000 or 15,000 member company employees, and we also train up to 20,000 law enforcement officials at
no charge. Why shouldn’t we provide these webinars as an option
for people who may not be able to attend a conference? There are
a lot of states out there with regulatory requirements for claims adjusters and insurance agents, so these webinars can help them stay
up to date on the latest scams and techniques. It just makes sense.
What else has the Nicb been doing to stay on top of the
We will begin releasing a quarterly NICB report on our site and on
You Tube to make people more aware of what we are doing as an
organization. We’re also really excited about having started our own
social media plan.