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TOP FIVE QUESTIONABLE CLAIMS, BY INSURANCE TYPE, FIRST THREE QUARTERS 2011-2013 (1)
Rank Type of insurance 2011 2012 2013 Percent change,
first three quarters,
2011-2012
Percent change,
first three quarters,
2012-2013
1 Workers compensation 3,591 4,470 4,662 24% 4%
2 Vehicle 26,598 31,297 32,698 18 4
3 Casualty 40,500 44,248 44,476 9 1
4 Property 11,880 16,723 16,720 41 -3
5 Commercial 1,426 1,782 1,556 25 -13
  Total questionable claims (2) 74,944 87,684 93,053 17% 6%

(1) Based on claims insurance companies refer to the National Insurance Crime Bureau (NICB) to be reviewed and investigated.
(2) Does not equal the sum of claims by type of insurance because a single questionable claim may have more than one referral reason.

Source: National Insurance Crime Bureau.

 
QUESTIONABLE CLAIMS, BY INSURANCE TYPE, 2010-2011
Rank Type of insurance 2010 2011 Percent change
2010-2011
1 Miscellaneous (1) 67,247 78,039 16%
2 Casualty (2) 46,741 54,003 16
3 Workers compensation (3) 4,231 4,773 13
4 Vehicle (4) 34,585 35,652 3
5 Property (5) 15,853 16,227 2
6 Commercial (6) 1,940 1,937 -0.2
  Total questionable claims 91,797 100,450 9%

(1) Miscellaneous: includes premium avoidance, medical provider, agent/adjuster, attorney, medical provider, organized ring and vendor fraud; and other causes.
(2) Casualty: includes duplicate, inflated, and services not rendered billing; faked/exaggerated and prior injuries; staged/caused, jump-in, and slip and fall accidents; solicitation; improper facility/provider license; excessive treatment and unbundling or upcoding.
(3) Workers compensation: includes duplicate and inflated billing; prior injury/not work-related; false social security number, false loss, working while collecting and other claimant causes; employer misrepresentation and other premium fraud and other causes.
(4) Vehicle: includes hail, faked, water/flood and suspicious fire/arson damage; odometer, owner give-up and auto glass fraud; paper/phantom accident; VIN manipulation; auto repair/body shop fraud and other causes.
(5) Property: includes flood/water, hail and inflated damage; suspicious disappearance/loss of jewelry, suspicious theft/loss excluding vehicle; and fire/arson.
(6) Commercial: includes farm, construction/farm/heavy equipment, cargo, fire/arson, vehicle and other theft loss; slip and fall; suspicious object in food; product liability; and other causes.

Source: National Insurance Crime Bureau.

 
QUESTIONABLE CLAIMS, BY INSURANCE TYPE, FIRST HALF 2011-2012
Rank Type of insurance First half, 2011 First half, 2012 Percent change,
first half 2011-2012
1 Miscellaneous (1) 39,303 43,091 10%
2 Casualty (2) 26,644 29,778 12
3 Vehicle (3) 17,564 21,103 20
5 Property (4) 7,983 11,197 40
  Workers compensation (5) 2,398 2,866 20
6 Commercial (6) 983 1,207 23
  Total questionable claims (7) 48,887 58,523 20%

(1) Miscellaneous: includes premium avoidance, medical provider, agent/adjuster, attorney, medical provider, organized ring and vendor fraud; and other causes.
(2) Casualty: includes duplicate, inflated, and services not rendered billing; faked/exaggerated and prior injuries; staged/caused, jump-in, and slip and fall accidents; solicitation; improper facility/provider license; excessive treatment and unbundling or upcoding.
(3) Vehicle: includes hail, faked, water/flood and suspicious fire/arson damage; odometer, owner give-up and auto glass fraud; paper/phantom accident; VIN manipulation; auto repair/body shop fraud and other causes.
(4) Property: includes flood/water, hail and inflated damage; suspicious disappearance/loss of jewelry, suspicious theft/loss excluding vehicle; and fire/arson.
(5) Workers compensation: includes duplicate and inflated billing; prior injury/not work-related; false social security number, false loss, working while collecting and other claimant causes; employer misrepresentation and other premium fraud and other causes.
(6) Commercial: includes farm, construction/farm/heavy equipment, cargo, fire/arson, vehicle and other theft loss; slip and fall; suspicious object in food; product liability; and other causes.
(7) The total by type of insurance is greater than the total questionable claims shown because a single claim can contain up to 7 referral reasons.

Source: National Insurance Crime Bureau.

 
TOP TEN QUESTIONABLE CLAIMS BY INSURANCE TYPE, 2011-2012 (1)
Rank Type of insurance 2011 2012 Percent change, 2011-2012
1 Personal automobile 69,219 78,024 12.7%
2 Personal property: homeowners 11,887 17,183 44.6
3 Workers compensation (2) 3,470 4,459 28.5
4 Commercial automobile 3,092 3,554 14.9
5 Commercial and general liability 2,571 2,650 3.1
6 Personal property: other 1,090 2,621 140.5
7 Commercial property: commercial multiple peril 698 941 34.8
8 Commercial liability: business owners 387 464 19.9
9 Personal property: fire 488 411 -15.8
10 Commercial property: business owners 325 406 24.9
  All questionable claims (3)
100,201 116,171 15.9%

(1) Based on claims insurance companies refer to the National Insurance Crime Bureau to be reviewed and investigated.
(2) Includes employers' liability.
(3) Includes all policy types, not just top 10.

Source: National Insurance Crime Bureau.