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Showing posts with label National Insurance Crime Bureau. Show all posts
Showing posts with label National Insurance Crime Bureau. Show all posts

Saturday, October 5, 2013

New York Second in Nation for Questionable Workers’ Compensation Claims

New York State is second in the nation, only behind California, for questionable workers’ compensation insurance claims. The Empire State jumped to the second place in 2012 from fifth in 2011, the New York Insurance Association noted.

Workers compensation insurance fraud is a serious problem in New York,” Ellen Melchionni, president of the New York Insurance Association, said. “Fraud drives up workers compensation rates. The state and insurance industry need to remain vigilant in cracking down on those looking to cheat the system.”

The National Insurance Crime Bureau (NICB) analysis shows that the number of New York’s questionable claims reported in 2012 was more than double the questionable claims reported in 2011. There were 344 reported in 2012 versus 161 in 2011.

The NICB analysis also shows that in New York State, questionable claims in 2013 are on pace to exceed the 2012 figure. According to data available for the first half of 2013, 183 questionable claims were reported in the state between January and June.

“The growing rate of questionable workers compensation claims is alarming,” Melchionni said. “Fraud takes away from workers compensation serving its intended purpose of protecting injured workers.”
Source: The New York Insurance Association
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Wednesday, September 25, 2013

Questionable Workers Comp Claims Report: Fewer Claims and More Disputes

The National Insurance Crime Bureau (NICB) today released an analysis of workers’ compensation (WC) questionable claims (QC) referrals submitted from Jan. 1, 2011, through June 30, 2013. 

The report finds that while the total number of WC claims has been decreasing, the percentage that is deemed “questionable” has been rising. 

QCs 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.
 
California ranked first generating a total of 2,270 WC QCs. It was followed by Illinois with 689. New York was third with 688. 

In 2011, 3,349,925 WC claims were found in the Insurance Services Office (ISO) ClaimSearch® database. That number decreased to 3,244,679 in 2012, and is on track to decrease again in 2013 based on the 1,498,725 claims received in the first half of 2013. 
In 2011, 3,474 WC QCs were referred to NICB. That number increased to 4,460 in 2012 — a 28 percent rise. WC QCs accounted for 3.5 percent of the 100,201 QCs submitted in 2011, and increased to 3.8 percent of the 116,171 QCs in 2012.  

Through the first half of 2013, 2,325 WC CQs have been referred to NICB (3.7 percent of 62,352 total QCs), compared with 1,681 through the first half of 2011 and 2,174 through the first half of 2013.

The distribution of WC QCs follows a standard Monday–Friday workweek with...
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