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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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