5 States With the Most Questionable Claims

There has been an increase in the number of questionable claims (QC) submitted for the United States the last three years. According to the National Insurance Crime Bureau (NICB), there were 74,676 QCs in 2008, 85,018 in 2009 and 91,730 in 2010. For its three-year analysis, NICB looked at loss state, loss city, core-based statistical area, policy type, loss type and referral reasons.

Questionable claims are those claims that NICB member insurance companies refer to NICB for closer review and investigation based upon one or more indicators of possible fraud.

Just five states—California, Florida, Texas, New York and Michigan—generated 49% of all QCs during this period. California had the most QCs in each of the three years. North Dakota had the fewest QCs in 2008 and 2009, and Vermont had the fewest in 2010.

New York was city that had the most QCs in each of the three years. Los Angeles, Houston, Tampa and Detroit followed New York. Florida is unique in that it has three cities in the top 10 for QCs—Tampa, Miami and Orlando. Florida is also the only state where NICB operates two Major Medical Fraud Task Forces.

There were 51 policy types identified in the 2008 QC data, and 53 policy types identified in the 2009 and 2010 QC data. “Personal Automobile” was the Policy Type that had the most QCs in each of the three years.

There were 74 loss types identified in the 2008 QC data, 64 in the 2009 QC data and 73 in the 2010 QC data. “Theft” had the most QCs in 2008 and 2009, while “Bodily Injury” had the most QCs in 2010.

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