Questionable claims (QCs) referred to The National Insurance Crime Bureau (NICB) have increased 26.7 percent, to a new record of 116,268 in 2012 from 91,797 in 2010. The total for 2011 was 100,450. QCs are those claims referred to NICB for review and investigation based on one or more indicators of possible fraud.

NICB said the report examines six referral-reason categories property, casualty, commercial, workers’ compensation, vehicle and miscellaneous claims referred in 2012, and compares them with claims filed in 2010 and 2011.

In the property category, “suspicious disappearance/loss of jewelry” increased by 86 percent, the largest percent change; “suspicious theft/loss (not vehicle)” had the largest volume increase to 10,680 in 2012, up from 7,152 in 2011. In the vehicle category, “hail damage,” with 1,505 referrals, and “suspicious hit while parked,” with 5,006 referrals, were the two top referral reasons.

States with the most QCs include:

California (21,935)

Florida (10,693)

Texas (10,368)

New York (9,059)

Maryland (4,296)

QCs represent a small percentage of claims processed, NICB said, and with more than 56 million claims processed each year, QCs accounted for 0.20 percent of total claims. In addition, while QCs are by definition suspicious, they have not been identified as definitive acts of fraud at the time they were referred. Access the full report by clicking here, the 2012 state QC totals by clicking here.

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