Slideshow Top Questionable Claims Referral Reasons for Q3

Published
  • November 18 2013, 3:25pm EST

Comparing the first three quarters of 2012 and 2013, casualty, workers’ compensation, vehicle and miscellaneous showed increases, while commercial referral reasons showed a slight decrease and property referral reasons showed no statistical change, according to the latest data from the National Insurance Crime Bureau outlining Q3 questionable claims data by segment.

Overall, comparing the first three quarters of 2011 and the first three quarters of 2013, the numbers of QC’s increased 24 percent.

Content Continues Below


Overall, property QC referral reasons had no significant change when comparing the first three quarters 2012 to the first three quarters 2013. However, the first three quarters 2011 to the first three quarters 2012, property QC referral reasons increased overall by 41 percent. For the first three quarters 2012 and the first three quarters 2013, two categories showed a negative percentage change. Flood/water damage referrals showed the highest percent increase with a 21 percent increase from the first three quarters 2012 to the first three quarters 2013.

Overall, casualty QC referral reasons increased 1 percent from the first three quarters 2012 to first three quarters 2013.

Commercial QC referral reasons decreased in volume in nine out of 11 categories when comparing the first three quarters 2012 and the first three quarters 2013. Commercial QC referral reasons decreased overall by 13 percent.

Content Continues Below


Overall, workers’ compensation QC referral reasons increased 4 percent when comparing the first three quarters 2012 to the first three quarters 2013. Disability referrals had the highest increase of volume in the workers’ compensation category when comparing the first three quarters 2012 to the first three quarters 2013; while claimant fraud remains the largest workers’ compensation referral reason by over 2.5 times the next highest referral reason.

Vehicle QC referral reasons increased 4 percent when comparing the first three quarters 2012 to the first three quarters 2013.

The miscellaneous category had the highest increase in volume and the highest percentage increase: Miscellaneous QC referral reasons increased 16 percent when comparing the first three quarters of 2012 to the first three quarters of 2013. For a single referral reason, medical provider referrals in the miscellaneous category had the largest increase in volume, as well as the highest percentage increase.