Questionable claims in Massachusetts rose 57 percent from 2010 through 2012, according to the National Insurance Crime Bureau’s (NICB) 2010-2012 Massachusetts questionable claims referral reason analysis.
Questionable claims (QC) are those 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.
In 2010, there were 1,492 Massachusetts QCs referred to NICB from its member insurance companies. In 2011, the number increased to 1,768 and in 2012, it rose to 2,346 — a 57 percent increase over 2010′s figure.
The top five cities in Massachusetts generating the most QCs last year were Boston (511), Springfield (119), Worcester (79), Brockton (75) and Lawrence (55).
The top five Core Based Statistical Areas (CBSAs) reporting QCs in Massachusetts last year were Boston-Cambridge-Quincy (1,440), Springfield (205), Worchester (151), Providence-New Bedford-Fall River (122), and Barnstable Town (44). The top five loss types were: collision, bodily injury, personal injury protection, property damage and theft.
NICB said it’s important to note that QCs represent a fraction of overall claims traffic. Nationally in 2012, QCs totaled 116,268 out of an overall claims population of more than 70.5 million — or 0.164 percent. The volume of QC referrals can increase or decrease over a given period of time and may be caused by a number of factors, including better reporting by the industry and an increase or decrease in fraudulent activity.
Source: National Insurance Crime Bureau