Insurance Fraud Claims on Rise in New York

April 13, 2011

Suspicious insurance claims in New York were up about 4.5 percent in 2010, an industry report shows.

In 2010, insurers reported a total of 7,026 questionable claims in the state, compared with 6,726 in 2009, according to the insurance industry’s National Insurance Crime Bureau (NICB).

Questionable claims (QCs) are ones 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.

The 2010 total represents about a 10 percent rise since 2007, when 6,378 QCs were recorded in the state.

Of New York’s 7,026 questionable claims reported in 2010, NICB says 4,016 of them—57 percent—were from New York City alone. The rest were scattered around the state with the next highest number—145—originating from Buffalo.

Most were referred for “faked/exaggerated injury” followed by “excessive treatment” and “staged/caused accident.”

Under policy type, “personal automobile” was the single most cited policy generating 5,838 QCs in 2010—83 percent of all New York QCs in 2010.

NICB has had task force in New York since 2002 to help the industry and officials target insurance fraud activity.

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