NICB: Questionable Insurance Claims on the Rise in New York, New Jersey

December 18, 2013

New York State’s questionable claims rose 29 percent from 2010 to 2012, while New Jersey’s questionable claims were up 63 percent during the same period, according to the National Insurance Crime Bureau (NICB). The figures, published Wednesday, are based on NICB’s 2010-2012 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 New York State, there were 7,015 QCs referred to NICB from its member insurance companies in 2010. In 2011, the number increased to 7,328 and in 2012, it rose again to 9,059 — a 29 percent increase over 2010’s figure.

The top five cities in New York State generating the most QCs last year were New York City (5,140), Buffalo (184), Rochester (155), Hempstead (110) and Yonkers (88).

The top five Core Based Statistical Areas (CBSAs) reporting QCs in New York State last year were New York-Northern New Jersey-Long Island (6,421), Buffalo-Niagara Falls (323), Rochester (208), Albany-Schenectady-Troy (170) and Poughkeepsie-Newburgh-Middletown (131). The top five loss types were: personal injury protection, bodily injury, collision, theft and other automobile.

Meanwhile, in New Jersey, there were 1,412 QCs referred to NICB from its member insurance companies in 2010. In 2011, the number increased to 1,903 and in 2012, it rose again to 2,300 — a 63 percent increase over 2010’s figure.

The top five cities in New Jersey generating the most QCs last year were Newark (173), Paterson (105), Jersey City (82), Elizabeth, (57) and Trenton (51).

The top five CBSAs reporting QCs in New Jersey last year were New York-Northern New Jersey-Long Island (1,491), Philadelphia-Camden-Wilmington (259), Trenton-Ewing (84), Atlantic City (58) and Vineland-Millville-Bridgeton (13). The top five loss types were: personal injury protection, bodily injury, collision, theft and other automobile.

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

NICB- New York

NICB- New Jersey

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