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NICB: Referrals for investigation of possible work comp fraud rise in first quarter of 2011

The National Insurance Crime Bureau (NICB), the non-profit organization that "partners with insurers and law enforcement agencies to facilitate the identification, detection and prosecution of insurance criminals" recently released an analysis on the incidence of workers' compensation/employee fraud in the first quarter of 2011.

The results?

The number of dubious claims (i.e., potentially fraudulent workers compensation claims) referred to the NICB by both property/casualty insurers and self-insured entities for investigation during the first quarter of 2011 were up 24 percent from the same time last year.

The NICB analysis, which categorizes/ranks the reasons why the claims were submitted, determined that the category with the most significant increase from the first quarter of 2010 to the first quarter of 2011 was "inflated medical billing."

"It's significant," said Aaron Soline, an NICB data analytics manager. "It tends to show medical providers are, obviously, involved in this. That's an indication of fraud shifting from previous years."

Interestingly, the category with the largest overall increase from the first quarter of 2009 to the first quarter of 2011 was found to be "prior injury/not related to work."

"[The category] decreased in the previous year [by nine percent] and now is up almost 60 percent," said Soline.

It is worth noting that the following categories all demonstrated significant increases in the number of potential work comp/employee fraud claims submitted for review:

  • Premium fraud - up fifty percent from the first quarter of 2010
  • Material misrepresentation on fraud warning form - up 44 percent from the first quarter of 2010
  • False Social Security number - up 38 percent from the first quarter of 2010

Workers compensation fraud/employee fraud is a very serious crime. If you suspect that such a crime has been perpetrated against your organization, you should strongly consider speaking with an experienced workers' comp defense attorney.

Stay tuned for further developments in the area of workers' compensation defense law ...

This post was provided for informational purposes only and is not to be construed as legal advice.

Related Resources:

Rate of questionable comp claims up 24 percent, report indicates (Risk & Insurance)

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