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  • Dean Smith

Report: Questionable Workers’ Compensation Claims

The National Insurance Crime Bureau analyzed questionable workers’ compensation claim referrals from January 1st, 2011 to June 30th, 2013, and ultimately determined that even though the total number of workers’ compensation claims is on a decline, questionable claims are on an incline.

Workers’ Compensation Claims Reported By Year

in the ISO ClaimSearch Database:

2011: 3,349,925

2012: 3,244,679

2013: 1,498,725 claims were submitted through the first half of 2013, and if the numbers stay on track after the end of the year, it should result in another decrease.

Questionable Workers’ Compensation Claims

Reported to NICB By Year:

2011: 3,474

2012: 4,460 (28% increase)

2013: 2,325 questionable workers’ compensation claims were submitted through the first half of 2013, resulting in a trend that will perpetually increase.

According to the NICB, California came in first place with a total of 2,270 questionable workers’ compensation claims throughout January 1st, 2011 to June 30th, 2013. Illinois came in second with 689 questionable claims, and New York in third with 688.

Top Three Reasons for Referral to the NICB in

2011, 2012, and first half of 2013:

Claimant fraud (6,107 referrals)

Prior Injury/not related to work (2,319 referrals)

Malingering (1,380 referrals)

Suspicious? Get Answers TODAY with ICU Investigations.

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