Questionable Insurance Claims on the Rise in Texas: Report

Questionable insurance claims rose by 38 percent in Texas from 2010 through 2012, the National Insurance Crime Bureau (NICB) reports.

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.

This report analyzes QCs by loss city, core-based statistical area (CBSA), policy type, loss type, policy and loss type combined and referral reasons.

In 2010, there were 7,520 Texas QCs referred to NICB from its member insurance companies. In 2011, the number increased to 8,016 and rose again in 2012 to 10,368 — a 38 percent increase over 2010′s figure.

The top five cities in Texas generating the most QCs last year were:

• Houston (2,010)
• Dallas (892)
• San Antonio (682)
• El Paso (455)
• Fort Worth (357)

The top five CBSAs reporting QCs were Dallas-Ft. Worth-Arlington, Houston-Sugar Land-Baytown, San Antonio-New Braunfels, El Paso and Austin-Round Rock-San Marcos.

The top five loss types were: bodily injury, theft, collision, burglary and property damage.

It is 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, etc.

Source: NICB