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Slip and Fall Claims Under the Microscope

Fri Aug 27th, 2010 on     Insurance Claims,    

Florida businesses may be glad to hear that the National Insurance Crime Bureau (NICB) is stepping up its efforts to uncover “slip and fall” insurance fraud. NICB agents have teamed with insurance company investigators and law enforcement personnel to look into the thousands of questionableclaims submitted to insurance companies over the past couple of years.

Most of these fraudulent claims are made by “organized criminal rings,” the bureau said. A group of people target a specific town or city, stage multiple slip and falls, collect quickly, and move on before either the business community or the insurance companies catch on.

The investigation was triggered in part by a 57 percent increase in questionable claims reported since 2008, most of which were tied to commercial properties. In the first quarter of 2008, the NICB received 325 claims for further analysis. In the first 6 months of 2010, they received 997. 

In addition to the increased scrutiny, the NICB has been communicating with insurers regularly about the risks of not fully analyzing claims before they pay. For self-insured companies, though, that analysis may not be possible or may not seem practical; these companies tend to pay right away. According to the bureau, the failure to investigate could be costing businesses millions of dollars in unwarranted payouts.

While the increased focus is good news for businesses and insurance companies, it may not be such good news for consumers. The additional scrutiny may result in slower processing of legitimate claims.

Florida joined California, New York, Texas and Illinois in the top five states for questionable slip and fall claims. The cities with the most claims were New York, Los Angeles, Philadelphia, Las Vegas, and Chicago.

Resource: NICB “NICB Says Many Slip and Fall Claims Getting a Second Look” 8/24/01

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