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Workers Compensation And National Insurance Crime Bureau

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The National Insurance Crime Bureau

I had not heard of the National Insurance Crime Bureau (NICB) until last week. The organization functions as a repository for questionable claims. The organization seems to be somewhat similar to the Index Bureau.

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This is from the NICB’s website – The National Insurance Crime Bureau is a not-for-profit organization that receives support from approximately 1,000 property/casualty insurance companies. The NICB partners with insurers and law enforcement agencies to facilitate the identification, detection and prosecution of insurance criminals.

The NCIB centers on questionable claims, not all claims. Questionable claims (QCs) are those claims that NICB member insurance companies submit to NICB for closer review and investigation based on one or more indicators of possible fraud.

There are over 1,100 Property and Casualty insurance companies and self-insured organizations that comprise the NICB membership base.

A single incoming QC may contain as many as seven “red flags,” or reasons for further investigation. Each file is categorized according to type, such as property, casualty, commercial, workers’ compensation, vehicle, and miscellaneous.

Hand With Percentage Icon National Insurance Crime Bureau Holding Magnifying Glass
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The areas of possible Workers Compensation fraud that increased the most from 2010 to 2011 on a percentage basis were:

  • Duplicate Billing – 207%
  • Inflated Billing – 113%
  • Material Misrepresentation on Employment App – 67%

The first two are based on questionable activities by medical providers. I found this a little surprising with all of the preferred provider networks and medical bill analysis and review companies that operate in today’s Workers Comp environment. Does this mean that medical providers have become more dishonest in the last two years?

The highest non-medical issue for referral to the NICB was the employee not accurately completing the employment application. Through the years, I have seen this occur often in claims. One of the main things left off of the employment application by the employee is the subject of prior injuries or ability to perform a certain job function.

The %’s above are from certain claims from a set group of insurance carriers or TPA’s. I do not think there was a large enough base to make any type of statistical inferences. The report can be found here. It may be worth a quick read. You will need a PDF reader to open the document.

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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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