In a recent featured article with Claims Advisor, NICB President and CEO Joe Wehrle spoke about current fraud trends and the need for the insurance industry to take on more responsibility for rooting out fraud schemes. The following is some of what Wehrle shared.
Wehrle stated, "Professional crime rings and gangs play a much bigger role in insurance fraud. They have gone beyond just making an auto theft claim and collecting payment. In many ways, they operate like a corporation. They still make the initial claim, but they also push for all policy limits by utilizing runners to recruit additional participants, conspiring with auto body shop owners to enhance damages, co-opting medical professionals (medical doctors, chiropractors, physical therapists, acupuncturists, etc.) who provide unnecessary medical treatments and/or surgeries (durable medical equipment, diagnostics testing, etc.), and working with attorneys who bill and demand payment up to the policy limit. These groups are so sophisticated that they conduct counter-surveillance, verify new patients' Social Security numbers, and know which insurance companies to submit claims to."
Wehrle further added that the frontline claims person is usually in the best position to initially detect questionable aspects concerning a claim. The claims person is the holder of proof of loss and the supporting paperwork (application, policy, police reports, receipts, etc.), and they also interact with the insured/claimant. The NICB's fraud resources such as Indicators of Fraud and other materials can be beneficial in helping the claims person as the "first line of defense" against fraud.
Read the full article.
To learn more about the NICB and fraud-fighting resources, visit www.nicb.org