NICB: Slip and Fall Claims Second Look

DES PLAINES, Ill – The National Insurance Crime Bureau (NICB) reported that “slip and fall” claims addressed to businesses and targeting insurance companies are now carefully scrutinized for potential fraud.

As in most cases, businesses frequently pay without investigating.

Member companies submitted to the NIBC showed a 57 percent increase in the number of referrals over the past two and a half years. After analysis, there were more than 4,600 questionable claims received in 2008, 2009 and the first half of 2010.  Those claims were mostly related to commercial policies.

Joe Wehrle, NICB president and chief executive officer said that there are many people with legitimate accident claims in stores and businesses across the country but there are also a growing number of cases that indicate some kind of fraud. Agents from NIBC who are working with insurance company investigators and law enforcement, are bent on identifying and targeting organized criminal rings that make slip and fall accidents a good source of living.

These criminal rings come into an area and hit several retailers, grocers, or other businesses using sophisticated schemes and professional execution.  They intend to collect a quick payout and move on before anyone realizes what’s going on.

As an example, he cited two people going into a big box store or retailer, and splitting up.  One actor goes down an aisle while the other acts as a lookout. When no one is around, the actor pulls out a small bottle of liquid, pours it on the floor and then pretends to fall on the floor.  The lookout runs to help and tells everyone that he witnessed the fall.

Today, many companies have worked with insurers to increase the awareness level and urged companies to study claims closely before they pay.  The bad news is, many retailers are self-insured and consider this racket as a cost of doing business so they’ write a check without investigating. This technique adds up to millions of dollars in unwarranted payouts. NIBC is reaching out to all companied to join them fight against fraud.

Wehrle said that NICB is focusing on all kind of commercial fraud, slip & falls and workers’ compensation fraud. They have given these cases top priority for many of their member companies who write commercial policies.

NIBC noted that questionable claims of slip submitted went from 325 in the first quarter of 2008 to a high of 565 in the fourth quarter of 2009.  During the first half 2010, there were 997 slip and fall claims referred to NICB for further analysis.

The five cities with the most questionable claims for slip and falls are New York, Los Angeles, Philadelphia, Las Vegas and Chicago; while the state with the most questionable claims are: California, Florida, New York, Illinois and Texas.

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