PALOS HILLS, Ill., Aug. 2, 2000 — Insurance company claims and special investigation personnel can now report questionable claims to the National Insurance Crime Bureau's (NICB) Questionable Claims Database through a secure link from the ISO ClaimSearch® system, via ISOnet®, an Internet delivery platform. This new capability is the result of a joint effort of the NICB and the Insurance Services Office, Inc. (ISO).
"Submitting questionable claims to the NICB is critical to supporting industry antifraud efforts — it helps in the detection of suspicious claims and patterns that simultaneously affect multiple carriers," said James S. Spiller, executive vice president of the NICB. "Submitting questionable claims can prevent paying fraudulent claims and provides important information to investigate and prosecute insurance fraud. We encourage all of our members to submit questionable claims to the NICB database through ISO ClaimSearch."
"The addition of the questionable claim submission capability to the ISO ClaimSearch Internet site is key to streamlining users' reporting to NICB and ISO. In many states, it also fulfills the mandatory requirement to report this activity to designated state fraud bureaus," said Richard P. Boehning, ISO senior vice president.
Insurers deem an insurance claim questionable when it doesn't appear in all respects to meet the requirements for a valid insurance claim. It may contain outright falsehoods, elements of exaggeration, or include indications of insurance fraud, such as minor vehicle property damage with major injuries reported.
The NICB maintains the property/casualty industry's Questionable Claims Database, which is used to support the activities of its field investigators and the insurance industry, as well as law enforcement personnel involved in investigating and prosecuting insurance fraud.
"If a claims professional submits a claim to the ISO ClaimSearch system, and the ISO ClaimSearch report shows suspicious characteristics, that claim should be submitted to the NICB immediately," said Boehning. "Once a claim is reported to the ISO ClaimSearch system, it can easily be updated into a questionable claim, when warranted."
The completion of the questionable claims submission capability over the Internet is part of NICB's and ISO's ongoing effort to fight insurance fraud.
The National Insurance Crime Bureau is a not-for-profit organization supported by approximately 1,000 property/casualty insurance companies. Through unique partnerships with insurers and law enforcement, the NICB provides advanced interactive resources, strategic information, training and technical analysis to facilitate the identification, detection and prosecution of insurance fraud. To learn more about the NICB, visit the website at www.nicb.org.
The ISO ClaimSearch system — which contains more than 147 million claim records — is a service of ISO, a leading source of information about property and liability risk. ISO provides statistical, actuarial, underwriting and claims information and analyses; consulting and technical services; policy language; and information about property locations for a broad spectrum of commercial and personal lines of insurance. In the United States and around the world, ISO serves more than 2,900 insurers and reinsurers, as well as agents, brokers, self-insureds, risk managers, insurance regulators and other government agencies. For more information about ISO, visit its website atwww.verisk.com/iso.
NICB and ISO each adhere to privacy and security policies. These policies establish rules and procedures required of NICB, ISO and all database users in order to maintain the privacy and security of the databases. To implement these policies, NICB, ISO and each user must ensure that: a) information is accessed by appropriate entities and that use is limited to authorized individuals; b) information is accessed and used in a manner consistent with existing laws and regulations; and c) procedures are implemented to audit the access and use of database information.
James Spiller (NICB)