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Organized Insurance Fraud: Florida Leads Top 10

Questionable claims from organized fraud have surged over the past few years. Despite an 11 percent dip from 2010 to 2011, overall activity rose 47 percent from 2008 to 2011, according to the Insurance Information Institute (I.I.I) citing National Insurance Crime Bureau (NICB) statistics. And the NICB expects another spike of close to 50 percent from 2011 to 2012 — to around 4,700 — when the NICB data becomes available.

Based on NICB questionable claims data from 2008 through the first half of 2012, the ten states with the highest levels of questionable claims related to organized insurance fraud are:

Data Center

  1. Florida: 3,530 claims
  2. California: 2,679
  3. Michigan: 1,080
  4. Texas: 1,050
  5. New York: 765
  6. Illinois: 591
  7. Georgia: 422
  8. South Carolina: 244
  9. North Carolina: 236
  10. Minnesota: 198

To help insurers fight organized fraud more effectively, ISO Claims Solutions plans to release a new tool in third-quarter 2013. It will apply predictive analytics to the data in ISO ClaimSearch®, which has more than 843 million claim records and continues to grow every day. With the tool, rather than react to the possibility of organized fraud, insurance special investigation units (SIUs) will proactively get the head start they’ve always needed.

This fraud network analytics system will scan ISO ClaimSearch to find indicators of organized fraud and then build out the related networks.

Thomas Mulvey

Thomas Mulvey has been in the business of insurance investigations for more than 27 years. In his current position, he serves ISO as assistant vice president of SIU and claim services. He is also the coordinator of ISO’s Insurance Fraud Management Conference.

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