By David Colmans
One evening in 2009, I was leaving a restaurant in an Atlanta suburb during a rainstorm. The wheelchair access ramp was covered with small pebbles in concrete and my feet slipped out from under me. Other than a pair of torn pants, I was none the worse for wear. I know real slip and fall incidents happen, but I didn't make an issue of it. That being said, businesses are increasingly paying more attention to these claims and how they supposedly occurred.
"Slip and fall" claims targeting businesses and their insurance companies are being scrutinized more carefully for potential fraud, according to a report by the National Insurance Crime Bureau (NICB).
An analysis of questionable slip and fall claims submitted by NICB member companies showed a 57 percent increase in the number of referrals over the past two-and-a-half years. More than 4,600 questionable claims were received in 2008, 2009 and through the first half of 2010. Most of those claims were tied to commercial policies meaning individuals file claims against businesses for so-called injuries while on the property owned by the business.
"While many people have legitimate accidents in stores and businesses across the country, we've seen a growing number of cases that have some indication of potential fraud," said Joe Wehrle, NICB president and chief executive officer. "Our agents, working with insurance company investigators and law enforcement, are busy identifying and targeting organized criminal rings that make a good living staging slip and fall accidents."
According to Wehrle, these "accident teams" come into an area and hit several retailers, grocers, or other businesses with sophisticated schemes and professional execution. They hope to collect a quick payout and move on before anyone realizes what's going on.
Here's how a typical slip and fall case works. It may involve two people going into a big box store or retailer, and splitting up. The first person goes down an aisle while the other keeps a lookout. When the coast is clear, he or she pulls out a small bottle of liquid, pours it on the floor and then pretends to fall on the floor. The partner runs to assist and tells everyone that he or she witnessed the fall.
NICB reports it works with insurers to raise the awareness level and urges companies to analyze claims before they pay. The bad news is, many retailers are self-insured and they look at this as a cost of doing business. They will write a check without investigating. NICB reports that these costs add up to millions of dollars in unwarranted payouts. According to Wehrle, "We're reaching out to these companies and urging them to join us in fighting commercial fraud."
Wehrle said the NICB has increased its focus on commercial fraud, as well as slip and falls and workers' compensation fraud. These cases are priorities for many of its member companies who write commercial policies.
The number of slip and fall questionable claims submitted to NICB went from 325 in the first quarter of 2008 to a high of 565 in the fourth quarter of 2009. In the first half of 2010, there were 997 slip and fall claims referred to NICB for further analysis.
New York, Los Angeles, Philadelphia, Las Vegas and Chicago were the five cities with the most questionable claims for slip and falls, and California, Florida, New York, Illinois and Texas were the top five states.
Anyone with information concerning insurance fraud can report it anonymously by calling toll-free 1-800-TEL-NICB (1-800-835-6422), or by visiting http://www.nicb.org. You may also text your information to TIP411, keyword "FRAUD" and remain anonymous if you so desire.
NICB is supported by nearly 1,100 property and casualty insurance companies and self-insured organizations. Other major fraud issues investigated by NICB include medical fraud, staged accidents and other auto fraud and roof hail damage fraud schemes.
David Colmans is the executive director of the Georgia Insurance Information Service. Contact him at (770) 565-3806 or e-mail dcolmans@giis.org.