“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.
So what do these cases of slip-and-fall fraud entail? Wehrle explains that, “A typical slip-and-fall case 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 witnessed the fall.
“They 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.” 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.
Wehrle said the NICB has increased its focus on commercial fraud, and slip and falls and workers’ compensation fraud are priorities for many of its member companies who write commercial policies. The attention is warranted, considering that 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. Just in the first half of 2010, there were 997 slip-and-fall claims referred to NICB for further analysis.
“Fortunately, we’ve worked with insurers to raise the awareness level and urged companies to analyze claims before they pay,” Wehrle continued. “The bad news is, many retailers are self-insured and they look at this as a cost of doing business; they’ll write a check without investigating. Based on what companies have told us, we think that adds up to millions of dollars in unwarranted payouts. We’re reaching out to these companies and urging them to join us in fighting commercial fraud.”