Regarding: U.S. Slip and Fall Questionable Claim Referrals, (Public Dissemination) SECTION 1: Executive Summary

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1 Date: Regarding: U.S. Slip and Fall Questionable Claim Referrals, (Public Dissemination) Prepared By: Christopher McNees, Strategic Analyst SECTION 1: Executive Summary The purpose of this report is to analyze Questionable Claim Referrals (QCs) submitted to the National Insurance Crime Bureau (NICB) listing Slip and Fall as a referral reason from through and identify any trends. The volume of Slip and Fall Questionable Claim Referrals (SFQCs) received in was higher than those received in. The year over year increase in volume of SFQCs amounted to 12%. A noteworthy 26% increase in SFQCs occurred in the 1 st quarter of, which was the largest volume of SFQCs observed, and amplified the change in volume between the 2 years. Policy types were analyzed revealing the most common policy type for SFQCs in this timeframe was Commercial General Liability, accounting for 62% of all SFQC policy types. The SFQCs were also analyzed to determine the top 10 states and cities with SFQCs. The state with the largest number of SFQCs was California (667) and accounted for 16% of the total SFQCs analyzed. New York, NY was the city with the largest number of SFQCs in this analysis (134). The analysis of SFQCs has identified an overall increase in the number of SFQCs submitted to the NICB from to. SECTION 2: Introduction In a proactive effort to increase awareness for member companies, the NICB has prepared a report on Slip & Fall Questionable Claims (SFQCs). This report contains an overview of SFQCs submitted from through, as submitted by member companies. Please note that the dates of loss for the SFQCs ranged from 1998 through, as a claim may be referred as questionable at any time. It should also be noted that a single Questionable Claim can contain up to seven (7) different referral reasons. For the purpose of this report, a SFQC is defined as a QC submitted with any of the seven (7) referral reasons listing Slip and Fall. A Slip and Fall claim, as defined by the NICB s Injury Claim Investigation Guide, is based on the liability of real estate property owners or those who are responsible for maintaining a property for activities or conditions occurring on the land or premises. Slip and Fall claims are claims involving a person slipping (or tripping) and falling due to a hazard allegedly created by the negligence of the property owner or tenant. This type of claim can be fraudulent when it is an orchestrated event where the individual creates a false and potentially dangerous scenario with the specific intent to stage a fall for monetary gain. This report analyzes the SFQCs referred to the NICB from through, comparing year to year, referral date to date of loss, and SFQCs to all QCs. The composition of the claims will also be analyzed by policy types, the top 10 loss states, and the top 10 loss cities.

2 Page 2 of 5 SECTION 3: Analysis Year Over Year SFQC Analysis The number of SFQC s submitted by member companies to the NICB climbed by 12% from 1,944 SFQCs in to 2,168 SFQCs in. An analysis of the SFQCs, by quarter, determined that the volume of SFQCs recorded in remained higher than any of the 4 quarters in. Also, a notable 26% increase in the number of SFQCs reported occurred in the 1 st quarter of compared to the 4 th quarter of. The following chart shows the number of SFQCs by quarter from through Number of SFQC Submissions and Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr Referral Dates compared to Date of Loss Due to the complexity of some slip and fall claims, investigations may require more time for adequate research of the questionable activity. Therefore, some SFQC submissions can be delayed. An analysis was conducted comparing the dates of loss to the SFQC referral date. The analysis revealed that 7 of the SFQCs in the 1 st quarter of both and had dates of loss prior to the year that the SFQCs were referred. There was an average delay of 246 days, measured from the date of loss to the referral date, observed in the 1 st quarter of. In comparison to the 1 st quarters, the SFQCs with a date of loss prior to the year referred account for less than 50% of the overall SFQCs in the respective 2 nd, 3 rd and 4 th quarters and trend downward as each year progresses. The following chart shows the portion of SFQCs with dates of loss prior to the year it was received.

3 Page 3 of 5 Policy Types Analysis The majority of SFQCs were referred with a policy type of Commercial General Liability, which indicates that a majority of SFQCs are occurring at retail stores, parking lots, or restaurants. Commercial Liability Business Owners and Personal Property Homeowners composed the second and third largest volume of policy types, respectively. Commercial related policy types composed 80% of the total SFQCs in and 81% of the total SFQCS in. The charts below summarize the policy types that accounted for 3% or more of the overall SFQCs received in and ; all policy types that accounted for less than 3% are grouped within the All Other policy type category.

4 Page 4 of 5 Policy Types of Slip and Fall QCs All Other Policies Workers' Compensation and Employers Liability 3% Commercial Mulit-Peril Other Liability Commercial General Liability 63% Personal Property Homeowners 8% Commercial Liability Business Owners 9% Commercial Mulit-Peril Policy Types of Slip and Fall QCs All Other Policies Workers' Compensation and Employers Liability 2% Other Liability 8% Commercial General Liability 61% Personal Property Homeowners Commercial Liability Business Owners 10% Analysis by State In order to identify new trends, the top 10 states with SFQCs submissions in were analyzed by comparing their volume to the volume of SFQCs in. It should be noted that the top 10 states account for 59% of the combined and SFQCs, with California accounting for 16% overall. With the exception of Florida and Connecticut, eight (8) of the top 10 states with SFQCs displayed an increase from to. The number of SFQCs in Florida declined by 2, and the number of SFQCs remained the same for Connecticut during the time period analyzed. Additionally, two states that would have been ranked in the top 10 states in displayed decreases in the number SFQCs in ; Ohio decreased 13% and moved to rank 13 while

5 Page 5 of 5 Nevada decreased 28% and moved to a rank of 18 in. Georgia and Missouri moved from lower rankings in to the top 10 in. The following chart displays the top 10 states with SFQCs in and Top Ten States with Slip and Fall QCs and CA NY IL FL PA GA NC CT MO Analysis by City The top 10 cities with SFQCs submissions in were also analyzed by comparing their volume to the volume of SFQCs in. It should be noted that 5 cities (Denver, CO, Dallas,, Louisville, KY, Charlotte, NC, and Houston, ) had 11 SFQC submissions in and were included in the top 10 city ranking. The top 10 cities account for 1 of the combined and SFQCs. Eight (8) of the top 10 cities with SFQCs displayed an increase from to. The number of SFQCs in both Las Vegas, NV and Denver, CO remained the same from through, while Philadelphia, PA and Charlotte, NC decreased. New York, NY and Chicago, IL displayed similar increases in SFQC activity, which came to an average of 32%. The following chart displays the top 10 cities with SFQCs in and. 80 Top 10 Cities with Slip and Fall QCs and New York, NY Los Angeles, Philadelphia, CA PA Chicago, IL Las Vegas, NV Saint Louis, MO Fort Worth, Denver, CO Dallas, Louisville, KY Charlotte, NC 5 Houston,