Motor claims fraud
Expose organized claims fraud that looks legitimate one claim at a time: rings linked by shared vehicles, providers and parties.
Motor · Life · Medical · Property · SIU
Insurance fraud detection for claims and SIU teams
Score claims, policies, parties and providers against 14 explainable typologies across motor, life, medical and property lines. Entity resolution links the recurring tow operators, assessors, providers and claimants that make a ring.
Capabilities
What the workspace covers
Life & medical fraud
Protect the life book against its most expensive schemes and give SIU teams provider-level visibility into collusive billing.
Property claims fraud
Connect losses across time and parties: clustered fire claims, repeat losses and contents inflated past the segment baseline.
Typology coverage
14 typologies, each with a public reference page
Every typology is parameterized and explainable. Open any of them for red flags, the data signals evaluated and the recommended response.
Motor claims
- Staged-accident ringsOrganized groups that cause or fake collisions, then claim through a recurring cast of drivers, witnesses, tow operators and repairers.
- Phantom vehiclesCover taken out on a vehicle that does not exist or is no longer held by the insured, followed by a theft or total-loss claim.
- Multi-claim VINsOne vehicle identification number on several claims across policies, claimants or insurers, often for the same damage claimed more than once.
- Inflated claimsA genuine motor loss padded with unrelated damage, excess labor hours, parts that were never fitted, or inflated towing and storage charges.
Life
- Ghost policiesLife or funeral policies written on fictitious people, or on real people who never agreed to cover, to earn commission or claim benefits.
- Early-death clustersDeath claims bunching soon after policy inception, often around one intermediary, area, certifying doctor or funeral home.
- Over-insuranceCover far beyond the insured’s income, means or need, often stacked across several policies or insurers before a claim.
Medical
- Provider collusionMedical providers acting together, or with members and recruiters, to bill for care that was unnecessary, never given or inflated.
- Phantom billingClaims for consultations, procedures, tests or supplies that were never provided, usually submitted against real member details.
- Doctor shoppingA member visiting several doctors and pharmacies to obtain overlapping prescriptions, often for controlled medicines, for misuse or resale.
- Impossible billing daysA provider billing more time in a day than one practitioner could work, or for services in two places at once.
Property claims
- Arson patternsFires set or arranged by the insured to claim on buildings, stock or vehicles, often preceded by financial strain and clustered by area or party.
- Repeat lossesThe same person, address or asset claiming repeated losses, often across several insurers, more often than the underlying risk explains.
- Inflated contents claimsContents claims padded with items never owned, values above what was paid, or receipts that were altered or fabricated.
Investigation & governance
From alert to filing, in one workbench
Sanctions & watchlist screening
Parties, providers and counterparties screened at ingest, on demand and inline at interdiction decision time, every hit raised as a reviewable alert.
Entity resolution & ring analysis
Continuous identity resolution collapses "distinct" customers into a governed party master, exposing fraud rings on an interactive network graph.
Alert queues & case management
SLA-driven queues route work by severity into an investigator workbench with the full evidence trail. One click escalates alerts into audited cases.
AI copilot & assessments
Fraud score, risk level, ranked risk factors, anomalies and recommended actions, with explanations a reviewer or regulator can read.
SAR & regulatory filings
Generate SAR-style filings directly from case evidence, plus branded DOCX and PDF investigation reports, ready for the regulator.
Automation playbooks
Auto-escalate, assign and dispatch interdiction recommendations over HMAC-signed webhooks, with a per-workspace kill switch. Automation never moves money.
Hard-walled by designThe insurance workspace is licensed independently of banking. Data, models and API keys never cross the wall.
In the field
Scenarios this workspace is built for
InsuranceStaged-accident ring across provincesThe same tow operators, assessors and 'witnesses' keep resurfacing in collision claims across multiple provinces, but each claim looks clean when reviewed on its own.Ring dismantled before payoutInsuranceGhost policies and provider collusionBilling clerks and colluding medical providers write phantom policies and file claims for treatments no patient ever received, quietly bleeding the book for years.Phantom claims surfaced across the book
Get started
Take the next step
See the workspace scoring your own historical data in a backtest before anything goes live.