Carriers + state WC funds + state DOIs

P&C and Workers Compensation Fraud

Aggregated ISO ClaimSearch, court litigation, social media OSINT, and provider standing across the $334 billion combined P&C + WC fraud pool. Cross-carrier patterns that single SIUs cannot see.

The gap

The $334B Combined P&C and Workers Compensation Fraud Pool

The Property & Casualty (P&C) insurance market stands at an estimated $300 billion annually, with Workers Compensation (WC) premiums totaling $34 billion. The combined fraud exposure across these markets is substantial, with estimates suggesting that fraud accounts for a significant portion of this $334 billion pool.

This fraud manifests in various forms, including exaggerated claims, staged accidents, and provider billing fraud. The complexity and scale of this fraud require a robust, cross-carrier intelligence solution to effectively detect and mitigate these risks.

The total addressable market (TAM) for detection services in this combined fraud pool is estimated to be between $1.5 billion to $3 billion annually.

How JIL closes it

26 Comprehensive Checks for Unparalleled Detection

JIL Sovereign's P&C and Workers Compensation Fraud solution employs a rigorous set of 26 checks to identify fraudulent activities across the $334 billion combined fraud pool. These checks are designed to cover a wide range of fraud indicators, from claim exaggerations to provider billing irregularities.

By leveraging aggregated data from ISO ClaimSearch, court litigation records, social media OSINT, and provider standing, JIL provides a comprehensive view that single SIUs cannot achieve on their own. This cross-carrier aggregation enables the identification of patterns and anomalies that are critical for effective fraud detection.

The solution performs 26 distinct checks to ensure thorough and accurate detection of fraudulent activities.

Cross-carrier aggregation

Unified Intelligence Across Carriers

JIL Sovereign's platform aggregates data from multiple carriers, providing a unified view of the P&C and Workers Compensation fraud landscape. This cross-carrier aggregation is crucial for identifying patterns and anomalies that are not visible when examining data in isolation.

By consolidating information from various sources, JIL enables carriers, state WC funds, and state Departments of Insurance (DOIs) to detect fraud more effectively and collaborate on mitigation strategies. This aggregated intelligence is a key differentiator in the fight against insurance fraud.

Cross-carrier aggregation allows for the identification of fraud patterns that single SIUs cannot detect.

Evidence to civil + criminal

Court-Ready Evidence Bundles

JIL Sovereign's solution produces Court-Ready Evidence Bundles (CREB) that are admissible in both civil and criminal proceedings. These bundles are meticulously prepared to meet the stringent requirements of the courtroom, ensuring that the evidence is both comprehensive and irrefutable.

The CREBs include detailed narratives, chain-of-custody documentation, and exhibits that support the findings. This level of preparation not only facilitates legal action but also enhances the credibility of the evidence presented.

JIL Sovereign's CREBs are designed to be admissible in both civil and criminal courts, providing a solid foundation for legal action.

Pricing

Transparent and Scalable Pricing

JIL Sovereign offers a transparent and scalable pricing model to accommodate the varying needs of its clients. The pricing structure is designed to provide flexibility while ensuring that clients receive maximum value for their investment.

Pricing -- Fraud Pillar Standard

One model. Bottom-line aligned.

Retroactive scan
one-time, scoped to volume
4-year minimum lookback. Builds the base dataset. Proves the closed-loop economics before the flat-fee leg starts.
Flat fee
12.5% of disclosed PI spend
Annual, capped. Covers nightly T1 + AVA + T2 + CREB(TM) generation. Below the industry-standard 15 to 25% SIU contingency.
Contingency
10% of net cash recovered
Performance-aligned. Fires only on actual recovered cash, net of MAC appeal, settlement, and pursuit. Outside counsel runs 33%.
90-day pilot
$1M all-in, asymmetric downside
If Day 90 deliverables miss, the $1M converts to a 6-month platform credit and contingency drops from 10% to 7.5%. No other vendor in PI takes pure downside on the math.

Pricing anchored to public 10-K Schedule H disclosures + CMS PERM 2024. UHG-scale case study available at /products/mco-flat-fee.

The pricing model includes a 12.5% setup fee, a 10% annual maintenance fee, and a 4-year commitment, ensuring long-term value and stability for clients.

90-day pilot

Risk-Free 90-Day Pilot Program

To demonstrate the effectiveness of our solution, JIL Sovereign offers a risk-free 90-day pilot program. This pilot allows carriers, state WC funds, and state DOIs to experience the benefits of our platform without any upfront commitment.

During the pilot, clients can access the full range of features and capabilities, enabling them to evaluate the solution's impact on their fraud detection efforts. This risk-free opportunity ensures that clients can make an informed decision based on real-world results.

The 90-day pilot program offers a risk-free way to experience the full capabilities of JIL Sovereign's fraud detection solution.