Stop Paying Ghost Contractors. Stop Funding Staged Claims.
Insurance fraud is not edge-case risk. It is embedded in your loss ratio. The Coalition Against Insurance Fraud estimates $221.5 billion in annual P&C, auto, life, and workers' compensation fraud - approximately 20% of every claim filed in the United States. It is priced into every policy premium your customers pay.
in annual P&C, auto, life, and workers' compensation fraud (Coalition Against Insurance Fraud 2024). 1 in 5 claims filed in the US is estimated fraudulent.
The problem in one paragraph
Carriers release claim payments based on documentation submitted at the time of the claim - without pre-settlement verification that the contractor is credentialed, the claimant is eligible, or the payment instruction has not been redirected. Ghost contractors are registered with the carrier but perform no work. Post-disaster claim surges overwhelm manual review, and fraud rings know a percentage of fraudulent claims will clear under volume pressure. There is no pre-settlement gate. SIU investigators find the fraud after the money is gone.
Four questions your current system does not ask.
Before any claims disbursement is released, JIL answers:
- Is this contractor or claimant actually who they say they are - and are they currently credentialed to perform this work?
- Does the supporting documentation for this claim exist and match what was submitted?
- Is the claimed amount consistent with what this claim type, geographic region, and contractor class normally produces?
- Has this claim - or one substantially similar to it - been submitted to any other carrier in your network?
If any answer is no, the payment holds. If the claim surge pattern matches known post-disaster fraud ring behavior, every claim in that cluster holds for review simultaneously - not one at a time after the ring has already been paid.
Eight checks. Scoped to claims disbursement fraud.
- Contractor and claimant identity verification - credential registry lookup at disbursement time, not at policy inception
- License and certification status - active, expired, or suspended on the date the work was allegedly performed
- Documentation binding - estimates, receipts, and service records tokenized and bound to the claim before a Yes verdict; undocumented claims cannot receive a Yes
- Claim amount corridor analysis - amount evaluated against established norms for this claim type, region, and contractor class; inflated estimates trigger Review
- Cross-carrier duplicate detection - same claimant, same event, multiple carriers; shared attestation ledger catches it before the second payment clears
- Surge anomaly detection - post-disaster claim volume spikes evaluated against geographic and temporal baseline; ring patterns flagged before disbursement begins, not after
- BEC / account substitution blocking - changed vendor bank account that does not match the attested contractor record returns a No verdict immediately
- UBO and entity verification - beneficial ownership traced to confirm the contractor entity is real, active, and not a shell connected to a known fraud ring
8 CHECKS. NO MANUAL SIU REFERRAL REQUIRED FOR NO VERDICTS - THEY SIMPLY DO NOT PAY.
Direct loss prevention. Loss ratio improvement. Reserve and reinsurance leverage.
Direct Loss Prevention (per $1B annual claims disbursement)
- Industry average fraud rate: ~20% of claims
- At even 50% detection rate on fraud: $100M in fraudulent payments prevented per $1B disbursed
- JIL engagement cost at 35 bps on $1B = ~$3.5M annually
- Net benefit at 50% fraud detection: $96.5M annually
- Even at 10% detection rate: $20M prevented on $3.5M cost = net benefit $16.5M annually
Loss Ratio Improvement
- Every 1% reduction in the combined loss ratio on a $500M book of business = $5M in underwriting improvement
- JIL's pre-settlement gate directly reduces paid losses - the most controllable component of loss ratio
- Post-disaster surge containment prevents the single largest annual fraud event most carriers face
SIU and Operational Efficiency
- SIU investigators redirected from post-payment recovery (low success rate) to pre-payment Review queue management (high success rate - fraud has not yet been paid)
- Manual callback and verification procedures eliminated for the checks JIL runs automatically
- Fraud ring disruption at the first claim - not after the ring has cycled through multiple carriers
Reserve and Reinsurance Benefits
- Lower paid losses reduce IBNR reserve requirements
- Demonstrable pre-settlement fraud prevention may reduce reinsurance costs on catastrophe layers where fraud spikes post-disaster
- Audit and regulatory evidence generated automatically - no post-hoc reconstruction of why a claim was denied
3 to 5 weeks for P&C and auto carrier engagements.
Life and workers' compensation corridors typically 4 to 6 weeks due to additional credentialing configuration. JIL runs alongside your existing claims management system. No migration required.
Schedule an Insurance Fraud Prevention Consultation
See JIL's Verdict Engine applied to your claims disbursement corridor. Most engagements go live in 3 to 5 weeks.
or email support@jilsovereign.com