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 and 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.
Here's what we catch for you before the claim payment releases.
If you run claims operations, SIU (special investigations), or P&C / auto / life / workers' comp risk, this is what JIL screens before any claim disbursement leaves your treasury. JIL plugs in between your claim adjudication system and your payment-release function, runs a verdict in seconds, and produces a sealed evidence record per disbursement. Your SIU gets a clear queue (only the holds, not the clears).
Ghost contractor / phantom service provider
Repair shop submits an invoice. JIL checks the entity against state corporate registry, beneficial-owner records, and prior-claim history. The shop registered 60 days ago, has no commercial-utility records, no prior tax filings, and the owner has 3 other entities that received claim payments and dissolved within a year. JIL flags the ghost-contractor pattern before the disbursement.
Staged-claim ring
Multiple "victims" filing claims linked by a shared bank fingerprint, a shared attorney, a shared body shop, a shared medical provider, or a shared address cluster. JIL surfaces the network pattern across your active claim queue - the kind of ring that takes a SIU investigator months to map by hand surfaces in seconds.
Inflated repair / inflated medical claim
Claim amount is 4x the median for the same vehicle/injury type/zip code. Repair invoice lists parts at 2x manufacturer-published pricing. Medical claim bills for procedures that are statistically inconsistent with the diagnosis. JIL surfaces the outlier with the comparison data your adjuster can act on.
Faked injury claim with clinic kickbacks
Same chiropractor, same attorney, same diagnosis pattern across 47 claims in 6 months. Or a clinic with a beneficial owner who shares a bank fingerprint with the attorney's firm and the body shop. JIL surfaces the kickback ring with the entity-graph evidence.
Workers' comp premium evasion
Employer claims they have 12 employees. Their actual payroll filings show 47. JIL cross-checks against state employment tax records, federal W-2 filings, and prior-year payroll signals to surface the misclassification before the claim payment.
Sealed evidence per blocked payment
Every claim JIL holds gets a sealed evidence record showing exactly why - the network pattern, the inflated-amount comparison, the fingerprint match. Useful both for SIU investigation and for defending the hold to the policyholder, the regulator, or in litigation.
A clear / hold / fail verdict per claim, with sealed evidence.
For every claim disbursement your system asks JIL about, you get back: a verdict at sub-second latency, a sealed evidence bundle (CREB™ - Court-Ready Evidence Bundle) showing every check that ran, and a cryptographic signature that proves the verdict hasn't been altered. Cleared claims release immediately. Holds go to your existing SIU queue with structured reasoning your investigator can act on without re-investigating from scratch. The bundle is admissible in administrative hearings, civil court, and criminal referral without an expert witness on the stand.
Plug in between adjudication and payment release.
1 · Your claims system calls JIL
Standard REST integration. JIL sits between your adjudication output and your payment-release function. No change to the adjuster workflow.
2 · Verdict in seconds
JIL runs entity-graph, beneficial-owner, ring-detection, inflated-amount, and fingerprint-clustering checks in parallel. Verdict + sealed evidence returned synchronously.
3 · Holds go to your SIU queue
Cleared claims release immediately. Holds go to your existing investigation queue with structured evidence your SIU can act on without re-investigating.
Per-claim pricing. ROI in basis points of loss ratio.
JIL Insurance Claims screening is priced per-claim, with volume discounts for carrier-scale processing. P&C / auto / life / WC fraud is estimated at 20% of claim payouts (Coalition Against Insurance Fraud 2024). Even a 2% reduction in a single carrier's fraud exposure typically returns 50x or more on the JIL spend. Fixed-fee per scan, not contingency - your loss-ratio savings stay with the carrier.
$221.5 billion annually. One in five claims fraudulent.
$221.5B in annual P and C, auto, life, and workers' compensation fraud (Coalition Against Insurance Fraud 2024). 1 in 5 claims filed in the US is estimated fraudulent.
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 credential registry lookup at disbursement time, not at policy inception.
Active, expired, or suspended on the date the work was allegedly performed.
Estimates, receipts, and service records tokenized and bound to the claim before a Yes verdict; undocumented claims cannot receive a Yes.
Amount evaluated against established norms for this claim type, region, and contractor class; inflated estimates trigger Review.
Same claimant, same event, multiple carriers; shared attestation ledger catches it before the second payment clears.
Post-disaster claim volume spikes evaluated against geographic and temporal baseline; ring patterns flagged before disbursement begins, not after.
Changed vendor bank account that does not match the attested contractor record returns a No verdict immediately.
Beneficial ownership traced to confirm the contractor entity is real, active, and not a shell connected to a known fraud ring.
Direct loss prevention. Loss ratio improvement. Reserve and reinsurance leverage.
- 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.
- 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 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.
- 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.
Built to operate. Not demonstrated in a lab.
JIL Sovereign's reference mainnet runs in production today across ten SCN validator jurisdictions on three continents.
Loss ratio is the most consequential number on the carrier's income statement. Pre-settlement attestation moves the dial faster than any underwriting tweak you can deploy this quarter. JIL Sovereign - Insurance corridor thesis
3 to 5 weeks for P and C and auto.
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.
Request a briefing
One mailbox for carrier briefings, SIU integrity intake, and reinsurance-aligned scoping. Response within one business day.
Schedule a call
For confidential institutional inquiries. Routed to the partner desk for insurance corridor diligence and POC scoping.