Use Cases / Auto Claims
Auto claims investigation, fully automated
Auto fraud costs insurers $29 billion annually. Staged collisions, phantom passengers, and body shop collusion require investigation resources most carriers don't have. Hesper AI investigates every auto claim in under 60 minutes.
[01] Fraud Patterns
Common auto claims fraud schemes
Auto fraud ranges from individual exaggeration to sophisticated rings involving drivers, attorneys, medical providers, and body shops working in coordination.
Staged accidents
Organized rings orchestrate collisions with predetermined participants and pre-arranged witnesses. Hesper AI cross-references participant histories, analyzes accident scene photos for staging indicators, and maps connections between drivers, passengers, and attorneys.
Phantom passengers
Claimants add non-existent passengers to increase injury payouts. Hesper AI verifies passenger identities against DMV records, cross-references medical treatment timelines, and detects patterns of the same individuals appearing across multiple unrelated accidents.
Inflated injury claims
Minor accidents with exaggerated medical treatment. Hesper AI analyzes medical records for altered billing codes, detects inconsistencies between reported injuries and accident severity, and flags treatment patterns that exceed expected norms for the type of collision.
Repair shop collusion
Body shops inflate repair estimates or bill for work not performed. Hesper AI detects altered amounts in repair invoices, maps relationships between claimants and specific shops, and cross-references repair costs against regional benchmarks.
[02] Investigation Flow
How Hesper AI investigates auto claims
Every auto claim runs through a structured investigation pipeline - from document forensics and vehicle verification through network analysis to resolution.
Document and photo ingestion
Accident photos, police reports, medical records, repair estimates, and rental receipts are ingested simultaneously. Each document is analyzed across 200+ fraud signals at the pixel level before any text extraction.
Vehicle and identity verification
Vehicle VINs are checked against NMVTIS for title history, salvage records, and prior damage reports. Driver and passenger identities are verified against DMV records and cross-referenced with prior claims in ISO ClaimSearch.
Medical treatment validation
Medical records are analyzed for altered billing codes, fabricated treatment dates, and inflated charges. Treatment timelines are cross-referenced with the accident date and severity to detect patterns inconsistent with the reported injuries.
Network and ring analysis
Hesper AI maps connections between all parties - drivers, passengers, witnesses, attorneys, medical providers, and body shops. Shared service providers across multiple claims are flagged as potential organized fraud indicators.
Investigation report and resolution
A complete investigation report is generated with evidence citations, network diagrams, risk scores, and recommended actions. Denial justifications and referral packages are prepared for SIU review or law enforcement referral.
[03] By the Numbers
Annual auto insurance fraud in the US
Of auto injury claims involve fraud
Hesper AI investigation time per claim
Fraud signals per document analyzed
See an auto claim investigation in action
Book a 30-minute demo and watch Hesper AI investigate a real auto claim from intake to audit-ready report.
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