Auto claims automation, with fraud investigation built in
Fraud and buildup add up to $7.7 billion in excess payments on US auto injury claims. Staged collisions, phantom passengers, and body shop collusion require investigation resources most carriers don't have. Hesper AI investigates every auto claim in minutes.
In short
Hesper AI's agents pick up an auto claim at first notice, extract the loss details, verify coverage, quantify damage, and route clean files straight through to payment. Suspicious claims get an investigation-grade workup instead - vehicle history, medical timelines, and network analysis - and every file is screened for subrogation before it closes.
Last updated
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. Hesper investigates every flagged claim against all four schemes simultaneously.
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, attorneys, and medical providers.
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 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 and OEM parts databases.
Manual workflow vs. Hesper
Every phase compresses. The cumulative effect is the difference between a two-week investigator assignment and a decision in minutes.
How Hesper AI investigates an auto claim
Every auto claim runs through a structured investigation pipeline. Phases run in parallel where dependencies allow - the full sequence completes in minutes.
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. Driver and passenger identities are verified against DMV records and cross-referenced with prior claims in ISO ClaimSearch and NICB.
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 injury severity to detect patterns inconsistent with the reported impact.
Network and ring analysis
Hesper AI maps connections between all parties - drivers, passengers, witnesses, attorneys, medical providers, 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.
Excess payments on US auto injury claims from fraud and buildup
Upper bound of the $5.6B-$7.7B range
Source: Insurance Research CouncilOf auto bodily injury claims closed with payment show fraud or buildup
18% of personal injury protection claims
Source: Insurance Research CouncilHesper AI investigation time per claim
Hesper internal benchmark. Vs. 14+ days manually
Fraud signals analyzed per document
Hesper internal benchmark. Pixel-level plus text-level
Auto claims automation, answered
How does AI claims automation handle an auto claim from first notice to payment?
Hesper's agents take the first notice of loss, extract the details from ACORD forms, emails, and photos, verify coverage against the policy and its endorsements, quantify damage from estimates and images, and recommend a reserve. Clean claims resolve straight through. Anything carrying a red flag routes into the investigation module before a payment decision is made.
Can AI detect a staged accident or an organized auto fraud ring?
Yes. Fraud detection is built into Hesper rather than licensed from another vendor. The agents map every party on the claim - drivers, passengers, witnesses, attorneys, medical providers, and body shops - and flag service providers who keep reappearing across unrelated claims. Scene photos are checked at the pixel and metadata level for staging indicators.
How long does an auto claim investigation take with Hesper?
Minutes rather than the 14+ days a manual assignment takes, because the investigation phases run in parallel instead of one at a time. A human investigator can only look at one thing at a time, which is why a caseload of 200+ files per investigator means roughly three quarters of flagged claims never get a full workup.
Does Hesper work inside Guidewire ClaimCenter or Duck Creek?
Yes. Hesper integrates with the claims system of record through its API and writes evidence, coverage positions, and recommended actions back to the file. It is not a claims administration system and does not replace one. It can pick up an auto claim at first notice for full-lifecycle handling, or mid-stream for investigation, settlement review, or subrogation screening.
How does Hesper handle bodily injury and medical records on an auto claim?
Medical records are read for billing-code alterations, treatment dates that do not line up with the reported loss, and charges that exceed what the collision severity supports. The agents reconstruct the treatment timeline against the accident date and cite the source document behind every inconsistency, so the adjuster reviews evidence instead of assembling it.
Does Hesper screen auto claims for subrogation?
Every file is screened for subrogation and salvage before closure, not only the ones an adjuster happens to flag. Where a recovery opportunity exists, the agents draft the demand and assemble the supporting evidence package. The decision to pursue or waive stays with your team.
Go deeper on auto claims fraud
Research, technical deep-dives, and playbooks from the Hesper AI team.
See Hesper investigate your auto claims
We'll run a sample investigation on your real flagged claims and show you the evidence package and report it produces.