Use Cases / Workers' Comp
Workers' comp investigation, fully automated
Workers' compensation fraud drains $7.2 billion annually from the system. Fabricated injuries, exaggerated disability, and employer premium schemes require investigation resources that most carriers lack. Hesper AI investigates every claim in under 60 minutes.
[01] Fraud Patterns
Common workers' comp fraud schemes
Workers' comp fraud comes from both employees and employers. Hesper AI detects schemes on both sides - from fabricated injuries to premium manipulation.
Fabricated injuries
Claimants report workplace injuries that never occurred. Hesper AI cross-references medical records with workplace incident reports, analyzes document timelines for inconsistencies, and detects altered or fabricated medical documentation at the pixel level.
Exaggerated disability
Legitimate injuries with exaggerated severity or extended recovery periods. Hesper AI analyzes medical treatment patterns against expected recovery timelines, cross-references provider billing against diagnosis norms, and flags treatment that exceeds standard protocols.
Working while claiming
Claimants collecting disability benefits while employed elsewhere. Hesper AI conducts OSINT analysis including social media monitoring, employment database checks, and business registration searches to identify income sources inconsistent with claimed disability status.
Employer premium fraud
Employers misclassifying workers or underreporting payroll to reduce premiums. Hesper AI analyzes payroll documents for alterations, cross-references employee classifications against job descriptions, and detects discrepancies between reported and actual workforce data.
[02] Investigation Flow
How Hesper AI investigates workers' comp claims
Every workers' comp claim runs through a structured investigation pipeline - from medical record forensics through OSINT analysis to resolution.
Document ingestion and forensic analysis
Medical records, incident reports, wage statements, employer documentation, and treatment receipts are ingested and analyzed across 200+ fraud signals. Pixel-level forensics detect alterations in medical records, altered dates, and fabricated documentation.
Medical treatment and timeline validation
Treatment records are cross-referenced with the reported injury date, workplace incident reports, and expected recovery timelines. Hesper AI identifies billing anomalies, excessive treatment duration, and inconsistencies between diagnosis and prescribed treatment.
Employment and activity verification
OSINT analysis scans social media, business registrations, and public records for evidence of activity inconsistent with the claimed disability. Employment databases are checked for concurrent employment during the benefit period.
Provider and claimant network analysis
Claims are mapped against historical patterns to identify shared medical providers, attorneys, and employers involved in multiple claims. Hesper AI detects organized fraud schemes where providers and claimants work together to fabricate or inflate claims.
Investigation report and resolution
A complete investigation report is generated with medical timeline analysis, OSINT findings, network diagrams, and recommended actions. Denial justifications and regulatory filing documentation are prepared automatically.
[03] By the Numbers
Annual workers' comp fraud in the US
Of claims are outright fabricated
Hesper AI investigation time per claim
Of comp fraud involves employer schemes
See a workers' comp investigation in action
Book a 30-minute demo and watch Hesper AI investigate a real workers' comp claim from intake to audit-ready report.
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