Workers' comp investigation, fully automated
Workers' comp fraud costs insurers $7.2 billion annually. Fabricated injuries, exaggerated disability, and provider collusion require investigation depth most carriers can't staff. Hesper AI runs a full investigation on every claim in hours.
Common workers' comp fraud schemes
Workers' comp fraud spans individual claimants, provider networks, and employer premium avoidance. Hesper investigates every flagged claim across all four schemes simultaneously.
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 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.
Manual workflow vs. Hesper
Every phase compresses. The cumulative effect is the difference between a two-week cycle and a same-day decision.
How Hesper AI investigates a workers' comp claim
Every workers' comp claim runs through a structured pipeline. Phases run in parallel where dependencies allow.
Medical record ingest and forensics
~9 minAll medical records, treatment notes, diagnostic imaging reports, and billing codes are ingested and analyzed. Hesper checks for document authenticity, altered dates, fabricated records, and CPT upcoding against injury severity.
Treatment timeline reconstruction
~6 minTreatment patterns are cross-referenced with the reported injury mechanism and recovery norms. Claims where treatment dates predate the injury, exceed standard protocols, or conflict with diagnostic imaging are surfaced with cited evidence.
OSINT and claimant activity scan
~8 minPublic social media, professional networks, and business registrations are scanned for evidence inconsistent with claimed disability status. Findings are captured with source URLs, timestamps, and archived snapshots.
Provider and network analysis
~11 minTreating physicians, attorneys, and therapy providers are mapped against prior claims. Hesper surfaces patterns of shared providers across multiple suspicious claims and flags network clusters consistent with organized fraud.
Investigation report and recommendation
~13 minA complete investigation report is generated with medical findings, OSINT evidence with preserved links, network diagrams, and a denial or settlement recommendation. Report is SIU-ready and defensible in administrative hearings.
Annual workers' comp fraud in the US
Per Coalition Against Insurance Fraud
Of workers' comp claims involve some fraud signal
Across all claim severities
Hesper AI investigation time per claim
Vs. 14+ days manually
Fraud signals analyzed per document
Medical + OSINT + financial
Go deeper on workers' comp fraud
Research, technical deep-dives, and playbooks from the Hesper AI team.
See Hesper investigate your workers' comp claims
We'll run a sample investigation on your real flagged claims and show you the evidence package and report it produces.