Claims fraud is getting more sophisticated. Carriers can fight back with AI to sift through huge amounts of data and find patterns, says Ashley Fong, VP with Carpe Data. Injury fraud thrives in areas where strong legal networks, high population density, heavy tourism, economic hardship, and legal loopholes create opportunities for fraudulent claims to flourish, Carpe Data research finds. Younger adults are more likely to commit fraud; riskier behaviors and cultural pressure to overshare on social media channels are likely reasons. “Insurance fraud is a costly and a persistent problem,” Ashley says. In 2023 alone, an estimated $300 billion was lost to fraudulent claims—equivalent to 10 Hurricane Helene disasters, she notes. Advances in technology are essential, but ultimately human judgement and creativity will continue to be needed to mitigate fraud, she says. “Human roles will evolve to areas that require more brainpower, judgement, creativity—things that a computer can’t necessarily do. Traditionally, carriers reviewed only 4% of open claims with a manual, rules based, tedious and expensive process. But with AI and human intervention, insurers can generate 10 times the reviews.”

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