Claim CLM-20260119-6552A0
INTERNAL VIEWSubmitted January 19, 2026 at 12:33 PM
Claim Details
22
Documents
No documents uploaded
Analysis Results
Document Extraction
Vehicle Validation
Policy Verification
Fraud Detection
The claim was submitted on 2026-01-19 for an incident allegedly occurring on 2026-01-20, which is 1 day in the future. This is physically impossible and indicates either fraudulent backdating, system manipulation, or fabricated incident details. This temporal impossibility is a clear red flag for claim fraud.
The policy verification shows the claimant as 'ineligible' despite the policy being found and policyholder match being confirmed. This suggests the policy may have been cancelled, suspended, or otherwise invalid at the time of the claimed incident, which would make this claim fraudulent if the claimant knew of the ineligibility.
The claim is missing critical documentation including detailed incident description, contact information, location, all vehicle information (make, model, year, VIN), damage description, supporting documentation, police report, witnesses, and photos. This level of missing information is highly suspicious and consistent with hastily fabricated claims where fraudsters cannot provide authentic supporting evidence.
For an auto insurance claim, the complete absence of vehicle identification information (make, model, year, VIN) is extremely unusual. Legitimate claimants typically provide this basic information immediately, as it's fundamental to any auto incident. This omission suggests potential fraud or an attempt to claim for a non-existent or uninsured vehicle.
The complete lack of police reports, witness statements, or photographic evidence for an auto incident is suspicious. Even minor incidents typically generate some form of documentation. This absence suggests either the incident never occurred or the claimant is unable to provide evidence because they were engaged in fraudulent activity.
Complexity Assessment
This claim exhibits multiple critical fraud indicators including a future-dated incident (physically impossible), expired policy coverage, and severely inadequate documentation. The fraud risk score of 85/100 with 5 significant fraud flags requires immediate SIU investigation. While the claim amount is minimal ($22), the combination of temporal impossibility, policy ineligibility, and complete lack of supporting documentation suggests potential fraudulent activity that needs thorough investigation.
Final Decision
Referred to Special Investigations
This claim requires investigation by the Special Investigations Unit.