Document Extraction
Policy Verification
Fraud Detection
Complexity Assessment

Claim Details

Claimant John Smith
Policy Number AUTO-2026-12345
Claim Type auto
Incident Date January 20, 2026
Claim Amount $22.00
Last Updated Jan 19, 2026 12:34 PM
Incident Description

22

Documents

No documents uploaded

Analysis Results

Document Extraction

claimant name John Smith
contact info None
policy number AUTO-2026-12345
incident date 2026-01-20
incident location None
incident type auto
incident summary Auto incident occurred on January 20, 2026. Specific details of the incident are not provided in the available documentation.
damages description None
estimated loss amount $22.00
witnesses None
police report number None
medical providers None
vehicle info None
property info None
documentation quality minimal
missing information ['Detailed incident description', 'Contact information', 'Incident location', 'Vehicle information (make, model, year, VIN)', 'Damage description', 'Supporting documentation', 'Police report information', 'Witness information', 'Photos of damage']
vehicle validation {'claimed_vehicle': None, 'vehicle_exists': 'unknown', 'validation_notes': 'No vehicle information provided in claim documents', 'image_vehicle_match': 'no_vehicle_images', 'discrepancies': []}

Vehicle Validation

Claimed Vehicle Not specified
Vehicle Make/Model/Year Exists ? Unknown
Images Match Claimed Vehicle No vehicle images provided
Validation Notes No vehicle information provided in claim documents

Policy Verification

policy found ✓ Yes
policy active ✓ Yes
coverage applies ✗ No
coverage type match ✓ Yes
within policy period ✗ No
coverage limit 50000
deductible 500
estimated payout 0
exclusions triggered []
eligibility status ineligible
eligibility reason Incident date (2026-01-20) falls outside the policy period which expires on 2025-12-31
policy holder match ✓ Yes
verification notes Policy was active but expired 20 days before the incident occurred. Claim amount of $22 is also below the $500 deductible.

Fraud Detection

Risk Score
85/100
Fraud Indicators
⚠ Future-dated claim submission high

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.

⚠ Policy ineligibility at time of claim high

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.

⚠ Severely inadequate documentation high

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.

⚠ No vehicle information provided medium

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.

⚠ Absence of supporting evidence medium

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

Complexity Score 8/10
Routing Recommendation siu review
Reasoning

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.

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