Carpe Data conducted a wide-scale review of injury claims fraud, uncovering geographic hot spots, fraudulent tactics, and claim patterns in 2024

SANTA BARBARA, Calif.: Carpe Data, a leading provider of next-generation data solutions for the insurance industry, today released its 2025 Online Fraud Insights report, analyzing the top locations, demographics, and tactics for insurance claims fraud in the United States. The report found that 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. The findings highlight the most common ways insurers uncover contradictory evidence, including through online channels such as social media, local news, and public records.

This report analyzes Carpe Data’s findings from 2024, based on continuous monitoring of open injury claims across auto, workers’ comp, general liability, and disability lines. This quantitative data analysis, paired with qualitative insights from internal subject matter experts, identifies trends, patterns, and anomalies in fraudulent behavior related to injury claims.

Carpe Data’s new data analysis uncovered the following key findings:

• Disability, Workers’ Comp, and Auto lines uncover the highest rates of contradictory evidence online. 8.9% of disability claimants were found to have misrepresented their claim, compared to 6.9% of workers comp claims and 5.7% of auto claims.
• 35% of all fraud referrals occur in the first two months. The early spike shows the power of continuous monitoring in two ways. First, claimants often make their most revealing online updates before the traditional fraud detection process ever kicks in. Second, there are limits of static investigations. If a carrier relies solely on point-in-time checks, they’ll miss the moment when evidence is most visible.
• Younger claimants, between 18-24, are more likely to fraudulently claim injury. Carpe Data found this age demographic is far more likely to trigger physical activity and unlawful activity-related flags than people over 35. This is likely due to riskier behaviors and cultural pressure to overshare on social media channels.

"Many individuals committing fraud don’t see themselves as criminals – they’re often led to believe they’re simply maximizing their claims," explains Tom Rasmussen, VP of Claims Product at Carpe Data. “Unfortunately, professional injury attorneys who know how to exploit legal loopholes are coaching claimants into exaggerating their injuries, sometimes without them fully realizing the consequences. The reality is, what starts as a small embellishment can quickly turn into fraud, benefitting attorneys who take a cut while leaving claimants to face the legal fallout.”

Every undetected fraudulent injury claim drains thousands from insurers, yet traditional fraud detection methods barely scratch the surface, typically analyzing just 5% of open injury claims. AI-driven fraud detection tools can scale claim analysis to 100% and identify inconsistencies more efficiently. Carpe Data’s AI-powered Online Injury Alerts & Investigative Reports help carriers spot fraud faster, reduce attorney-driven inflation, and automate key aspects of the claims cycle. By synthesizing data-driven findings and behavioral analysis, Carpe Data provides insurers insight on fraudulent activity and offers targeted recommendations for fraud detection and prevention efforts.

About Carpe Data

Carpe Data enables insurers to overcome their biggest claims and commercial underwriting challenges by transforming millions of online data points into actionable insights. Our AI-powered Online Injury Alerts, Investigative Reports, and Commercial Solutions help carriers spot fraud faster, automate the claims cycle, and truly understand small business risks – because outdated information doesn’t cut it in today’s market.

See how Carpe Data is giving insurers the edge they need to make quicker, better decisions and save money: www.carpe.io

Fonte: Business Wire