4 signs of claim fraud – and how canvassing helps you spot them

Insurance fraud takes many forms and each poses unique challenges for claims professionals. But all forms of fraud have the potential to inflate costs, delay resolutions, and undermine the integrity of the claims process. Spotting red flags of fraud early is critical to saving your team time and expenses.

That's where canvassing comes in. By leveraging medical and social canvassing, adjusters and investigators gain deeper visibility into claimants' treatment histories, activities, and potential misrepresentations. At INTERTEL, we've spent decades refining medical and social canvassing strategies that uncover the truth, empowering carriers to distinguish between legitimate claims and exaggerated or fabricated ones before valuable time and resources are wasted.

Here are four signs that may indicate potential claims fraud—and how INTERTEL helps you verify, validate, and act.

1. Delayed Reporting or Inconsistent Timelines

One of the first warning signs of potential fraud is when there's a significant delay in reporting an injury or loss, or when timelines just don't add up. If the claimant can't clearly explain when and how the incident occurred—or the account keeps changing—that's reason to pause.

How INTERTEL Helps: Our investigators cross-reference reported dates with public social media activity, public records, and provider documentation to verify the timeline. This process involves collecting and verifying identifying information to ensure the accuracy and integrity of the data. This can quickly reveal inconsistencies or outright fabrication.

2. Claimant Unreachable or Avoids Communication

Another potential sign of fraud is when a claimant suddenly becomes hard to contact or only responds through a third party (like an attorney) without a clear reason. This behavior can signal avoidance or coaching.

How INTERTEL Helps: Our social canvassing solution helps determine the claimant's current activities and whether they're actively trying to conceal their location or lifestyle. We conduct an in-depth search to verify social media accounts and uncover hidden or contradictory activities.

3. Exaggerated or Inconsistent Medical Treatment Details

A classic claims fraud indicator is when claimed injuries don't align with the alleged incident —or when new symptoms mysteriously appear as the case progresses. Overlapping diagnoses from multiple providers or unusually high treatment volume are also red flags.

How INTERTEL Helps: Our medical canvassing solution uncovers all potential facilities and providers where treatment occurred, not just those named in the claim. The canvassing includes medical facilities such as physical therapy clinics and aims to uncover unknown treatment information not previously disclosed by the claimant. Typically, the starting point for a canvass is the subject's home address, ensuring a logical and efficient approach to gathering data. This comprehensive view can reveal preexisting conditions, treatment contradictions, or "doctor shopping."

4. Social Media Activity That Contradicts the Claim

Finally, people are often careless on social media, even when attempting to commit fraud. A person claiming debilitating injury might still post about running a marathon, renovating a house, or enjoying an active vacation. Or someone in their immediate family or close circle of friends may post photos or other content that inadvertently reveals incriminating or contradictory evidence about the claimant's injury.

How INTERTEL Helps: Our social media canvassing tools and expert investigators monitor publicly available online activity across platforms to identify lifestyle inconsistencies. These tools capture social media accounts and corresponding metadata from various social media platforms, preserving digital evidence as part of a comprehensive solution.

Preserving the integrity of digital information is critical in any legal process, and our methods ensure that the evidence collected is reliable and admissible. We don't just screenshot profiles—we build timelines, verify identities, and preserve digital evidence that holds up.

Early Detection Means Smarter Claims Management

Spotting these red flags early helps adjusters make better decisions—reducing time spent on suspicious claims and reserving resources for those truly in need.

At INTERTEL, we believe in proactive intelligence. Our investigative solutions are designed to empower claims professionals with the facts they need, fast. Whether you're handling a simple injury claim or a complex multi-party case, we provide the insights to help you stay ahead of fraud.

Ready to sharpen your claims fraud detection strategy?
Contact us today for a free demo!