Insurance Fraud Detection
The insurance industry loses over $308 billion annually to fraud — and generative AI is making it exponentially worse. Fabricated damage photos, synthetic medical records, and AI-generated identity documents now bypass traditional detection methods. Sightova gives claims adjusters, SIU teams, and underwriters the forensic tools to catch synthetic evidence across health, life, and commercial lines before payouts clear.
Full-spectrum fraud detection for every claim touchpoint
Six specialized modules covering the entire claims lifecycle — from first notice of loss through settlement — across health, life, property, casualty, and commercial lines.
Claim Photo Verification
Analyze claim-submitted photographs for generative AI artifacts, splicing boundaries, and clone-stamp traces. Whether it's a fender-bender photo or a warehouse fire scene, our models distinguish authentic damage from synthetic fabrication at pixel level.
Damage Assessment Validation
Cross-reference submitted damage imagery against physics-based damage models. Detect impossible shadow angles, inconsistent lighting conditions, and AI-hallucinated structural details that betray synthetic or manipulated damage evidence.
Medical Document Screening
Screen medical records, diagnostic reports, lab results, and prescription images for signs of AI generation or manual tampering. Flag synthetic letterhead, fabricated physician signatures, and inconsistent document formatting across healthcare providers.
Identity Proof Verification
Validate driver's licenses, passports, utility bills, and other identity documents submitted during enrollment and claims. Detect face-swapped ID photos, synthetically generated barcodes, and forged holographic elements.
Historical Image Comparison
Compare newly submitted claim images against your historical database to identify recycled fraud — the same damage photo submitted across multiple claims, policyholders, or time periods. Surface serial fraud rings operating across your book of business.
Synthetic Injury Detection
Purpose-built models for detecting AI-generated bodily injury evidence in workers' compensation, personal injury, and disability claims. Identify synthetic bruising, fabricated X-rays, and generated wound imagery with medical-grade precision.
Forensic intelligence at the speed of claims
Each submitted image returns a comprehensive forensic report within milliseconds. Integrate directly with your claims management system, Guidewire, Duck Creek, or custom platforms. Adjusters get actionable verdicts; SIU teams get the evidence chain they need for investigation.
- Per-pixel manipulation heatmaps for adjuster review
- Automated SIU referral triggers based on configurable risk thresholds
- Cross-claim duplicate image detection across your entire book
- NAIC and state regulatory compliance-ready audit exports
{
"request_id": "ins_clm_7f2b4d91",
"claim_number": "CLM-2026-0847291",
"policy_id": "POL-HO3-992847",
"line_of_business": "commercial_property",
"file_name": "warehouse_fire_evidence_03.jpg",
"scan_ms": 142,
"verdict": "SYNTHETIC_DETECTED",
"confidence": 0.982,
"risk_tier": "CRITICAL",
"detections": [
{
"type": "generative_artifact",
"model_family": "stable_diffusion_xl",
"region": [0.08, 0.15, 0.72, 0.89],
"confidence": 0.98
},
{
"type": "physics_violation",
"detail": "shadow_angle_mismatch",
"sun_position_expected": 42.3,
"sun_position_rendered": 67.8,
"confidence": 0.95
}
],
"duplicate_matches": [
{
"claim_number": "CLM-2025-0612044",
"similarity": 0.97,
"filed_by": "different_policyholder"
}
],
"siu_referral": true,
"action_taken": "FLAGGED_FOR_REVIEW"
}Stop Fraudulent Claims
Every day you wait, synthetic claims are clearing your pipeline. Deploy Sightova into your claims workflow and give your adjusters and SIU teams the AI-powered forensic edge they need to protect your loss ratio.