Insurance claims fraud
Pay the claim. Not the ring.
Claims fraud rings file through people who are not insured, copy police reports between claims, date losses before a policy started and redirect payouts. Omnareth checks every claim and payout against the policy before money moves, and recognizes the device behind a ring when it turns up on another policy.
| # | Event | Decision |
|---|---|---|
| 1 | Genuine collision claim with a police report | ALLOW |
| 2 | A stranger claims on another policy with the same police report ▲ Copied police report: case opened |
DENY CLAIMANT_NOT_INSURED · REPORT_REUSE |
| 3 | Water damage dated 12 days before the policy started, same device ▲ Repeat offender case; device watched |
DENY PRE_INCEPTION_LOSS |
| 4 | Payout on policy 1 redirected to a new account, same device ▲ One device across three policies: case opened |
DENY PAYOUT_UNVERIFIED_ACCOUNT · WATCHLIST_MATCH · REPEAT_OFFENDER · DEVICE_HOPPING |
| 5 | The same incident claimed a second time | DENY DUPLICATE_CLAIM |
| 6 | Genuine windshield claim 12 days into a policy | FLAG EARLY_CLAIM |
| – | Analyst confirms the device case ▲ Device blocked everywhere |
analyst · state |
| – | An adjuster adds the ring's claimant to a policy | analyst · state |
| 7 | The ring claims again as an "insured" party | DENY WATCHLIST_BLOCK · REPEAT_OFFENDER · DEVICE_HOPPING |
| 8 | Genuine payout to the policyholder's verified account | ALLOW |
How it fits
A check before money moves
Claims fraud costs insurers and honest policyholders alike, and rings work at scale: one device, many policies, documents copied from genuine claims. Your system sends each request to Omnareth and acts only on what it allows.
The policy
Who is insured, the covered losses, the limit, the payout accounts verified for the policy and the incidents already claimed.
Claims and payouts
A claim must come from an insured person, for a covered loss after the policy started, once. A payout must go to a verified account.
One device, many policies
Omnareth holds the ring's device responsible, not the genuine policyholder whose policy it targeted, and recognizes it across policies.
Reference rules
13 rules, ready to adapt
Authorization checks fail closed, and every rule names who it holds responsible when it fires.
| Threat | What Omnareth checks | Rule code | Decision |
|---|---|---|---|
| Claimant Not Insured | Only people insured on the policy may claim. | CLAIMANT_NOT_INSURED | DENY |
| Duplicate Claim | An incident may be claimed only once. | DUPLICATE_CLAIM | DENY |
| Claim Soon After Inception | Flag claims within 30 days of the policy starting. | EARLY_CLAIM | FLAG |
| Loss Not Covered | The type of loss must be covered by the policy. | NOT_COVERED | DENY |
| Claim Over Limit | A claim may not exceed the coverage limit. | OVER_LIMIT | DENY |
| Policy Not Active | Claims are paid only on active policies. | POLICY_NOT_ACTIVE | DENY |
| Loss Before Inception | A loss that happened before the policy started is not covered. | PRE_INCEPTION_LOSS | DENY |
| Payout to Unverified Account | Claim payouts go only to accounts verified for the policy. | PAYOUT_UNVERIFIED_ACCOUNT | DENY |
| Device Across Policies | Flag a device or account implicated in denials on two or more other policies in 24 hours. | DEVICE_HOPPING | FLAG |
| Police Report Reuse | A police report belongs to one incident; seen on another policy, it is likely copied. | REPORT_REUSE | FLAG |
| Repeat Offender | Flag events involving an identity implicated in two or more denied events in the last 30 days. | REPEAT_OFFENDER | FLAG |
| Blocked Identity | Identities blocked on the fraud watchlist may not take part in any policy event. | WATCHLIST_BLOCK | DENY |
| Watched Identity | Identities under watch may proceed only with a flag for review. | WATCHLIST_MATCH | FLAG |
The insider case
Added to the policy. Still not paid.
After the analyst confirms the case, an adjuster adds the ring's claimant to a policy. The next claim passes every policy check. Omnareth refuses it on the watchlist, and the audit record shows the block it acted on.
Victims are not suspects
Only the identities a rule implicates are held responsible. Genuine customers named in a fraud attempt are never counted against.
Policy as rules
Your checks run on every request, with the reason and a remediation step recorded.
For auditors and regulators
Every refused request is sealed with what was known at the time, and verifiable later.
Adapt the model
The Policy model, its rules and its fraud identifiers are plain JSON you can change.
Pilot program
Put insurance claims fraud prevention to work in 90 days
One lane, facility or process, in shadow mode, with results measured against criteria we agree with you. Qualified companies and organizations can apply.