Case Study
Case Study
How Origin uncovered coordinated fraud and saved an insurer more than $1.4MM in exposure
Company
Confidential Insurance Provider
Company
Confidential Insurance Provider
Company
Confidential Insurance Provider
Services
Surveillance · Claims Investigation · Background Analysis · SIU Coordination · Fraud Pattern Identification
Services
Surveillance · Claims Investigation · Background Analysis · SIU Coordination · Fraud Pattern Identification
Services
Surveillance · Claims Investigation · Background Analysis · SIU Coordination · Fraud Pattern Identification
Industry
Insurance SIU
Industry
Insurance SIU
Industry
Insurance SIU
Year
2025
Year
2025
Year
2025
A national insurer noticed irregular patterns across several bodily injury and property claims submitted within weeks of each other. Internal adjusters suspected orchestration but lacked the investigative bandwidth to confirm it. Origin was engaged to determine whether the claims were legitimate, quantify exposure, and identify any organized fraud activity before settlements were issued.
Senior SIU Manager
National Insurance Carrier
“Origin’s investigation gave us clear, defensible evidence that stopped several fraudulent claims in their tracks. Their work saved us well over a million dollars and strengthened our fraud protocols moving forward.”
The challenges
The insurer was facing a cluster of suspicious claims marked by:
Identical injury descriptions submitted by unrelated claimants.
Treatments at the same medical clinic with questionable billing practices.
Inconsistent statements regarding dates, times, and mechanisms of injury.
High projected payouts if claims were approved without intervention.
Indicators of staged collisions, but insufficient evidence to deny or litigate.
The SIU team needed a rapid, coordinated response that could expose the truth before substantial losses occurred.
Our approach
Origin structured its investigation around a multi-layered verification model.
Phase 1: Background & association mapping
We examined prior claims histories, shared addresses, vehicle registrations, and phone records. Multiple claimants were linked indirectly through overlapping networks and repeat medical providers.
Phase 2: Surveillance & activity verification
Our surveillance teams documented active lifestyles inconsistent with reported injuries, including heavy lifting, sports activity, and commercial work that contradicted disability assertions.
Phase 3: Clinic audit & billing analysis
We reviewed treatment timelines, CPT coding, and referral patterns, identifying inflated charges and templated medical reports lacking individualized assessments.
Phase 4: SIU report & fraud coordination briefing
Origin compiled a comprehensive fraud package that clearly outlined the relationships, discrepancies, and indicators of organized activity, enabling SIU leadership to move forward confidently.
The challenges
The insurer was facing a cluster of suspicious claims marked by:
Identical injury descriptions submitted by unrelated claimants.
Treatments at the same medical clinic with questionable billing practices.
Inconsistent statements regarding dates, times, and mechanisms of injury.
High projected payouts if claims were approved without intervention.
Indicators of staged collisions, but insufficient evidence to deny or litigate.
The SIU team needed a rapid, coordinated response that could expose the truth before substantial losses occurred.
Our approach
Origin structured its investigation around a multi-layered verification model.
Phase 1: Background & association mapping
We examined prior claims histories, shared addresses, vehicle registrations, and phone records. Multiple claimants were linked indirectly through overlapping networks and repeat medical providers.
Phase 2: Surveillance & activity verification
Our surveillance teams documented active lifestyles inconsistent with reported injuries, including heavy lifting, sports activity, and commercial work that contradicted disability assertions.
Phase 3: Clinic audit & billing analysis
We reviewed treatment timelines, CPT coding, and referral patterns, identifying inflated charges and templated medical reports lacking individualized assessments.
Phase 4: SIU report & fraud coordination briefing
Origin compiled a comprehensive fraud package that clearly outlined the relationships, discrepancies, and indicators of organized activity, enabling SIU leadership to move forward confidently.
The challenges
The insurer was facing a cluster of suspicious claims marked by:
Identical injury descriptions submitted by unrelated claimants.
Treatments at the same medical clinic with questionable billing practices.
Inconsistent statements regarding dates, times, and mechanisms of injury.
High projected payouts if claims were approved without intervention.
Indicators of staged collisions, but insufficient evidence to deny or litigate.
The SIU team needed a rapid, coordinated response that could expose the truth before substantial losses occurred.
Our approach
Origin structured its investigation around a multi-layered verification model.
Phase 1: Background & association mapping
We examined prior claims histories, shared addresses, vehicle registrations, and phone records. Multiple claimants were linked indirectly through overlapping networks and repeat medical providers.
Phase 2: Surveillance & activity verification
Our surveillance teams documented active lifestyles inconsistent with reported injuries, including heavy lifting, sports activity, and commercial work that contradicted disability assertions.
Phase 3: Clinic audit & billing analysis
We reviewed treatment timelines, CPT coding, and referral patterns, identifying inflated charges and templated medical reports lacking individualized assessments.
Phase 4: SIU report & fraud coordination briefing
Origin compiled a comprehensive fraud package that clearly outlined the relationships, discrepancies, and indicators of organized activity, enabling SIU leadership to move forward confidently.
The results
The findings were conclusive:
Four claims denied outright due to verified misrepresentation.
Two additional claims significantly reduced after exposure of exaggeration.
Estimated $1.4MM in prevented financial loss.
Referrals made to law enforcement for potential organized activity.
A medical provider flagged for further investigation across multiple jurisdictions.
Origin’s work empowered the insurer to take strong, defensible action while avoiding unnecessary payouts.
Lessons learned
Patterns matter: Fraud often reveals itself in repeated behaviors across seemingly unrelated claims.
Surveillance is decisive: Real-world activity continues to be one of the most reliable indicators of misrepresentation.
Early intervention saves money: SIU involvement before settlement prevents cascading losses.
Collaboration increases impact: Tight coordination between SIU, adjusters, and investigators yields clearer, faster outcomes.
Key takeaways
This case demonstrates the value of structured investigations in uncovering coordinated fraud. With disciplined verification and comprehensive reporting, insurers can dramatically reduce exposure and strengthen their fraud-prevention posture.
The results
The findings were conclusive:
Four claims denied outright due to verified misrepresentation.
Two additional claims significantly reduced after exposure of exaggeration.
Estimated $1.4MM in prevented financial loss.
Referrals made to law enforcement for potential organized activity.
A medical provider flagged for further investigation across multiple jurisdictions.
Origin’s work empowered the insurer to take strong, defensible action while avoiding unnecessary payouts.
Lessons learned
Patterns matter: Fraud often reveals itself in repeated behaviors across seemingly unrelated claims.
Surveillance is decisive: Real-world activity continues to be one of the most reliable indicators of misrepresentation.
Early intervention saves money: SIU involvement before settlement prevents cascading losses.
Collaboration increases impact: Tight coordination between SIU, adjusters, and investigators yields clearer, faster outcomes.
Key takeaways
This case demonstrates the value of structured investigations in uncovering coordinated fraud. With disciplined verification and comprehensive reporting, insurers can dramatically reduce exposure and strengthen their fraud-prevention posture.
The results
The findings were conclusive:
Four claims denied outright due to verified misrepresentation.
Two additional claims significantly reduced after exposure of exaggeration.
Estimated $1.4MM in prevented financial loss.
Referrals made to law enforcement for potential organized activity.
A medical provider flagged for further investigation across multiple jurisdictions.
Origin’s work empowered the insurer to take strong, defensible action while avoiding unnecessary payouts.
Lessons learned
Patterns matter: Fraud often reveals itself in repeated behaviors across seemingly unrelated claims.
Surveillance is decisive: Real-world activity continues to be one of the most reliable indicators of misrepresentation.
Early intervention saves money: SIU involvement before settlement prevents cascading losses.
Collaboration increases impact: Tight coordination between SIU, adjusters, and investigators yields clearer, faster outcomes.
Key takeaways
This case demonstrates the value of structured investigations in uncovering coordinated fraud. With disciplined verification and comprehensive reporting, insurers can dramatically reduce exposure and strengthen their fraud-prevention posture.
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Reaching out is the only difficult step. From there, we manage the process and guide your case with precision.
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Our offices are open 24 hours a day, 365 days a year.
Services
Reaching out is the only difficult step. From there, we manage the process and guide your case with precision.
Address
Prefer meeting in-person? We have nine offices across five continents. Learn More
Opening Hours
Our offices are open 24 hours a day, 365 days a year.
Services
Reaching out is the only difficult step. From there, we manage the process and guide your case with precision.
Address
Prefer meeting in-person? We have nine offices across five continents. Learn More
Opening Hours
Our offices are open 24 hours a day, 365 days a year.
Services