How Adjusto Flagged A Contents Claim As Potential Fraud For One Carrier

Recently at Adjusto one of our carrier partners’ content claims was headed toward payment when our system flagged something unusual.

Media submitted by the policyholder appeared to be AI-generated and, potentially, exaggerated the value of the claimed contents loss. Adjusto identified $2,161.16 in questionable replacement cost value (RCV) and tagged the submission for review by the handling adjuster.

The adjuster reviewed the findings and escalated the claim to the carrier’s Special Investigations Unit (SIU). She later told us that without the flag, she would have paid the claim.

From proof of loss to SIU escalation, the process took less than 48 hours. Direct contents handling cost was less than $5.

A growing challenge for claims teams

Contents adjusters can be responsible for reviewing hundreds or thousands of individual items, along with supporting photos, videos, receipts and other documentation.

Now they also have to consider whether the evidence in front of them is even real.

AI-generated photos and videos are becoming increasingly convincing and accessible. For claims professionals already managing large inventories and tight turnaround times, identifying questionable evidence adds another layer to the review process.

In this case, we surfaced the questionable submission. The adjuster reviewed the information and made the decision to escalate it. SIU took it from there.

Our team is careful about drawing broad conclusions from a single result. But this example shows what’s possible when adjusters have better information in front of them at the right time.

As AI-generated evidence becomes more common, Adjusto will continue building tools that help claims professionals identify what deserves a closer look, make informed decisions and protect claim dollars.

The case by the numbers

• $2,161.16: Questionable RCV identified for further investigation
• Less than $5: Direct contents handling cost
• Under 48 hours: Proof of loss to SIU escalation
• One claim headed toward payment: The adjuster said she would have paid it without the flag

About Adjusto

Adjusto is transforming contents claims from a transaction into a human-centered experience. By combining AI with deep claims expertise, Adjusto simplifies workflows, reduces friction, and empowers adjusters to move claims forward with greater clarity, speed, and confidence. Built by an adjuster for adjusters, Adjusto supports carriers in delivering fairer, faster, and more transparent outcomes at scale.

Media Contact

Brett McKenzie
Principal Strategist & Founder
CoVerse Communications

Brett@coversecomms.com
773-294-9724