Carpe Published 2025 Injury-Claims Fraud Report
A new industry analysis found that while claim referral rates dipped, the total value of potential fraud increased.
Updated on Oct. 7, 2026 in Insurance
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Carpe published its 2025 injury-claims fraud report on October 7, 2026, analyzing trends across disability, workers' compensation, and auto insurance. The data revealed that fraud referral rates declined while the modeled value of contradictory alerts rose to $263.8 million.
Why it matters
The report highlights an emerging trend in the insurance industry where the frequency of fraud referrals is decreasing, but the severity and financial impact of each individual claim continue to climb.
Modeled contradictory alert values climbed to $263.8 million in 2025 compared to $230.6 million the previous year. Meanwhile, referral rates for disability, workers' comp, and auto claims fell by 1.7%, 0.7%, and 0.4% respectively.
The players
Carpe
This organization specializes in using artificial intelligence to identify potential insurance fraud.
This social media platform was cited as the source for 60.5% of the contradictory evidence flags found during the investigation.
The details
Carpe utilized artificial intelligence to monitor open injury claims, identifying flags where social media activity contradicted reported injuries. Facebook served as a primary source for this evidence, accounting for 60.5% of all flags, with auto claims generating the bulk of alerts at 60.9%.
Timeline
2024 served as the baseline year for data comparisons.
2025 was the primary period analyzed in the fraud report.
October 7, 2026, was the official publication date of the report.
Market Dynamics
This data marks a pivot in insurance fraud detection as automated monitoring shifts from high-volume flagging to identifying high-value anomalies. This development mirrors broader efforts by insurers to use AI to counteract rising claim costs across the sector.
The rise in modeled fraud alert values suggests that insurance providers may face increased overhead in claims processing and investigative costs. Investors should monitor how these findings influence premium adjustments and the adoption of AI-driven loss prevention tools by major carriers.
The takeaway
Insurance claimants should be aware that AI-driven monitoring now routinely reviews social media activity against reported injuries. Maintaining consistency between public social media documentation and insurance claims remains the most effective way to avoid potential fraud flags.
Further reading
For additional analysis on the evolving landscape of coverage, visit the Insurance section.
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