Thursday, July 9th, 2026 — Artificial intelligence is reshaping both insurance fraud and fraud detection, creating new challenges for claims professionals. Industry research has shown insurers rapidly expanding the use of AI and machine learning within anti-fraud programs, while experts warn that the same technology is helping fraudsters produce increasingly convincing fake evidence, including manipulated photographs, fabricated documents, and deepfake audio or video.
Members of the Claims and Litigation Management Alliance (CLM) say they are seeing AI used more often to enhance existing claims rather than generate entirely fraudulent claims from scratch. Sarah Thomas of Jones Jones LLC points to workers’ compensation cases where AI could be used to create more polished job search documentation or assist with medical records. Christopher Del Bove of Callahan & Fusco described cases involving photographs that appeared to exaggerate vehicle damage through AI image manipulation, prompting fraud defenses and additional litigation.
Claims organizations are responding by investing in AI-powered fraud detection, document analysis, and pattern recognition tools. At the same time, experienced adjusters, SIU investigators, attorneys, and medical professionals remain central to the investigative process. Interviewing claimants, comparing evidence, reviewing records, and identifying inconsistencies continue to be the foundation of successful fraud investigations, even as AI becomes more sophisticated.
There are also the practical challenges of proving AI-generated evidence. Fraud investigations increasingly require metadata analysis, corroborating records, witness testimony, and careful examination of digital evidence. Claims professionals may also face longer investigations and litigation as courts evaluate allegations involving manipulated content.
Looking ahead, CLM members believe widespread adoption of AI by organized fraud rings could increase claim complexity, investigation costs, and claim cycle times. As insurers, carriers, and TPAs continue investing in AI tools, adjusters will need to balance new technology with experienced investigative judgment to distinguish legitimate claims from increasingly sophisticated fraud.
