Catching the same invoice submitted on three different claims
A property insurer that suspected the same repair evidence was being presented on more than one claim, but had no way to see across its portfolio.
The situation
A property insurer with a large claim portfolio and a suspicion it could not act on: that the same repair paperwork was being presented on more than one claim. Each claim was reviewed on its own merits, by whichever adjuster picked it up.
Nothing in the process compared an incoming submission against the portfolio. A duplicate invoice only surfaced by accident, when the same adjuster happened to recognize it. Fraud suspicion was a feeling, and a feeling cannot be put on record or defended in a refusal.
The rule Ceertia applies
Flag any invoice or supporting paper already used in another claim, citing both claim references as evidence.
How it runs
The case arrives from whoever sends it, with the repair invoices, contractor quotes, property photos, ownership proof, claim history and loss adjuster notes. Anything missing is flagged on receipt.
Each rule returns a verdict with its evidence: what Ceertia saw, where, and why it concluded. Every verdict is stored with its rule version, source excerpt and timestamp. Portfolio-wide cross-checking on receipt, alongside the usual internal consistency rules. A submission already seen elsewhere is flagged with both claim references attached as evidence, and each external lookup (ownership, address, contractor identity) is recorded with its result and its impact on the confidence score.
Your team keeps the decision, on sourced evidence, with a full audit log.
What changes in the work
- Each claim was reviewed in isolation; nobody compared submissions across claims.
- Duplicate invoices only surfaced by accident, when the same adjuster recognized one.
- Fraud suspicion was a feeling, not something you could put on record.
- Every incoming submission is checked against the whole portfolio.
- A reused invoice is flagged with both claim references as evidence.
- The risk level is sourced, so a refusal can be defended.
Your team keeps the decision, on sourced evidence, with a full audit log.
A mid-sized insurer receiving motor claims from policyholders, garages and experts, with volumes that spike after every storm.
Read the case InsuranceBrokers fix their own incomplete claimsAn insurer receiving claims through a network of brokers, where every incomplete submission meant a phone call and a delay.
Read the case