Property claims glossary
What is a fraud signal in insurance claims?
A fraud signal is a pattern in a claim that warrants a closer look before payment, such as damage that does not match the reported cause, no recorded storm at the location on the date of loss, or invoices that do not line up. A signal is not an accusation; it is a reason for a person to review the file, sometimes with the carrier's special investigations unit (SIU).
Worked example · fictitious claim
A $22,000 hail claim gives a date of loss when no hail was reported near the home, and the roof photos show wear consistent with age. The file is referred for review before payment. If review confirms $4,000 of genuine wind damage and nothing else, the claim pays $4,000 − $1,000 = $3,000 after a $1,000 deductible.
How it affects a settlement
A fraud signal can pause payment while the facts are checked, but state claim-handling deadlines generally still apply and any denial must be explained. Many signals clear on review, and those claims are paid in the normal way.
In practice
A pattern that warrants investigation before payment: losses inconsistent with the reported peril, no corroborating storm activity at the location, patterns across claims. A signal is not an accusation. It is a reason for a human to look closer.
Related
Loss run · Peril · AI claims audit trail · property claims glossary