Trip Cancellation Claim Fraud: A Case Study Using Metadata, Language, and Pattern Analysis

Trip Cancellation Claim Fraud

Industry: Travel Insurance

Engagement Type: Independent Fraud Analysis

Client: U.S.-Based Carrier

1. Background

The carrier referred multiple trip cancellation claims for review after identifying that newly submitted claims closely matched several previously paid claims.

Although the claims were submitted by different insureds residing in different states, similarities in documentation, formatting, and narrative structure raised concern. At the time of referral, cumulative paid losses on similar claims exceeded $64,000 across two years.

Claims were processed under standard quick-settlement workflows, where screenshots and PDF documentation were acceptable and claims were handled by multiple adjusters. In many instances, direct contact with the insured was not required prior to settlement.

2. Reason for Referral

• The carrier requested independent analysis due to:

• Multiple claims submitted by unrelated insureds

• Submissions originating from different states

• Supporting documentation that closely resembled previously paid claims

• Repetition that could not be explained by coincidence

No coverage determinations had been made at the time of referral. The objective was verification and risk assessment, not assumption.

3. Claim Analysis Group Scope of Work

Claim Analysis Group was engaged to:

• Review supporting documentation across multiple claims

• Assess document origin and authorship indicators

• Identify patterns or similarities across unrelated insureds

• Provide documented findings to support carrier decision-making

All work was performed independently, using materials already contained within claim files.

4. Investigative Methodology

Claim Analysis Group applied a structured, human-led review using publicly defensible investigative techniques.

4.1 Document Metadata Analysis

Claim Analysis Group reviewed submitted PDFs and images to assess:

• document creation properties

• author fields and file generation markers

• consistency across claims attributed to different insureds

This analysis identified repeated metadata characteristics across multiple claims.

4.2 Language & Similarity Analysis

Claim narratives and supporting documents were compared for:

• repeated phrasing and sentence structure

• uniform formatting and layout

• consistent sequencing of materials

The review determined that approximately 75% of reviewed claims shared a common authorship pattern, despite being submitted under different identities.

4.3 Behavioral Pattern Review

Claim Analysis Group evaluated submission behavior across claims, including:

• timing and method of submission

• use of screenshots in place of source documents

• consistency in claim presentation across unrelated insureds

The analysis indicated coordinated activity rather than independent claim events.

5. Key Findings

Claim Analysis Group’s review concluded that:

• Multiple claims submitted by different insureds were not independently generated

• Supporting documents originated from a single source

• Aliases were used to create the appearance of unrelated claimants

• Fraud risk was amplified by fast settlement processes and decentralized handling, not by individual adjuster error

Claim Analysis Group did not make coverage determinations or recommend claim outcomes.

6. Outcome

Based on Claim Analysis Group’s documented findings:

• Additional payments on similar claims were halted

• New claims exhibiting the same characteristics were flagged earlier

• The carrier strengthened internal awareness of cross-file similarity risk

• Legitimate claims continued to be processed efficiently

7. Claim Analysis Group Value Delivered

Independent Analysis: No system access or IT integration required

• Human-Led Review: Professional judgment applied beyond automation

• Evidence-Based Findings: Documented patterns supported defensible decisions

• Capacity Support: Analysis completed without disrupting ongoing claim operations

8. Key Takeaway

When claims submitted by unrelated parties appear identical, structured analysis can reveal risk that isolated file review cannot. Claim Analysis Group provides clarity when time, bandwidth, and visibility are limited.

Claim Analysis Group, LLC

Clarity when capacity is limited