The Modern Claims Investigation in the Age of Skepticism
By Caroline Caranante | Jan. 27, 2026 | 5 min. read
What you will find below:
- How Modern Consumers’ Skepticism and Digital Habits are Reshaping Claims Expectations
- The Limitations of Traditional Investigation Methods and Why They Leave Insurers Exposed
- The Rise of Digitally Altered Evidence and the Need for Advanced Fraud Detection Tools
- Strategies for Using Claims Investigations to Build Trust, Fairness, and Transparency
On paper, the insurance industry continues to grow. New fraud detection technology, new platforms, and new efficiencies are rolling out faster than ever. But if you ask consumers how they feel about insurance, the answer is far less optimistic. Trust in insurance remains fragile, and nowhere is that trust tested more than during a claims investigation.
Today’s consumers are more informed, more skeptical, and more vocal than any generation before them. They’re navigating claims in a digital-first environment where expectations are shaped by seamless apps, instant communication, and online narratives that spread fast. In this landscape, claims investigation is no longer just a backend function. It’s a frontline trust exercise.
A Claims Environment Defined by Mutual Skepticism
Insurance fraud is no longer a hidden issue. In fact, 78% of consumers say they are concerned about insurance fraud, signaling a high level of public awareness and skepticism around how claims are handled.
At the same time, insurers are seeing rising risk. In a recent industry survey, carriers suspected that roughly 20% of claims may contain some form of fraud, up from 18% just a few years earlier.
This creates a new kind of claims environment: one where both sides are cautious. Policyholders want insurers to stop fraud and protect the system, but they don’t want to feel treated like suspects the moment they file a claim. Insurers, meanwhile, must identify risk without slowing legitimate claims or eroding customer confidence.
That tension puts claims teams in a challenging position. Every claims investigation must be thorough enough to identify risk, but fair and transparent enough to maintain trust. When that balance is missed, when processes feel unclear or impersonal, confidence erodes quickly.
Why Traditional Claims Investigation Models Can’t Keep Up
This pressure would be manageable if claims volumes were low and fraud patterns were simple. But scale has changed the equation.
Traditional fraud detection methods reportedly analyze only about 5% of open injury claims, meaning most claims receive limited scrutiny unless obvious red flags appear. In a digital environment where claims volume is high and resources are finite, reactive investigation models leave gaps.
Fraud doesn’t always announce itself clearly. Relying solely on manual review or legacy indicators increases the risk of both missed fraud and unnecessary friction for honest policyholders. The modern claims investigation must do more than react. It requires smarter prioritization, better data, and tools that help investigators focus where risk truly exists.
The Rise of Altered Evidence in Digital Investigations
On top of these operational pressures, the nature of claims evidence itself has changed.
Claims today are built on digital inputs, including photos, videos, documents, online activity, and social media behavior. While this creates convenience, it also introduces new forms of risk.
Some industry sources estimate that 20–30% of claims may include altered or synthetic media, such as AI-generated images or manipulated documentation. These materials can be convincing at first glance, making detection more complex and time-consuming.
This shift has elevated the importance of digital investigations as part of the claims process. Investigators now need the ability to assess digital credibility, verify online behavior, and identify inconsistencies that aren’t visible through traditional methods.
As digital investigations rely more heavily on digital verification, the process can feel more intrusive to policyholders, making transparency and clear explanations even more critical.
Why Investment in Fraud Detection Technology Is Accelerating
Faced with higher volumes, more sophisticated fraud, and digitally altered evidence, the industry’s response is clear. The global insurance fraud detection technology market reached approximately $7.5 billion in 2024 and is projected to grow to over $22 billion by 2029.
This growth reflects more than a push for efficiency. It signals recognition that modern insurance fraud detection technology is essential to protecting both financial outcomes and customer relationships. Advanced analytics, automation, and digital intelligence tools allow claims teams to investigate more consistently, document decisions more clearly, and resolve claims with greater confidence.
Fraud detection technology doesn’t just improve detection rates. It helps insurers make digital investigations more consistent and defensible, which is essential in an environment where customers expect fairness and clear reasoning.
The Claims Investigation as a Foundation for Trust
It’s easy to think of the claims investigation purely as enforcement. In reality, it plays a much broader role.
Effective claims investigation protects honest policyholders, reinforces fairness, and supports transparency, especially when decisions must be explained or claims are denied. Clear investigative processes and well-documented findings help replace frustration with understanding, even when outcomes aren’t favorable.
In an era where social media amplifies negative experiences and skepticism spreads quickly, how investigations are conducted matters just as much as what they uncover. Consistency, clarity, and defensibility turn investigations into proof of fairness rather than signs of suspicion.
Final Thoughts
Trust in insurance isn’t built through marketing messages or promises. It’s built in moments of stress, when people file claims and wait for answers.
As consumers become more digitally savvy and fraud grows more sophisticated, the modern claims investigation has become a cornerstone of credibility. By combining thoughtful investigation practices, advanced fraud detection technology, and digital investigations, insurers can protect the system while reinforcing the trust that long-term relationships depend on.
Conversations about trust, digital expectations, and modern claims challenges don’t end here. Sign up for an upcoming CE to keep your knowledge current.
Check out our sources:
Anderson, Michael. “Combating AI-Generated Media Fraud in Insurance Claims.” Guidewire, Guidewire Software, 16 Jan. 2026, https://www.guidewire.com/resources/blog/industry-trends/combating-ai-generated-media-fraud-in-insurance-claims.
The Business Research Company. Insurance Fraud Detection Global Market Report 2025. The Business Research Company, Dec. 2025. https://www.thebusinessresearchcompany.com/report/insurance-fraud-detection-global-market-report.
Coalition Against Insurance Fraud. “Fraud Stats.” InsuranceFraud.org, Coalition Against Insurance Fraud, 2025, https://insurancefraud.org/fraud-stats/.
TrustCloud. Uncovering Fraud with Data Analytics: A Modern Approach. TrustCloud, https://community.trustcloud.ai/docs/grc-launchpad/grc-101/compliance/uncovering-fraud-with-data-analytics-a-modern-approach/.