Clarity for Claims That Demand a Closer Look

Fraud Indicator Analysis

Travel Claim Analysis

Claim Defensibility Analysis

OUR CORE SERVICES

The question is not whether documentation exists. The questions is whether the totality of the evidence supports the reported event.

We work alongside existing claims operations, SIU teams and investigative technologies, providing independent analysis without requiring software implementation or system integration.

Technology can strengthen the investigation, human judgement governs the analysis

Insurance Carriers:

SIU and claim teams needing structured review when documentation, indicators, or circumstances require deeper clarity

TPA

High-volume or complex claim environments that benefit from external investigative support.

MGA & Brokers

Specialized reviews to protect program integrity.

Attorney & Coverage Counsel

Defensible, evidence-led records before taking legal positions.

Employers and entities requiring independent review of incidents, documentation, and claim circumstances.

Self-insured organizations

Common examples include:

• Questionable documentation

• Travel claims involving cancellation, interruption, medical abroad, or baggage loss

• Material questions remain unresolved

• Reported circumstances conflict with available evidence or timeline date.

• International verification challenge

• Internal investigative capability constraints

• Claims requiring enhanced defensibility before significant decisions are made

Not every claim requires independent review. CAG is engaged when documentation, chronology, claim circumstances, or available evidence raise questions that warrant closer examination.

WHEN TO ENGAGE CAG

Review

Verify

Document

Clarify

Analyze

Understand the complete file

Establish material facts through appropriate independent sources and verification methods

Evaluate evidence, inconsistencies and unresolved information collectively.

Clearly separate established facts from analytical observations.

Deliver concise findings showing what the evidence supports

"Plausibility is not verification. Suspicion is not evidence".

OUR METHODOLOGY

CAG operates outside client systems and internal workflows. No software implementation required

CAG evaluate the evidence without ownership of the underlying claim decision

CAG does not adjust claims or make coverage decisions. The client retains 100% authority over all final decisions.

Independent Perspective

Carrier Control

No system Integration

1

2

3

Designed to complement your existing operation

THE CAG DIFFERENCE

Tone fades. Facts remain

What Claims Work Taught Me About Documentation

Trip Cancellation Claim Fraud

A Case Study Using Metadata, Language, and Pattern Analysis

REAL-WORLD OUTCOMES

Insurance Fraud Doesn’t Have a Financial Profile

Observations and analysis drawn from real-world claims handling, SIU operations, and fraud review work.

Have a Claim That Warrants a Closer Look?

When a claim presents unresolved questions, documentation concerns, fraud indicators, or required additional analytical rigor, CAG can provide an independent assessment.