Fraud screening at first report — before the adjuster assigns.
Fraud indicators present at FNOL often go unnoticed until adjuster investigation, weeks into the claim lifecycle. Fnolwise flags those indicators at intake — using ISO ClaimSearch, claimant history analysis, and incident description pattern matching — so the routing decision already accounts for elevated fraud risk.
Fraud indicators detectable at first report
Not every fraud indicator is visible at FNOL. But a meaningful subset is — and those that are visible are most useful when they inform the initial routing decision, not when they're discovered mid-investigation.
ISO ClaimSearch prior claim hits
Fnolwise runs an ISO ClaimSearch lookup at intake against the claimant's identity and property address. Multiple prior claims within a carrier-configurable lookback period — particularly for the same coverage type or same loss location — constitute a flag under your SIU referral threshold rules.
Claimant identity patterns
Identity inconsistencies detectable at intake include policy holder name / claimant name mismatches, address changes recorded close to the loss date, and contact information matching other recently filed claims in the carrier's system. These patterns don't confirm fraud but constitute a flag for enhanced handling.
Incident description inconsistencies
Fnolwise applies pattern matching to incident descriptions for known red-flag narratives: claim filed significantly after the reported loss date, incident description that doesn't match the coverage type claimed, or loss circumstances described in terms inconsistent with the physical coverage (e.g., fire described for a water-only property policy).
Timing patterns
Claims filed within a short window after policy inception — particularly for high-limit commercial property policies — are a known fraud timing indicator. Fnolwise records the policy effective date (from ISO PolicyServices) and the claim report date, flagging short-tenure claims above a configurable threshold for enhanced review.
Attorney involvement at FNOL
First-notice-of-loss submissions that include attorney representation are treated as an elevated handling flag — not necessarily a fraud indicator, but a signal that the claim requires specialized adjuster handling and potentially earlier SIU awareness. Attorney involvement at FNOL correlates with higher ultimate loss development in both auto BI and general liability lines.
Photo metadata inconsistencies (mobile channel)
For mobile app FNOL submissions with photo attachments, Fnolwise extracts photo metadata — location coordinates, timestamp, device information. Metadata that contradicts the reported incident location or predates the reported loss date by more than a carrier-configured threshold is flagged for adjuster review.
How ISO ClaimSearch works at intake
ISO ClaimSearch is a participating insurer database maintained by Verisk Analytics. At intake, Fnolwise submits a lookup request using the claimant identity and policy information gathered during FNOL processing. The lookup returns prior claim records across participating insurers — including carrier, date of loss, coverage type, and settlement status for prior claims matching the claimant profile.
Fnolwise uses your existing ISO subscriber credentials. We do not independently subscribe to ISO ClaimSearch on behalf of carriers — your Verisk subscriber agreement governs the lookups. What Fnolwise does is automate the lookup that your adjusters currently perform manually, hours or days into the claim lifecycle, and move that lookup to the moment the FNOL arrives.
Lookup timingAt intake, not at adjuster assignment
The ClaimSearch query runs within seconds of the FNOL arriving. The result is available to the triage engine when the routing decision is made — not after an adjuster has already been assigned and has begun working the file.
Return dataWhat ClaimSearch returns
For each matching prior claim: reporting carrier, date of loss, line of business, loss description summary, and settlement status. Fnolwise writes the ClaimSearch result to the triage record and includes the hit count and most recent prior claim date in the fraud flag evaluation.
Threshold logicCarrier-configurable referral thresholds
The number of prior claims that triggers a fraud flag — and the lookback period — is configured per carrier and per line of business during pilot setup. A commercial property carrier may set a different threshold than a personal auto carrier. Thresholds are documented and can be adjusted post-pilot by your claims operations team.
What happens after a fraud flag
A fraud flag at FNOL is a routing signal — it does not determine the outcome of the claim. The routing decision based on the flag is configured by your claims operations team.
SIU referral
Claims that meet your SIU referral threshold are routed directly to your Special Investigations Unit queue in the CMS. The triage record includes the flag rationale — ClaimSearch hit count, pattern flags, timing indicators — for the SIU investigator's review. See SIU Routing for the full routing rule framework.
Enhanced handling queue
Claims that trigger a fraud flag but do not meet the full SIU referral threshold are routed to an enhanced handling queue for senior adjuster review. The adjuster receives the fraud flag context at assignment and can determine whether to escalate to SIU or proceed with standard investigation under elevated scrutiny.
Standard processing with flag notation
Claims where a fraud indicator is noted but does not meet the enhanced handling threshold proceed to standard adjuster assignment. The triage record preserves the flag notation for adjuster reference. Your claims operations team configures the threshold bands that determine which outcome applies.
No false certainty
Fnolwise does not characterize flagged claims as fraudulent. The output is a routing signal based on pattern indicators. The investigation, determination, and any claim decision rests with your adjusters and SIU team. The triage output is a decision-support record, not a fraud finding.