There has been a sharp increase in the number of casualty fraud cases seen by our clients over the last couple of years due to:
- The amounts that can be claimed in damages and costs compared to an average motor claim are significantly higher;
- Fraudsters becoming more sophisticated and being able to exploit loopholes in working practices;
- The emergence of organised Fraud Rings, particularly in Public Liability cases.
We deal with a range of Casualty Fraud cases to include exaggeration/fabricated incidents/fabricated injuries/staged and contrived claims through to rings involving organised criminals.
A pro-active stance is adopted by our team, employing technical and procedural tactics whenever the opportunity arises to defeat the claims as quickly as possible, thereby maximising savings for clients. We will increase clients pound-for-pound spend against savings through earlier successful repudiations and trial wins and thereby overall reducing indemnity spend.
In addition, our Intelligence team can identify and provide:
- Latest scams as they are emerging, specifically in the organised arena;
- Individuals to look out for;
- Commercial organisations involved in fraud;
- Adverse practices adopted by Claimants Solicitors enabling us to advise on appropriate strategies in dealing with casualty fraud cases;
- Up-to-date information on Courts and Judicial Decisions being made for fraud;
- Where you are in the marketplace in terms of the amount of Casualty Fraud you are detecting/how you are being targeted and how successful you are in dealing with Casualty Fraud.
What we do
We support our insurer clients and their insured's in defending fraudulent casualty claims. We work in partnership with our clients and their insured's, and we look for the best possible outcome on a case-by-case basis. We provide bespoke training for insured's on how they can reduce their exposure and risk to casualty claims, as well as providing on-going workshops and training to our clients to share knowledge, intelligence and strategies.
What we are known for
We have a strong track record in this area and we work with small and large insurers, their insured's and brokers, as well as retail and commercial clients. Due to our breadth of experience and our ability to focus not just on fraud, but also on technical and procedural issues, we can maximise the opportunities to defeat these types of claims. We have a down-to-earth and practical approach when dealing with all our clients, their insured's and brokers, which make us trusted advisors and first port of call for any queries.
Detailed elements of our services
- Types of Fraud: We deal with a range of Casualty Fraud cases to include exaggeration, fabricated incidents, fabricated injuries, staged and contrived claims through to rings involving organised criminals;
- Exposure identification: Identification of loopholes and exposure to casualty fraud for insureds;
- Strategies: Casualty fraud bespoke strategies for our insurer clients;
- Trends: We will provide bespoke emerging trends analysis for our clients and their insured;
- Data sharing and collaboration: We will, on a monthly basis, let you have our intelligence report on latest scams/fraud issues. We will wash your claims through our database systems to see if we have any matches;
- Portal Access: Secure access to search our database for known fraudsters and access to back catalogue of alerts and briefing notes;
- Bespoke Manuals and Training: We will provide training free of charge to your Claims Handling teams on prevention/detection of fraud, and provide your claims handlers with the necessary tools to deal with cases effectively pre litigation;
- Clinics/Placements: We will second members of our fraud team into your teams to assist and act as extension of your team.
Rae v RS Smith t/a Lodge Holdings
The Claimant stated she was hit on the head by a falling picture whist visiting the Defendant's café.
The Defendant stated the Claimant knocked the picture as she tried to sit down. She then attempted to put the picture straight, but it came off the wall and did not make contact with her head. Despite repudiations in relation to the inconsistencies in her evidence, she proceeded with her claim.
This matter proceeded to a two-day multi track trial following which the Claimant's claim was dismissed.
This case had many features to it, including the fact that the Claimant refused to accept the content of her medical and occupational health records, which lead the judge to suggest that her evidence was at odds with reality. The Claimant was unable to prove her claim.
Total savings: £208,190. We recovered £38,000 in costs.
This was a PL claim arising out of an incident on 17 February 2012 at 8.30pm when the Claimant tripped on a pothole. The claim was presented with features for handling within Operation Clapham, with two other near identical claims for incidents at the same location.
Liability remained in dispute. The Claimant disclosed images of the accident locus showing the very poor state and condition of the forecourt area.
Key to the Defence was to secure digital copies of the locus photos to enable them to be authenticated as an accurate depiction of the accident locus and defect dimensions. The Claimant advised at all stages that the digital photos were not available. The authorship of the photos was not confirmed, it was asserted under a statement of truth that the Claimant was present when the photos were taken and this had occurred on 2 March 2012. We served a Notice to prove the authenticity of the photos with our Witness of Fact evidence (which would prove fundamental to the outcome). The Claimant did not respond to this notice.
TRIAL Before HHJ Butler
- Claimant confirmed in evidence (including in direct response to a question by the Trial Judge) that he was present when the locus photos were taken. The Claimant then conceded that he had directed and shown the author of the photos to the accident locus, but he could not be sure he was present when the photos were taken and specifically was not present when three photos were taken, which had a spirit level and tape measure in shot.
- The Claimant's solicitors confirmed they were instructed 1 March 2012 and instructed agents to attend and photograph the locus. Having served the Notice, the Judge found that the solicitors had been on notice that proving the authenticity of the photos was pivotal. The Judge noted that a statement from the author of the photos could have been secured. The solicitors had failed to get this and had even served a List of Documents with a signed statement of truth suggesting this was not known by the Claimant, which was misleading given the Claimants evidence at Trial.
The authenticity of the locus photos had not been proven by the Claimant, which were pivotal to identifying the locus. The photos annexed to the Letter of Claim may have been taken at different times and absent of being authenticated, it was unclear whether some of the photos were even of the locus.
The Judge dismissed the claim on the technical point that the Claimant had failed to prove his case. Absolutely central to this was the failure to prove the authenticity of the locus photos.
Total Savings: £42,800.00 with a further £8,458.00 recovered in costs.
Mrs Ann Walker v Cannon Plastics Limited
Assumed Fraud – Fabricated Injury. The Claimant alleged that she was taking bin bags to a skip in the course of her employment with the Defendant when she slipped on water and fell. The reasons for running the matter to trial were:
- The Claimant has been inconsistent reporting different accident circumstances to the medical experts and within her witness statement and the Particulars of Claim;
- The Claimant did not report the specific accident circumstances to her GP until 22 months later;
- The Claimant only reported the accident to her GP the day she received the letter regarding possible redundancies and the GP has recorded that the Claimant seemed to "have her own agenda";
- The Claimant continued to work for the Insured up until the date she reported the accident to her GP, including overtime without any complaint to any Manager or to the Insured himself;
- The medical expert (orthopaedic) believes that the Claimant is exaggerating the level of her injury, or is doing so for psychosomatic reasons. He considers that she is not a reliable historian;
- The Claimant withdrew her claim before Trial.
Total savings: £94,225.78.