Discovering and defending housing association fraudulent claims
Catherine Luke, Claims Fraud Investigator discusses a recent claim that was defended at trial
The claim was first received while I working as a claims handler in 2019 and I have had the privilege of dealing with it ever since. The Claimant alleged that he was a visitor to a block of flats owned and occupied by our customer Rochdale Boroughwide Housing when he slipped and fell on a communal staircase due to the stairs still being wet after being cleaned by the building caretaker earlier in the day.
Immediately when I reviewed the details of the claim alarm bells started to ring for the following reasons:
- injuries weren’t specific and lacked details
- with the claimant was unemployed
the address where the witness resided was the exact same address where the claimant used to live. - There was no CCTV in the particular area where he is alleged to have slipped on a wet floor in the communal area; falling down the stairs. There was slight rain on that day which could have explained any wet floor however the claimant said that it was as a result of excess bleach being used and the witness agreed there was a strong smell of bleach.
- an ambulance was called and left after giving the claimant some paracetamol.
In partnership with Weightmans we originally denied liability as there was no supporting evidence and closed the file in early 2020.
We then received a summons in December 2020. The medical report confirmed the claimant had leg and back issues but didn’t mention the accident circumstances anywhere other than verbally from the claimant.
We maintained a denial of liability through to Trial supported by a witness statement from the buildings caretaker.
Our fraud concerns were effectively focused on 2 areas;
1) That there were significant inconsistencies in the Claimant’s evidence about the accident circumstances and the injuries/losses arising from it which were suggestive of either a fabricated accident or a significantly exaggerated one.
2) That the Claimant had lied to his medical expert by denying any relevant medical history when his medical records demonstrated ongoing reports of back pain right up to the accident date to the extent that the Claimant was actually signed off work by his GP with back pain at the time the accident occurred.
At the Trial
The Claimant was subjected to a lengthy cross examination by our Trial counsel, in which he struggled throughout to provide convincing explanations for the inconsistencies in his evidence. There were also marked inconsistencies in the evidence given by his friend and witness. The Judge would not allow the Claimant’s Mother to give evidence as it was immediately evident upon her entering the witness box that English was not her first language.
The Judge could not satisfy himself that she understood the contents of her own statement or the meaning of the statement of truth she had signed.
In particular, the Claimant was unable to explain why he had told his medical expert that he had no previous history of back pain when this was untrue and could also not explain why his post-accident medical records contained scarce mention of back pain and no reference to the accident despite the Claimant alleging a significant worsening of symptoms post-accident which meant he required 3 hours of care per day from his Mother for 3-4 months post-accident.
Outcome
The QC giving Judgment concluded that the reason why the Claimant had not mentioned any of the alleged significant post-accident injuries to his GP or his physiotherapist is that there weren’t any genuine injuries sustained. He took the view that there had been significant and gross exaggeration by the Claimant of his reported symptoms and also made a finding that the Claimant had sought to conceal his pre-existing back condition from the Court. The Judge was entirely satisfied that the Claimant’s false presentation went to the very root of this claim and had no difficulty in reaching the conclusion that this was fundamental dishonesty.
In light of the numerous inconsistencies in the Claimant’s evidence the Judge went on to say that he was not even satisfied that an accident happened at all despite a 999 call having been made which described the accident in largely consistent terms and paramedics having attended the scene.
Jonathan Wenn from Rochdale Boroughwide Housing Association commented on the outcome “This is an example of the continuing need for good record keeping and diligence at work to be able to defend such claims in the future.
As a mutually owned (by tenants and employees) Housing Association, this result has not just been a benefit to the corporate body, but has the benefit of being able to use our tenant’s rents on services rather than pay-outs to claimants, highlighting that we are fighting on behalf of our tenants as well”.
