Judge orders fraudster to pay £21,000 after submitting false claim
Here our Claims Investigation Manager Catherine Luke discusses a recent claim which was defended on behalf of our customer Newcastle City Council.
The claim was first received in 2016 where the claimant was playing football with a friend and alleged that as he ran for the ball he tripped on a damaged pole and fell forward over the fence onto the pavement striking his head and fracturing his elbow. The inference was that had the pole not been present he would not have fallen.
Photographs were provided of a metal pole which had been partially removed, leaving a damaged stump, immediately next to a low fence, surrounding a grassed area where the claimant was playing football.
This claim was not initially suspected as being fraudulent. The Claimant was involved in a genuine accident and suffered a fractured elbow. However, what this case demonstrates is the importance of carrying out intelligence checks as this was the key factor and enabled us to take it further and pursue fundamental dishonesty.
Uncovering Fraud through intelligence checks
Searches of the Claimant’s social media accounts revealed a post on the day of the accident in which the Claimant referred to the incident and the injuries sustained. In the comments on that post, the
Claimant revealed that he had slipped on the grass whilst trying to avoid a child on a bicycle. When we obtained the Claimant’s hospital records, this account was repeated in his clinical notes. This account simply could not be reconciled with the pleaded version of events that he had tripped on a metal post.
The Claimant’s social media and medical records were also the source material used to demonstrate that the Claimant had been able to return to playing football significantly earlier than he had indicated to his medical experts.
When the above inconsistencies were brought to light, the matter was referred to Weightmans’ fraud team for strategic input and advice and was similarly flagged as a potential fraud claim.
Weightmans considered simply offering the claimant the chance to discontinue. If not discontinued we would amend the defence to seek Fundamental Dishonesty. Our own medical expert supported our concerns regarding exaggeration. We had evidence of dishonesty (the claim for future loss of earnings); misrepresentation, (the accident circumstances) and clear exaggeration (continuing ongoing symptoms).
In the lead up to trial
We received an offer to settle for £11,000. However all parties for the defendant agreed to proceed to trial and we rejected the offer. A Notice to Discontinue was then received. The claimant’s solicitors were also no longer representing. Court documents were sent to the claimant however the claimant did not submit a defence. He then said he could not attend the hearing however the hearing proceeded in his absence, the judge agreed there was no point in delaying matters and increasing costs.
Outcome at Trial
The Judge found that the claim was fraudulent and a Fundamental Dishonesty judgement was awarded.
The claim was Fundamentally Dishonest on 2 counts;
1) the accident did not occur in the manner alleged
2) the injuries had been exaggerated regarding the impact on his daily life and in particular the fact that he had lied to his own experts suggesting he had not been capable of returning to football, when he had.
Having found the claim fundamentally dishonest, the Judge agreed we could enforce an order for costs, which he summarily assessed at £21,248.
