Vigilance against fraudulent claims is the watchword of insurers and their legal advisors alike. Such claims cost everyone dear, not just the insurance companies who have to deal with the outcome but also the policyholder who has to face higher premiums. All the more important, then, that fraudulent claims are discouraged and, where evidence is clear, defended to the hilt.
The outcome of a recent trial reinforces this stance and sends a very strong message to potential fraudsters that they will both be found out and subject to hefty penalties and sanctions as a result.
In Sumegi v Gate Gourmet Ltd, we were instructed by Zurich, the defendant’s EL insurer, to defend the claimant’s claim for a back injury he suffered as the result of an accident at work in 2012. Liability had been conceded but causation and quantum were in dispute.
The claim had initially been pleaded as a low-value injury claim but the claimant alleged that he had not recovered and, indeed, had developed urological and gastroenterological symptoms which, he said, meant he could not go back to work. He assessed the value of his claim at over £500,000 in his amended schedule of loss and, later in his skeleton argument, he declared it was worth £2.2m.
Although legally represented to begin with, the claimant’s solicitors came off the record before we had served the defendant’s medical or surveillance evidence. The claimant proceeded as a litigant-in-person, therefore.
His solicitors might have been able to tell the way the wind was blowing. The evidence from both sides’ medical experts was that the claimant:
- Suffered a lower back injury of 14 months’ duration;
- Had not suffered any urological, neurological or gastroenterological injuries in the accident;
- Had a degenerative condition in his back which was causing any residual symptoms.
The claimant refused to accept this. He insisted that he suffered from a range of problems associated with the accident, including:
- Gross disablement due to back pain;
- An inability to walk without a stick;
- Being unable to drive for more than an hour;
- Having to spend up to 16 hours a day in bed;
- Being unable to look after his family; and
- Having to stop work.
Because of the thorough investigation we carried out, we were able to gather evidence to show that the claimant was lying about his lack of capability. It was clear that:
- The claimant was very well able to look after his family;
- He had driven himself and them across country to go on outdoor holidays;
- He had participated in activities such as fishing, paddle-boarding and kayaking; and
- He had used his walking stick only when attending medico-legal appointments.
We pleaded that the claimant had been fundamentally dishonest for the purposes of s.57 of the Criminal Justice and Courts Act 2015.
At the quantum trial, our client was represented by Sadie Crapper of 39 Essex Chambers. The court made the following findings:
- The Claimant knew that he was not functionally limited to the extent that he said he was to the medico-legal experts.
- He had been dishonest in one of his witness statements and in oral evidence in relation to events surrounding a ‘second accident’ in order to exaggerate the effect of his back injury claim.
- The Claimant failed to report his relevant past medical history including his injury from the index accident and the physiotherapy he was undergoing.
- The Claimant did not leave the Defendant’s employ because of pain arising from his back injury, but to look after his wife and children.
- The Claimant knowingly made false reports and gave false evidence about urinary and faecal incontinence.
The Order made by the court dismissed the claim pursuant to s.57 as above and awarded indemnity costs against the claimant with an interim payment of £75,000 to be made on account by 22nd April. Permission to appeal was refused.
This result shows what can be achieved by a cross-disciplinary team. We were able to call on our in-house Intel team which came up trumps on the social media evidence and which, together with the surveillance and contemporaneous records went a long way to helping secure the result. The determination of the client, our team and counsel to secure the correct result also paid off.
Claire Laver says “this is a great outcome for our clients and just goes to show that utilising expertise from multiple disciplines achieves the best results.”
For more information or advice, please contact one of our experts.
