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Our Fraud Expertise
Case Study - Fraud, Spain
Background
Our expertise covers a broad range of insurance fraud, including animal, casualty, motor and fleet, travel, household and property and commercial.
From identification and investigation, through to civil and criminal prosecution, our fraud risk management service provides a tailored approach to managing fraud exposure, helping to protect brand, maintain policyholder relationships and minimise costs. We hold extensive cross-border data on fraud and our Fraud Sentry intelligence system screens claims to identify instances of fraud early in the process. Our dedicated, in-house fraud team work in conjunction with our EL/PL and Motor fee earning teams, employing a range of tools to assist in the identification and handling of potentially fraudulent claims. An example of this is Genesis, our own weighted fraud detection tool, designed for specific types of claim. We have now developed a version of Genesis to assist in the identification of potentially fraudulent holiday sickness claims. As well as identifying the risk of fraud, Genesis also identifies the risk of exaggerated claims, making it quite unique in the EL/PL claims space. Our sophisticated Opponent Based Strategy (OBS) has been running for a number of years, and assists us in controlling indemnity spend, through conducting detailed analysis of individual claimant firms and their behaviour. We are now expanding the scope of our OBS to include holiday sickness claims.
We represented a Spanish insurer of a hotel in Barcelona. The Claimant alleged that during her stay whilst using the hotel’s disabled platform lift it was forcefully lowered into her face, causing her to suffer a fractured nose, facial injuries and significant neurological injuries. Our investigations in UK and Spain showed that there was no conclusive and/ or contemporaneous evidence that this accident happened as described.
Outcome
We successfully defended this claim to trial, where the claim was dismissed. The defence we mounted was that no such accident occurred at all; we obtained expert evidence to prove that the claimant’s version of events was physically impossible, and we had substantial evidence to show that the claimant, who had severe long- standing mental disabilities, had previously fabricated events to correspond to injuries. We placed the claimant and her solicitors on notice, of our intentions to seek a finding of fundamental dishonesty. Shortly before trial, the Claimant’s solicitor submitted evidence to show that the claimant no longer had the necessary capacity to conduct litigation. We put our case to the claimant’s daughter in cross examination and her evidence was found lacking, and the entire claim was dismissed with an order for the claimant to pay our costs, and a separate provision for us to issue an application seeking an order for the claimant’s solicitor to show cause as to why they should not pay our entire wasted costs of bringing the claim.
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