Claimant in a ‘hole’ lot of trouble as fabricated fall leads to 12 month suspended prison sentence

A claimant who fell off a coffee table and tried to blame her injuries on a pothole has been sentenced to 12 months imprisonment, suspended for 18 months, and required to carry out 200 hours of unpaid work in the community. Diane Evans was sentenced at Merthyr Tydfil Crown Court on 5 January 2023 following a private prosecution by Keoghs and AXA UK, after the initial civil claim was struck out due to a successful defence by AXA UK and Keoghs Fraud. Mark Stanger of the Keoghs Advocacy team conducted the private prosecution. 

Dodgy claim

Evans initially claimed that she was leaning on the boundary wall of the insured’s commercial property when her foot became wedged down a hole in the pavement. This was said to have caused her to lose balance and fall, resulting in a fractured wrist and a claim for £10,000.

The incident was only reported two years later, leading to concerns from AXA UK and Keoghs that this was a fabrication. Suspicions were heightened when Evans supplied the medical expert with a different story, stating that her right foot went into a deep pothole when walking down the street. Meanwhile A&E records revealed a third version of events with Evans attending hospital in the early hours of the morning having been drinking and then falling in an unspecified location.

Acting the fool

A defence was filed disputing liability and putting the claimant to proof, with the case being handled by Nicola Wise of Keoghs and Alison Young of AXA UK. Evans subsequently served a witness statement with a signed statement of truth reverting to the original story that her foot was caught in a hole next to the boundary wall. She went on to say that she took great issue with the fact that the blame was being shifted to her which was “deeply upsetting and completely untrue”.

Keoghs obtained copies of Evans’ medical records as part of investigations, including a copy of the call made to the Welsh Ambulance Service. In the recording Evans confirms her name and date of birth, following which the call handler, noting that she has injured her wrist, asks exactly how it happened. Evans responds, “I was acting the fool on the table… I fell off and I heard a crunch”. 

Strike out

Given the ambulance records conflicted with Evans’ pleadings and witness statement, a successful application was made to rely on an amended defence of fundamental dishonesty, following which the claimant’s solicitors were removed from the court record as acting on her behalf. Evans, who was now representing herself as a litigant in person, failed to file a Listing Questionnaire. Her claim was struck out by the court and the trial date vacated.

Prosecution

Given the seriousness and sustained nature of the deceit, which included lying under oath, AXA decided to privately prosecute in the criminal courts rather than settling for a finding of fundamental dishonesty.

A successful application was made to Pontypridd County Court for permission to rely on the evidence obtained in civil proceedings, and the prosecution commenced with Nicola Wise from Keoghs Casualty Fraud and Keoghs in-house barrister, Mark Stanger, working in collaboration.

Evans was notified of the prosecution but failed to respond. She was also invited for an interview to no avail.  AXA’s allegations of fraud were then sent to Merthyr Tydfil Magistrates Court and a summons issued to Evans. A hearing was listed for 27 October 2022 which Evans also failed to attend. She was subsequently arrested and bailed to re-attend the Magistrates Court on 4 November 2022 where she pleaded guilty to the charge of fraud by dishonestly making a false representation with the intention of financial gain, contrary to sections 1 and 2 of the Fraud Act 2006. 

The case was committed to the Crown Court for sentencing where Recorder G Bull KC, sentencing the defendant, stated:

“This is not a victimless crime, it strikes at the very heart of the insurance business because it undermines confidence, not only that insurance companies have in genuine claimants but it also causes the public to lose confidence in the ability of insurance companies to investigate claims.”

The judge also praised the “careful investigation” carried out by Keoghs and AXA that had brought the defendant to justice.

Nicola Wise FCILEx in Keoghs Casualty Fraud team said:

“This was a clear case where contemporaneous medical records contradicted the pleaded case and the correct decision to plead dishonesty and privately prosecute was made. The joint approach between Keoghs and AXA resulted in a significant saving for our client and provided a lesson to the claimant on our approach to these types of claim. 

Mark Stanger, prosecuting barrister and Head of Advocacy at Keoghs said: 

“This case demonstrates what can be achieved when an insurer takes a robust stance against claims fraud, treating it as the criminal behaviour that it is. It is to be hoped that those such as Evans who view this sort of behaviour as victimless and without consequence should take note.”

Chris Walsh, AXA Commercial Claims Director said: 

“Through AXA’s robust fraud strategy, the technical capability of our people and the collaboration with our legal partners, we are pleased to have secured a successful outcome for our customer, our business and industry on this occasion.

“Insurance fraud is a serious crime which has significant consequences for fraudsters. Fraudulent claims result in higher insurance premiums for honest customers as insurers are faced with increased costs. That’s why AXA works hard to prevent fraud by investigating suspicious claims and by taking fraudulent claimants to court when necessary.”