Investigations by Keoghs counter-fraud and LV= General Insurance (LV=GI) have exposed a claimant’s exaggerated symptoms, leading to £100k savings.
A recent case successfully defended by Keoghs and LV=GI has shone a spotlight on the potential consequences for claimants who may have a legitimate claim but decide to exaggerate injuries and loss of earnings.
The claimant in Tambu v Gafoor was involved in a genuine road traffic accident, sustaining injuries to his neck and right shoulder. Despite surgery to his neck the pain continued, with the claimant obtaining medico-legal reports from a GP, neurosurgeon, and two orthopaedic experts over a two year period.
During these examinations the claimant repeatedly made assertions that he had been unable to return to work as a result of the accident, a statement which was reiterated in a preliminary schedule of loss.
However, when LV= GI and Keoghs instructed an independent medical expert to examine the claimant, his case began to fall apart. The claimant told the expert that he had difficulty driving because his right arm was almost useless. Indeed, he repeated his statement that he had not worked at all since the accident, and would not be able to undertake any type of work due to the level of pain and disability.
Despite this, the expert did not believe that the claimant was providing an honest account of his injuries, suggesting that it was likely he had much more functionality in his arm, noting there was very little evidence of muscle wasting.
Surveillance agents were then commissioned to obtain covert surveillance footage of the claimant. This footage found that he was working as a licensed taxi driver and was clearly able to drive. He was also observed lifting bags and shutting the boot of his taxi, exhibiting full use of his right arm.
Nevertheless the claimant continued to state he was telling the truth, providing a witness statement which said; “I understand that the defendant suspects that I have been working but this is not true. I have been unable to work at all since the accident”. He then issued legal proceedings against LV= GI’s policyholder.
Following further investigation, a witness statement was obtained from the taxi licensing authority to confirm that the claimant had obtained a private hire taxi licence following the accident. He also insured the relevant vehicle for hire and reward and was the only named person on the policy.
Based on this evidence, a defence to the legal proceedings was filed, admitting liability but contending that the claimant had been fundamentally dishonest in the presentation of his primary claim, meaning the entirety of his claim should be dismissed.
Shortly after, the claimant discontinued the entirety of his action. The court then found the claimant to have been fundamentally dishonest, ordering him to pay the defendant’s costs.
Keoghs Fraud Partner, Ben Leech, was delighted with the result, saying;
“Despite this being a genuine accident with genuine injuries, the claimant’s persistent misrepresentations and exaggeration of his injuries and loss of earnings were such that he was forced to discontinue his claim before the court did so. This case highlights the need for claimant’s to be truthful in respect of all aspects of their claim or face the consequences of losing their ability to obtain compensation and pay the costs incurred in defending such exaggerated claims.”
LV= General Insurance Complex & Organised Crime Manager, Matt Crabtree, said:
“Where claimants are genuinely injured in an accident we will always do all we can to provide care, rehabilitation and compensation. However, in this case it was clear Tambu was deliberately exaggerating his injuries. He maintained his lies in several false statements as well as trying to deceive medical experts in order to maximise his claim for compensation. Bringing together experts in both our Technical Claims Team and Financial Crime Team we were able to obtain evidence which enabled Keoghs to secure this finding of fundamental dishonesty against the claimant. This was a great collaboration, both across LV= General Insurance and Keoghs, which has seen a significant saving and sends a clear message that we will not tolerate any claim with fraudulent exaggeration even when arising from a genuine accident.”
For more information, contact Ben Leech
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