CASUALTY CLAIM FOUND TO BE FUNDAMENTALLY DISHONEST

A judge has ruled that a casualty claim was ‘fundamentally dishonest’ following an application by Allianz Insurance.

The claimant, a manager of a well known stationery store based in Leicester, was ordered to pay legal costs in excess of £17,000 after staging a trip on a wire which allegedly took place whilst at work in a store room.

Allianz referred the matter to its specialist in-house Casualty Fraud Team to review the claimant’s allegations. On investigation it emerged four years earlier the claimant had pursued a tripping claim against her local council, which was promptly withdrawn when challenged by the insurer.

Witness statements obtained from the claimant’s colleagues also confirmed that the claimant had identified the potential tripping hazard some hours before she allegedly fell – having been heard to say that “there’s a claim if anyone fell over it”.

Crucially, the witnesses were clear in their evidence that the claimant was seen to photograph the alleged defect four hours prior to the alleged time she tripped over it, a fact later confirmed by Allianz’s detailed analysis of the photographic evidence.

Upon receipt of Allianz’s letter of repudiation, the claimant moved to litigate her case and Allianz instructed DAC Beachcroft to maintain the defence of the claim.

DAC Beachcroft put questions to the claimant regarding the timing of the photographs and, upon receipt of claimant’s dishonest response, amended the defence of the claim to one of fraud.

Three weeks after lodging the fraud defence with the Court, the claimant’s solicitors filed a notice of discontinuance, seeking the claimant to becoming reliant upon her Qualified One Way Costs (QOCS) protection to avoid the payment of any legal costs.

At Allianz’s instruction, DAC Beachcroft made an Application to the Court for an order compelling the claimant to attend a trial to determine the issue of fundamental dishonesty.

At the subsequent hearing, the District Judge made a finding that the claim was fundamentally dishonest and that the accident had been staged, ordering the claimant to pay legal costs in to the sum of £17,839.86.

Mark Merrix, fraud manager, Allianz Insurance commented:

“Allianz is committed to the fight against fundamental dishonesty. The outcome of this case is not only an excellent result for our customer but hopefully, it will deter others who are thinking about intimating a dishonest claim.

“The skills demonstrated by our claims handler in conjunction with the expert advice provided by our panel solicitors, puts Allianz at the forefront when it comes to defending dishonest claims.”

ENDS