Claimant trips up in Fundamental Dishonesty case

Authored by Allianz

In a recent personal injury case against an Allianz Commercial customer, claimant, Ms. Swift was found to be fundamentally dishonest, despite sustaining a fractured foot in a genuine fall. Her dishonesty over the cause of the accident was at the heart of the claim.

Ms. Swift’s claim reported she tripped outside of her home, where she had provided photographs of a defect on the pavement to insurers, together with measurements to show the extent of the tripping hazard. The claim was for around £100,000 in damages and legal costs of approximately £50,000.

The claim was initially accepted by the defendant as the defect was present, but a subsequent review of the claimant’s medical records revealed a reference to falling over a laundry basket and losing her footing in a variety of circumstances which were not consistent with the claim.

The trial was held to cover the question of whether or not the accident occurred as alleged, and whether the injuries were caused as suggested by Ms. Swift.

During cross-examination, Ms. Swift conceded she could not have fallen as a consequence of the defect, suggesting that the photograph of the defect was taken as an “illustration” of the state of the pavement.

She also conceded that she could not remember the full details of her fall, and eventually indicated she lost her footing some 18 inches away from the photograph provided to insurers.

The Judge – HHJ Walsh, accepted that the Claimant had a genuine fall, and that the fall genuinely resulted in a fractured ankle. However, he commented that “the positive assertion that she had tripped in the particulars of claim and the witness statement was not, I am satisfied, a genuinely held belief. It was, moreover, an assertion that was fundamental in character and went to the heart of the claim that she had suffered serious injury by reason of a trip. It was, in the circumstances, fundamentally dishonest.”

He then went on to dismiss the claim and disapplied Qualified One-Way Cost Shifting (QOCS) so that the Defendant will be entitled to enforce its costs of up to £19,000.

James Burge, head of counter fraud at Allianz Commercial, commented: “We are seeing an increase of claimants exaggerating their claims in the hope of obtaining more money from the insurer and pulling our customers into disrepute. At Allianz we take a zero tolerance to claimants taking this route and I am pleased to see the result of this case.”

William Stobart, Solicitor with DWF, said: “This is a significant judgment for Casualty insurance teams and those who work with them to prevent fraudulent claims. It is important to appreciate that fraud does not only encompass exaggerated injuries, but also claims where a Claimant fraudulently tries to misrepresent circumstances that could give rise to a claim.”