Catching Fraud: Soup-erficial claim

  • It is becoming increasingly clear that insurance fraudsters will go to extreme lengths to make fraudulent claims to insurers
  • The average insurance scam is now worth £12,000, and the number of claims exposed as fraudulent has reached 1,300 per day
  • Scott Clayton, Claims, Fraud & Investigation Manger, is featured on the BBC series ‘Claimed and Shamed’, in which he recalls a number of fraudulent claims.

It is becoming increasingly clear that insurance fraudsters will go to extreme lengths to make fraudulent claims to insurers. According to the ABI, the average insurance scam is now worth £12,000, and the number of claims exposed as fraudulent has reached 1,300 per day.

Scott Clayton, Claims, Fraud & Investigation Manger at Zurich, has been featured on the BBC series ‘Claimed and Shamed’, in which he recalls the stories of a number of fraudulent claims.

In this example, the issue centred around a woman who claimed a loose tin of soup on a shop floor caused her to slip, severely injuring her knee which incapacitated her and had a detrimental effect on her life.

The incident

Although the initial claim, against the shop, was valued at around £10,000, developments in the claim led to it grow in value based on what it was suggested she couldn’t do as a result of the injury, eventually totalling £100,000. “Although the matter was reported to the store manager at the time, there were no witnesses who actually saw her falling on any item, so there was no corroboration to suggest this had happened”, Clayton explains. “She claimed she was unable to do various tasks around the house, or care for relatives, so the claim value increased as more and more information came forward.”

CCTV tells a different story

Zurich liaised with the policyholder (the store), which provided CCTV footage from multiple cameras. “What the CCTV footage does show, is that she actually did come into the store that day, and it also shows that there was shelf stacking and we do see a loose tin of soup. What it (the CCTV) doesn’t show, however, is the two together i.e. she didn’t fall over this tin of soup.” What was captured on CCTV however, was the claimant actually picking the tin of soup up and handing it to a shop assistant.

Given the CCTV footage, Zurich continued to investigate the claim, especially as ongoing health issues meant the claim had now risen to £100,000. Whilst Zurich were still not convinced the claim was genuine, the claimant’s solicitors decided to litigate and take the matter to court. It was at this stage that the matter was referred to solicitors to act on Zurich, and the policyholders, behalf. Extensive documentation was requested, including medical and employment records, and a full forensic investigation was launched into those documents. It was at this stage that it was discovered the claimant had quite a chequered medical history, which included ongoing symptoms for which she had been receiving treatment. Clayton explains, “She had ongoing symptoms and had been receiving treatment, so there was a real question mark over whether this injury actually happened and, if it did, what effect it had given the other symptoms and conditions she had.”

Through the extensive research, material supplied from the Department for Work and Pensions (DWP) showed the claimant hadn’t worked for 20 years prior to the accident, wasn’t able to step out of her home, and wasn’t able to walk more than four metres at a time. Whilst it was claimed her husband had supported her since the accident, DWP records showed that in fact they were not together and hadn’t actually lived together for several years.

“What was becoming clear to us, was that this woman had fabricated the claim. She had suggested that she had fallen in the retailer, when in actual fact she hadn’t. What she did have, was various ailments and medical conditions which she was looking for compensation for.”

The claim goes to court

In light of all the evidence, the claimant was offered the opportunity to reconsider, and discontinue, the claim. Despite this, she continued and took the claim to court. Three days in to the court proceedings, the claimant did decide she wanted to discontinue the claim, which led to the defendant (the store) making a claim against her for fundamental dishonesty. The judge found the claimant had been dishonest in her support of a claim for care and as a result, the entirety of the claim was dismissed which enabled the defendant to recover the costs of the legal proceedings in full.

With no evidence that the claimant had slipped, and with previous records showing a history of lies, justice prevailed in court. The message is simple, lawyers and insurers work tirelessly to fight fraudulent claims, and fraudsters are warned that, should they seek to exaggerate genuine incidents, they stand the risk of losing everything and facing the consequences.

To learn more about the topics discussed in this article, please speak to your local Zurich contact.

BBC’s Claimed and Shamed is a documentary series that highlights the ever-growing problem of insurance fraud, and follows the stories of claimants who were caught out. To watch this episode, or to watch past episodes, please click here.