Court success: Zurich exposes dishonest account of ankle injury
The claimant brought a claim for loss and damage against his employer, a housing association, as a consequence of an ankle injury sustained at work when he was clearing snow.
It was not disputed that this was a genuine accident and that the claimant had likely suffered an injury; nor was liability in issue.
However, the symptoms described by the claimant – which he said were permanent and debilitating – were far more significant than one might have expected.
The claimant contended he was unable to flex his right ankle beyond 10 degrees (which essentially meant it had to remain flat on the ground). He said this had left him unable to walk without the use of at least one crutch, or to drive or work. As a result of this alleged inability to work, he had obtained benefits totalling £48,000 since the accident.
The claim itself was pleaded up to £150,000, with costs of £110,000 budgeted.
Zurich became suspicious because the claimant had only recently begun working for the housing trust, and the symptoms he alleged varied significantly in terms of their severity. There also seemed to be little orthopaedic rationale for the continuing injuries, with the claimant instead relying on the opinion of a pain management consultant to support his account of his symptoms.
Based on these suspicions, Zurich began investigations into the claimant’s purported limitations, and obtained medical evidence which showed he had more movement in his ankle than he had suggested. It also appeared he was able to drive without much difficulty.
The claimant continued to exaggerate his injuries with his disclosed evidence, making it impossible to avoid the conclusion that he had put forward a dishonest claim.
Zurich and Clyde & Co disclosed their own evidence to the claimant’s representatives and made it clear they would reject any attempt at settlement.
The court endorsed an order for the claimant to discontinue his claim and pay £5,000 to the defendant over a period of months. The court ruled that if he failed to maintain these payments, £15,000 would be due immediately.
This case demonstrates perfectly what a zero-tolerance approach to fraud looks like.
It would have been easy for Zurich to have simply disclosed its evidence at an early stage and paid the claimant a much-reduced sum in relation to his claim. Indeed, once the evidence was disclosed, the claimant made an offer to settle for £45,000, covering costs and damages.
While many might have seen that as a good result, given that the claim had been reserved at around £300,000, we took the view that dishonesty of this nature should be confronted robustly and defeated.
Zurich Claims Handler: Steven Marsh. Clyde & Co: Damien Rourke.
Summary prepared by Damien Rourke & Michelle Pickering.