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Sizeable disease fraud saving

Sizeable disease fraud saving

A recent case handled by Carrie Hoey in Keoghs’ Disease Fraud team underlines how robust counter-fraud processes developed in the motor fraud arena can be applied equally well to suspicious non-motor cases.

The claimant alleged that he suffered from respiratory, dermatological and psychological injury arising out a specific incident in his construction job. He claimed that he had been working inside premises at the same time as heavy vibration tools were being used outside – causing the loft he was working in to fill with dust. He subsequently retired on ill health grounds at 55 – two years after the alleged incident.

The claimant’s insurers identified a number of potential concerns including the fact that the incident was unwitnessed, there was no corresponding accident report and the claimant’s version of events had a number of inconsistencies. Further enquiries also revealed that the claimant was an embittered employee with a 13 year history of workplace grievances. The claimant’s insurers therefore referred the case to Keoghs for handling.

Our strategy was to utilise our own medical and engineering experts to test out the inconsistencies in this claim. Keoghs intelligence team were also instructed to produce an intelligence profile on the claimant – to identify any potential credibility issues.

Our medical expert highlighted the claimant’s selective recall of the facts and uncovered other underlying medical conditions which had prompted his retirement, which he had failed to disclose. Meanwhile, our engineering expert provided evidence that heavy percussive tools could not have been used in the manner alleged and, even so, that any exposure due to building resonance would have been minimal.

The intelligence profiling exercise also uncovered a number of Facebook entries in which the claimant was mocking the insured and had relocated to the South of France to work as a novelist – suggesting that his loss of earnings claim had been wilfully exaggerated.

When he was made aware of the wealth of evidence we had gathered against him, the claimant discontinued his action, saving our client over £400,000.

Carrie Hoey
Partner
T: 01204 677320
E: choey@keoghs.co.uk