In many ways the UK authorities are in a no-win situation. They tighten regulations for personal injury claims to reduce fraudulent activity and get criticised, they do nothing, and are accused of letting the fraudsters run free. While there is a growing focus on fraudulent personal injury claims it appears there is no quick fix and no perfect solution. In this article we will also take a look at the timescale for responding to a personal injury claim and options available.
Insurance company response to personal injury claims
The vast majority of personal injury claims will at some point end up on the desk of an insurance company. While this industry has attracted more than its fair share of criticism over the years for “dragging its heels” there is a set process when it comes to personal injury claims.
Rules of response
In previous articles we have covered the issue of providing evidence when looking to prove liability and then move on towards a personal injury compensation claim. On the flipside of the coin, once a claim has been lodged directly with the defendant they then have a further 21 days to respond. This response could come from the defendant, insurers or solicitors and is simply a recognition they have received the claim and are looking into it.
Assuming that acknowledgement has been received within the 21 day period, the defendant, insurers and solicitors then have a further three months in which to investigate the claim and provide a detailed response. In the event that liability is accepted then the process moves on to the compensation claim and, more often than not, an out-of-court settlement. Where liability is denied, the defendant will need to provide documentation which they believe clears them of any liability.
Slow response from the defendant
If the defendant fails to acknowledge the initial claim within the 21 day period, or a more detailed response within the three month period, the claimant can then make a pre-action disclosure application. This is an application through the courts by which the defendant is legally obliged to provide what are known as “disclosure documents”. These are detailed documents which will prove/dismiss claims of liability.
Road traffic accident
As road traffic accidents are by far and away the most common reason for personal injury claims there is a slightly quicker protocol for this. Under the road traffic accident protocol an initial claim notification form will be sent to the defendant’s insurers with details of the incident. Initially the defendant, or parties acting on their behalf, has 15 days in which to respond. If they fail to respond then the claim will switch to the traditional personal injury protocol as detailed above.
Historically, many insurance companies have been extremely slow in responding to personal injury claims which prompted the introduction of the above protocols and backup procedure.
How do insurance companies identify fraudulent claims?
While it would be wrong to suggest there is no fraudulent activity with regards to personal injury claims, recent years have seen a significant reduction. The insurance companies and legal profession are now carrying out regular checks on many claims as a matter of course. These initial checks often highlight potential issues thereby prompting further investigation. Some of the more common checks undertaken include:-
While social media platforms such as Facebook have revolutionised the way in which people contact friends, family and acquaintances, they also open up the lives of many to the public. There is nothing illegal or morally wrong in looking at a public Facebook pages to see the lifestyle of an individual and their recent activity. You would be amazed at the number of personal injury claims which have been rejected because of activity on the claimant’s social media channels!
Some of the more common issues include:-
- Undertaking rigorous exercises despite claiming whiplash/back injuries
- Claimant enjoying holidays while claiming personal injury compensation as they are physically “unable to work”
- Socialising with friends and family while claiming to be housebound as a consequence of mental/physical injuries
To be fair the reasons that claimants have been “found out” as a consequence of their social media activity is endless. Over the last couple of years we’ve also seen a number of those pursuing fraudulent claims prosecuted by the insurance companies in order to send out a warning. In some case this has resulted in significant prison sentences.
For many years the fraudsters seemed to be one step ahead of the insurance companies when pursuing personal injury claims. We saw gangs of fraudsters working together, often at the same address, to pursue claims which were fabricated to say the least. As more information is now available in electronic format, with programs to crosscheck addresses and names, this is a very easy way to identify fraud. We are talking about gangs of fraudsters who manage to defraud the system out of millions upon millions of pounds and then simply walk away.
It is also possible to crosscheck claims across a whole raft of different insurance services, not only personal injury claims. Some fraudsters will also pursue other avenues such as fraudulent property claims at the same address as that registered for personal injury claims. While numerous claims at the same address for the same/different person will start alarm bells ringing, there are occasions where they are perfectly legitimate. Further investigation will likely clarify this, with the claimant given the right to respond.
Unfortunately, as the cost of living continues to rise and more and more people struggle to make ends meet, “victimless” crimes such as fraudulent personal injury claims appear an easy option for many people. One of the strongest red flags when it comes to potentially fraudulent personal injury claims is significant personal debt. Finance and insurance companies regularly access credit files for individuals which give a deeper understanding of their financial situation. There may be County Court judgements, bankruptcy proceedings or other similar activities highlighting a precarious financial position.
The fact that somebody is struggling financially does not necessarily mean that there personal injury claim is fraudulent but it could well prompt further investigation. While some people caught up in this particular scenario will pursue compensation to the bitter end, despite queries and questions from the insurance companies, others can crack as soon as their account of the event is questioned.
The UK certainly has more than its fair share of CCTV coverage and, while often criticised, there is an upside when it comes to fraudulent personal injury claims. Time and time again we have seen insurance companies locating CCTV in the vicinity of an alleged incident, as well as public transport CCTV recordings, often using the recordings in court. Relatively minor bus crashes have been a common issue in years gone by, with many claimants alleging whiplash injuries when CCTV coverage has shown they were not even on the vehicle at the time.
In a similar fashion, many drivers now use dash cams to protect themselves from fraudulent claims such as vehicles reversing into them. Initially, when the damage to a vehicle suggests it has been hit from behind the onus tends to be on the defendant to prove it was not their fault. There was the infamous moped incident whereby fraudsters literally wheeled their moped backwards into the front of an oncoming car. An accomplice was present as a “witness” and the “victim” claimed they’d been injured. However, in this instance, the fraudsters had no idea that the driver in question had their own dash cam.
Over the years we have seen many legitimate personal injury claims thrown out of court because of “white lies”. The temptation to embellish the facts surrounding an accident and the resulting injuries has been too much for many people. Claimants forget that insurance companies have seen this all before, they know the patterns and they know the questions to ask. We have seen many insurance companies “tripping up” claimants by identifying differing accounts given to different parties. Once the claimant loses the trust of the legal system it can be very difficult to prove there is actually a legitimate claim underneath the “white lies”.
If you have a legitimate case for a personal injury claim then you should not need to embellish the evidence. In the event that you do need to correct evidence given at an early stage there are ways and means of doing this within the legal system.
The first thing to clarify is that fraudulent personal injury claims are not a “victimless crime” – someone has to pay and there can be significant knock-on effects. It is also worth noting that the days of insurance companies “dragging their heels” may not have disappeared completely but the process is certainly more focused and compact. Then we move on to identifying and taking action against fraudulent claims and the many ways in which this type of activity is exposed.
Red flags such as social media activity, which does not correspond with alleged injuries, financial distress occurring at the same time as dubious claims and the cross-referencing of claimants living in the same house will prompt further investigation. There will be occasions where these red flags are raised but the claims are perfectly legitimate. In these cases the insurance companies may well request additional information, and dig a little deeper, but legitimate claims will still make it to the courts/potential out-of-court settlements. However, there is no doubt that the insurance industry is hot on the heels of the fraudsters!