Facts of the case
In April 2009, the Claimant, her husband and two children were involved in a low velocity accident. Minor damage to the vehicle was sustained costing £800 to repair.
In February 2012, the Claimant claimed that, due to severe back pain as a result of the accident, spinal surgery and loss of earnings were going to cost in the order of £100,000 and the Claimant commenced proceedings for this sum.
On further investigation, the Ageas Claims Team learned that the Claimant not only had a long history of back pain and sciatica, but that she received the highest disability benefit and claimed for a significant care allowance.
Ageas looked into the case further, using the CUE (Claims Underwriting Exchange) Personal Injury system, which indicated that the Claimant had been previously involved in other incidents of a similar nature. Ageas investigations discovered, among other examples of inconsistent behaviour, the Claimant taking her children to a popular adventure park and riding on an extreme rollercoaster, one which specifically advises passengers with back pain not to participate.
At trial, the court heard more medical evidence, which showed that the Claimant had pre-existing back problems and her injuries were not directly as a result of the accident in question. In the judgment the court ordered the Claimant to repay over £19,000 in sums already received from Ageas Insurance Ltd.
Ageas understands that the Claimant may be seeking permission to appeal.
The fight against fraud
According to consumer research recently conducted by Ageas*, half of respondents think that it would be fairly easy to make a fraudulent claim. However nearly 80% did not know that price comparison sites ‘red flag’ consumers if details are repeatedly changed to obtain a lower quote. Although 91% of respondents said they understood what constitutes fraud, by the end of the survey 43% believed that the survey had increased their awareness.
As well as setting up a dedicated in-house fraud team, to supplement existing fraud tools such as the Claims Underwriting Exchange (used at both policy set-up and for claims), Ageas has invested significantly in fraud detection systems over the past two years including utilising the Syndicated Intelligence for Risk Avoidance (SIRA or anti-fraud database). These systems helped to identify 2.4% new policies in 2012 where prior claims information had not been disclosed by the policyholders, and it contributed to the avoidance of over 8,200 policies where we found evidence that the customer supplied information was incorrect or fraudulent.
Ahead of his presentation at the Marketforce fourth annual Insurance Fraud Conference in March, Mark Cliff, Managing Director, Ageas Insurance Limited, commented: “This particular case is a perfect example where our claims team identified and followed up on some key indicators of a fraudulent claim. We know that fraudsters are getting more sophisticated, accounting for an extra £50 on every premium, so we’ve got to keep up. Not only do organisations need to work together, we all need to put more investment behind exposing this activity as early as possible.
“Our figures suggest that less gross written premium was lost in 2012 because of fraud than in 2011, making the investments all the more worthwhile”, continues Cliff.