The personal injury claims market is enormous with negligent employers and third parties more likely to be held to account today than ever before. We also know that there are a large number of fraudulent claims, sometimes made after prompting from third parties or simply as a consequence of greed. Over the years we have seen a number of common red flags emerging which indicate a potentially fraudulent claim.
It is worth noting that perfectly valid claims may also include the various scenarios listed below. Where there is doubt, insurance companies will look into the finer details although perfectly valid claims will still be honoured.
Red Flags From Claimants
It is worth remembering that not all fraudulent claims will originate from the claimant themselves. Sometimes they may be approached by third parties offering compensation when the case is maybe borderline at best and fraudulent at worst. However, when it comes to a claimant’s individual situation some of the more common red flags include:
- Personal financial issues
As many people still see personal injury claims as a “victimless crime” it is often seen as a quick way to address personal financial problems. Issues such as County Court Judgements and bad credit ratings are in the public domain and an interesting port of call for insurance companies. However, personal financial issues on their own may not be the strongest of red flags.
- Personal approach to compensation
Insurance companies regularly see overly aggressive or overly nice individuals pursuing fraudulent compensation claims. The aggressive nature is a way of trying to intimidate insurance companies in the hope of obtaining a quick settlement. The overly nice approach is often a softly-softly approach to unlawful activity.
- Detailed knowledge of the claims process
When it comes to legal issues the vast majority of people will take advice from third parties such as personal injury claims solicitors/ claims management companies. So, if an individual seems to have more knowledge than most about the compensation process this can be an indicator of potentially fraudulent activity. On the flipside of the coin, there is so much information now available through the Internet that it may simply be a case of researching the process prior to making a claim.
- Willingness to accept an early settlement
Again, a claimant with a willingness to make an early settlement does not necessarily mean the claim is fraudulent. They may have financial issues, they may be unable to work and therefore unable to bring money into the household. Sometimes however it can be a case of trying to close a claim as quickly as possible to avoid detection of fraud. Those who are willing to accept a reduced claim/compromise without dispute will often push for early settlement. A sign of desperation, or a sign of financial distress, this can be an extremely strong red flag.
- History of pursuing personal injury claims
As we touched on above, the Internet has brought a vast array of information and research into the public domain. In some cases this has prompted the pursuit of multiple personal injury claims by individuals with enhanced knowledge. While not always a red flag for fraudulent activity, those who continue to pursue personal injury claims for an array of different scenarios will prompt further interest. Insurance companies will also look at the success rate of their past cases and the details of claims made/any compensation received. Patterns do emerge!
- Late submission and unsubstantiated evidence
No doubt you will regularly see personal injury claims companies advertising on the TV and mass media in relation to perfectly valid claim scenarios. In some cases these can lead to late submissions which can be seen as a last throw of the dice. The potentially fraudulent actions behind some of these claims would be further highlighted with a reluctance to provide substantiated supporting evidence. While many insurance companies will seek an out-of-court settlement where negligence has been proved beyond reasonable doubt, those unable to provide evidence will not receive the same courtesy.
Red Flags For Circumstances
There are many fraudulent personal injury claims which somehow make it to the courts when the circumstances often don’t make sense. Some of the more common issues include:
- Vague and changing evidence
The vast majority of personal injury claims will not be lodged until weeks or months after the actual event. This ensures that the claimant has time to clear their mind, address any health issues and give a focused concise summary of the circumstances surrounding their claim. Where a claim has not been thought through, the details can often be vague and many of those pursuing fraudulent claims will change their “evidence” on numerous occasions. Changing evidence to suit the scenario, and in theory potentially strengthening a claim, is an extremely strong red flag. Giving false evidence in a court of law is an offence in itself.
- Injuries appear exaggerated for the situation
The TV and mass media have given significant attention in recent years to exaggerated personal injury and insurance claims in general. We have seen blatant fraudulent claims of whiplash, as one example, involving a minor bus accident. There have also been numerous occasions where the injuries received do not correspond to the circumstances. It is worth noting that in the event of an incident the insurance companies can use evidence given by the claimant at the scene, such as “I am okay with no injuries”. On occasion there may be medical evidence to suggest concussion or some kind of shock which can reduce the value of such comments. However, it is still permissible for many claims.
- Lack of third-party evidence
In the past, insurance companies have called out many fraudulent parties pursuing numerous personal injury claims. One common trait amongst this type of fraudulent activity is the emergence of “third party” witness statements from the same individuals. If a connection can be proven between the various parties, and numerous claims, this is often enough to suggest unlawful activity. While it will depend upon the size and nature of the claim, insurance companies are starting to pursue these parties through the courts.
Alternately, a suggestion that the insurance company is “onto them” can often see claims withdrawn. On numerous occasions witnesses often decided against assisting a claim when faced with a legally binding document which they need to sign. There is nothing like the force of the law to clear someone’s mind!
Red Flags For Documents
Unfortunately for those caught up in fraudulent personal injury claims, often tempted in by the “no victim” suggestion, it is often very easy for insurance companies to request an array of missing documentation.
- Details of the scene
Where for example whiplash claims have been made as a consequence of a road traffic accident it is very easy for the insurance companies to obtain weather reports for that day. If the claims revolve around dangerous driving in difficult weather conditions this can be confirmed or challenged fairly easily. Where there are gangs working together it may be possible to obtain independent third-party witness statements which cast doubt on the original scenarios. The police and emergency services can also be called upon to give evidence where they are asked to attend an incident.
- Medical records
As the vast majority of personal injury claims revolve around some form of physical injury, medical records can prove extremely important. Where a claimant has refused to attend a medical examination by an independent third-party, or provide their own medical records, this can prompt concerns of fraud. The fact is that those with nothing to hide would have no issue in supplying details of a medical examination or treatment received from their doctor. Why would you hide such information?
- Delay in supplying medical records
As much as refusing to provide medical records is often a red flag for insurance companies, so is a delay in supplying this information. This tends to give the impression that the claimant was unable to find a sympathetic medical expert to back up their claim for injury compensation. The same can be said of psychological issues “brought on” by an accident. In many ways this confirms the fact that you should have all of your information together before you seek to pursue a claim.
- Using artificial intelligence to spot fraudulent activity
In years gone by the insurance companies would be forced to go through many manual records to try and prove cases of fraudulent activity. After weighing up the cost and time associated with such claims, it was often more cost-effective to pay-up than undertake a potentially time-consuming manual record review. However, the Internet and advanced computer systems have created the perfect scenario for artificial intelligence.
There are now systems which can review written and verbal evidence from thousands of cases and flag any patterns of interest – automatically. The insurance industry claims that while artificial intelligence is still in its relative infancy it has already paid for itself many times over.
Summary
Even if a claim is flagged as potentially fraudulent this does not necessarily mean the claim will not be settled in full. It will however prompt the insurance companies to undertake a more detailed investigation of the evidence. The industry is now able to monitor patterns by certain individuals, certain advisers as well as the use of evidence provided by individual doctors. Whether or not this will force organised crime gangs to look elsewhere is debatable. However, for those individuals pursuing fraudulent compensation claims because it is a “victimless crime” it could prompt them to think again.
