Hospital A&E departments and orthopaedic wards are stretched to their limits dealing with casualties from genuine road traffic accidents. Likewise, general practitioners' surgeries and physiotherapists are busy providing aftercare for victims.
But the problem for insurers is the ever increasing number of fraudsters and their accomplices who on a daily basis exploit the high number of accidents: their aim is to defraud the insurance sector by presenting dishonest claims forms.
The players are not restricted to the poor or unemployed. In our experience, we are dealing with well-heeled claimants that have professional positions in the workplace and that are simply driven by greed.
On the other hand, we know of groups of dedicated individuals who set themselves up as an illegal co-operative and systematically, by using false identities and mail drop addresses, attack insurance companies one by one.
Our experience shows that they have no fear of detection even when, under the Theft Act, there are specific criminal offences, including attempting to obtain a pecuniary advantage by deception, perverting the course of justice and perjuring themselves in the process of giving formal written statements, that carry significant prison sentences.
But clearly this is of no deterrent to the determined and well organised fraudster.
In establishing whether a claim is fraudulent, the claims handler who has initial control of a file, needs an eye for detail and a sharp and enquiring mind. For example, the handler must be aware that the claimant will usually have a plausible explanation and will readily admit that he or she is at fault for a particular incident.
However, when questioned more closely, it will often become apparent that, for example, the police were not called, even though there were injuries such as whiplash.
It is not unusual for the person making the claim to state that he had arranged for the vehicle to be towed to a particular garage and that his claim is being dealt with by a well known named claims management company and lease hire company.
This will be closely followed by letters from lawyers who are well established in the personal injury sector for dealing with such claims.
Ideally, an investigation should begin at this stage, without delay.
How to go about it
The bona fides of a claim must be established immediately to trace, firstly, the background of the vehicle in the claim and the bona fides of the claimant and his associates.
Thereafter, all those involved should be interviewed and details of the incident recorded in a comprehensive statement, including any witnesses and passengers in the vehicles concerned.
It is not unusual to discover that vehicles involved in a claim have been previously written off, having been purchased from a salvage dealer. This would illustrate a typical pattern of a fraudulent claim.
It is clearly preferable that the insured, on first notification that his vehicle has been damaged, is instructed to take it to a nominated garage. This should coincide with the location of the third party's vehicle, so that both can be thoroughly examined.
For some considerable time, RG Investigations (RGI) has been working on establishing faster and more effective means of dealing with such claims. RGI has its own forensic scientists who carefully examine vehicles – to the extent that they take paint samples and age the damage on a vehicle at the point of the alleged impact.
Furthermore, forensic evidence has enabled us to mathematically reconstruct accidents that at first appear genuine, but are later identified as fraudulent. This is a new concept in the detection of staged accidents, but has proved successful in foiling well organised teams involved in this lucrative and fraudulent operation.
Our clients are now seeing the benefits of such examinations, as claims are being repudiated quickly because the forensic evidence contradicts the insured's and third party's version of events. This also indicates that alleged injuries may be fraudulent.
At RGI, we only accept that a credit hire company has supplied a vehicle to an insured, or third party, when we have checked whether the documentation for that vehicle's hire matches the accident repair garage's invoices for the order of new parts for the vehicle concerned.
Invariably, these enquiries establish that this is another area where companies have been far from honest and have, in fact, assisted in some fraud.
No effort is spared
In some cases, the evidence collated shows the claimant has been assisted by legal advisors, medical experts, credit management companies and garages in claims that have been repudiated and then referred to the police.
It cannot be stated any more clearly than this: the dishonest claimant will go to any lengths to state that his claim is genuine. This will include the forgery of a vehicle's service history, repairs and other documentation which in most cases can deceive a claims handler. They use a well practised and previously successful version of events, including plausible witnesses to back their claim.
In a recent case, we discovered that receipts for repairs surrendered to our claims investigator were bogus. On forensic examination of not only these documents, but also the vehicle, it was discovered that the documents had been professionally forged.
The vehicle was not involved in a collision with another car, as had been reported, but had been driven into a tree. On further examination we discovered the vehicle had been stolen and that it had, in fact, been used as a taxi – but this detail had not been declared at the inception of the policy.
Not only was the claim fraudulent, but there had been serious misrepresentations of the policy conditions and usage.
RGI is currently presenting a full forensic package to either confirm or repudiate the circumstances described in the case. Our approach to staged accidents is clearly breaking new ground and we believe greater success can be derived from insurers using forensic science.
Within the next few years, we envisage solicitors and accident investigation companies will work together more closely to protect their clients' interests.
This will achieve a more efficient investigation and form new partnerships for the detection and prevention of future systematic fraudulent claims.
Without doubt the insurance sector has been on the back foot for far too long in respect of such claims, but there is no better time to attack and identify this problem than now.
