There are some claims that sound so unbelievable, you just have to take a closer look. We open the file on the claims to remember

The case of the rockstar’s rug

Some cases reveal obvious evidence of foul play – but not actually on the part of the claimants. Crawford & Company’s national customer service manager Vic Noble recalls several cases where the specialists employed by loss adjusters have had to break the news that claimants’ priceless heirlooms are not all they seem.

A few years ago, the lead singer of a very famous (but unnamed) rock band bought a mansion on the outskirts of north-west London, and paid the previous owner £25,000 to leave behind an exquisite Persian rug. But when the rug suffered water damage, he got a nasty surprise. The specialist team sent by his insurers to see if the rug could be salvaged immediately realised that it was in fact a fairly average carpet you could get in the market for £150. “He wasn’t best pleased with the person he bought the house from,” Noble says.

On another occasion, an elderly lady claimed for some 17th-century Italian glassware. “She was adamant that it had been in her family forever, but when we got it checked, they turned out to be early 20th-century copies. She could never explain it. Someone in the family must have swapped them,” Noble recalls.

The case of the fake traveller

Sometimes it’s the smallest or most irrelevant things that may raise suspicion. When Aon’s head of claims John Bell first started out as a loss adjuster in the 1980s, he was sent to investigate what on first sight was a fairly run-of-the-mill travel claim.

“The claimant said he’d been on a trip to France for a few days and had all his bags stolen from a café along with all his money. It was only for £1,500, but things just didn’t seem quite right in my mind – it didn’t sound entirely plausible.”

When the claimant couldn’t produce either his passport or travel documents, it was a sign to probe further. Bell added the man’s name to a market circular sent round insurers and loss adjusters – not something insurers would get away with these days – and received several perplexing responses.

“I don’t have any record of a Barry Thomas,” said one, “but I have had the same sort of claim from a Thomas Barry.” Another had heard from a Thomas Lloyd, another from a Lloyd Thomas. Bell reported it to the police, who discovered paperwork relating to multiple claims – and the man got nine months in Wormwood Scrubs. “He actually never went on any of the trips. When we asked for the tickets, he was like ‘what do you want them for?’ We said ‘you have to prove you went on the trips’, it was almost like he never thought of it.”

But what first alerted Bell’s suspicions was a seemingly small detail – the man’s refusal to turn the TV off because he was watching the cricket. “It was an unexpected response. I was doing 500 domestic theft claims a year round the East End of London, and you could often tell when people opened the door. It was very much a behavioural thing.”

The case of the painted sofa

Allianz claims validation officer Hannah Stoker was recently passed an intriguing case where a man claimed he had been painting his living room ceiling, and moved his three-piece suite into the garage to avoid getting paint on it. Then he went to the garage to get a tin of paint, knocked the shelf and spilled a 2.5 litre tin of emulsion all over the sofa and chairs.

While plausible, such as odd claim was always going to merit further investigation. Stoker found the man had made a few previous claims for accidental damage. Then when she took him through what exactly had happened step-by-step, his account was word-for-word the same as the first notification, in other words it sounded rehearsed.

When a loss adjuster arrived at the property, he discovered that the furniture had been replaced in the living room even though the decorating wasn’t finished. And when he asked the claimant to describe how the furniture had been stacked up in the garage, he struggled. The loss adjuster pointed out that if it had been stacked the way he said, not all the furniture would have been damaged. The man couldn’t explain.

Stoker asked the forensic team to look at the report and photos. He said: “Based on what the insured had said, we concluded that while the incident itself could have been plausible, the paint damage was not consistent at all.”

But the real mystery of the case is why the claimant decided to make up such an elaborate story when he would have been covered for paint damage to the three-piece suite if he had left it in the living room. “Maybe he thought he wouldn’t be mitigating his loss if he left it in the lounge,” suggests Stoker. “But it seems completely mad to me.”

The case of the bookish intruder

In his long career as a loss adjuster, Grant Thornton’s client service director Angus Tucker has found diplomacy to be as important as technical knowledge when dealing with claims.

He was once called to the house of a elderly lady in west London. She was now too arthritic to use the upstairs rooms of her house, but following a recent storm she said the roof and some of her books had been damaged. Tucker found the roof was damaged, but the books seemed to be untouched.

“They were fine, there was no water damage at all,” he recalls. “But she said ‘no, you have to look inside’.” It turned out she had a dispute with her neighbour and she believed that he had been climbing up an apple tree in the garden, since the storm, shinning across into her attic and reading her books. “She was claiming for wear and tear on the words in the books – the black and white was wearing away as he read them. She was really, really genuinely serious and she couldn’t understand why the claim wasn’t being paid.”

With a straight face, Tucker meticulously compared the “damaged” books with some she stored downstairs and demonstrated that there was no difference. There was no claim, he explained, because there was no damage.

When he got back to the office, the claims manager was on the phone with a complaint from the poor lady. Tucker says: “He sounded like he was trying not to laugh. ‘You’ve gone too far this time Angus,’ he said. ‘When you left, you slammed the door so hard, you smashed three windows.’”

Tucker hastens to add that he hadn’t done anything of the kind. “In a way, claims like that are harder to deal with than fraudulent claims.”

The case of the flaming trousers

It’s not hard to see why this story has stuck in the mind of AXA’s claims director, David Williams, and not only because it ended up costing the insurer an awful lot of money.

“A gentleman who ran a printing firm claimed that on Christmas Eve, he was painting within the property and the next thing he knew, he woke up and his trousers were on fire. He couldn’t explain it.” A master of understatement, Williams adds: “It just didn’t ring true.” The property had been completely destroyed, resulting in a claim for over £1m. The business was struggling – it wasn’t a good time for the printing industry – and though the man claimed he had just got a new multimillion-pound contract from the States, he couldn’t provide any evidence of this. But as far-fetched as the claim seemed, the insurer ended up paying out. “We couldn’t prove that he was lying,” says Williams. “That’s the problem with these things.”

The case of the £60,000 ski suit

High net worth claims tend to be a little more exotic than the norm, or at the very least quite a bit more expensive. The broker Home & Legacy’s household manager Ian Davies is regularly confronted with tales of people doing reckless things in glamourous locations.

“One client who was very wealthy had a large schedule of jewellery insured with us. He went skiing and his wife decided to wear all her jewellery on the slopes. One item was a £60,000 bracelet – and lo and behold, it wasn’t on her wrist for very long.”

Davies could perhaps have argued that wearing a very precious bracelet on a ski slope doesn’t exactly count as taking reasonable care, but there was no way he could prove it hadn’t happened. “I think that’s a pretty strange thing to do, but it’s the sort of thing you see all the time in high net worth claims. People with money do very silly things.”

The case of the kamikaze pigeon

Just because a claim sounds mad, that doesn’t mean it didn’t happen. Esure’s head of corporate communications Adrian Webb heard of a case where a policyholder claimed for a chimney stack that had collapsed – because a pigeon had flown into it.

“The claims handler suggested it was highly unlikely that a pigeon could cause so much damage, but the policyholder replied: ‘Well, they are big pigeons that fly around here. I think this is a case of kamikaze pigeons!’ We investigated and paid out as the chimney stack had clearly been hit by something.” IT