Fraud in deafness cases

Numbers of new disease claims, and deafness claims in particular, have rocketed in recent years. Some insurers have seen new deafness claims increase by over 25% in the last 12 months alone. There are obvious reasons for this trend. The new ELTO database has made it easier for claimant solicitors to trace the insurers of defunct companies and so turn more client enquiries in to claims.

Marketing by claims management companies has been more aggressive than ever. Many set up stalls in shopping centres offering free hearing tests as well as generating claims from cold calling and text messaging. Some claims management companies and claimant solicitors obtain medical reports before a claim has even been initiated, often engaging the services of doctors who do not apply as rigorous an assessment as to diagnosis of noise induced hearing loss as we would expect.

In a depressed financial climate and in the face of such tactics, it is hardly a surprise that numbers of claims are on the increase. However, as the numbers increase so too, in our experience, do the number and proportion of spurious and fraudulent claims.

So what makes deafness claims a target for fraud?

One factor is that many involve historical exposure with companies who are no longer trading. Insurers often do not have any means of gathering the evidence they would need to defeat the claim. They are usually claims of low value. The temptation to an insurer can be to settle cases early in an effort to limit claimant costs and so overall indemnity spend rather than investigate them rigorously. The focus for the defendant community needs to be on dampening the expectations of the claimants and overturning any perception that these claims are an easy target. Fraud in the context of deafness claims can take many forms:

• Bogus claims where, for example, an imposter has attended the medical examination. There is no reason why medical experts should not be instructed to routinely check photographic ID at each examination
• Claimants misrepresenting the material facts, alleging, for example that they worked for long periods in noisy areas of a factory when that was not the case or denying they ever had access to hearing protection which was provided. Often, the content of a claimant's personnel records and/or a thorough investigation with the defendant company can help to discredit these claimants.
• Claimants failing to give consistent and accurate responses to audiometric testing, fuelling the belief that they are attempting to deliberately exaggerate their hearing deficit when their hearing is tested. In such situations, objective "CERA" testing can be arranged to determine their true hearing thresholds
• Exaggerated claims for special damages, typically hearing aids. Some doctors routinely suggest that claimants with a modest hearing deficit need very expensive, state of the art hearing aids supporting claims for tens of thousands of pounds for aids which the claimant may have no intention of purchasing.

If the right tactics are adopted and evidence obtained, the fraudsters can be identified and their claims defeated. Keoghs' disease team handles large volumes of pre-litigation deafness claims. We are getting a number of these withdrawn and discontinued on the basis of fraud.

So how can insurers ensure that they are identifying the cases where there are potential fraud issues and selecting the right cases to fight?

We advocate a checklist approach to handling these claims, putting processes in place to identify potential fraud issues at key stages of the case to ensure that they do not slip through the net. The process is also assisted if insurers and their solicitors take a strategic approach, building claims profiles for different categories of claim, firms and experts whose activities give them cause for concern and then directing resources in to a thorough investigation of those cases. Adopting these strategies, can change behaviours in the claimant community and send the message that the fraudulent cases will be defeated.