Keoghs Insight



Soup tin trip claim found to be fundamentally dishonest

News And Events25/01/2018

Department of Work and Pensions records help expose fraudulent claim, saving insurer Zurich over £100,000

Edwards v 99p Stores Limited

A blatant attempt to fraudulently secure damages arising from a trip in a discount store has come unstuck, with a judge finding a substantial care claim to be fundamentally dishonest. This has resulted in the claimant losing her QOCS protection, and having to pay the defendant’s costs on an indemnity basis.

The finding represented a saving of over £100,000 for insurer Zurich who, with the help of leading defendant law firm, Keoghs, uncovered flagrant exaggerations.

The claim originated from an alleged fall when the claimant trod on a tin of soup; an incident which was not witnessed or captured on CCTV.

The claimant submitted medical evidence which conceded minor symptoms prior to the trip, but claimed up to 60% of her ongoing symptoms were caused by the fall. She also stated that it had put paid to the possibility of her obtaining employment whilst her daughter was now required to help with a substantial amount of domestic and personal care tasks. Furthermore she said that her husband had provided a lot of care and support whilst she had subsequently taken on a paid carer who had, apparently, been in the store at the time of the incident.

She also claimed, without supporting documentation, costs for window cleaning and the laying of a new patio, asserting she had previously been able to clean some of her windows and her decreased mobility levels since the incident meant her uneven patio needed relaying.

In fact, investigations by Keoghs revealed a very different story. DWP records showed that the claimant had been receiving the same rate of mobility allowance as a paraplegic for numerous years and had applied for a stair lift prior to the incident. It was also disclosed that she had not worked for over 20 years and was on a plethora of medication at the time of the accident for her pre-existing symptoms. Indeed, the records showed that she had reported to the DWP that she could not leave the house alone or walk more than four metres, further highlighting the strange decision to drive to the defendant’s shop rather than going to a convenience store situated 50 feet from her front door.

Equally perplexing was the fact that she had been separated from her husband for many years and, crucially, that her daughter had been carrying out a multitude of personal care and domestic tasks for several years prior to the incident. It was also concerning that the claimant’s paid carer, who had apparently been in the store at the time of the incident, was not asked to give any witness evidence regarding the fall or care received post-accident. Neither was her husband.

A medical expert was employed to examine the claimant’s medical records. He found the claimant to be an unreliable witness who even refused to answer some questions, also concluding that she had longstanding, significant problems pre-accident.

Despite the claimant being invited to abandon her claim, the offer was rejected and the case proceeded to a four day trial. Here the claimant’s medical expert proved to be unreliable, conceding under examination that he suspected a further injury which he had not mentioned in his previous reports. The claimant was also a poor historian in court, her account proving inconsistent with written records.

The claimant’s daughter, who had been present on the previous trial days, did not turn up to trial when due to give evidence. At this point the claimant made an attempt to settle outside of court, an offer which was flatly rejected. She then sought a discontinuance on the basis that she was not reported to the DWP. This was also refused, following which the claimant discontinued unequivocally.

A finding of fundamental dishonesty was sought and, whilst the DDJ Rogers declined to impose such a finding on the claimant, the judge had little hesitation in finding the substantial care claim was, indeed, dishonest and was a fundamental part of the overall claim. As a result, the claim was dismissed, her QOCS protection lifted and the claimant ordered to pay the defendant’s costs on an indemnity basis, saving insurer, Zurich, over £100,000.

Chris Henson, Keoghs’ Associate who handled the claim said;

“This was a great result for Zurich and serves as a warning to any claimants who try to exaggerate their claims for damages. It proves the value of obtaining relevant disclosure documents and painstaking examination of the records. This claimant could have abandoned her care claim at any point prior to trial but proceeded all the way through and presented witness evidence from her daughter which was substantially inconsistent with evidence presented to the DWP over time.”

Keoghs Partner, Nina Dayal, added;

“This is a particularly satisfying judgment given the potential costs involved for Zurich, and the work put in by both Keoghs’ and Zurich’s teams. We are seeing an increase in the overall trend for slip and trip claims, and it’s vital that the industry takes heed of the warning signs and acts wherever possible to stamp out this area of insurance fraud.”

Keoghs casualty fraud team is the longest established in the defendant insurance market, dealing with fraudulent EL/PL claims for major insurers and their corporate clients across all sectors.