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CRAWFORD & COMPANY

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Don't ‘write off' recoveries: insurer pays claim, CLS uncovers fraud & subsequently recovers ú21k

07/27/2021 | 04:00pm EDT

Meet 'Fred'. (For the purposes of this article, we've changed his real name). Fred's account of the incident was straightforward.

He dropped his Mercedes 4x4 into his local garage in Knockloughrim, NI, on a Friday. The car went in for a 'winter service'.

The owner of the garage (let us call him 'Barney') called Fred on Monday morning with 'bad' news. The service had been completed but, on a test drive, the car had been badly damaged - debris in the road had punctured the oil sump. Oil drained from the engine causing catastrophic engine damage.

Fred hadn't yet seen the car and no one had assessed the damage, however, Fred immediately contacted his GAP insurers to begin a claim.

Before the GAP claim could be considered, an insurer needed to make a total loss payment. Fred initially began a claim against the garage. The garage's insurance broker referred the claim to the wrong insurer - the goods in transit policy refused to respond. In response, Fred switched his total loss claim to his own motor insurer who arranged for its engineer to assess the damage, and subsequently took the accident circumstances at face value and paid the claim. The total loss payment to Fred was £21K.

The GAP insurer was not convinced - Fred's car was high mileage, the policy had two days left on a three-year policy term. A total loss payment would net Fred £16K. The claim was referred to Crawford Legal Services (CLS) to validate…

CLS' Investigation and the Fraud

Things that immediately struck CLS' counter-fraud team:

  • Fred reported the claim to his GAP insurer on the same day of the 'accident'. He hadn't even had the damage assessed at that point. How did he know the car was a total loss?
  • Barney was questioned about the fact that Fred's car had been damaged on the test drive - he was vague. On one hand the damage was caused by a pothole, but on the other the garage mechanic had driven over scrap metal fallen from the rear of a lorry.
  • Fred was asked about his previous claim history - he admitted an earlier accident from 'five or six' years ago. CLS insisted that Fred provide details and documents relating to the claims - it turned out this was actually just over three years earlier. Only under pressure did Fred admit his earlier accident had led to a previous GAP insurance claim.
  • Fred's previous RTA had led to the total loss of his Jaguar XJ and, by striking coincidence, the RTA occurred on the second last day of the GAP policy term. The previous GAP insurer was traced and the claim reviewed - the previous motor insurer and previous GAP insurer had no concerns at the time, but conceded the claim looked suspect with the benefit of hindsight.
  • Fred and his wife stated that they had no social connection with Barney and his garage - ie they didn't know him. Detailed social media analysis by our Insight Team established extensive social media connections between Fred and Barney's families.
  • CLS sought to interview Barney and the garage owner. Insight established that Barney had previously been banned from being the director of a business for the maximum 12 year period due to serious corporate misdemeanours. Barney and the garage owner refused to cooperate with CLS attempts to establish the accident circumstances.

With serious concerns established, CLS instructed forensic engineers to reinspect Fred's vehicle. It turned out that the damage to the bottom of Fred's car had been caused deliberately by the use of an angle grinder, a hammer, and a screwdriver.

After this piece of evidence was established, both Fred and Barney were contacted again by our counter-fraud team. Barney aggressively denied that the garage had caused the damage to the car. Fred refused to provide a further statement and instead instructed solicitors.

CLS, liaising with Fred's motor insurer, declined the GAP claim on the grounds of fraud, specifically:

  • The damage had been caused deliberately.
  • Fred had a substantial financial motive to have the car deemed a total loss.
  • Fred was dishonest regarding his relationship with Barney.
  • The garage story, like the bottom of Fred's car, was full of holes - the garage's vagueness about the cause of the damage was significant.
  • Barney had previously been convicted of serious dishonesty.
  • The alleged RTA was on the second last day of the policy term.
  • Inferences could be drawn from the previous GAP insurance claim in remarkably similar circumstances, which Fred had attempted to conceal.
Recovery proceedings

Immediately following the decline of the claim, CLS was instructed by Fred's motor insurer to recover the total loss payment made to Fred in the sum of £21K. A recovery action was launched against Fred, Barney and the garage on the basis that all parties associated with the deliberate damage to Fred's car were jointly and severally liable in the tort of deceit for the loss caused.

CLS is acting for numerous RTA insurers in similar circumstances to recover substantial total loss and other claim payments, exemplary damages, and costs from fraudsters motivated by the existence of GAP insurance to fabricate accident, arson, deliberate damage and theft claims from policyholders and their associates.

Often, fraudsters (even when caught red-handed) compound their original fraud by refusing to repay insurers.

Fred, however, quickly agreed to repay insurers £21K.

Lessons for Insurers - Don't 'WRITE OFF' recoveries

For Fred's motor Insurer this was a familiar scenario - one faced regularly by all motor insurers: its policyholder's vehicle was damaged beyond repair but through no fault of his own. The garage would have insurance and Fred's insurer naturally expected to recover the total loss payment via a subrogated claim. Quite rightly, motor insurers try to settle non-fault claims as quickly as possible, but inevitably with minimal or no validation. The motor engineer, in this case, had simply valued the vehicle and confirmed the existence of damage, but he/she had missed the fact that the damage had actually been caused deliberately.

The motor insurer in this case had no knowledge of the GAP claim, and this is common when it comes to motor claims.

Had the RTA insurer noted the previous total loss from September 2017 it still would have been unaware of the associated GAP insurance claim.

When fraud is uncovered, motor insurers regularly write off the payments they have made and don't consider going down the road of pursuing recoveries. Recovery actions are often seen as costly with little prospect of success. But, in our experience, we would urge insurers to reconsider the viability of recovery actions.

CLS acts for GAP and motor insurers on a CFA basis and has recovered hundreds of thousands of pounds for motor insurers that have been induced into making a total loss and other claim payments by fraudsters.

What we also know with some certainty is that previous, similar claims are a strong fraud indictor. Previous GAP insurance claims can be difficult to identify and investigate. But given CLS acts for a number of GAP insurers, our team was able to trace and investigate the previous claim in this particular case.

Fred's winter service turned out to be more expensive than he bargained for - his insurers have returned his very badly damaged 4x4 to him and retained his insurance premium, Fred has repaid the £21k, plus CLS' costs. The garage insurer has been notified of its policyholder's fraudulent conduct. Fred didn't get his £16K GAP payout either.

Fred now faces a recovery action in relation to the September 2017 RTA. Both the GAP insurer and motor insurer from that claim want their money back too….

Let us help, contact:

Peter Oakes
Head of Counter-Fraud, Crawford Legal Services
E: peter.oakes@crawco.co.uk

Disclaimer

Crawford & Company published this content on 27 July 2021 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 27 July 2021 19:59:00 UTC.


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