# Insurance paid fraudulent personal injury claim



## krissyn (Jul 27, 2014)

Hi,

My partner was involved in an small incident two and half years ago. She was reversing into a parking space at very low speed and accidentally touched a parked car. No damage to her car, the other car had a broken indicator plastic/lens. No other damage to the other lights, no dents, nothing. 

The other car wanted to £400 for the damage, then £200, then finally £150. My partner notified the insurance company, but then proceeded to settle privately.

Fast forward two years and now the other car is claiming personal injury and has a doctors note to support this. My partners insurance company spoke to my partner on a couple of occasions but have never sent anything in writing despite being asked to. They have now paid out to the other party without evening finding out the circumstances of the incident e.g. where the cars were hit, what speed they were travelling at etc. Not to mention taking into account the fact the other car was already covered in dents from previous accidents. They haven't even checked if somebody was actually in the parked car at the time of the incident.

My partners insurance company has said "it's a personal injury claim, we can't refute the independent doctors evidence that the accident caused the injury". therefore they have just paid out. 

Is it normal for an insurance company to pay out like that without finding out the circumstances of the incident? Should they have asked my partner for the circumstances surrounding this incident? And asked her for any evidence she may have for the damage etc?

They haven't even been able to give her an accurate date for when the incident occurred, initially they claimed it was this year!

To cap it all, she did raise a complaint with them. They didn't bother to speak to her to find out about the complaint and just sent a final decision letter with regards to the complaint straight away. This was the first time they had given her any written acknowledgement of the claim.


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## Guitarjon (Jul 13, 2012)

Sounds dodgy but also sounds like its all too easy for it to happen.


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## nick_mcuk (Jan 4, 2008)

Jesus I wish I would get paid out on my accident last September when I got taken out by a lorry and ended upside down in a field....only just got the wife's NCD back and my solicitors are still fighting for my compensation!


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## krissyn (Jul 27, 2014)

Nick, that sounds dreadful. I know many injury claims are fully justified as yours is, its the blatantly fraudulent ones that **** me off.

Interestingly the ABI has guidelines on personal injury, they talk about settlement in less than 3 months, and interest is payable on delayed claims. Might be worth having a look.


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## Darlofan (Nov 24, 2010)

Been saying for years that minor injury payments should only cover losses. So you should only be able to claim for lost wages or costs. I know a few people who took no time off work yet still claimed for whiplash. If you can work you're not in that much discomfort. Also anyone not working should be able to claim as they have lost nothing.


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## Guitarjon (Jul 13, 2012)

nick_mcuk said:


> Jesus I wish I would get paid out on my accident last September when I got taken out by a lorry and ended upside down in a field....only just got the wife's NCD back and my solicitors are still fighting for my compensation!


I remember seeing the pictures you posted of that. Saab wasn't it! Looked really bad.

They aren't the quickest people in the world to arrange things. I waited over 4 years for the insurance company to sort my claim out. I wasn't even claiming compensation just wanted my £500 excess back and my no claims to be reinstated as it wasn't my fault. In fact The third party completely smashed up my rear end and didn't even report it to their company. I did but it took a while for their insurance to even accept liability. I wasn't in the car ( parked up). They get there in the end. I was ready to go to court though.


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## davo3587 (May 9, 2012)

Many years ago i was involved in an accident where by the driver in front of me slammed on and tried to turn right, i slammed on and made contact with her tow bar and caused quite some damage to my nova ( thats how long back it was ). There was no damage to her car as the tow bar took the brunt of it, the police came out and took statements, 12 months later when i went to renew my insurance i was informed by them that my premium was so high due to them paying her £11500, i almost choked and asked for what, they told me for the driver and her 3 passengers, i told them that the police had turned up and took statements and she was the only occupant of the car, the insurance told me that they had no reason to disprove her so they paid her out. What a joke they are.


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## ITSonlyREECE (Jun 10, 2012)

krissyn said:


> To cap it all, she did raise a complaint with them. They didn't bother to speak to her to find out about the complaint and just sent a final decision letter with regards to the complaint straight away. This was the first time they had given her any written acknowledgement of the claim.


Unsure about your position, but this might shed some light on the complaint and what you can do if you think you are right...

If complaints which are handled buy insurance are a similar process to banking (which I think they are), then they either send out an 'acknowledgement letter', investigate your case and then follow up with a Final Response Letter. Alternatively, if they don't need much time to review the case then they will acknowledge and close off your case in one letter... Which is what they've done with you - they're allowed to do that. If you have any further evidence which they didn't know if before then you can contact them again to re-activate the case. Otherwise if you are unhappy with the decision you need to contact the Financial Ombudsman Service (FOS) to take the complaint further... That's not to say that you will still win the case. If you go to the FOS then you will want to clearly state each reason why you think your insurance company acted too hastily in paying out on your behalf, that they didn't consult or inform you before hand, and if you have any archived emails which prove you settled with the other person privately send them as well!

I don't know if you are in the right or if the insurance company acted correctly due to the time which had passed (I don't work in insurance), but this might help you if you think you have a leg to stand on


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## smegal (Aug 14, 2009)

Darlofan said:


> Been saying for years that minor injury payments should only cover losses. So you should only be able to claim for lost wages or costs. I know a few people who took no time off work yet still claimed for whiplash. If you can work you're not in that much discomfort. Also anyone not working should be able to claim as they have lost nothing.


Hear hear.

I guess most people who aren't self employed incur minimal costs if any as a result of a minor injury.


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## millns84 (Jul 5, 2009)

It's a farce.

Independent doctors?? How would they make an absolute fortune if they weren't getting hundreds of claimants to examine from dodgy solicitors? They're not going to stitch themselves up are they?

I'm unfortunate enough to work in the profession and know all the tricks that these people use. It's a disgrace, and the pretence of "cracking down on fraudulent claims" is a complete joke.


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## MDC250 (Jan 4, 2014)

millns84 said:


> It's a farce.
> 
> Independent doctors?? How would they make an absolute fortune if they weren't getting hundreds of claimants to examine from dodgy solicitors? They're not going to stitch themselves up are they?
> 
> I'm unfortunate enough to work in the profession and know all the tricks that these people use. It's a disgrace, and the pretence of "cracking down on fraudulent claims" is a complete joke.


Easy tiger, expert fees have unquestionably been massively driven down by changes to the MOJ process. Medical experts often get a relatively small amount if instructed via an agency and the insurer will often get a kickback from the medical agency!

Where a Claimant has been found to be fundamentally dishonest even on a discrete aspect of their claim their entire claim fails under the current system. This does need advertising more.

Dodgy Claimants will get costs orders against them and Defendants will actively go after money. A colleague of mine has successfully compelled sale of a Claimant's property to meet the adverse costs order that was made against them at Trial.

The fact Defendant Solicitor firms are making redundancies predominantly across their fraud departments suggests to me that either fraud is not as big a problem as insurers would have you believe or the system is fit for purpose as the demand for Defendant Fraud specialists is dwindling.

Nobody makes an insurer fight a claim, they do have redress. If they pay out they can't have it both ways.

Only one loser in this and it's access to justice, Joe Public just can't see it.


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