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Insurers fighting fraud

Published: 16/12/2016

Allianz has secured another Fundamental Dishonesty ruling, as the judge dismissed a bus driver‘s claim and ordered him to pay the indemnity costs of the defendant.

In June 2013, the engine of the bus the claimant was driving suddenly caught fire, whilst it was travelling along a motorway. The driver alleged that his co-driver abandoned the bus immediately and that as he attempted to evacuate there was a sudden explosion which caused him to be thrown backwards onto the metal barrier of the hard shoulder. He claimed that he managed to crawl under the barrier before losing consciousness, coming around some time later. As a result, he’d sustained serious injuries to his back, in addition to suffering from smoke inhalation and subsequently, Post-Traumatic Stress Disorder. His claim for damages had the potential to exceed £100,000.

As part of the investigation the Allianz major loss claims team interviewed the co-driver who confirmed that both he and the driver had left the bus without incident and had watched the fire take hold from a safe distance. He, along with a fire investigation officer, had taken photos of the bus at the scene. The claimant was clearly visible in these photos and looks perfectly well, which was entirely at odds with his version of events.

Based on the evidence, Allianz chose to deny liability and applied in advance of the hearing for a finding of Fundamental Dishonesty.

On reviewing the medical evidence, which contained anomalies, and hearing the testimony of the two key defence witnesses, the Judge found that by the standard of ordinary honest people the conduct of the driver could only sensibly be described as “Fundamentally Dishonest”. The claim was dismissed and the bus driver was ordered to pay costs in the sum of £35,000 upfront, with the balance to be assessed at a later date.

Earlier this year, Allianz successfully appealed against a noise induced hearing loss case, with the judge ruling that the Fundamental Dishonesty test had been satisfied as the claimant has not been truthful about facts which formed the basis of his claim.

Insurers have to take a tough stance on fraud to protect their clients and to dissuade future fraudulent claimants. Fraudulent claims costs the industry millions every year; ultimately pushing up premiums for the majority of honest policyholders.

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