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FRAUD

Review

A quarterly review from Greenwoods Issue 16: December 2010

Personal Injury l Property & Construction l Insurance l Commercial & Financial Risks l Fraud l Health & Safety l Motor Prosecutions Greenwoods’ Counter Fraud Group works to prevent

fraudsters capitalising on illegal activity commonly involving road traffic accidents. Our specialist teams, based across the country, have in-depth knowledge and experience of defending all aspects of such claims, including personal injury, bogus passengers, credit hire exaggeration and falsified damage. We also work to combat fraud rings and our intelligence team has access to high quality modern databases enabling thorough

analysis of parties and companies alike. We consistently provide the highest standard of service to our clients and our focus is always that of our clients’ best interests. This publication provides details of some of our recent successes and updates as to the expansions of our teams and services. Should any reader wish to make further enquiry then full contact details are provided at the end of the bulletin.

INTRODUCTION

In this issue

- Case examples

- An introduction to some of

our team

- Counter Fraud Group

expands to Milton Keynes

- Updates on fraud capabilities

Seminars

- Review of the Construction

(Design & Management)

Regulations 2007, 13 January

- Fraud Update, 25 January

Bristol

One Redcliff Street BS1 6NP T. 0117 910 0200

London Bedford Square

18 Bedford Square WC1B 3JA T. 020 7323 4632

London Market Office

77 Gracechurch Street EC3V 0AS T. 020 7220 7818

Manchester

57 Spring Gardens, M2 2BY T. 0161 245 6520

Milton Keynes

2 Eskan Court Campbell Park MK9 4AN T. 01908 298200

www.greenwoods-solicitors.com

Case

STARBUCKS LOGISTICS LIMITED (JOHN SHAVE) v

KHEYAL GUL, BOURNEMOUTH COUNTY COURT

The claimant alleged that the insured driver had driven

into the claimant's stationary vehicle, causing significant damage and personal injury. The insured driver admitted that the accident had occurred, but categorically maintained that he was not at fault. His version of events was that the claimant had pulled out from a parked position and had collided with the rear offside of his vehicle. The claimant’s statements of case were consistently poorly drafted and this led (despite our objection) to the trial in March 2010 being adjourned, and the claimant being given permission to amend his Particulars of Claim.

The amended Particulars alleged that there had been two collisions: the one originally pleaded and one prior to that, where the defendant was said to have driven past the claimant and hit his wing mirror.

Two independent witnesses, who had provided their details at the scene, attended the trial.

The claimant's counsel surprisingly conceded at the outset that the only damage caused by the first impact was valued at £200. The remaining losses, which totalled £15,443.85 for pre-accident value (£1,800), hire (£10,810), storage and recovery (£2,798.85), and miscellaneous expenses (£35), as well as personal

injury, quantified at around £3,100, were all alleged to be the result of the second impact.

The defendant denied that there had been two accidents. There were numerous discrepancies in the medical evidence, and the claimant’s witness statements, as well as the stark differences between his first and second particulars of claim. All these points were used to discredit him at trial. A lot of emphasis was placed on the contact point between the two vehicles, and the defendant, although not very clear on road layout clearly remembered the collision itself and provided a clear description of how he could not have hit the claimant's vehicle as alleged (in the second accident).

The outcome of the liability decision was: 1) the defendant had unknowingly collided with the wing mirror of the claimant's vehicle as he drove past it in his DAF lorry.

2) the claimant had then chased the defendant and parked ahead of him at the side of the road. As the defendant's lorry was passing, the claimant pulled out to follow him and collided with the rear of the lorry. The claimant was at fault for the second accident.

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The second accident was the one we had been defending all along. The judge made it very clear that he considered the defendant to have won the trial, but he awarded the claimant £200 for damage to his wing mirror, to be offset, and he awarded the claimant his legal costs of issuing the proceedings, which were £360.

The defendant was awarded costs on a standard basis to be dealt with by detailed assessment if not agreed. Savings to the client = £46,000.

Appeal

The claimant applied at the hearing for permission to appeal and this was denied. The judge indicated that he would advise against the claimant pursuing the appeal.

The claimant later filed a written application to appeal. He attempted to utilise his own summary of the judgment. We wrote to the court objecting to this as the summary was biased. The court agreed and the claimant was ordered to serve the full judgment. He

did so, coupled with a number of sketches supplied by his counsel which it was suggested amounted to expert evidence. We took the unusual step at this stage, of writing to the court expressing our concern at the claimant’s attempts to have an appeal on new evidence, and that the origin of this evidence was unclear. The court has now confirmed that permission to appeal has been denied. Laura Kelly: lmk@greenwoods-solicitors.com

/cont’d

FRAUD

Review

The claimant insured claimed indemnity from the defendant, its insurer in respect of a fire which occurred at the claimant's industrial estate. The principal shareholder in the claimant company was an individual. Condition 7 of the general policy conditions applicable to the policy issued by the defendant entitled it to avoid the policy from inception if a claim was fraudulent or intentionally exaggerated or a false declaration or statement was made. The defendant denied liability on a number of grounds: that the claimant had previously made a fraudulent claim for which it had paid £9,870 in respect of damage to a drain at the industrial estate; the claimant failed to disclose to the defendant at inception of the policy that the individual and his wife had made a fraudulent claim against a prior insurer in respect of water damage to a holiday lodge; the claimant failed to disclose that on numerous previous occasions that the individual had made misrepresentations and/or non-disclosures when presenting to other insurers.

In respect of the drain the defendant's loss adjuster was told that it had collapsed and a contractor had given a quotation of £8,000 for the repair works. The loss adjuster was later sent a copy invoice from the contractor for £8,400 plus VAT making £9,870. The invoice was marked "Paid in full with thanks". The defendant paid the claim. It contended that the problem with the drain was lack of maintenance which

was not an insured peril and that the contractor's invoice was bogus and the amount claimed was exaggerated. Accordingly it was entitled to void the policy from inception under condition 7, with the result that the £9,870 should be repaid together with the payment made in respect of another earlier claim. The defendant further contended that it was not liable to pay the instant claim in respect of the fire. The High Court judge found that the evidence did not show that the collapse of the drain was not an insured peril but, on the evidence, the claimant had not paid £9,870 to the contractor and had not actually paid that sum to anyone. The claimant only paid the contractor £5,000 at most. To that extent the claim had been knowingly exaggerated. The contractor had given a quotation to the individual for £8,000 or so plus VAT and they had agreed that he should put in an invoice for around that sum. The wording "Paid in full with thanks" was designed to show that the monies claimed were properly due and had been paid. The claimant falsely and fraudulently stated by submitting the invoice that the contractor was owed that sum and had been paid. No more than about £6,700 had been paid in total. The claim was thus both fraudulent and intentionally exaggerated within Condition 7. The invoice was also a false declaration or statement. The individual and thus the claimant had acted dishonestly. It was no defence to say that the claimant could have

made a lesser claim in a non-fraudulent manner. Nor could it rely on a concept of proportionality to the effect that it had paid out most of the sum claimed. The defendant did not have to show under Condition 7 that it had relied on the fraudulent statements. The judge also found that the operation of Condition 7 meant that the defendant was not liable to indemnify the claimant in respect of the instant claim and could reclaim the monies paid out on the drainage claim and the other prior claim. The defendant would also have been entitled to void the policy on the basis that the individual and his wife had made a false claim against the insurers of their holiday lodge. On the evidence, they had taken out a policy to cover the lodge after they had discovered that it had been affected by flood damage and then made a claim representing that the damage had occurred after inception. Such a fraudulent claim should have been disclosed to the defendant and was not, thereby entitling the defendant to avoid the policy from inception and reclaim all monies paid under it.

The individual had a conviction for criminal damage which he had failed to disclose to previous insurers. He and his businesses had also made other false statements to other insurers when seeking insurance or when making a claim. Where several facts were said not to have been disclosed, the court had first to

ENTITLEMENT TO AVOID POLICY WHERE CLAIM WAS FRAUDULENTLY AND

INTENTIONALLY EXAGGERATED

Case

Joseph Fielding Properties (Blackpool) Ltd v Aviva Insurance Ltd (2010) EWHC 2192 (QB)

Page 2 of 7

(3)

find the relevant facts and then consider materiality in the round. The focus in this case was a series of false statements made to prior insurers. Even if it was possible to conclude that one false statement in isolation was relatively insignificant, taken together, the collection of facts not disclosed was material. Responses to questions in proposal forms were likely

to be material. The non-disclosure was concerned with moral hazard. On the evidence, inducement was clearly made out.

There was no obligation on the claimant to disclose to the defendant the fact of the previous conviction when it was "spent" under the Rehabilitation of

Offenders Act 1974, but the non-disclosure alleged was not limited to the previous conviction as such but concerned the making of false statements about having no convictions at a time when it was not spent. Mark Aitken:mxa@greenwoods-solicitors.com

/cont’d

FRAUD

Review

This case was referred to Greenwoods due to concerns that the accident was induced by the driver of the vehicle in which the claimants had been travelling, in that he had deliberately stopped at a green traffic light, thus causing the insured’s vehicle to drive into the rear of his vehicle. Seven personal injury claims were submitted which contrasted with the four occupants the insured said there in the third party vehicle.

Enquiries identified inconsistencies within the evidence provided to the medical expert by each of the claimants regarding their attendances at their GP, the extent of previous injuries sustained in previous accidents and the actual injuries sustained as a result of this accident. The medical expert, in response to our questions to him, stated that he had doubts as to the credibility of the evidence presented by the claimants. There were also inconsistencies between the witness evidence served initially and subsequently as to seating

arrangements and occupancy.

The insured was also interviewed in conference with counsel. His evidence regarding the occupancy of the third party vehicle was found to be strong, with particularly good evidence given regarding his recall of the inside of the third party vehicle. In addition, the insured had a counter-claim for the pre-accident value of his vehicle and other associated losses.

At the trial, the judge found that the defendant’s evidence was more credible than that of the claimants. He found that the accident had occurred when the traffic lights were on green and that fault for the accident lay with the first claimant.

Accordingly, the claimants’ claims were all dismissed. The judge also found that three of the claimants were not, in fact, present within the vehicle at the time of

the accident as alleged and that these claims were fraudulent.

Despite the finding of fraud against the claimants (for either pursuing a fraudulent claim or supporting a fraudulent claim), the judge was not inclined to refer this matter for contempt of court proceedings, on the basis that whilst fraud was to be dissuaded, this was not the worst example of a fraudulent case that he had come across.

The defendant was successful in his counter-claim in the sum of £2,834 including interest and was also awarded the costs of the proceedings, assessed in the sum of £13,833.

The reserve for the case was £59,520. Paul Williams:pdw@greenwoods-solicitors.com

Case

Shakil Ahmed & 5 others v Adil Mansoor, 9bm10719, Birmingham CC

Trial 9 & 10 November 2010, before hhj HHJ McKenna

Page 3 of 7

Case

Kauser Parveen Mohammed v Abdul Ghaffar & Zenith Insurance PLC

Bradford County Court

Background

The circumstances were that two vehicles collided at a T-junction as they were both turning. The insured was turning left and the claimant turning right.

The fraud element of this claim was that the claimant alleged that three of her children were in the vehicle and all suffered injuries. The defendant stated there was only one child in the vehicle. Liability was also in dispute.

The bogus passenger issue was fully pleaded in the

defence requiring the court to make findings of fact, which would have cost consequences for the claimant if the court found against her. Pleading this issue also raised the question of the claimant’s credibility, to assist with liability arguments.

Evidence

The main evidence was a police report, which confirmed that when the officers arrived on the scene approximately 15 minutes after the accident there was only the claimant and one child who had been involved in the accident.

The medical records showed that only the child known to be at the scene of the accident had attended hospital and received treatment.

The claimant’s evidence was that a friend of the claimant had taken the other two children to school before the police arrived. The friend provided a statement to that effect.

The defendant described in conference how he had looked in the claimant’s vehicle and confirmed the presence of one child only. He denied that the friend

(4)

had been on the scene and asserted that there was no opportunity for the children to have been taken away without him seeing. Additionally he believed that based on the direction that the claimant was travelling; she had already taken the other two children to school.

School records showed only that the children had attended school that day but did not prove the issue

either way.

In cross-examination the claimant admitted that she had told the police and also the medical staff at the hospital that there had only been one child in the car. The judge found in favour of the defendant on liability but also held that the evidence of the claimant and her witness had been incorrect and that there had been one child in the car.

The claimant was ordered to pay the defendant’s costs on an indemnity basis to be listed for a detailed assessment hearing if not agreed.

Fraud savings: damages £10,850 and claimants’ costs approximately £21,000.

Katie James: kej@greenwoods-solicitors.com

/cont’d

FRAUD

Review

Background

The defendant alleged that whilst approaching a T-junction a can of de-icer became dislodged under his brake pedal and he was unable to stop at the junction and collided with the claimant’s passing Bentley Arnage.

When Greenwoods received instructions in November 2009, a default judgment had been obtained by the claimant. We successfully applied for the default judgment to be set aside and applied to join Zenith Insurance to the proceedings as second defendants.

The claim brought by the claimant was for repair costs to his vehicle at £20,557.38 and credit hire charges of £21,450.95 as well as further minor special damages claimed at £110 and interest.

Letters of claim for two passengers within the insured’s vehicle were received which gave a different accident date but the claims were never advanced and

were abandoned before our instruction. Evidence

We obtained forensic motor engineering evidence that indicated that the claimant vehicle was stationary at the time of the collision which contradicted the claimant’s evidence that he was proceeding passed the T-junction.

An inspection of the first defendant’s vehicle also showed that the vehicle had serious mechanical faults that were not accident related that would have made the vehicle almost impossible to drive forwards. We also received information that the first defendant knew the claimant.

Outcome

After filing a defence highlighting our insurer client’s concerns it became apparent that the claimant’s solicitor was having difficulty in obtaining instructions from his client. The claimant failed to file a disclosure

list and so we made an application to the court for an “unless order” for service of the disclosure list or for the claim to be struck out without further order. The claimant’s solicitor immediately applied to come off the record as acting for the claimant and at the same time the ATE funding was withdrawn. However, even before the solicitor’s application was heard, the court made an order that unless the claimant’s disclosure was served by a specified date, the claim be struck out without further order. No disclosure list was served and the claim was automatically struck out. We are looking into the claimant’s financial status to see whether it will be worthwhile attempting to recover our client’s costs.

Fraud savings: damages £42,418.33; costs approximately £12,500.

Darren Draper: dd@greenwoods-solicitors.com

Case

Nashater Singh v (1) Amarjeet Singh & (2) Zenith Insurance Plc

Fraud suspected: Staged accident and suspicious credit hire claim

Page 4 of 7

Case

Mr Aiden Reilly v Miss R Winter

Fraud Suspected: LVI

Background

The insured’s vehicle collided with the offside of a bus on which the claimant was a passenger. The claimant alleged that he had suffered soft tissue injuries to the neck and back for which the medical expert gave a prognosis for recovery of between six and eight months.

Evidence

We obtained good forensic engineering evidence indicating that this was a low velocity impact collision. We also obtained evidence from the driver of the bus and the insured, together with written evidence of passengers, suggesting that the collision occurred at low speed.

At the liability trial the judge found as a matter of fact that the accident had occurred at a low speed. We questioned the medical expert and asked for her to review her opinion in the light of our client’s engineering evidence and witness statements. The medical expert concluded that in view of the engineering evidence and the content of the witness

(5)

statements, she had not had the correct facts available when providing a prognosis. In view of that, she rescinded her report and stated that it was unlikely that the reported symptoms were sustained in the index accident.

The claimant’s solicitors have now served a sealed Notice of Discontinuance and we are in the process of preparing our schedule of costs.

An estimated saving of £26,000 approximately, with our costs to be recovered from the claimant’s ATE

provider.

Fraud saving: Damages £2,750, Third Party Costs £17,500 approximately.

Susan Lane:sml@greenwoods-solicitors.com

/cont’d

FRAUD

Review

AN INTRODUCTION TO SOME OF OUR TEAM

Page 5 of 7

Paul Williams, team leader - Manchester Counter Fraud

Paul has five years' experience of dealing with all aspects of fraudulent claims. He joined Greenwoods in April 2010 after working for a well known firm in Liverpool. Paul spent four years acting exclusively for the Motor Insurers' Bureau, three of which involved dealing with fraudulent claims. During his time undertaking work for the Bureau, Paul developed a particular interest in indemnity issues.

Paul’s contact details are as follows.

T. 0161 245 6537

E. pdw@greenwoods-solicitors.com

David Green, senior assistant - Manchester Counter Fraud

David arrived at Greenwoods in May 2010 with nearly ten years of fraud experience. His particular area of expertise is in the more complex areas of insurance fraud, involving the tort of deceit and exemplary damages, which have inevitably led to him dealing with higher profile fraud cases. Most notably in 2008/2009 David led litigation on behalf of two insurers for the recovery of monies in the tort of deceit from six individuals perceived to be the guiding minds to the fraud. This resulted in the insurers obtaining judgement for a sum of in excess of £300,000 together with costs. The same case

was also subject to a Court of Appeal ruling which provided guidance on the cost issues raised in Widlake (Sulaman v Axa - 2009). David has developed a process to assist clients with identifying cases suitable for recovery and prosecution by the Greenwoods' Counter Fraud Group.

David’s contact details are as follows.

T. 0161 245 6529

E. ddg@greenwoods-solicitors.com

David Booker, Head of Intelligence Services

David joined Greenwoods in September 2010. He previously worked at a leading firm as Director of Intelligence Services where he spent almost seven years creating and developing their intelligence unit. Prior to that, David spent six years working for a major UK insurer within their Counter Fraud claims units.

He has experience of working with a wide range of clients, assisting them to define and implement counter fraud strategies and processes, geared to the early identification and pro-active handling of potentially fraudulent claims. He also has a wealth of experience in dealing with major cross industry fraud rings on behalf of insurers, and the co-ordination and close liaison with the Insurance Fraud Bureau and law enforcement agencies.

As a result, David has a leading profile in the counter fraud market - he has regularly spoken on the subject of fraud and intelligence at conferences and training seminars. He attained a Masters Degree in the subject of Fraud Management in 2008. He is a member of the Association of Counter Fraud Specialists, and a newly appointed committee member with the Insurance Fraud Investigators Group (IFIG). David’s contact details are as follows.

T. 01908 298 298274

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As part of the continued growth of the national Counter Fraud Group, the recent arrival of David Booker, Head of Intelligence Services and Paul Wainwright, Senior Assistant (see profiles above) in the Milton Keynes office has boosted its presence in the Midlands region.

The team now boasts nine fee earners including five intelligence analysts who form the hub of Greenwoods’ national intelligence service. The Greenwoods Counter Fraud Group offers the full portfolio of counter fraud services dealing with all legal and intelligence aspects of motor fraud including fraud ring and operational

Counter Fraud strategies, and opportunistic fraud. In addition to motor fraud, the new Midlands based team adds strengths in areas, such as fraudulent employers’ liability, public liability and public sector liability claims, as well as enforcement and recovery claims. The Milton Keynes team forms part of a single specialist Counter Fraud Group headed up by Karen Mann, with shared intelligence and high levels of quality assurance. Our clients can look forward to better national coverage, to the same high standards from all three offices – London, Manchester and Milton Keynes.

/cont’d

FRAUD

Review

Greenwoods’ Counter Fraud Group has recently joined the Credit Industry Fraud Avoidance System (CIFAS) as affiliate members. The Group comprises 280 national banks, telecoms and credit card companies, among others. This membership will enable greater intelligence sharing opportunities across multiple sectors and provide us with the ability to identify patterns, anomalies and indicative behaviours better than previously.

We now also have access to a range of new and innovative data intelligence tools which, when combined with the skills of our analysts, allows us to quickly gather and interpret fraud data, subsequently allowing us greater insight into the motivations and actions of the suspected fraudster.

Further intelligence tools and systems are currently being scrutinised and/or built as a bespoke offering for

the sole use of Greenwoods Intelligence Services. These tools are anticipated to further augment our key role in the prevention and detection of fraud but, perhaps more crucially, by assisting Greenwoods’ Counter Fraud Group in identifying and recovering assets as a result of successfully defending fraudulent claims.

UPDATES ON FRAUD CAPABILITIES

Page 6 of 7

Paul Wainwright, senior assistant - Milton Keynes Counter Fraud

Paul Wainwright joins the Counter Fraud Group at Greenwoods from a nationally recognised insurance fraud practice and adds a wealth of fraud and defendant insurance experience to Milton Keynes’ growing team. He will be providing technical guidance and support to the Counter Fraud Group in the Milton Keynes office.

Having worked with all of the leading national insurers liaising closely with their fraud teams,

Paul specialises in all aspects of complex multi-party motor fraud and has valuable experience of liability fraud including employers’ liability, public liability and public sector fraud and recovery.

Paul’s contact details are as follows.

T. 01908 298 287

E. plw@greenwoods-solicitors.com

COUNTER FRAUD GROUP EXPANDS TO MILTON KEYNES

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FRAUD

Review

/cont’d

Case example

Mrs Sumaiya Pathan v Mr Mamod Basid

Page 7 of 7

GREENWOODS FRAUD HOTLINE:

fraud@greenwoods-solicitors.com

This dedicated email account is designed for you to email any ad hoc queries you have. Emails will be directed to the Counter Fraud Group who will respond within 24 hours. We hope that this service will be of use and look forward to hearing from you. For further information email: km@greenwoods-solicitors.com

Editor: Laura Kelly, Solicitor, Manchester CFG: lmk@greenwoods-solicitors.com

We are always happy to take on basic intelligence searches should prospective or existing clients wish us to assist. Please do not hesitate to contact one of the team if you would like our assistance, in this, or any, matter.

To subscribe or unsubscribe from this Alert, please email crm@greenwoods-solicitors.com

Greenwoods holds a series of training events for both our lawyers and interested clients. Below are those events being held in January.

If you would like to attend either or both of the seminars please email crm@greenwoods-solicitors.com, indicating which you are interested in attending.

Seminars

FRAUD UPDATE

Date Time Location Speaker(s)

25 January 16.00-17.00 57 Spring Gardens Steven Turner

Manchester M2 2BY

REVIEW OF THE CONSTRUCTION (DESIGN & MANAGEMENT) REGULATIONS 2007

Date Time Location Speaker(s)

13 January 08.30-9.30 77 Gracechurch Street Rebecca Drake

London EC3V 0AS 39 Essex Street

Other Greenwoods publications

Greenwoods produces a number of regular publications on various topics, namely: PERSONAL INJURY ALERT (Weekly)

PROPERTY, CONSTRUCTION & INSURANCE REVIEW (Monthly) MOTOR CRIME FOCUS (Quarterly)

H & S REVIEW (Quarterly)

MARINE INSURANCE REVIEW (QUARTERLY)

If you would like to subscribe to any of the above publications, please email crm@greenwoods-solicitors.com, indicating which you would like to receive. The information and opinions contained in this document are not intended to be a comprehensive study, nor to provide legal advice, and should not be relied on or treated as a substitute for specific advice concerning individual situations. This document speaks as of its date and does not reflect any changes in law or practice after that date. Greenwoods is a firm of solicitors regulated by the Solicitors Regulation Authority in England and Wales. You can access the rules which regulate our professional conduct at: www.rules.sra.org.uk

© Greenwoods Solicitors 2010

This matter provides a brief example of the importance of our intelligence capabilities. Following receipt of five claims from individuals in different vehicles who claimed to have been involved in a genuine accident our suspicions were aroused as no engineering evidence had been received. Although we pushed for it, it was never forthcoming and so we expanded our investigations to ascertain histories of the parties and perform ‘mapping’ of their addresses

and the location of the accident.

It transpired that the parties were linked together in previous accidents, and that a number of them lived at the same address. Following this, DVLA results revealed that the first defendant was in fact the owner of both vehicles.

We put it to the claimants’ solicitors that their clients

were in cohorts and knew each other. Shortly after the solicitors came off record for all parties and letters to the claimants to confirm whether they were pursuing their claims were met with silence. Saving to the client = £40,000.

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