Réglementation et enquêtes
Regulatory & Investigations Newsletter January 2023
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Les clients font confiance à notre équipe primée spécialisée dans la fraude à l’assurance pour garantir que les demandes frauduleuses soient contestées et rejetées avec succès. De grandes compagnies d’assurance, des gestionnaires en sinistres, de grandes entreprises ainsi que des organismes publics et privés comptent parmi nos clients.
L’équipe est spécialisée dans tous les domaines, de la fraude à l’assurance, en passant par la détection et la gestion des réclamations suspectes ou les services-conseils auprès des clients sur les meilleures stratégies de prévention de la fraude.
Nous avons planté une série de jalons historiques dans le domaine de la fraude, notamment la première poursuite au privé pour une réclamation en responsabilité civile; la plus importante condamnation en dommages-intérêts exemplaires dans le cadre d’une demande reconventionnelle pour tromperie en vertu de la section 20; le plus grand nombre de cas d’outrages terminés avec succès dans l’industrie; la résolution du premier réseau de fraude en matière de responsabilité patronale et civile dans le domaine et du plus grand réseau de fraude automobile intersectoriel connu à ce jour.
Grâce à une portée mondiale et à une équipe interne spécialisée dans le renseignement, nous offrons une occasion unique de partager des renseignements et de fournir des services transfrontaliers.
Nous avons investi des sommes importantes dans des systèmes innovants pour améliorer notre service de lutte contre la fraude. Mentionnons notamment Genesis, une application sur mesure de détection de la fraude et d’interrogation des données, et Sentinel, un outil de prise de décision en matière de litiges liés à la fraude faisant appel à l’intelligence artificielle.
Notre expertise en matière de fraude englobe un large éventail de secteurs d’assurance et de disciplines professionnelles, y compris l’assurance automobile (passagers fictifs, impact à basse vitesse, accidents provoqués et incidents feints), la responsabilité civile, les maladies (y compris la perte auditive due au bruit), les biens (incendies criminels, vols, cambriolages et véhicules volés), les réseaux de fraude et les réclamations fabriquées ou exagérées dans tous les secteurs d’activité.
We acted for an insurer on a large motor fraud operation. The operation focused on 367 third parties claiming against 136 fraudulently incepted policies and was complex given it involved suspected staged accidents where often individuals did not exist. The strategies resulted in savings of 3.4 million for the insurer client. Additionally, following over 500 individuals being under investigation; payments were made on just 4 claims in total (97.55% success rate).
We successfully applied for the committal of three Defendants for contempt of court. The application was made following their attempts to bring a fraudulent insurance claim, in relation to a staged road traffic accident. The first and third Defendants filed witness statements refuting our client’s allegations of fraudulent behaviour. All Defendants received custodial sentences, this ruling has important ramifications for those involved in fraudulent claims.
The claimant, attempted to claim over £55,000 for injury in a road traffic accident, he claimed that injuries to his foot meant he could neither stand nor walk for long periods. His appearance on Sky TV’s Soccer AM for scoring a goal from the halfway line, was one of the pieces of evidence we presented to the Court to prove the claimant was exaggerating the extent of his injuries. He agreed to a court order to withdraw his insurance claim and pay £5,000 costs.
Representing a large local authority on a sensitive employee-led fraud ring. We ensured that reputational damage was avoided whilst achieving maximum repudiation and an IFED referral.
We acted for a large public liability insurer following a genuine accident. The claimant alleged serious physical and psychological injuries, with his claim for damages and costs in excess of GBP 40,000. Our investigation uncovered that he was lifting heavy weights and we obtained video of him on one of the world’s highest waterslides. At trial, the claim was dismissed and the claimant was ordered to pay GBP 14,000 in costs.
Following a genuine accident at work, our insurer client contacted us as they were concerned about the extent and impact of the injuries. This claim was handled using our Project Martello strategy for exaggerated claims. Our investigation uncovered that the Claimant was much more active than he was admitting. The Court ordered that the GBP 260,000 claim be discontinued and the claimant to pay GBP 5,000 to the Defendant.
Acting for several large clients in the Preston area dealing with, what was deemed to be, the first industry-wide EL/PL fraud ring. We assisted our client by liaising with the IFB and delivered a 100% repudiation rate for all intimated claims.
Acting on behalf of a global insurer defending a staged tripping claim brought against a supermarket. After defending the original GBP 60,000 claim to a successful conclusion at trial, we then pursued a private prosecution against the claimant - who received a 21 month suspended jail sentence for her part in the scam.
We pursued contempt of court actions against three individuals who had brought claims against a top 10 UK motor insurer following a staged road traffic accident, part of a larger fraud ring investigation. While the claims had not proceeded to trial meaning the three individuals hadn't lied under oath, we pursued contempt proceedings and they each received prison sentences of between 4 and 6 months.
We successfully applied for the committal of three Defendants for contempt of court. The application was made following their attempts to bring a fraudulent insurance claim, in relation to a staged road traffic accident. The first and third Defendants filed witness statements refuting our client’s allegations of fraudulent behaviour. All Defendants received custodial sentences, this ruling has important ramifications for those involved in fraudulent claims.
We acted for an insurer on a large motor fraud operation. The operation focused on 367 third parties claiming against 136 fraudulently incepted policies and was complex given it involved suspected staged accidents where often individuals did not exist. The strategies resulted in savings of 3.4 million for the insurer client. Additionally, following over 500 individuals being under investigation; payments were made on just 4 claims in total (97.55% success rate).
The claimant, attempted to claim over £55,000 for injury in a road traffic accident, he claimed that injuries to his foot meant he could neither stand nor walk for long periods. His appearance on Sky TV’s Soccer AM for scoring a goal from the halfway line, was one of the pieces of evidence we presented to the Court to prove the claimant was exaggerating the extent of his injuries. He agreed to a court order to withdraw his insurance claim and pay £5,000 costs.
Representing a large local authority on a sensitive employee-led fraud ring. We ensured that reputational damage was avoided whilst achieving maximum repudiation and an IFED referral.
Acting for several large clients in the Preston area dealing with, what was deemed to be, the first industry-wide EL/PL fraud ring. We assisted our client by liaising with the IFB and delivered a 100% repudiation rate for all intimated claims.
We pursued contempt of court actions against three individuals who had brought claims against a top 10 UK motor insurer following a staged road traffic accident, part of a larger fraud ring investigation. While the claims had not proceeded to trial meaning the three individuals hadn't lied under oath, we pursued contempt proceedings and they each received prison sentences of between 4 and 6 months.
We acted for a large public liability insurer following a genuine accident. The claimant alleged serious physical and psychological injuries, with his claim for damages and costs in excess of GBP 40,000. Our investigation uncovered that he was lifting heavy weights and we obtained video of him on one of the world’s highest waterslides. At trial, the claim was dismissed and the claimant was ordered to pay GBP 14,000 in costs.
Following a genuine accident at work, our insurer client contacted us as they were concerned about the extent and impact of the injuries. This claim was handled using our Project Martello strategy for exaggerated claims. Our investigation uncovered that the Claimant was much more active than he was admitting. The Court ordered that the GBP 260,000 claim be discontinued and the claimant to pay GBP 5,000 to the Defendant.
Acting on behalf of a global insurer defending a staged tripping claim brought against a supermarket. After defending the original GBP 60,000 claim to a successful conclusion at trial, we then pursued a private prosecution against the claimant - who received a 21 month suspended jail sentence for her part in the scam.
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