TACKLING FRAUDULENT CLAIMS by wfh15908

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									TACKLING FRAUDULENT
       CLAIMS




                Helen Brown,
  Partner and Head of the Public Sector Unit
       Putting it into context
• Fraud against local authorities cost £12 million
  per year
• Fraudulent claims are an ‘issue’ for 63% of
  local authorities
• 1 in 11 claims are fraudulent in some way
      Recent and proposed
          legislation

• Fraud Act 2006

• Serious Crime Act 2007
    What do we mean by a
fraudulent or dishonest claims?
• Arranged accident
• No accident
• Transferred accident
• Dishonest account of accident
• Deliberate exaggeration of the injury
• Improper losses claimed
• Injury whilst engaged in criminal activity
            The warning signs
•   Have claims been made in the past?
•   Does the contemporaneous documentation correlate?
•   Are witnesses impartial?
•   Alcohol involved?
•   Where did the claim originate from?
•   Claimant under financial pressure?
•   What do the medical records say?
•   Involvement of certain solicitors and experts?
• Are the injuries consistent?
  Practical guidance from the
              court
• Conflicting account of the accident
  circumstances
• Medical records
• Surveillance
    Summary of guidance from
           the court
•   What is the liability position?
•   Use of medical experts
•   Enquiry agents
•   Disclosure of evidence and cost
    protection
  Sanctions for the fraudulent
           claimant
• Civil sanctions

• Criminal sanctions
         Anti-fraud strategies
• Collate evidence at an early stage
• Ask the Claimant to attend a site inspection
• Make sure the initial response to the claim puts you
  in a position of strength
• Send detailed questions to the Claimant’s solicitors
• Scrutinise every aspect of the claim
• Seek access to DWP records
• Interrogation of claims database
• CCTV
• Obtain GP and hospital records
             Initiatives
• Insurance Fraud Investigators Group
  (IFIG)
• Insurance Fraud Bureau (IFB)
• National Strategic Fraud Authority
• Planned Licensing and Regulation of
  Investigators
• MoJ
CONCLUSION

								
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