The latest case report from AND-E for you;
AND-E (Aioi Nissay Dowa Insurance Europe) has recently achieved success in two cases of fraudulent claims, saving over £40,000 in the original claims and costs. Ahead of IFB Fraud Awareness Week, the cases demonstrate the importance of robust investigation, strong collaboration with legal partners and a commitment to pursue claims to trial where there is clear evidence of dishonest behaviour.
“Our Special Investigations Unit (SIU) continues to deliver outstanding results in the fight against insurance fraud,” explained Jan Martin, Head of Third Party Claims, AND-E. “Protecting honest customers and challenging exaggerated claims is vital to keep premiums fair. We remain committed to taking the right cases all the way to trial to send a clear message to the market that we have a zero-tolerance attitude to fraud.”
Case One: Exaggerated Injury Exposed
A personal injury claim was referred to the AND-E SIU after claims handlers identified inconsistencies in a physiotherapy invoice and questioned why the matter was incorrectly submitted through the Ministry of Justice (MOJ) portal rather than the lower-value Official Injury Claim (OIC) route. Although the collision itself was genuine, several red flags emerged: an unrealistic prognosis of 18 months for minor soft-tissue injuries, a rapid return to work and football, pressure for an early interim payment, and inconsistencies in medical evidence.
Requests for full disclosure of medical, occupational health, and gym records were ignored and when no early offer was made, the claimant’s solicitors issued proceedings. Medical records revealed only one GP attendance after the accident and no reference to ongoing symptoms, while physiotherapy lasted less than one month. When questioned, the medical expert accepted that there was no record of the alleged shoulder injury and that symptoms would reasonably have been mentioned if ongoing.
At trial, the Judge found significant inconsistencies, noting the claimant had signed statements without reading them. The court dismissed the claim in full, resulting in savings of £18,000, with a finding of Fundamental Dishonesty and awarding recovery of AND-E’s costs.
The case is a clear example of why perseverance and trial attendance matter as Jan Martin explained. “Cross-examination was vital. There was no change in the evidence, and our defence was vindicated. This was a strong result, highlighting the importance of standing firm when the facts don’t align.”
Case Two: Contradictory Testimony and Fabricated Damage Claims
The AND-E FNOL (First Notification of Loss) team identified early inconsistencies in a moped claim with the policyholder reporting that a group of men arrived at the scene and deliberately caused further damage to the third party’s vehicle, who then demanded £2,000 for repairs. Given the unusual circumstances and potential exaggeration of damage and injury, the matter was referred to the AND-E SIU.
The policyholder’s own engineering evidence did not support claims that the bike had fallen. The unusual use of separate solicitors for the vehicle damage and injury claims were other red flags for the SIU team. Proceedings were issued, and a Fundamental Dishonesty defence was filed after it became clear that the injury claim relied on false information.
At hearing, the claimant admitted he had never fallen from his bike, contradicting both his medical report and signed witness statement. The Judge rejected attempts to blame solicitors or language difficulties, ruling it was implausible that three separate professionals had misunderstood the claimant’s story. The court made a finding of Fundamental Dishonesty, ordering repayment of £11,800 and preventing any further related claims from proceeding.
The decisive action prevented over £22,000 in fraudulent payments and reinforced AND-E’s commitment to protecting genuine policyholders. “This result shows the importance of persistence – not just accepting a discontinuance when dishonesty is clear,” said Jan Martin. “The Fundamental Dishonesty finding sends a clear message that misleading the court has consequences.”
Be the first to comment