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Investigation into suspected exaggeration helps QBE defeat £150,000 claim and recover costs

DWF, Cunningham Lindsey t/a Sedgwick, and QBE have successfully obtained a finding of fundamental dishonesty against a claimant who exaggerated the nature and extent of the injuries he suffered in an accident at work and attempted to falsely increase the value of his claim. The case was handled by Paul Holmes, Head of Casualty Fraud, and William Stobart, Lead Paralegal in DWF's Occupational Health team. 

Background

Curt Gorog brought a personal injury claim against his employer following an accident at work in November 2012. Liability was admitted, but the extent of the claim was contested. The claimant's case was that he had sustained a fracture of the T6 vertebra in his back, leaving him with chronic pain. He alleged an inability to work for a period of approximately five years, having returned to work in January 2017. The schedule of loss was pleaded at £130,000, and a CRU certificate showed recoverable benefits of over £50,000.

In the course of litigation, evidence from social media was uncovered showing that the claimant was living a normal life, attending the gym and going on holidays with his family. Evidence from the Claims and Underwriting Exchange and medical records revealed that the claimant had sought damages in a substantial number of other personal injury claims since 2005. Surveillance showed the claimant working out in the gym using very heavy weights.

The defendant alleged that the claimant had exaggerated the effects of his injuries to his medical experts.

Following a lengthy disclosure process, the claimant discontinued his claim less than a week before trial. As this was a case to which the QOCS provisions applied, the defendant made an application to set aside the discontinuance and for permission to disapply QOCS and enforce its costs pursuant to CPR r.44.16

Hearing outcome

A hearing was listed to determine whether the claim had been fraudulently exaggerated and was therefore fundamentally dishonest. The claimant was questioned on a number of matters including:

  • His significant previous claims history;

  • His claim for a slip in a Tesco in July 2013, brought at a time when he told his medical experts he was unable to do any shopping;

  • His links with criminals and his convictions for assault and assisting an offender;

  • His involvement in a high-speed police car chase in March 2015, during the course of which he was chased through a field by police officers and forcibly restrained after jumping over a hedge;

  • Attending for benefits assessments in a wheelchair as late as March 2016;

  • The large number of holiday and gym pictures contained on his Facebook account, none of which featured the walking stick he said he needed to move around.

The claimant told a medical expert in November 2016 that he was out of work and unable to lift heavy weights. As the litigation progressed he stated that he had gradually recovered and returned to work by the beginning of 2017.

However this was inconsistent with the evidence that had been obtained over the course of 2016. The claimant had received a suspended jail sentence for assisting an offender in August 2016, and in mitigation before sentencing the claimant's probation officer told the court that he was in work. Footage obtained from his Facebook page in the same month showed the claimant completing a press-up challenge, involving 22 press-ups with his child on his back. The claimant was also unable to explain why a Facebook friend described him as a "workhorse" in August 2016.

In giving judgment, Her Honour Judge Hudson was satisfied that the claimant had exaggerated his symptoms. Whilst no single piece of evidence was on its own conclusive as to the extent of the claimant's functioning, there were too many discrepancies in the evidence the claimant had given to medical and other professionals for these to constitute errors on the part of those individuals. There was evidence that the claimant had returned to everyday activities such as shopping as early as March 2013. She concluded that the claimant had lied about his current position and had lied about his ongoing position for several years.

Accordingly the judge agreed with the allegation that the claim was fundamentally dishonest. QOCS was disapplied and the claimant was ordered to pay QBE's costs of defending the claim in the sum of £35,000.

Comment

This case illustrates the importance of carrying out in-depth disclosure exercises in cases where claimants are alleged to have exaggerated their symptoms. An exceptionally large amount of material was uncovered on Mr Gorog, including his DWP records, court sentencing transcripts, medical reports from past claims, medical records, newspaper articles, social media evidence, and an entire file of papers from the Motor Insurers' Bureau, including witness statements from police officers and transcripts from an interview with the claimant under caution.

It is rare that a single piece of evidence will deliver a knockout blow resulting in a finding of fundamental dishonesty. As cases like this show, what is required is extensive investigation of potential leads and forensic examination of the disclosure in the case to build an overall picture of dishonesty. At DWF we continue to work with insurers to identify those who bring exaggerated or fraudulent claims. This outcome is another example of defendants making use of the new provisions for fundamental dishonesty to dismiss claims and obtain findings of fraud where claims are exaggerated. Claimants would be well advised to note that they will be put under the microscope if they decide to claim for damages they are not entitled to.

Contact

For further information, please contact Paul Holmes on 0113 261 6521 or at paul.holmes@dwf.law or William Stobart on 0161 604 1893 or at william.Stobart@dwf.law   

By Paul Holmes & William Stobart

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This information is intended as a general discussion surrounding the topics covered and is for guidance purposes only. It does not constitute legal advice and should not be regarded as a substitute for taking legal advice. DWF is not responsible for any activity undertaken based on this information.

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