QBE wins private criminal prosecution against Employers’ Liability fraudster
Following trial in Liverpool Crown Court, Liam Jones was found guilty on 18th September 2018 and last week received a two years custodial sentence, which was suspended for two years.
Mr Jones suffered injuries when he fell from a roof while employed by an insured of QBE in 2011. However, an investigation by QBE’s counter fraud unit revealed evidence that the claimant was exaggerating the extent of his injuries.
After an assessment of liability and the extent of injuries, QBE made an early offer to settle the claim, which was not accepted. Thereafter, following submission of several medical reports, legal proceedings were received which valued the claim for damages at approximately £700,000.
Mr Jones reported that he was unable to work, required help in washing and dressing, found it difficult to negotiate stairs because of pain and breathlessness, and could not stand for a length of time. He claimed that he could only walk with the assistance of a crutch in his left hand and reported that he was unable to carry a light bag of shopping or bend over.
However, surveillance footage showed Mr Jones walking freely without a crutch on one occasion for approximately five miles. In other instances, footage showed he walked with a crutch, but only to and from expert medical appointments. Evidence also showed Mr Jones ascending and descending ladders while working as a roofer.
After taking into consideration the evidence, QBE, supported by law firm BLM, made the decision to pursue Mr Jones by way of a private criminal prosecution for fraud and Mr Jones received no money for his claim.
At the hearing, Her Honour Judge Smith told Mr Jones that “Your offences are not victimless offences. Fraud causes losses that affect society at large”.
Mike East, Claims Director for QBE Business Insurance said “Fraud, including exaggerated claims, remains a major issue in our industry and we are pleased with the sentencing of Mr Jones. His prosecution is another in a long line of fraud cases in which our counter fraud team have been alert to fraudulent activity and have tirelessly pursued perpetrators in defence of our customers’ interests”.
Stuart Furniss, Partner, BLM, who acted for QBE and their insured in relation to both the defence of the civil claim and private prosecution, said “This case demonstrates how important it is to take a hard line when faced with a claim tainted by fraud or exaggeration. The sentence should also act as a clear deterrent to those seeking to defraud insurers and their customers and hopefully help to reduce the number of similarly fraudulent claims which continue to drive up premiums for others”.
QBE European Operations is part of QBE Insurance Group, one of the world’s leading international insurers and reinsurers and Standard & Poor’s A+ rated. Listed on the Australian Securities Exchange, QBE’s gross written premium for the year ended 31 December 2018 was US$13.7 billion.
As a business insurance specialist, QBE European Operations offers a range of insurance products from the standard suite of property, casualty and motor to the specialist financial lines, marine and energy. All are tailored to the individual needs of our small, medium and large client base.
We understand the crucial role that effective risk management plays in all organisations and work hard to understand our clients’ businesses so that we offer insurance solutions that meet their needs – from complex programmes to simpler e-trading solutions – and support them in minimising their risk exposures. Our expert risk management and rehabilitation practitioners focus on helping clients improve their risk management so that they may benefit from a reduction in claims frequency and costs.
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