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Fraude

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Chef de file dans la détection, la défense et la résolution de réclamations frauduleuses en assurance dommages

Chaque année, notre équipe chevronnée chargée des enquêtes sur les cas de fraude à l’assurance conseille des assureurs, des sociétés, des entités publiques et des organisations privées. Elle s’attarde à des milliers de cas liés à des polices d’assurance dommages, maladie, automobile, voyage, habitation, biens, animaux et commerciale, entre autres. Nous aidons nos clients à protéger leur entreprise et leur clientèle contre le préjudice de la fraude.

Nous nous consacrons à découvrir les fraudes à l’assurance automobile, ce qui comprend les fausses réclamations et celles impliquant des passagers fictifs, des impacts à basse vitesse et des accidents mis en scène ou provoqués. Nous maîtrisons le traitement des réclamations suspectes d’assurance maladie, dont celles relatives aux pertes auditives causées par des bruits forts. De plus, nous possédons une vaste expérience dans la fraude à l’assurance biens (incendies criminels, vols, cambriolages et véhicules volés, etc.). 

Notre équipe experte a démantelé de nombreux réseaux de fraude et résolu une grande quantité de réclamations fabriquées ou exagérées dans tous les secteurs d’activité. Nous conseillons en outre des clients sur des stratégies de prévention de la fraude en offrant une approche adaptée, ce qui favorise la protection de la marque, le maintien des relations avec les détenteurs de polices et la réduction des coûts. Nous mettons à profit notre réseau d’information transfrontalier et nos systèmes innovants pour améliorer notre service de lutte contre la fraude. 

Nous avons franchi une série de jalons dans le domaine de la fraude à l’assurance, certains desquels constituaient une première pour nos clients :

  • La première poursuite pénale 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 gains de cause d’outrage dans l’industrie

  • Le démantèlement du premier réseau de fraude intersectorielle en matière de responsabilité civile et de l’employeur et de l’assurance automobile

  • L’obtention du prix d’Insurance Times pour la collaboration de l’année 2021 (approche innovante d’utilisation de S57 pour l’économie de plus de 12 M£ dans la sphère des services à volume) 

Expérience solide dans la gestion de tous les aspects relatifs aux réclamations d’assurance frauduleuses. Un cabinet chef de file en la matière. 

The Legal 500 2022

Les avocats ont des connaissances poussées et éprouvées dans le domaine de la fraude à l’assurance ainsi que sur divers enjeux sous-jacents. En tant que cabinet, l’équipe est efficiente, proactive et réaliste. Elle obtient des résultats. 

The Legal 500 2022

Notre travail en matière de fraude

  • Tout
  • Royaume-Uni et Europe

  • Fraud screening processes uncovers large motor fraud ring

    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).

    United Kingdom

    Fraudulent claims result in custodial sentences

    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. 

    United Kingdom

    Own goal by non-league footballer as TV appearance defeats dishonest claim

    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.

    United Kingdom

    Employee-led fraud ring

    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.

    United Kingdom

    Exaggerated claim undone by investigation

    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.

    United Kingdom

    Exaggeration costs claimant dearly

    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.

    United Kingdom

    First industry-wide EL/PL fraud ring

    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.

    United Kingdom

    First private prosecution for public liability claim

    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.

    United Kingdom

    Motor Fraudsters jailed for contempt of court

    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.

    United Kingdom

  • Fraudulent claims result in custodial sentences

    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. 

    United Kingdom

    Fraud screening processes uncovers large motor fraud ring

    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).

    United Kingdom

    Own goal by non-league footballer as TV appearance defeats dishonest claim

    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.

    United Kingdom

    Employee-led fraud ring

    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.

    United Kingdom

    First industry-wide EL/PL fraud ring

    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.

    United Kingdom

    Motor Fraudsters jailed for contempt of court

    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.

    United Kingdom

    Exaggerated claim undone by investigation

    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.

    United Kingdom

    Exaggeration costs claimant dearly

    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.

    United Kingdom

    First private prosecution for public liability claim

    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.

    United Kingdom

Notre équipe consacrée à la fraude

Damian Rourke
Damian Rourke

Partner

Sarah Hill
Sarah Hill

Partner

Mark Aitken
Mark Aitken

Partner

Patrick Connolly
Patrick Connolly

Partner

Neil Beresford
Neil Beresford

Partner

Isabel Burón
Isabel Burón

Partner

Ik Wei Chong
Ik Wei Chong

Partner / Managing Director, Asia

Andrew Constable
Andrew Constable

Partner

Deon Francis
Deon Francis

Partner

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