Suspected insurance fraud, how to gain evidence?

[motorbiking]

Did you see the bit were the OP said "To cut a long story short he claimed for the damage and more from me through the small claims court". There is of course a vert slim chance they settled to stop the action and that without the benefit of legal advice the settlement was not in full and final settlement etc. Would you agree - this is unlikely?

This suggest its settled.

point 1 - yes unless the claimant was short with the truth and said it was him who damaged the pipe or that pipe just leaked on its own (as they can easily do when they get old.

point 2 - That depends on a few things.

point 3 - agree

 

[kingandy2nd]

no I wouldn’t agree, as the op doesn’t say a claim was successful. given the scant information provided by the op, it could have just been a lba threat. either of us could be correct and neither of us can prove the other right or wrong without more info.

if you want to offer a better view for point 2 for the op then go ahead, I’m not not to get into a circular argument with you about a vague post from some random person on the internet.

my view is that the op is not going to gain anything financially by trying to take this matter forward even if the customer made two claims. the op can do what they like with my opinion

 

[motorbiking]

Well the OP hasn't returned, so we wont know. As I said in post 13, he has some scope, it all depends on the timing and amount claimed.

 

[MeldrewsMate]

Lets start with the basics.. based on your post can I conclude some facts:

- he sued you for the damages in the small claims court and won a judgement against you for his losses?
- You suspect that the basis of his claim was fraudulent because he had claimed on his insurance?
- The action was not brought against you on behalf of the Insurance?

If the above are Yes, then really getting him prosecuted for fraud, is of no benefit to you. What would be a benefit to you is getting his claim against you reversed due to litigation misconduct. Better still getting him to settle out of court to avoid the serious consequences

Thanks for all your replies, there are some wise words here among some confused replies and misunderstandings, so to clarify:

I did not claim on my PLI, mainly because I assumed the initial damage to be to a pipe (which I repaired), a small area of ceiling plasterboard (which I cut out and replaced with a new patch), plastering and painting (done by others and organised by customer), mopping and drying the floor (done by me), and washing down the walls. I estimated it would cost me around £300 in outlay, so hardly worth claiming on MY insurance.

To answer the points from motorbiking...
Yes, correct on all 3.

Can anyone shed light on the workings of the CUE as mentioned in my first post on this subject?

 

[MeldrewsMate]

Personally I don’t believe there has been an insurance claim made, as the insurer would have pursed the Op at the time of claim.

My assumption is that the customer told HIS insurance company that there had been a leak which had caused damage (true), then he added that he had paid for the pipe repair himself, knowing that insurance covers the damage caused, but not the repair to the pipe.

I tried to keep the facts brief and the story short, and there has been an interesting exchange of legal points, however if there are some further points to clarify I am happy to add more (subject to time off from Self Assessment tax return). My motivation here is revenge rather than recovery of outlay, revenge for being taken advantage of (the enhanced claim) after making a mistake. A prosecution for fraud would satisfy me completely, money recovery being a bonus.

 

[carmanmemoranda]

Has any outlay by any insurance company been enough to warrant the expense of investigation to potentially recover anything.

They may just view it as history and not be concerned about it.

 

[MeldrewsMate]

Why do you suspect that? What evidence do you have?

My suspicion is because I waited almost a year from the date of the original damage before I sent him a letter stating that I hadn't heard further 'so here is my bill for the work done'. It was shortly after that that I received the summons to the Small Claims Court for a much larger sum than I was expecting, and including a fridge freezer (it got splashed) a new oak floor (which got wet, but which I dried thoroughly at the time), and the purchase of a dehumidifier, the receipt from which shows it to have been bought 3 months after the event.

To confirm: I lost the court case, though his claim for a new fridge-freezer was downgraded on the basis of not getting new for old.

The evidence is low but the suspicion is high....I chanced upon him just before Christmas 2023, and challenged him to give me the dehumidifier that I'd effectively paid for. His reply was that he was still using it, 5 years after the damage. But for the presence of witnesses I'm sure we'd have come to blows at that point. Glad I didn't, revenge is, as they say, a dish best served cold.

 

[MeldrewsMate]

Oh it's pretty easy to get to the bottom of it. Someone who knows they have either committed insurance fraud and/or litigation misconduct/perjury, will not want to risk formal proceedings and the appropriately worded letter possibly from a lawyer, would likely trigger pant filling.

Thank you, a very good point. Would you be prepared to suggest some appropriate words?

 

[motorbiking]

hold on - I have more questions

did he ever pay you for your work, did you counter sue for the work, was it taken into account for the judgement?

but before we go any further was the claim <2K 2-5K >5k?

I have to say - it wasn't your brightest move, chasing him for payment, nor asking him for the dehumidifier, something you have no right to. The demand/argument is also on the border of harassment, you need to be very careful.

 

[JonathanM]

Given the further information about the timeline, if there was an insurance claim, could that have been paid out before the small claim had even started? Might that alter the seriousness of any fraud?

My motivation here is revenge rather than recovery of outlay, revenge for being taken advantage of (the enhanced claim) after making a mistake. A prosecution for fraud would satisfy me completely, money recovery being a bonus.

If a prosecution is not forthcoming, is there a lesser level of revenge that might satisfy you somewhat?

Also, did you ask as part of the small claim proceedings, whether he had made a claim on his house insurance?

 

[martygturner]

You are all missing the the question of home insurance policy exclusions..in most cases home insurance will not pay out for faulty workmanship, as that is covered by the workman's insurance...its a general policy exclusion so the home owner had no choice but to recover his costs from the workman via small claims.

see the aa guide here : https://www.theaa.com/home-insurance/advice/damage-caused-by-builders-and-workmen

So no the home did'nt not commit fraud...perhaps the op should do a better job.

 

[JonathanM]

You are all missing the the question of home insurance policy exclusions

I believe that has already been covered. I've only joined at a late stage, but the assumption behind all this discussion seems to be that the homeowner didn't mention the role of the OP to his insurance company, and made up some other reason as to how the damage had occurred.

 

[martygturner]

I believe that has already been covered. I've only joined at a late stage, but the assumption behind all this discussion seems to be that the homeowner didn't mention the role of the OP to his insurance company, and made up some other reason as to how the damage had occurred.

That's a silly assumption to start with.... as the op was taken to small claims, where the first question is are any of the losses being covered by an insurer, which the small claims court automatically check on CUE with MIB...hence no claim has been submitted. Its in the disclosure part of a small claims form.., do you agree to to standard checks, credit reference, identity check, insurance databases etc..tick no and the small claims route is not open and you go to the county or high court.

 

[MeldrewsMate]

.... as the op was taken to small claims, where the first question is are any of the losses being covered by an insurer, which the small claims court automatically check on CUE with MIB...hence no claim has been submitted. Its in the disclosure part of a small claims form.., do you agree to to standard checks, credit reference, identity check, insurance databases etc..tick no and the small claims route is not open and you go to the county or high court.

Are you suggesting that the small claims court will ACT to gain this sort of information from CUE without being prompted? Do you have information to show that they actually do these checks and so the judge will know if a claim was made BEFORE any hearing takes place? If so my court case (from 2019) shows that an insurance claim wasn't made before we appeared at court. This is vital information and completely undermines my suspicions. This raises further questions:
1. Did CUE exist in 2019?
2. Did the court carry out these checks for which the customer had given permission?

 

[MeldrewsMate]

Also, did you ask as part of the small claim proceedings, whether he had made a claim on his house insurance?

No, that did not occur to me.
Nor did it occur to challenge the VAT that was taken off my bill by the judge as part of the calculation for the settlement figure. That only occurred ten minutes after leaving court and once I had got my thoughts together. I hadn't charged VAT, and I'm not VAT registered. By that time the judge had scarpered and no-one at the court office was willing to help bring this to his attention. (yes there was an option to appeal, but that would incur further expense and time, and I didn't have time for that until the festering anger had had time to act, and then the opportunity to appeal had time expired. It still hurts!