help with a misleading claim

dipsy

Hi

can anyone advise, I can't reveal all details as asking for a friend and don't want this being traceable,

basically mr x claimed for an item value of XXXX thousand pounds, at time I thought claim was an honest claim, friend of Mr X

Insurance paid out in full

Mr x then split up with partner that they were with and that partner (miss Y)knew the claim to be false, but name not on any insurance documents and did not receive any of the money, Mr x in meantime had reported miss Y for making a WFTC (working families tax credit), claim, a benefit claim (as single person) along with a report that Miss Y was driving with no licence, Miss Y moved straight in with someone else. (obvious that Mr X did it as was angry, though the term people in glass houses kind of springs to mind)

to cut long story short how does Mr X stand, can he just claim its sour grapes as he had reported Miss Y .. what is the procedure when investigating claims, he is beside himself, I don't really want to get involved, but equally as a friend don't want to see him land himself in trouble that he can avoid, yes what he did was wrong and I don't agree, but don't think him getting in bother will serve any further purpose,

Can anyone advise what insurance companies normally do when they are told a claim is fraudulant, will they take his word over Miss Y (one word against another) or what is the procedure..

The insurance company wrote to them a good 18 months after the claim and they don't have any insurance with them now.

a) what will happen ?
b) will this affect their future insurance of house etc ?
c) will it be better if they come clean and pay back the money?

Many thanks

jonesMUFCforever

It will depend on the amount.
If I was ripped off then I would want revenge wouldn't you?
Whether that is the opinion of the insurance company is another matter.

If insurance company investigate how will your 'friend' react - will he crumple in a heap and admit guilt and offer to repay or will he try to brazen it out?

They might well make an example of him!

mandarinduck

Unless it's a small amount of money the insurance company will probably feel duty bound to investigate and - dependent on their findings and the policy wording - your friend could have a claim against him for the full value of the claim he made and possibly any investigation costs. Insurance companies DO share this kind of information so it probably won't be forgotten about. Additionally, any future claims he makes will be heavily scrutinised (though I'm assuming he's learnt his lesson about defrauding insurers).

If it's a lot of money and the evidence against him is good, then there's every chance they might pursue it legally etc. If it's just a case of he said/she said, then it might not get that far. It depends on a) the item, b) the money involved and b) what evidence was provided in support of the claim (i.e can it be looked into and found to be false).

A company cannot term a claim to be fraudulent without any evidence but if they have concerns they will probably do their best to try and find evidence. And if it is a false claim, there's probably evidence there.

I can't advise your friend what to do here and it's really a no-win situation. All I can say that if he IS going to be found out (i.e. it's clear there's plenty of evidence in the company's favour), an apology and prompt repayment is probably the best way forward. It would go down much better than bare-faced lying and it ending up being passed on to solicitors.

Hope it works out.

nickmack

dipsy wrote: »

but don't think him getting in bother will serve any further purpose

I'm not sure from your message, whether he's actually been reported or whether he is worried about being reported.

I don't necessarily agree that it wouldn't serve any further purpose. It sounds like a tit-for-tat spat between these two people. He reported her for fraud so she does the same. If both of them have been defrauding various authorities and companies, I have no sympathy. I appreciate this is your friend, but if it is fraud, it's in the interests of the insurer and the public that he is investigated and if necessary punished.

Can anyone advise what insurance companies normally do when they are told a claim is fraudulant, will they take his word over Miss Y (one word against another) or what is the procedure..

Usually investigate if there are sufficient grounds. He may find they do nothing, however if they do confirm fraud, he could reasonably expect to be made to repay claim, be prosecuted for fraud and have future premiums loaded.

dipsy

thanks for all your replies, hopefully this will go away, and hopefully a lesson learnt....