Insurance: Hospitals see false accident claims every week, says A&E doctor

Staged accidents are among most common types of insurance fraud in Ireland

Staff in emergency rooms see fraudulent cases every week, says Dr Chris Luke. Photograph: Alan Betson

Staff in emergency rooms see fraudulent cases every week, says Dr Chris Luke. Photograph: Alan Betson

 

Emergency medicine expert Dr Chris Luke claims that staff in emergency departments in Ireland see between one and six fraudulent accident claimants every week.

“I would be surprised if they don’t see at least one fabricated or exaggerated case every week,” he told RTÉ’s Today with Sean O’Rourke show.

He said there were three hallmarks of such cases: mystery, misery and massive expense.

Such cases usually involve a person “screaming blue murder” at the scene, but the absence of any injury.

He said that in his experience the louder the noise at the scene, the less there is to see in the form of an injury.

This all adds to the misery of emergency department staff who are already under pressure and stressed.

Rising premiums

Staged accidents are the most common and costly types of fraud for insurers, the head of Axa Insurance’s special investigation unit (SIU) Frances McDonnell has said.

“There might be minimal damage to a car and yet everyone is getting out – or not getting out – insisting that the roof was cut off the car and they all have these soft tissue injuries, usually whiplash,” said Ms McDonnell.

Compensation awarded for whiplash injuries in Ireland is, on average, 4.4 times higher than awards made in England and Wales, according to the Personal Injuries Commission, which launched its report last September.

The Commission noted, in its report, that exaggerated and fraudulent claims are having an adverse impact on overall claims costs, driving up the cost of premiums.

One of the problems is that fraudulent activities currently carry a low risk of detection and an even lower risk of prosecution.

It is estimated that fraudulent claims add, on average, €50 to insurance premiums a year, according to director of government affairs at Insurance Ireland, Declan Jackson.

'Where there is insurance, there is fraud'

Dr Luke said it is frustrating that such cases require endless complaints and tests, which can lead to “massive expenditure”.

Sadly, this can lead to an erosion of trust between health care professionals and patients, he added.

“Every emergency department is extraordinarily busy with staff up the walls doing their daily work,” said Dr Luke.

Having to monitor fraudulent cases could be a “huge perceived burden”.

Triage nurses and emergency department staff are now being trained to look out for evidence and proof of injuries consistent with accident reports.

He warned that “where there is insurance, there is fraud”.

Where there is no evidence, then the conservative approach is to wait and see what action is appropriate.

On the same programme, Rob Smyth, investigations and fraud manager with Aviva insurance, said that the company has adopted a new approach to fight every case they consider fraudulent.

He explained that in some cases the arrival of gardaí on the scene is considered validation for fraudulent claims.

Insurance companies and gardaí need to be able to share data to combat fraud, he said, but this can be difficult due to data protection issues.

Mr Smyth also said that all calls are recorded and voices compared, which had helped to thwart a recent fraudulent scheme where voice analysis had highlighted that the same man had made a number of claims using different names and different policies.

A new Garda fraud unit, funded by the insurance industry, is due to be set up to tackle bogus insurance claims.