AND-E Denies Allegations of Involvement in Moped Crash

Insurance Company Thwarts Fraudulent Claims, Saves Over £40,000

Aioi Nissay Dowa Insurance Europe (AND-E) has successfully challenged two fraudulent insurance claims, resulting in savings exceeding £40,000 in potential payouts and legal costs. The cases highlight the insurer’s zero-tolerance approach to fraud ahead of the Insurance Fraud Bureau’s Fraud Awareness Week.

“Our Special Investigations Unit continues to deliver outstanding results in the fight against insurance fraud,” said Jan Martin, Head of Third Party Claims at AND-E. “Protecting honest customers and challenging exaggerated claims is vital to keep premiums fair. We remain committed to taking the right cases all the way to trial to send a clear message to the market.”

The first case involved a personal injury claim that raised red flags when claims handlers spotted inconsistencies in physiotherapy documentation. The claimant had submitted the case through the Ministry of Justice portal rather than the lower-value Official Injury Claim route, which was the appropriate channel for this type of incident.

Although the collision itself was genuine, investigators noted several suspicious elements: an unrealistic 18-month prognosis for minor soft-tissue injuries, the claimant’s quick return to work and sporting activities, pressure for early interim payment, and contradictions in medical evidence.

When AND-E requested full disclosure of medical, occupational health, and gym records, the claimant’s solicitors ignored these requests and proceeded to issue legal proceedings. During the investigation, medical records revealed only a single GP visit following the accident with no mention of ongoing symptoms. The physiotherapy treatment had lasted less than one month.

At trial, the judge identified significant inconsistencies in the claimant’s testimony, noting they had signed statements without reading them. The court dismissed the claim entirely, resulting in savings of £18,000, with a finding of Fundamental Dishonesty that allowed AND-E to recover its legal costs.

“Cross-examination was vital,” Martin explained. “There was no change in the evidence, and our defence was vindicated. This was a strong result, highlighting the importance of standing firm when the facts don’t align.”

The second case began when AND-E’s First Notification of Loss team identified early inconsistencies in a moped claim. The policyholder reported that after a minor collision, a group of men arrived at the scene and deliberately caused additional damage to the third party’s vehicle. The third party subsequently demanded £2,000 for repairs.

Engineering evidence commissioned by AND-E didn’t support claims that the bike had fallen over. Investigators also noted the unusual circumstance of separate solicitors handling the vehicle damage and personal injury aspects of the claim.

When the case reached court, the claimant admitted he had never fallen from his bike, directly contradicting both his medical report and signed witness statement. The judge rejected attempts to blame solicitors or language difficulties, ruling it implausible that three separate professionals had all misunderstood the claimant’s account.

The court made a finding of Fundamental Dishonesty, ordering repayment of £11,800 and preventing any further related claims from proceeding. The insurer’s actions prevented more than £22,000 in fraudulent payments.

“This result shows the importance of persistence – not just accepting a discontinuance when dishonesty is clear,” Martin said. “The Fundamental Dishonesty finding sends a clear message that misleading the court has consequences.”

These cases come at a time when insurance fraud remains a significant industry challenge. According to the Association of British Insurers, insurance fraud costs the UK economy over £1 billion annually and adds approximately £50 to each policyholder’s premium.

The insurance sector continues to invest in sophisticated fraud detection systems and specialized investigation units to combat the problem. Companies like AND-E have established dedicated teams that work alongside legal partners to identify suspicious claims and gather evidence that can withstand scrutiny in court.

Industry experts note that the willingness of insurers to pursue cases to trial, rather than settling questionable claims, serves as an effective deterrent and helps protect the interests of honest policyholders who ultimately bear the cost of fraud through increased premiums.