QBE Insurance v Liam Jones
A two year custodial sentence has been handed down to roofer, Liam Jones, who was found guilty of fraud in a private criminal prosecution brought by BLM on behalf of QBE Insurance. The custodial sentence, which has been suspended for two years, followed significant costs penalties in the earlier civil claim.
On 24 January 2011, Mr Jones suffered genuine and potentially serious injuries when he fell approximately 40 feet to the ground from a roof, whilst in the employment of an insured of QBE, a roofing contractor. In a claim for damages likely to have exceeded £700,000, he alleged significant ongoing incapacity and financial loss as a result. Working with QBE, BLM obtained surveillance evidence that demonstrated that Mr Jones had grossly exaggerated the level of injury and capacity.
At the hearing on 29 October 2018 in Liverpool Crown Court, Her Honour Judge Smith told Mr Jones that “Your offences are not victimless offences. Fraud causes losses that affect society at large.”
BLM partner, Stuart Furniss, represented QBE and its insured in relation to both the defence of the civil claim and the Private Criminal Prosecution. He said, “This case demonstrates how important it is to take a hard line when faced with a claim tainted by fraud or exaggeration. The sentence should also act as a clear deterrent to those seeking to defraud insurers and their customers and hopefully help to reduce the number of similarly fraudulent claims which continue to drive up premiums for others.”
On 24 January 2011, whilst working for his employers, Mr Jones fell through a roof, landing some 40 feet on the ground below and then falling further into a six foot pit. He sustained serious injuries (both physical and alleged psychological).
Prior to proceedings, a Part 36 offer of £50,000 gross of recoverable benefits was made reflecting an assessment of liability and the injuries known at the time. Thereafter and after submission of several medical reports, legal proceedings were served which pleaded the claim for damages at £669,651.66 (exclusive of general damages and interest), plus costs. The preliminary schedule of loss referred to medical evidence regarding what Mr Jones could and could not do.
After investigation of the evidence, it became apparent that Mr Jones was presenting a higher disability than he had which was a cause for concern and suggested there may be some credibility issues. Four days of surveillance was commissioned and this showed Mr Jones walking freely without a crutch on one occasion for a number of miles. In other instances, footage showed he walked with a crutch but only when walking to and from experts’ medical appointments. Evidence also showed Mr Jones working as a roofer which involved ascending and descending ladders.
A robust approach was taken which included applying to bring a counterclaim for damages in the tort of deceit. Mr Jones’ solicitors ceased to act for him and, on 15 September 2015, during an application to strike out the claim, he accepted the Part 36 offer. Due to costs owed given the late acceptance, Mr Jones received no money in respect of his claim.
QBE, supported by BLM, then took the decision to pursue Mr Jones by way of a Private Criminal Prosecution for fraud. Once the case reached the Crown Court, Mr Jones, through new solicitors, asked the Crown Prosecution Service (CPS), to take over the prosecution, although the basis for this was never clear. When the CPS declined to do so, Mr Jones applied for judicial review of its refusal and that application was also unsuccessful.
After pleading not guilty to the fraud charges, the matter proceeded to trial. William Featherby QC represented QBE and its insured.
A jury found Mr Jones guilty of fraud on 18 September 2018 and he received a two year custodial sentence which was suspended for two years.
What this means for you
This case demonstrates that fraud and attempted fraud, including exaggerated claims following a genuine and potentially serious injury, will not be tolerated in both the civil and criminal courts. This case pre-dated the commencement of s57 Criminal Justice and Courts Act 2015 and the potential consequences but the end result in the civil matter was equally as effective. For the right case, it may also be appropriate to go one step further, as with this one, and prosecute the offender. The outcome further enforces the message and hard line that can be taken to would-be perpetrators.
The case also exemplifies the benefits of close liaison between serious personal injury and fraud expertise in combatting fraud and exaggeration in large loss cases.