Background

Upon receipt of a first notice of loss for a burglary claim, we were instructed, and the claim was initially handled by a general Property Adjuster. The Policyholder, Mr J, was claiming on a policy that was incepted three weeks before the reported burglary. We were advised that he had recently acquired full ownership of his family home and subsequently arranged insurance at that time.

The Adjuster held serious reservations regarding the validity of the submitted claim. Mr J was less than accommodating during his meeting with him and he was simply expecting his insurance provider to settle his claim without validation.

The handling Adjuster escalated the matter for investigation by our Special Investigations Team. An Investigator was deployed on the case and worked closely with key stakeholders including the Adjuster, the Insurer and the Insured’s Broker.

The investigation

Our Investigator also found Mr J less than accommodating and very pushy for settlement, being very rude and abrupt in the process.

It was alleged that Mr J left his home fully secure and went to his brother’s house for a family barbeque. He was not expecting to stay the evening but ended up staying the night due to alcohol consumption, which prevented him from driving home. The theft was discovered by him upon his return home the following morning.

He noticed the side window ajar, but claimed the window was left secured. Mr J entered his home via the front door as normal but found the lounge in a state of disarray and immediately called the Police. As he continued to walk through the property, he also found that two of the three bedrooms had been untidily searched. Mr J claimed that this was the first time he had ever been a victim of crime.

These events were plausible and generally corroborated by local neighbour enquiries. However, it was considered of crucial value to cross check with the Police and ensure events described and the claim submitted was in accord with what they had been told.

Mr J explained that gold coins and cash were missing and gave this information to the Police. He provided delivery notes for the claimed gold coins and gold bar, and clearly held an account with The Royal Mint. However, we did not believe it to be an unreasonable request for him to contact the supplier and ask them to provide a statement to mirror his purchases, and to eliminate the possibility that any of the items had been returned.

Mr J also claimed for a ring and chain but his descriptions of the same were very vague. Mr J claimed to have purchased these items from friends but could not confirm the dates. We were provided with photographs showing these items being worn but a photograph does not support legal entitlement, value or authenticity.

As part of the investigation, enquiries were undertaken with the Police to corroborate Mr J’s testimony. A formal application for the Crime Report was made and on receipt, our Investigator was alerted to the following salient extract:

This is a high value burglary dwelling, estimated £20,000. The victim strongly believes one of these offenders is the same male that was the offender for previous crimes the victim has reported recently.

It was confirmed by the Police within the Crime Report that Mr J had previously reported crimes to them. When advised of the content of the Police Crime Report Mr J vehemently denied any prior incidents where he was a victim of crime. The pressure to settle the claim intensified, resulting in a tactical complaint to senior personnel at Davies and with the Client.

Our Investigator followed the protocols of the ABI ACPO Memorandum of Understanding and under the jurisdiction of an Appendix E application, was able to get full details of the previous incidents.  The following extract from the subsequent Crime Reports revealed the following key and material information:

Suffolk Constabulary have a record of investigation where Mr J was the victim. It was reported that over the period between 14/05/2019 and 14/06/2019 Mr J has had three males turn up at his address, demanding £5,000 because he has ‘stitched them up’. He has been told that there was a fourth male up the road, waiting with a gun. On the first occasion Mr J has handed over a diamond ring with a fake Rolex. When the circumstances were repeated, he has given them £200. Mr J denies owing any money and claims not to know what this is all about. NFA decision made.

Results

Mr J had previously been targeted, for whatever reason, which he failed to mention during two interviews. These incidents occurred at the time when Mr J was considering arranging insurance cover. It was confirmed by his insurance brokers that Mr J enquired about taking out a policy on 09/05/2019 and agreed to take out the policy on 14/05/2019, which we note is the date of the first attack. The policy started 01/06/2019.

It is reasonable to consider that Mr J arranged the policy fearing further reprisals. Mr J was clearly quite susceptible to attack. Given the information recorded in the Crime Report for the burglary, it was reasonable to consider that the individuals that targeted Mr J were responsible for this theft.

In due course the policy was voided because of Mr J’s failure to disclose the previous crime related incidents at inception. The claim automatically failed resulting in a saving of £20,000 for our client, the insurer.

To find out more about our special investigation capabilities, please get in touch with Associate Director, Ahmed Esat on Ahmed.Esat@davies-group.com.