Fraudulent and Exaggerated Claims in Catastrophic Injury Cases

Uncovering the truth behind fraudulent and exaggerated claims in catastrophic injury cases.

Fraudulent and exaggerated claims pose significant challenges in defending large loss personal injury cases. These claims often involve long-term disability, brain injuries, paralysis, or chronic pain conditions that are difficult to objectively quantify. We set out below the key aspects and defence strategies that we deploy when investigating such claims:

Are the claimant's own experts consistent in the assessment of diagnosis, causation and prognosis? For example, if one expert attributes chronic pain entirely to the accident while another suggests a pre-existing condition as a contributing factor, this divergence may indicate uncertainty or potential bias in the claimant's favour. Seminally, conflicting opinions on prognosis - such as one expert predicting disability while another foresees significant recovery - can raise questions about the reliability of the claimant's reported impairments. 

Systematically compare all medical reports for coherence in the following areas: a. Diagnosis: Do all experts agree on the nature and extent of the injury? Are diagnoses supported by objective evidence, such as imaging or laboratory results, or do they rely heavily on subjective complaints? b. Causation: Is there consensus that the accident directly caused the claimant’s injuries, or do some experts point to pre-existing conditions, degenerative changes or unrelated factors? c. Prognosis: Do the experts’ predictions about recovery timelines and long-term impacts align, or do they vary significantly in terms of expected disability or functional limitations? Inconsistencies in these areas may not only weaken the claimant’s case but also suggest an attempt to exaggerate the severity or obscure contributing factors.

Cross-referencing expert reports with pre-accident medical records, witness statements, and, where applicable, surveillance evidence can further clarify whether the claimant’s presentation is consistent with the alleged injury.

While inconsistent medical reports can signal potential fraud, they must be evaluated with caution to avoid unfairly dismissing legitimate claims.

Delayed or Opportunistic Claims

Delayed or opportunistic claims, where injuries are reported long after an accident, often signal potential fraud or exaggeration, particularly when tied to financial distress. A significant delay in reporting symptoms - weeks or months post-incident - without a plausible explanation (e.g., gradual symptom onset) undermines the claim’s credibility, especially if no contemporaneous evidence, such as GP or hospital records, documents complaints in the accident’s aftermath. Opportunistic claims, triggered by external factors like financial hardship, publicity about compensation, or legal solicitation, further raise suspicion.

Legal teams should scrutinise the timing of the claim, review pre- and post-accident medical records, and investigate the claimant’s financial or social media activity for motives. While legitimate delays, such as those due to psychological trauma, may occur, independent medical evaluations can clarify causation. Discrepancies in timing or documentation should be leveraged to challenge questionable claims while ensuring valid cases are fairly assessed.

Pre-Accident Medical History

Look out for a pattern of frequent attendances at GP, particularly when accompanied by numerous investigations for symptoms that lack a clear medical diagnosis, unexplained pain, or vague complaints. A history of repeated consultations for conditions such as chronic fatigue, diffuse pain or non-specific neurological complaints - often labelled as “idiopathic” - can indicate a pattern of health-seeking behaviour unrelated to the index accident.

Multiple referrals to specialists, diagnostic tests or exploratory procedures without conclusive findings further amplify this red flag. Unexplained pain syndromes, such as fibromyalgia, CRPS or persistent headaches without identifiable pathology often rely heavily on subjective reports, which can complicate attribution of symptoms. A claimant with a documented history of amplified or medically unexplained symptoms may be more likely to exaggerate the severity or impact of injuries, whether intentionally or due to somatisation. Whilst these symptoms do not automatically indicate fraud, they serve as a cautionary signal prompting further investigation.

Social Media & Surveillance Evidence

Social media and surveillance evidence can expose fraudulent or exaggerated claims when claimants engage in physical activities inconsistent with their alleged limitations. For instance, a claimant reporting severe mobility restrictions or chronic pain may post videos of themselves participating in strenuous activities, such as sports, dancing, or heavy lifting, on platforms like Instagram or TikTok. Similarly, surveillance footage capturing the claimant performing tasks they claim to be incapable of - such as running, gardening, or working - can undermine their credibility.

Legal teams should systematically review the claimant’s social media activity, including posts, photos, and metadata, to identify discrepancies with reported injuries. Professional surveillance can further corroborate inconsistencies. While such evidence is powerful, it must be contextualised - occasional activity may not negate genuine limitations. Cross-referencing with medical records and expert opinions ensures a balanced approach to challenging questionable claims.

Multiple Claims History

A history of multiple claims, particularly for similar injuries across different incidents or jurisdictions, is a significant red flag for potential fraud or exaggeration in catastrophic injury cases. Claimants who repeatedly file for comparable injuries - such as recurring back pain, whiplash, or neurological complaints - may be exploiting the subjective nature of these conditions to secure payouts.

"Cross-referencing with medical records can reveal whether prior injuries overlap with current claims."

Legal teams should thoroughly investigate the claimant’s claims history through insurance databases, court records, or inter-jurisdictional checks to identify patterns. Cross-referencing with medical records can reveal whether prior injuries overlap with current claims. While a history of claims doesn’t automatically indicate fraud, it warrants scrutiny, balanced with consideration of legitimate injury patterns, to challenge questionable claims effectively.

Early Settlement vs. Aggressive Litigation Strategy

In catastrophic injury cases, deciding between early settlement and aggressive litigation is critical for managing potentially fraudulent or exaggerated claims. Early settlement may be strategic when the costs of prolonged litigation - legal fees, expert reports, and court expenses - outweigh the claim’s value, particularly for low-value or ambiguous cases with limited fraud indicators. Settling early can minimise financial and reputational risks while conserving resources. Conversely, when fraud is strongly suspected, such as with inconsistent medical reports or a history of multiple claims, pursuing aggressive litigation can deter future frivolous claims and expose deceit.

Legal teams should weigh factors like the strength of evidence (e.g., surveillance footage, medical discrepancies), the claimant’s credibility, and jurisdictional trends. A balanced approach ensures cost-effective resolutions for weaker claims while robustly challenging clear fraud, safeguarding against abuse of the compensation system.