Large Loss Technical Lead Reflects on Landmark Settlement Claim

Maria Bridgman, our Large Loss Technical Lead, reflects on a recent settlement agreement on a case pleaded at almost three quarters of a million pounds: -

“This was a complex, multi-faceted claim involving disputes on liability, causation, and quantum, along with a pleaded allegation of fundamental dishonesty”

Claimant’s Case

The Claimant sustained a complex clavicle fracture, soft tissue injuries to the neck and thoracic spine, and reported psychological symptoms.

The clavicle fracture was treated with internal fixation, later removed. Despite imaging confirming full union, the Claimant maintained she suffered significant pain, discomfort, and stiffness in her right shoulder. Against the advice of both her treating and medico-legal experts, she refused further surgery and failed to engage in psychological therapy. Without such interventions, her symptoms were expected to persist indefinitely. Her approach raised concerns regarding failure to mitigate loss and her overall credibility.

The original Schedule of Loss, served with the proceedings, was valued at £433,210.22. An updated version served in December 2024 increased this to £732,701.69.

The Claimant argued that due to her injuries, she lost the opportunity to establish her business. While not entirely incapacitated, she claimed she could only treat one client per day, averaging four clients per week. Her claim included, in addition to other less significant heads of loss:

Past loss of earnings: ~£152,000

Future loss of earnings: ~£440,000

Past care costs: ~£33,000

Strategy

Recognising the complexities of the case—including concerns over causation, quantum, and credibility, we deployed an early Part 36 offer on quantum. This was aimed at securing costs protection at trial, given the anticipated expense of investigation and litigation.

From the outset, we identified that:

• Expert medical evidence would be required across at least three disciplines.

• Disclosure obligations would be substantial and onerous.

Accordingly, in June 2023, we advanced a Part 36 offer of £135,000, net of liability, which remained in dispute at that stage.

Upon its expiry, we proceeded with a full quantum investigation.

Outcome of Investigations

A forensic analysis of the evidence, supported by a detailed chronology, established that:

• The Claimant had previously admitted to tax evasion 

• She abandoned her business plan shortly after arriving in the UK.

• The business would have been halted anyway due to the COVID-19 pandemic until at least July 2021.

• In March 2020, she informed the Home Office that she had recovered from accident-related injuries but was unable to work due to the pandemic.

• Records confirmed she resumed work in July 2020, continuing until May 2024 when she moved out of London.

• Multiple bank accounts revealed unexplained wealth.

• Transaction records and bank statements contradicted her witness evidence, showing she regularly saw four or more clients per day and worked six days a week.

• By 2023, she operated a salon in London.

• Bank income did not match declared sales transactions, payslips, or dividends.

• Additional undisclosed bank accounts likely existed for receiving business payments.

• Alleged care payments to a friend were actually loan repayments.

The Claimant was put on notice that fundamental dishonesty was engaged in the Counter-Schedule of Loss.

Following a Joint Settlement Meeting, but before trial, the Claimant accepted a costs-inclusive offer representing a 73% saving for our insurer client.

Learning Points

This case highlights the importance of early identification of large loss and complex injury claims to ensure a bespoke defence strategy from the outset. Key takeaways include:

• Specialist expertise is crucial: Claims should be handled by true subject matter experts with the right skills and technology to proactively drive resolution which aligns with the Carpenters Group philosophy of “Having the right people with the right skills, using the right technology”.

• Appoint skilled counsel and medico-legal experts early and utilize case conferences effectively.

• Early access to records enables forensic evidence analysis, helping to identify inconsistencies or pre-existing conditions.

• Ongoing social media monitoring and, where appropriate, surveillance can provide critical evidence.

• Fundamental dishonesty detection justifies deeper investigations and can prevent exaggerated or fraudulent claims.

• Early and strategic Part 36 offers place the Claimant at risk and secure costs protection at trial.

• Consider ADR for commercial settlement where appropriate.

Final Thoughts

This case demonstrates the power of forensic analysis, expert evidence, and strategic disclosure in defending large loss and complex injury claims. By adopting a methodical, evidence-based approach, insurers can significantly reduce exposure and achieve fair settlements while deterring fraudulent claims.