Esure saves over £1m after fraudster has unnecessary surgery

Esure has saved over £1m after a fraudster was found exaggerating an injury claim.

Samuel Mervin was involved in a motorcycle accident with an Esure policyholder and sustatined severe injuries to his legs.

He needed multiple surgeries and suffered from intense pain as a result of increased pressure in his muscles.

Liability was admitted in the early stages of the claim, and Esure funded his rehabilitation and care.

But suspicions started to rise when, after a substantial amount of time, he continued to make claims.

He insisted that he still needed substantial care, was unable to work, and was virtually immobile. As a result, Esure commissioned surveillance on Mervin.

The surveillance revealed that he was in fact fully mobile, he had got back on the motorcycle, and that he had done some removal work.

However, he continued to insist that he needed help walking and even went through further, unecessary surgeries to keep the charade going.

He initially claimed around £825,000, but after the continued lies, it ended in the region of £1.5million.

After Esure took its surveillance and medical evidence to the courts, it pleaded the claim was fundamentally dishonest under section 57 of the Criminal Justice and Courts Act (2015). As a result, Mervin withdrew his claim with no damages or costs being paid.

Esure’s head of technical claims, Steve Morrison said:

“Esure operates a zero-tolerance policy on any type of fraud and whilst fraud in serious injury cases is thankfully unusual, this is a great example of how to approach a claim when there are suspicions of fraudulent exaggeration and an excellent outcome for our premium paying customers.”

Keoghs’ complex injury partner, Matthew Perkins added:

“This case has a number of important features which are of considerable significance for insurers when considering their approach in potential S57 cases involving exaggeration. In particular, despite his serious injuries and his decision to undergo unnecessary further surgery to perpetuate his fraud, the claimant was still prepared to drop his claim, rather than allowing his dishonesty to be further scrutinised via the court process.

”This decision is likely to have been a wise one in light of the guidance issued by the High Court, which reflects the hardening legislative and judicial attitudes to fraud.”