Fraud experts warn of worrying rise in physiotherapist-driven ‘prognosis creep’ on OIC portal

Counter fraud experts have warned that the time it takes for Official Injury Claim (OIC) portal claimants to provide medical prognoses is increasing, partly influenced by the rise in physiotherapists providing these medical reports.

Speaking at Insurance Times’ Fraud Charter event in December 2022 – sponsored by Carpenters Group – Ruth Needham, partner at Keoghs, told delegates: “We have started to see a little bit of prognosis creep on the OIC, with this increase in [the time it takes to receive] prognoses to 13 months.

“But the bit that worries me the most about this is, on the cases where we’re seeing this 13 months, most of the medical reports have been prepared by a physiotherapist.”

Needham questioned whether the system was “pushing” claimants to acquire medical reports to support their claims via physiotherapists, who were holding up the process and potentially increasing the risk of fraud.

The Ministry of Justice’s OIC Portal came online at the end of May 2021 following a government effort to mitigate the large quantity of fraudulent minor injury claims being made following car accidents – it was intended to allow litigants in person to process their own whiplash injury claims following a road traffic accident, with claims awards based on a corresponding tariff table that aligns compensation with injury recovery times.

Despite this, the majority of portal claimants continue to be represented rather than unrepresented, with the latest data – released in October 2022 – showing that of a total 351,409 claims submitted since the portal’s launch, only 31,493 were unrepresented, while the remaining 319,916 claimants opted for representation in the process.

Aware of the issues

In the face of fraud experts’ worries over prognosis creep Susan Brown, director at MedCo – a firm that facilitates the sourcing of medical report providers to support claims – said: “MedCare are already on it – insurers have already raised this with us.”

Brown confirmed that the increased involvement of this class of medical professional was increasing the time period between reporting of medical incidents and the providing of reports, thus holding up the claims process.

She said: “I was looking at some reports from physiotherapists and absolutely the prognosis period has gone up – some of them are physiotherapists that we’ve reviewed before, so we’ll do what we can long term.”

Donna Scully, director at Carpenters Group, added that this sort of behaviour was on the radar for counter fraud experts.

She explained that while technical issues with the portal had been problematic in the first 18 months of its operation, “[the issues with the OIC portal] that are coming out now are more to do with policy behaviour – more MoJ-related issues around the rules not working and gaming, that sort of thing”.