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This is what we are in the business to do, but some insurers are
better than others at doing it.
However, the task of insurers is always made more difficult by the
spurious and fraudulent claims that plague our industry. There
are too many examples of frivolous claims and our industry needs
to take a stand before it is too late. These can have a serious
impact on the cost of insurance and in some cases the reputation
of the insured. Too often insurers do not take the time or trouble
to look into the smaller or some of the more contentious claims,
putting them in the ‘too hard’ basket.
But this can have a very detrimental
effect on the client.
I’d be quite happy to say that some-
times they need to grow a backbone
when it comes to the current stance
of claims departments and insurers
regarding dubious claims. There have
been several recent examples of claims
that have come across my desk that
required a closer look and which we
fought because they were clearly spuri-
ous or fraudulent.
In one claim a women attending a
children’s dance night at an RSL club
got up from her table and tripped or
slipped on a step down onto the dance
floor. She injured her arm quite serious-
ly. There was strip lighting delineating
the step and also reduced lighting
in the building normal to a concert
performance in progress. She sued
both the dance school and the RSL club
seeking a large sum in compensation
which was grossly exaggerated. The circumstances of the inci-
dent were thoroughly investigated and the cause appeared to be
simply a case of not watching where one was going properly. We
considered there was no liability on the part of the dance school
(or the RSL for that matter) and we elected to maintain a strong
defence of the claim on the insured’s behalf. The matter went
before the NSW Supreme Court and the verdict was returned in
our client’s favour.
In another, the claimant was attending an outdoor exercise class
in a well known park in Victoria. The class was supervised by our
insured, a personal trainer. The claimant alleged that she frac-
tured her ankle after putting her foot in a depression in the park’s
surface. She sued the insured alleging amongst many things that
the park surface was unsafe and lack of proper supervision by
the insured. The circumstances were thoroughly investigated and
we considered the claim to be totally spurious. The park is a well
known one, regularly used by families and is well maintained. It
is most unlikely there was any depression or hole. The claim was
recently withdrawn shortly after mediation.
And in a third example a collision between two players who
were competing for the ball during a soccer match resulted in
the claimant seriously injuring his knee. The claimant sued the
local soccer club alleging poor supervision by the referee, and
also the other player. Fortunately there was film of the incident
which clearly showed a simple collision
between two players during a sporting
contest. There was no liability on the
part of the club, referee and the other
player. A strong defence was main-
tained throughout and the claim was
recently withdrawn.
These are claims that would have
been recorded against the insured and
would have impacted upon their claims
history and subsequent insurance
premiums had we not made a stand to
defend them.
However, we are fully aware that there
is a balance between taking a stand
and compassion and understanding in
genuine cases. We are proud of being
very compassionate to genuine cases,
often going beyond the insurance
payout to help out the families and
communities where we can.
Taking a hard-line approach to certain
claims is not always easy, but it is vital
in supporting small businesses and upholding the integrity of the
industry. The problem is, if you pay fraudulent or exaggerated
claims it can cripple a business either through increased insur-
ance premiums or damaged reputation.
Weeding out the false claims also means we can concentrate
more time and effort in making sure that genuine claims are paid
promptly. I think the average person on the street who is honest
and wants fair insurance cover would encourage insurers to
identify those excessive and fraudulent claims and take a strong
stand on those.
Sports clubs and associations need the strength of insurance
behind them. They also need an insurer with the strength and
courage to know when to pay promptly and when to defend the
claim on their behalf.
“Sometimes they need
to grow a backbone
when it comes to the
current stance of
claims departments
and insurers regarding
dubious claims.
There have been several
recent examples of
claims that have come
across my desk that
required a closer look
and which we fought
because they were
clearly spurious or
fraudulent.”
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ISSUE 21 | AUGUST 2015