Initial concerns
We were concerned from the outset about whether the claimant had suffered any accident-related injuries in the first place and the extent of any true accident related injury. Our concerns were supported by the expert medical evidence and intelligence we obtained.
History
It became clear that the claimant had failed to declare a significant pre accident physical and psychological history. We put Part 35 questions to the claimant’s medical experts after having provided them with the claimant’s full medical records. When presented with these, the claimant’s orthopaedic expert stated that the history given by the claimant was “not a reliable account”. In addition, her injuries were inconsistent with the entries in the records and the nature of the accident.
We further obtained and disclosed the claimant’s own extensive social media postings over multiple platforms which came to more than 40 hours of footage. This had not been disclosed by the claimant and included evidence that, post-accident, she had promoted her various businesses and continued to work. There was no evidence of any of the restrictions from which the claimant had told the medical experts and the DWP she was suffering.
Review
We requested a review of the CRU certificate on the basis that the benefits awarded to the claimant were not paid as a result of accident related injury and that there was serious concern over the credibility of the claimant having regard to the social medial evidence.
Upon carrying out the review, the CRU revoked the entire certificate and reduced recoverable benefits from £38,189.27 to nil.
Practice points
This case is a reminder of the power of the CRU review and appeals system. Certificates of Recoverable Benefits should be challenged in appropriate circumstances. There are three ways of doing this:
1) A Certificate of Recoverable Benefits (the CRB) can be reviewed at any time during a case by any of the parties involved. The case does not have to be settled or the recoverable benefits paid to the CRU before a review can take place. The grounds for a review are:
- the Certificate was issued in ignorance of, or based on a mistake as to, a material fact;
- a mistake was made when the Certificate was being prepared;
- incorrect or insufficient information was supplied to begin with and, as a result, the amount of benefit or lump sum payment specified in the Certificate was less than it would have been if the information had been correct;
- a ground for appeal is satisfied under Section 11 of the 1997 Act.
2) The amount of recoverable benefits set out in the CRB can also be the subject of a Mandatory Reconsideration which is a final chance for the CRU to re-consider the CRB before the formal appeal stage. The CRU will consider all the evidence and decide if the CRB should be:
- changed and a partial refund issued;
- revoked and a full refund issued; or
- confirmed as correct.
3) The final step, the appeal, can be taken after the Mandatory reconsideration stage should you still consider the CRB is wrong. An appeal cannot be lodged until the claim has been settled and the amount of recoverable benefits has been paid to the CRU. The compensator or the injured person can make an appeal on the following grounds:
- any amount, rate or period specified in the Certificate is wrong;
- the Certificate shows benefits and lump sum payments which were not paid as a result of the accident, injury or disease;
- benefits and lump sum payments listed which have not and are not likely to be paid to the injured person have been brought into account; or
- the compensation payment made was not as a consequence of the accident, injury or disease.
The CRU will respond with a written decision.
OurComplex Injury Teamdeals with cases like this on a regular basis. For more information or advice, please contact one of our experts.
