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Emergency depts seeing up to six fraudulent accident cases each week, doctor claims

Emergency medicine expert Dr Chris Luke claims that staff in emergency departments in Ireland see between one and six fraudulent accident claimants every week.

“I would be surprised if they don’t see at least one fabricated or exaggerated case every week,” he told RTE’s Today with Sean O’Rourke show.

He said there were three hallmarks of such cases – mystery, misery and massive expense.

Dr Chris Luke

Such cases usually involve a person “screaming blue murder” at the scene, but the absence of any injury. He said that in his experience the louder the noise at the scene, the less there is to see in the form of an injury.

This all adds to the misery of emergency department staff who are already under pressure and stressed.

It is frustrating as such cases require endless complaints and tests which can lead to “massive expenditure.”

Sadly, this can lead to an erosion of trust between health care professionals and patients, he added.

“Every emergency department is extraordinarily busy with staff up the walls doing their daily work,” said Dr Luke. Having to monitor fraudulent cases could be a “huge perceived burden.”

Triage nurses and emergency department staff are now being trained to look out for evidence, for proof of injuries consistent with accident reports.

He warned that “where there is insurance, there is fraud.”

Where there are no marks, no evidence then the conservative approach is to wait and see what action is appropriate.

On the same programme Rob Smyth, investigations and fraud manager with Aviva insurance, said that the company has adopted a new approach to fight every case they consider fraudulent.

He explained that in some cases the arrival of gardai on the scene is considered validation for fraudulent claims.

Insurance companies and Gardai need to be able to share data to combat fraud, he said, but this can be difficult due to data protection issues.

Mr Smyth also said that all calls are recorded and voices compared which had helped thwart a recent fraudulent scheme where voice analysis had highlighted that the same man had made a number of claims using different names and different policies.