QUEEN'S BENCH DIVISION
Strand, London, WC2A 2LL |
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B e f o r e :
(sitting as a Judge of the High Court
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DIRECT LINE INSURANCE plc |
Claimant |
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- and - |
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KENNETH RONALD FOX |
Defendant |
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Edward Brown (instructed by Attwater & Liell ) for the defendant
Hearing dates: 23 and 24 February 2009
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Crown Copyright ©
His Honour Judge Richard Seymour Q.C. :
Introduction
"If any claim or part of a claim is made fraudulently or falsely, the policy shall become void and all benefit under this policy will be forfeited."
"Subject to your approval and subject to the terms and conditions of the Policy I agree to accept the sum of £46,524.50 in full settlement and discharge of all my Buildings claims under your Policy No. 40595540/01 for loss and damage by Fire which occurred on the 8th April 2007.
I understand that my Insurers will make an interim payment of £42,412.00, followed by a final payment of £4,112.50, subject to me providing invoices demonstrating my outlay in respect of the VAT element of replacement bespoke kitchen which will be manufactured by Darren Brett Furniture Ltd.
I confirm that there is no other insurance covering this loss or damage and that no other persons have an interest in the property the subject of this claim other than Abbey National.
I accept that any valuation used in assessing policy liability was calculated for that purpose only and is not a valuation for future insurance or loss adjustment. "
"Gilbert, I am please [sic] to tell you we have now moved back to the above address. Thank you very much for your prompt and professional assistance with handling our claim. As per our agreement dated 07/06/07 there remains one small outstanding amount of monies for £4112.50. I enclose a copy of there [sic] invoice which has been settled by myself. Could you please ask Direct Line to forward me a cheque for the above amount?
Once again many thanks, if you have any queries please don't hesitate to contact me."
"To remove granite tops and set aside.
To dismantle existing kitchen and take away.
To manufacture kitchen as per existing, re install, re paint as per original, re fit granite tops, sink etc.
At a cost of £23,500.00 plus vat @ 17.5% £4112.50
Total £27,612.50
Paid in full
Many thanks"
"I refer to your claim with the above incident and advise that we are instructing Cunningham Lindsey to make a further visit to you to verify the works that have been completed and ensure that all is proceeding as it should be. It will involve taking a statement and verifying the documentation received to date.
Whilst the claim is ongoing, it must be clearly understood that if your policy is cancelled, renewed or amended in any way and/or further premium payments are accepted, then this is done strictly without prejudice to any rights we may have to avoid your policy or take other appropriate action, from the date of this claim or from another appropriate date.
This is a standard paragraph, and we reserve our position generally."
"Insured advised that he has rec[eive]d a letter from Insurers and now no longer wishes to pursue the o/s [i.e. outstanding] aspect of his claim – namely VAT element of the kitchen replacement. I advised that I would speak to Insurers about his request and come back to him with their comments."
"Advised that on Insurers instructions he should now write to them explaining why he no longer wishes to pursue the claim."
"I am writing with regard to the invoice I submitted from Mr. Darren Brett in respect of the above insurance claim.
As you are probably aware, after my house was damaged by fire, I negotiated a financial settlement with Direct Line Plc that enabled me to oversee the reinstatement of works. The final settlement figure I had to accept allowed no margin for adjustment, being some £20k under the closest quotation. Yet I agreed to it, because I was keen to ensure the highest standards of refurbishment work and my family were back in our home A.S.A.P.
During these negotiations, I witnessed the lengthy claim processes and got a fair insight into just how protracted the matter was going to become. For instance, I was told at the outset that it would take at least two months before the refurbishment would even be approved!
Bearing in mind my personal situation, of having a family with three young children – 11 years, 15 months and 4 months respectively; and my running a business that relies on my hands-on, day-to-day presence, I was eager to resolve matters as soon as possible. Living out of cases in a hotel and subsequently moving into rented accommodation of questionable standard, was stressful to say the least. Family life was suffering and I was becoming concerned with the knock-on effects on my business.
Therefore, after my completing the preparation work, I gave Mr. Brett – a previously trusted supplier – the go ahead to start work on refitting the kitchen in early July. Bearing my comments regarding processing in mind, I also asked for him to raise an invoice for the agreed amount (£23,500 + vat) so that I could pass it on and avoid any delays.
This he eventually did (copy enc.) but after enduring six weeks of delays and a series of heated discussions over his reliability and constant requests for cash advances, I was forced to dispense with his services. To say that relations between us are strained would be putting it mildly, yet I have subsequently learnt that amongst others, Mr. Brett is currently undergoing investigations by the CSA and has problems enough of his own.
However, in order for my family to get back into our home, I commissioned the completion of the work, albeit at substantially increased cost to me, and yet I submitted Mr. Brett's invoice.
In hindsight, I realise this was unwise, a mistake on my behalf.
In an attempt to resolve this situation swiftly and amicably, I would like to withdraw my claim for the final payment of £4,112.50, ask you to accept my sincere apologies and to consider the claim closed.
I look forward to your earliest response."
"10) In respect of the repairs to my kitchen I spoke with Daren Brett, the person who had built my kitchen originally. I asked Daren how much it would cost to put my kitchen back to the way it was. I told him it was an insurance job and that I would leave him to get on with it. Daren gave me a verbal quote of £23,500.00 and I submitted this figure with the tender. I didn't get a written estimate from D. Brett and he didn't visit my house because he already had the spec. from when he made my original kitchen. I told D. Brett that the whole kitchen had to be stripped out and replaced and this was agreed by the loss adjuster and surveyor.
11) …
12) …
13) After enduring 6 weeks of delays and heated discussions with Mr. Brett I decided to dispense with his services. At that point he hadn't done any work at my house but he had given me his invoice no. 2007007 which he had prepared at my request for the work he was going to be doing in my kitchen, work which was needed as a result of the fire.
14) I had asked him for the invoice because I wanted to make sure I had it ready to send to my insurers for the final VAT payment.
15) The invoice that I sent to Cunningham Lindsey is a photocopy that I made of the original invoice that D. Brett gave to me. I have shown Miss Foster the original invoice that I was given.
15) [sic] I have also shown her an original invoice given to me by D. Brett in respect of work he did at Plots 1 & 2 Upshire Road, these being 2 new build properties that my company was building.
16) Both invoices are numbered 2007007. I have no idea how this came about and the first time I noticed it was when Miss Foster pointed it out to me today.
17) I was definitely given the 2 invoices I have referred to by D. Brett and had absolutely nothing to do with the preparation of either of them.
18) The invoice for my kitchen was handed to me personally by Daren Brett.
19) Having dispensed with D. Brett's services in respect of my kitchen I then got the work done by my own company. Any joinery work that was done for the kitchen was done by G. Miller and I can get documentation detailing exactly what work was done in the kitchen.
20) All the work was done by Fox Developments, my own company and any payments were either by means of cash or through the company.
21) I cannot remember exactly how much I paid G. Miller for the making of replacement parts for the kitchen but think it was about £4 – 5000.
22) I already had the invoice from D. Brett and even though he didn't do the work I sent the invoice to Cunningham Lindsey. The reason this was done was because other works needed to be done as a result of the fire which were not originally priced for or included costwise in the settlement that had been agreed as per my letter 7/9/07.
23) On hindsight I accept that I should never had [sic] sent the invoice from D. Brett in and that in doing so (with him not having done the work) I have submitted a false document.
24) At the end of the day the work was carried out to my kitchen regardless of who it was done by. In my view because a cash settlement was agreed it was irrelevant who I chose to do the work as long as it was brought back to its original standard.
25) I understand from Miss Foster that D. Brett has said the invoice I have submitted was not prepared by him and has been fraudulently prepared by me. This is absolutely not the case and I have proved this by showing Miss Foster two invoices from D. Brett both numbered 2007007. One of which is the original I was given by him for my kitchen and the other which is the original of the one in respect of the new build in Upshire Road.
26) I accept that I should not have submitted the invoice from D. Brett as he had not carried out the work. However, the reason I did this was because the work was actually costing more than I was being paid by my insurers so in effect I was saving them money.
27) I am well aware that the VAT was not paid by me and I shouldn't have claimed that it was.
28) I have been very foolish by my actions re this matter. I did try to retrieve the invoice for £4112.50, letter sent to Direct Line refers."
The claim made in this action
"A fire insurance, …, is a contract of indemnity; that is, a contract to indemnify the assured against the consequences of a fire, provided that it is not wilful. Of course, if the assured set fire to his house, he could not recover. That is clear. But it is not less clear that, even supposing it were not wilful, yet as it is a contract of indemnity only, that is, a contract to recoup the insured the value of the property destroyed by fire, if the claim is fraudulent, it is defeated altogether. That is, suppose the insured made a claim for twice the amount insured and lost, thus seeking to put the office off its guard, and in the result to recover more than he is entitled to, that would be a wilful fraud, and the consequence is that he could not recover anything. This is a defence quite different from that of wilful arson. It gives the go-bye to the origin of the fire, and it amounts to this – that the assured took advantage of the fire to make a fraudulent claim. The law upon such a case is in accordance with justice, and also with sound policy. The law is, that a person who has made such a fraudulent claim could not be permitted to recover at all. The contract of insurance is one of perfect good faith on both sides, and it is most important that such good faith should be maintained. It is the common practice to insert in fire-policies conditions that they shall be void in the event of a fraudulent claim, and there was such a condition in the present case. Such a condition is only in accordance with legal principle and sound policy. It would be most dangerous to permit parties to practise such frauds, and then, notwithstanding their falsehood and fraud, to recover the real value of the goods consumed. And if there is wilful falsehood and fraud in the claim, the insured forfeits all claim whatever upon the policy."
The defences of Mr. Fox
"It seems to me that if an intending litigant bona fide forbears a right to litigate a question of law or fact which is not vexatious or frivolous to litigate, he does give up something of value. It is a mistake to suppose it is not an advantage, which a suitor is capable of appreciating, to be able to litigate his claim, even if he turns out to be wrong. It seems to me it is equally a mistake to suppose that it is not sometimes a disadvantage to a man to have to defend an action even if in the end he succeeds in his defence; and I think therefore that the reality of the claim which is given up must be measured, not by the state of the law as it is ultimately discovered to be, but by the state of knowledge of the person who at the time has to judge and make the concession. Otherwise you would have to try the whole cause to know if the man had a right to compromise it, and with regard to questions of law it is obvious you could never safely compromise a question of law at all. "
"When an action is compromised by an agreement to pay a sum in satisfaction, it gives rise to a new cause of action."
"Before hearing my Lords' judgments I had been inclined to the view that the letter of May 12 was not an offer to enter into a contract independent of the policy, but merely an offer of quantification of a claim made under a policy, both parties at that stage believing that there was a valid policy under which the insurers could have no answer to the claim."
"But the judge upheld the claim on the letter of May 12. He said it was a binding contract of compromise. I am not so sure about this. It might be said to be a mere quantification of the account which should be paid in case the insurance company were liable: and that it did not preclude them from afterwards contesting liability. But on the whole, I do not think we should regard it as a mere quantification. The letter contains the important words: "in settlement of your claim," which import that it is to be settled without further controversy. In short, it bears the stamp of an agreement of compromise. The consideration for it was the ascertainment of a sum which was previously unascertained."
"The question of retraction raises a serious question of legal policy. The counterpart to the declared policy of discouraging fraudulent claims must be the encouragement of honest claims. There is also a distinct moral difference between the position of a fraudulent claimant and a fraudulent claimant who retracts before the claim is considered by the insurer or settlement, particularly where the retraction manifests repentance rather than strategic advantage (which might be the interpretation placed on the change of mind by the insured in The Michael [1979] 2 Lloyd's Rep 1). It is suggested that the law in its development should recognize this difference and encourage honesty by recognizing the effectiveness of a genuine retraction. This could, for example, be achieved by continuing to recognize the validity of the honest element of a claim. However, it has to be admitted that as yet there is no hint of any such concession in the developing law, the general tone of which may even indicate that the suggested policy has an unlikely prospect of acceptance."
"What is the position where there is use of a fraudulent device designed to promote a claim? I would see no reason for requiring proof of actual inducement here, any more than there is in the context of a fraudulent claim for non-existent or exaggerated loss. As to any further requirement of "materiality", if one were to adopt in this context the test identified in the Royal Boskalis case [1997] LRLR 523 and The Mercandian Continent [2001] 2 Lloyd's Rep 563, then, as I have said, the effect is, in most cases, tantamount to saying that the use of a fraudulent device carries no sanction. It is irrelevant (unless it succeeds, which only the insured will then know). On the basis (which the cases show and I would endorse) that the policy behind the fraudulent claim rule remains as powerful today as ever, there is, in my view, force in Mr. Popplewell's submission that it either applies, or should be matched by an equivalent rule, in the case of use of a fraudulent device to promote a claim – even though at the end of a trial it may be shown that the claim was all along in other respects valid. The fraud must of course be directly related to and intended to promote the claim (unlike the deceit in The Mercandian Continent). Whenever that is so, the usual reason for the use of the fraudulent device will have been concern by the insured about prospects of success and a desire to improve them by presenting the claim on a false factual basis. If one does use in this context the language of materiality, what is material at the claims stage depends on the facts then known and the strengths and weaknesses of the case as they may then appear. It seems irrelevant to measure materiality against what may be known at some future date, after a trial. The object of a lie is to deceive. The deceit may never be discovered. The case may then be fought on a false premise, or the lie may lead to a favourable settlement before trial. Does the fact that the lie happens to be detected or unravelled before a settlement or during a trial make it immaterial at the time when it was told? In my opinion, not. Materiality should take into account the different appreciation of the prospects, which a lie is usually intended to induce on insurers' side, and the different understanding of the facts which it is intended to induce on the part of a judge at trial."
"34. Mr. Witten-Hannah submits nevertheless that the respondent can have no basis for denying liability, in circumstances where, as the judge found, the appellant admitted the true position on 3rd December 1992, four months before the respondent rejected the insurance claim in April 1993. He submits that the respondent cannot have relied on the false statement in that rejection. At one point, he also submitted that the case should be seen as one where the appellant had himself corrected the false statement (in effect voluntarily), rather than one where the lie was detected or unravelled by insurers. That submission, even if it could have any legal relevance, does not marry with the judge's findings in paragraph 47 of the judgment. The correction was only made when and because it became apparent that the respondent could point to the previous statement as a ground for saying that Mr. Byrne had been given false information.
35. Mr. Witten-Hannah did not take any issue with the statements of legal principle advanced in the judgment given by Mance LJ in Agapitos v. Agnew [2003] QB 556, including those in paragraph 37 relating to the use of fraudulent devices to promote a claim. In that regard, he specifically accepted the following opinion expressed in that paragraph:
"Does the fact that the lie happens to be detected or unravelled before a settlement or during a trial make it immaterial at the time when it was told? In my opinion, not."
36. On that basis, the Board has no hesitation in upholding the judge's conclusion that, quite apart from any question of arson, the respondent was entitled to reject the appellant's insurance claim (as it did) on the ground that the appellant had sought to promote it in May 1992 by lying to the respondent about the position, and his state of mind, regarding any attempt to sell the house prior to the fire. The materiality of such matters to the respondent's investigation and evaluation of this insurance claim is not challenged, and is, as the judge indicated, obvious."
"So the effect of a fraudulent claim is retrospectively to remove or bar the insured's pre-existing cause of action: see [23](i), above. This retrospective effect is underlined by the application of the rule to circumstances where a valid insurance claim has been presented to insurers, which is later precluded by the addition of a fraudulent element or the use of fraudulent devices to support all or part of the claim: see [23](i), above. The insured may thus not only be exposed to lack of cover in respect of genuine uninsured loss which would, but for his fraud, have been insured, but also to having to repay any sum received by way of indemnity in respect of such loss before the fraud is discovered. The question on Mr. and Mrs. Gottlieb's appeal is whether it makes all the difference if the sum happens to have been received before the fraud is even committed. If it had not been received, but was merely outstanding, then it would be forfeit. But Mr. Jacob submits that, where a genuine right to indemnity has both arisen and been subject of a payment made prior to any fraud committed in respect of the same claim, there is no conceptual basis for requiring the insured to repay the amount so paid.
27. I disagree with this last submission. If a later fraud forfeits a genuine claim which has already accrued but not been paid, the obvious conceptual basis is that the whole claim is forfeit. Lord Woolf in Galloway v. Guardian Royal Exchange (UK) Ltd [1999] Lloyd's Rep IR 209 at 213 and Buxton LJ in Direct Line Insurance plc v. Khan spoke of the whole claim being forfeit, although in neither case in the context of a payment made prior to fraud. If the whole claim is forfeit, then the fact that sums have been advanced towards it is of itself no answer to their recovery. The sums previously paid on that claim will have been paid on a consideration which has now wholly failed. What I said in Insurance Corp of the Channel Islands Ltd. v. McHugh [1997] LRLR 94 at 135 in relation to forfeiture of 'all benefit under this Policy' under an express clause also applies in this context to the common law rule:
'If payments on account have already been made with respect to that claim [ie the particular claim to which the fraud relates], they have been made on the assumption that an obligation to indemnify exists or would arise. Once that obligation is forfeit, any such payments cease to have any basis and, if already made, are recoverable accordingly as payments made on a false premise or for a consideration which wholly failed.'
28. Mr. Jacob's submission is in effect that we should view the forfeiture of the whole claim as restricted to the whole of the outstanding claim, ie to any part that remains unpaid at the date of the fraud. But his suggested justification for this restriction, that to allow recovery of previous payments would undermine settled expectations and impose windfall hardship, is met by the consideration that the fraud rule is designed to forfeit existing rights, so leaving an insured exposed, without insurance cover, to genuine loss and/or liability to pay for repairs which would otherwise have been insured. The actual rationale of the rule of law relating to fraudulent claims is that an insured should not have the settled expectation that, even if the fraud fails, he will lose nothing. There is no obvious reason why the consequences of making a fraudulent claim should depend upon the timing of any payment in respect of any genuine part of the claim. Further, while it may be fanciful to suppose that many dishonest insureds would tailor their fraud so that it came at the end, and after settlement of all or the bulk, of their genuine claim, insurance fraud is not uncommon and it is not impossible that some well-informed practitioners might do so. …
31. The rule relating to fraudulent insurance claims is accordingly a special common law rule. We have to set its limits without benefit of authority binding on us. The answer more consistent with principle – namely the forfeiture of the whole claim including any part of it that is or may be otherwise good – seems to me that indicated in [27] – [28] above. Mr. Jacob's submission is that we should temper the harshness of the rule by excluding from its ambit payments made on the same claim prior to the fraud in respect of genuine loss. This invites the question why we should in any way reduce the severity of a rule which is deliberately designed to operate in a draconian and deterrent fashion. The only justification offered is that to do so would reflect settled expectation, but the policy of the rule is to discourage any feeling that the genuine part of a claim can be regarded as safe – and that any fraud will lead at best to an unjustified bonus and at worst, in probability, to no more than a refusal to pay a sum which was never insured in the first place. The arguments in favour of a modification of the policy according to the relative 'happenchance' of when payments are made do not appear to me strong.
32. I therefore conclude that the proper scope of the common law rule relating to fraudulent insurance claims is to forfeit the whole of the claim to which the fraud relates, with the effect that the consideration for any interim payments made on that claim fails and they are recoverable. It follows that I consider that the judge was correct on both issues argued before us, and that the appeal and the cross-appeal should be dismissed."
"36. As I read these Regulations they do not apply to a situation where a contract is affected by a rule of law, even though the contract is made with a consumer and is otherwise within the purview of these Regulations. Such a term could not be described as one which has been "drafted in advance". Moreover, I would find it a startling proposition if any rule of law could be reviewed under these Regulations. It seems to me to be well outside the purpose and spirit of the Regulations and might produce some surprising results.
37. Moreover, so far as any unfairness is concerned it would have to take into account that the rule of law set out in the Galloway case is in furtherance of a policy of discouraging fraudulent claims.
38. Mr. Nicol has submitted that the law is effectively penal, but I would go back to what Lord Woolf said in the Galloway case that the policy of the law is to discourage fraudulent claims. Millett LJ was of the same view. He said this:
The making of dishonest insurance claims has become all too common. There seems to be a widespread belief that insurance companies are fair game, and the defrauding them is not morally reprehensible. The rule which we are asked to enforce today may appear to some to be harsh, but it is in my opinion a necessary and salutary rule which deserves to be better known by the public. I for my part would be most unwilling to dilute it in any way.
39. So it is not simply a question of the rule preventing recovery of a benefit to which the policyholder was not entitled. The rule is also directed to deterrence and to discouraging false claims. Contrary to Mr. Nicol's submission, in my judgment this is a proper objective of the civil law in an appropriate case and this is one such case. A civil law sanction, particularly a financial one, made in an appropriate case may be more effective than a criminal sanction or other sanction."
"32. After the works completion I decided to go away with my family just to get away from it all. During the holiday I realised that I should not have submitted the invoice. With a young family living in unacceptable accommodation my judgment was clouded and although I know now, with hindsight, that this was the wrong thing to do, I didn't think much more of it as I had incurred considerably more than I would have paid Mr. Daren Brett so I simply bore the rest of the work personally. I had intended to speak with Mr. Gilbert Theodore when I got home.
33. On my return I received a letter from Direct Line [Mr. Bates's letter of 4 September 2007] and immediately wrote to withdraw the invoice … after a couple of discussions with Mr. Gilbert Theodore."
Conclusion