1. Motor Vehicle Insurance Clearly informed theft or fraud John Price June 2011

2. Is it fraud? Is it theft? Barry’s bad luck A case study and discussion exploring the process and procedure before the Financial Ombudsman Service when considering a fraud dispute.

3. How we conduct ourselves How we start our investigation How we review our position

4. The Power of the Paradigm “a model, theory, perception, a frame of reference” The way we see things....perception, understanding, interpreting

5. Our perceptions, our understanding is shaped by the map, by the position from which we start People are fundamentally honest

6. FOS is not a court It’s an alternative not a substitute Inquisitorial not adversarial

7. TERMS OF REFERENCE clause 8.2 What is fair in all the circumstances Legal principles Applicable industry codes Good industry practice Previous relevant decisions (not binding)

8. Guided by the TOR’s and Briginshaw test Balance of probabilities Clear, cogent evidence Circumstantial evidence...rely on the inferences to be drawn from the established facts.. i.e. What is the more probable FRAUD

9. A matter of Intent The mental element required to establish fraud is an intention to deceive, that is an intention to create a false belief in the person deceived for the purpose of obtaining money or some other benefit. Buchannan JA To v AAMI (2001) 3 VR 279 Fraud

10. Motive Character/Credibility Opportunity Forensic evidence Fraud

11. Mr Justice Young, ALJ 1997 Usual v Unusual Witness consistency Do not rely on observations of demeanour Observational evidence needs to be tested Do not be misled Cultural Characteristics Just because a person is shown to be a liar does not establish something is so (e.g. claim to be somewhere but proven not to be does not establish fraud) Fraud

12. FOS not strictly bound by rules of evidence Use of Hearsay Unsigned statements Coincidence Non co-operation Provide all the information Fraud

13. Special Circumstances Expert evidence...Hired guns or independent experts Fraud

14. BARRY’s BAD LUCK Is it theft or fraud?

15. QUESTIONS