The Latvian File – or how to lose a leg and not get away with it

Date published

09/01/2018

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Some years back I wrote an article regarding the so-called “Odessa file”, where a taxi driver domiciled in Denmark went through an elaborate scheme to collect life insurance sums from five different Danish insurers, after claiming that his wife had died in an accident in Odessa, Ukraine. She turned out to be very much alive, and the taxi driver wound up in prison for 2½ years.

It was a case that one will always remember as a case that falls into the “You couldn’t make those things up” category. They don’t come often, but as luck would have it, another case in this category came up recently. We named it “The Latvian File”.

The insured, a Danish national, was run over by a regional train in eastern and rural Latvia shortly before 17 o’clock in December 2011. It was reported by the train drivers that the insured’s leg was run over by the train while he was lying on the ground with one leg resting on the railroad track. His right foot was traumatically amputated when the leg was run over, and because of complications, the leg later had to be surgically amputated above the knee.

The insured, a man in his mid-forties, who claimed that he had travelled to Latvia to arrange an excursion for his local Lions Club, stated that he was out looking for a suitable excursion spot to take the Lions Club. He said that, for unknown reasons, he had fallen down at a railway crossing in the quite deserted rural area when he was on his way back to his car (in the dark) after he had given up finding the tourist attraction he claimed to be looking for. At first, the Latvian police classified the incident as attempted suicide, which the insured vehemently denied, when waking up at the hospital.

This could have been just another case of a tragic train accident, where the insurers had to decide whether they could prove intent on the part of the insured, which is almost impossible. However, the insured was not your “every day victim” of a tragic event that potentially could have cost him his life.

The insured reported the accident to the three insurance companies where he had taken out three accident insurance policies with very large insurance sums and at very high insurance premiums.

He had upheld the policies since 1998 and 1999, and the three companies had previously paid out a compensation of approximately DKK 9 million (approximately US$1.4 million) to the insured after an incident in 2000 where his forearm was amputated following an accident involving a circular saw.

The insurance companies refused to pay any compensation (estimated at a total of DKK 12.5 million)(approximately US$1.9 million), and contended that this was, strictly speaking, not an accident in the true sense of accident insurance, and that the accident had been caused either deliberately or through gross negligence.

The insured then sued in 2014, and after a lengthy discovery process, the insurers stood their ground, and obtained two video-recorded reconstructions of the trail that the insured claimed to have taken prior to the accident. One of the reconstructions was done in 2015 at the exact same date and time in December as the accident. The reconstruction showed that it was quite dark, and that it would have been very difficult for the insured to walk the path that he claimed to have taken prior to the accident.

The main hearing took three days, which is quite lengthy for a trial in Denmark, and it included a thorough review of the sequence of events in Latvia. The review showed that it was clear that the insured had some difficulty accounting for the sequence of events during the time leading up to the accident. The case also included a comprehensive review of the insured’s pre-existing financial and medical circumstances. Furthermore, the video reconstructions were reviewed, and witnesses, including the Latvian train conductors, were questioned.

The court found that, objectively speaking, the incident fulfilled the definition of an accident in the insurance policies. The insurance companies, therefore, had to prove that the accident was caused on purpose or due to strict negligence on the part of the insured.

The court stated that, by default, there is a presumption against a person deliberately lying down on a railroad track in a desolated part of Latvia to commit suicide or with the aim of self-mutilation to obtain financial compensation.

Based however, on an overall assessment of the circumstances surrounding the accident, the insured’s inconsistent explanations regarding these circumstances, the circumstances regarding the insurance policies, including the insurance premiums which were disproportionate to the insured’s dire financial situation, and the information about his medical situation prior to the incident, the court found that the insurance companies had demonstrated with the necessary degree of certainty that this was a deliberate act by the insured with the purpose of either committing suicide or be awarded damages in the amount of approximately DKK 12 million in total (Approximately $1.9 Million USD).

Consequently, the insurance companies were acquitted, and the insured did not appeal the verdict, which is – thereby – the first court ruling since the 1930’s, where accident insurance companies in a civil case have successfully denied coverage for an intentionally inflicted accident.

This article first appeared in SIU Today, published by the IASIU (International Association of Special Investigation Units)