Marine Liability and Personal Injury Claim Fraud
Domain 6 examines protection and indemnity claims, crew injuries, passenger claims, and third-party liability. The exam tests causation, medical evidence, employment records, and the line between exaggeration and fabrication.
Core rules
- P&I cover responds to third-party liabilities such as crew injury, passenger claims, collision liability, and pollution. Cover is subject to policy terms, deductibles, and exclusions.
- Crew claims may involve maintenance and cure, wages, repatriation, or Jones Act remedies in the United States. The Maritime Labour Convention 2006 sets minimum standards for living and working conditions.
- Causation is central. A pre-existing condition, degenerative disease, or injury occurring off-duty may be presented as a work accident.
- Indicators include no accident report, inconsistent witness statements, delayed reporting, treatment gaps, social-media contradictions, and a claim filed just before crew change or contract end.
- Medical records, employment history, vessel logs, CCTV, and independent medical examination are core evidence. Surveillance must be lawful and proportionate.
Worked example
A crew member claims a back injury after a fall on deck. The medical record shows earlier back treatment, no accident entry appears in the deck log, and the vessel was in calm seas. The injury may still be genuine, but causation is doubtful. Investigators should obtain the full medical history, separate witness statements, and the vessel's work schedule before rejecting the claim.
Traps
Do not assume a claim is fraudulent because the claimant has a prior condition. Do not obtain evidence unlawfully or ignore jurisdiction-specific employment remedies.