I don’t understand this story. It’s really badly presented:
Hopper dishonestly made a false representation to Aviva and Old Mutual Health that his “legs had been amputated because of illness rather than self-inflicted injury”, the court heard
Aviva is a private health insurance, Old Mutual Health doesn’t seem to operate in the UK, only in Kenya, Rwanda and South Africa? Either way, don’t insurance companies legally have to pay even for treating self-iflicted injuries requiring amputation?
In April 2019, he used dry ice to freeze his legs to the extent they were no longer viable and required amputation.
The amputation had to happen, else he would have died. Hell, I’d even argue the freezing occured due to mental illness so he misrepresented it only by claiming the amputation was physical illness. How is the cause even relevant for a health insurance?
After the amputation, he made claims to the insurers that resulted in payouts of £466,653.81. He spent the money on a campervan, a hot tub, wood burner and building works.
These are health insurances. Not life insurances or similar that would pay you for losing your legs. Don’t health insurances just cover the treatment (amputation), recovery and prosthetics? Sure they can get expensive - a six digit figure seems like a lot still but not fully implausible - but why would you get a “payout”? Health insurance would only cover bills.
Surely it can’t be insurance fraud to harm yourself and then make an insurance claim for the recovery, right? Otherwise literally everyone who survived a suicide attempt would have to cover all associated expenses.
For some health insurance, there are payouts for losing a body part. In college, the university gave each of the students an emergency and dismemberment t policy so that in a catastrophe, you’d have some form of coverage. Crazy to see how low the payout was for losing an eye, leg, hand at the age of 18 was.
Isn’t it that he was the surgeon? So he billed the insurance for himself and paid himself the money. Instead of the money going to the hospital and some portion of it going towards his paycheck, but most of it going towards the cost of running and supplying a hospital with all the tech and tools they need to stay current and have competitive success rates.
Or did he just claim disability or something by way of accident instead of by choice, to get a higher disability insurance pay out?
Either way, fraud is basically any time you lie to get money, criminal fraud is when you lie to get enough money that the police care. And it certainly seems like he lied to get more money than he was entitled.
I would be very impressed if he surgically removed his own legs. I mean, there is a lot of tissue and bone to cut through. That’s not easy to do by yourself. But if that’s the case, that’s where the fraud aspect could come from.
Also, is that a thing? “Disability by choice” so you get a lower payout? But even if, wouldn’t that be paid by some other insurance - like a specific disability insurance rather than your typical health insurance? At least in Germany the latter is very much different, health insurances only pay for treatments, recovery and prevention.
The lie about the cause of the injury must somehow be related to the payout, otherwise I can’t believe how it would constitute fraud. Still, this is really confusing because private health insurances usually cannot decline/reduce claims due to intentional injury.
Also, it looks like “old mutual health” was recently re-branded to “ReAssure” in the UK, so that would be who to look up for what type of insurance they would provide. It does sound like they were life insurance, or “life assurance” as they called it. Sounds very much like disability insurance would be under their umbrella.
I mean, even if they had to pay in the event of self-afflicted injury, that first quote is fraud on its own, though I bet the huge payout is also a part of it.
how is the cause even relevant for a health insurance?
I have a feeling most insurers would want to charge a higher premium to someone with a history of freezing their own legs off.
I doubt they have data to support it, but it’s not unreasonable to expect there’s a higher chance that this guy might self harm than the average person. Or require mental health support.
I don’t understand this story. It’s really badly presented:
Aviva is a private health insurance, Old Mutual Health doesn’t seem to operate in the UK, only in Kenya, Rwanda and South Africa? Either way, don’t insurance companies legally have to pay even for treating self-iflicted injuries requiring amputation?
The amputation had to happen, else he would have died. Hell, I’d even argue the freezing occured due to mental illness so he misrepresented it only by claiming the amputation was physical illness. How is the cause even relevant for a health insurance?
These are health insurances. Not life insurances or similar that would pay you for losing your legs. Don’t health insurances just cover the treatment (amputation), recovery and prosthetics? Sure they can get expensive - a six digit figure seems like a lot still but not fully implausible - but why would you get a “payout”? Health insurance would only cover bills.
Surely it can’t be insurance fraud to harm yourself and then make an insurance claim for the recovery, right? Otherwise literally everyone who survived a suicide attempt would have to cover all associated expenses.
So where did the fraud part come from?
For some health insurance, there are payouts for losing a body part. In college, the university gave each of the students an emergency and dismemberment t policy so that in a catastrophe, you’d have some form of coverage. Crazy to see how low the payout was for losing an eye, leg, hand at the age of 18 was.
Isn’t it that he was the surgeon? So he billed the insurance for himself and paid himself the money. Instead of the money going to the hospital and some portion of it going towards his paycheck, but most of it going towards the cost of running and supplying a hospital with all the tech and tools they need to stay current and have competitive success rates.
Or did he just claim disability or something by way of accident instead of by choice, to get a higher disability insurance pay out?
Either way, fraud is basically any time you lie to get money, criminal fraud is when you lie to get enough money that the police care. And it certainly seems like he lied to get more money than he was entitled.
I would be very impressed if he surgically removed his own legs. I mean, there is a lot of tissue and bone to cut through. That’s not easy to do by yourself. But if that’s the case, that’s where the fraud aspect could come from.
Also, is that a thing? “Disability by choice” so you get a lower payout? But even if, wouldn’t that be paid by some other insurance - like a specific disability insurance rather than your typical health insurance? At least in Germany the latter is very much different, health insurances only pay for treatments, recovery and prevention.
The lie about the cause of the injury must somehow be related to the payout, otherwise I can’t believe how it would constitute fraud. Still, this is really confusing because private health insurances usually cannot decline/reduce claims due to intentional injury.
Its possible to do but you gotta do a lot of yoga…
Also, it looks like “old mutual health” was recently re-branded to “ReAssure” in the UK, so that would be who to look up for what type of insurance they would provide. It does sound like they were life insurance, or “life assurance” as they called it. Sounds very much like disability insurance would be under their umbrella.
No, that’s Old Mutual Wealth which rebranded. Wealth, not Health. Maybe this is a mistake in the article?
Oh, as far as I could tell they were part of the same company, the health was an umbrella with the wealth one under it.
Huh, you’re right but the umbrella company was still only called “Old Mutual”.
That makes more sense.
I mean, even if they had to pay in the event of self-afflicted injury, that first quote is fraud on its own, though I bet the huge payout is also a part of it.
I have a feeling most insurers would want to charge a higher premium to someone with a history of freezing their own legs off. I doubt they have data to support it, but it’s not unreasonable to expect there’s a higher chance that this guy might self harm than the average person. Or require mental health support.