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Insurance fraud has reached epidemic levels in the UK. | 0:00:05 | 0:00:09 | |
It's costing us more than £1.3 billion every year. | 0:00:09 | 0:00:14 | |
That's almost 3.6 million every day. | 0:00:14 | 0:00:17 | |
Deliberate crashes, bogus personal injuries, and even phantom pets. | 0:00:19 | 0:00:24 | |
The fraudsters are risking even more to make a quick killing, | 0:00:25 | 0:00:29 | |
and, every year, it's adding around £50 to your insurance bill. | 0:00:29 | 0:00:33 | |
LIFT CHIMES But insurers are fighting back, | 0:00:33 | 0:00:36 | |
exposing just under 15 fake claims every hour. | 0:00:36 | 0:00:39 | |
Armed with covert surveillance systems... | 0:00:39 | 0:00:41 | |
That's the subject out of the vehicle. | 0:00:41 | 0:00:44 | |
..sophisticated data analysis techniques... | 0:00:44 | 0:00:48 | |
Police! | 0:00:48 | 0:00:49 | |
..and a number of highly-skilled police units... | 0:00:49 | 0:00:51 | |
Police! Don't move! Stay where you are! | 0:00:51 | 0:00:53 | |
..they're catching the criminals red-handed. | 0:00:53 | 0:00:55 | |
Just don't lie to us. | 0:00:55 | 0:00:58 | |
All those conmen, scammers and cheats on the fiddle | 0:00:58 | 0:01:01 | |
are now caught in the act and claimed and shamed. | 0:01:01 | 0:01:04 | |
Today, the wheels come off a bus driver's claim for compensation... | 0:01:10 | 0:01:14 | |
He's doing all of the things he said he couldn't do. | 0:01:14 | 0:01:17 | |
If he's driving cars around a busy carwash, | 0:01:17 | 0:01:20 | |
anything could happen. | 0:01:20 | 0:01:22 | |
..a thrill-seeking holiday-maker sees his case crash and burn... | 0:01:22 | 0:01:26 | |
The customer then started to tell us that | 0:01:26 | 0:01:29 | |
he couldn't remember what happened. | 0:01:29 | 0:01:30 | |
..and an elaborate "crash for cash" con hits a bump in the road. | 0:01:37 | 0:01:41 | |
-BRAKES SCREECH -He was simply reading the script. | 0:01:41 | 0:01:44 | |
He had a piece of paper with all of the details on. | 0:01:44 | 0:01:47 | |
Whether you phone-bash all day in a call centre, | 0:01:51 | 0:01:53 | |
or break bricks on a construction site, | 0:01:53 | 0:01:55 | |
it is an employer's legal obligation to make | 0:01:55 | 0:01:58 | |
your working environment a safe one. | 0:01:58 | 0:02:01 | |
If you have an accident at work that could have been prevented, | 0:02:01 | 0:02:03 | |
you have the right to seek fair compensation. | 0:02:03 | 0:02:07 | |
Lee Ingram is the claims team manager for First Group Transport | 0:02:07 | 0:02:11 | |
and found himself facing just such a case | 0:02:11 | 0:02:13 | |
involving one of their bus drivers back in 2007. | 0:02:13 | 0:02:17 | |
The claimant alleges he was asked by his manager to bring some signs in | 0:02:17 | 0:02:21 | |
from the car park, | 0:02:21 | 0:02:22 | |
and, as he's carrying them through to the understairs area, | 0:02:22 | 0:02:26 | |
he slipped on a plastic, sort of, wallet or folder on the floor | 0:02:26 | 0:02:30 | |
and he alleged he's fallen backwards and struck his head on the floor | 0:02:30 | 0:02:33 | |
and knocked himself out. | 0:02:33 | 0:02:35 | |
SIREN WAILS This was a potentially life-shattering accident. | 0:02:35 | 0:02:39 | |
He's claiming that he's sustained some quite serious injuries. | 0:02:39 | 0:02:43 | |
He's alleging that he's prone to blackouts and dizzy spells now. | 0:02:43 | 0:02:47 | |
He's claiming he's got no memory of the incident, and so he's got | 0:02:47 | 0:02:49 | |
post-traumatic amnesia for some hours after the incident. | 0:02:49 | 0:02:53 | |
Bearing in mind this chap could potentially black out at any time, | 0:02:53 | 0:02:57 | |
he's a bus driver, so this does have some quite serious ramifications for | 0:02:57 | 0:03:01 | |
his future employment. | 0:03:01 | 0:03:03 | |
With such severe injuries, | 0:03:03 | 0:03:05 | |
the claimant's days ferrying passengers from A to B | 0:03:05 | 0:03:08 | |
had come to a grinding halt... WHEELS SCREECH | 0:03:08 | 0:03:11 | |
..as well as his ability to make a living. | 0:03:11 | 0:03:14 | |
First Group were head-on for a colossal pay-out. | 0:03:14 | 0:03:17 | |
By the time we got to the stage | 0:03:18 | 0:03:19 | |
where he was ready to put his claim forward in | 0:03:19 | 0:03:21 | |
its entirety, we'd moved up to round about £650,000. | 0:03:21 | 0:03:26 | |
A large element of that was for loss of earnings. | 0:03:26 | 0:03:29 | |
Obviously, he's a bus driver, so, with the potential blackouts, | 0:03:29 | 0:03:33 | |
he's not going to be driving a bus any more. | 0:03:33 | 0:03:35 | |
Also, he's got a potential care element - | 0:03:35 | 0:03:39 | |
over £250,000 he was claiming for that. | 0:03:39 | 0:03:42 | |
So, it's not an insubstantial claim. | 0:03:42 | 0:03:44 | |
And, on top of that, you've always got the ever-present legal fees - | 0:03:44 | 0:03:47 | |
around about £150,000 for those. | 0:03:47 | 0:03:50 | |
With a whopping £650,000 on the line, | 0:03:50 | 0:03:54 | |
Lee had to be sure that the details of the claim submitted were genuine, | 0:03:54 | 0:03:58 | |
and that First Group were in fact liable for the claimant's injuries, | 0:03:58 | 0:04:02 | |
but there were a few issues authenticating the facts. | 0:04:02 | 0:04:06 | |
Initial investigations in this case were complicated by the fact that | 0:04:06 | 0:04:09 | |
the premises where the incident had happened were demolished. | 0:04:09 | 0:04:14 | |
We can't go back a look at the scene and check the mechanics | 0:04:16 | 0:04:20 | |
of the incident itself. | 0:04:20 | 0:04:22 | |
But this didn't stop Lee examining | 0:04:22 | 0:04:24 | |
what information was available to him in forensic detail. | 0:04:24 | 0:04:28 | |
He analysed the claimant's original hospital report, | 0:04:28 | 0:04:32 | |
which turned up some rather head-scratching evidence. | 0:04:32 | 0:04:36 | |
He's gone to A&E shortly after, | 0:04:36 | 0:04:38 | |
and they have found no blemishes, no lumps, | 0:04:38 | 0:04:42 | |
no marks, no bruising... | 0:04:42 | 0:04:44 | |
Now, for a head injury of this magnitude, | 0:04:44 | 0:04:46 | |
to knock someone out and cause them a loss of memory | 0:04:46 | 0:04:49 | |
for a number of hours, you would have thought that there would have | 0:04:49 | 0:04:52 | |
been some sort of bruise, but they found nothing. | 0:04:52 | 0:04:55 | |
His Glasgow Coma Scale, | 0:04:55 | 0:04:57 | |
which is the reading of how someone's conscious state reads, | 0:04:57 | 0:05:00 | |
he was 15 out of 15, which is fully awake. | 0:05:00 | 0:05:04 | |
A 3 rating would be dead or in a coma, | 0:05:04 | 0:05:06 | |
so you would expect him to be somewhere in between. | 0:05:06 | 0:05:09 | |
So, the medical evidence would suggest the claimant was | 0:05:09 | 0:05:12 | |
firing on all cylinders. | 0:05:12 | 0:05:15 | |
But it was his treatments that really gave cause for concern, | 0:05:15 | 0:05:19 | |
or rather, the lack of it. | 0:05:19 | 0:05:21 | |
He refused to take a lot of the medication. | 0:05:21 | 0:05:24 | |
He was very difficult to pin down for appointments. | 0:05:24 | 0:05:27 | |
Not the action of someone who wants to get better, | 0:05:27 | 0:05:30 | |
but rather someone who's trying to hide the fact that | 0:05:30 | 0:05:33 | |
maybe there there's nothing wrong with him. | 0:05:33 | 0:05:35 | |
First Group had serious concerns that the claimant | 0:05:35 | 0:05:37 | |
wasn't as impaired as he was professing. | 0:05:37 | 0:05:40 | |
Lee needed proof to back up his suspicions. | 0:05:40 | 0:05:42 | |
Following the number of irregularities, | 0:05:44 | 0:05:46 | |
and the claimant's strange behaviour, | 0:05:46 | 0:05:47 | |
we decided to seek authority to undergo a series of | 0:05:47 | 0:05:50 | |
surveillance so that we could actually film the claimant | 0:05:50 | 0:05:53 | |
and see what he was up to. | 0:05:53 | 0:05:55 | |
Well, if you're prone to random blackouts, | 0:05:55 | 0:05:57 | |
need around-the-clock care, | 0:05:57 | 0:05:59 | |
and are battling bouts of post-traumatic memory loss, | 0:05:59 | 0:06:02 | |
you might imagine very little, wouldn't you? | 0:06:02 | 0:06:05 | |
Looking at the footage, it's showing the claimant being allowed to walk | 0:06:08 | 0:06:12 | |
around quite freely on the family business, which is a small carwash. | 0:06:12 | 0:06:16 | |
It's quite clear that the impairments he's alleging... | 0:06:16 | 0:06:20 | |
He's doing all of the things he said he couldn't do. | 0:06:20 | 0:06:23 | |
You can see him driving cars. | 0:06:23 | 0:06:26 | |
If he's driving cars around a busy carwash, anything could happen. | 0:06:26 | 0:06:30 | |
He could drive into pedestrians, into his fellow employees... | 0:06:30 | 0:06:35 | |
Well, at least he's got his family around to keep a close eye on him. | 0:06:35 | 0:06:39 | |
He's allowed to cross the road on his own with no real concerns that | 0:06:39 | 0:06:43 | |
he could black out at any moment. | 0:06:43 | 0:06:45 | |
Or maybe not. | 0:06:45 | 0:06:47 | |
He visits the bank on a couple of occasions for 20 and 25 minutes, | 0:06:47 | 0:06:52 | |
assumingly to carry out some financial transactions. | 0:06:52 | 0:06:54 | |
The surveillance footage suggested the claimant was living | 0:06:54 | 0:06:57 | |
what appeared to be a very normal and surprisingly active life, | 0:06:57 | 0:07:01 | |
and his next task would leave his £650,000 claim all washed up. | 0:07:01 | 0:07:06 | |
He's seen to be cleaning some of the dirty elements of the car, | 0:07:06 | 0:07:10 | |
the wheel trims and the lower side of the car. | 0:07:10 | 0:07:13 | |
He's also seen to be giving supervisory advice. | 0:07:13 | 0:07:16 | |
He's managing people, to a respect, as well. | 0:07:16 | 0:07:19 | |
And to cap it off, a spot of DIY. | 0:07:19 | 0:07:22 | |
Later on in the day, he can actually be seen moving a rather large piece | 0:07:22 | 0:07:26 | |
of fencing, or a gate, quite near to the carwash. | 0:07:26 | 0:07:29 | |
And, yeah, this is... | 0:07:29 | 0:07:31 | |
I think it's with his son, that's helping him do it. | 0:07:31 | 0:07:33 | |
So, you wouldn't really trust your dad to be moving that | 0:07:33 | 0:07:36 | |
if he was as ill as he says he is. | 0:07:36 | 0:07:38 | |
When I first saw the surveillance footage, I thought, | 0:07:41 | 0:07:43 | |
"This doesn't look like the actions of a person who is | 0:07:43 | 0:07:49 | |
"needing chaperoning on a 24-hour basis." | 0:07:49 | 0:07:51 | |
This is someone who can black out at any time. | 0:07:51 | 0:07:54 | |
With the claimant looking compos mentis, | 0:07:54 | 0:07:57 | |
his case for compensation was about to take a real blow. | 0:07:57 | 0:08:00 | |
With all of the inconsistencies that we had in this claim, | 0:08:01 | 0:08:04 | |
we just weren't happy paying anything out, | 0:08:04 | 0:08:06 | |
so we went back to the claimant and told him we had concerns, | 0:08:06 | 0:08:10 | |
and that we weren't going to pay him any money, | 0:08:10 | 0:08:12 | |
leaving him with very little option to either drop his claim | 0:08:12 | 0:08:15 | |
or take us to court, and he chose to go down the court route. | 0:08:15 | 0:08:18 | |
Despite being quite agile day to day, | 0:08:20 | 0:08:22 | |
when the case got to court, | 0:08:22 | 0:08:24 | |
the claimant didn't have a leg to stand on. | 0:08:24 | 0:08:26 | |
When the judge had viewed the surveillance footage, | 0:08:26 | 0:08:29 | |
he'd said that he would have expected to see someone drive | 0:08:29 | 0:08:33 | |
this gentleman to the family business, | 0:08:33 | 0:08:35 | |
escort him from the car under supervision, | 0:08:35 | 0:08:38 | |
take him to maybe an office and leave him in there, | 0:08:38 | 0:08:42 | |
seated, without expecting him to be wandering around, | 0:08:42 | 0:08:44 | |
carrying out aspects of work. | 0:08:44 | 0:08:47 | |
Once the claimant was shown to be more limber than laid up, | 0:08:47 | 0:08:51 | |
his case collapsed. | 0:08:51 | 0:08:52 | |
The outcome of the case was that the judge simply didn't believe | 0:08:52 | 0:08:55 | |
the level of impairment that the claimant was alleging | 0:08:55 | 0:08:58 | |
matched the surveillance footage that we had. | 0:08:58 | 0:09:01 | |
He felt that parts of the claim had been put in with an intention | 0:09:01 | 0:09:05 | |
to try and deceive us, and therefore, | 0:09:05 | 0:09:08 | |
because part of the claim was found to be predominantly not true, | 0:09:08 | 0:09:12 | |
he wouldn't allow any of the claim through, | 0:09:12 | 0:09:14 | |
so the whole thing was struck out as an abuse of the process. | 0:09:14 | 0:09:17 | |
It was a just result for Lee and the First Group claims team | 0:09:17 | 0:09:20 | |
and proof that any suspicious cases will be investigated. | 0:09:20 | 0:09:24 | |
First will fight these claims to trial. | 0:09:24 | 0:09:27 | |
We do often take these sorts of cases on and we will normally win. | 0:09:27 | 0:09:32 | |
A particularly satisfying element of this claim is that we had a rather | 0:09:32 | 0:09:36 | |
large bill of costs that the claimant was ordered to pay us. | 0:09:36 | 0:09:40 | |
He's going to have to wash an awful lot of cars to pay that one off. | 0:09:40 | 0:09:43 | |
Still to come, | 0:09:48 | 0:09:50 | |
a first-class postal fraud is detected by Royal Mail... | 0:09:50 | 0:09:54 | |
Checks revealed that Mr Mohammed had set up three online auction accounts | 0:09:54 | 0:10:00 | |
in the space of three minutes. | 0:10:00 | 0:10:02 | |
..and a group of pretend passengers' personal injury claims | 0:10:02 | 0:10:05 | |
come under scrutiny. | 0:10:05 | 0:10:06 | |
That's fundamentally inconsistent, | 0:10:06 | 0:10:08 | |
and meant that we had to doubt | 0:10:08 | 0:10:10 | |
whether or not the claims were genuine. | 0:10:10 | 0:10:12 | |
Going on holiday, whether you're a sun-worshipper, | 0:10:17 | 0:10:19 | |
a culture vulture or thrill-seeker, | 0:10:19 | 0:10:21 | |
is most people's chance to get away from the stresses and strains | 0:10:21 | 0:10:24 | |
of everyday life. | 0:10:24 | 0:10:26 | |
Holiday insurance is something you hope you will never have to use, | 0:10:26 | 0:10:29 | |
but if your great escape turns into a bout of tourism trauma, | 0:10:29 | 0:10:33 | |
then having the right level of cover in place can be a life-saver. | 0:10:33 | 0:10:37 | |
Simon Cook is head of special investigations | 0:10:38 | 0:10:41 | |
for holiday insurers Cega. | 0:10:41 | 0:10:43 | |
His team received one particular call from a distressed holiday-maker | 0:10:43 | 0:10:47 | |
in a desperate situation. | 0:10:47 | 0:10:48 | |
The customer contacted our medical emergency helpline to explain that | 0:10:50 | 0:10:54 | |
he had fallen whilst trekking in Morocco. | 0:10:54 | 0:10:56 | |
With such a serious accident, | 0:10:58 | 0:11:00 | |
Simon's team didn't waste any time getting to grips with the claim. | 0:11:00 | 0:11:04 | |
As part of our service, | 0:11:04 | 0:11:05 | |
we contacted the hospital to obtain a medical report, | 0:11:05 | 0:11:08 | |
so we could see the injuries the customer had sustained. | 0:11:08 | 0:11:12 | |
It sounds like it was a serious fall, | 0:11:12 | 0:11:14 | |
because the customer had sustained a fractured vertebra, | 0:11:14 | 0:11:17 | |
ankle and wrist. | 0:11:17 | 0:11:18 | |
The value of the claim was just over £50,000. | 0:11:18 | 0:11:22 | |
The claims handler passed the medical report over to | 0:11:22 | 0:11:25 | |
Cega's specialist team, as is standard practice, | 0:11:25 | 0:11:28 | |
which revealed a rather major discrepancy. | 0:11:28 | 0:11:32 | |
What rang alarm bells for us was that the medical report, | 0:11:32 | 0:11:35 | |
which did, in fact, contain limited information, | 0:11:35 | 0:11:38 | |
stated that the customer had been involved in a paragliding accident, | 0:11:38 | 0:11:41 | |
which was completely different to what he initially told us happened. | 0:11:41 | 0:11:45 | |
In case your French is a little rusty, | 0:11:45 | 0:11:47 | |
this translates as "victim of a paragliding fall", | 0:11:47 | 0:11:51 | |
ie gracefully riding pockets of air at heights of up to 18,000 feet. | 0:11:51 | 0:11:56 | |
Just a tad different to a mosey through the Moroccan hills, | 0:11:56 | 0:12:00 | |
as he originally reported. | 0:12:00 | 0:12:01 | |
We asked the customer to clarify why the circumstances were different on | 0:12:01 | 0:12:05 | |
the medical report to what he actually had told us when he first | 0:12:05 | 0:12:09 | |
contacted us. | 0:12:09 | 0:12:11 | |
A claims handler from Simon's team gave the claimant a call | 0:12:11 | 0:12:14 | |
to clarify the details. | 0:12:14 | 0:12:15 | |
So, the claimant was now adamant he had not paraglided, | 0:13:00 | 0:13:04 | |
but that wasn't the only thing that didn't add up. | 0:13:04 | 0:13:07 | |
Cega's experts had been taking a close look at the medical report. | 0:13:07 | 0:13:11 | |
For the customer to have sustained these type of injuries, | 0:13:11 | 0:13:14 | |
he would have had to have fallen from a significant height. | 0:13:14 | 0:13:17 | |
A significant height. | 0:13:18 | 0:13:20 | |
A couple of metres? | 0:13:29 | 0:13:30 | |
The claimant's injuries were more consistent with a fall | 0:13:30 | 0:13:33 | |
from a much greater height - | 0:13:33 | 0:13:35 | |
I don't know, maybe those sustained from a paragliding accident. | 0:13:35 | 0:13:39 | |
With his story starting to feel like a flight of fancy, | 0:13:39 | 0:13:42 | |
the team dug a little deeper. | 0:13:42 | 0:13:45 | |
On the back of the initial call, | 0:13:45 | 0:13:46 | |
we did some background searches on the internet | 0:13:46 | 0:13:49 | |
and found some videos that heavily affiliated the customer | 0:13:49 | 0:13:53 | |
with paragliding and paramotoring. | 0:13:53 | 0:13:56 | |
This information was put to the claimant. | 0:13:56 | 0:13:58 | |
MUSIC: Eine Kleine Nachtmusik by Wolfgang Amadeus Mozart | 0:14:24 | 0:14:27 | |
It's about now that the claimant should be reaching | 0:14:34 | 0:14:36 | |
for his parachute, as his story is set to crash and burn. | 0:14:36 | 0:14:41 | |
He has now admitted to paragliding in the past, albeit a long time ago, | 0:14:41 | 0:14:45 | |
but is claiming not to be active any more. | 0:14:45 | 0:14:48 | |
Let's see what other grains of truth the claims handler can extract | 0:14:48 | 0:14:51 | |
on this call. | 0:14:51 | 0:14:53 | |
Determined to ground the claimant's version of events for good | 0:14:53 | 0:14:56 | |
and get to the bottom of this case, | 0:14:56 | 0:14:58 | |
investigation turned towards the scene of the accident | 0:14:58 | 0:15:01 | |
in search of new evidence. | 0:15:01 | 0:15:03 | |
As we knew the precise location where the incident occurred, | 0:15:03 | 0:15:07 | |
we managed to obtain the telephone number | 0:15:07 | 0:15:09 | |
for a local paragliding company. | 0:15:09 | 0:15:11 | |
The person that we spoke with at the paragliding company confirmed | 0:15:11 | 0:15:15 | |
that, at the same day and at the same time, he had in fact | 0:15:15 | 0:15:18 | |
attended to someone who had had a paragliding accident. | 0:15:18 | 0:15:22 | |
On the balance of probability, | 0:15:48 | 0:15:49 | |
the fact that the incident had occurred at the same time, | 0:15:49 | 0:15:52 | |
the same day and the same location, | 0:15:52 | 0:15:55 | |
it would certainly suggest that this could well be our customer. | 0:15:55 | 0:15:58 | |
Between the discrepancy in the initial medical report, | 0:15:59 | 0:16:02 | |
the nature of the claimant's injuries, | 0:16:02 | 0:16:04 | |
his affiliation to paragliding, | 0:16:04 | 0:16:06 | |
and the eyewitness account from the scene of the accident, | 0:16:06 | 0:16:09 | |
his version of events really started to nosedive. | 0:16:09 | 0:16:13 | |
As the call went on and we disclosed the evidence we had, | 0:16:13 | 0:16:16 | |
the customer then started to tell us that he couldn't remember | 0:16:16 | 0:16:19 | |
what happened, which we thought was extremely odd. | 0:16:19 | 0:16:22 | |
The claimant has developed a sudden and very convenient case of amnesia, | 0:16:39 | 0:16:44 | |
but playing dumb wouldn't help his cause. | 0:16:44 | 0:16:46 | |
Due to the fact that the customer was still denying that the incident | 0:16:46 | 0:16:51 | |
was as a result of paragliding, | 0:16:51 | 0:16:53 | |
we explained to him that we were going to have to | 0:16:53 | 0:16:55 | |
complete on-the-ground inquiries in Morocco, | 0:16:55 | 0:16:57 | |
and we required him to sign an authority form for us. | 0:16:57 | 0:17:00 | |
It may have taken a while, but the truth had at last landed. | 0:17:29 | 0:17:34 | |
We firmly believe that the customer knew that he didn't have the right | 0:17:34 | 0:17:37 | |
level of insurance cover, and that's why he provided us false information | 0:17:37 | 0:17:41 | |
from the outset of the claim. | 0:17:41 | 0:17:43 | |
We had no option but to decline the claim in full | 0:17:43 | 0:17:46 | |
and there was no appeal from the customer. | 0:17:46 | 0:17:48 | |
Having an accident abroad and finding yourself uncovered | 0:17:50 | 0:17:53 | |
is stressful enough, | 0:17:53 | 0:17:55 | |
but, by lying about the circumstances of his accident, | 0:17:55 | 0:17:58 | |
the claimant could have added an attempted fraud prosecution | 0:17:58 | 0:18:02 | |
to his problems. | 0:18:02 | 0:18:03 | |
We certainly appreciate the situation the customer | 0:18:03 | 0:18:06 | |
found himself in, because the claim value was over 50,000, | 0:18:06 | 0:18:10 | |
but this doesn't mean that you can provide false information to obtain | 0:18:10 | 0:18:14 | |
insurance cover. | 0:18:14 | 0:18:15 | |
Holidays can be expensive, | 0:18:15 | 0:18:17 | |
and extreme sports can bump up a travel insurance premium, | 0:18:17 | 0:18:21 | |
but trying to save a few quid here or there | 0:18:21 | 0:18:23 | |
could cost you thousands later | 0:18:23 | 0:18:25 | |
should something go wrong and you're not appropriately covered. | 0:18:25 | 0:18:29 | |
We're still unsure why such an experienced paraglider | 0:18:29 | 0:18:31 | |
wouldn't have taken out the right level of cover prior to travelling. | 0:18:31 | 0:18:35 | |
You do need to have the right level of insurance cover when you travel, | 0:18:37 | 0:18:41 | |
especially when you're going to take part in extreme sports | 0:18:41 | 0:18:44 | |
such as paragliding. | 0:18:44 | 0:18:46 | |
Abraham Lincoln once famously said, | 0:18:51 | 0:18:54 | |
"No man has a good enough memory to be a successful liar." | 0:18:54 | 0:18:58 | |
Now, I'm no history teacher, but Honest Abe certainly had a point. | 0:18:58 | 0:19:01 | |
In essence, all fraud begins with a lie. | 0:19:01 | 0:19:04 | |
Modern-day fraudsters continue to come up with ever more sophisticated | 0:19:04 | 0:19:08 | |
scams to defraud insurers. | 0:19:08 | 0:19:10 | |
But ultimately, the complexity of their deception is usually | 0:19:10 | 0:19:14 | |
their undoing. | 0:19:14 | 0:19:15 | |
Staging elaborate road traffic accidents known as "crash for cash" | 0:19:15 | 0:19:19 | |
has long been seen as easy money by fraudsters. | 0:19:19 | 0:19:22 | |
Mihir Pandya is the fraud manager for insurers Allianz, | 0:19:23 | 0:19:27 | |
and recently dealt with one particular case that appeared to be | 0:19:27 | 0:19:30 | |
an everyday accident. | 0:19:30 | 0:19:32 | |
This claim first came to light when we received a claim | 0:19:32 | 0:19:37 | |
from an individual who had been involved in an accident | 0:19:37 | 0:19:41 | |
in a hire car which belonged to one of our customers. | 0:19:41 | 0:19:45 | |
With two cars involved, one of which was a hired vehicle, | 0:19:45 | 0:19:48 | |
and multiple passengers, | 0:19:48 | 0:19:49 | |
this was a complex, high-value claim. | 0:19:49 | 0:19:52 | |
All in all, we received claims valuing up to £75,000 | 0:19:53 | 0:20:01 | |
and this consisted of seven personal injury claims, | 0:20:01 | 0:20:05 | |
a hired vehicle which was apparently needed, | 0:20:05 | 0:20:08 | |
and replacement cars, as both cars were damaged. | 0:20:08 | 0:20:12 | |
An accident with this many claimants generates a lot of paperwork - | 0:20:12 | 0:20:17 | |
however, it was going through their version of events | 0:20:17 | 0:20:20 | |
that gave cause for suspicion. | 0:20:20 | 0:20:22 | |
We had no concerns with our actual customer, our policy holder, | 0:20:23 | 0:20:27 | |
which was the vehicle hire company, | 0:20:27 | 0:20:29 | |
but there were certain inconsistencies within | 0:20:29 | 0:20:33 | |
the claimant's statements of what actually had occurred. | 0:20:33 | 0:20:36 | |
The main concern centred around the cause of the accident. | 0:20:36 | 0:20:40 | |
In their initial version of events, | 0:20:40 | 0:20:43 | |
the hirer had told us that a cyclist had swerved in front | 0:20:43 | 0:20:47 | |
of the car in front, which had braked suddenly, | 0:20:47 | 0:20:50 | |
and unfortunately he didn't have time to stop and went | 0:20:50 | 0:20:52 | |
into the rear end of the car. | 0:20:52 | 0:20:54 | |
Two months later, | 0:20:54 | 0:20:56 | |
he said it was a dog that ran out in front of the car in front. | 0:20:56 | 0:21:00 | |
Now, having any type of accident can be distressing | 0:21:00 | 0:21:03 | |
and could affect the way we recall events. | 0:21:03 | 0:21:05 | |
But confusing a dog and a cyclist - | 0:21:05 | 0:21:08 | |
well, that's just too big a stretch of the imagination to ignore. | 0:21:08 | 0:21:11 | |
The driver of the fault car had really slipped up here, | 0:21:11 | 0:21:14 | |
and given Mihir's team a strong reason to question the entire claim. | 0:21:14 | 0:21:20 | |
Having identified this inconsistency, | 0:21:20 | 0:21:24 | |
we took the decision to investigate the claim further. | 0:21:24 | 0:21:29 | |
Even more anomalies to do with the alleged circumstances of | 0:21:29 | 0:21:32 | |
the accident were revealed, | 0:21:32 | 0:21:34 | |
which wasn't good news for the claimants. | 0:21:34 | 0:21:37 | |
On the basis of the information and evidence that we had, | 0:21:37 | 0:21:40 | |
we rejected all the claims, | 0:21:40 | 0:21:43 | |
and all bar one were dropped. | 0:21:43 | 0:21:46 | |
But one of the parties decided to take us to court. | 0:21:46 | 0:21:50 | |
At this point, specialist insurance solicitor Sarah Hill | 0:21:50 | 0:21:54 | |
was instructed to handle the case. | 0:21:54 | 0:21:56 | |
On the face of it, the claim looked legitimate. | 0:21:56 | 0:21:59 | |
It looked like a genuine road traffic collision, | 0:21:59 | 0:22:02 | |
but when we started to investigate, | 0:22:02 | 0:22:04 | |
it was quite clear that this wasn't a legitimate claim. | 0:22:04 | 0:22:08 | |
Mihir's team had already established major inconsistencies | 0:22:08 | 0:22:11 | |
in the cause of the accident, | 0:22:11 | 0:22:13 | |
which had suspiciously changed from a rogue cyclist to a runaway dog, | 0:22:13 | 0:22:18 | |
and Sarah didn't have to look far | 0:22:18 | 0:22:20 | |
before she found further discrepancies. | 0:22:20 | 0:22:22 | |
The passengers in the first vehicle, that was the non-fault vehicle, | 0:22:22 | 0:22:26 | |
said that the weather was sunny and dry. | 0:22:26 | 0:22:29 | |
Unfortunately, erm, | 0:22:29 | 0:22:31 | |
the passengers in the fault vehicle said it was | 0:22:31 | 0:22:34 | |
wet and raining at the time. | 0:22:34 | 0:22:36 | |
Now, while microclimates do exist, | 0:22:36 | 0:22:39 | |
it is a meteorological miracle for two to occur | 0:22:39 | 0:22:42 | |
over one accident location. | 0:22:42 | 0:22:44 | |
It was starting to seem like the accounts of the accident | 0:22:44 | 0:22:47 | |
were works of fiction. | 0:22:47 | 0:22:49 | |
Part of our investigations included looking at | 0:22:49 | 0:22:52 | |
whether the parties knew one another, | 0:22:52 | 0:22:54 | |
so we looked at the backgrounds of the individuals | 0:22:54 | 0:22:57 | |
and we looked on social media. | 0:22:57 | 0:23:00 | |
Quite stupidly, some of the profiles of the individuals had been | 0:23:00 | 0:23:04 | |
left open and we were able to establish, prior to the accident, | 0:23:04 | 0:23:07 | |
some quite beefy conversations going on between the parties of | 0:23:07 | 0:23:12 | |
the two vehicles that allegedly didn't know one another. | 0:23:12 | 0:23:15 | |
So, it appeared to be one big happy family, | 0:23:15 | 0:23:18 | |
and, with so much communication, you'd think they'd all be in | 0:23:18 | 0:23:21 | |
agreement over the events of the accident. | 0:23:21 | 0:23:23 | |
Next to be called into question were the navigation skills | 0:23:23 | 0:23:26 | |
of one of the drivers. | 0:23:26 | 0:23:28 | |
The policyholder had said that he had gone to collect his son | 0:23:28 | 0:23:31 | |
at a local pub, but when we plotted the route, | 0:23:31 | 0:23:35 | |
it just wasn't a direct route to his home address and it didn't | 0:23:35 | 0:23:38 | |
really make much sense in terms of why he'd take that route. | 0:23:38 | 0:23:42 | |
When the questions were asked around that, | 0:23:42 | 0:23:44 | |
there was no reasonable response for why that route was taken. | 0:23:44 | 0:23:47 | |
All the evidence strongly suggested the event had been fabricated | 0:23:47 | 0:23:51 | |
between the two parties involved, | 0:23:51 | 0:23:53 | |
but they haven't got their stories straight | 0:23:53 | 0:23:55 | |
and were reading from two very different scripts, | 0:23:55 | 0:23:57 | |
as the driver of the hire vehicle's next act proved. | 0:23:57 | 0:24:01 | |
He went into the vehicle rental company | 0:24:01 | 0:24:03 | |
that he'd hired the vehicle from, | 0:24:03 | 0:24:05 | |
and gave an account over the phone to the insurance company, | 0:24:05 | 0:24:09 | |
and it appeared to the proprietor that he was simply reading a script. | 0:24:09 | 0:24:14 | |
He had a piece of paper with all of the details on. | 0:24:14 | 0:24:17 | |
Well, how else are you meant to remember your lines? | 0:24:17 | 0:24:19 | |
But the less-than-Oscar-winning performance | 0:24:19 | 0:24:22 | |
would make no difference. | 0:24:22 | 0:24:23 | |
Once we have gathered all of the evidence together, | 0:24:23 | 0:24:26 | |
we entered a defence with the court, | 0:24:26 | 0:24:29 | |
which pleaded that we felt the accident was fraudulent, | 0:24:29 | 0:24:33 | |
that it had been staged, due to the evidence | 0:24:33 | 0:24:35 | |
-of all the inconsistencies. -BRAKES SCREECH AND CAR SMASHES | 0:24:35 | 0:24:38 | |
We felt, based on the evidence, | 0:24:38 | 0:24:40 | |
that the individual had hired the vehicle | 0:24:40 | 0:24:43 | |
purely to set up this accident to claim compensation. | 0:24:43 | 0:24:46 | |
With a trip to court on the horizon, | 0:24:46 | 0:24:48 | |
the claimant developed a severe case of stage fright. | 0:24:48 | 0:24:51 | |
This case never actually went to trial | 0:24:51 | 0:24:54 | |
because, when we served the defence, pleading fraud, | 0:24:54 | 0:24:57 | |
the claimant decided not to progress the claim | 0:24:57 | 0:24:59 | |
and she discontinued her claim, | 0:24:59 | 0:25:02 | |
so it was quite clear that there was a real intention to try it on, | 0:25:02 | 0:25:08 | |
and that, once faced with the evidence, | 0:25:08 | 0:25:10 | |
the claimant wasn't prepared to go all the way to trial. | 0:25:10 | 0:25:13 | |
Insurance investigators will use any and all means at their disposal to | 0:25:13 | 0:25:17 | |
expose suspected fraudulent claims. | 0:25:17 | 0:25:20 | |
We find a lot of liars through looking at what | 0:25:20 | 0:25:23 | |
they've posted openly on their social media accounts. | 0:25:23 | 0:25:26 | |
Later, a sickening fraud that duped an entire American city is exposed. | 0:25:32 | 0:25:38 | |
The Royal Mail has been collecting, carrying and delivering all packages | 0:25:51 | 0:25:54 | |
great and small for over 500 years, | 0:25:54 | 0:25:57 | |
so, if something fails to arrive at its intended destination, | 0:25:57 | 0:26:01 | |
it's a big deal. | 0:26:01 | 0:26:02 | |
Customers are always compensated for any genuine losses | 0:26:02 | 0:26:05 | |
or damaged items. | 0:26:05 | 0:26:06 | |
It's a fact that insurance cheats have cottoned on to | 0:26:06 | 0:26:09 | |
and are exploiting - | 0:26:09 | 0:26:11 | |
commonly submitting false claims for lost or unreceived items. | 0:26:11 | 0:26:15 | |
Diane Matthews is a fraud manager for Royal Mail, | 0:26:21 | 0:26:24 | |
and it's her job to identify and investigate | 0:26:24 | 0:26:27 | |
any suspected fraudulent claims. | 0:26:27 | 0:26:29 | |
She was passed one case which involved their | 0:26:29 | 0:26:31 | |
premium delivery service. | 0:26:31 | 0:26:33 | |
Royal Mail customer services received a complaint from | 0:26:34 | 0:26:37 | |
a customer that a special-delivery item was delivered | 0:26:37 | 0:26:41 | |
without the contents. | 0:26:41 | 0:26:42 | |
There's nothing more frustrating than receiving an empty package, | 0:26:42 | 0:26:46 | |
and it's a matter Royal Mail takes very seriously. | 0:26:46 | 0:26:49 | |
The contents of the special-delivery item were said to be | 0:26:50 | 0:26:52 | |
a gift card of £260, so, obviously, quite valuable, | 0:26:52 | 0:26:56 | |
and a loss to Royal Mail of quite a significant amount. | 0:26:56 | 0:26:59 | |
These cases are always investigated, and it's standard practice | 0:26:59 | 0:27:03 | |
to look into the claims history of the customer. | 0:27:03 | 0:27:06 | |
Checks were made as to the recipient, | 0:27:06 | 0:27:09 | |
and it was found that they'd made three similar claims | 0:27:09 | 0:27:12 | |
in the space of six weeks. | 0:27:12 | 0:27:14 | |
Mr Mohammed, the claimant, | 0:27:14 | 0:27:16 | |
was actually stating that there was gift cards inside | 0:27:16 | 0:27:19 | |
each and every one of them envelopes, and, on each occasion, | 0:27:19 | 0:27:23 | |
the envelope was delivered to him empty. | 0:27:23 | 0:27:26 | |
The chances of that are, I would say, slim to none. | 0:27:26 | 0:27:29 | |
With the gift cards mysteriously disappearing, | 0:27:31 | 0:27:34 | |
but the actual packages being successfully delivered, | 0:27:34 | 0:27:37 | |
it was one of Royal Mail's employees who first came under scrutiny. | 0:27:37 | 0:27:41 | |
The finger of suspicion fell on the postman | 0:27:41 | 0:27:44 | |
that was due to deliver that item, | 0:27:44 | 0:27:46 | |
and, when we went further into the case | 0:27:46 | 0:27:49 | |
and found out this was one of several claims, obviously, | 0:27:49 | 0:27:53 | |
our impression changed and we then started looking at Mr Mohammed. | 0:27:53 | 0:27:58 | |
And they didn't have to look far to see an alarming pattern. | 0:27:58 | 0:28:02 | |
It was found that, over the 14-month period, | 0:28:02 | 0:28:04 | |
he'd made numerous claims for loss, | 0:28:04 | 0:28:08 | |
mainly small electronic items and mobile phones, | 0:28:08 | 0:28:11 | |
latterly going on to the gift cards that he'd bought. | 0:28:11 | 0:28:15 | |
To further this investigation, | 0:28:15 | 0:28:17 | |
I started to look a bit more closely at the gift cards. | 0:28:17 | 0:28:20 | |
With such a high number of claims over a short period, | 0:28:20 | 0:28:24 | |
the spotlight of suspicion was now fixed on Mohammed. | 0:28:24 | 0:28:27 | |
Diane and her team turned their attention to | 0:28:27 | 0:28:30 | |
Mohammed's online activities. | 0:28:30 | 0:28:32 | |
Checks revealed that Mr Mohammed had set up three different | 0:28:32 | 0:28:37 | |
online auction site accounts in the space of three minutes, | 0:28:37 | 0:28:42 | |
and on each one, it was used to facilitate a purchase. | 0:28:42 | 0:28:47 | |
On each occasion, he told the seller that they had not been delivered. | 0:28:47 | 0:28:52 | |
Royal Mail had sussed out Mohammed's MO. | 0:28:52 | 0:28:56 | |
The evidence suggested he was buying discounted gift cards online under | 0:28:56 | 0:29:00 | |
different guises, and claiming to both the vendor and Royal Mail | 0:29:00 | 0:29:03 | |
that his purchases had never been received. | 0:29:03 | 0:29:06 | |
The seller was contacted and they forwarded details of the card, | 0:29:06 | 0:29:10 | |
which allowed us to go to the various stores | 0:29:10 | 0:29:13 | |
and find out the transactions, | 0:29:13 | 0:29:16 | |
and also to ascertain if any CCTV evidence of them transactions | 0:29:16 | 0:29:21 | |
was still available. | 0:29:21 | 0:29:23 | |
Each gift card has a unique identity number, | 0:29:23 | 0:29:25 | |
making them easily trackable when purchases are made. | 0:29:25 | 0:29:29 | |
With this information, | 0:29:29 | 0:29:30 | |
Diana was able to zero in on specific store locations where | 0:29:30 | 0:29:34 | |
the supposedly-lost gift cards had been used, | 0:29:34 | 0:29:37 | |
and, most importantly, check their CCTV recordings. | 0:29:37 | 0:29:41 | |
When the CCTV footage was viewed, | 0:29:44 | 0:29:47 | |
we identified Mr Mohammed as being the person spending | 0:29:47 | 0:29:52 | |
the £260 gift card on several occasions, | 0:29:52 | 0:29:55 | |
as well as being used by a family member. | 0:29:55 | 0:29:58 | |
Mohammed had been caught red-handed on camera. | 0:29:58 | 0:30:01 | |
It was the crucial evidence Royal Mail needed to prove | 0:30:01 | 0:30:04 | |
the fraudulent activity. | 0:30:04 | 0:30:06 | |
He'd also passed the gift card to an unknowing relative, | 0:30:06 | 0:30:09 | |
who had also been using it in good faith to make purchases, | 0:30:09 | 0:30:12 | |
therefore implicating an innocent family member in his crime. | 0:30:12 | 0:30:16 | |
At this point, we had enough evidence to arrest Mr Mohammed, | 0:30:18 | 0:30:23 | |
so we sought assistance from Greater Manchester Police, | 0:30:23 | 0:30:25 | |
who assisted us with that. | 0:30:25 | 0:30:27 | |
Diane and her investigative team had worked hard to crack this case, | 0:30:28 | 0:30:32 | |
and were determined to be there when justice was delivered. | 0:30:32 | 0:30:35 | |
Myself and my colleagues from Royal Mail investigations | 0:30:35 | 0:30:37 | |
accompanied the police on a search of Mr Mohammed's home address. | 0:30:37 | 0:30:42 | |
Evidence was then seized from his bedroom that matched | 0:30:42 | 0:30:45 | |
the identical cards that were reported as not being received, | 0:30:45 | 0:30:49 | |
and at that moment you knew that the right person had been caught. | 0:30:49 | 0:30:52 | |
Mohammed was given an opportunity to explain why the gift cards | 0:30:55 | 0:30:59 | |
were found at his property. | 0:30:59 | 0:31:01 | |
Mr Mohammed was subsequently interviewed by officers of | 0:31:01 | 0:31:04 | |
Royal Mail and he chose to answer no comment to all of our questions. | 0:31:04 | 0:31:09 | |
But by the time the case reached court, | 0:31:09 | 0:31:12 | |
Mohammed had changed his tune. | 0:31:12 | 0:31:14 | |
Mr Mohammed pled guilty at court to two charges of fraud, | 0:31:14 | 0:31:18 | |
and he received a six-month community service order | 0:31:18 | 0:31:22 | |
and also a curfew. | 0:31:22 | 0:31:24 | |
No matter how big or how small attempts to defraud Royal Mail are, | 0:31:24 | 0:31:28 | |
they will always be met with the same response. | 0:31:28 | 0:31:31 | |
The actual value of this claim is irrelevant to Royal Mail. | 0:31:31 | 0:31:34 | |
The modus operandi of this is fraud and therefore it needs to be | 0:31:34 | 0:31:38 | |
investigated and stopped. | 0:31:38 | 0:31:39 | |
Now, in recent years, | 0:31:45 | 0:31:47 | |
the UK has acquired the catchy title of the whiplash capital of Europe, | 0:31:47 | 0:31:51 | |
with an estimated 2.7 claims made for every reported accident. | 0:31:51 | 0:31:56 | |
Now, while many of those claims are genuine, | 0:31:56 | 0:31:58 | |
the injury has long been seen by potential fraudsters | 0:31:58 | 0:32:01 | |
as an easy, low-risk way to make a few quid. | 0:32:01 | 0:32:04 | |
Whether it's otherwise honest individuals making | 0:32:04 | 0:32:07 | |
a one-off exaggerated claim from a real accident | 0:32:07 | 0:32:10 | |
or organised gangs masterminding calculated | 0:32:10 | 0:32:13 | |
"crash for cash" cons, it is all fraud. | 0:32:13 | 0:32:16 | |
The Government was so concerned by this systemic crime that they set up | 0:32:22 | 0:32:26 | |
the Insurance Fraud Taskforce to investigate. | 0:32:26 | 0:32:29 | |
It's chaired by former Law Commissioner David Hertzell. | 0:32:29 | 0:32:32 | |
The Government sent the Insurance Fraud Taskforce out | 0:32:34 | 0:32:37 | |
for three reasons. | 0:32:37 | 0:32:38 | |
First of all, they were worried about the cost of fraud increasing | 0:32:38 | 0:32:41 | |
the cost of premiums for honest policyholders. | 0:32:41 | 0:32:43 | |
Secondly, they were worried about fraud becoming morally acceptable - | 0:32:43 | 0:32:48 | |
people thinking it was OK to just increase or exaggerate their claim | 0:32:48 | 0:32:52 | |
a little bit here and there. | 0:32:52 | 0:32:53 | |
And the third thing they were worried about was | 0:32:53 | 0:32:56 | |
the link between organised crime and insurance fraud | 0:32:56 | 0:32:58 | |
and difficult areas such as terrorism. | 0:32:58 | 0:33:01 | |
The Taskforce's findings showed an alarmingly complacent | 0:33:01 | 0:33:05 | |
public attitude towards this crime. | 0:33:05 | 0:33:07 | |
Opportunistic fraud. By that, we mean people who might just, | 0:33:08 | 0:33:12 | |
on the spur of the moment, add an item to their claim. | 0:33:12 | 0:33:15 | |
So they claim for an iPad they've never had, | 0:33:15 | 0:33:17 | |
they might claim for a camera they didn't have, etc, etc. | 0:33:17 | 0:33:20 | |
And so it's people who would otherwise be completely honest | 0:33:20 | 0:33:24 | |
on the spur of the moment thinking it's OK to | 0:33:24 | 0:33:26 | |
be dishonest with an insurer. | 0:33:26 | 0:33:27 | |
And these opportunistic scammers continue to think that they can | 0:33:27 | 0:33:30 | |
get away with it. | 0:33:30 | 0:33:32 | |
There is a perception out there that something very much happens. | 0:33:32 | 0:33:35 | |
In fact, the courts are quite tough on fraud. | 0:33:35 | 0:33:38 | |
Axa's head of fraud Richard Davies is no stranger to these of claims. | 0:33:38 | 0:33:43 | |
His team received one particular case from an Axa customer | 0:33:44 | 0:33:48 | |
which involved multiple third-party passengers. | 0:33:48 | 0:33:51 | |
Our customer told us that they'd collided with another vehicle - | 0:33:51 | 0:33:56 | |
as a result, five whiplash claims were submitted to us. | 0:33:56 | 0:34:00 | |
They were meant to involve three male passengers - | 0:34:00 | 0:34:04 | |
one of 60, one of 40 and one of roughly 20 - | 0:34:04 | 0:34:07 | |
-and two younger Caucasian females. -BRAKES SCREECH AND CAR SMASHES | 0:34:07 | 0:34:12 | |
So, three boys and two girls in the car during the accident - | 0:34:12 | 0:34:15 | |
seems pretty clear. | 0:34:15 | 0:34:17 | |
There was a really big problem with this claim. | 0:34:18 | 0:34:21 | |
Our customer had told us there were three males and two females | 0:34:21 | 0:34:27 | |
in the car. | 0:34:27 | 0:34:28 | |
However, when the claims came in, | 0:34:28 | 0:34:31 | |
there were two males and three females in the car. | 0:34:31 | 0:34:35 | |
That's fundamentally inconsistent and meant that we had to doubt | 0:34:35 | 0:34:39 | |
whether or not the claims were genuine. | 0:34:39 | 0:34:41 | |
Aside from one of the passengers mysteriously morphing into a woman, | 0:34:41 | 0:34:45 | |
there's also the matter of the two female occupants who were reportedly | 0:34:45 | 0:34:48 | |
Caucasian, but now seem to be hailing from an Asian background. | 0:34:48 | 0:34:52 | |
It was a discrepancy that brought the case to an emergency stop. | 0:34:53 | 0:34:58 | |
We rejected all of these claims, | 0:34:58 | 0:35:00 | |
which were at that point valued at around £23,000. | 0:35:00 | 0:35:05 | |
The claimants, however, refused to accept that | 0:35:05 | 0:35:07 | |
and decided to take us to court, | 0:35:07 | 0:35:10 | |
and we estimated that it would cost around about £200,000 | 0:35:10 | 0:35:15 | |
to defend those claims. | 0:35:15 | 0:35:17 | |
That's over ten times the amount of the original claim. | 0:35:18 | 0:35:22 | |
Confident that this was a classic case of an opportunistic attempt | 0:35:22 | 0:35:25 | |
at fraud, Axa weren't prepared to back down. | 0:35:25 | 0:35:28 | |
The claimants came across very badly in court. | 0:35:28 | 0:35:31 | |
When they were cross-examined, they changed their story, | 0:35:31 | 0:35:34 | |
they changed the circumstance of the accident | 0:35:34 | 0:35:37 | |
and the judge held that they just weren't credible witnesses. | 0:35:37 | 0:35:41 | |
So far, it may have looked like a game of "Guess Who?", | 0:35:41 | 0:35:44 | |
but there was no mistaking the identity of the claimants when | 0:35:44 | 0:35:47 | |
the final judgment was passed. | 0:35:47 | 0:35:49 | |
The judge threw all five claims out of court. | 0:35:49 | 0:35:52 | |
He said that the people weren't in the car and he made an order | 0:35:52 | 0:35:57 | |
against them to pay Axa's legal costs. | 0:35:57 | 0:36:00 | |
These individuals clearly thought, win or lose, | 0:36:00 | 0:36:03 | |
there would be no consequences to submitting a false claim, | 0:36:03 | 0:36:06 | |
but they were gravely mistaken. | 0:36:06 | 0:36:09 | |
We think that the claimants were motivated just by money. | 0:36:09 | 0:36:12 | |
They thought that they could get away with £23,000 from an insurance | 0:36:12 | 0:36:16 | |
company simply by submitting five fake claims. | 0:36:16 | 0:36:21 | |
When we know that a claim is false, | 0:36:21 | 0:36:23 | |
we will defend it and we will take those claimants through the court | 0:36:23 | 0:36:27 | |
system to make sure they are shown to be criminal. | 0:36:27 | 0:36:30 | |
And it's the honest policyholders who ultimately pay the price. | 0:36:30 | 0:36:34 | |
It cost us £200,000 to defend them. | 0:36:34 | 0:36:38 | |
Those costs are paid on to genuine customers | 0:36:38 | 0:36:41 | |
and is the reason why £50 is added to each premium that we pay | 0:36:41 | 0:36:46 | |
for each policy we own. | 0:36:46 | 0:36:47 | |
If you live in the UK, | 0:36:52 | 0:36:53 | |
the NHS provides free and comprehensive health care, | 0:36:53 | 0:36:56 | |
covering you for anything from a minor injury to life-threatening | 0:36:56 | 0:36:59 | |
illnesses like cancer, | 0:36:59 | 0:37:02 | |
but, in America, they operate a private health care system | 0:37:02 | 0:37:05 | |
with all citizens required to buy health insurance | 0:37:05 | 0:37:08 | |
out of their own pocket, | 0:37:08 | 0:37:09 | |
much like you'd buy car insurance over here, | 0:37:09 | 0:37:12 | |
and where there's insurance, there's fraud. | 0:37:12 | 0:37:14 | |
Michigan State, located in the north-east of America - | 0:37:16 | 0:37:20 | |
the car capital of the US. | 0:37:20 | 0:37:22 | |
90 miles north of Detroit, | 0:37:25 | 0:37:27 | |
Sara Ylen is sentenced by St Clair County Court. | 0:37:27 | 0:37:31 | |
She received five years' imprisonment. | 0:37:40 | 0:37:43 | |
This is just one part of a jaw-dropping story, | 0:37:43 | 0:37:46 | |
which follows a fraud worth hundreds of thousands of dollars, | 0:37:46 | 0:37:50 | |
an entire community deceived, | 0:37:50 | 0:37:52 | |
and an innocent man jailed. | 0:37:52 | 0:37:54 | |
11 years earlier, in 2003, | 0:37:59 | 0:38:02 | |
Sara Ylen claimed to have contracted | 0:38:02 | 0:38:04 | |
a sexually transmitted disease, | 0:38:04 | 0:38:06 | |
which developed into cervical cancer, | 0:38:06 | 0:38:08 | |
after allegedly being attacked by James Grissom, | 0:38:08 | 0:38:12 | |
who was subsequently jailed. | 0:38:12 | 0:38:13 | |
Sara would call upon her health insurers, | 0:38:16 | 0:38:19 | |
who footed what would be extensive medical bills. | 0:38:19 | 0:38:22 | |
They received regular invoices from a hospice for Sara's in-home care. | 0:38:24 | 0:38:28 | |
Medical records, which looked to have originated from | 0:38:30 | 0:38:33 | |
a Michigan cancer centre, | 0:38:33 | 0:38:34 | |
showed that Sara's cancer had tragically spread, | 0:38:34 | 0:38:38 | |
and she was now suffering with the debilitating bone cancer, | 0:38:38 | 0:38:41 | |
multiple myeloma. | 0:38:41 | 0:38:43 | |
Every day, Sara would rely on the support of care from nurses, | 0:38:45 | 0:38:48 | |
who helped her with everything from household chores | 0:38:48 | 0:38:51 | |
to bathing and dressing. | 0:38:51 | 0:38:54 | |
The bills for this level of daily in-home care quickly ran into | 0:38:54 | 0:38:57 | |
tens of thousands of dollars. | 0:38:57 | 0:38:59 | |
She would make frequent trips to hospital to receive treatments | 0:39:01 | 0:39:04 | |
and could commonly be seen coming and going in a wheelchair, | 0:39:04 | 0:39:07 | |
wearing a tightly-wrapped headscarf. | 0:39:07 | 0:39:09 | |
Sara's future appeared bleak. | 0:39:11 | 0:39:13 | |
In 2011, the health insurance claims team received | 0:39:17 | 0:39:20 | |
a disturbing anonymous tip-off. | 0:39:20 | 0:39:23 | |
A caller claimed that Sara Ylen did not have multiple myeloma, | 0:39:23 | 0:39:28 | |
and in fact had never suffered from any form of cancer. | 0:39:28 | 0:39:31 | |
On examination of Ylen's medical records, | 0:39:33 | 0:39:36 | |
her insurers determined that they were in fact forgeries. | 0:39:36 | 0:39:40 | |
Ylen had simply downloaded X-rays of genuine multiple myeloma sufferers | 0:39:44 | 0:39:48 | |
on her home computer, and had been passing them off as her own. | 0:39:48 | 0:39:53 | |
When the doctors she had named were interviewed about | 0:39:53 | 0:39:56 | |
her supposed disease, they had never heard of her. | 0:39:56 | 0:39:59 | |
With this shocking discovery, her health insurance was terminated. | 0:40:01 | 0:40:05 | |
By this point, Ylen had claimed 122,000 worth of medical care | 0:40:07 | 0:40:13 | |
from her insurers. | 0:40:13 | 0:40:15 | |
With her cancer scam exposed and her cash flow cut off, | 0:40:15 | 0:40:18 | |
you'd expect Ylen to call it quits, | 0:40:18 | 0:40:20 | |
but this only launched her into an even more heinous deception, | 0:40:20 | 0:40:23 | |
which would encompass her entire local community. | 0:40:23 | 0:40:26 | |
Lexington is a quaint, family-orientated suburb | 0:40:28 | 0:40:31 | |
of Michigan - the kind of place where everyone knows everyone - | 0:40:31 | 0:40:35 | |
so, when news circulated that one of their own was fighting a supposed | 0:40:35 | 0:40:39 | |
heroic fight against cancer, | 0:40:39 | 0:40:41 | |
big-hearted locals responded with a flood of support. | 0:40:41 | 0:40:44 | |
Neighbours would visit Ylen daily, bringing food, mowing the lawn, | 0:40:45 | 0:40:49 | |
cleaning her house and handing over their hard-earned cash in the belief | 0:40:49 | 0:40:53 | |
that she was bravely battling a terminal illness. | 0:40:53 | 0:40:56 | |
Ylen's local church group held various fundraising days | 0:41:00 | 0:41:03 | |
on her behalf, which she would attend. | 0:41:03 | 0:41:06 | |
They raised over 10,000, which she pocketed without hesitation. | 0:41:06 | 0:41:12 | |
Ylen had been successfully deceiving a hospice, | 0:41:12 | 0:41:14 | |
her medical insurers and an entire community for years. | 0:41:14 | 0:41:20 | |
She also had an innocent man jailed for allegedly assaulting her, | 0:41:20 | 0:41:23 | |
from which she claimed to have contracted her fictitious cancer. | 0:41:23 | 0:41:27 | |
SIREN WAILS In May 2013, Michigan State police | 0:41:29 | 0:41:32 | |
arrested Ylen on six felony counts, | 0:41:32 | 0:41:34 | |
including fabricating an assault report and health care fraud. | 0:41:34 | 0:41:38 | |
In January 2014, | 0:41:41 | 0:41:43 | |
Sara Ylen stood trial for claiming two men had attacked her | 0:41:43 | 0:41:46 | |
in her own home. | 0:41:46 | 0:41:48 | |
She had faked the injuries supposedly sustained | 0:41:49 | 0:41:52 | |
during the attack. | 0:41:52 | 0:41:54 | |
When she sought treatment, | 0:41:54 | 0:41:55 | |
her cuts and bruises simply wiped off with gauze. | 0:41:55 | 0:41:58 | |
At trial, she was found guilty. | 0:42:08 | 0:42:11 | |
The figure visible behind her is that of | 0:42:11 | 0:42:13 | |
the recently-freed James Grissom, | 0:42:13 | 0:42:16 | |
who she had falsely sent to prison for her alleged attack back in 2003. | 0:42:16 | 0:42:21 | |
James Grissom had spent ten years behind bars for | 0:42:23 | 0:42:26 | |
a completely fabricated crime, | 0:42:26 | 0:42:29 | |
victim to Ylen's manipulative lies. | 0:42:29 | 0:42:32 | |
She was sentenced to five years for fabricating a sexual assault, | 0:42:37 | 0:42:41 | |
and a month later was sentenced to an additional year | 0:42:41 | 0:42:43 | |
for health care fraud, | 0:42:43 | 0:42:45 | |
taking her total prison term to six years. | 0:42:45 | 0:42:48 | |
She was also ordered to pay back the 122,000 she had illegally obtained | 0:42:48 | 0:42:54 | |
from her health insurers. | 0:42:54 | 0:42:56 | |
Insurance fraud hits all of us in the pocket, | 0:43:02 | 0:43:05 | |
but more and more of these scammers and conmen | 0:43:05 | 0:43:07 | |
are being claimed and shamed. | 0:43:07 | 0:43:10 |