Episode 9 Claimed and Shamed

Insurance fraud in the UK is reaching epidemic levels.

And it's costing us billions of pounds a year.

Deliberate crashes, bogus personal injury claims,

even fake deaths.

The fraudsters are risking more and more to make a quick killing.

And every year, it's adding up to £50 to your insurance bill.

Insurers are fighting back.

Armed with covert surveillance systems...

The equipment that we have to use has to be cutting edge.

It's as simple as that.

..sophisticated data-analysis techniques...

This is connected to a bank account and a second mobile phone number.

..and a newly-formed dedicated police unit...

Police! Get back!

..they're catching the criminals red handed.

All those conmen, scammers, cheats on the fiddle,

now they're caught in the act and claimed and shamed.

Today - a £750,000 claim comes under suspicion.

It was very pertinent to the case

that we showed exactly how much she was able to do on a day-to-day basis.

A police fraud unit executes an early-morning raid on a suspect.

I'm going to be questioning you about a no-claims discount. OK?

And a stubborn fraudster sticks to his story.

In the face of such overwhelming evidence,

he wanted to try to find an excuse why he should still be paid.

This is Joanne Kirk from Preston.

In September 2001, she was injured in a car crash.

The shunt left her with neck and shoulder pain,

but her injuries seemed relatively minor.

Well, this was an accident

where Mrs Kirk was stationary at a roundabout

and our customer hit her from behind.

So this was a genuine accident.

We had no doubt that the accident occurred.

We also had no doubt that Mrs Kirk received injuries

as a result of the accident.

One year after the crash, Mrs Kirk's condition deteriorated.

Complaining of extreme muscle spasms,

chronic pain and exhaustion,

she decided to quit her job as a university administrator.

As well as making a claim for Disability Living Allowance,

she began legal proceedings against the insurer of the driver

who had crashed into her.

The claim was handed to the insurer.

Mrs Kirk's claim came to us about two years

after the initial accident had happened.

She was claiming for £750,000.

To the experienced claims handlers at RBS,

Joanne Kirk's physical deterioration didn't fit the usual pattern.

We understand the types of injuries likely to come from accidents.

We also understand how people normally recover from the accidents.

So where we find someone whose injuries are inconsistent

with the type of accident that's occurred,

then we have to investigate in more detail.

And that's what happened in Mrs Kirk's case.

To get the full picture, the insurer needed to see

how Mrs Kirk was going about her daily activities.

If you want to spy on someone, this team of undercover investigators

will get the job done using their highly-trained operatives.

The operatives themselves have to have a huge amount of concentration.

Ultimately, what we're seeking to do is maximise the footage that we get.

And today, I'm on a two-operatives task

with observation and surveillance on a Joanne Kirk.

With the Kirk case, we were presented with an individual

who was claiming physical disability.

It was very pertinent to the case

we showed exactly how much she was able to do on a day-to-day basis.

So for us, it was about maximising the surveillance footage

and showing her in every scenario that we found her in.

Joanne Kirk had submitted a £750,000 claim.

In that claim, she stated that she needed crutches when going outside.

That she was unable to carry out the simplest of tasks without help.

That she was unable to hold a pen.

That she was unable to sit or stand comfortably.

And she could only walk a maximum of five metres without stopping.

In the spring of 2005,

the surveillance company set about filming Mrs Kirk.

In order to get a fair picture of her everyday life,

the surveillance ops filmed her on several occasions

spread over a period of 18 months.

What they saw in the footage shocked the insurer.

She can be seen now.

What you see when you start to look at the surveillance picture

is somebody going about their normal daily tasks.

They're going for walks,

they're going to cashpoints, they're going into shops,

they're carrying bags.

They're carrying out their normal daily life.

One of the surveillance tapes

shows Joanne Kirk on a 90-minute shopping trip.

When we were filming her, she didn't exhibit any form of disability.

It was central to the case itself

in showing the courts that there was a deliberate fraud involved

or a level of exaggeration

that went way beyond just trying to elevate your claim.

Mrs Kirk claimed that she could only walk

a maximum of five metres before needing to stop.

And that she used crutches when going out.

After watching the footage,

that was something that the insurer found hard to believe.

When the final claim was submitted by Mrs Kirk's lawyers,

we presented them with the evidence that we'd gathered over two years

of all the things that she said that she couldn't do,

but actually, our evidence demonstrated that she could.

So immediately, they dropped the claim for £750,000

and accepted £25,000.

We were dealing with a lady who had clearly exaggerated her injuries

in order to gain an increased payout through an insurance claim.

But was clearly taking the mickey from the courts.

Abusing the legal system and the process that sits behind it.

When faced with the evidence,

Joanne Kirk settled for a hugely-reduced payout of £25,000.

That wasn't the end of it for her.

She had attempted to fraudulently claim over £750,000.

We didn't think it was right she should be able to walk away

from a claim like that, from that kind of lie,

without some kind of consequences.

In an unprecedented move, the insurer hit back at Joanne Kirk

and pursued the matter in court.

We undertook what was a landmark proceeding at the time

to bring a case against her for contempt.

Now, that was something that no insurance company had done before.

In May 2009, Joanne Kirk was found in contempt of court.

Ordered to pay her own legal bill of £125,000,

a £2,500 fine for contempt

and half of the defendant's legal costs.

It took a lot of time, it took a lot of effort

and we had to be quite brave in what we were trying to do.

But when we finally got to a conviction,

we were really pleased that we were sending a message.

We'd blazed a trail on behalf of insurers

and set a precedent that people can't make claims

that are totally fabricated or exaggerated

and walk away from their lies without any consequences.

An insurer spots a suspicious pattern of claims...

Always in a remote road.

Police were never called to the scene of the accident.

..and a carpet fitter fits up his insurance company.

He had told us that his foot was far too painful for him to work.

In the fight against a growing problem of insurance fraud,

an elite police squad have come together to form IFED -

the Insurance Fraud Enforcement Department.

Insurance fraud isn't a victimless crime.

£50 of each premium you pay each year goes to the fraudsters.

We've been set up to tackle that problem.

This dedicated team works tirelessly to bang up the crooks and conmen

getting rich off other people's money.

Police! Get back!

We intend to create a climate of fear for the fraudster.

There's every chance an IFED detective may knock on their door

to arrest them for committing an insurance fraud.

Police! Don't move! Stay where you are!

By April 2012, after only six months of operating,

they had already busted 80 fraudsters,

adding up to £12 million of fraud under investigation.

These people are criminals.

These are nasty people.

They don't go out to work on a Monday morning like most people do.

Their work is submitting insurance fraud claims.

IFED doesn't just deal with large fraud gangs

running crash-for-cash rings.

It tackles insurance fraud of any type and scale.

Today, it's raiding the property of a man

suspected of lying on his motor insurance form.

He has submitted a forged no-claims discount letter

in order to show that he's a lower risk and to get a lower premium.

The actual gain in this case isn't that great.

It's, um...somewhere between £500 and £1,000,

which is the discount he got

from lying about his no-claims history.

We deal with criminals, all the way from the most organised

down to the very low level of fraudsters.

And the person I'm going to arrest today

does fit into the very low level, opportunist category.

By tackling cases all across the spectrum,

we can make it clear to people that insurance fraud is unacceptable.

The small four-man unit from IFED

prepare to enter the suspect's property.

We've come here from the City of London Police.

We need to get access to the building.

-Would you mind buzzing us in?

-'OK.'

-Thank you.

'Door's opening.'

KNOCKS ON DOOR

KNOCKS ON DOOR

The IFED team can hear some activity behind the door,

but no-one is answering.

KNOCKS ON DOOR

Can you open the door, please? It's the police.

-City of London Police. Is

-BLEEP

-here, please?

-Yeah.

-Is that the bathroom or the bedroom?

-The bedroom.

-OK.

-Mr

-BLEEP,

-Alex Cooley, City of London Police.

I'm arresting you for fraud by false representation

in relation to a forged no claims discount document.

The reason it's necessary for me to arrest you is to look

for any documentation relating to the alleged fraud.

-Let me change my clothes.

-I'll let you get changed, yeah.

-Where are you planning to get changed? In the bathroom?

-Bathroom.

I'm washing my teeth.

OK, you need to get changed under the supervision of my colleague.

We need to search the suspect's bedroom

and any other common areas that he might be keeping

documentation in relation to the insurance fraud.

When we've completed the search, we'll be taking the suspect back to Bishopsgate Police Station.

Just to explain what it's about... OK. But I'm interested...

I'll write it down.

IFED's search is being delayed by the suspect.

I'm going to be questioning you about a no claims discount, OK?

I'm going to have to quickly have to search your pockets.

I'm looking for any documentation

relating directly to the claim we're investigating,

so anything relating to that insurance company and the other

insurance company which was used for the forged no claims discount.

That's yours. OK.

The stuff that will be left behind is being left on the floor here.

It's essential the team finds the documents linked to the claim.

TI Alex Cooley needs to get the suspect to start cooperating.

-That's your bank statement, yeah?

-Yeah.

-OK.

-That's the amount I'm paying every...

-OK.

-That's fine.

You can bring that with you. OK?

TI Cooley must find

the documentation he needs to build his case.

We're looking for a bank statement on around the second of February.

So that's May to June.

-2009 or...?

-Second of February 2012.

I just found the documentation in this drawer.

-OK.

-Oh, the...

-You can change in the car.

-The second of February 2012.

-So if we go back.

I've got this statement here.

Could that be the one from the second of February?

INDISTINCT RESPONSE

OK, we'll have to keep looking for it.

Yeah, yeah. No problem.

Suspect took out a motor insurance policy.

He declared that he had five years no claims discount.

Personal injury insurance exists to help us when

due to an accident we are unable to work or need money for extra care.

And like motor insurance, it's being abused by dishonest claimants.

The number of personal injury claims received by insurers

leapt 72% between 2002 and 2010,

a figure that's set to rise.

July 2008, three months ago this man broke his foot whilst at work.

The gentleman had injured his foot, broken some bones in it,

and was unable to work.

So under the terms of the policy,

we were able to pay him for his inability to work.

He worked as a carpet fitter, but being self-employed,

hadn't earned a penny since sustaining the injury.

Despite his lack of income, the carpet fitter was safe financially.

He had personal injury cover,

and having supplied adequate medical notes, his insurer had paid out.

As a result of his injuries,

he was unable to carry out his full duties of laying a carpet.

He couldn't drive, the pain was too much for him to work.

So that was... Under the terms of the policy,

we would pay him until he was able to return to work.

We were making benefit payments to the claimant

for a period of several months.

He'd broke his foot in, I think, the April

and for some three months after that,

was receiving regular payments from us as part of his insurance cover.

The claim in total was in the region of £2,300.

Three months after the accident,

his insurer attempted to contact him for an update on his condition.

We found it very difficult to get hold of him after some months...

some months after the injury. He wasn't answering his telephone,

we weren't able to get updates on his medical condition or to find out

if the plaster had been removed and if he was able to return to work

some three months after the initial injury to his foot.

Three days after failing to get hold of the carpet fitter,

the insurer was handed some intriguing information,

in the form of a tip-off from a member of the public.

We have a wide network of people with whom

we work in the insurance industry.

And that can be repairers, engineers, loss adjusters

and even members of the public.

And all of those are often willing to let us know where

they feel that circumstances of an insurance claim are suspicious.

The informant called the insurer,

stating that the carpet fitter had been seen working.

Potentially, the insurer was looking at a fraudulent claim.

So they reacted with one of their most effective tools.

The next step for us, having received the tip-off,

was to send out some surveillance.

We sometimes do this in cases where we need to gather evidence

to back up our suspicions that all is not as it should be.

And when they received the report back from the surveillance team...

We were shocked.

Okey doke, thanks for that. Lovely.

This is what they saw.

The surveillance team found that

the carpet layer was not only working,

he was driving his vehicle, he wasn't in plaster.

And we had footage of him carrying heavy carpet rolls

and fitting the carpet in somebody's house.

When we had eventually managed to get hold of him,

he had told us that his foot was far too painful for him to work,

that he was suffering particular pains in the evening.

Perhaps not surprising after the amount of work he'd been doing,

carrying carpets all day.

Confronted with such hard evidence,

most people would back down and retract their fraudulent claim.

Not the carpet fitter.

The carpet fitter claimed that the footage was obtained

on a day when he was testing his foot.

But the suspect was filmed working for over six hours.

This was, in the eyes of the insurer,

more than enough time to test his foot.

I was surprised that he wanted to,

in the face of such overwhelming evidence,

try to find an excuse why he should still be paid.

In court, his excuses proved futile.

The carpet fitter was ordered to pay back the £1,672 in payouts

he had received,

and was landed with the bill for the insurers' investigation and legal costs.

With the added interest,

he was looking at a bill totalling almost £9,000.

I'm happy that we have the money back

and that it's meant that we haven't paid out for a fraudulent claim.

I would like to see deterrent measures,

I would like to see a strong message sent out.

People who make exaggerated claims, I think,

should consider the impact it has on the millions of law-abiding

and honest policy holders, who all have to pay for it.

This is not a victimless crime.

These people are not, you know,

taking money out of the system or some faceless insurance company.

It's all going back to the innocent people

who have to pay their premiums.

It's 2005.

A fraud ringleader is gathering foot soldiers to take part

in an audacious plot against an insurer.

If successful,

he could be masterminding one of the biggest crash-for-cash scams ever.

Standing in his way is an insurance industry determined to stamp out

the increasing number of these bogus crashes.

Later that year, a large insurer became suspicious

after receiving a number of claims that seemed to be linked.

We started to see an unusual amount of claims all coming out

of the same depot of this big telecommunications company.

Within a very short space of time,

and they all seemed to be of very similar nature.

The cars were always full of people, always on a remote road.

Police were never called to the scene of the accident.

Feeling sure that the claims were all linked, the insurer called on

the help of the telecommunications company being targeted.

The telecommunications company were able to release employment records,

which then gave us links between the individuals involved.

All of the alleged smashes involved

individuals who worked as sales reps for the company.

January 2005 to June 2005, a lot of them joined, a lot of them left,

and that's when we saw the spike.

The connections continue to mount.

We also found out from employment records

that a lot of these guys worked together previously.

By this point, the insurer was convinced that the sales reps

had been using their company cars in staged crashes in order to

make money from their company's policies.

But this was a big operation. There had to be a ring leader.

The insurer still didn't know who that was.

At the time, this was the biggest conspiracy fraud involving

fake car crashes against one insurance company.

Total of 49 claims. The value of the fraud

if successful would have been in excess of £1.3 million.

In the hunt for the ringleader,

the insurer turned its attention to the details of the crash victims.

In terms of the injury claims, they were all whiplash.

Very difficult to diagnose. Very difficult to disprove.

Furthermore, the insurer found that, just like the sales reps,

there was an uncanny coincidence with the victims too.

The people in the other cars were all friends and family.

Suspecting that the smash victims were part of the scam too,

the insurer took its research to the police.

The police questioned all the people involved in the crashes.

One name cropped up time and time again,

that of the man at the centre of the scam...

..fraud ringleader Darren Duvall,

a 38-year-old butcher.

How he recruited them was interesting.

He would sit in McDonalds,

watched the same team of sales reps come in for their team breakfast.

He then approached them, he approached the team leader,

which he recruited first, and said,

"If you can give me your details, I'll give you £1,000."

So in total, you're talking maybe £40,000, £50,000,

going between the whole group of foot soldiers.

Had his plan succeeded, from his humble fast food cafe headquarters,

his scheme could have cost the insurer

a massive £1.5 million.

I do believe the ringleader, at a time,

thought he was going to get away with this.

Erm... He was very confident,

the way he recruited his foot soldiers,

the way he went about this, the way he planned this, executed it.

Very well organised and I do believe he thought

he was going to get away with it.

This massive organised crime had been busted.

25 defendants were charged with conspiracy to defraud.

It took five days for the court to process them.

Eight individuals received custodial sentences.

The longest, three years, being handed to the ringleader,

Darren Duvall.

In terms of how I felt and how Allianz felt,

it was a very satisfying outcome.

It sent out a message that insurance fraud, you're going to get caught.

I'm arresting you for fraud by false representation.

Today, IFED is raiding the property of a man

suspected of lying on an insurance application.

One piece of evidence TI Cooley is keen to get hold of

is a bank statement.

-OK, we'll have to keep looking for it.

-Yeah, yeah. No problem.

It's not the bank statement, but TI Cooley thinks he may have

come across some potentially incriminating evidence,

paperwork directly relating to the suspect's insurance application.

-OK, I send this to them.

-OK, that's fine.

-That's the letter.

If you want to place that on the bed,

I'm just going to look....

This might be relevant because it refers to the vehicle

registration number I'm interested in.

If we can seize this pile of documentation and those phones and a wallet.

We'll keep the wallet out separately.

OK, where are your shoes?

I've seized a lot of miscellaneous documentation. I think...

Did we ever get that bank statement from the second of February?

-No, we didn't find it.

-No, it went back to March.

If need be, we can get that information from the bank.

So on that basis, I think we've got everything we need.

I'm just going to... If you put your arms over to that side, please.

Both arms over there.

I arrested him for fraud by false representation,

in relation to a forged no claims discount document.

In his bedroom wardrobe, he'd very helpfully kept a file

of exactly what he'd sent to the insurance company.

And there in a little plastic folder was the forged no claims document.

The suspect took out a motor insurance policy.

And when taking out the policy,

he declared that he had five years no claims discount.

The suspect sent them a document

purporting to be the no claims discount

and that document has been proved to be a forgery.

-Do you understand why you're here?

-Yeah.

He didn't look too shocked, though.

I think he knew potentially what was coming.

I've authorised your detention

so the officers can interview you regarding the allegation.

We're trying to crack down at the moment

on a whole load of forged documents,

which are circulating around the country.

We'll do your fingerprints now, OK?

We are now picking up a whole number of suspects,

trying to build together a picture of what's going on.

With the evidence gathered at the flat and the suspect cooperating,

the IFED team is happy with the outcome of the raid.

After further questioning

he was later cautioned for fraud by false representation.