Episode 10 Claimed and Shamed


Episode 10

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Transcript


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Insurance fraud in the UK has hit epidemic levels.

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It's costing us over £2 billion every year.

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That's almost £6 million every day.

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Deliberate crashes,

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bogus personal injuries,

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even phantom pets -

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

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Every year, it's adding over £50 to your insurance bill.

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But insurers are fighting back, exposing 15 fake claims every hour.

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Armed with covert surveillance systems...

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Subject out of the vehicle.

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..sophisticated data analysis techniques

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and a highly skilled, dedicated police unit...

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Police, don't move, stay where you are!

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..they're catching the criminals red-handed.

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Just don't lie to us.

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All those conmen, scammers and cheats on the fiddle

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are now caught in the act and claimed and shamed.

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Coming up, secret filming saves an insurance company

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from a fraudulent claim worth almost £2 million.

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Instead of somebody who could not use their right arm,

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the footage shows somebody going about everyday life

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with absolutely no trouble.

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A nasty collision between a pedestrian and a bus, but who was to blame?

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If the driver's made eye contact and he's carried on,

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is he saying that he's deliberately run him over?

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And IFED execute 20 warrants, in their biggest operation this year.

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You know him, don't you?

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I can tell by your answer you know him.

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With many jobs, there's a risk of personal injury.

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Although with some, the element of danger is far greater than others.

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Particularly, professions which rely on manual labour,

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such as building or factory work.

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For people who do these sort of jobs, a personal injury claim

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can be the saving grace in the event of an accident.

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But in 2010, Royal & Sun Alliance dealt with a claim submitted

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by a young man which showed that things aren't always as they appear.

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Danny Wykes is a young man who was working as a floor layer,

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and with a colleague, he was unloading a mixer from a trailer.

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The mixer was rolling down the trailer

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but his colleague lost control of it, and so it free-fell, effectively,

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and struck him on the right hand.

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So he did sustain an injury to his right hand,

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but it was relatively minor.

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It was a soft tissue injury.

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It was the type of injury you may expect to heal within, say, a year.

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But this was a problem which didn't have any signs of going away.

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He went on to develop a condition known as complex regional pain syndrome.

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That's where somebody has a relatively minor injury.

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The injury appears to have healed,

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there's no reason why they would continue to experience pain

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but they carry on having a lot of pain.

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Complex regional pain syndrome is a serious condition which can be

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severely debilitating, and Danny Wykes' case was no different.

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He claimed that he couldn't use his right hand at all.

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It hurt if somebody just touched it.

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If somebody brushed past it, he would be in agony for days.

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He couldn't raise his hand to smoke a cigarette.

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He couldn't carry anything.

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It caused difficulty with sexual relationships

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and he had to adopt a certain position.

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He had difficulty driving his vehicle, he couldn't work.

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He did say that he felt like, at times, it would be better

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to amputate it because it was so useless.

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He was effectively like somebody with one arm.

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It was quite a claim, and one which raised concerns at Royal & Sun Alliance's headquarters.

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The claim was made to us, ultimately as his insurers,

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and with his company and ourselves we were very sympathetic

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and made some payments to him, and in fact were working

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with him on rehabilitation to get him back to work.

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The lengths that Royal & Sun Alliance had gone to in an effort to

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make life easier for Wykes weren't to be sniffed at.

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They paid for adaptations to his car,

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they provided him with voice-activated software

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for his computer because he allegedly couldn't type using his right hand.

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Over the course of the first 18 months, they would've spent

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tens of thousands of pounds trying to help him to reach a full recovery.

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By July 2011 he claims that in fact

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he was getting worse rather than better,

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and that the pain was now spreading up his right arm into his shoulder,

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and he was also experiencing similar pain in his left arm.

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As far-fetched as this injury from a single knock to the back of the hand sounds,

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specialist opinion confirmed that this could be a legitimate claim.

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Medical experts, based primarily on his reported symptoms,

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came to the view that he was suffering from his condition

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and so they backed his claim.

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He ultimately made a claim for £1.9 million of compensation

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and this was based on his incapacity,

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his inability to work and his future earnings,

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plus a considerable amount of care that he would need in his life going forward.

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At almost £2 million,

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the claim was effectively for a lifetime of compensation.

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But, before they handed over any money,

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Royal & Sun Alliance began having doubts.

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There came a point when we began to get suspicious

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about the level of his incapacity.

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We began to investigate the case and deployed some surveillance.

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The footage captured by the surveillance unit painted

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a very different picture to the one that Danny Wykes had portrayed.

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Instead of somebody who could not use their right arm,

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and had trouble with their left arm, the footage shows somebody

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going about everyday life with absolutely no trouble.

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It shows him driving his car, using both hands at the steering wheel,

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going to the supermarket with his girlfriend,

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selecting produce from the shelves, loading up the trolley.

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At one point he seemed to put his weight through his arms

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and ride on the trolley.

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He carries the heavy shopping bags,

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he unloads bags from the car.

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He's seen throwing a ball to a dog,

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wheeling a wheelbarrow

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and, in particular, in November 2011, which is the time that

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he was signing court documents saying that he was extremely disabled,

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the footage shows him at what appears to be a place of work

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carrying a folded up table in one hand

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and a double glazing unit in another hand.

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To say that the footage didn't help Danny Wykes' claim

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ranks as the understatement of the year.

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We showed the footage to the medical experts,

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who then, as a result of that, changed their opinion

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and formed the view that Mr Wykes was either

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grossly exaggerating the level of pain, or indeed making it up.

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With Wykes' claim seemingly in tatters,

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Royal & Sun Alliance sent a copy of the video evidence to his legal team.

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When his solicitors received the surveillance footage,

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they ceased to act for him.

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They weren't prepared to continue being his solicitors in light

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of what he was seen doing on the footage.

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With no-one to represent him, Danny Wykes withdrew his claim,

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but this story doesn't end there.

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I would imagine that he may have thought that he would

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get to keep the money he had already had and he would simply walk away.

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He was on a no-win, no-fee agreement with his solicitor, so he wasn't

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obliged to pay their costs because, effectively, he had not won his case.

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By this stage, Danny Wykes had received interim payments

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totalling around £25,000.

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So if that WAS the end of it, he'd still have pocketed a tidy sum,

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but unfortunately for him, the case was far from over.

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In a normal case like this it wouldn't be unusual for the insurer

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just to cut their losses and walk away.

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In RSA, we take a really dim view of people that try and defraud us

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because, ultimately, it affects our honest customers.

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So we applied to the court for him

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to be dealt with for contempt of court.

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Danny Wykes had gone from claimant to defendant.

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But even when it came to his defence for disrupting

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the course of justice, his version of events raised a few eyebrows.

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He initially claimed that he wasn't guilty, and in fact

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he had lacked the mental capacity to bring the civil claim

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in the first place, and somebody else should have been

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acting for him, therefore he shouldn't be held accountable.

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The court gave him permission to obtain a report from a psychiatrist

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to say whether this was the case or not.

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The psychiatrist concluded that he DID have the mental capacity.

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So that defence fell away.

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He then went on to allege that he hadn't read the court documents

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and he wasn't actually aware that he was trying to claim £2 million.

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So he tried various defences to get away with it.

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After over a year of trying different tactics to absolve

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himself of any blame, and at a cost of £12,000 in legal aid,

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Danny Wykes finally appeared in court.

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On the first day of trial,

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he admitted that he was guilty of contempt of court.

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He said that whilst he had sustained an injury to start with,

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and when he saw his first medical expert in September 2010

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he was entirely truthful, he then started to get better

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but he didn't tell anybody that he was getting better.

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He admitted that he had signed documents that he knew were false

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and that he knew that would interfere with the course of justice.

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As a result, he was found guilty of contempt of court

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and he was sentenced to prison for six months

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and ordered to pay RSA's costs of the proceedings.

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Danny Wykes had stretched the truth,

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but was now faced a six-month stretch behind bars.

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And his story is a stark reminder that when it comes to fraud,

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insurance companies are no longer easy targets.

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People probably think that there's nothing to lose

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and everything to gain by trying to get maximum damages.

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However, there is obviously, as this case shows, everything to lose

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because Mr Wykes has lost his liberty.

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Still to come, IFED discover what could be promising leads

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as a nationwide operation is carried out.

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We are finding stuff going all the way back to 2010

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right the way up to present day.

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Road traffic accidents can be a nasty business.

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They often happen in a split second, and if there's no eyewitnesses,

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then determining who's at fault

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is inevitably one man's word against another.

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This is exactly the situation that bus operator FirstGroup

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found themselves in back in 2012,

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when one of their vehicles was involved in a gruesome incident.

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This case involved a gentleman who stepped out in front of a bus

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on a busy High Street, and the driver reported that he's had a fairly

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nasty collision with an individual who's been thrown to the floor,

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he's sustained some quite serious injuries.

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And serious they were.

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In fact, the pedestrian was lucky that they weren't fatal.

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It's caused fractures to his left hip, fractures to his left thigh.

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It's quite a big bone, the thigh bone, it's quite hard to break,

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so that in itself is a nasty injury.

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He's also got some severe bruising, and he's got some

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facial injuries as well, from where he's struck the side of the bus.

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The man was hospitalised for two weeks, but it wasn't long

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before FirstGroup received a claim from him for compensation.

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Although his account of how the accident unfolded

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placed the blame solely at the feet of the driver.

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The pedestrian has told us that he's standing behind a group of people.

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He's looked to the left and to the right.

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He's seen the bus driver gesticulate towards the rest of the pedestrians to cross the road,

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and he himself has made eye contact with the bus driver

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and then stepped out, and the bus has subsequently just driven into him.

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All told, we're probably looking at around about £50,000.

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There was no disputing this was an horrendous accident,

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and with a version of events as damning as that,

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FirstGroup immediately launched an investigation.

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The first thing we're going to do is investigate fully,

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but on top of the compensation

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we're also faced with the situation that he's laying some pretty severe allegations against our driver

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so of course we want to look at the CCTV footage

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and interview as many witnesses as we can.

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Buses are equipped with as many as 16 CCTV cameras,

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covering virtually every angle inside and outside the bus.

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So, if the pedestrian's claims were true,

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then FirstGroup would be hard pressed to argue otherwise.

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The key thing to remember in the third party's version of events

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is that he makes it quite clear that the driver gesticulates

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towards the pedestrians, and that he himself has made actual eye contact

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with the driver, yet the bus still didn't stop.

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These are quite severe allegations to be making against one of our drivers.

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If the driver has made eye contact and he's carried on,

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is he saying that he's deliberately run him over?

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Highly unusual, and I'm not buying that for a second.

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There was only one way to find out what really happened.

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And fortunately for FirstGroup,

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they had the entire sequence of events on camera.

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This CCTV footage was very important

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because it revealed that the statement made by the injured

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pedestrian was total fabrication, it didn't happen.

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The best camera view is the camera from the near side

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looking towards the front of the bus,

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which clearly shows the pedestrian walking along the path,

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and for absolutely no reason at all, with no real warning,

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he just turns right and steps into the path of the bus.

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The camera in the driver's cab

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shows there were no gesticulations from the driver.

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With evidence as clear as this,

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the pedestrian's case wasn't exactly what you'd call rock solid.

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I would say this whole claim hinges on the fact that this gentleman has

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said that the driver has waved him across, made eye contact with him.

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He's assumed it's safe to cross, and the bus has then driven into him.

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We know that just did not happen.

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Just to be sure, let's take another look.

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As the bus approaches, we can clearly see that the man

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is walking along the road and is not waiting to cross.

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Meanwhile, in the cab,

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at no point does the driver raise his hand to wave the man over.

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When the pedestrian steps out into the road, it's only when the bus is

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inches from his face that he turns to see whether it's safe to cross.

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It felt very good to actually throw this claim out because we could prove

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that this chap was just not telling the truth.

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We don't like people who don't tell the truth, it makes our job harder!

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There is a valuable lesson to be learned from this case,

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and that's to be honest about where the blame really lies

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before submitting a claim.

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Because if you're the one who's at fault,

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then the chances are you don't have a leg to stand on.

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I think, despite the fact that he's suffered some very severe

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injuries, I think it's disgraceful that he's deliberately tried

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to mislead us just so that he can get a pay out on his injuries.

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And no-one's denying the fact that they were severe,

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but you can't just expect someone else to pay up

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because you've not looked properly when you've crossed the road.

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In January 2012, the police joined the fight against insurance fraud

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by forming an elite squad known as IFED,

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the Insurance Fraud Enforcement Department.

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IFED is a dedicated team that deals with insurance fraud.

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Whatever insurance policy there is out there, we investigate it.

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There is a dedicated 40-strong unit that work 24/7,

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hunting down insurance fraudsters.

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IFED has made over 450 arrests

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and saved millions of pounds in fraudulent insurance claims,

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money which ultimately goes back in our pockets.

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From now on, fraudsters need to watch their backs.

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We are out there in numbers.

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You might get a nasty knock on your door in the morning

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if you commit this type of fraud.

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Police, don't move! Stay where you are.

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It's 5:50am, and today IFED are carrying out

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a major nationwide sting

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involving over 100 police officers across the country.

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Today's operation is targeting suspected fraudsters

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who make fake insurance claims for courtesy cars,

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provided to motorists while their vehicles are being fixed.

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With 20 warrants being simultaneously executed

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across the UK,

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this is IFED's largest operation this year.

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DC Jamie Kirk and DS Marcus Allen are heading up

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one of the many units.

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Today is massive because warrants will be executed

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at home addresses, where we hope to arrest the suspects

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and then move on to business addresses to seize items

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which will show the level of criminality of those involved.

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The first stop for Marcus and Jamie

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is what's believed to be the home address of the prime suspect.

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-Good morning.

-Morning.

-We're officers from the City Of London Police.

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We've got a warrant to come into the premises, so we need to come in.

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We'll come in and we'll explain what's happening to you.

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But once inside, the team hit a bit of a dead end.

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We've got a warrant to search this premises.

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It's in relation to a chap called...

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You know him, don't you?

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I can tell by your answer you know him.

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It turns out that although this house belongs to the suspect,

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the family living here are actually tenants

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and are nothing to do with the investigation.

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But that doesn't mean they can't be of assistance.

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Do you have a contact number for him?

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OK, can we have that?

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They might not have got their man yet,

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but Marcus and Jamie have been given contact numbers

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for both the suspect and his family.

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Right, we have a warrant here.

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That warrant has been signed by a judge

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and that gives us the authority to search this house.

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There's no sign of the offences we're investigating,

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no evidence for that.

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So what we need to do now is contact him.

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We've got officers at the business address,

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so if he turns up there to get rid of any evidence

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he'll be intercepted, arrested and a warrant will be done there.

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Although the team now have phone numbers for the suspect

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and his family,

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as yet they haven't been able to get hold of either of them.

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We're going to the business premises,

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where we will wait for office hours,

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and hopefully staff or our suspect will turn up.

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We'll arrest the suspect if he turns up.

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If staff turn up there,

0:19:200:19:21

we'll execute the warrant and search the premises for evidence.

0:19:210:19:24

Through here, then a right at the end.

0:19:280:19:30

It's still only 8:00am,

0:19:310:19:33

so it's a waiting game for the team as they stake out the offices.

0:19:330:19:36

But while they're lying in wait,

0:19:380:19:40

the suspect's family returns their phone call.

0:19:400:19:43

My name's Jamie Kirk,

0:19:430:19:44

I'm a detective with the City Of London Police.

0:19:440:19:47

I came to your brother's property this morning,

0:19:470:19:50

cos I need to speak to him

0:19:500:19:51

and I need to speak to you in relation to some matters.

0:19:510:19:55

Where's your brother, then? Where is he?

0:19:550:19:58

He must be somewhere.

0:19:580:20:00

He's gone back home?

0:20:000:20:02

Well, where's back home?

0:20:020:20:03

It sounds as though the main suspect may be overseas.

0:20:040:20:08

But his family has given them an address

0:20:080:20:10

which they didn't know was connected to the case.

0:20:100:20:12

So Jamie and Marcus are going to leave another team

0:20:130:20:15

to stake out the office, while they chase up this unexpected lead.

0:20:150:20:19

Right, I don't think we should rest on our laurels.

0:20:290:20:33

Number one...yeah.

0:20:350:20:37

-Right, shall we go?

-Let's go in, yeah.

0:20:380:20:41

DC Kirk from City Of London Police, just spoke you on the phone.

0:20:460:20:49

I need to come in and talk to you.

0:20:490:20:51

The cameras remain outside, but the investigation is progressing well.

0:20:510:20:55

The business premises for which we have a warrant,

0:20:570:21:00

there is activity there,

0:21:000:21:01

so officers have gone through the door of the business premises.

0:21:010:21:04

They'll secure that. We'll start the search.

0:21:040:21:07

Hopefully, the suspect may even turn up there.

0:21:070:21:09

In the meantime,

0:21:090:21:11

we're doing a comprehensive search of the premises here.

0:21:110:21:13

We've already found some documentation

0:21:130:21:16

that may be linked to the offence.

0:21:160:21:18

We found cash in one of the vehicles outside the address,

0:21:180:21:22

and also some money secreted in one of the bedrooms.

0:21:220:21:25

The person arrested, the brother of the main suspect,

0:21:270:21:30

has been taken away now.

0:21:300:21:31

He'll be held at the police station and we'll question him in due course.

0:21:310:21:35

IFED have managed to confirm that their main suspect is abroad,

0:21:370:21:40

so they'll have to wait to get their hands on him.

0:21:400:21:42

But all is not lost, as another family member,

0:21:420:21:45

who is also believed to be involved, has been arrested

0:21:450:21:48

and taken to the local police station for questioning.

0:21:480:21:51

We are finding stuff going all the way back to 2010

0:21:510:21:54

right the way up to present day.

0:21:540:21:56

There's round about £90,000 we've managed to identify so far.

0:21:560:22:00

Just from looking at documentation here,

0:22:000:22:02

I would imagine that our financial investigators

0:22:020:22:04

are going to find substantially more than that.

0:22:040:22:06

With everything at the house done and dusted,

0:22:110:22:13

Marcus and Jamie head to the business premises

0:22:130:22:16

where they soon discover documents of interest.

0:22:160:22:19

We've found documentation that supports the allegations

0:22:190:22:24

of defrauding the insurance companies.

0:22:240:22:26

This is the specific claims where we know

0:22:260:22:29

that the fraud's been made in these names.

0:22:290:22:33

So if we can get the original paperwork for that, that's great.

0:22:330:22:36

It's been a long day with many twists and turns,

0:22:380:22:41

but Marcus and Jamie are delighted with the way things have gone.

0:22:410:22:44

The original was 26 claims and we were looking at around £90,000.

0:22:440:22:50

I think we're in excess of that.

0:22:500:22:52

So, with everything else today it's a great job, really.

0:22:520:22:57

As successful as today has been,

0:23:010:23:04

there's a final loose end to be tied,

0:23:040:23:06

or more likely, collared and cuffed.

0:23:060:23:08

Yeah, it's been a great day - successful, achieved everything,

0:23:100:23:13

just one thing we need to do now is to arrest the main suspect.

0:23:130:23:17

Just got some information in that

0:23:170:23:19

he's flying into the country on Monday.

0:23:190:23:21

We need to get him early as possible,

0:23:210:23:24

so he doesn't have the chance to speak to others

0:23:240:23:26

and to maybe destroy evidence.

0:23:260:23:28

Therefore I will be there, and we will be the welcoming committee

0:23:280:23:31

when he steps off the plane.

0:23:310:23:32

A total of 17 people were arrested across the country

0:23:380:23:41

as part of IFED's nationwide operation into credit hire fraud.

0:23:410:23:45

As any animal lover will tell you,

0:23:520:23:54

getting a pet can be an exciting time.

0:23:540:23:57

But for breeders, handing over a young puppy or kitten

0:23:570:24:00

to a new family can be a precarious business, as there's no way

0:24:000:24:04

of knowing whether there will be any problems with the animal's health.

0:24:040:24:07

Thankfully, many pet insurers provide breeders

0:24:070:24:10

with a short-term period of cover.

0:24:100:24:12

There's a facility that insurance companies offer breeders

0:24:120:24:15

when they're selling new puppies and kittens,

0:24:150:24:18

and that is to put a temporary period of insurance on the puppy or kitten

0:24:180:24:23

that allows the new owner the ability just to take the puppy or kitten

0:24:230:24:27

to the vet at the earliest sign that they suspect a problem.

0:24:270:24:30

Because most of the breeders are breeding pedigree animals,

0:24:300:24:33

because there's a purchase price involved, there is the ability,

0:24:330:24:38

if the animal does sadly die, to claim for the purchase price.

0:24:380:24:41

So it protects the new owner, ensures the puppy has the best care

0:24:410:24:44

and it also to a certain extent protects the breeder.

0:24:440:24:47

But for unscrupulous scammers, even a short-term insurance policy

0:24:470:24:51

like this can be used as a means to cash in.

0:24:510:24:55

Which is something that Agria Pet Insurance discovered in 2012.

0:24:550:24:59

The breed was a pug. A young puppy.

0:24:590:25:02

Sold at the end of December in 2012,

0:25:020:25:04

and a few days later

0:25:040:25:06

it was presented to a vet with acute respiratory problems.

0:25:060:25:10

Not unusual for a pug puppy.

0:25:100:25:12

The puppy was seen by the policyholder's vet,

0:25:120:25:17

and then seen again by the breeder's vet and sadly euthanized.

0:25:170:25:21

Losing a pet is never easy.

0:25:220:25:24

But in this case it was particularly painful,

0:25:240:25:27

because pedigree pugs don't come cheap.

0:25:270:25:30

Normally, pug puppies will be sold maybe between £800 and £1,500,

0:25:300:25:34

and the purchase price that the policyholder was claiming for

0:25:340:25:37

in this instance was about £1,500.

0:25:370:25:40

It was a hefty loss.

0:25:400:25:41

But it wasn't just the new owners who were out of pocket.

0:25:410:25:44

Our suspicions were that the breeder had had a litter of pugs,

0:25:440:25:50

maybe one or two in the litter.

0:25:500:25:52

The breed also have usually Caesarean sections,

0:25:520:25:56

so there would have been investment by the breeder

0:25:560:25:58

just to have the puppies born.

0:25:580:26:00

So the breeder had money on the table,

0:26:000:26:03

and if one puppy wasn't saleable

0:26:030:26:04

because it wasn't well, he was going to lose some investment.

0:26:040:26:08

Fortunately, the policy that was in place would cover

0:26:080:26:11

the financial loss, but as Agria began to process the claim,

0:26:110:26:15

they noticed something rather unusual.

0:26:150:26:17

Our suspicions were alerted with this case

0:26:170:26:19

because the policyholder and the breeder had the same surname.

0:26:190:26:23

In itself, that's not a fraud indicator.

0:26:230:26:25

However, when the claim form was submitted,

0:26:250:26:27

a letter came in stating categorically

0:26:270:26:30

that the breeder and the policyholder,

0:26:300:26:32

although they shared the same surname, weren't related.

0:26:320:26:36

That's quite important because, with this type of policy,

0:26:360:26:38

if the breeder has sold the puppy to a new owner, and issued

0:26:380:26:43

the insurance, and that new owner is a member of the family,

0:26:430:26:46

the insurance will be invalid.

0:26:460:26:49

Unsurprisingly, Agria began to investigate the legitimacy of the claim.

0:26:490:26:54

So we approached the owner and the breeder

0:26:540:26:57

to just determine they weren't in fact related.

0:26:570:27:00

We asked them the question, they denied that they were related,

0:27:000:27:05

but then they became very evasive

0:27:050:27:07

and trying to get hold of them became very difficult.

0:27:070:27:11

And, as it turned out, there was good reason as to why the owner

0:27:110:27:14

and the breeder weren't responding to the insurance company's calls.

0:27:140:27:18

When we started to probe,

0:27:180:27:19

when we started to look at the veterinary records,

0:27:190:27:21

and the vet categorically had got

0:27:210:27:24

the owner and the breeder down as brothers.

0:27:240:27:26

When we looked at Facebook

0:27:260:27:28

and social media, it was very evident that the two were related

0:27:280:27:31

and the policy was invalid.

0:27:310:27:33

Thankfully, a fraudulent claim had been avoided,

0:27:330:27:37

but this is typical of the kind of underhanded activity

0:27:370:27:40

that companies like Agria need to be on their guard against.

0:27:400:27:43

I think in this instance it was an opportunistic claim.

0:27:430:27:46

I think breeders think that insurance companies

0:27:460:27:49

are remote and distant,

0:27:490:27:51

and with the volume of claims that certainly go through with pet insurance,

0:27:510:27:55

this one will probably slip under the radar.

0:27:550:27:57

No, it's not sophisticated fraud, it's very opportunistic fraud,

0:27:570:28:01

it's often not thought through at all.

0:28:010:28:03

For the individuals who think they can get away with this, we're looking for them.

0:28:030:28:07

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