Episode 9 Claimed and Shamed

Insurance fraud in the UK has hit epidemic levels.

It's costing us over £1.3 billion every year.

That's almost £3.6 million every day.

Deliberate crashes, bogus personal injuries, even phantom pets.

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

and every year it's adding over £50 to your insurance bill.

But insurers are fighting back, exposing 14 fake claims every hour.

Armed with covert surveillance systems...

Subject out of vehicle...

..sophisticated data analysis techniques...

Police!

..and a number of highly skilled police units...

Police, stand back, stay where you are!

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

Just don't lie to us.

All those con men, scammers and cheats on the fiddle,

are now caught in the act and claimed and shamed.

Coming up: A fraudster bends the truth about his bad back.

However, when Paul Gustar left the building, the doctor saw him

walk away, not using the stick.

In Las Vegas, the chips are down

for a pair of criminals caught in the act.

And it's not all roses for a potential

fraudster on Valentine's night.

They knew they were going to make a claim,

and they needed the photographs to help support that claim.

The workplace is a hive of activity.

Whether it's a building site, an office or even a haulage firm,

transporting goods from A to B.

Thankfully, with health and safety being such a priority nowadays,

the number of work-related injuries has been levelling off

in recent years, but even so, there's bound to be the odd mishap.

So when accidents do happen,

an insurance policy could be worth its weight in gold.

Meet Paul Gustar. He may be sat in his car here,

but he used to be employed by a haulage lorry firm.

Unfortunately, Gustar was one of the unlucky ones

who suffered an accident at work,

but never fear, insurance company Axa was there to help him

in his time of need, as Richard Davies explains.

When the claim first came into Axa at the back end of 2007,

Paul Gustar told us he had a very serious back injury,

he told us he couldn't work, he told us he couldn't walk very well,

and in fact, he told us that his whole life was

being destroyed by the back pain and was claiming around £100,000

because he couldn't work as a result of that condition.

Anyone who's suffered from back pain will tell you what a

crippling condition it can be, but Gustar was claiming

that it was his work that had caused the problem.

Paul Gustar was a packer, he worked inside a warehouse,

he'd said that he'd twisted his back whilst he was working.

He normally would carry out an action which required him

to move from left to right between 100 and 200 times an hour.

But what really alerted Axa to foul play is that during

the early stages of the investigation,

Gustar moved the goalposts.

Soon after the claim was submitted was a change in story.

Instead of the injury being caused by a twisting of the back,

he was now saying that he'd slipped on a wet surface inside a lorry

and claiming that that was caused his back injury.

And for us, such a significant change in story was a real red flag.

With a colossal claim on the cards, Axa wanted to carry out

a few checks before they settled it.

And in cases like this,

undercover surveillance is an insurer's best friend,

because as we all know, the camera never lies.

Time of day is stated,

observations in respect of Paul Gustar.

Yep, you guessed it,

it was at this point in the road that Gustar's claim hit the skids.

We wanted to verify that he actually was in such pain that he couldn't work.

So the surveillance team kept a watchful eye on Gustar's every move.

Paul Gustar told us that his injury meant that he couldn't

walk easily, that he was in a lot of pain,

and that he would need a stick to get around at all times.

Our surveillance showed something very different.

Too right it did.

And quite frankly, Axa couldn't believe their eyes.

We can see him walking normally...

Hardly looks like a man who's struggling to get about.

..we can see him going into shops...

He's come out of the coffee shop, subject's standing on foot and into Maplin Electronics.

Ah, a nice bit of retail therapy. Just what the doctor ordered!

..we can see him bending down...

Ah, there's the crippling back condition!

Has it locked up?

No, false alarm.

..we can see him going to a pub.

Hold on, rewind.

You're off sick and you're shopping and you're having a swift half?

Mind it doesn't interfere with your medication.

That appeared to be somebody who has a relatively normal life,

certainly not somebody who's completely incapacitated

by a back injury which was stopping him working,

and indeed walking in a normal way.

With alarm bells ringing louder, Axa explored other avenues.

And a quick chat to Gustar's employer

brought about an interesting piece of evidence.

He told us that he'd received a text message from Mr Gustar's partner,

and she said that she thought that the back injury

might have been caused by Paul Gustar pushing the car up a hill.

Well, that's thrown a spanner in the works.

Pushing a car? Up a hill?!

No wonder you've got bother with your back, mate.

We were able to show that The AA had been called out

to the car at the same time.

So we were convinced that the vehicle had indeed broken down.

For us, that added some credibility to the thought

that Paul Gustar had injured his back whilst pushing a vehicle up a hill.

He might have been wearing camouflage

in the surveillance footage, but there was no hiding the fact

that Gustar was attempting to con Axa out of £100,000.

It does appear that in this case the employee is making up that claim,

that actually the injury, if it existed,

was nothing like as bad as he said it was

and indeed, as we found out,

that Paul Gustar may have had a back injury

before he submitted the claim to us.

When it comes to personal injury claims,

medical evidence is a must, but unfortunately for Gustar,

a trip to the doctor proved to be the kiss of death for his claim.

The key piece of evidence came from his doctor.

It's doctors that normally provide the confirmation

that an injury has actually occurred.

And one particular doctor assessed Paul Gustar's injury.

He told us that when Paul Gustar entered his office,

he appeared to be in a lot of pain,

that he was walking with a stick and was walking with some difficulty.

However, when Paul Gustar left the building,

the doctor saw him walk away,

not using the stick, and walk away without any visible pain.

Between the surveillance, the incriminating text

and the statement from the doctor, Axa had a mountain of evidence

and unsurprisingly denied the claim.

When the evidence was put to Paul Gustar,

he decided to walk away.

He decided that he didn't want to make that claim any more.

With an apparently non-existent back injury,

walking away wasn't a problem for Gustar.

But what he didn't bank on, though,

was that Axa had no intention of letting this go.

If a fraudster is allowed to walk away from a claim,

they have no consequence in actually making that fraudulent claim.

That's wrong.

And we don't think that fraudsters should be allowed to walk away

from that as a situation.

AXA took Gustar to court, where he was found guilty of fraud

and sentenced to a three-year suspended sentence.

In his attempt to swindle £100,000 out of his employer,

Gustar really had fallen flat on his back

and was incredibly fortunate not to have wound up behind bars.

We think it's important that the fraudsters should actually face some kind of sentence.

Whether or not that prison sentence is suspended, we don't mind,

but we do feel that they should end up with a criminal record.

And that's exactly what he got.

Bet that's the last time he'll complain of a bad back!

Still to come - a potential fraudster

submits a claim for a poorly puppy, but will the insurer bite?

We listened to the policy holder, we listened to the breeder calls.

The breeder call was exactly the same voice.

And a bogus burglar who was just too organised for his own good.

The first thing they noticed was a folder entitled List Of Items Taken,

which straight away, they thought, "This seems very strange."

It's estimated around 8.5 million dogs

make up the UK's pet population.

But with the average vet bill for a dog costing around £300 a year,

keeping a pet can be rather costly.

So when your little pooch falls ill and needs expensive treatment,

pet insurance is a must.

However, some unscrupulous pet owners will weave a tangled web

to get an insurer to cough up,

as Simon Wheeler from Agria found out when it came to a claim involving a wounded puppy.

We received a claim from the owner of a pug puppy,

who sadly had injured its eye,

and taken the puppy to the vet to have the eye treated.

Sadly, the puppy had died under general anaesthetic.

The owner put in a claim of £432 to cover the vet fees.

But they were rather vague when it came to the details.

They weren't sure whether the puppy was insured or not

so they were asking us what the policy number was,

they didn't seem to have a policy number,

they were asking us why they hadn't got any policy documentation

so some strange questions for somebody who believed

they had an insurance policy.

To be fair to the claimant, breeders sometimes set up policies themselves

so the claimant got in touch with the breeder to help clear things up.

The breeder and policy holder obviously spoke

and the policy holder called us again

and said that the breeder had set up the policy

three or four days before the incident occurred.

They thought they provided a receipt and they thought they provided policy documentation,

but again the whole process was very, very vague.

Agria made some routine inquiries and contacted the vet.

The good news was that they found a policy.

The bad news is that it wasn't worth the paper it was written on.

Gawping mistake!

The policy had been set up on the day that the operation had occurred,

therefore the condition was pre-existing to the insurance being set up.

There might have been a policy, but for Agria,

it didn't make a difference.

Because the puppy had a pre-existing condition,

the policy was null and void.

At the point that we declined the claim,

the policy holder became quite upset, pleaded with us

to cover the condition and again we refused.

Agria weren't going to roll over and it's just as well

because this claim hadn't been put to bed just yet.

Bizarrely, about 20-30 minutes later,

we got a call from the breeder.

The breeder activating cover at that point, giving us a false date of sale

so endeavouring to backdate the cover to cover the condition.

Agria smelled a rat.

The timing of the phone call from the breeder

was too much of a coincidence so they went back and listened to the phone calls again.

When we started to investigate both calls,

we listened to the policy holder, we listened to the breeder calls.

It had been very noticeable that the policy holder

had quite a distinctive accent and quite a pronounced stammer.

The breeder call was exactly the same voice - same accent

and same stammer.

The phone call appeared to have been a last-ditch attempt

to set up a policy that would pay out.

Not swayed, Agria still declined the claim.

But to their surprise,

the policy holder wouldn't let sleeping dogs lie.

Even after the claim was rejected,

they still pushed to have the claim settled

and referred it to the FOS, the Financial Ombudsman Service.

It's the first point of referral

when the policy holders have claims they're not happy with the assessment of.

Agria continued to dig away with their own investigation.

After analysing earlier phone calls,

they suspected the policy holder had been impersonating the breeder,

but it turned out there was a lot more to their relationship than they'd realised.

When we started to look at some of the documentation that had come in,

so very obviously the postcode for the breeder

was the same as the postcode given by the policy holder when we spoke to them.

When the breeder telephoned us,

it was on the same number that the policy holder had given us.

With a bit more investigation,

it became clear why this pair had so much in common.

The breeder and the owner were co-habiting

and actually the breeder was expecting the owner's baby at that time.

With this evidence in hand,

Agria invited the couple in to talk about their findings,

but their actions spoke louder than words.

The meeting was set up, the date arranged, the place arranged.

The policy holder never turned up.

It's no wonder they didn't turn up

and the findings of the Financial Ombudsman Service didn't come as much of a surprise either.

The incident was pre-existing to the insurance if the insurance had been set up properly

so the FOS found obviously in favour of Agria.

Putting a claim in to try and recoup some vet fees is one thing,

but our next claimant took things to a whole new level.

Halfway across the world in Las Vegas,

a pet business hit the headlines after the owner tried to swindle insurers out of 100,000.

It's almost 1am at Prince & Princess Pet Shop.

The CCTV'S on, capturing the night's events.

The front door has just opened.

Is this an unexpected prowler hoping to make a few bucks?

No, thankfully it's the owner, Gloria Eun Hye Lee.

It's a little early to be opening for business though, wouldn't you say?

This CCTV footage proved to be vital

because Lee wasn't here to do some late night paperwork.

In fact, she was about to commit a diabolical crime,

but she made a whopping mistake.

Disappearing into the office,

she went to disconnect the feed to the CCTV.

But this flick of the switch was about to land her in hot water

because she removed the utility cord instead,

which left the world and his wife to see her crime revealed before their very eyes.

Bet she was kicking herself for that

when she later appeared in front of the judge.

But our criminal wasn't on her lonesome in what was about to unfold.

Lee had a partner in crime in the shape of Mr Kirk Bills,

who was her partner in more ways than one

because she was seeing him behind her husband's back.

But he didn't turn up empty handed.

He's carrying two cans filled to the brim with kerosene

and he doesn't waste any time in dowsing the place with fuel.

With two dogs and 25 puppies in the shop,

Bills was heartless in his act

and can clearly be seen randomly throwing kerosene,

including, unbelievably, onto the animals' cages.

With the scene set, Lee disappears from the pet shop,

leaving Bills to light the touch paper.

Within seconds, the fire takes hold.

Bills makes a hasty exit,

leaving the animals to perish as the store goes up in flames.

Thankfully, the store sprinkler system kicked in,

saving all 27 pets from the flames.

In October 2014, Lee and Bills pleaded guilty to arson

and cruelty to animals.

Lee also pleaded guilty to insurance fraud,

but then played what she thought was her trump card

by announcing she was pregnant.

However, the judge wasn't swayed,

saying the Nevada jail system was well equipped for this.

Lee was sentenced to a maximum of 14 years in prison

with her being eligible for parole after she spends five years behind bars.

Bills was given 4-10 years in jail

for his part in the despicable crime.

On sentencing, the judge commented on their appalling act, saying...

For this merciless act,

these criminals got what they well and truly deserved.

Red roses, chocolates, Cupids and hearts -

all romantic gestures for the one you love.

We all know that the way to man's heart is through his stomach,

but on February 14th,

you can't get a table at a fancy restaurant for love or money.

John Beadle from RSA came across a claim from a damsel

who'd found more than her Prince Charming.

This has got a bit of a romantic twist to it, this story,

because it allegedly happened on Valentine's night

and a lady and her partner had booked a table

and were on their way to have a romantic Valentine's dinner.

This loving couple are all set for a romantic night out.

But will Cupid's arrow be on target? Aww, isn't love grand?

Is she about to be swept off her feet?

They claimed that the lady tripped over in a pothole in the car park.

And injured herself.

SHE SCREAMS

And she alleged that this was the liability of the pub.

For our two lovebirds, this was a disastrous night

that was well and truly spoiled.

The insurer tried to get to the heart of the matter,

but, after speaking to the pub owner,

it seemed that this claim might be on the rocks.

At the time that the accident allegedly happened,

the pub had actually stopped serving food.

They were, as you would be on Valentine's night,

completely full and I know, from personal experience,

it's very difficult to get a seat in a restaurant.

They had no reservation.

Arriving without a booking after the pub had stopped serving,

they were definitely pushing it to get a bite to eat.

Were they on their way for a loved-up dinner

or just looking for someone else to foot the bill?

In a case like this, you really need an eye witness.

Fortunately, the CCTV cameras next to the pub had all angles covered

and one camera gave a bird's eye view.

We reviewed the CCTV footage from the pub

and one of the cameras covered the car park

and we observed that the claimant

and her partner came into the car park, parked the car and,

rather than heading into the pub, went to the pothole.

That all sounds a bit bizarre, if you ask me.

Let's find out what really happened in the car park.

So the couple did drive in. They got out and walked through the car park.

Hope you clocked that they weren't holding hands!

Not sure she's fallen head over heels, though.

It's all a bit suspect, if you want my opinion.

The lady in question and her partner were taking photographs of the pothole.

Photographs!

Yes, that's clearly a camera flash.

So, let's get this straight - they parked up, jumped out,

took a few snapshots of the pothole

and they didn't even go in the pub for dinner.

We feel this was all a premeditated step.

They knew they were going to make a claim

and they needed the photographs to help support that claim.

The way you're running to your car,

you don't look like you've much of an injury there, sweetheart.

These people simply weren't there, didn't have a reservation

and weren't on their way to dinner at the pub.

Unsurprisingly, RSA weren't going to pay up,

which meant that this potential fraudster could kiss her claim goodbye.

In January 2012,

the police joined the fight against insurance fraud

by forming an elite squad known as IFED, the Insurance Fraud Enforcement Department.

There's different types of insurance fraudsters.

You have the opportunists, who'll exaggerate a small claim to make a slightly bigger gain,

and then you have the organised crime element that do this for a living.

They've made over 660 arrests

and have saved millions of pounds in fraudulent insurance claims,

money which ultimately goes back in our pockets.

From now on, fraudsters need to watch their backs.

Insurance fraud isn't a victimless crime.

If commit insurance fraud in England and Wales, we'll find you.

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

One case that landed on IFED's desk was particularly unusual.

In September 2012,

Nicholas Warner reported he'd been the victim of a burglary.

Although even by his own admission, the thief's method of entry

was rather out of the ordinary, as DC Aman Taylor explains.

As he reported it, he said the circumstances seemed improbable,

they didn't seem right,

saying that he'd left his keys in an open locker within a gym.

The keys had been taken from his bag

and someone had somehow located his home address.

They were then used to open his door, go in, ransack his flat

and take a load of items of high value.

As unusual as the circumstances were,

thankfully Warner was a very organised individual,

which was rather handy when it came to his claim.

He supplied proofs of ownership in the form of a lost list

and on that lost list, he detailed all of the items that were stolen.

But this list seemed never-ending.

As he said he found further items had been stolen,

-he produced further lost lists.

-Of course he did!

And this ever-growing list of stolen gear

had now grown to something in the region of £30,000.

Various different items of jewellery - earrings, necklaces,

bracelets, as well as a number of electrical items.

There was Wii games, phones and in particular one laptop.

A variety of household items that you'd expect to find

in a home belonging to a couple.

Right from the start, Warner didn't appear to put his best foot forward.

In that first phone call, he said, "There's a Jimmy Choo handbag here and they haven't taken it."

Then when he submitted his lost list,

one of the items on the lost list was "Jimmy Choo handbag".

Bet the Mrs wasn't a happy bunny!

But Warner's organisational skills were about to trip him up.

One e-mail in particular, which was a photograph of a laptop.

The laptop screen is open.

The first thing they noted was a folder entitled List Of Items Taken,

-which straight away they thought, "This seems very strange."

-Oh, dear!

Never mind a slip-up - this was more like what you'd call dropping yourself right in it.

Then when they looked at the metadata of the photograph,

which contains when and where it was taken,

they saw it was taken on the same date that the e-mail was sent so two weeks after the burglary.

Warner claimed it was all down to a hiccup with the latest technology.

Yep, that old chestnut!

But the insurer wasn't falling for that one

so they rejected the claim and referred it to IFED,

who paid the suspected fraudster a home visit.

We found different items of jewellery,

all of which matched with the same sets that were reported stolen in the burglary.

But it was when they came across Warner's laptop

that IFED really hit the jackpot.

After closer inspection, it was the same make and model

as the one reported stolen in the burglary.

On the laptop was the final piece of the jigsaw -

Warner's list of stolen items.

I had the laptop examined by a company.

One thing I particularly asked them to focus on was this List Of Items Taken,

which was the document folder contained on the homescreen.

When they looked at the dates of that folder,

you could see it was created four days prior to the burglary

and contained within that folder were six items which matched

with the top six items as per the lost list which was subsequently

reported to the insurance company.

So, he created his list of stolen items before the break-in

and saved it on his laptop. Now, that was a little silly!

Even with all this concrete evidence,

Warner still wouldn't budge.

He made a partial admission, saying it had been exaggerated,

but he wouldn't out and out say, "This is clearly a staged burglary,"

or, "This didn't occur and I was trying to make a claim

"through my own means to gain a financial advantage," he wouldn't say that.

By the time he was put in front of the judge,

Warner had come clean and in January 2015,

pleaded guilty to fraud by false representation at Bristol Crown Court.

He received a ten-month suspended sentence

and 270 hours' community service.

Something which, on the face of it, appears quite simple,

we can detect it and we will look to take every sort of avenue to find out what has gone on.

For the unfortunate ones who really are victims of this terrible crime,

being burgled isn't just about having personal possessions stolen.

It's an experience which Andrew Tancock

and Michelle Bressington are all too familiar with,

after returning home from holiday to find their home had been broken into.

It is a real horrible violation to your personal space.

It just made me feel really sick and really frightened

that they'd come in, taken all our stuff and been in our home.

It's just the most horrible feeling ever.

It's not just items like TV and cash that are stolen,

but it's possessions with great sentimental value.

Like rings and things which you can't really get back

because one was a bespoke ring, which was just made purely for me.

So things like that, you can't really replace.

But the worst impact of a burglary doesn't go away easily.

I didn't even want to be in the house because I felt scared

and weeks after, I kept checking all the doors were locked around the house.

It became an obsession

and I didn't want to be in the house at night on my own.

Understandably, Andrew and Michelle have no sympathy

for those who attempt to cash in on staged burglaries.

People who stage fictitious burglaries, yeah,

it just makes you really angry.

They're just in it for themselves

and they don't think about anybody else and then people like us obviously suffer.