Episode 2 Claimed and Shamed

Insurance fraud in the UK has hit epidemic levels.

It's costing us over £1 billion every year.

That's almost £3.5 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 just under 15 fake claims every hour.

Armed with covert surveillance systems...

That's the subject out the vehicle.

..sophisticated data analysis techniques...

Police!

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

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

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

Just don't lie to us.

All those conmen, scammers and cheats on the fiddle

are now caught in the act and claimed and shamed.

Today, a massive fraud involving seven bus crashes is kerbed.

In my time at First Group, this is probably one of the

biggest frauds I've had to deal with.

A personal injury claim in a pub is knocked back by camera footage.

Everybody who looked at the CCTV

was in actual shock.

I didn't expect for somebody to be quite so brazen.

And a landlord's false fire claim combusts at court.

This is a classic example of a greedy and dishonest

individual who was hellbent on attempting to elicit monies.

Insurance fraud is becoming increasingly attractive

to organised criminal gangs,

who see it as a way to make a lot of money very quickly,

with supposedly little risk of being detected.

But conmen often get caught out by their own greed -

drawing attention to themselves with minor mistakes or multiple claims.

Julie Randle is the transportation claims fraud prevention officer

at FirstGroup.

She recently worked on a bus case that involved multiple

personal injuries.

For 30 passenger claims to come in from a single bus accident,

we'd expect it to be quite a significant accident

and we'd expect to see extensive damage to our bus,

emergency services on scene.

This was just not one of those accidents.

According to the internal company file, it was a very minor accident,

so any compensation costs should have been minimal.

We would have expected their claims to have been around £7,000.

This would have been for whiplash, loss of earnings,

special damages, third party legal costs.

But the figure of £7,000 seemed out of proportion to the

small scale of the accident.

Not long afterwards, FirstGroup found themselves looking into

another case of a car colliding with a bus full of passengers...

..and another...

..and another...

In all, five very similar incidents came to light,

all in Chester, all suspicious.

Julie's team launched an investigation.

So using the latest analytical software

we have access to, we found various passenger links

between the passengers that were on one bus and passengers on another.

We had, obviously, the vehicle damaged...

that was verified by forensic engineering as being extremely minor

and highly unlikely to cause injury.

We had passengers boarding at certain stops that did not

live around the area. Ticketing data showed unusual

passenger numbers for that time of day on those particular routes.

We even had phantom passenger claims presented where,

having a look at their addresses, they were not registered there.

So this obviously caused us, you know, real concerns.

Real enough for FirstGroup to involve the police.

DC Stephen Owens was the chief investigating officer on the case.

One thing immediately stood out.

The collisions were all very similar.

They were very low speed, low impact collisions

which resulted in very minor damage to both vehicles -

the vehicle that drove into the bus and the bus itself.

Despite this, every incident had resulted in dozens of claims.

But there was a key piece of evidence

which would reveal what was going on -

CCTV.

The images start as it's coming up Sealand Road

past the industrial estate.

And you can see the left-hand side

it's a Rover 25 and you can see it's well over the white line

and the junction nine.

As the bus approaches, there's no other vehicles on the road.

You can see it could have easily have pulled out.

It chooses not to and just as the bus has passed,

he seems to pull out and just clip the side of the bus.

As you can see, there was minimal impact to the bus,

there was minimal impact to the other vehicle involved

and for the majority of these passengers being injured,

I just can't see how it could have happened.

In another of the five dubious accidents, the images show

the suspicious behaviour of the car driver as the bus

travels along its route.

The Audi TT was at the junction for some time before our bus passed.

And then it just seemed to shoot out into the path of our bus.

He appears to have had to accelerated to have hit the corner.

Maybe he had second thoughts

but then decided at the last moment to go ahead with it.

It's not just the car driver who's acting strangely.

There are numerous passengers on our bus and you can see afterwards they

all hanging around on their phones, which is a little bit suspicious.

A lot of them do walk to the side of the bus

and they take out their mobile phones and they take photographs.

Why would you do that?

Unless it was in your mind at that time you wanted to make a claim.

Great evidence. Great evidence.

CCTV footage wasn't the only thing the gang had overlooked.

The fault vehicle in yet another one of the five suspect collisions

wasn't properly insured.

This meant that the incident was investigated by a team

from the Motor Insurers' Bureau.

Paul Ryman-Tubb is their head of technical.

One of the first things we did was commission a report from

a forensic motor engineer to go

and have a look at the van,

tell us what sort of damage had been

sustained to the van,

take some photographs and give us a view as to the severity

of the collision.

23 passengers claiming whiplash pointed towards a serious accident.

But this was totally contradicted by the report.

The engineer was very clear that this was a very minor collision.

He described it as the glancing blow.

He took some photographs of it showing a very small dent

in the rear panel of the van.

It was so slight that it was difficult to see it

on the photographs and hadn't even broken the paintwork.

It was clear from the CCTV that this was more than

just a few dodgy whiplash claims.

Tellingly, all the personal injury claims

were being processed by just one company,

Swift Accident Solutions Limited in Chester.

And the man behind it, a certain John Smith, was making big bucks.

And how it works - John Smith has an accident management company,

looks to get claims to sell on to accident claims solicitors.

He was invoicing in the region of £800-£960 per claim.

So he's getting almost £1,000 per claim that he sold on.

John Smith might have sounded like a fake name but it was real,

just like the money he was turning over

from the multiple injury claims.

When we looked at it and we understood how it worked,

John Smith could be the only person who would have done it.

What motivation would there be for people to crash into a bus?

Stephen suspected that the people driving the vehicles into the buses

were also part of the scam and were being paid for their services.

Now, who would pay them? The person who would benefit.

And who would benefit? Well, John Smith.

The net was closing in but before they could finish the investigation,

Stephen and his team were confronted by a chilling new development.

There was another collision on Liverpool Road in Chester.

That collision made us realise that the gang were still active,

and they were still doing this and it forced our hand.

It put pressure on us to act quickly, which is what we did.

In a huge operation, strikes were carried out

on the properties of the main suspects,

including Smith's office at Swift Accident Solutions,

where they found an all-important memory stick.

And on there were details of all the claimants

and their mobile phone details.

So when we looked at his records and those of the people

we believed have set up the collision,

we could see that they did know everyone,

they did know the claimants and they knew them before

and after the collision.

Evidence from the strikes also revealed the existence

of another incident that hat happened several months before.

All in all, there were seven staged collisions,

involving approximately 200 people and a vast amount of money.

We estimated this to have been worth around £1.7 million,

which would have been the financial cost to the insurers involved.

In my time at FirstGroup, this is probably one of the biggest frauds

I've had to deal with.

And it resulted in a big trial.

The case went to Manchester Crown Court

and after a three-month trial, John Smith was found guilty.

For a £1.7 million fraud, he was sentenced to 6.5 years

and the rest of the gang suffered similar fates.

We were extremely pleased with the results of the trial.

30 years in custodial sentences, 15 people prosecuted,

the police did a fantastic job.

The consequences are very severe and it should act as a deterrent

to people getting involved in such crime.

Although the claims were fake, the accidents were very real

and it's frightening to think what could have happened.

This could have gone very, very wrong.

We could have been looking at serious injuries,

we could have been looking at fatalities.

It could have been elderly people or young children that

could have been seriously hurt.

Later, a landlord's fraudulent fire claim goes up in smoke.

Mr Shah's motivation can be summed up in two ways -

one was sheer greed

and the second was blatant dishonesty.

And a fake insurance claim in the States

annihilates an entire neighbourhood.

CCTV cameras are increasingly being seen as part of the furniture

in the UK's pubs and bars.

They are vitally important in these kind of environments,

making the difference in cases where

it's one person's word against another.

Gillian Ofori-Nyarko is part of JD Wetherspoon's legal department.

We currently have 951 pubs up and down the country

in the UK and in Ireland.

We get hundreds of thousands of customers per year

walk through our doors.

And ideally they want everyone to walk back out again

safely and securely at the end of the night.

But disaster recently struck at one busy watering hole.

An ambulance was called to assist a customer that had come a cropper

and sustained a serious injury.

The claimant alleges that she walked into our pub

and slipped on wet floor.

As a result of the fall, she claims that she fractured her leg.

The amount of compensation involved was sobering.

We referred the claim to our solicitors,

who priced the whole thing up at around £26,000.

This would have included costs for the claimant, for her going

to her solicitors, for damages, medical care and our costs as well.

As with any accident on its premises,

Wetherspoons decided to take a close look at what had allegedly happened.

Well, as part of the investigation we always

ask for a copy of the rota, a copy of CCTV,

witness statements from anyone who might have seen the accident,

from the manager or from any other members of staff

who were working that day.

However, this evidence contradicted the story

put forward by the claimant.

She claimed that she reported the accident to the manager

yet the first thing he knew about the accident was

when he went outside and she was being attended to by a paramedic.

Could the claimant have made a simple slip-up in telling

her side of the story?

Luckily, the pub's CCTV would reveal whether the case had legs.

If her story was true, we would have expected to see a woman slip

on wet floor and, I imagine, people come to her aid,

seeing as she'd fallen over.

But that is not what was seen on the footage.

In fact, the truth was so far from what was alleged

that it put the boot into the claim.

We couldn't believe that this claim had ever been made.

It was quite clear to see that she'd walked in already injured

and on crutches.

The whole time that she's there,

there's no sign of any accident occurring.

They then go out for a cigarette

and the last we see is her leaving because she'd called the ambulance.

Everybody who looked at the CCTV was in actual shock.

We didn't expect for somebody to be quite so brazen.

The broken leg injury claim was cast firmly aside.

So we sent the footage to her solicitors

and we didn't hear anything back from them afterwards.

And that's where the matter rested...

Or so they thought, until a second set of solicitors got in touch.

When we received the second claim notification form, I think

we were all quite shocked that it had come through again

and she had nothing to support the allegations that she was making.

She must have suffered a bang to the head in the alleged fall

for her to think she could get away with putting the claim in again.

There were major inconsistencies with the claimant's claim.

In the first form that she submitted,

she said that she was unemployed,

whereas in the second form that she submitted she said she was

a bank nurse and had been unable to work since the date of her accident.

Evidently, the intention was to try and increase

the amount of compensation by claiming for loss of earnings.

However, the company called time on the second injury claim.

And this time it was kicked into touch.

JD Wetherspoon are completely against false claims.

If a customer comes into our pub and genuinely hurts themselves,

then we are definitely there to help.

However, we won't stand for the process being abused.

While technology has made a huge difference, good investigators

are able to detect the whiff of fraud from a mile off,

using nothing but gut instinct.

Andy Morris is Assurant's Chief Marketing Officer.

His company recently dealt with a claim for compensation

for a lost mobile phone.

So this claimant was a construction worker and they were

working down a manhole in a sewer

and everything that that conjures up.

Unfortunately, the phone,

they'd lost it down the sewer in the effluent.

Ugh - that's one phone you'd never want to use again.

During the claims process,

technological analysis meant that concerns were logged

or, to put it another way...

As this case developed, it started to smell.

Assurant's fraud team has a nose for a phoney story

and their findings supported their suspicions.

It became very clear to our agents that the claimant was using

exactly the same telephone number

and exactly the same SIM from the handset that had been

irretrievably lost down the sewage in the effluent.

That's where the claim will be going

unless there was a good explanation.

When we then challenged the claimant,

the claimant then informed us that they

had gone back down the manhole and fished around the sewer

to find the device that they had claimed was lost.

But investigators were privy to further analysis

which proved that the SIM and telephone number were paired

with a unique identification number from the mobile.

The pairing of that telephone number with the SIM

to the unique identification number on the device,

all of those three evidence points and data points,

for us, proved that it was the original phone

that the claimant had claimed was lost down the sewer.

Assurant spoke to the claimant about the concerns

and he kicked up quite a stink.

He immediately responded in an emotional fashion.

He was very aggrieved about that situation.

As the old saying goes, where there's muck, there's brass,

but in this instance, there was lots of muck but not very much brass.

What was quite strange about this case

is that it wasn't a high-end smartphone.

The actual device they were claiming for was just a standard phone.

I think psychologically, some people feel that if it's under a certain

amount of money, that somehow that's not a crime, or that's not fraud.

But mud sticks and Assurant is determined to flush out

any bogus behaviour.

The clear message that this case sends out is,

if you are thinking about attempting to submit a false claim, don't.

While some fraudsters try to claim for incidents that never happen,

some attempt to exploit real events for their own benefit.

But without a lot of background planning,

their greed often gives them away.

Mike Brown is head of Counter Fraud Intelligence at Direct Line.

Mr Shah, who is in fact a landlord of a number of properties,

contacted Direct Line to initiate a fire claim

against his property at Langdale Road which had been subject

to a fire caused by an electrical fault.

According to Mr Shah,

the blaze had caused a significant amount of damage.

The initial claim made by Mr Shah was in the region of £810,000.

Thankfully, no one had been hurt.

With the best part of £1 million on the line,

Mike's team took a close look at the case.

It was very quickly established that Mr Shah had incepted

the policy the day before the claim was made.

Investigators quickly assessed the phone recording

of Mr Shah taking out the policy.

The first part of the call sounded genuine enough.

Mr Shah would have been asked standard questions, one of which

would be the current maintenance and condition of that property.

But later in the phone call,

they heard something which immediately fired up concerns.

At the point of inception,

he asked for the policy to be commenced five days previous.

That in itself is a flag.

It's a flag because there is no reason to backdate a policy,

unless you are trying to get cover for an incident

that has already happened and you are uninsured at the time.

Suspicions had been ignited

and a loss adjuster was then sent to the address.

His estimation of the value of that property,

prior to the fire taking hold, was £250,000.

The claim implemented by Mr Shah was £810,000,

clearly an exaggeration of the value of this property.

An exaggeration that would make even an estate agent blush.

With doubt smouldering, investigators focused on the blaze.

They retrieved the fire logs from the Fire Brigade

which has the timings of the initial call from a member of the public,

that there was a fire or smoke coming from Langdale Road,

to the point of when the Fire Service arrived on scene,

to the point that the fire is put under control.

That would have been then correlated

to when Mr Shah took out the policy itself for Langdale Road.

Which, when we look at the timeline,

was within two hours of the actual fire.

So, the fire had actually taken place

before Mr Shah had taken the policy out.

The findings were explosive.

They now knew the true timeline of events.

That Mr Shah was on scene at the fire within an hour,

and an hour later,

took out the policy of inception for the property at Langdale Road.

Then lodged a claim the following day.

The timeline meant that he had been less than truthful

when he said the property was in good condition.

Basically, he lied all the way through the process.

Not only had he tried to claim compensation

for his uninsured property, but he also exaggerated the value,

to try and make a massive profit.

As far as Direct Line was concerned,

he wasn't entitled to a penny of compensation

and they duly informed him that his claim had been declined.

Not content with this outcome,

Mr Shah then proceeded to take the company to court.

The evidence was compelling.

Any reasonable person would have walked away from that claim.

This is a classic example of a greedy and dishonest individual

who was hellbent on attempting to elicit moneys from an insurer.

Direct Line weren't alone in that assessment.

At the County Court, Mr Shah's own legal advisers

withdrew on the basis of professional embarrassment.

Unsurprisingly, his case was extinguished

but Direct Line weren't prepared to leave things there

and passed their evidence to the police.

He subsequently appeared before the Old Bailey

where he was convicted for fraud.

He was sentenced to 18 months imprisonment,

suspended for two years.

Mr Shah's motivation, I think, can be summed up in two ways.

One was sheer greed and the second was plain dishonesty.

This was a clear case where Mr Shah had a property

that was uninsured, sustained serious fire damage,

and was looking at paying for those repairs himself

and sought to deceive an insurer into footing the bill,

at an exaggerated rate, as I say, of £810,000.

Mr Shah got burned when he fraudulently attempted

to profit from a fire that had already happened.

While in the States,

fraudsters are prepared to turn on the heat to take it

to a whole other level,

and they don't care who gets hurt in the process.

Life in the American suburbs is known for being peaceful

and largely uneventful.

So, nothing prepared the residents of Indianapolis for this.

A deadly explosion in November 2012

ripped through an entire neighbourhood.

More than 80 homes were destroyed or damaged in the initial blast

and more were ruined in the fierce blaze which followed the explosion.

Buildings, gardens and cars were wrecked, with repair costs

estimated at a staggering 4 million.

Given the scale of the devastation,

it was remarkable that only two people tragically lost their lives.

The whole community was affected.

Some people found themselves suddenly homeless.

Some were seriously injured and others suffered

post-traumatic stress disorder as a result of the events of that night.

When morning came, it looked like a bomb had been dropped,

but the true cause was something no one at the time suspected.

Investigators focused their attention on the property

at the centre of the explosion,

the house that was immediately next door to the residence

where the couple died.

The property turned out to be the home of Monserrate Shirley

and her partner, Mark Leonard.

On the night in question,

they'd been out of the house gambling at a nearby casino.

The investigation revealed that the couple were in considerable debt

and in the weeks before the blast,

insurance on the home had been increased to 300,000.

But the real bombshell was that the explosion was no accident.

Physical evidence indicated that the house had been filled with gas,

which had been ignited using the spark from a microwave

set in advance.

MICROWAVE BEEPING

BANG

All the evidence pointed towards Shirley and Leonard

deliberately and recklessly blowing up their house

to fraudulently collect an insurance payout, with tragic consequences.

When the case went to court, Mark Leonard,

judged to be the ringleader, was found guilty

and sentenced to two consecutive life sentences without parole,

and an additional 75 years in prison.

Monserrate Shirley pleaded guilty to two counts of conspiracy

to commit arson as part of a plea agreement.

She remains in jail and faces a sentence of over 20 years.

While this part of Indianapolis

will eventually return to suburban peacefulness,

nothing can bring back the two people

who lost their lives as a result of the couple's sheer greed.