Episode 4 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...

Subject out the vehicle.

..sophisticated data analysis techniques...

..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.

Coming up, one musical mailman's insurance claim is

far from first-class.

I would have thought it was very difficult for Mr Masumbu to

go all the way to Malaysia, to go on a stage and play a guitar.

CCTV cameras capture the performance of a lifetime.

As a high level estimate on the value of the injury,

we would have placed that at around about £2,500-£3,000.

DOG BARKS

And Agria think they might be dealing with a shaggy dog story.

We could find no evidence that these puppies ever existed.

In January 2012, the police joined the fight against insurance

fraud by launching an elite squad known as IFED.

IFED is Insurance Fraud Enforcement Department,

which is based in the city of London, but is countrywide.

IFED is involved in all sorts of insurance fraud,

notably for vehicles, personal injury or slip and trip.

We cover the whole spectrum.

They've made over 700 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.

You carry out fraud, we will follow you and we will arrest you

and we will convict you. We will take everything you gained

and give it back to the people who you've robbed.

Over 600,000 of us are injured at work each year.

But working as a postman for the national treasure that is

the Royal Mail isn't generally considered one of

the most hazardous of jobs.

You might deliver to the wrong house,

or at worst be on the receiving end of a particularly nasty dog bark.

But if we're to believe one former postman,

the risks of the job can be life destroying.

Mr Masumbu was at work when he went to the back of the van,

opened the sliding door and took out some parcels,

and while he was there, someone driving behind skidded

on the wet road and slammed in the back of him.

CRASH

As a result of the accident, Mr Masumbu sustained bruising

to his torso and upper body...

..leaving him physically unable to work.

During the course of the following months, he went

and sought medical advice and was examined.

He couldn't dress himself properly,

he couldn't live a normal life, in fact.

He actually stated to the doctor that his life was over.

After the accident, Mr Masumbu received £25,500 in compensation.

But with life-changing injuries, he was also potentially in line

to receive a six figure pay-out from the insurance company

should his claim be settled.

However, with a claim of this scale, before handing over any more

money, the insurers wanted to check a few facts.

Before any pay-out, an insurer will make an assessment

and do their own investigations.

In this day and age, many people love to share what they've been up

to by posting it on the internet.

But unfortunately for Mr Masumbu, investigators discovered one little

nugget online that I'm sure he would have preferred to have kept quiet.

They looked at a blog and this was a blog from the Malaysia music

festival, which shows Mr Masumbu on stage playing a guitar.

Just to be clear, that's him on the right.

Let's have a look at that again.

Surely a man in your condition shouldn't be strumming

the guitar with such gusto.

You could put your back out.

I would have thought it'd be very difficult for Mr Masumbu to

get all the way to Malaysia, to go on a stage and play a guitar.

The insurers, of course, were pretty suspicious of Mr Masumbu.

But jetting off to Malaysia wasn't the only travelling he was doing.

Investigators discovered that Mr Masumbu had been

involved in yet another car accident and was driving at the time,

which is something he'd told the medical examiner he couldn't do.

They put a surveillance team behind Mr Masumbu to watch if he was in

fact, as he said he was, someone who was restricted in their movement.

Yet again, when investigators saw the footage the surveillance team

had captured, they couldn't believe their eyes.

The surveillance footage showed Mr Masumbu getting in and out

of his car outside his home address with bags of shopping,

a guitar and other instruments,

and walking quite freely to and from his home address.

That looks like an awfully big box to be carrying for a man who

claims he struggles to walk.

Seemed to be walking perfectly all right,

not impaired, and he certainly wasn't walking with a stick.

Hang on, I thought you said you couldn't drive.

You want the passenger side.

It was now that there was grave doubts as to Mr Masumbu's claims.

And he was called in for a further medical

examination for his injuries.

But when Mr Masumbu arrived, the miracle cure that had

enabled him to drive again

and rock out on stage with his guitar appeared to have worn off.

Strange, that.

He came in walking very badly with the use of a stick,

and in fact needed the help of the doctor to undress

so the examination could take place.

By now, the doctor was aware of the possibility that the claim

was bogus and during the examination could find no injuries

consistent with Mr Masumbu's status at that point.

Sounds like this postman's claim form needs to be sent

back to the sorting office.

Mr Masumbu did have injuries as a result of his accident,

but they were very minor in comparison to what he'd

actually alleged and which had paid out for.

By now, it was clear that Mr Masumbu had been seriously

exaggerating the severity of his injuries, and with hundreds

of thousands of pounds on the line, the case was referred to IFED,

who wasted no time in delivering the bad news to their suspect.

Mr Masumbu was arrested in the early part of 2014. The full facts

were put to him, including the video footage. Mr Masumbu denied that the

claim that he'd made was false, and stuck to his story throughout.

However, his argument didn't stand up and IFED hit Mr Masumbu with two

charges of fraud, before he appeared at the Old Bailey to face the music.

Mr Masumbu, faced with the overwhelming evidence against him,

could do nothing else but to plead guilty.

Masumbu was ordered to repay the £25,500

he'd already wrongfully received from his £300,000 claim...

and was sentenced to 18 months in prison.

I don't know what made him turn to crime apart from greed.

He'd a perfectly good job and a good pension and a good lifestyle.

He chose to do something different, he took the wrong choice,

and now he's spending 18 months in prison.

Still to come, two puppies go walkies, apparently.

If I'd got two new family members and they'd gone missing,

I'd be out looking for them.

-And FirstGroup take a sure-footed approach.

-We did go back to them

and say, "We have no intention of making any payments in this.

"If you want to get anything else from us, you're going

"to have to sue us."

Whilst the majority of insurance claims are legitimate

and deserving of pay-outs, insurers in the UK uncover

a whopping 350 cases of fraud every day.

Thankfully, public liability experts like Rob Smith-Wright from QBE are

on hand to identify the claims that are more opportunistic than honest.

Although, as Rob knows only too well,

some bogus claimants trip themselves up with their own stupidity.

The circumstances that a claimant reported to us

was that he was on his way to a local pub

and was using our policyholder's car park as a short cut through.

As he was walking through the car park, he's tripped over in a

pothole and suffered soft tissue injuries to his ankle and foot.

As a high level estimate on the value of the injury,

we would have placed that at around about £2,500-£3,000.

Luckily, the company who own the car park had a CCTV camera

rolling at the time. It sounds like a particularly nasty accident

so viewer discretion is advised.

The CCTV evidence showed the claimant

entering the car park,

it showed him walking across the car park.

And quite visible in the CCTV, and would have been to anyone

walking there, would have been two potholes.

He then stops, turns around, walks back

and walks back straight in the direction of the pothole.

As he gets to the pothole, he steps into it

and then falls quite theatrically to the floor.

Quite theatrically?

I've seen pantomime dames more convincing than that.

It's at that point that we realised that this was a fabricated incident.

As you can see, the claimant walks into the car park,

and the CCTV quite clearly shows the pothole is visible.

I've got to see that again. Can we rewind it?

OK, so he comes in, mind the hole, son...

Phew. Danger avoided.

Does a u-turn. Hang on...

And he's down.

More like a feather than a tonne of bricks, to be fair.

Come on, get yourself up now.

Come on. Go on, you can do it.

OK, this chap's really milking it now,

but I'll give him his due, he is committed to the role.

A picture paints a thousand words, and this,

this footage absolutely identifies to us that this was

a fabricated incident and should not be worthy of compensation payment.

And it soon became obvious that this chap's case was full of potholes.

There was no short cut through this car park to the local pub

that the claimant was visiting.

We also established that the claimant had been

living in the area for nine years

and therefore he will have known this.

We also established that the particular local pub that he

was going to visit wasn't actually open at the time he was

walking through the car park either.

As far as QBE were concerned, this actor's audition was over.

We made a referral of this case to IFED, the Insurance Fraud Enforcement Department.

He admitted that he did indeed fabricate the incident.

His reasons were he was short of money

and he wanted some extra funds.

He was of previously good character, so he was given a caution.

So, if anyone out there thinks they can trip up insurance companies,

remember, it's more than likely that you'll be the one to fall

flat on your face.

Africa, with its breathtaking scenery, bustling cities

and diverse wildlife.

It's one of the most beautiful continents in the world.

But for one woman, it was the scene of a nightmare.

Fortunately, travel insurers CEGA were on hand to

help during this difficult time.

The customer contacted our emergency assistance helpline to

advise us that

while she was visiting her husband in Nigeria, he'd sadly passed away.

We naturally offered the customer our sincere condolences.

We then explained to her that we would do everything

we could to assist her at this difficult time.

She now wanted our assistance in returning home early.

This wasn't a particularly high-value claim, around £700.

At least with CEGA on hand to help, she wasn't going through this

horrific ordeal alone.

In order to assist the customer, we do need various documents to

substantiate the claim. The customer provided us

with a death certificate for her husband and also provided us with

details of the doctor that treated her husband before his sad passing.

With everything they needed, CEGA began to process the claim.

We asked our in-house medical team to contact the doctor to find out

exactly what happened leading up to her husband's death.

But it was at this point that things got suspicious.

Our in-house medical expert spoke with the doctor,

but came away from the call thinking that they weren't actually

speaking with a genuine doctor.

What made them jump to that conclusion?

The alleged doctor couldn't even understand any basic medical terms.

A doctor who doesn't know his knees from his kidneys,

just a bit worrying.

But surely the death certificate would be enough proof.

Due to the international nature of our business, we're well

versed in knowing what original

and genuine documents actually look like, particularly death

certificates, and on this occasion, the death certificate didn't conform

to the normal standards we would expect for this type of document.

Concerned, CEGA decided to check the death certificates with

the hospital where it supposedly came from.

Our investigator was then referred to the medical directorate,

who proceeded to write a statement for our investigator,

confirming that the death certificate was a false

document and didn't ever originate from their hospital.

It appeared that CEGA were dealing with a phantom fatality,

and by now, the woman's claim was in a critical condition.

We were particularly shocked at what lengths the customer had gone to

to try and make this fraudulent claim.

We decided to e-mail the customer and highlight what our concerns

were with her claim, and invited her comments.

As we didn't receive a response from the customer,

we formally declined the claim.

The claim was well and truly dead and buried,

and the claimant was incredibly lucky to walk away.

Is it really worth potentially getting a criminal

record for the sake of £700?

We all trip up and take a tumble every now and then.

But usually we pick ourselves up,

dust ourselves down and hope nobody saw.

But sometimes falls can result in nasty injuries,

as Lee Ingram from FirstGroup discovered when he dealt with

a claim from a woman who'd been injured at a train station.

The initial allegations from the claimant were that she'd

slipped on a piece of wet cardboard just inside the entrance

of the station and this had caused her to fall over and hit her head.

Ouch, that does sound painful.

The injuries sustained were quite serious. She'd knocked herself

out, so she was unconscious and she had a really bad cut to her head.

This claim would have been worth around about £18,000,

so that would have covered the injury itself, treatment fees

and replacement of the clothing, and legal costs on top of that as well.

FirstGroup take personal injuries very seriously,

so the first thing they did was investigate the woman's claim.

But from the off, something didn't ring true.

The very fact that she'd said that cardboard had been

put down to soak up the water was a little bit unusual. I mean,

when people are trailing wet footprints in bad weather,

through stations, you wouldn't put cardboard down, you would send out

a clean-up crew to try and make sure that any excess water was removed.

Far from happy with the woman's description of the incident,

Lee and his team set about cleaning up this claim,

and the first step was to try and establish what really did happen.

We thought we'd go back to our client, get the CCTV

and surveillance footage and see what else we could find out.

Fortunately, when we're looking at railway footage, they've got static

cameras and they tend to cover most of the station, so you can

pretty much plot someone's passage throughout the whole of the station.

But when Lee examined the footage, it painted a rather different

picture to the one the claimant would have FirstGroup believe.

What we noticed from the CCTV is that the incident clearly doesn't

happen just inside the entrance to the station, that's not true at all.

This is a covered station, the floors don't look wet,

there's no signs of the alleged cardboard that she's tripped on.

So, with the CCTV clearly showing no wet patches on the floor,

and certainly no cardboard, what really did happen?

We'll see her pause at the top of one escalator, and you think,

"Right, she's a little bit wary of escalators,

"that's quite normal, quite a few people are."

I can see those metal steps aren't filling her with confidence.

When she comes to go up the next escalator,

she pauses for some 22 seconds before she actually plucks up

the courage to get on the escalator.

She eventually goes up about four steps and then she just takes

a really hard fall backwards.

It's clearly a genuine accident.

She has taken a nasty tumble. You can see she's hit her head on the way down.

She's landed just in a heap on the escalator.

Luckily for this poor woman, the public and station staff

were there to help her back to her feet.

She really does hit her head on the way down,

and you can understand, that's a metal tread as well.

So that's going to make a nasty whack,

you can see why she's knocked out.

There's no disputing that this was a nasty accident,

and thankfully the woman recovered from her injuries.

Looking at this, you can clearly see she's just lost her footing and fallen backwards.

She's lied about the circumstances. No-one's to blame for that,

it's just an unfortunate accident.

FirstGroup sent their CCTV evidence off to the claimant's

solicitors to prove once and for all that there was no soggy cardboard.

So we, we've sent the footage back to her solicitors,

we've pointed out there's no tripping hazard,

as was alleged. They've then come back to us

and said, "We made a mistake, it was actually a wet floor she slipped on."

The floors weren't wet, that's not true at all,

as you can see from the footage.

As far as Lee was concerned, it was what the woman

and her solicitors weren't saying that spoke volumes.

I think the key point here is that, all

the way along, we've got an allegation of a slip on a wet

floor. Never have they mentioned an escalator.

Armed with concrete evidence from the CCTV cameras, FirstGroup

took a robust stance and flat out refused to settle the claim.

The solicitors did want to carry on with this claim.

But we did go back to them

and say, "We have no intention of making any payments in this.

"If you want to get anything else from us, you're going to have to sue us."

They've never come back to us on that.

So it looks like they've accepted what we were saying.

So, for any would-be claimants out there

who think they can lie about an accident, Lee has a message.

Where there's a situation where we've caused something to happen,

we would really like to get those claims dealt with,

compensate people for what they're entitled to.

In situations where they're going to make things up, though,

and they're just not true, we're not going to make payments on those.

With more and more cameras watching our every move, potential

fraudsters need to watch their step.

There are 8.5 million dogs around the country, and for many of us,

they're more than just pets, they're part of the family.

Thankfully, insurers are there to help protect our furry little

friends during their time of need.

Good morning, Kennel Club Pet Insurance, you're through to

Megan, how can I help?

So, when a dog owner called up

to report the theft of two puppies worth £3,000,

Simon Wheeler's team were more than happy

to get their paws into the claim.

The first we heard from the claimant in this case was that he'd

had two bulldog puppies stolen.

He'd come down early in the morning and the padlock on his garage door

had been broken and the two puppies stolen.

There weren't really any alarm bells that gave our claims handlers

any inkling that there might be problems with this claim.

Eh? Did he just say he's about to go on holiday?

Now, for me, if I'd got two new family members

and they'd gone missing, the last thing I would do is go on holiday.

I'd be out looking for them, I'd be panicking

and doing everything possible to try and find them.

It doesn't sound to me

as though the owner is exactly missing his furry pals too much.

Hang about, you're telling me you've just spent three grand

on a couple of puppies and didn't chip them? So much for puppy love.

With all these question marks hanging over the claim,

investigators got on the dog and bone.

When we began our investigations, the first thing

we discovered was that neither puppy had ever been seen by a vet.

As there were no leads on the dog's whereabouts,

investigators turned to technology to dig a little deeper.

It was very evident the policy holder was an avid

user of social media, there were postings everywhere.

But, surprisingly, no mention that he'd acquired two puppies,

no mention that they'd been stolen and very little coverage,

certainly no pictures of those puppies.

When pushed further, he came up with a single picture of two

bulldog puppies. They could have been any old bulldogs.

OK, so let me get this right. The puppies have apparently never

been to the vets, have never been microchipped

and the owner doesn't have a single photo of him with the dogs.

It's not looking good for this chap, but I'll give him his due,

he doesn't give up easily.

But no matter how many times he called, there was

no chance Agria were going to roll over on this one.

By the time we'd exhausted

most of the avenues of trying,

and established that the puppies existed, the policy holder was

getting quite, quite aggressive with our claims handlers.

But it was all to try and establish and verify his claim.

I think he might have hit the nail right on the head.

So, after trying very hard over a long period of time,

over successive phone calls,

we could find no evidence that these puppies ever existed.

He'd made a right dog's dinner of this claim.

The policy holder's response to the decline of the claim was that he

would take our decline letter and take it to the solicitors.

We never heard from him again.

And finally, proof that a pretty face

doesn't guarantee model behaviour.

Meet Shawna Lynn Palmer.

But her gorgeous smile hides an ugly secret.

Just two days before entering this beauty pageant,

she told her employers that she was claiming

compensation for an injury she'd suffered while working as a clerk.

According to her statement, she'd fractured her toe

so severely that she couldn't put any weight on her foot or

wear shoes for any length of time.

So she shouldn't have been able to parade around,

yet alone wear these.

So, either her commitment to world peace allowed her to smile

through the pain, or there was something fraudulent going on.

With lots of videos from the pageant on social media,

Shawna's employers were soon onto her.

The compensation claim was given the boot,

Shawna was ordered to pay 6,000 and given 50 hours community

service, proving that while she may have been blessed with beauty,

the brain side of things need a bit more work.