Episode 7 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.

It's the police, can you open up, please?

The game is up for one fraudster.

You're under arrest on suspicion of fraud by false representation.

One man mistakes a bus for his bed.

You can see by the position of his head he's beginning to doze off.

You've got to feel a little bit sorry for,

for the chap in that it's an unfortunate accident.

And one claimant has an unlikely career change.

He presented himself as a security doorman, over time his career

fortune seemed to have blossomed into him becoming a surgeon.

With 29 million customers nationwide,

it's inevitable that Aviva get their fair share of fraudulent claims.

But whilst many of these are from opportunists trying their luck.

Sometimes they're faced with a fraud on a much larger scale.

Angela Bailey and her team found themselves dealing with

exactly this type of case.

Within one of our claims locations they identified a couple of

claims where the claimants addresses and telephone numbers linked.

So these were referred into our claims fraud intelligence unit,

who then reviewed the claims for further exposure.

The same people involved in numerous claims was strange enough.

But as they continued to investigate,

that wasn't all they discovered.

There were seven policies that had all been taken out by the same

bank accounts and all of these policies linked back to Mr Qadri.

We identified that Mr Qadri had taken out seven policies

all by the same credit card with us.

Holding numerous insurance policies isn't a crime.

But Abdul Qadri had already received two pay-outs,

totalling £12,000 and Aviva's investigation

revealed that this was potentially just the tip of the iceberg.

In total there were 16 claims, which resulted in 60 injury claims

submitted to Aviva with a value of £300,000.

Such a high volume of claims and injuries was a huge red flag

and with around £300,000 on the line, Aviva's investigation

continued and it wasn't long before their suspicions were confirmed.

Mr Qadri appeared on a couple of the claims

but the majority were names and addresses where people had no

idea that the claims had been made for them.

So Qadri had been submitting claims using other people's details

and it appeared he wasn't too picky about whose identities he used.

People that he'd put in these claims were linked to him

via friends, family.

On the whole they had no idea that the claims had been submitted.

By now Qadri had already fraudulently received £12,000

but now they were onto him.

Aviva set the wheels in motion to bring this fraudster to justice.

Once Aviva had sufficient evidence we contacted the Insurance

Fraud Enforcement Department at the City of London Police to take

the investigation further.

Since it was formed in January 2012 IFED has convicted over 700

fraudsters and they didn't waste any time in taking up this case.

Simon Styles was one of the officers who worked on the investigation.

When the case was referred to IFED,

all we had at that stage was a number of fraudulent claims

all linked together by a single bank account.

We did some further enquiries around the details of the vehicles

that was used in the, in the accidents.

We found that these people either didn't exist as far as we were

aware, they didn't live where they said they lived

and they didn't actually own the vehicles that they were

reportedly driving at the time of the accidents.

It was looking as though Mr Qadri was not only impersonating

claimants but shockingly investigators were also

concerned that he was potentially fabricating some of the crashes.

We believe that a number of them did take place but also a number of them

were what's called staged, where two vehicles are brought together

deliberately to make it look as though it is a proper accident.

IFED began putting together a detailed

profile of their suspect and it pointed to one conclusion.

Well, looking at Mr Qadri's bank account it looks as

though he had some means.

He didn't appear to be working at all.

There wasn't a salary, there wasn't any legitimate source of income

and therefore we think he was the mastermind behind this.

It was time to speak to Qadri face-to-face.

So DC Kate Sibley and her team paid him

an early morning visit at his home address.

Hopefully, we're going to be finding telephone numbers that have

been used, names that have been used to open up the policies.

Officers arrive at Qadri's address and immediately secure the front and

back of the house to avoid anyone attempting to leave the property.

It's the police, so can you open the door?

The longer we spend outside knowing that someone's in there,

the more concerned we get as to whether they're going to attempt to

escape, arm themselves or hide the evidence or attempt to destroy it.

Eventually their knocks are answered.

Good morning, my name's DC Einsmann from City Police.

Mr Qadri, I'm going to arrest you.

OK, you're under arrest on suspicion of fraud by false representation.

Still to come.

We seized a number of handwritten documents which are, basically,

an outline of the accident.

As the search gets underway, IFED officers hit the jackpot.

It was a whole diary of his criminal activity.

In the UK there are around 6,000 accidents involving buses each year.

When someone claims they've had an accident on a FirstGroup bus

it usually lands on the desk of Lee Ingram.

It's alleged that in late 2014 a gentleman was

injured on one of our buses when it took a corner too abruptly

and he was thrown from his seat.

Now, most of us have been caught off balance on a bus before,

but usually the only harm done is a bruised ego.

However, when the passenger in this claim lost his balance,

the results were disastrous.

He sustained a black eye, a nasty cut to his head

and also a soft tissue injury to his neck.

This claim would have been worth about £9,500

and that will have been made up of the personal injury, the treatment

costs and legal fees arising for bringing the claim itself.

As with every claim they receive FirstGroup investigated further,

and their first port of call was a fancy bit of onboard technology.

All of First buses are fitted with telematics equipment.

Generally, what they do is, they record changes in speed,

changes in direction, sudden acceleration, deceleration.

It's quite easy to see if a bus has turned quickly, it would

show a record of this happening.

With the telematic technology showing no evidence of any

sudden turns the team switched their attention to the onboard cameras

in the hope they might provide some answers as to exactly what happened.

The CCTV footage shows this gentleman

sitting in one of the front seats.

You can see by the position of his head he's beginning to doze off.

It's a nice sunny day and the shadows thrown across the bus

can sometimes have a soothing effect, it's quite warm.

So, it's not surprising he's probably fallen asleep.

Now, pay attention, folks it certainly looks as

though he's starting to drift off.

Next stop is the land of nod.

He's going, going, gone.

Owf, that was a nasty fall.

When you see him fall off his seat, face first into the stairwell,

you know that, that's hurt, you've got to feel a little bit

sorry for, for the chap in that it's an unfortunate accident.

As painful as it may have been FirstGroup remain

certain of one thing.

We do see some cases obviously where people deliberately will

throw themselves to the bus floor.

This isn't one of those incidences,

it clearly is a situation where, the gentleman has fallen off his seat.

But the difference here is that he's alleging that this was

caused by the bus movement

and it's not it's actually caused by him being asleep and being

unable to stay on his chair as the bus is moving quite normally.

Let's see that again, eyes peeled for the mysterious quick turn,

no, the only thing I can see turning is his fellow passengers' heads.

You'll notice from the actual footage itself that no-one

moves or shows any real issues with the way the vehicle's moving

or travelling, you've got the young boy there

sitting in the luggage rack and, he doesn't, he doesn't budge.

If the vehicle had suddenly turned the way that the claimant has

said, he would have needed to hang on otherwise he's going to

get thrown out of that luggage rack.

Cos you've seen the way that the gentleman's come off his seat.

Fortunately, FirstGroup's buses are also fitted with

cameras on the outside.

So just to be sure that the footage from inside wasn't misleading,

Lee's team checked out every angle just in case they'd missed

the quick turn the passenger was claiming against.

Did you see it?

Nope, looked like smooth driving to me, let's take another look.

It showed absolutely nothing at all, so it's more a case of what

it didn't show than what it did show in this instance.

There's no doubt at all that this is a genuine incident where the

chap has fallen off his seat, but are First to blame for that?

Absolutely not.

Armed with such convincing evidence, FirstGroup put this claim to bed.

It was quickly decided that there was no way

that we were at fault for this gentleman's fall.

We quickly rejected the claim and we haven't heard since.

The UK jewellery and watch industry is worth more than £5 billion.

But it's not all about the money.

From inherited diamonds to wedding bands,

jewellery often has a sentimental value.

Thankfully, insurance is there to cover our prized possessions

should they get misplaced, broken or stolen.

When one woman lost her treasured engagement ring John Beadle,

RSA's counter fraud manager, and his team were on hand to help.

This lady had a policy, a household domestic policy

which would cover the normal perils that you would expect, fire,

theft, and in this case it, it also covered accidental loss both

within the insured premises and externally as well.

To John and his team the lost engagement ring appeared to

be run of the mill claim.

She said that she had gone for a walk in a local beauty spot

and she'd lost her engagement ring which was valued at £2,400, it

being apparently a handmade design.

It sounded initially like, like a genuine claim

and of course as we would do normally

we began arrangements to settle her claim for her.

Before any money could be handed over,

RSA needed some proof that the customer had owned the item.

But as luck would have it, she had a clear photo of herself

wearing the ring, a very clear photo.

Unlucky for her,

when we examined the photographs we found that they were timed

and date stamped three days after the alleged loss of the ring.

The claimant had been caught out by the metadata that's stored

within all digital images.

We've come a long way from the film cameras of yesteryear,

when you take a snap today you aren't just capturing

the image you're also recording the time and date it was taken and

sometimes even the exact location of where you were at the time.

For insurers these hidden details can be gold dust,

but for potential fraudsters they can be a nightmare.

I'm never surprised by things in this job. I've been in it

quite a long time, but this is a clear outrageous cheek.

To RSA it was crystal clear that she was trying it on,

and I'm not talking about the jewellery.

She was making a claim for a very precious item,

an engagement ring, which you would naturally be very upset about

if you had lost it in those circumstances.

And we were doing our best to try and compensate for this, this

loss, when actually it's quite clear that the loss never occurred at all.

Armed with the incriminating photo RSA reported the case to the

Insurance Fraud Enforcement Department who wasted little time.

They paid her an unannounced visit at her place of work.

And, lo and behold, she was at that time of their visit wearing

the said engagement ring, which she had allegedly lost.

Talk about being caught red-handed.

It'll come as no surprise that this woman didn't receive the pay-out

she was hoping for but that's not to say she left empty handed.

She was arrested and taken back to the police station where

she was interviewed under caution and she admitted her guilt.

It was decided to deal with her by way of an official police caution.

This woman learned the hard way that committing fraud comes with

serious consequences.

You will end up on the insurance fraud register, which will

cause you problems in obtaining insurance cover in the future.

As head of fraud at Aviva insurance,

Tom Gardiner knows a thing or two about accidents and injuries.

The extensive experience of Tom and his team came in handy

when one of their customers was involved in a collision,

where all five occupants of the other car claimed they'd

suffered whiplash.

So, a straightforward whiplash injury on its own may have a value

between £1,500 and £3,000.

But as Aviva began the lengthy task of processing the five claims,

one of the passengers, a Mr Shah, had a slightly different account.

In the first place he presented a claim for straightforward

whiplash injuries.

Over time that escalated, astonishingly, into really

quite catastrophic injuries, including being in a coma

for two months, multiple fractures,

broken jaw, broken teeth and blackouts.

Was he in the ejector seat?

Now, it's fair to say that some whiplash injuries can worsen

over time,

but this was taking it to a whole new level

as the list of injuries went on to include a fractured skull,

blindness in one eye and loss of taste.

As far as Aviva were concerned though,

the entire claim left a bad taste in the mouth

because Mr Shah's injuries weren't the only details

that were ever-changing.

There were a number of inconsistencies with

Mr Shah's claim, including his employment status.

In the first place, he presented himself as a security doorman.

Over time, his career fortunes seemed to have blossomed

into him becoming a surgeon.

We suspect that was all about trying to inflate his claim for wages

and loss of earnings.

From doorman to surgeon in a matter of months.

Now, that's some career progression.

But Tom thinks he knows the reason

behind Mr Shah's meteoric rise up the ranks.

If he had had a genuine whiplash claim as a doorman,

his claim may have had a value of several thousand pounds.

If he was a surgeon, with such catastrophic injuries,

it would have been hundreds of thousands.

It will come as no surprise that with such dubious inconsistencies

on the claim, Aviva decided to look into this one a little further.

We carried out detailed investigations

and in particular we arranged for engineers is to inspect

the damage to the vehicles which proved to be wholly inconsistent

with the circumstances and injuries presented.

With the damage to Mr Shah's car a million miles away

from what the claim suggested,

Aviva turned their attention to the alleged injuries.

I think we were surprised by the inconsistency

and escalation of the injuries.

Medical evidence was never presented.

Refusing to be stitched up by a pseudo-surgeon,

Aviva sent Shah and his solicitors packing.

But they soon discovered that they were dealing with a man

who was as determined as he was deluded,

when Shah instructed another solicitor

to pursue his claim for injury.

We were particularly surprised the firms were prepared to accept

Mr Shah's claim without validating him or the truth of his injuries.

It was Aviva that notified the solicitors and alerted them

to their client's fraud.

But with a potentially life-changing amount of money in his sights,

Shah was not going to give in easily.

He enlisted an astonishing 12 different solicitors

to pursue his claim over the course of the investigation.

However, without any proof of his injuries whatsoever, none of his

army of solicitors were successful in securing Shah a pay-out.

And in a shocking turn of events,

investigators discovered yet another bombshell,

this time involving the car that allegedly caused the incident.

We also interviewed the driver of our insurance vehicle who was

complicit in the fraud and eventually put his hands up

and admitted it was a scam.

So they were all in on it.

This claim was dodgier than Mr Shah's medical credentials.

What we are quite clear about is that this was an entirely bogus

accident and entirely bogus injuries.

Tom and his team compiled their evidence

and handed it over to the Insurance Fraud Enforcement Department

who gladly took on the case.

We then worked with them to bring a prosecution and eventually Mr Shah

was sentenced to six months in prison,

which we were very pleased with.

For Aviva, the outcome was a great success.

In total, we avoided all five claims,

including Mr Shah's catastrophic injuries, which potentially

had a value of several hundreds of thousands of pounds.

Pets can be a great addition to the home

but caring for them isn't cheap.

In fact, the average trip to the vet's costs around £300.

Thankfully, pet insurance is there to take the brunt of the cost

when our furry friends are injured or become ill.

But, just like any other type of insurance, it is open

to spurious and exaggerated claims,

as Simon Wheeler and his team from Agria discovered

when they dealt with a dog owner who had an upsetting visit to the vet's.

This was undoubtedly a very sad incident.

A young puppy had had heart failure and sadly died.

After receiving a claim form from the grieving owner for £500,

Agria started looking into the claim but as they read through

the policy holder's paperwork, something jumped off the page.

We looked at the policy details and we found that the policy had

only been set up less than two hours before the puppy had died.

To all intents and purposes, if it had been a clean-cut accident

and the puppy has died, the policy holder would have been covered.

The problem was that this was anything but clean-cut.

The timing of the puppy's passing

was a real concern for Simon and his team.

The death of the puppy was very, very, very close

to the start of the policy and ordinarily,

young puppies don't just drop dead without any warning.

What we suspect is that the puppy had shown signs of being ill

and the owner was then deciding to make sure

they had insurance in place to cover that previous illness.

If the poor little pup was showing signs of illness

before the insurance policy was taken out,

then unfortunately the owner's policy would not be valid.

Pet health insurance is no different to human health insurance

or motor insurance.

If your grandma has a chronic heart condition,

you can't take out an insurance policy

to pay for private medical fees for that heart condition.

It's pre-existing, it's already there.

To establish whether the puppy had been showing any signs

of illness before the policy was taken out, they spoke to the owner.

Sounds fair enough, but Agria wanted an expert opinion too,

so they also spoke to the vet who treated the puppy,

although their account of what had happened was remarkably different.

On 30th July, the puppy had been seen for its primary

vaccinations and was, to all intent and purposes, healthy.

A week later, the puppy was brought in to see the vet again

but this time the poor thing wasn't so well.

The puppy was coughing, was marginally distressed.

Over the next two days, the puppy's condition continued to deteriorate.

After repeated visits to the vet, the poor pup sadly passed away.

But there was more bad news to come.

The vet unequivocally told her that the puppy wouldn't be

insured as the condition was pre-existing.

It started before the insurance was set up.

You might think that being told by a vet that your dog

is definitely not covered would be the end of the matter.

Not in this case.

Upon hearing that, the policy holder quite candidly asked the vet

if they could just lose the veterinary history or amend

the veterinary history so that the insurance would pay out.

The vet obviously told the policy holder, if I change my notes,

if we change the veterinary history, that would be fraudulent.

The owner asking for the records to be changed

was the final straw for Agria.

As far as they were concerned, this claim was 100% null and void.

But, just to make sure the message sank in, they put it in writing.

That included the fact that she had asked the vet to act fraudulently

and amend the veterinary records.

She was quite stressed at that point.

She was quite frightened because she tried to act fraudulently

and had been rumbled.

Unsurprisingly, Agria are still waiting for that response.

I think that policy holder won't be doing this type of thing again.

They were very shaken by the fact that one,

they had been discovered and two, they had foolishly tried to take

some money from an insurance company that they weren't entitled to.

Previously, in Birmingham, IFED's DC Kate Sibley

tracked down Abdul Qadri who was suspected of masterminding

a huge motor insurance scam with an estimated value of over £300,000.

You're under arrest on suspicion of fraud by false representation.

With Qadri under arrest,

the team began searching the property for evidence.

We're completing a search of your address, OK.

I'm looking for certain things, insurance documents

and anything to do with motor vehicle insurance.

With the search well underway,

the team uncover a mountain of suspicious paperwork.

We're in one of the main bedroom is at the moment

and it is just sackfuls of paperwork, documentation.

Quite a lot of it relating to what we're investigating.

We've got documents relating to the insurance company,

all the names, telephone numbers, the registration numbers

that we're looking for that are in relation to this inquiry.

We're only about halfway through the search now

but we're finding stuff all the time.

As the bags of evidence mounted, it was starting to become clear

that this was a meticulously planned operation.

We seized a number of handwritten documents which are basically

an outline of the accident.

Notes of where the accident took place, how it took place

but we found a number of those driver details of third-party

vehicle, victim's details, insurance company details and obviously a

full description of how the accident happened with a nice little diagram.

To investigators, the revealing detail in the documents

far exceeded their expectations.

It was a whole diary of his criminal activity

and we were very pleased to actually take possession of it.

We knew at this stage Mr Qadri had a lot of explaining to do.

Faced with such damning evidence, it wasn't long

before Qadri was banged to rights.

Mr Qadri was charged with fraud by false representation

and he was bailed to attend the local magistrates courts

in early January 2014.

But IFED were in for a nasty surprise,

because when Qadri's day in court arrived,

he was nowhere to be seen.

The UK Borders were informed in case he'd left the country and returned

and inquiries were made through relatives

and family at previous addresses.

Unfortunately we could not find him.

Wherever Qadri may have run to, IFED were certain of one thing.

It was now a waiting game. We knew he'd show up.

We didn't know where and we didn't know when. We knew he would.

Sure enough, eventually IFED got their man.

We got a call that Mr Qadri had been arrested at Heathrow

having returned on a flight from Afghanistan.

With Qadri finally back in the UK, IFED did the polite thing

and greeted him at the airport.

He was a bit surprised that we were waiting for him.

I don't think he thought we'd take that much trouble over him

but we take trouble over catching anybody who commits insurance fraud

or any other crime in the UK.

Now in the hands of IFED,

there was no way Qadri was going to escape this time.

Within 24 hours of Mr Qadri setting off the plane

after he arrived from Afghanistan,

he was before the Crown Court in Birmingham.

Faced with overwhelming evidence,

Mr Qadri immediately put in a plea of guilty.

The judge sentenced him to 38 months imprisonment for his offences

and an extra three months to serve for failing to return on bail

and fleeing the country.

Qadri thought he was in line to receive over £300,000.

In fact, he got over three years behind bars.

I believe Mr Qadri received such a long sentence

due to the organised nature of these incidents

from the notebooks the detectives

found when they raided his address.

This has quite clearly been planned to some detail

and with every intent of financial gain through fraudulent means.

IFED have since made a proceeds of crime application against Qadri

to recoup the money he fraudulently claimed from Aviva.