Episode 1 Claimed and Shamed

Insurance fraud has reached epidemic levels in the UK.

It's costing us more than £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 around £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 of vehicle.

..sophisticated data analysis techniques...

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

Police. Don't move. Stay where you are.

..they are 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.

An insurance claim goes up in smoke...

By this time, major alarm bells were ringing

because somebody had clearly hidden the stolen items

in the premises before the fire.

..a large-scale fraud ring is brought down

thanks to the exhaustive detective work of insurance staff...

During the course of our investigation we identified

60 linked claims totalling £1.2 million.

..and a fake phone claim is called in.

I think the only word I can think of is stupidity.

That an insurer would actually accept those circumstances.

Once upon a time, making an insurance claim was a simple case

of filling out a form and waiting for a cheque to arrive in the post.

However, with modern technology

and insurers alert to the possibility of fraud,

today it's a much more involved process.

And with the police now working alongside insurance companies,

the chances of spurious claims being detected are higher than ever.

RSA provide insurance cover to people up and down the country.

John Beadle heads up their counter-fraud department

so it's his job to make sure only genuine customers get paid.

Back in early 2015 he dealt with

a seemingly devastating home insurance claim.

Not only had one unlucky couple been burgled,

but the thief then caused severe damage to their home.

So, this was a claim for a fire in a house belonging to our policyholder

whereby in the early hours of the morning

somebody entered the house, and having stolen

several items of property from the lounge then,

using the policyholder's own white spirit and matches,

set fire to the kitchen.

The house was substantially damaged in the fire.

Fortunately, nobody was injured.

The couple had had a narrow escape.

However, the claim was substantial.

With their stolen items,

which included expensive computer equipment,

the fire damage to the house and the cost involved

in temporarily rehousing them, it totalled a staggering amount.

Just over £80,000.

RSA and the authorities began investigations

which almost immediately sparked concerns.

The police and indeed ourselves were suspicious

of the circumstances surrounding the fire.

There was no signs of forced entry or exit

and the fire had actually been started

with some domestic white spirit and, indeed,

using matches that were in the kitchen.

And I think if you were going to be subject of an attack

by arsonists they would normally bring their own materials with them.

RSA and the police couldn't understand why the thief

would want to set fire to the house.

The robbery had been a success.

They'd stolen expensive goods undetected.

Why not just creep away quietly?

John turned his attention to the official statements given

by the unfortunate husband and wife who owned the house.

The gentleman couldn't really account for his whereabouts

at the time of the fire.

He was allegedly staying nearby with some friends

but that was not verified at that time.

The claim was looking more and more dubious.

But John needed hard evidence

if he was going to prove it was indeed fraudulent.

It wasn't long before that emerged.

When properties have sustained fire damage, experts are sent in

to ensure the house is safe before any repairs can start.

They are called the Disaster Rectification Team.

In this case they found it a lot more than they bargained for.

Whilst they were going about their work they actually discovered

that secreted in the base of an upstairs divan bed were the

alleged stolen items that were taken from the downstairs of the premises.

By this time, major alarm bells were ringing, because somebody had

clearly hidden the stolen items in the premises before the fire.

This led to only one possible conclusion.

No burglary had ever taken place.

The validity of the claim melted away.

We reported what had been found to the police and the police

subsequently arrested both the gentleman and his wife.

However, there was a very sad twist.

This case was complicated by the tragic

subsequent death of the gentleman,

where he died of a completely unrelated illness in hospital.

After his death, his wife contacted the police

and said that the idea for starting the fire was indeed her husband's.

He'd hidden the property and started the fire

with the intention of making a fraudulent insurance claim.

The case was closed.

It was a tragic end to one man's calculated attempt to defraud RSA

out of more than £80,000.

The outcome of this case,

because of the circumstances,

we clearly cancelled the policy and the family received no payment

from us in respect of the fire.

Still to come,

a phantom passenger tries to submit a personal injury claim.

The start of the sinister case of the white van hauntings.

Now, when we get behind the wheel car insurance offers peace of mind

that in the event of an accident,

our repair costs will be taken care of

and we'll be compensated for any loss.

While for most of us that's the sole purpose of motor insurance

there are some out there who see it as a way to make serious money

by defrauding insurers out of tens of thousands of pounds

with staged collisions, grossly exaggerated claims

and even accidents that never happened.

Thankfully, insurance companies like Direct Line Group are getting

better and better at detecting fraud and stopping it in its tracks.

Their staff, using sophisticated computer programs,

carefully examine policies, looking for anything which may suggest

that there are fraudsters at work.

Back in 2011, Mark Chiappino, a fraud manager at DLG,

was alerted to several claims from people

who had been involved in car accidents.

We were receiving lots of claims from the North London area

and on first inspection they appear to be genuine claims.

Deeper investigation, however,

revealed lots of common factors between these claims.

The same firms kept cropping up again and again,

the same accident management companies,

the same hire companies, the same garages and recovery people.

Also, we discovered that a lot of the policies had only very recently

been taken out and were using fictitious mail drop addresses.

In fact, there was far too many similarities

for this to be a coincidence.

Mark and his team suspected they had honed in on a fraud ring.

In this case a network of criminals conspiring together to lie about

being involved in car accidents

in order to receive large insurance pay-outs.

Direct Line Group sent out specialist forensic engineers

to examine the cars that had supposedly crashed into each other.

Inspection of some of the vehicles involved in these claims

showed that in fact they have never been near each other.

We also discovered some of the damage to these vehicles was totally

inconsistent with the circumstances that had been described.

Mark was certain about what was really going on.

The attempted scam works by either having

a fictitious accident that never actually occurred

or deliberately crashing two vehicles together.

The parties involved would then claim for numerous items,

including injuries, whiplash, storage of vehicles,

recovery of vehicles, hire of new replacement vehicles, etc.

This was a deliberate targeting of Direct Line Group

solely for financial gain.

These weren't opportunists, this is a deliberate scam.

Once the team at Direct Line Group knew what they were looking for,

the amount of claims that were part of the scam mushroomed.

During the course of our investigation we identified

60 linked claims totalling £1.2 million.

A staggering figure.

Understandably, Direct Line Group needed help.

They got in touch with their solicitors, Keoghs, to assist with

further investigations and represent them in any legal proceedings.

Ruth Needham, a lawyer who specialises in investigating

fraud rings, remembers when she first heard from Direct Line Group.

So, in early 2011 we had that phone call that I sometimes get saying,

"We've got something, it looks massive.

"Can you come and help us with it?"

DLG have a great team that have done this several times

so very quickly, we were able to get into a position

with DLG where we could repudiate.

So we could say to these individuals,

"You're not going to be getting paid on these cases.

"We don't believe for one moment what you're telling us is true."

With Keoghs' support, Direct Line Group told all the claimants

not yet paid that they wouldn't be receiving a penny.

Several of them came back and said they would sue for payments

they felt they were owed and started legal proceedings.

We started out with nine cases that were being made against DLG.

Eight of those cases, with the evidence we presented,

the individuals withdrew their cases and discontinued as it's called.

One of the cases - the eighth case out of the nine -

proceeded to trial but they were unsuccessful in trial.

They lost at trial.

A victory for Direct Line Group.

All the unpaid claims were cancelled.

But Keoghs and DLG didn't stop there and continued their investigations.

When we initially got to the point

that the evidence was strong enough to say to individual claimants,

"You're not going to get paid,"

we sent out, again, investigators to say,

let's see if they want to give another segment.

Let's ask them some questions and confront them with some of the evidence that we have.

And we then managed to get some witness statements from

individuals who admitted that it was set-up.

That it was all lies and they'd done it for lots of desperate reasons.

People weren't in a hurry to tell us who told them

because of fear of retribution, we can only assume,

but that was at the point when we were confident.

Once you've got a statement that's signed from somebody who says

this is made up you are reasonably strong in your evidence

to say we can continue with what we're doing.

This is just completely illogical.

Direct Line Group had paid out money on some of the car crash claims

they now knew to be bogus before the fraud was spotted so they,

along with Ruth and her team at Keoghs,

wanted to take things further.

We started to work on a tort of deceit action.

The tort of deceit, in layman's terms,

basically involves somebody being dishonest.

You recognising they've been dishonest and you making

a payment, unfortunately, before you established that dishonesty.

We therefore sued these individuals to get back any money they

had been paid but also there was another element to it

which is called exemplary damages, and that is a

punishment for the fact that you've lied to the courts,

to the insurers, and you must pay extra money for the punishment.

Direct Line Group and Keoghs turned the tables on this criminal gang

and took 29 of them to court.

In November 2015, we issued proceedings against each of

these individuals for the return of monies paid,

and this actually came to trial in June of this year

and none of the individuals attended.

They didn't come to defend themselves,

they didn't come to explain themselves.

They were quite happy for the judge

to decide how much they needed to pay back.

The judge decided that the claimants had to pay damages of £175,000.

A great result.

But the fact that the fraud ring had been stopped in its tracks

was a win in itself.

It's critically important that people realise the importance

of combating this type of fraud.

The cash that comes from this type of fraud when it is paid out,

where does it go to? It certainly doesn't go to help society.

If anything it seems to be a cash flow for the more criminal

aspect of our communities and it's important for all of us

to ensure that we stop that wherever we can,

whether we are aware of it happening and we need to report it

or if we can assist in giving evidence.

It is incredibly important we stop this cash flow of money

going to the criminal fraternity.

For Mark and his team back at DLG the fact that the criminals

had been ordered not only to pay back their costs but also

extra money as punishment for the fraud was a huge success.

This was a great result for us and a terrible result for them.

The hunter became the hunted.

Now, I'm no Derren Brown but I like to think

I'm a pretty good judge of character.

But there is one fraud detection company

that takes it to a whole new level.

i-COG specialises in the technique of conversation management.

You could call them human lie detectors.

Identifying fraud at the highest level requires a certain skill set.

Something that Tara Shelton of i-COG knows all about.

I have been a hostage negotiator, a firearms officer,

I've been involved in major investigations.

Not forgetting her degree in psychology.

If MI5 are recruiting I know just the person.

Just by talking to someone on the phone,

Tara can tell whether their claim is genuine.

What we actually do is measure their behaviour throughout the call

against 27 deceptive indicators and then these are given

a weighting on the basis of what the handler believes

and can evidence as to what they've heard.

Tara's approach is different to traditional fraud detection techniques.

People assume that they have to be

louder than the next person in order to have control.

No. Control that we get

is by knowing we have control, but saying less.

Which means that if the claimant is lying,

it will be obvious to an expert like Tara.

What is often missed to the untrained ear

is that when someone is actually under a position of stress,

the heart beats faster, breathing changes, voice pitch changes.

And that's the level of detail that we actually listen at.

So, for anyone trying to put through a fraudulent claim,

Tara is the last person they'd want picking up the phone.

I think I'd be pretty certain in saying we wouldn't be

the fraudsters' choice for phone a friend.

One of Tara's recent cases involved what seemed like a simple loss.

We'd been notified of a claim from a client where a soldier had

notified them that he had lost two high-end mobile phone handsets,

same brand but completely different models.

The approximate value of the claim collectively was around £1,000.

A tidy sum, but not something that would automatically be paid out,

no questions asked.

Clearly, Tara needed to do more digging.

I was unable to get hold of the claimant because the mobile

number he provided was actually a mobile phone for one of the

handsets that he said he'd lost.

OK, let's give him the benefit of the doubt.

Tara eventually pinned down the claimant via e-mail and was

finally given a working member to call him on.

He was cooperative but quite aloof.

Very full of self-confidence and rather dismissive

of the claims process.

One of the main aims was to get his version of events.

He had stated that he was abroad

on exercise for probably a period of five weeks.

Most people investigating insurance claims wouldn't be able

to relate to this scenario but Tara isn't most people.

As my past experience as a police firearms officer

I was very aware of the activities that generally take place

during a day's exercise and straightaway some of the memory

that he presented just didn't ring true.

Despite having forked out for top-of-the-range handsets fitted

with tracking software, the claimant presented himself as a technophobe.

He didn't know how to use the technology on those devices

to locate phones. It just didn't seem reasonable to me.

At this point in the call Tara's psychology training came into play.

What's really important with losses is to tap into what I call the sensory memory of the customer.

I asked him something very simple, which was to describe the rucksack that he was carrying on exercise.

Immediately he focused on the two areas where the phone handsets

were actually in and that wasn't what I was asking.

What I was hearing at the time was someone who was not only delivering

a scripted delivery but there were long pauses before the next answer.

And, again, to the trained ear that's someone who is giving

themselves thinking time before they answer.

Tara had given the soldier an opportunity to tell his side

of the story but he'd failed to convince.

The time had come to change strategy and confront him.

He soon realised he'd been outflanked.

As soon as he became aware that I had concerns with the claim

he presented, his tactics just completely changed.

And to say that he lost control on the phone

was probably an understatement.

But the real bombshell was still to come.

He'd landed himself in it when he sent Tara

his contact details by e-mail.

It was quite clear at that stage that I needed to confront him.

And when I actually did that, the immediate answer after silence was "no",

which was rather unbelievable seeing as I was looking at that e-mail

at the time I asked him that question.

The claimant had well and truly shot himself in the foot.

For me that was the killer piece to deliver as a concern to him.

That's when it became very clear to me that he had been outmanoeuvred.

Well, that should have been that, but the customer wasn't prepared to surrender yet.

After the call ended, I received an e-mail from him,

this time from a different device,

saying that he wished to withdraw the claim of the handset that

he'd originally e-mailed me on, thanking me for my professional

conduct, but he still wanted to continue with the other claim.

Tara wasn't having any of it.

We can't separate one claim into two.

The methodology is still there, the scenario that he described is still there.

For me I think the only word that I can think of is stupidity,

that an insurer would actually accept his circumstances.

This was one battle the soldier couldn't win.

His false claim had been well and truly defeated.

Make no mistake, if you try and slip a fraudulent claim

through the net, it will be caught.

Car owners, listen up.

There are 35 million registered vehicles in the UK and with

so much traffic it is inevitable that accidents will happen.

Navigating high levels of traffic is a challenge at the best of

times but it is especially true if you are driving

a ten-metre long 11½ tonne bus.

Lee Ingram is the fraud manager for Transportation Claims,

which is part of First Group.

One such claim recently landed on Lee's desk.

On the face of it, it appeared genuine.

The circumstances of this incident were that the gentleman was alleging

that our bus had gone past his parked van and the wing mirror

had just clipped the van.

Although this was quite a minor impact

he was also alleging that this had caused him to be thrown

forwards and backwards in his van and subsequently caused him injury.

The claimant went into some detail about how badly

he had been hurt in the incident.

The driver of the vehicle was alleging that he had suffered

a neck and lower back whiplash type injury.

Two months on, he was still having aching in his back.

We also received a call from the passenger in the van,

who also alleged he'd suffered from some lower back injuries

and subsequent headaches.

The alleged injuries were very serious

and could have long-term consequences.

The soft tissue injuries that can occur to the neck

can vary from those that will last for a week

to those that will cause lifetime injuries.

The potential cost to the company was significant.

With the costs and the actual injuries themselves

we're probably looking at round about £7,500-£10,000 between them.

With such a large amount of money at stake, Lee needed to be sure

that the claimant's version of events checked out.

These days every bus is fitted with multiple cameras,

both inside and out.

In a case like this, the interior recording can be particularly revealing.

As I'm watching this I'm expecting to see some sort of reaction

from the passengers to the collision that has happened outside the bus.

Viewers of a nervous disposition may want to look away.

The crash is coming up in three, two, one... Wait, what?

You can quite clearly see there is no reaction.

They just carry on as if nothing has happened.

And the realisation that nothing had happened was confirmed when

Lee looked at the exterior footage. It's barely noticeable.

Even using the magic of television to zoom in and slow it down reveals diddly squat.

We then look at the driver in the van.

Is he moving forwards and backwards to cause him the alleged

whiplash injury? I can't see any movement from him.

Me neither.

But as it turned out that wasn't even the biggest issue with the claim.

Assessing whether the passenger has been injured by his forward

and backward movement is going to prove a little more difficult

because as you can see he's not even in the van.

Either this is another example of a great successful investigation

resulting in repudiation of a claim

or it's the start of the sinister case of the white van hauntings.

The claim defied all logic. Not to mention the laws of physics.

Even the great Sir Isaac Newton would have sleepless nights trying

to prove how a non-existent force upon

a non-existent individual could cause a whiplash claim.

It's enough to give you a headache, just thinking about it.

You don't have to be a scientific genius to figure out what happened next.

Both of these claims were repudiated and we didn't pay a penny.

That's not surprising really,

when you consider if they're going to pursue this claim it's going to have to go before a judge.

Once he sees that the passenger is not actually in the vehicle

he's going to think, "What else is actually false about this claim?"

No solicitor in their right mind is going to take this client on.

It's hard for anyone to argue with CCTV.

Especially if they don't even exist.

It's important that we crack down on these types of claims for a number of reasons.

The first one is probably the financial reason.

The more claims that go to insurance companies

the more premiums go up, that's costing you money.

It can't be right for someone to make a dishonest living

out of putting in claims like this when the majority of us

just go around our daily business making an honest buck.

It's, I think, incumbent upon all of us to do what we can

to make sure these people are exposed.

Whether it's exaggerating real injuries,

totally making up a story for a dodgy claim

or masterminding insurance fraud on an industrial scale,

insurers are coming down hard

on the people who think they can make a quick buck

with their scams and cons.

But the fraudsters need to think again

as more of them than ever before are being caught in the act

and claimed and shamed.