Episode 5 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, and even phantom pets.

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

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

LIFT CHIMES But insurers are fighting back,

exposing just under 15 fake claims every hour.

Armed with covert surveillance systems...

That's the subject out of 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, the wheels come off a bus driver's claim for compensation...

He's doing all of the things he said he couldn't do.

If he's driving cars around a busy carwash,

anything could happen.

..a thrill-seeking holiday-maker sees his case crash and burn...

The customer then started to tell us that

he couldn't remember what happened.

..and a group of pretend passengers' personal injury claims

come under scrutiny.

That's fundamentally inconsistent and meant that we had to doubt

whether or not the claims were genuine.

Whether you phone-bash all day in a call centre,

or break bricks on a construction site,

it is an employer's legal obligation to make

your working environment a safe one.

If you have an accident at work that could have been prevented,

you have the right to seek fair compensation.

Lee Ingram is the claims team manager for First Group Transport

and found himself facing just such a case

involving one of their bus drivers back in 2007.

The claimant alleges he was asked by his manager to bring some signs in

from the car park,

and, as he's carrying them through to the understairs area,

he slipped on a plastic, sort of, wallet or folder on the floor

and he alleged he's fallen backwards and struck his head on the floor

and knocked himself out.

SIREN WAILS This was a potentially life-shattering accident.

He's claiming that he's sustained some quite serious injuries.

He's alleging that he's prone to blackouts and dizzy spells now.

He's claiming he's got no memory of the incident, and so he's got

post-traumatic amnesia for some hours after the incident.

Bearing in mind this chap could potentially black out at any time,

he's a bus driver, so this does have some quite serious ramifications for

his future employment.

With such severe injuries,

the claimant's days ferrying passengers from A to B

had come to a grinding halt... WHEELS SCREECH

..as well as his ability to make a living.

First Group were head-on for a colossal pay-out.

By the time we got to the stage

where he was ready to put his claim forward in

its entirety, we'd moved up to round about £650,000.

A large element of that was for loss of earnings.

Obviously, he's a bus driver, so, with the potential blackouts,

he's not going to be driving a bus any more.

Also, he's got a potential care element -

over £250,000 he was claiming for that.

So, it's not an insubstantial claim.

And, on top of that, you've always got the ever-present legal fees -

around about £150,000 for those.

With a whopping £650,000 on the line,

Lee had to be sure that the details of the claim submitted were genuine,

and that First Group were in fact liable for the claimant's injuries,

but there were a few issues authenticating the facts.

Initial investigations in this case were complicated by the fact that

the premises where the incident had happened were demolished.

We can't go back a look at the scene and check the mechanics

of the incident itself.

But this didn't stop Lee examining

what information was available to him in forensic detail.

He analysed the claimant's original hospital report,

which turned up some rather head-scratching evidence.

He's gone to A&E shortly after,

and they have found no blemishes, no lumps,

no marks, no bruising...

Now, for a head injury of this magnitude,

to knock someone out and cause them a loss of memory

for a number of hours, you would have thought that there would have

been some sort of bruise, but they found nothing.

His Glasgow Coma Scale,

which is the reading of how someone's conscious state reads,

he was 15 out of 15, which is fully awake.

A 3 rating would be dead or in a coma,

so you would expect him to be somewhere in between.

So, the medical evidence would suggest the claimant was

firing on all cylinders.

But it was his treatments that really gave cause for concern,

or rather, the lack of it.

He refused to take a lot of the medication.

He was very difficult to pin down for appointments.

Not the action of someone who wants to get better,

but rather someone who's trying to hide the fact that

maybe there there's nothing wrong with him.

First Group had serious concerns that the claimant

wasn't as impaired as he was professing.

Lee needed proof to back up his suspicions.

Following the number of irregularities,

and the claimant's strange behaviour,

we decided to seek authority to undergo a series of

surveillance so that we could actually film the claimant

and see what he was up to.

Well, if you're prone to random blackouts,

need around-the-clock care,

and are battling bouts of post-traumatic memory loss,

you might imagine very little, wouldn't you?

Looking at the footage, it's showing the claimant being allowed to walk

around quite freely on the family business, which is a small carwash.

It's quite clear that the impairments he's alleging...

He's doing all of the things he said he couldn't do.

You can see him driving cars.

If he's driving cars around a busy carwash, anything could happen.

He could drive into pedestrians, into his fellow employees...

Well, at least he's got his family around to keep a close eye on him.

He's allowed to cross the road on his own with no real concerns that

he could black out at any moment.

Or maybe not.

He visits the bank on a couple of occasions for 20 and 25 minutes,

assumingly to carry out some financial transactions.

The surveillance footage suggested the claimant was living

what appeared to be a very normal and surprisingly active life,

and his next task would leave his £650,000 claim all washed up.

He's seen to be cleaning some of the dirty elements of the car,

the wheel trims and the lower side of the car.

He's also seen to be giving supervisory advice.

He's managing people, to a respect, as well.

And to cap it off, a spot of DIY.

Later on in the day, he can actually be seen moving a rather large piece

of fencing, or a gate, quite near to the carwash.

And, yeah, this is...

I think it's with his son, that's helping him do it.

So, you wouldn't really trust your dad to be moving that

if he was as ill as he says he is.

When I first saw the surveillance footage, I thought,

"This doesn't look like the actions of a person who is

"needing chaperoning on a 24-hour basis."

This is someone who can black out at any time.

With the claimant looking compos mentis,

his case for compensation was about to take a real blow.

With all of the inconsistencies that we had in this claim,

we just weren't happy paying anything out,

so we went back to the claimant and told him we had concerns,

and that we weren't going to pay him any money,

leaving him with very little option to either drop his claim

or take us to court, and he chose to go down the court route.

Despite being quite agile day to day,

when the case got to court,

the claimant didn't have a leg to stand on.

When the judge reviewed the surveillance footage,

he'd said that he would have expected to see someone drive

this gentleman to the family business,

escort him from the car under supervision,

take him to maybe an office and leave him in there,

seated, without expecting him to be wandering around,

carrying out aspects of work.

Once the claimant was shown to be more limber than laid up,

his case collapsed.

The outcome of the case was that the judge simply didn't believe

the level of impairment that the claimant was alleging

matched the surveillance footage that we had.

He felt that parts of the claim had been put in with an intention

to try and deceive us, and therefore,

because part of the claim was found to be predominantly not true,

he wouldn't allow any of the claim through,

so the whole thing was struck out as an abuse of the process.

It was a just result for Lee and the First Group claims team

and proof that any suspicious cases will be investigated.

First will fight these claims to trial.

We do often take these sorts of cases on and we will normally win.

Still to come,

a first-class postal fraud is detected by Royal Mail...

Checks revealed that Mr Mohammed had set up three online auction accounts

in the space of three minutes.

Going on holiday, whether you're a sun-worshipper,

a culture vulture or thrill-seeker,

is most people's chance to get away from the stresses and strains

of everyday life.

Holiday insurance is something you hope you will never have to use,

but if your great escape turns into a bout of tourism trauma,

then having the right level of cover in place can be a life-saver.

Simon Cook is head of special investigations

for holiday insurers Cega.

His team received one particular call from a distressed holiday-maker

in a desperate situation.

The customer contacted our medical emergency helpline to explain that

he had fallen whilst trekking in Morocco.

With such a serious accident,

Simon's team didn't waste any time getting to grips with the claim.

As part of our service,

we contacted the hospital to obtain a medical report,

so we could see the injuries the customer had sustained.

It sounds like it was a serious fall,

because the customer had sustained a fractured vertebra,

ankle and wrist.

The value of the claim was just over £50,000.

The claims handler passed the medical report over to

Cega's specialist team, as is standard practice,

which revealed a rather major discrepancy.

What rang alarm bells for us was that the medical report,

which did, in fact, contain limited information,

stated that the customer had been involved in a paragliding accident,

which was completely different to what he initially told us happened.

In case your French is a little rusty,

this translates as "victim of a paragliding fall",

i.e gracefully riding pockets of air at heights of up to 18,000 feet.

Just a tad different to a mosey through the Moroccan hills,

as he originally reported.

We asked the customer to clarify why the circumstances were different on

the medical report to what he actually had told us when he first

contacted us.

A claims handler from Simon's team gave the claimant a call

to clarify the details.

So, the claimant was now adamant he had not paraglided,

but that wasn't the only thing that didn't add up.

Cega's experts had been taking a closer look at the medical report.

For the customer to have sustained these type of injuries,

he would have had to have fallen from a significant height.

A significant height.

A couple of metres?

The claimant's injuries were more consistent with a fall

from a much greater height -

I don't know, maybe those sustained from a paragliding accident.

With his story starting to feel like a flight of fancy,

the team dug a little deeper.

On the back of the initial call,

we did some background searches on the internet

and found some videos that heavily affiliated the customer

with paragliding and paramotoring.

This information was put to the claimant.

MUSIC: Eine Kleine Nachtmusik by Wolfgang Amadeus Mozart

It's about now that the claimant should be reaching

for his parachute, as his story is set to crash and burn.

He has now admitted to paragliding in the past, albeit a long time ago,

but is claiming not to be active any more.

Let's see what other grains of truth the claims handler can extract

on this call.

Determined to ground the claimant's version of events for good

and get to the bottom of this case,

the investigation turned towards the scene of the accident

in search of new evidence.

As we knew the precise location where the incident occurred,

we managed to obtain the telephone number

for a local paragliding company.

The person that we spoke with at the paragliding company confirmed

that, at the same day and at the same time, he had in fact

attended to someone who had had a paragliding accident.

On the balance of probability,

the fact that the incident had occurred at the same time,

the same day and the same location,

it would certainly suggest that this could well be our customer.

Between the discrepancy in the initial medical report,

the nature of the claimant's injuries,

his affiliation to paragliding,

and the eyewitness account from the scene of the accident,

his version of events really started to nosedive.

As the call went on and we disclosed the evidence we had,

the customer then started to tell us that he couldn't remember

what happened, which we thought was extremely odd.

The claimant has developed a sudden and very convenient case of amnesia,

but playing dumb wouldn't help his cause.

Due to the fact that the customer was still denying that the incident

was as a result of paragliding,

we explained to him that we were going to have to

complete on-the-ground inquiries in Morocco,

and we required him to sign an authority form for us.

It may have taken a while, but the truth had at last landed.

We firmly believe that the customer knew that he didn't have the right

level of insurance cover, and that's why he provided us false information

from the outset of the claim.

We had no option but to decline the claim in full

and there was no appeal from the customer.

Having an accident abroad and finding yourself uncovered

is stressful enough,

but, by lying about the circumstances of his accident,

the claimant could have added an attempted fraud prosecution

to his problems.

We certainly appreciate the situation the customer

found himself in, because the claim value was over 50,000,

but this doesn't mean that you can provide false information to obtain

insurance cover.

Holidays can be expensive,

and extreme sports can bump up a travel insurance premium,

but trying to save a few quid here or there

could cost you thousands later

should something go wrong and you're not appropriately covered.

We're still unsure why such an experienced paraglider

wouldn't have taken out the right level of cover prior to travelling.

You do need to have the right level of insurance cover when you travel,

especially when you're going to take part in extreme sports

such as paragliding.

The Royal Mail has been collecting, carrying and delivering all packages

great and small for over 500 years,

so, if something fails to arrive at its intended destination,

it's a big deal.

Customers are always compensated for any genuine losses

or damaged items.

It's a fact that insurance cheats have cottoned on to

and are exploiting -

commonly submitting false claims for lost or unreceived items.

Diane Matthews is a fraud manager for Royal Mail,

and it's her job to identify and investigate

any suspected fraudulent claims.

She was passed one case which involved their

premium delivery service.

Royal Mail customer services received a complaint from

a customer that a special-delivery item was delivered

without the contents.

There's nothing more frustrating than receiving an empty package,

and it's a matter Royal Mail takes very seriously.

The contents of the special-delivery item were said to be

a gift card of £260, so, obviously, quite valuable,

and a loss to Royal Mail of quite a significant amount.

These cases are always investigated, and it's standard practice

to look into the claims history of the customer.

Checks were made as to the recipient,

and it was found that they'd made three similar claims

in the space of six weeks.

Mr Mohammed, the claimant,

was actually stating that there was gift cards inside

each and every one of them envelopes, and, on each occasion,

the envelope was delivered to him empty.

The chances of that are, I would say, slim to none.

With the gift cards mysteriously disappearing,

but the actual packages being successfully delivered,

it was one of Royal Mail's employees who first came under scrutiny.

The finger of suspicion fell on the postman

that was due to deliver that item,

and, when we went further into the case

and found out this was one of several claims, obviously,

our impression changed and we then started looking at Mr Mohammed.

And they didn't have to look far to see an alarming pattern.

It was found that, over the 14-month period,

he'd made numerous claims for loss,

mainly small electronic items and mobile phones,

latterly going on to the gift cards that he'd bought.

To further this investigation,

I started to look a bit more closely at the gift cards.

With such a high number of claims over a short period,

the spotlight of suspicion was now fixed on Mohammed.

Diane and her team turned their attention to

Mohammed's online activities.

Checks revealed that Mr Mohammed had set up three different

online auction site accounts in the space of three minutes,

and on each one, it was used to facilitate a purchase.

On each occasion, he told the seller that they had not been delivered.

Royal Mail had sussed out Mohammed's MO.

The evidence suggested he was buying discounted gift cards online under

different guises, and claiming to both the vendor and Royal Mail

that his purchases had never been received.

The seller was contacted and they forwarded details of the card,

which allowed us to go to the various stores

and find out the transactions,

and also to ascertain if any CCTV evidence of them transactions

was still available.

Each gift card has a unique identity number,

making them easily trackable when purchases are made.

With this information,

Diana was able to zero in on specific store locations where

the supposedly-lost gift cards had been used,

and, most importantly, check their CCTV recordings.

When the CCTV footage was viewed,

we identified Mr Mohammed as being the person spending

the £260 gift card on several occasions,

as well as being used by a family member.

Mohammed had been caught red-handed on camera.

It was the crucial evidence Royal Mail needed to prove

the fraudulent activity.

He'd also passed the gift card to an unknowing relative,

who had also been using it in good faith to make purchases,

therefore implicating an innocent family member in his crime.

At this point, we had enough evidence to arrest Mr Mohammed,

so we sought assistance from Greater Manchester Police,

who assisted us with that.

Diane and her investigative team had worked hard to crack this case,

and were determined to be there when justice was delivered.

Myself and my colleagues from Royal Mail investigators

accompanied the police on a search of Mr Mohammed's home address.

Evidence was then seized from his bedroom that matched

the identical cards that were reported as not being received,

and at that moment you knew that the right person had been caught.

Mohammed was given an opportunity to explain why the gift cards

were found at his property.

Mr Mohammed was subsequently interviewed by officers of

Royal Mail and he chose to answer, "No comment,"

to all of our questions.

But by the time the case reached court,

Mohammed had changed his tune.

Mr Mohammed pled guilty at court to two charges of fraud,

and he received a six-month community service order

and also a curfew.

No matter how big or how small attempts to defraud Royal Mail are,

they will always be met with the same response.

The actual value of this claim is irrelevant to Royal Mail.

The modus operandi of this is fraud and therefore it needs to be

investigated and stopped.

Now, in recent years,

the UK has acquired the catchy title of the whiplash capital of Europe,

with an estimated 2.7 claims made for every reported accident.

Now, while many of those claims are genuine,

the injury has long been seen by potential fraudsters

as an easy, low-risk way to make a few quid.

Whether it's otherwise honest individuals making

a one-off exaggerated claim from a real accident

or organised gangs masterminding calculated

"crash for cash" cons, it is all fraud.

Axa's head of fraud Richard Davies is no stranger

to these types of claims.

His team received one particular case from an Axa customer

which involved multiple third-party passengers.

Our customer told us that they'd collided with another vehicle -

as a result, five whiplash claims were submitted to us.

They were meant to involve three male passengers -

one of 60, one of 40 and one of roughly 20 -

-and two younger Caucasian females.

-BRAKES SCREECH AND CAR SMASHES

So, three boys and two girls in the car during the accident -

seems pretty clear.

There was a really big problem with this claim.

Our customer had told us there were three males and two females

in the car.

However, when the claims came in,

there were two males and three females in the car.

That's fundamentally inconsistent and meant that we had to doubt

whether or not the claims were genuine.

Aside from one of the passengers mysteriously morphing into a woman,

there's also the matter of the two female occupants who were reportedly

Caucasian, but now seem to be hailing from an Asian background.

It was a discrepancy that brought the case to an emergency stop.

We rejected all of these claims,

which were at that point valued at around £23,000.

The claimants, however, refused to accept that

and decided to take us to court,

and we estimated that it would cost around about £200,000

to defend those claims.

That's over ten times the amount of the original claim.

Confident that this was a classic case of an opportunistic attempt

at fraud, Axa weren't prepared to back down.

The claimants came across very badly in court.

When they were cross-examined, they changed their story,

they changed the circumstance of the accident

and the judge held that they just weren't credible witnesses.

So far, it may have looked like a game of "Guess Who?",

but there was no mistaking the identity of the claimants when

the final judgment was passed.

The judge threw all five claims out of court.

He said that the people weren't in the car and he made an order

against them to pay Axa's legal costs.

These individuals clearly thought, win or lose,

there would be no consequences to submitting a false claim,

but they were gravely mistaken.

We think that the claimants were motivated just by money.

They thought that they could get away with £23,000 from an insurance

company simply by submitting five fake claims.

When we know that a claim is false,

we will defend it and we will take those claimants through the court

system to make sure they are shown to be criminal.

And it's the honest policyholders who ultimately pay the price.

It cost us £200,000 to defend them.

Those costs are paid on to genuine customers

and is the reason why £50 is added to each premium that we pay

for each policy we own.

Insurance fraud hits all of us in the pocket,

but more and more of these scammers and conmen

are being claimed and shamed.