0:00:05 > 0:00:09Insurance fraud has reached epidemic levels in the UK.
0:00:09 > 0:00:14It's costing us more than £1.3 billion every year.
0:00:14 > 0:00:17That's almost £3.6 million every day.
0:00:19 > 0:00:24Deliberate crashes, bogus personal injuries, even phantom pets.
0:00:26 > 0:00:29The fraudsters are risking more and more to make a quick killing,
0:00:29 > 0:00:33and every year it's adding around £50 to your insurance bill.
0:00:33 > 0:00:36But insurers are fighting back,
0:00:36 > 0:00:39exposing just under 15 fake claims every hour.
0:00:39 > 0:00:41Armed with covert surveillance systems...
0:00:41 > 0:00:44Subject out of vehicle.
0:00:44 > 0:00:46..sophisticated data analysis techniques...
0:00:48 > 0:00:51..and a number of highly skilled police units...
0:00:51 > 0:00:53Police, stay where you are!
0:00:53 > 0:00:55..they're catching the criminals red-handed.
0:00:55 > 0:00:57Just don't lie to us.
0:00:58 > 0:01:01All those conmen, scammers, and cheats on the fiddle
0:01:01 > 0:01:04are now caught in the act, and Claimed And Shamed.
0:01:10 > 0:01:14Today, a gang of fraudsters finally gets busted.
0:01:14 > 0:01:16The chances of actually being caught,
0:01:16 > 0:01:18as far as they were concerned, was nil.
0:01:18 > 0:01:19They hadn't been caught to date
0:01:19 > 0:01:22and there's no reason why somebody's going to knock on their door now.
0:01:22 > 0:01:24..a slip and trip claim evaporates...
0:01:24 > 0:01:27In terms of defending the claim, it was quite clear to us that
0:01:27 > 0:01:30the reason the floor was wet in the showers was because he had just
0:01:30 > 0:01:33come out of the shower himself.
0:01:33 > 0:01:37..and the diagnosis isn't good for an overseas medical claim.
0:01:37 > 0:01:41Our investigator visited the hospital, and spoke with one of
0:01:41 > 0:01:44the doctors, who immediately confirmed that the customer
0:01:44 > 0:01:46was never treated at this hospital.
0:01:51 > 0:01:54These days, there is a real determination to stamp out fraud.
0:01:54 > 0:01:56Security has been improved,
0:01:56 > 0:02:00insurers are more aware, and legal loopholes have been closed.
0:02:00 > 0:02:05But the biggest change is that there is now a specialised police unit.
0:02:05 > 0:02:08Ifed is the City of London Police's
0:02:08 > 0:02:11Insurance Fraud Enforcement Department,
0:02:11 > 0:02:13a dedicated team of detectives
0:02:13 > 0:02:17committed to stopping insurance fraudsters.
0:02:17 > 0:02:19There's ever more sophisticated detection tools
0:02:19 > 0:02:22being used by the industry.
0:02:22 > 0:02:25We're getting more and more cases every day.
0:02:25 > 0:02:28This elite squad has prevented millions of pounds being paid out
0:02:28 > 0:02:31to criminals in fraudulent claims.
0:02:32 > 0:02:36From now on, insurance cheats need to look over their shoulders.
0:02:36 > 0:02:40It's all fraud, it's all crime, and it can all lead to prison.
0:02:40 > 0:02:44Police! Don't move! Stay where you are.
0:02:44 > 0:02:48Simon Styles is an Ifed financial investigator.
0:02:48 > 0:02:52He recently worked on a complex case involving motor insurance.
0:02:53 > 0:02:57Early 2012, there was about 15 different insurers
0:02:57 > 0:03:00found that there was a pattern linked to credit cards being used
0:03:00 > 0:03:03and compromised, the same bank accounts that were being used,
0:03:03 > 0:03:06and the same details of vehicles being used in accidents.
0:03:06 > 0:03:10The case was referred to Ifed, and an investigation was launched.
0:03:10 > 0:03:14It soon became clear that these were no ordinary fraudsters.
0:03:14 > 0:03:17They had gone to great lengths to cover their tracks.
0:03:17 > 0:03:20In the beginning of this investigation,
0:03:20 > 0:03:22we didn't know who was involved.
0:03:22 > 0:03:25We had the instances, but we didn't have the suspects.
0:03:25 > 0:03:28One thing they did know was that the gang had targeted
0:03:28 > 0:03:31the most vulnerable members of society.
0:03:31 > 0:03:37This criminal gang was operating by opening insurance policies
0:03:37 > 0:03:41by use of credit cards from unsuspecting members of the public,
0:03:41 > 0:03:44elderly women or, in fact, ladies who were deceased.
0:03:45 > 0:03:48After using the stolen identities to take out motor insurance,
0:03:48 > 0:03:51they then moved to the next stage of the scam.
0:03:51 > 0:03:54And so what they would then do was to put together an accident
0:03:54 > 0:03:56and make an accident claim report to the insurer,
0:03:56 > 0:03:59stating that they had had an accident
0:03:59 > 0:04:01and giving details of the other driver.
0:04:01 > 0:04:03But these were all made up.
0:04:03 > 0:04:06They used random houses, random names, random cars,
0:04:06 > 0:04:09just to legitimise their claim.
0:04:09 > 0:04:11Once they had invented an accident,
0:04:11 > 0:04:15they were then able to make money from selling the details on.
0:04:15 > 0:04:18This was targeting solicitors in the main,
0:04:18 > 0:04:20and the referral fee.
0:04:20 > 0:04:24So if they put together a claim with the driver
0:04:24 > 0:04:28and two passengers, they would get £700 per claim.
0:04:28 > 0:04:32So those three claims, they would pocket £2,100.
0:04:32 > 0:04:34And they would do that by producing an invoice
0:04:34 > 0:04:36to the unsuspecting solicitor,
0:04:36 > 0:04:39who would readily pay that money to take the case on.
0:04:40 > 0:04:44The law has now changed in England and Wales, but at the time,
0:04:44 > 0:04:46solicitors paid big money for referrals
0:04:46 > 0:04:49on the assumption that they would recoup their costs
0:04:49 > 0:04:52down the line when the claim was paid out by insurers.
0:04:52 > 0:04:55By the time they found out there were no accidents,
0:04:55 > 0:04:56it was too late.
0:04:57 > 0:05:00This gang wasn't interested in the claims going forward
0:05:00 > 0:05:03because the accident didn't happen.
0:05:03 > 0:05:05What they're interested in is referral payments,
0:05:05 > 0:05:07and that is what they were focused on
0:05:07 > 0:05:09and that's what they got.
0:05:09 > 0:05:12£167,000 that this gang received.
0:05:12 > 0:05:16They'd been freely lining their pockets for a year and a half.
0:05:16 > 0:05:20But with Ifed on the case, the net was about to close in.
0:05:20 > 0:05:23As a financial investigator, it's always about following the money.
0:05:23 > 0:05:27Everything out of this investigation was false,
0:05:27 > 0:05:31or forged, or altered, to hide the suspects' trail.
0:05:31 > 0:05:34The only thing is true and, in my experience always is,
0:05:34 > 0:05:35is a bank account.
0:05:35 > 0:05:38It's got to be opened by two forms of identification,
0:05:38 > 0:05:39usually a passport or a utility bill,
0:05:39 > 0:05:42which usually shows the identity of that individual.
0:05:42 > 0:05:46This occasion, it did. It showed the identity of Mr Shad.
0:05:46 > 0:05:47He was one of our main suspects.
0:05:47 > 0:05:51In any event, it showed the money going in and the money going out.
0:05:51 > 0:05:55Once they had pinpointed one person, the rest were soon identified.
0:05:55 > 0:05:58The other main player was Israr Hussain.
0:05:58 > 0:06:01At this stage, the gang didn't suspect a thing.
0:06:03 > 0:06:05The chances of actually being caught,
0:06:05 > 0:06:07as far as they were concerned, the gang were concerned, was nil.
0:06:07 > 0:06:10They hadn't been caught to date, and there was no reason
0:06:10 > 0:06:12why someone's going to knock on their door now.
0:06:12 > 0:06:14But that all changed.
0:06:14 > 0:06:18Ifed decided it was time to move in and arrest the main suspects.
0:06:18 > 0:06:20Just pull up here.
0:06:20 > 0:06:24Some six addresses were visited on the day of the raid,
0:06:24 > 0:06:26April 23rd 2013.
0:06:26 > 0:06:28Coming!
0:06:28 > 0:06:31Quiet, please. Quiet, please.
0:06:31 > 0:06:34When they arrive, they aren't exactly given a warm welcome.
0:06:34 > 0:06:37- What? - BLEEP
0:06:37 > 0:06:41KNOCKING, THEN SEVERAL VOICES SHOUTING
0:06:41 > 0:06:43Come down, please, and talk to the police.
0:06:45 > 0:06:4850 officers attended these addresses
0:06:48 > 0:06:50and I attended one address, in Keighley,
0:06:50 > 0:06:54where the main subject, Hussain, resided.
0:06:54 > 0:06:57Fortunately, he's at home, and is promptly dealt with.
0:06:57 > 0:07:00I am arresting you on suspicion of conspiracy to defraud.
0:07:00 > 0:07:03You do not have to say anything, but it may harm your defence
0:07:03 > 0:07:05if you do not mention when questioned
0:07:05 > 0:07:07something that you later rely on in court.
0:07:07 > 0:07:10What a morning, yeah? What a morning, eh?
0:07:10 > 0:07:13Hussain is then removed to a local police station
0:07:13 > 0:07:16for further questioning.
0:07:16 > 0:07:19With the house clear, the search can begin in earnest.
0:07:23 > 0:07:25You don't know where people hide things,
0:07:25 > 0:07:28so you have to go through everything, really.
0:07:28 > 0:07:32That methodical approach pays off an hour into the search,
0:07:32 > 0:07:35when Simon makes an important discovery.
0:07:35 > 0:07:37I'm going through some files here.
0:07:37 > 0:07:40One of note, here, is a vehicle registration number.
0:07:40 > 0:07:43This relates to a vehicle
0:07:43 > 0:07:45that is currently sat on the driveway of these premises,
0:07:45 > 0:07:48that I know from my investigation has been used,
0:07:48 > 0:07:51or at least the registration number and details have been used,
0:07:51 > 0:07:53in contrived accidents.
0:07:53 > 0:07:56It links that vehicle to this address.
0:07:56 > 0:07:57That is vital evidence.
0:07:57 > 0:08:00Coordinating the multiple raids is DCI Dave Wood.
0:08:02 > 0:08:06This Toyota motorcar does actually feature itself in the inquiry.
0:08:06 > 0:08:08As you can see, as we walk round it,
0:08:08 > 0:08:10there are some minor nicks, which you'd expect on a car of its age.
0:08:10 > 0:08:13But there would appear to be no substantial damage
0:08:13 > 0:08:15to indicate that it has been involved in
0:08:15 > 0:08:17any road traffic accidents.
0:08:17 > 0:08:21Uniformed officers then perform a thorough search of the car.
0:08:21 > 0:08:25As predicted, it yields plenty of potential evidence.
0:08:25 > 0:08:27As we looked through the front window,
0:08:27 > 0:08:30we could see, on the front passenger seat, some paperwork.
0:08:30 > 0:08:32That documentation was relating to an accident
0:08:32 > 0:08:34that occurred in November last year,
0:08:34 > 0:08:36so clearly, we're interested in that
0:08:36 > 0:08:38and the circumstances behind it.
0:08:38 > 0:08:40That will form part of the investigation,
0:08:40 > 0:08:42and those papers are now part of the evidential chain.
0:08:42 > 0:08:46They've been seized and exhibited by the officer that found them.
0:08:46 > 0:08:48Back inside, Simon is still hard at work.
0:08:50 > 0:08:52I've found a piece of paper that was found on the floor just by the bin,
0:08:52 > 0:08:56and what it's got is a couple of e-mail addresses, one for a
0:08:56 > 0:09:00solicitor's and one for an accident management company in Glasgow.
0:09:00 > 0:09:02That's something we don't know about.
0:09:05 > 0:09:08It looks as though the referrals have finished in England and Wales,
0:09:08 > 0:09:13but have started or are continuing in Scotland.
0:09:13 > 0:09:15The Scottish connection is significant
0:09:15 > 0:09:19as, in Scotland, referral fees are still legal.
0:09:19 > 0:09:22The piece of paper had an e-mail address on it
0:09:22 > 0:09:25which Simon traced to a solicitors' practice in Glasgow.
0:09:25 > 0:09:28So I rang them up and asked them, had they been victims?
0:09:28 > 0:09:30They did not know that they had been,
0:09:30 > 0:09:32and it was shown that they were,
0:09:32 > 0:09:34and that was a vital piece of evidence
0:09:34 > 0:09:37that we subsequently used in a criminal trial.
0:09:37 > 0:09:41But the raid yields more than just paperwork.
0:09:41 > 0:09:44It's a ceremonial sword.
0:09:46 > 0:09:48In the wrong hands, deadly.
0:09:48 > 0:09:50So it is upsetting and annoying to see,
0:09:50 > 0:09:53especially as that's so close to where all the children are running,
0:09:53 > 0:09:55next to their bedrooms.
0:09:55 > 0:09:58And that's not the only weapon they find.
0:09:58 > 0:10:00DCI Dave Wood receives a shocking update
0:10:00 > 0:10:03from one of the other raid locations.
0:10:03 > 0:10:05The officers have found a handgun.
0:10:05 > 0:10:07They're not sure exactly what it is and what it isn't,
0:10:07 > 0:10:09so they've called out the local police,
0:10:09 > 0:10:11West Yorkshire's firearms team, to come and make it safe
0:10:11 > 0:10:14and identify exactly what the weapon is.
0:10:14 > 0:10:16I believe it was found in one of the bedrooms,
0:10:16 > 0:10:18but it's just come through to me, that's all I know at the moment.
0:10:18 > 0:10:21The raids had been a huge success, and the evidence collected
0:10:21 > 0:10:24laid bare the true extent of the fraud.
0:10:24 > 0:10:28Just to show you the scale of the events, say there's 300 claims,
0:10:28 > 0:10:31there were seven bank accounts identified
0:10:31 > 0:10:33that received over £167,000,
0:10:33 > 0:10:37which would result in 105 payments into that account.
0:10:37 > 0:10:40There were ten claims management companies that they set up.
0:10:40 > 0:10:4635 insurers were targeted in this 18-month period.
0:10:46 > 0:10:49The sheer magnitude was startling.
0:10:49 > 0:10:52But they had reached the end of the road.
0:10:52 > 0:10:55Six people arrested, six people were interviewed
0:10:55 > 0:10:56and six people attended court.
0:10:56 > 0:10:59The case was due to go to trial at Bradford Crown Court,
0:10:59 > 0:11:01but at the last minute,
0:11:01 > 0:11:04the defendants appeared to have a reality check.
0:11:04 > 0:11:06In fact, due to the overwhelming evidence
0:11:06 > 0:11:08that we presented to the courts,
0:11:08 > 0:11:12the main instigators in this organised gang, this scam,
0:11:12 > 0:11:14pleaded guilty.
0:11:14 > 0:11:18The sentences that were handed out reflected the seriousness
0:11:18 > 0:11:21of the £167,000 fraud.
0:11:21 > 0:11:24Two of them, Hussain and Shad,
0:11:24 > 0:11:26received four and a half years' imprisonment.
0:11:26 > 0:11:29To me, it was a great result.
0:11:29 > 0:11:32Simon has a warning for any would-be fraudsters.
0:11:32 > 0:11:35The people like this gang in Bradford
0:11:35 > 0:11:38who think they can get away with this, targeting people
0:11:38 > 0:11:41who cannot look after themselves or whatever,
0:11:41 > 0:11:44we will do something about it.
0:11:44 > 0:11:46We knocked on the door, they were unsuspecting,
0:11:46 > 0:11:49they didn't expect that we were going to be turning up, we did,
0:11:49 > 0:11:52and as a result of our efforts, they're now sitting in prison.
0:11:58 > 0:12:02Still to come, a claimant doth protest too much.
0:12:14 > 0:12:18Getting ill while you're abroad is most people's worst nightmare.
0:12:18 > 0:12:21But fraudsters see it as an opportunity.
0:12:21 > 0:12:24They assume that the further away something happens,
0:12:24 > 0:12:27the less likely it is to be investigated.
0:12:27 > 0:12:29Big mistake.
0:12:30 > 0:12:32But things have changed,
0:12:32 > 0:12:35as Simon Cook, Cega's head of special investigations,
0:12:35 > 0:12:37knows all too well.
0:12:37 > 0:12:40He recently worked on the case of a traveller who was struck down
0:12:40 > 0:12:43by a serious illness on a trip to Nigeria.
0:12:45 > 0:12:49The customer contacted our medical emergency helpline to tell us
0:12:49 > 0:12:51that he was in Nigeria, and unfortunately,
0:12:51 > 0:12:53for the last eight days, he had been in hospital,
0:12:53 > 0:12:56where he had been diagnosed with malaria.
0:12:56 > 0:12:59Malaria is a tropical disease
0:12:59 > 0:13:01that can be fatal if not treated properly.
0:13:01 > 0:13:06Initially the patient didn't provide any details about his condition.
0:13:06 > 0:13:08We didn't find this too unusual,
0:13:08 > 0:13:12because he had been in hospital for eight days with malaria.
0:13:12 > 0:13:15The next stage for Cega was to contact the hospital.
0:13:15 > 0:13:18We tried to make contact with the doctor,
0:13:18 > 0:13:19but couldn't get through to him.
0:13:19 > 0:13:23We also tried to get in contact with the administration staff,
0:13:23 > 0:13:26but there was simply no answer from the hospital.
0:13:26 > 0:13:29We could understand why the doctor might not be available,
0:13:29 > 0:13:31because he would be treating patients,
0:13:31 > 0:13:34but not to actually get hold of anyone at the hospital
0:13:34 > 0:13:36was particularly strange.
0:13:36 > 0:13:41Also strange was the cost of the treatment, according to the patient.
0:13:41 > 0:13:46And he had already paid £1,850 sterling for his medical treatment.
0:13:46 > 0:13:48The costs being claimed by the customer
0:13:48 > 0:13:51were completely disproportionate to what we would expect from
0:13:51 > 0:13:54a reputable hospital in Nigeria.
0:13:54 > 0:13:56Two days before his flight home,
0:13:56 > 0:13:59the customer appeared to have made a remarkable recovery.
0:13:59 > 0:14:02He contacted Cega to say he had been discharged,
0:14:02 > 0:14:06and would be returning to the UK as planned.
0:14:06 > 0:14:09We referred the case through to our medical team, who stated
0:14:09 > 0:14:12it was a little bit unusual that the customer would be deemed
0:14:12 > 0:14:15fit to travel so soon after being discharged from hospital,
0:14:15 > 0:14:18where he was diagnosed with malaria.
0:14:18 > 0:14:23The customer subsequently sent in paperwork to support his claim.
0:14:23 > 0:14:26The customer provided us with various documents,
0:14:26 > 0:14:29such as a medical report, a booking invoice.
0:14:29 > 0:14:32But he had also provided us with a couple of photographs of himself
0:14:32 > 0:14:34in a hospital bed.
0:14:34 > 0:14:38There were question marks, though, about the documents.
0:14:38 > 0:14:41We noted there were various spelling mistakes in the medical report
0:14:41 > 0:14:44that he provided, which we wouldn't expect from
0:14:44 > 0:14:46a reputable hospital in Nigeria.
0:14:46 > 0:14:50But of even more cause for concern were the photographs.
0:14:50 > 0:14:53We have absolutely no understanding
0:14:53 > 0:14:56why the customer sent these photographs through to us,
0:14:56 > 0:14:59because we didn't ask for photos of him in a hospital bed,
0:14:59 > 0:15:01as that would be completely unethical.
0:15:01 > 0:15:05The customer intended the photos to put his claim in the clear,
0:15:05 > 0:15:08but they actually moved it to the critical list.
0:15:08 > 0:15:11We referred them over to our medical team, and they stated
0:15:11 > 0:15:14that it certainly appeared that the cannula
0:15:14 > 0:15:18had been Sellotaped to his arm, as opposed to inserted into his arm.
0:15:18 > 0:15:21A cannula is a tube that is inserted into the body
0:15:21 > 0:15:24to deliver or sometimes remove fluids.
0:15:25 > 0:15:28If the customer was genuinely unwell with malaria,
0:15:28 > 0:15:32he certainly wouldn't have a cannula Sellotaped to his hand.
0:15:32 > 0:15:34This wasn't just a sticking point -
0:15:34 > 0:15:37it called the whole claim into question.
0:15:37 > 0:15:40Based on the information we had received from the customer,
0:15:40 > 0:15:42we did have serious concerns,
0:15:42 > 0:15:46which led to us appointing one of our overseas investigators
0:15:46 > 0:15:48to actually go out to the hospital
0:15:48 > 0:15:51and interview the doctor or the hospital staff.
0:15:51 > 0:15:55His evidence effectively put the claim out of its misery.
0:15:57 > 0:15:59Our investigator visited the hospital
0:15:59 > 0:16:00and spoke with one of the doctors,
0:16:00 > 0:16:03who immediately confirmed that the documents were false,
0:16:03 > 0:16:07and that the customer was never treated at this hospital.
0:16:07 > 0:16:10But Cega decided to give the customer one last chance
0:16:10 > 0:16:12to tell his side of the story.
0:16:12 > 0:16:14He didn't really have much to say,
0:16:14 > 0:16:19apart from he was going to complete his own investigations in Nigeria.
0:16:19 > 0:16:21At this point, we were wholly satisfied
0:16:21 > 0:16:24that the claim submitted was fraudulent.
0:16:24 > 0:16:27And that meant that there were consequences for the customer.
0:16:27 > 0:16:29He couldn't just walk away.
0:16:29 > 0:16:31We declined the claim in full.
0:16:31 > 0:16:35The customer actually agreed to pay our investigation fee back,
0:16:35 > 0:16:37so we still don't know what happened
0:16:37 > 0:16:40about his own investigations on this occasion.
0:16:40 > 0:16:44Far from stinging the company for an undeserved malaria pay-out,
0:16:44 > 0:16:48the customer has now been hit in the pocket.
0:16:48 > 0:16:51It just proves that where there are concerns with the claim,
0:16:51 > 0:16:53no matter where in the world
0:16:53 > 0:16:55the incident is said to have taken place,
0:16:55 > 0:16:57we will investigate these claims thoroughly.
0:17:03 > 0:17:07Now, we've all dropped the odd plate or mug and thought nothing of it.
0:17:07 > 0:17:09Some more than others.
0:17:09 > 0:17:11But smashing a top-of-the-range appliance
0:17:11 > 0:17:13is another matter entirely.
0:17:13 > 0:17:15Without insurance cover, you're potentially looking at
0:17:15 > 0:17:17a pay-out that could break the bank.
0:17:19 > 0:17:23Kayleigh Farrell is the operations manager at i-Cog Claims Management.
0:17:23 > 0:17:27She recently dealt with a case involving a household contents claim
0:17:27 > 0:17:30as a result of an unlucky accident.
0:17:30 > 0:17:34The lady's children had been playing in the living room.
0:17:34 > 0:17:37There was a knock at the front door, and she had ordered a pizza.
0:17:37 > 0:17:40Therefore, she had departed the room itself
0:17:40 > 0:17:42and gone and collected the pizza.
0:17:42 > 0:17:45While she was making the payment, she had heard a loud bang,
0:17:45 > 0:17:48and all of a sudden, her children had gone quiet.
0:17:49 > 0:17:53When the woman returned to the living room, all became clear.
0:17:54 > 0:17:57They had knocked the unit which held the television.
0:17:57 > 0:17:59That resulted in the television falling onto the floor.
0:18:01 > 0:18:04The set was broken, and the claimant wanted a pay-out
0:18:04 > 0:18:07so she could purchase a replacement.
0:18:07 > 0:18:10On paper, the account was quite feasible.
0:18:10 > 0:18:14However, the main concern we had was that she took the policy out
0:18:14 > 0:18:17on a midweek evening, and within 24 hours,
0:18:17 > 0:18:19she had actually made the claim.
0:18:19 > 0:18:22The timing left a bad taste in the mouth,
0:18:22 > 0:18:24and further investigation was needed.
0:18:24 > 0:18:27The team re-examined the initial sales call from the customer.
0:18:29 > 0:18:34She asked the handler whether accidental damage to a television,
0:18:34 > 0:18:36caused by children, would be covered.
0:18:36 > 0:18:39This, to us, was of high concern.
0:18:39 > 0:18:42And their concern was only intensified
0:18:42 > 0:18:44by the next part of the call.
0:18:44 > 0:18:46The claimant also asked how soon
0:18:46 > 0:18:48she could make a claim on the policy itself.
0:18:48 > 0:18:53And, hey presto, just 24 hours later, she then made a claim.
0:18:53 > 0:18:56There could only be one conclusion.
0:18:56 > 0:18:58This quite clearly suggested to us
0:18:58 > 0:19:01that the incident had actually occurred prior to the claimant
0:19:01 > 0:19:03taking out the policy.
0:19:03 > 0:19:07In other words, the woman hadn't had insurance when the TV was broken.
0:19:07 > 0:19:10She'd subsequently taken out a policy
0:19:10 > 0:19:11and then attempted to claim on it
0:19:11 > 0:19:15by saying the damage had happened after she'd purchased cover.
0:19:15 > 0:19:20What's more, she had also amended the value of the claim upwards.
0:19:20 > 0:19:24So the claimant had informed us that the television was worth £400.
0:19:24 > 0:19:28At a later stage, she informed us that it was £1,000.
0:19:28 > 0:19:31Not many televisions more than double in value in the space
0:19:31 > 0:19:33of a few days. At this point,
0:19:33 > 0:19:37Kayleigh decided to discuss her concerns with the claimant.
0:19:39 > 0:19:41And when we informed the claimant that we had listened
0:19:41 > 0:19:44to the sales call, where she specifically asked
0:19:44 > 0:19:48whether the damage would be covered if it was caused by children,
0:19:48 > 0:19:52we then asked her, within 24 hours, how that damage had occurred,
0:19:52 > 0:19:56she simply explained to us that it was an omen,
0:19:56 > 0:19:57because it was Friday 13th.
0:20:11 > 0:20:15We were heavily surprised by the claimant's answering in this.
0:20:15 > 0:20:17It didn't make any sense to us.
0:20:17 > 0:20:21In fact, nothing about the woman's account made any sense,
0:20:21 > 0:20:24and there were further concerns about the timeframe.
0:20:24 > 0:20:27The claimant had initially informed us the damage had happened
0:20:27 > 0:20:31in the morning. However, she then obviously relayed a story
0:20:31 > 0:20:34that she had collected the pizza within the evening.
0:20:34 > 0:20:36She also claimed that she had taken
0:20:36 > 0:20:40the broken TV to a repair shop for assessment.
0:20:40 > 0:20:44She had been informed that it was unrepairable,
0:20:44 > 0:20:46it was a total write-off.
0:20:46 > 0:20:50The timeframe she provided didn't allow enough time
0:20:50 > 0:20:52for her to actually take a television to a company.
0:21:12 > 0:21:15When Kayleigh suggested that the damage had occurred
0:21:15 > 0:21:19earlier than claimed, the woman's reaction was striking.
0:21:19 > 0:21:22The claimant became almost like she had lost self-control.
0:21:22 > 0:21:25She started gabbling to us and repeating words,
0:21:25 > 0:21:29especially stating that the television was, in fact, working
0:21:29 > 0:21:31when she took the policy out.
0:21:42 > 0:21:46In Kayleigh's expedience, the woman's response was significant.
0:21:46 > 0:21:50She almost said it too often, and it was quite clear at that point
0:21:50 > 0:21:52that she was aware that we knew.
0:21:57 > 0:21:59With all the evidence on her side,
0:21:59 > 0:22:02Kayleigh wasn't about to be fobbed off.
0:22:02 > 0:22:04I obviously didn't let it go,
0:22:04 > 0:22:08and I believe that, really, she became quite tired of lying.
0:22:08 > 0:22:11See, one of the interesting things about lying
0:22:11 > 0:22:13is that it requires a lot of effort,
0:22:13 > 0:22:15sometimes resulting in stress, anxiety.
0:22:15 > 0:22:17In turn, it can take its toll on the body.
0:22:17 > 0:22:21After a while, the person telling the lie starts to become weary,
0:22:21 > 0:22:24and that's when they tend to fess up.
0:22:33 > 0:22:35Just as Kayleigh had suspected,
0:22:35 > 0:22:39the damage had occurred before the woman had taken out insurance.
0:22:39 > 0:22:42I believe the claimant was quite relieved
0:22:42 > 0:22:44once she had become truthful with myself,
0:22:44 > 0:22:47and that she wouldn't be further questioned.
0:23:02 > 0:23:05The claimant seemed quite surprised,
0:23:05 > 0:23:08and quite happily said that it wasn't fraud.
0:23:08 > 0:23:11That, to us, made it quite clear that she wasn't aware
0:23:11 > 0:23:14of the consequences of what she had actually done.
0:23:14 > 0:23:17But if she wasn't aware then, she is now.
0:23:17 > 0:23:22The claimant is clearly now not insured by that company,
0:23:22 > 0:23:25and she also was sent a letter to inform her
0:23:25 > 0:23:27that the police may be involved.
0:23:27 > 0:23:31In this case, the claimant had bitten off more than she could chew
0:23:31 > 0:23:34by cooking up an unconvincing cover story.
0:23:34 > 0:23:38She had lied, she'd been untruthful, and she wasn't on cover at the time.
0:23:38 > 0:23:42Fraud is a criminal offence and it will be dealt with seriously.
0:23:47 > 0:23:51Defending false insurance claims is important for commercial companies,
0:23:51 > 0:23:55as they want to avoid passing on costs to customers like you and me.
0:23:55 > 0:23:58But it is arguably even more important
0:23:58 > 0:24:00when it comes to protecting taxpayers' money.
0:24:04 > 0:24:06This is something that Jennifer Willis,
0:24:06 > 0:24:11acting governor of HMP Wakefield, takes very seriously.
0:24:11 > 0:24:13Wakefield is a Category A prison.
0:24:13 > 0:24:16It holds approximately 740 offenders
0:24:16 > 0:24:19and it forms part of the high security estate.
0:24:19 > 0:24:20Recently, a prisoner was injured
0:24:20 > 0:24:23in what appeared to be an unfortunate accident.
0:24:25 > 0:24:27Originally, he stated that he had fallen in the showers
0:24:27 > 0:24:29on an accumulation of water.
0:24:44 > 0:24:48There was never any doubt that he had genuinely been hurt as a result
0:24:48 > 0:24:50of his tumble in the prison showers.
0:24:50 > 0:24:52The injuries sustained were serious,
0:24:52 > 0:24:55in that there was a fracture to the right wrist.
0:24:55 > 0:24:58We ensured that the individual concerned received the right
0:24:58 > 0:25:01medical treatment, which included a visit to an outside hospital
0:25:01 > 0:25:04to ensure that the right care and support was given.
0:25:04 > 0:25:07Following the incident, all the relevant steps were taken.
0:25:07 > 0:25:12When an accident occurs, we document exactly what has happened and why,
0:25:12 > 0:25:15to see if there are any causes or reasons that we can then do
0:25:15 > 0:25:18to mitigate that incident happening again in the future.
0:25:18 > 0:25:20Generally speaking, after an accident,
0:25:20 > 0:25:22that's the end of the matter.
0:25:22 > 0:25:24But not in this case.
0:25:24 > 0:25:26The individual alleged his injuries
0:25:26 > 0:25:28were not the result of an unfortunate accident -
0:25:28 > 0:25:31instead, the prison was to blame.
0:25:31 > 0:25:34This, he claimed, was due to negligence on the part
0:25:34 > 0:25:37of the prison service, due to water being on the floor
0:25:37 > 0:25:40and the flooring being recently refurbished.
0:25:40 > 0:25:43Quite some claim.
0:25:43 > 0:25:46The individual had taken a shower, slipped on wet flooring
0:25:46 > 0:25:49and then alleged that the prison was at fault.
0:25:49 > 0:25:50And it wasn't cheap.
0:25:52 > 0:25:56The initial claim was submitted for £10,500.
0:25:56 > 0:25:59As far as the prison was concerned, there was no case to answer.
0:25:59 > 0:26:03We demonstrated to the claimant's solicitors that we were satisfied
0:26:03 > 0:26:05that we had robust systems in place,
0:26:05 > 0:26:07there were no witnesses to this event,
0:26:07 > 0:26:09there was no evidence that the flooring had been changed,
0:26:09 > 0:26:11and that this wasn't, in fact, an accident.
0:26:11 > 0:26:16However, the solicitors continued to proceed with a claim of negligence
0:26:16 > 0:26:18against the prison service.
0:26:18 > 0:26:21The case then proceeded to court.
0:26:21 > 0:26:23In terms of defending the claim,
0:26:23 > 0:26:26it was quite clear to us that the reason that the floor was wet
0:26:26 > 0:26:30in the showers was because he had just come out of the shower himself
0:26:30 > 0:26:34and there was no negligence on behalf of the service.
0:26:34 > 0:26:37The claimant's case was unsteady from the start.
0:26:37 > 0:26:41There were a number of elements that were contradictory during this case.
0:26:41 > 0:26:43First of all, during the court case,
0:26:43 > 0:26:47the claimant withdrew the claim that the floor surface was inappropriate.
0:26:47 > 0:26:52Also, there were inconsistencies around where he had dried himself,
0:26:52 > 0:26:55and he changed the statement about the floor being wet
0:26:55 > 0:26:59when entering the shower and identified that it was, in fact, dry
0:26:59 > 0:27:03until he came out of the shower, and then it was subsequently wet.
0:27:03 > 0:27:06In addition to this, there was also some question around
0:27:06 > 0:27:09the length of time, based on medical evidence,
0:27:09 > 0:27:13that he took to recover as a consequence of the injury sustained,
0:27:13 > 0:27:19which called into question the validity of the case presented.
0:27:19 > 0:27:22So much so, that the court ruled against him.
0:27:22 > 0:27:25Accidents happen and we need to make sure that we treat people decently.
0:27:25 > 0:27:28However, there was no compensation issued in this claim
0:27:28 > 0:27:31and actually, more than that, we were able to recoup the costs
0:27:31 > 0:27:36of £7,250 for the case to go to court in the first place.
0:27:36 > 0:27:40Ultimately, we are the ones who pay for false, negligent claims.
0:27:40 > 0:27:42But Jennifer and her colleagues
0:27:42 > 0:27:44are determined to protect the public purse.
0:27:44 > 0:27:47It's taxpayers' money that we're dealing with,
0:27:47 > 0:27:50and we will robustly defend any claims of this type.
0:27:55 > 0:27:58Insurance fraud in this country costs all of us money,
0:27:58 > 0:28:02but the days of no-questions-asked pay-outs are numbered.
0:28:02 > 0:28:05Insurers are using ever-more sophisticated technology
0:28:05 > 0:28:08to identify, track and prosecute fraudsters,
0:28:08 > 0:28:13and courts are using new powers to put these criminals behind bars.