Episode 6 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, 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, a gang of fraudsters finally gets busted.

The chances of actually being caught,

as far as they were concerned, was nil.

They hadn't been caught to date

and there's no reason why somebody's going to knock on their door now.

..a slip and trip claim evaporates...

In terms of defending the claim, it was quite clear to us that

the reason the floor was wet in the showers was because he had just

come out of the shower himself.

..and the diagnosis isn't good for an overseas medical claim.

Our investigator visited the hospital, and spoke with one of

the doctors, who immediately confirmed that the customer

was never treated at this hospital.

These days, there is a real determination to stamp out fraud.

Security has been improved,

insurers are more aware, and legal loopholes have been closed.

But the biggest change is that there is now a specialised police unit.

Ifed is the City of London Police's

Insurance Fraud Enforcement Department,

a dedicated team of detectives

committed to stopping insurance fraudsters.

There's ever more sophisticated detection tools

being used by the industry.

We're getting more and more cases every day.

This elite squad has prevented millions of pounds being paid out

to criminals in fraudulent claims.

From now on, insurance cheats need to look over their shoulders.

It's all fraud, it's all crime, and it can all lead to prison.

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

Simon Styles is an Ifed financial investigator.

He recently worked on a complex case involving motor insurance.

Early 2012, there was about 15 different insurers

found that there was a pattern linked to credit cards being used

and compromised, the same bank accounts that were being used,

and the same details of vehicles being used in accidents.

The case was referred to Ifed, and an investigation was launched.

It soon became clear that these were no ordinary fraudsters.

They had gone to great lengths to cover their tracks.

In the beginning of this investigation,

we didn't know who was involved.

We had the instances, but we didn't have the suspects.

One thing they did know was that the gang had targeted

the most vulnerable members of society.

This criminal gang was operating by opening insurance policies

by use of credit cards from unsuspecting members of the public,

elderly women or, in fact, ladies who were deceased.

After using the stolen identities to take out motor insurance,

they then moved to the next stage of the scam.

And so what they would then do was to put together an accident

and make an accident claim report to the insurer,

stating that they had had an accident

and giving details of the other driver.

But these were all made up.

They used random houses, random names, random cars,

just to legitimise their claim.

Once they had invented an accident,

they were then able to make money from selling the details on.

This was targeting solicitors in the main,

and the referral fee.

So if they put together a claim with the driver

and two passengers, they would get £700 per claim.

So those three claims, they would pocket £2,100.

And they would do that by producing an invoice

to the unsuspecting solicitor,

who would readily pay that money to take the case on.

The law has now changed in England and Wales, but at the time,

solicitors paid big money for referrals

on the assumption that they would recoup their costs

down the line when the claim was paid out by insurers.

By the time they found out there were no accidents,

it was too late.

This gang wasn't interested in the claims going forward

because the accident didn't happen.

What they're interested in is referral payments,

and that is what they were focused on

and that's what they got.

£167,000 that this gang received.

They'd been freely lining their pockets for a year and a half.

But with Ifed on the case, the net was about to close in.

As a financial investigator, it's always about following the money.

Everything out of this investigation was false,

or forged, or altered, to hide the suspects' trail.

The only thing is true and, in my experience always is,

is a bank account.

It's got to be opened by two forms of identification,

usually a passport or a utility bill,

which usually shows the identity of that individual.

This occasion, it did. It showed the identity of Mr Shad.

He was one of our main suspects.

In any event, it showed the money going in and the money going out.

Once they had pinpointed one person, the rest were soon identified.

The other main player was Israr Hussain.

At this stage, the gang didn't suspect a thing.

The chances of actually being caught,

as far as they were concerned, the gang were concerned, was nil.

They hadn't been caught to date, and there was no reason

why someone's going to knock on their door now.

But that all changed.

Ifed decided it was time to move in and arrest the main suspects.

Just pull up here.

Some six addresses were visited on the day of the raid,

April 23rd 2013.

Coming!

Quiet, please. Quiet, please.

When they arrive, they aren't exactly given a warm welcome.

-What?

-BLEEP

KNOCKING, THEN SEVERAL VOICES SHOUTING

Come down, please, and talk to the police.

50 officers attended these addresses

and I attended one address, in Keighley,

where the main subject, Hussain, resided.

Fortunately, he's at home, and is promptly dealt with.

I am arresting you on suspicion of conspiracy to defraud.

You do not have to say anything, but it may harm your defence

if you do not mention when questioned

something that you later rely on in court.

What a morning, yeah? What a morning, eh?

Hussain is then removed to a local police station

for further questioning.

With the house clear, the search can begin in earnest.

You don't know where people hide things,

so you have to go through everything, really.

That methodical approach pays off an hour into the search,

when Simon makes an important discovery.

I'm going through some files here.

One of note, here, is a vehicle registration number.

This relates to a vehicle

that is currently sat on the driveway of these premises,

that I know from my investigation has been used,

or at least the registration number and details have been used,

in contrived accidents.

It links that vehicle to this address.

That is vital evidence.

Coordinating the multiple raids is DCI Dave Wood.

This Toyota motorcar does actually feature itself in the inquiry.

As you can see, as we walk round it,

there are some minor nicks, which you'd expect on a car of its age.

But there would appear to be no substantial damage

to indicate that it has been involved in

any road traffic accidents.

Uniformed officers then perform a thorough search of the car.

As predicted, it yields plenty of potential evidence.

As we looked through the front window,

we could see, on the front passenger seat, some paperwork.

That documentation was relating to an accident

that occurred in November last year,

so clearly, we're interested in that

and the circumstances behind it.

That will form part of the investigation,

and those papers are now part of the evidential chain.

They've been seized and exhibited by the officer that found them.

Back inside, Simon is still hard at work.

I've found a piece of paper that was found on the floor just by the bin,

and what it's got is a couple of e-mail addresses, one for a

solicitor's and one for an accident management company in Glasgow.

That's something we don't know about.

It looks as though the referrals have finished in England and Wales,

but have started or are continuing in Scotland.

The Scottish connection is significant

as, in Scotland, referral fees are still legal.

The piece of paper had an e-mail address on it

which Simon traced to a solicitors' practice in Glasgow.

So I rang them up and asked them, had they been victims?

They did not know that they had been,

and it was shown that they were,

and that was a vital piece of evidence

that we subsequently used in a criminal trial.

But the raid yields more than just paperwork.

It's a ceremonial sword.

In the wrong hands, deadly.

So it is upsetting and annoying to see,

especially as that's so close to where all the children are running,

next to their bedrooms.

And that's not the only weapon they find.

DCI Dave Wood receives a shocking update

from one of the other raid locations.

The officers have found a handgun.

They're not sure exactly what it is and what it isn't,

so they've called out the local police,

West Yorkshire's firearms team, to come and make it safe

and identify exactly what the weapon is.

I believe it was found in one of the bedrooms,

but it's just come through to me, that's all I know at the moment.

The raids had been a huge success, and the evidence collected

laid bare the true extent of the fraud.

Just to show you the scale of the events, say there's 300 claims,

there were seven bank accounts identified

that received over £167,000,

which would result in 105 payments into that account.

There were ten claims management companies that they set up.

35 insurers were targeted in this 18-month period.

The sheer magnitude was startling.

But they had reached the end of the road.

Six people arrested, six people were interviewed

and six people attended court.

The case was due to go to trial at Bradford Crown Court,

but at the last minute,

the defendants appeared to have a reality check.

In fact, due to the overwhelming evidence

that we presented to the courts,

the main instigators in this organised gang, this scam,

pleaded guilty.

The sentences that were handed out reflected the seriousness

of the £167,000 fraud.

Two of them, Hussain and Shad,

received four and a half years' imprisonment.

To me, it was a great result.

Simon has a warning for any would-be fraudsters.

The people like this gang in Bradford

who think they can get away with this, targeting people

who cannot look after themselves or whatever,

we will do something about it.

We knocked on the door, they were unsuspecting,

they didn't expect that we were going to be turning up, we did,

and as a result of our efforts, they're now sitting in prison.

Still to come, a claimant doth protest too much.

Getting ill while you're abroad is most people's worst nightmare.

But fraudsters see it as an opportunity.

They assume that the further away something happens,

the less likely it is to be investigated.

Big mistake.

But things have changed,

as Simon Cook, Cega's head of special investigations,

knows all too well.

He recently worked on the case of a traveller who was struck down

by a serious illness on a trip to Nigeria.

The customer contacted our medical emergency helpline to tell us

that he was in Nigeria, and unfortunately,

for the last eight days, he had been in hospital,

where he had been diagnosed with malaria.

Malaria is a tropical disease

that can be fatal if not treated properly.

Initially the patient didn't provide any details about his condition.

We didn't find this too unusual,

because he had been in hospital for eight days with malaria.

The next stage for Cega was to contact the hospital.

We tried to make contact with the doctor,

but couldn't get through to him.

We also tried to get in contact with the administration staff,

but there was simply no answer from the hospital.

We could understand why the doctor might not be available,

because he would be treating patients,

but not to actually get hold of anyone at the hospital

was particularly strange.

Also strange was the cost of the treatment, according to the patient.

And he had already paid £1,850 sterling for his medical treatment.

The costs being claimed by the customer

were completely disproportionate to what we would expect from

a reputable hospital in Nigeria.

Two days before his flight home,

the customer appeared to have made a remarkable recovery.

He contacted Cega to say he had been discharged,

and would be returning to the UK as planned.

We referred the case through to our medical team, who stated

it was a little bit unusual that the customer would be deemed

fit to travel so soon after being discharged from hospital,

where he was diagnosed with malaria.

The customer subsequently sent in paperwork to support his claim.

The customer provided us with various documents,

such as a medical report, a booking invoice.

But he had also provided us with a couple of photographs of himself

in a hospital bed.

There were question marks, though, about the documents.

We noted there were various spelling mistakes in the medical report

that he provided, which we wouldn't expect from

a reputable hospital in Nigeria.

But of even more cause for concern were the photographs.

We have absolutely no understanding

why the customer sent these photographs through to us,

because we didn't ask for photos of him in a hospital bed,

as that would be completely unethical.

The customer intended the photos to put his claim in the clear,

but they actually moved it to the critical list.

We referred them over to our medical team, and they stated

that it certainly appeared that the cannula

had been Sellotaped to his arm, as opposed to inserted into his arm.

A cannula is a tube that is inserted into the body

to deliver or sometimes remove fluids.

If the customer was genuinely unwell with malaria,

he certainly wouldn't have a cannula Sellotaped to his hand.

This wasn't just a sticking point -

it called the whole claim into question.

Based on the information we had received from the customer,

we did have serious concerns,

which led to us appointing one of our overseas investigators

to actually go out to the hospital

and interview the doctor or the hospital staff.

His evidence effectively put the claim out of its misery.

Our investigator visited the hospital

and spoke with one of the doctors,

who immediately confirmed that the documents were false,

and that the customer was never treated at this hospital.

But Cega decided to give the customer one last chance

to tell his side of the story.

He didn't really have much to say,

apart from he was going to complete his own investigations in Nigeria.

At this point, we were wholly satisfied

that the claim submitted was fraudulent.

And that meant that there were consequences for the customer.

He couldn't just walk away.

We declined the claim in full.

The customer actually agreed to pay our investigation fee back,

so we still don't know what happened

about his own investigations on this occasion.

Far from stinging the company for an undeserved malaria pay-out,

the customer has now been hit in the pocket.

It just proves that where there are concerns with the claim,

no matter where in the world

the incident is said to have taken place,

we will investigate these claims thoroughly.

Now, we've all dropped the odd plate or mug and thought nothing of it.

Some more than others.

But smashing a top-of-the-range appliance

is another matter entirely.

Without insurance cover, you're potentially looking at

a pay-out that could break the bank.

Kayleigh Farrell is the operations manager at i-Cog Claims Management.

She recently dealt with a case involving a household contents claim

as a result of an unlucky accident.

The lady's children had been playing in the living room.

There was a knock at the front door, and she had ordered a pizza.

Therefore, she had departed the room itself

and gone and collected the pizza.

While she was making the payment, she had heard a loud bang,

and all of a sudden, her children had gone quiet.

When the woman returned to the living room, all became clear.

They had knocked the unit which held the television.

That resulted in the television falling onto the floor.

The set was broken, and the claimant wanted a pay-out

so she could purchase a replacement.

On paper, the account was quite feasible.

However, the main concern we had was that she took the policy out

on a midweek evening, and within 24 hours,

she had actually made the claim.

The timing left a bad taste in the mouth,

and further investigation was needed.

The team re-examined the initial sales call from the customer.

She asked the handler whether accidental damage to a television,

caused by children, would be covered.

This, to us, was of high concern.

And their concern was only intensified

by the next part of the call.

The claimant also asked how soon

she could make a claim on the policy itself.

And, hey presto, just 24 hours later, she then made a claim.

There could only be one conclusion.

This quite clearly suggested to us

that the incident had actually occurred prior to the claimant

taking out the policy.

In other words, the woman hadn't had insurance when the TV was broken.

She'd subsequently taken out a policy

and then attempted to claim on it

by saying the damage had happened after she'd purchased cover.

What's more, she had also amended the value of the claim upwards.

So the claimant had informed us that the television was worth £400.

At a later stage, she informed us that it was £1,000.

Not many televisions more than double in value in the space

of a few days. At this point,

Kayleigh decided to discuss her concerns with the claimant.

And when we informed the claimant that we had listened

to the sales call, where she specifically asked

whether the damage would be covered if it was caused by children,

we then asked her, within 24 hours, how that damage had occurred,

she simply explained to us that it was an omen,

because it was Friday 13th.

We were heavily surprised by the claimant's answering in this.

It didn't make any sense to us.

In fact, nothing about the woman's account made any sense,

and there were further concerns about the timeframe.

The claimant had initially informed us the damage had happened

in the morning. However, she then obviously relayed a story

that she had collected the pizza within the evening.

She also claimed that she had taken

the broken TV to a repair shop for assessment.

She had been informed that it was unrepairable,

it was a total write-off.

The timeframe she provided didn't allow enough time

for her to actually take a television to a company.

When Kayleigh suggested that the damage had occurred

earlier than claimed, the woman's reaction was striking.

The claimant became almost like she had lost self-control.

She started gabbling to us and repeating words,

especially stating that the television was, in fact, working

when she took the policy out.

In Kayleigh's expedience, the woman's response was significant.

She almost said it too often, and it was quite clear at that point

that she was aware that we knew.

With all the evidence on her side,

Kayleigh wasn't about to be fobbed off.

I obviously didn't let it go,

and I believe that, really, she became quite tired of lying.

See, one of the interesting things about lying

is that it requires a lot of effort,

sometimes resulting in stress, anxiety.

In turn, it can take its toll on the body.

After a while, the person telling the lie starts to become weary,

and that's when they tend to fess up.

Just as Kayleigh had suspected,

the damage had occurred before the woman had taken out insurance.

I believe the claimant was quite relieved

once she had become truthful with myself,

and that she wouldn't be further questioned.

The claimant seemed quite surprised,

and quite happily said that it wasn't fraud.

That, to us, made it quite clear that she wasn't aware

of the consequences of what she had actually done.

But if she wasn't aware then, she is now.

The claimant is clearly now not insured by that company,

and she also was sent a letter to inform her

that the police may be involved.

In this case, the claimant had bitten off more than she could chew

by cooking up an unconvincing cover story.

She had lied, she'd been untruthful, and she wasn't on cover at the time.

Fraud is a criminal offence and it will be dealt with seriously.

Defending false insurance claims is important for commercial companies,

as they want to avoid passing on costs to customers like you and me.

But it is arguably even more important

when it comes to protecting taxpayers' money.

This is something that Jennifer Willis,

acting governor of HMP Wakefield, takes very seriously.

Wakefield is a Category A prison.

It holds approximately 740 offenders

and it forms part of the high security estate.

Recently, a prisoner was injured

in what appeared to be an unfortunate accident.

Originally, he stated that he had fallen in the showers

on an accumulation of water.

There was never any doubt that he had genuinely been hurt as a result

of his tumble in the prison showers.

The injuries sustained were serious,

in that there was a fracture to the right wrist.

We ensured that the individual concerned received the right

medical treatment, which included a visit to an outside hospital

to ensure that the right care and support was given.

Following the incident, all the relevant steps were taken.

When an accident occurs, we document exactly what has happened and why,

to see if there are any causes or reasons that we can then do

to mitigate that incident happening again in the future.

Generally speaking, after an accident,

that's the end of the matter.

But not in this case.

The individual alleged his injuries

were not the result of an unfortunate accident -

instead, the prison was to blame.

This, he claimed, was due to negligence on the part

of the prison service, due to water being on the floor

and the flooring being recently refurbished.

Quite some claim.

The individual had taken a shower, slipped on wet flooring

and then alleged that the prison was at fault.

And it wasn't cheap.

The initial claim was submitted for £10,500.

As far as the prison was concerned, there was no case to answer.

We demonstrated to the claimant's solicitors that we were satisfied

that we had robust systems in place,

there were no witnesses to this event,

there was no evidence that the flooring had been changed,

and that this wasn't, in fact, an accident.

However, the solicitors continued to proceed with a claim of negligence

against the prison service.

The case then proceeded to court.

In terms of defending the claim,

it was quite clear to us that the reason that the floor was wet

in the showers was because he had just come out of the shower himself

and there was no negligence on behalf of the service.

The claimant's case was unsteady from the start.

There were a number of elements that were contradictory during this case.

First of all, during the court case,

the claimant withdrew the claim that the floor surface was inappropriate.

Also, there were inconsistencies around where he had dried himself,

and he changed the statement about the floor being wet

when entering the shower and identified that it was, in fact, dry

until he came out of the shower, and then it was subsequently wet.

In addition to this, there was also some question around

the length of time, based on medical evidence,

that he took to recover as a consequence of the injury sustained,

which called into question the validity of the case presented.

So much so, that the court ruled against him.

Accidents happen and we need to make sure that we treat people decently.

However, there was no compensation issued in this claim

and actually, more than that, we were able to recoup the costs

of £7,250 for the case to go to court in the first place.

Ultimately, we are the ones who pay for false, negligent claims.

But Jennifer and her colleagues

are determined to protect the public purse.

It's taxpayers' money that we're dealing with,

and we will robustly defend any claims of this type.

Insurance fraud in this country costs all of us money,

but the days of no-questions-asked pay-outs are numbered.

Insurers are using ever-more sophisticated technology

to identify, track and prosecute fraudsters,

and courts are using new powers to put these criminals behind bars.