Episode 7 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...

That's the subject out of the vehicle.

..sophisticated data analysis techniques...

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

Police, don't move, stay where you are!

..they're catching the criminals red-handed.

Just don't lie to us.

All those conmen, scammers and cheats on the fiddle are now

caught in the act and Claimed and Shamed.

A lorry driver claiming he can't walk pushes the boat out

with his false claim.

What you can actually see in this first period of surveillance

is Mr Heffer walking quite significant distances,

but, in addition to that, working on this fishing vessel as well.

Two men who stage a car crash claim to have never met,

but turn out to be old prison pals.

Not only they were in the same prison,

they were in the same cell block.

And not only were they in the same cell block,

but their cells were opposite each other.

So they would have seen each other every single day.

And a claimant who tries to board a moving bus is tripped up by CCTV.

What we actually see when we're looking at the footage is

a gentleman sprinting like a gazelle to try and get on the bus.

He lunges majestically at the last minute.

Every year, an estimated 4.1 million working days are lost

due to workplace injuries.

Whether it's a minor mishap or a life-threatening accident,

the goal for most of us is to get better and get back to work.

Now, if your employer is to blame for your accident,

you have the right to seek fair compensation.

However, this right is being exploited by fraudsters

who fake or exaggerate injuries in a bid for early retirement.

It's Rob Smith-Wright's job to suss out the real claims

from the rogue ones.

Back in 2009, he was handed what appeared to be an everyday claim.

Mr Heffer was an employee at one of our policyholders.

He claimed that when he was climbing into the cab of

a heavy goods vehicle, the tread plate that he was stepping onto

gave way, and he fell down to the floor,

injuring his back and left leg.

Although Mr Heffer's injuries were significant,

he was expected to make a full recovery.

After investigation,

the footplate that caused the accident was found to be faulty.

His employer admitted liability and awaited the claim.

But when it came in, there was something of a shock.

For an injury of this kind, sort of a simple back injury,

and injury to a left leg,

you would've expected some kind of compensation to the value of

around about £3,000-£5,000,

so when Mr Heffer served his schedule of damages,

it was served to the value of £400,000,

which would have been clearly things like lost earnings,

future lost earnings, care, future care and also provisions

that would allow him to lead a normal life.

That's a whopping ten times more than expected and suggested that

Mr Heffer's injuries were far more serious than first thought.

So, when Mr Heffer was being interviewed by the pain specialist,

he described that he was severely restricted in all

forms of mobility, he was unable to walk significant distances.

At this point he was also claiming that he was using walking sticks.

He wasn't able to drive.

He had severe pain in his left leg radiating down from his back.

He also described that actually, medication relief that

he was given for the pain was having no effect.

It sounded like Mr Heffer had suffered debilitating injuries

as well as losing his livelihood,

which had severely impacted on his quality of life.

But, given the nature of the accident,

something just wasn't adding up.

During the course of our investigations with

Mr Heffer's solicitors,

we were being told that Mr Heffer was suffering severe

restrictions and limitations as a result of the injuries,

which weren't really in-keeping with the circumstances that

were described to us.

We decided at that point that further investigations

would be needed because of those general red flags.

After taking a closer look at the case, a crucial decision was

made which Rob and his team hoped would address their doubts.

We undertook some general desktop profiling, which was starting

to reveal some inconsistencies in the account, certainly.

We decided at that point that a period of surveillance would help

us identify any inconsistencies that Mr Heffer may have been telling us.

It would be a period of surveillance that would last for over

three years, testing the commitment and patience of Rob's team.

The truth would slowly but most definitely reveal itself.

What you can actually see in this first period of surveillance

is Mr Heffer walking quite significant distances,

but in addition to that, working on this fishing vessel as well.

So, while claiming he could barely walk,

his sea legs appear to be just fine.

The second period of surveillance that we undertook here, again,

in direct contradiction to what he was telling the medical experts,

you can see that Mr Heffer has undertaken quite

a significant walk, around about 20 minutes,

to his local post office, where he's telling the medical expert

he's unable to walk any kind of significant distances.

Yep, previously he couldn't manage 100 yards because of the pain.

Now he was going miles to post his mail.

Generally speaking, you would have expected the surveillance

to show someone who was having problems with his mobility,

but the surveillance footage seems to indicate that there is

no problems at all and he is in fact walking quite freely.

Free as a bird and apparently without a care in the world.

My initial reaction on seeing this is one of surprise,

considering the level of disability and restriction that we were

being told that Mr Heffer was suffering.

With Heffer's energetic exploits and maritime mischief captured on

camera, the damning evidence was disclosed to his solicitor.

It was very clear at this point that we had discovered

an insurance fraud.

Very shortly afterwards, Mr Heffer's solicitor came off record

for him, leaving him as a litigant in person.

I think, at that point, if your solicitor's no longer

wanting to act for you, you have to say the game was very much up.

The game may have been up for Heffer,

but Rob and his investigative team were just getting started.

We were very pleased that Mr Heffer had decided

to discontinue his claim.

However, again,

we wanted to look at other ways in which we could send

a very strong deterrent message to someone who was prepared to

grossly exaggerate what looked like a genuine injury.

Given the statements that Mr Heffer had made to the court,

and these would have been statements of truth that

he would have signed and he had directly lied in those, we decided

that the best course of action was to take a Contempt of Court route.

And it wouldn't be long before Heffer found himself in

a dry dock, having to explain his open water adventures.

So, Mr Heffer was summoned to appear at Exeter Crown Court

in December 2015.

He claimed that the surveillance evidence was only really

showing him on good days, because he'd been taking painkilling

medication, but if we referred back to what

he actually told the pain specialist, he suggested that

the medication was having no effect on reducing his level of pain.

It had been a very lengthy process to bring Heffer to justice.

But when the case finally reached court, it was watertight.

The judge found him in contempt of court and described him as

abusing the civil procedure rules as a means to obtain financial

compensation above and beyond what he was entitled to,

so, effectively, calling him greedy.

And he was sentenced to three months imprisonment.

After a six-year investigation,

it was the result that Rob and his team had hoped for.

And for those who think what's the worst that can happen if

a claim is false or exaggerated?

There are claimants, including people like Mr Heffer,

that would think that simply walking away from the claim

is a risk that they are willing to take.

However, what they don't realise is that there are penalties

that can occur, including, as in this situation,

losing your liberty as a result of your direct greed.

A passenger's claim goes belly-up after trying to catch

a moving bus.

But the amazing thing from this footage is how fast this man

can actually run in flip-flops.

Now... PHONE RINGS

Oop! Just a minute.

Hello?

Yeah, hi.

No, I was riding my bike with no hands,

I was 11 years old at the time.

OK, thanks. See ya.

Now, if you've ever had an accident, the odds are you've received

an annoying call from a claims management company.

They'll tell you you're entitled to a nice little pay-out,

no win, no fee, so zero risk to you, whether you're injured or not.

What they don't tell you is that they'll take

a fat percentage of any successful claim.

But if your claim is found to be false,

then you are solely responsible.

And while they'll walk away, you could be in serious trouble.

Solicitor Ronan McCann has defended hundreds of cases

brought by claims management companies.

Many of these companies who farm claims are not all interested

in any individual.

They are solely interested in the profits

that they can make from your claim.

They will try all sorts of tactics

to convince you to pursue

a claim for compensation,

irrespective of whether

you are injured or not.

You must refuse under all circumstances to cooperate

with these dishonest companies.

The approach to persuading individuals into making

a claim can often be aggressive and persistent cold-calling.

If you succumb, the consequences can be severe.

The ramifications for pursuing a claim

when you are not genuinely injured are stark.

In the end, you may well go to prison.

There may be costs orders against you,

or you may indeed have your home taken away.

If any individual is invited to make a claim,

they should stop and ask themselves a very simple question...

were they injured?

Tom Gardiner is head of fraud for Aviva.

He deals with these types of claims on a daily basis.

But one case wasn't all that it appeared to be.

The accident that occurred was a relatively minor low-speed shunt,

at a roundabout, between a small Ford Fiesta

and a double-decker party bus.

So, a collision between a compact car and a whacking great bus.

The traffic accident equivalent of David and Goliath.

We inspected both of the vehicles.

There was minor damage to the bumper of the Fiesta

and only £70 worth of repairs to the bus.

On the face of it, this was a straightforward low-speed impact,

less than 10mph.

But it would have been impossible to predict what was to happen next.

What naturally aroused suspicion was that,

as the result of a very minor shunt, there was an epidemic of

whiplash injuries on the bus, resulting in 46 claims.

70 quid's worth of damage to the bus,

but the personal injury claims would amount to quite a bit more.

Whiplash injuries would typically have a value of

£1,500 to £3,000.

And with costs, each claim might be worth £5,000.

Clearly, 46 such claims is a significant amount of money.

And in this case, potentially a quarter of a million pounds.

It was just entirely disproportionate to what was

a low-speed impact and £70 worth of damage to the bus.

A staggering claim total.

So, what exactly was fuelling this tidal wave of compensation claims?

In this case, of the 46 claims that were brought,

two firms of solicitors represented 44 of the claimants,

which clearly doesn't hold up to any scrutiny.

With that many claims and alleged injuries,

surely the party bus would have diverted to the nearest A&E?

None of the 46 people sought medical attention at the time.

They were on a party bus, and continued their evening.

I'd be surprised if, following a significant collision,

resulting in whiplash injuries,

46 were able to continue partying.

With the overwhelming evidence that this group of revellers had been

cajoled into a bunch of cheeky chancers, the party had to end.

Of the 46 claims that were made, approximately half of them

disappeared and went away very quickly.

23 of them were litigated.

They started court action, but I'm pleased to say we successfully

defended those, and they were discontinued or struck out.

The robust approach to these suspect claims saved Aviva over

a quarter of a million pounds.

But for insurers,

the ultimate goal is to bring an end

to this compensation culture.

We will defend fraudulent claims even where it's not economic

to defend them.

And in this case, even faced with 23 litigated claims

and the threat of trial, we continued to defend those.

And, in the end, the lack of substance came through,

and none of the claims successfully made it to trial,

and we defended all of them.

There's an important role for claimant solicitors to play

to make sure that their door isn't open to fraud,

and they're not advancing what are clearly spurious claims.

Hey, life is busy, isn't it?

Whether you're rushing to work, running for a train

or trying to hop on a bus, most of us spend

a lot of time just trying to get from A to B without incident.

Unfortunately, our haste can occasionally lead to mishaps,

whether you trip on a step or clonk your head on a revolving door.

Most of us hold our hands up and say,

"All right, I should have been looking where I was going."

But there are some who see this type of accident as an opportunity

to exploit and defraud without conscience.

Lee Ingram of First Group sees his fair share

of personal injury cases.

Just like one customer who attempted to catch a bus a few years ago.

This gentleman's alleging that, as he's tried to get on the bus,

the driver's closed the doors on him.

He's also then saying that they've tried to drive off

while he's still boarding the bus.

This would be a terrifying situation.

You're going to be wondering whether you're going to be dragged

along the road and subsequently dragged under the wheels of the bus.

The claimant had a relatively lucky escape,

coming away with significant but not life-threatening injuries.

The injuries that were alleged by the claimant were quite

a severe laceration to the leg.

We could be looking at potential cosmetic surgery,

plastic surgery, you could be looking at secondary infections,

may well result in time off work, depending on what he does.

It's about a £20,000 claim. A nasty cut can produce a big bill.

But there was something wobbly about the claimant's story

which Lee just wasn't buying.

The suspicious thing about this claim is that we don't get

that many cases where drivers shut the doors on people,

and it was almost alleged that this was done deliberately.

I don't think that was the case.

Most of these incidents occur because people are rushing to get

on buses, and that's what we suspect actually happened in this case.

With the claimant making such severe allegations,

Lee had to get to the bottom of this case quickly

and find out if he did indeed have a leg to stand on.

As soon as we received this claim from the gentleman,

obviously we're going to look and see what our driver has said,

so we've gone back to the driver,

taken a full statement of their version of events,

and we've also gone to look at the on-board CCTV from the bus

to see if that does corroborate what this claimant is saying.

One of them has got it slightly wrong.

But which one?

Let's have a look.

What we actually see when we're looking at the footage

is a gentleman sprinting like a gazelle to try and get on the bus.

He lunges majestically at the last minute.

Hold on...

let's just check that one more time.

His left foot slips underneath the door, his right leg gives way.

And he falls backwards off of the bus.

All gazelle-like comparisons end at that point.

A bit different to a driver

intentionally closing the doors on him.

But the amazing thing from this footage is how fast this man

can actually run in flip-flops.

With the claimant's dash for personal injury cash kaput,

it seems his choice of footwear that day was

a big contributing factor to his fall.

The CCTV in this instance totally disproves the allegations

made by the claimant.

With the truth caught on camera, the claimant was busted.

Unlike his leg, which he had alleged had been gashed to the extent

he'd needed plastic surgery.

Not a drop of blood, not even a tear in his jeans -

although he might need a new pair of flip-flops.

This case resulted in a full repudiation of the claim.

Amazingly, the solicitor subsequently came back to us

changing their story, saying that the driver should have actually

seen their claimant, who was at the doors at the time they were closed.

Upon reviewing the CCTV, we can see that when those doors

were closing, that bus stop was empty.

None of our drivers are trained to wait for invisible passengers.

Proof that First Group will examine all claims thoroughly -

both genuine and false.

I think from this case it's clear to see that we will use

all evidence we have at our disposal to refute claims or,

as in a lot of cases, to uphold claims.

Thankfully, the chances of having an accident on the road

are relatively low, so what are the chances

of crashing into someone you know?

Pretty slim, you'd imagine.

Well, when it comes to scammers arranging deliberate crashes

to try and get a bumper pay-out from insurers, the odds shoot up.

This type of fraud is often arranged

between parties that know each other.

The first thing suspicious insurers will do is look into

claimants' backgrounds and establish that all-important connection.

Susan Evans has seen every type of car con in the book.

In 2012, she was passed a claim that required her well-trained eye.

This particular accident, our policy holder, Mr Bougoussa,

was driving his Jaguar when a third-party vehicle, Mr Chammeme,

pulled out of a side road into his path.

TYRES SCREECH

CRASH

There was quite a heavy impact.

Mr Bougoussa had a passenger in his vehicle, supposedly,

and we were told the damage had been occasioned to both vehicles.

The claim in total was about £16,000,

not an insignificant amount, but certainly one

that we would see on a regular basis.

On the surface, this case appeared to be an everyday claim,

but both men were overeager to ram home

particular details of the accident.

Mr Bougoussa was very specific in his description of the third party

and was quite adamant that he'd never met him before,

and the third party, in his description, again,

was adamant that they've never met and they'd never

come into contact before or after the accident.

TYRES SCREECH

But it would be the condition of their cars that first gave

real cause for concern.

Our suspicions were aroused as we sent an engineer out

to examine the vehicles.

That showed us that the car had not had just one impact,

that there'd been multiple impacts,

and also that he was stationary when the accident had taken place.

Strong evidence this was no genuine claim.

TYRES SCREECH

CRASH

With this in mind, it was time to visit the scene of the crash.

We actually sent an investigator out to look at the junction

where the accident happened.

It was a very wide, open junction,

really, really good visibility,

it was quite difficult to accept that somebody could have

pulled out into the path of another vehicle in those circumstances.

Susan suspected that this could be a staged collision and an attempt to

defraud Admiral, but further proof was needed to establish

a connection between Bougoussa and Chammeme.

So we actually looked into the background of all individuals

supposedly involved in the incident, and we were able to

establish that not only did they know one another prior to

the accident, but that they'd actually been in the same prison

for a considerable length of time.

CELL DOOR SLAMS

With the information that the accident wasn't

the first time these two men had been banged up together,

it was time to hand over their investigation.

DC Paula Doyle is an Ifed detective and part of the team

that took on the case.

Admiral had already worked out that

both men had been in prison together,

and that there were major inconsistencies

in the circumstances of the accident.

Ifed detectives analysed the evidence,

and quickly concluded that there were just too many coincidences

in Bougoussa and Chammeme's story to be plausible.

The first thing I actually did was to call the prison to ask them

how unlikely it would be for these two men

not to have come into contact with each other within the prison.

Their answer was that it was pretty unlikely, cos not only

they were in the same prison, they were in the same cell block.

And not only were they in the same cell block,

but their cells were opposite each other.

So they would have seen each other every single day.

So these two used to be neighbours in the nick.

Now they appeared to be crash buddies on the outside,

but they still couldn't get their stories straight.

An additional personal injury claim went in from

a guy called Abdul Rahid.

When he was interviewed,

Mr Bougoussa couldn't even remember

what he was called, he called him "Dino",

and in fact, further to that,

Mr Chammeme described him as a 6ft tall black male,

whereas in interview, Mr Bougoussa described him as an Asian male.

With this third passenger having all the credibility of Bigfoot,

Paula analysed the engineer's accident report in forensic detail.

Mr Bougoussa's car, which was meant to have been travelling at 30mph,

had damage consistent with it

being still at the time and not travelling.

The damage on his car was actually overlapping,

which would mean it had been hit more than once by Mr Chammeme's car.

The damage also indicated that Mr Chammeme's car didn't have

its registration plate on at the time.

Which is unusual, because normally when you are out driving,

you would have your number plate attached to your car.

And when asked to explain the discrepancies,

the pair had very different responses.

Mr Bougoussa simply said, "No comment."

Mr Chammeme, however, had a story,

and his story was that when he hit Mr Bougoussa, he'd reversed.

Which would not account for two impacts,

so I didn't believe this was true.

And I asked him, if that was the case, why did you not then

have your registration plate attached to your car?

And he pretended not to be able to understand what I'd asked him.

Playing dumb wouldn't help the fact that the physical evidence

suggested that Chammeme had

intentionally and repeatedly driven his car

into Bougoussa's, to stage the accident damage.

Both men maintained that the accident was genuine and that

they didn't know each other.

So obviously, I then have to go a little bit further to prove

that they do know each other,

and that meant a visit to the prison that held Mr Chammeme's file.

I did find eventually what I was looking for,

and that was a document that was from Mr Chammeme to the prison

requesting that he be allowed to send £100 to Mr Bougoussa's wife.

Despite the overwhelming evidence, the pair were sticking

to their rather confused stories, and the case proceeded to trial.

They both pleaded not guilty, but in a little bit of

a twist to the story, they actually did admit they knew each other.

Mr Chammeme gave a defence saying,

"We met in prison, we stayed in touch,

"and in fact, I was on my way to meet

"Mr Bougoussa when the accident happened,"

and the accident was genuine, just an unfortunate coincidence that

he happened to hit the person he was going to meet that day.

But Chammeme would soon change his tune.

I think after making that defence, Mr Chammeme must have realised

how ludicrous it was

and promptly changed his mind and pleaded guilty.

And Bougoussa quickly followed suit, changing his plea to guilty.

They were given nine-month suspended sentences,

suspended for two years,

they were both given a two-year supervision order,

and additionally, Mr Chammeme was

ordered to do 120 hours of unpaid work.

They may have narrowly avoided a custodial sentence,

but they were held accountable for their attempted fraud.

We never did find Mr Rahid, or Dino,

and given that the accident didn't actually happen,

it's highly unlikely that there was a passenger in the car.

And he's been just invented

to make more money out of the insurance company.

Bougoussa and Chammeme thought they were on to a winner

staging this accident,

but their shambolic execution was their undoing.

I think they thought the claim wouldn't get looked at

and they wouldn't get found out.

Unfortunately, it was looked at and they did get found out.

They underestimated the lengths that Ifed will go to, to prove a case.

Insurance fraud hits all of us in the pocket,

but more and more of these scammers and conmen

are being Claimed and Shamed.