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 > 0:00:30The fraudsters are risking more and more to make a quick killing
0:00:30 > 0:00:34and, every year, it is adding around £50 to your insurance bill.
0:00:34 > 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 the vehicle.
0:00:44 > 0:00:46..sophisticated data analysis techniques...
0:00:49 > 0:00:51..and a number of highly-skilled police units...
0:00:51 > 0:00:53Stay where you are!
0:00:53 > 0:00:55..they're catching the criminals red-handed.
0:00:55 > 0:00:56Just 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.
0:01:11 > 0:01:15A flashy fraudster shows off his ill-gotten gains...
0:01:15 > 0:01:18Exotic foreign holidays, exotic cars,
0:01:18 > 0:01:23we've identified £80,000 plus that couldn't be accounted for.
0:01:23 > 0:01:27It's a family affair, as one scammer steals from her own grandmother.
0:01:27 > 0:01:29This was so premeditated.
0:01:29 > 0:01:33I should imagine she's extremely unpopular in her family.
0:01:33 > 0:01:37And one claimant develops a very convenient case of amnesia.
0:01:46 > 0:01:50If you're a 17-year-old trying to get insurance on your first car,
0:01:50 > 0:01:53the premiums can be eye-wateringly expensive -
0:01:53 > 0:01:55well over £2,000 a year.
0:01:55 > 0:01:58And it goes up from there if you happen to be male,
0:01:58 > 0:02:01so if a broker offered you a much lower price,
0:02:01 > 0:02:04you can see why the temptation would be there to go for it,
0:02:04 > 0:02:07even if you thought it all sounded a bit too good to be true.
0:02:10 > 0:02:13It's these sorts of high-risk individuals that so-called
0:02:13 > 0:02:15ghost brokers target, as Clare Lunn
0:02:15 > 0:02:17from insurance providers LV explains.
0:02:19 > 0:02:23A ghost broker is an individual or group of individuals who set up
0:02:23 > 0:02:25policies for the general public,
0:02:25 > 0:02:30deliberately misrepresenting the risk to obtain cheaper premiums.
0:02:30 > 0:02:33So, a ghost broker might sell a policy to a 17-year-old,
0:02:33 > 0:02:36but get a cheap price, by telling the insurer
0:02:36 > 0:02:38it's for an older, lower-risk driver.
0:02:38 > 0:02:42The ghost broker then pockets the difference between what the policy
0:02:42 > 0:02:44costs and what he charged the 17-year-old.
0:02:44 > 0:02:47What's more, the insurance policy would be worthless,
0:02:47 > 0:02:50leaving the 17-year-old uncovered.
0:02:50 > 0:02:52In the worst-case scenario,
0:02:52 > 0:02:56someone who's been a victim of a ghost broker can be driving around
0:02:56 > 0:02:59in a vehicle, thinking that they're actually insured,
0:02:59 > 0:03:03when the policy has been cancelled and they're driving uninsured.
0:03:05 > 0:03:07Back at the start of 2013,
0:03:07 > 0:03:11LV started to get suspicious that they were being targeted by a ghost
0:03:11 > 0:03:15broker. They noticed some startling similarities in the details
0:03:15 > 0:03:17of some of their motor insurance policies.
0:03:19 > 0:03:23There were some key factors that linked these policies together.
0:03:23 > 0:03:29These were the use of bank accounts and foreign cards which had been
0:03:29 > 0:03:33compromised and also e-mail addresses
0:03:33 > 0:03:37and a common occupation of accountancy.
0:03:38 > 0:03:42During the investigations into the e-mail addresses and bank accounts
0:03:42 > 0:03:45that had been used on several different policies,
0:03:45 > 0:03:47one name kept cropping up - a Mr Abdulatif.
0:03:49 > 0:03:53At first, LV were only suspicious about a few motor policies,
0:03:53 > 0:03:56but once they knew what and who to look for,
0:03:56 > 0:03:59the scale of the fraud escalated.
0:03:59 > 0:04:02Originally, this started off as three policies,
0:04:02 > 0:04:06but it very quickly grew and it was, in fact, the fastest-growing
0:04:06 > 0:04:11fraud ring in LV's history, until it reached nearly 700 policies.
0:04:11 > 0:04:14With suspected fraud on a level this vast,
0:04:14 > 0:04:17LV got in touch with IFED.
0:04:19 > 0:04:21IFED is the City of London Police's
0:04:21 > 0:04:24Insurance Fraud Enforcement Department -
0:04:24 > 0:04:26a dedicated team of detectives
0:04:26 > 0:04:29committed to stopping insurance fraud cheats.
0:04:30 > 0:04:32There is ever-more sophisticated
0:04:32 > 0:04:34detection tools being used by the industry.
0:04:34 > 0:04:36We're getting more and more cases every day.
0:04:39 > 0:04:42This elite squad has prevented millions of pounds from being paid
0:04:42 > 0:04:44out to criminals in fraudulent claims.
0:04:44 > 0:04:48From now on, insurance cheats need to look over their shoulders.
0:04:49 > 0:04:53It's all fraud, it's all crime and it can all lead to prison.
0:04:53 > 0:04:55Police, don't move, stay where you are!
0:04:57 > 0:05:00Police Sergeant Steven Holland works for IFED.
0:05:00 > 0:05:03Once the team took up the case of the suspected ghost broker,
0:05:03 > 0:05:04their first port of call
0:05:04 > 0:05:07was to start investigating the prime suspect...
0:05:09 > 0:05:10..Mr Abdulatif.
0:05:11 > 0:05:13The initial investigation starts
0:05:13 > 0:05:17with some financial investigation work which highlighted that
0:05:17 > 0:05:21Mr Abdulatif is earning money through illegitimate sources,
0:05:21 > 0:05:25we believe. He stated his occupation was a trainee estate agent
0:05:25 > 0:05:29and also a courier. However, we've identified £80,000-plus
0:05:29 > 0:05:33of money going to the account that couldn't be accounted for.
0:05:34 > 0:05:37They also undertook a social networking search
0:05:37 > 0:05:40and were utterly astonished at what they found.
0:05:40 > 0:05:44Mr Abdulatif was enjoying luxuries well beyond the means of a trainee
0:05:44 > 0:05:47estate agent. He'd posted countless
0:05:47 > 0:05:50photos of himself all over his social media pages,
0:05:50 > 0:05:53flaunting his wealth and expensive tastes.
0:05:55 > 0:06:00It shows Mr Abdulatif living a champagne lifestyle.
0:06:00 > 0:06:01Exotic foreign holidays.
0:06:02 > 0:06:03Exotic cars.
0:06:05 > 0:06:08Something that we wouldn't put together with
0:06:08 > 0:06:10a trainee estate agent's salary.
0:06:12 > 0:06:15Everything indicated towards us that Mr Abdulatif was involved in the
0:06:15 > 0:06:18ghost broking and he was our initial and only suspect.
0:06:22 > 0:06:24If this wasn't proof enough,
0:06:24 > 0:06:28the investigation uncovered further undeniable evidence
0:06:28 > 0:06:30that Mr Abdulatif was, indeed, a ghost broker.
0:06:32 > 0:06:38We found over 100 text messages, in relation to offering and asking
0:06:38 > 0:06:41to supply fraudulent insurance.
0:06:41 > 0:06:45We also seized a laptop and, within that, we found several insurance
0:06:45 > 0:06:49companies, certificates of insurance, which he was obviously
0:06:49 > 0:06:52doctoring to provide to the people who were buying the insurance
0:06:52 > 0:06:54policies, but they were all fraudulent.
0:06:55 > 0:06:57And a lot of unsuspecting people
0:06:57 > 0:07:00were buying their car insurance through
0:07:00 > 0:07:02this particularly showy fraudster.
0:07:02 > 0:07:05Mr Abdulatif was making money through either selling
0:07:05 > 0:07:07fraudulent insurance policies
0:07:07 > 0:07:10to members of the public and they would pay him and that money
0:07:10 > 0:07:12would go into his own bank account,
0:07:12 > 0:07:15or alternatively, he was phoning the insurance companies directly
0:07:15 > 0:07:19and paying for these policies with compromised bank cards
0:07:19 > 0:07:22or compromised bank account details.
0:07:22 > 0:07:26The policies paid for by these fake or fraudulently-acquired bank cards
0:07:26 > 0:07:29would quickly be cancelled by the insurance company,
0:07:29 > 0:07:32but of course, Abdulatif wouldn't tell his clients this,
0:07:32 > 0:07:36so many were driving around totally unaware that they had
0:07:36 > 0:07:38no car insurance whatsoever.
0:07:39 > 0:07:43If one of these fraudulent insurance policyholders were in an accident,
0:07:43 > 0:07:45unfortunately, their policy would be worthless.
0:07:48 > 0:07:51Mr Abdulatif took advantage of innocent members of the public
0:07:51 > 0:07:53who paid him for their car insurance,
0:07:53 > 0:07:56but ended up with either no motor policy, at all,
0:07:56 > 0:07:59or a totally-invalid insurance policy.
0:07:59 > 0:08:03But this wasn't as low as this greedy fraudster would go.
0:08:03 > 0:08:07Mr Abdulatif realised that he could make even more money by selling
0:08:07 > 0:08:09insurance to the otherwise uninsurable.
0:08:11 > 0:08:14Mr Abdulatif was selling these policies to either genuine members
0:08:14 > 0:08:17of the public who thought they were buying insurance,
0:08:17 > 0:08:20but we also noticed a proportion of these policies going to known
0:08:20 > 0:08:24criminals and to criminals who had either been disqualified from
0:08:24 > 0:08:29driving, for offences such as drink-driving, or totting up points
0:08:29 > 0:08:31for things like no insurance.
0:08:31 > 0:08:32That's right.
0:08:32 > 0:08:34Thanks to Mr Abdulatif,
0:08:34 > 0:08:37banned drunk drivers were getting back behind the wheel.
0:08:38 > 0:08:41To provide these disqualified drivers with motor policies,
0:08:41 > 0:08:45he would simply forget to tell the insurance company that these people
0:08:45 > 0:08:47had convictions, in the hope they wouldn't check.
0:08:49 > 0:08:50But they did.
0:08:51 > 0:08:55Despite thinking he was untouchable, the police arrested Mr Abdulatif.
0:08:56 > 0:09:00And in October 2015, he was tried at the Old Bailey.
0:09:01 > 0:09:07We had a really strong case with all the evidence that we seized and that
0:09:07 > 0:09:09we went through and it showed
0:09:09 > 0:09:12Mr Abdulatif provided fraudulent insurance policies
0:09:12 > 0:09:15to various members of the public.
0:09:15 > 0:09:20Mr Abdulatif pleaded guilty to 18 charges of fraud.
0:09:20 > 0:09:24He had made over £100,000 from his criminal activities.
0:09:26 > 0:09:30Abdulatif was sentenced to three years behind bars and given
0:09:30 > 0:09:31a confiscation order,
0:09:31 > 0:09:34meaning that almost all of the money will be recovered.
0:09:42 > 0:09:44Still to come...
0:09:45 > 0:09:49A cyclist has a lucky escape, after colliding with not one,
0:09:49 > 0:09:51but two large metal objects.
0:09:51 > 0:09:54The cyclist has flown around the outside. He's just tried to get
0:09:54 > 0:09:57through this gap. There's no way he's going to get through that.
0:09:57 > 0:10:00True enough, he doesn't get through.
0:10:00 > 0:10:03And a woman lands herself in hot water, when her claim for a leak
0:10:03 > 0:10:05goes down the pan.
0:10:14 > 0:10:18Now, on our busy city centre roads there is a constant battle between
0:10:18 > 0:10:20cyclists and buses.
0:10:20 > 0:10:23Bus drivers say cyclists take unnecessary risks,
0:10:23 > 0:10:27and cyclists are adamant that bus drivers are not vigilant enough
0:10:27 > 0:10:30behind the wheel. One thing is for certain, though -
0:10:30 > 0:10:33when collisions DO happen between a 20-tonne bus and a bike,
0:10:33 > 0:10:37there is no contest about who comes off worse.
0:10:37 > 0:10:39And tragically, according to the latest figures,
0:10:39 > 0:10:44around 3,500 people are seriously injured or killed every year
0:10:44 > 0:10:46on their bikes.
0:10:53 > 0:10:56Lee Ingram works as a claims team manager for FirstGroup
0:10:56 > 0:10:59and it's his job to make sure that if any one of his fleet of over
0:10:59 > 0:11:026,000 buses cause an injury or an accident,
0:11:02 > 0:11:04the right people get compensated.
0:11:06 > 0:11:09FirstGroup run many buses around the country,
0:11:09 > 0:11:13covering a lot of distance on a lot of different types of roads.
0:11:13 > 0:11:15Naturally, in busy city centres,
0:11:15 > 0:11:18we also share those roads with not just other vehicles,
0:11:18 > 0:11:20but with pedestrians and cyclists.
0:11:22 > 0:11:25Lee dealt with one case in a town centre, where a cyclist
0:11:25 > 0:11:27was knocked off his bike by a bus.
0:11:30 > 0:11:32In this case, fortunately, it wasn't fatal,
0:11:32 > 0:11:35but it was quite a serious accident that we had to investigate.
0:11:35 > 0:11:39The claimant in this particular instance was alleging that he was
0:11:39 > 0:11:41travelling in a designated lane.
0:11:41 > 0:11:44He was turning right at a box junction,
0:11:44 > 0:11:47and one of our buses had come from behind him
0:11:47 > 0:11:48and, as it was passing him,
0:11:48 > 0:11:52it has clipped his arm, forcing him to careen off the bus.
0:11:52 > 0:11:57Unfortunately, there's an electrical junction box ahead of him
0:11:57 > 0:11:59and he smashed into this junction box.
0:11:59 > 0:12:03So, he's been unfortunate enough to be hit by a bus
0:12:03 > 0:12:07and then he's been forced into an immovable metal object.
0:12:07 > 0:12:09A serious accident.
0:12:09 > 0:12:12And, as expected, the unfortunate cyclist claimed to have sustained
0:12:12 > 0:12:13a number of injuries.
0:12:16 > 0:12:22So, he's suffered some cuts to his hands, injured his wrist, his arms,
0:12:22 > 0:12:27his shoulders, his neck, his lower back, he's got headaches.
0:12:27 > 0:12:31The trauma of being hit by a bus or shunted into this object,
0:12:31 > 0:12:34has caused him to have flashbacks, insomnia.
0:12:34 > 0:12:37He's claiming a temporary loss of vision.
0:12:37 > 0:12:39So, a wide range of injuries,
0:12:39 > 0:12:43valuing at probably around £15,000 to £20,000
0:12:43 > 0:12:46worth of damages on his claim alone.
0:12:47 > 0:12:48Given the gravity of the incident,
0:12:48 > 0:12:52the first thing Lee and his team did was to speak to the witnesses.
0:12:52 > 0:12:55And, you guessed it, there was a busload of them.
0:12:57 > 0:12:58You've got the driver.
0:12:58 > 0:13:01Obviously, you've got to question what they've done.
0:13:01 > 0:13:03Remember, this is a bus carrying passengers -
0:13:03 > 0:13:05always guaranteed to have plenty of witnesses.
0:13:05 > 0:13:08So, every single one of those we're going to want to check,
0:13:08 > 0:13:09to see if their version of events
0:13:09 > 0:13:12matches with the claimant's version of events.
0:13:12 > 0:13:16And in this case, they didn't. The passengers' accounts of what
0:13:16 > 0:13:19happened put a huge dent in the cyclist's story.
0:13:19 > 0:13:20They felt the driver of the bus
0:13:20 > 0:13:23was driving in a perfectly-normal manner.
0:13:23 > 0:13:26No evidence that he was driving too fast.
0:13:26 > 0:13:29In comparison to that, they did feel that the cyclist
0:13:29 > 0:13:32was going way too fast for the conditions.
0:13:32 > 0:13:36Certainly trying to squeeze through a gap, just as the bus has started
0:13:36 > 0:13:40moving forward and the witnesses themselves did actually feel
0:13:40 > 0:13:43that the cyclist was responsible for the collision.
0:13:43 > 0:13:45With these differing accounts,
0:13:45 > 0:13:49Lee and his team focused in on the CCTV cameras fitted on the bus.
0:13:51 > 0:13:54And the footage confirmed the witnesses' version of events,
0:13:54 > 0:13:55NOT the cyclist's.
0:13:57 > 0:14:00It showed the cyclist speeding alongside the bus.
0:14:00 > 0:14:04It turns right and then attempts to squeeze past through a tiny gap
0:14:04 > 0:14:06between the bus and the curb.
0:14:07 > 0:14:10The cyclist has flown around the outside
0:14:10 > 0:14:13and there's no way he can see ahead of him.
0:14:13 > 0:14:15He's just tried to get through this gap.
0:14:15 > 0:14:18There's no way he's going to get through that, and true enough,
0:14:18 > 0:14:20he doesn't get through that.
0:14:20 > 0:14:22It is a nerve-racking watch,
0:14:22 > 0:14:25as the CCTV footage captures the moment of impact.
0:14:25 > 0:14:29Keep your eye on the top right-hand corner of the screen.
0:14:29 > 0:14:32It was clear that it was the cyclist's own reckless actions
0:14:32 > 0:14:34that caused him to crash into the electrical box.
0:14:36 > 0:14:39This guy could have been horrendously injured.
0:14:39 > 0:14:42If he'd gone under that bus, his injuries could have been
0:14:42 > 0:14:44very serious, if not fatal.
0:14:44 > 0:14:47And all from an accident that could have easily been avoided.
0:14:48 > 0:14:52For Lee and his team, the CCTV evidence brought the cyclist's claim
0:14:52 > 0:14:53crashing to the ground.
0:14:53 > 0:14:55We promptly went back to his solicitors and said,
0:14:55 > 0:14:58"We're not paying this claim, for these reasons.
0:14:58 > 0:15:00"We don't think we were at fault.
0:15:00 > 0:15:04"Your client obviously put themselves in a position of danger"
0:15:04 > 0:15:07and we never heard back from them.
0:15:08 > 0:15:10This was a nasty accident
0:15:10 > 0:15:13and the collision with the electrical box must have been
0:15:13 > 0:15:15particularly shocking for the cyclist,
0:15:15 > 0:15:19who was lucky not to have suffered any serious injuries.
0:15:19 > 0:15:22However, in this case, the cyclist had to take responsibility.
0:15:22 > 0:15:26There can be conflict sometimes between cyclists and users of large
0:15:26 > 0:15:29vehicles. Maybe there just needs to be a bit of tolerance between road
0:15:29 > 0:15:32users, particularly cyclists and other vehicles,
0:15:32 > 0:15:35to avoid far more serious events actually happening.
0:15:44 > 0:15:46Family heirlooms are priceless.
0:15:46 > 0:15:49Really, there's no insurance cover in the world that can account for
0:15:49 > 0:15:53the sentimental value attached to items that have been handed down
0:15:53 > 0:15:56through the generations. But of course, if something has
0:15:56 > 0:15:59a financial value to it, as well as a sentimental one,
0:15:59 > 0:16:01it makes perfect sense to make sure
0:16:01 > 0:16:04it's included in your household insurance.
0:16:06 > 0:16:11Companies like RSA provide exactly this sort of protection.
0:16:11 > 0:16:13John Beadle heads up their counter-fraud department
0:16:13 > 0:16:16and previously dealt with a customer who had taken out contents insurance
0:16:16 > 0:16:18on her home.
0:16:21 > 0:16:27This particular lady took out a household policy with us
0:16:27 > 0:16:29and one of the specified items on
0:16:29 > 0:16:33her policy for all-risk cover was an
0:16:33 > 0:16:34emerald ring,
0:16:34 > 0:16:38valued at £11,650.
0:16:40 > 0:16:42So, an expensive piece of jewellery,
0:16:42 > 0:16:44which also had a rich family history,
0:16:44 > 0:16:47making it all the more valuable to the claimant.
0:16:47 > 0:16:51The ring actually had come from her grandmother,
0:16:51 > 0:16:54who had, in turn, been given it by her grandfather,
0:16:54 > 0:17:00who had bought it for his wife when he came back from India.
0:17:00 > 0:17:05A lovely little gem of a story, but it wasn't to have a happy ending.
0:17:05 > 0:17:09A very short time after she took the policy out, she made a claim,
0:17:09 > 0:17:13saying that the ring had slipped off her finger
0:17:13 > 0:17:16and got lost while she was gardening.
0:17:16 > 0:17:18Now, I've heard of having green fingers,
0:17:18 > 0:17:22but wearing your grandma's emerald ring, worth over 11 grand,
0:17:22 > 0:17:25whilst doing a spot of weeding seemed unlikely.
0:17:25 > 0:17:28John and his team weren't altogether convinced by the granddaughter's
0:17:28 > 0:17:31story, and asked her for further information.
0:17:31 > 0:17:37She provided to us some photographs of her wearing the ring,
0:17:37 > 0:17:39which, in itself, was quite curious,
0:17:39 > 0:17:44the way the photographs had almost been purposefully done to show
0:17:44 > 0:17:49the ring, and she produced a valuation for the ring,
0:17:49 > 0:17:52which had actually only just been obtained
0:17:52 > 0:17:55a relatively short while beforehand.
0:17:55 > 0:17:59Something just wasn't ringing true about the story of the lost piece
0:17:59 > 0:18:02- of jewellery.- I think there were a number of factors
0:18:02 > 0:18:05that conspired together to make us suspicious of this claim.
0:18:05 > 0:18:11The loss occurring so shortly after the policy had been taken out,
0:18:11 > 0:18:17the photographs, the recent evaluation which had been obtained,
0:18:17 > 0:18:21all added up to make us a little suspicious around the claim,
0:18:21 > 0:18:25so we decided to investigate further.
0:18:26 > 0:18:30And where better to get a few pearls of wisdom about the case than from
0:18:30 > 0:18:34the original owner of the ring, the claimant's grandmother?
0:18:34 > 0:18:38We spoke to the grandmother, who actually confirmed to us
0:18:38 > 0:18:40that the ring belonged to her,
0:18:40 > 0:18:43and hadn't been gifted to her granddaughter.
0:18:43 > 0:18:48And, in fact, the ring was still in the possession of the grandmother.
0:18:48 > 0:18:56She told us that the ring she hid in a secret place in her bedroom.
0:18:56 > 0:18:57The plot thickens.
0:18:57 > 0:19:02The ring wasn't lost, at all, but safe and sound in granny's house.
0:19:02 > 0:19:04However, there was another mystery to solve.
0:19:04 > 0:19:08Strangely enough, she did notice the ring missing recently,
0:19:08 > 0:19:10for a relatively short period,
0:19:10 > 0:19:15but the ring then reappeared back in its hiding place.
0:19:15 > 0:19:19Very few people knew where granny hid her precious emerald ring.
0:19:19 > 0:19:22Conveniently, her granddaughter did.
0:19:22 > 0:19:24To John and his team, it was obvious
0:19:24 > 0:19:27what their gold-digging customer had been up to.
0:19:27 > 0:19:30The claimant had removed the ring
0:19:30 > 0:19:33from her grandmother's hiding place...
0:19:35 > 0:19:38..taken photos of it on her finger...
0:19:39 > 0:19:41..and took a policy out with us
0:19:41 > 0:19:44with the specific aim of making a claim for
0:19:44 > 0:19:49the ring. Then, put the ring back where she had removed it from,
0:19:49 > 0:19:51in her grandmother's bedroom.
0:19:52 > 0:19:55They confronted their scamming customer with the facts they had
0:19:55 > 0:19:57gleaned from her own relative.
0:19:57 > 0:20:02She did try to withdraw the claim and cancel her policy,
0:20:02 > 0:20:04but the circumstances around this
0:20:04 > 0:20:07were so well thought-out that we decided
0:20:07 > 0:20:10it was a case that we needed to refer to IFED
0:20:10 > 0:20:12and that's what we did.
0:20:13 > 0:20:16IFED were keen to take up the case,
0:20:16 > 0:20:18and soon caught up with the claimant.
0:20:18 > 0:20:20She received a caution...
0:20:22 > 0:20:25..and, ultimately, we have now placed her on
0:20:25 > 0:20:27the insurance fraud register,
0:20:27 > 0:20:31which will cause her problems when she tries to get insurance
0:20:31 > 0:20:32in the future.
0:20:32 > 0:20:36But you'd hope that she was also getting a fair amount of comeuppance
0:20:36 > 0:20:37closer to home.
0:20:37 > 0:20:41I should imagine she's extremely unpopular in her family.
0:20:41 > 0:20:44I mean, this was so premeditated,
0:20:44 > 0:20:46and unbeknown to anybody else in her family,
0:20:46 > 0:20:52she had ultimately embroiled them, in her attempt to obtain
0:20:52 > 0:20:55quite a large amount of money.
0:20:55 > 0:21:00This fraudster's golden plan to make a quick £11,650
0:21:00 > 0:21:03was quickly foiled by John and his team.
0:21:09 > 0:21:13Coming up, a cat owner attempts to defraud her insurers, to pay for
0:21:13 > 0:21:16the treatment of her precious pet's upset tummy.
0:21:23 > 0:21:25As long as insurance policies exist,
0:21:25 > 0:21:29there will always be people out there who try and abuse the system.
0:21:29 > 0:21:33If an insurance company even has an inkling that something isn't quite
0:21:33 > 0:21:37right with a claim, they can refer it up to specialist agents.
0:21:39 > 0:21:43Agents like those employed at I-COG Claims Management,
0:21:43 > 0:21:46whose staff is trained to analyse speech and behaviour patterns,
0:21:46 > 0:21:48in order to expose those claimants
0:21:48 > 0:21:50who may not be telling the whole truth.
0:21:52 > 0:21:55One such claim was recently referred to Claire Mitten,
0:21:55 > 0:21:58I-COG's highly-skilled Operations Director.
0:22:03 > 0:22:07The case involves a man who claimed he'd been the victim of a mugging
0:22:07 > 0:22:10in a park in Glasgow, in which his gold necklace
0:22:10 > 0:22:13had been snatched from around his neck.
0:22:13 > 0:22:16The total of the claim was £750.
0:22:16 > 0:22:18He was claiming for a gold chain
0:22:18 > 0:22:21which had a diamante boxing glove pendant attached to it.
0:22:21 > 0:22:23Before we even got to speak to the insured,
0:22:23 > 0:22:27he had three failed appointments, where he wouldn't answer our calls.
0:22:27 > 0:22:30There were just so many concerns with it that we knew straightaway
0:22:30 > 0:22:32that this was a really interesting claim to deal with.
0:22:32 > 0:22:34It was fourth time lucky,
0:22:34 > 0:22:37as Claire finally got through to the claimant, to get a blow-by-blow
0:22:37 > 0:22:40account of the theft of his boxing-glove necklace.
0:23:00 > 0:23:01Mm-hm.
0:23:05 > 0:23:06Mm-hm.
0:23:10 > 0:23:11Mm-hm.
0:23:32 > 0:23:35So, a dramatic and frightening mugging,
0:23:35 > 0:23:38the sort of attack that can leave its mark on the victim
0:23:38 > 0:23:40both emotionally and physically.
0:24:18 > 0:24:19To Claire, the lack of injuries
0:24:19 > 0:24:22sustained by the claimant seemed unusual
0:24:22 > 0:24:23for an attack this physical,
0:24:23 > 0:24:26and especially given that a fairly thick necklace
0:24:26 > 0:24:28had been pulled off his neck.
0:24:29 > 0:24:33You would have thought that there would be some markings to the neck,
0:24:33 > 0:24:34such as scratchings or bruising to the neck
0:24:34 > 0:24:36where it had been ripped off.
0:24:56 > 0:24:59When somebody has been attacked, more often than not they can
0:24:59 > 0:25:01describe the offenders in great detail,
0:25:01 > 0:25:03because they've been so close to them.
0:25:03 > 0:25:07This insured was not able to give us any description, other than he was
0:25:07 > 0:25:10a well-dressed junkie with yellow skin.
0:25:10 > 0:25:13It seemed odd to Claire that the customer couldn't describe
0:25:13 > 0:25:16his attacker well, but it was what he claimed happened
0:25:16 > 0:25:20immediately after the attack that left his story on the ropes.
0:25:20 > 0:25:24Rather than calling 999 or seeking any sort of help,
0:25:24 > 0:25:25the claimant got into his car
0:25:25 > 0:25:29and drove off to collect his wife from work, as normal.
0:26:05 > 0:26:08The claimant went on to explain that, after he'd picked up his wife,
0:26:08 > 0:26:11they did then go to their local police station,
0:26:11 > 0:26:12to report the incident.
0:26:42 > 0:26:46Even if you lost your chain in the park, rather than had it stolen,
0:26:46 > 0:26:48you would still be given some sort of reference number from the police,
0:26:48 > 0:26:50so this was really alarming.
0:27:19 > 0:27:22The claimant was sticking to his story that he'd not been given
0:27:22 > 0:27:25a crime reference number, but the staff at I-COG have
0:27:25 > 0:27:29an expert knowledge of police systems and this gave Claire
0:27:29 > 0:27:32the upper hand. The gloves were now off, as she challenged
0:27:32 > 0:27:36her opponent further about his alleged written statement.
0:28:06 > 0:28:09When we asked the insured if we were able to contact the police,
0:28:09 > 0:28:11to get a copy of the statement that he made,
0:28:11 > 0:28:15he actually softened his voice. He became very nervous and explained
0:28:15 > 0:28:19that he didn't know what the police would be able to provide us with.
0:28:19 > 0:28:21If you do report an incident like that to the police and you have
0:28:21 > 0:28:24given a statement, then actually those reports and statements
0:28:24 > 0:28:26need to be kept for at least 15 years.
0:28:27 > 0:28:30There was one final inconsistency, in regards to the detail
0:28:30 > 0:28:32of the fight in the park
0:28:32 > 0:28:36that really packed the finishing punch to the validity of the case.
0:28:37 > 0:28:41It was the claimant's wife who had initially rung the insurance company
0:28:41 > 0:28:45to report her husband's mugging. But the version of events she told them
0:28:45 > 0:28:49differed substantially to what the claimant had just told Claire.
0:29:29 > 0:29:33Whether you make a claim that's worth £250 or a claim that is worth
0:29:33 > 0:29:35£1 million, the claim is always going to be investigated
0:29:35 > 0:29:38by the insurance company, and there's no way of thinking that,
0:29:38 > 0:29:41just because it's a low-value claim, it's going to get paid out.
0:29:41 > 0:29:44If it's not right, if the account doesn't add up,
0:29:44 > 0:29:46if the information you've given doesn't add up,
0:29:46 > 0:29:49then it will get investigated further.
0:29:49 > 0:29:51And in this case, the claim didn't add up.
0:30:02 > 0:30:06The inconsistencies and the fact there was no crime reference number
0:30:06 > 0:30:07meant that Claire had no choice
0:30:07 > 0:30:11but to recommend to the insurance company not to pay out a penny
0:30:11 > 0:30:13for the alleged stolen chain.
0:30:21 > 0:30:25Now, it's one of those things that none of us wants to be a victim of -
0:30:25 > 0:30:28coming home to find a burst pipe has flooded your house.
0:30:28 > 0:30:32Even a small leak can cost thousands.
0:30:32 > 0:30:34And if you don't have the right insurance,
0:30:34 > 0:30:37you'll be the one soaking up the costs.
0:30:37 > 0:30:40David Berry is the Technical Fraud Manager for Lloyd's Bank Group.
0:30:40 > 0:30:43His team recently dealt with a claim from a customer
0:30:43 > 0:30:45with a home contents policy.
0:30:47 > 0:30:51She called us on the 30th of October and reported to us that when she had
0:30:51 > 0:30:53returned home after being out for most of the day,
0:30:53 > 0:30:56she saw water pouring in through the ceiling in her bedroom.
0:31:14 > 0:31:17According to the customer, the damage was extensive.
0:31:25 > 0:31:29David recalls all the items that the customer was claiming for
0:31:29 > 0:31:30and it's quite the list.
0:31:30 > 0:31:32A mattress, an electric blanket,
0:31:32 > 0:31:35the carpeting, the decorations in the room,
0:31:35 > 0:31:39an iron. There was a hairdryer in the room as well and also a laptop.
0:31:39 > 0:31:42All of those items were damaged by the water that was coming
0:31:42 > 0:31:43through the ceiling.
0:31:44 > 0:31:48The value of the claim was estimated at £2,200.
0:31:48 > 0:31:52On closer inspection, it emerged that the policy had been taken out
0:31:52 > 0:31:54only two weeks before the claim.
0:31:55 > 0:31:59It's not unusual for customers to suffer losses so close to when
0:31:59 > 0:32:04the policy's taken out, but it can occasionally raise some concerns,
0:32:04 > 0:32:07particularly given the nature of the type of loss that's presented.
0:32:08 > 0:32:10As part of the standard process,
0:32:10 > 0:32:13the claims handler asked the customer to provide evidence
0:32:13 > 0:32:15of the damage the leak has caused.
0:32:28 > 0:32:30The customer obliged, and sent in photographs.
0:32:30 > 0:32:35But little did she know these would end up sinking her claim.
0:32:35 > 0:32:36When she produced that information,
0:32:36 > 0:32:41we identified, from the properties within the digital photographs,
0:32:41 > 0:32:44that they were actually taken in September.
0:32:44 > 0:32:46A month before she claimed the leak had occurred.
0:32:47 > 0:32:50Our customer couldn't explain that to us, and as a result,
0:32:50 > 0:32:53we declined the claim on the grounds of fraud and cancelled the policy.
0:32:54 > 0:32:56But there was worse to come.
0:32:56 > 0:32:58As fraud had been detected,
0:32:58 > 0:33:00David decided to refer the case up to IFED.
0:33:00 > 0:33:05The police accepted that she had no previous history of, er,
0:33:05 > 0:33:08inappropriate behaviour, no previous convictions or similar.
0:33:08 > 0:33:11As a result, they felt it was appropriate to deal with the matter
0:33:11 > 0:33:12by way of a police caution.
0:33:12 > 0:33:15IFED may have been lenient in this case,
0:33:15 > 0:33:19but the customer now has a criminal record.
0:33:20 > 0:33:22If you're going to try and make a false claim,
0:33:22 > 0:33:26you'd better make sure you have a watertight cover story.
0:33:27 > 0:33:30Lloyds Bank insurance take matters of fraud extremely seriously,
0:33:30 > 0:33:33and as a result of that, we hope to protect our honest customers.
0:33:42 > 0:33:44Whether you're a dog lover
0:33:44 > 0:33:46or it's cats that make you weak at the knees,
0:33:46 > 0:33:48if you love animals and have a pet,
0:33:48 > 0:33:50they soon become part of the family.
0:33:50 > 0:33:54Many people get a bit of a shock at the amount vets charge
0:33:54 > 0:33:58for their services. Sadly, there is no NHS for animals.
0:34:00 > 0:34:02Thankfully, though, there are companies,
0:34:02 > 0:34:06like Agria Pet Insurance, that will provide cover for vets' bills.
0:34:06 > 0:34:07Back in 2014,
0:34:07 > 0:34:10Simon Wheeler dealt with a case involving owners who had taken out
0:34:10 > 0:34:13a policy for their Ragdoll cat.
0:34:13 > 0:34:17This rather beautiful breed is renowned for its bright blue eyes
0:34:17 > 0:34:19and affectionate nature.
0:34:19 > 0:34:20CAT MEWS
0:34:20 > 0:34:24The policyholder insured the pet on the 1st of December.
0:34:24 > 0:34:28About 11 days after the policy started,
0:34:28 > 0:34:32we got a notification from the policyholder that their Ragdoll
0:34:32 > 0:34:35had suffered a bout of diarrhoea.
0:34:35 > 0:34:38And we got a notification claim for probably around the £200 mark
0:34:38 > 0:34:40would be coming in.
0:34:42 > 0:34:46The poor moggy had come down with a bad case of the runs
0:34:46 > 0:34:49and the owner had taken it to the vet for treatment.
0:34:49 > 0:34:53The cat's illness may not have been pleasant, but the timing of it was.
0:34:53 > 0:34:57All pet insurers insist on something called an exclusion,
0:34:57 > 0:35:01or waiting period, before you can make a claim for your pet's illness.
0:35:01 > 0:35:03This is to stop people from taking out cover
0:35:03 > 0:35:06the moment they think their pet is sick.
0:35:07 > 0:35:09Luckily, for the owner of this particular kitty,
0:35:09 > 0:35:12the cat's illness started just one day
0:35:12 > 0:35:14after they were allowed to put in the claim.
0:35:16 > 0:35:18At the time that we received the claim,
0:35:18 > 0:35:19the notification for the claim,
0:35:19 > 0:35:22it was just outside the exclusion period for illness.
0:35:22 > 0:35:24The dates all tied up.
0:35:24 > 0:35:27So, to all intents and purposes, it seemed a valid claim.
0:35:29 > 0:35:32The owner must have felt like the cat that got the cream,
0:35:32 > 0:35:35knowing their vets' bill would be covered.
0:35:35 > 0:35:38But as soon as Simon and his team were sent the paperwork,
0:35:38 > 0:35:39they found a problem.
0:35:42 > 0:35:44When we got the claim form,
0:35:44 > 0:35:47we also received the full veterinary history from the vet
0:35:47 > 0:35:50and, when we looked at the veterinary history,
0:35:50 > 0:35:53we noticed the first signs of diarrhoea
0:35:53 > 0:35:57and the first symptoms had been noted on the 4th of December,
0:35:57 > 0:36:01so a long time before the policyholder had told us,
0:36:01 > 0:36:04and certainly in the middle of the exclusion period
0:36:04 > 0:36:06at the start of a policy for illness.
0:36:07 > 0:36:11Simon and his team carefully examined the rest of the paperwork
0:36:11 > 0:36:15and found something that really set the cat amongst the pigeons.
0:36:15 > 0:36:17Not only did the policyholder
0:36:17 > 0:36:20submit the wrong date in their part of the claim form,
0:36:20 > 0:36:21they'd also filled in a date
0:36:21 > 0:36:23on the veterinary part of the claim form
0:36:23 > 0:36:27and put a Post-it note for the vet to say, if possible,
0:36:27 > 0:36:31can you make the date the 11th of December or later,
0:36:31 > 0:36:34otherwise this is unlikely to be covered.
0:36:34 > 0:36:39This one Post-it note led to the entire claim coming unstuck.
0:36:39 > 0:36:41It was blatant fraud.
0:36:41 > 0:36:45The policyholder knew exactly what they were doing.
0:36:45 > 0:36:48They knew that the condition of the diarrhoea wasn't covered,
0:36:48 > 0:36:49that it occurred
0:36:49 > 0:36:51within the exclusion period at the beginning of the policy.
0:36:51 > 0:36:56They then tried to coerce, or persuade, the vet to support them,
0:36:56 > 0:37:00in terms of getting a dishonest claim paid by the insurance company.
0:37:00 > 0:37:04Unsurprisingly, Agria didn't pay out a penny for the treatment
0:37:04 > 0:37:06of this cat's diarrhoea.
0:37:06 > 0:37:09It's very common for vets to talk to us about claims
0:37:09 > 0:37:13and for us to talk to vets about claims, when we receive them.
0:37:13 > 0:37:16In this instance, I think the policyholder
0:37:16 > 0:37:19misjudged just what information would come in with the claim
0:37:19 > 0:37:21and what would be on that information.
0:37:29 > 0:37:31When doctors graduate from medical school,
0:37:31 > 0:37:34they take an oath which states they have a duty to act in the best
0:37:34 > 0:37:36interests of their patients.
0:37:36 > 0:37:38But what if they don't?
0:37:38 > 0:37:42What if a doctor was only motivated by personal gain?
0:37:42 > 0:37:45Well, in America, individuals pay for their medical care,
0:37:45 > 0:37:48so private health care insurance is a must.
0:37:48 > 0:37:51But this can give unscrupulous physicians
0:37:51 > 0:37:53the opportunity to commit fraud.
0:37:57 > 0:38:01New York is renowned as the city that never sleeps
0:38:01 > 0:38:05and its 20 million residents require round-the-clock health care.
0:38:05 > 0:38:08Dr Spiros Paulos was an orthopaedic surgeon.
0:38:08 > 0:38:10These specialists exclusively perform bone
0:38:10 > 0:38:12or muscular-related operations.
0:38:13 > 0:38:16He practised at a high-volume private medical centre
0:38:16 > 0:38:17in New York state.
0:38:21 > 0:38:24Spiros reportedly carried out thousands of surgeries
0:38:24 > 0:38:26between 2006 and 2011,
0:38:26 > 0:38:31and was performing up to and over 20 procedures every single day.
0:38:33 > 0:38:36That's a staggering turnover for one doctor,
0:38:36 > 0:38:40which some might say is an example of a man devoted to his job.
0:38:42 > 0:38:45This couldn't have been further from the truth.
0:38:47 > 0:38:51Dr Spiros Paulos's only devotion was to lining his own pockets.
0:38:51 > 0:38:54He was conducting surgeries and carrying out procedures
0:38:54 > 0:38:56his patients didn't need,
0:38:56 > 0:39:00so he could submit false insurance claims, which would pay out
0:39:00 > 0:39:04in excess of 13 million, over the course of his deception.
0:39:08 > 0:39:11While he didn't directly receive payments from insurers,
0:39:11 > 0:39:13the revenue he generated for the company
0:39:13 > 0:39:15earned him massive pay-outs.
0:39:21 > 0:39:25Paulos falsified medical records for procedures he never performed,
0:39:25 > 0:39:28conducted surgery on patients that didn't need treatment
0:39:28 > 0:39:31and would give patients the wrong operation,
0:39:31 > 0:39:33so he could collect a bigger return from insurers.
0:39:38 > 0:39:42He wasn't just abusing his position and violating a sacred trust
0:39:42 > 0:39:43with these fake operations,
0:39:43 > 0:39:47he was botching the surgery with shocking efficiency
0:39:47 > 0:39:49and putting lives at risk.
0:39:51 > 0:39:54One fragile 76-year-old woman went under his knife
0:39:54 > 0:39:56for what should've been a routine procedure
0:39:56 > 0:39:59to reconstruct her arthritic knee.
0:39:59 > 0:40:0224 hours later, that woman was dead.
0:40:08 > 0:40:11The coroner's report found a blood clot entering her lung
0:40:11 > 0:40:13caused her death.
0:40:13 > 0:40:16It also found that no evidence of any reconstructive knee surgery
0:40:16 > 0:40:18had taken place.
0:40:18 > 0:40:21He'd simply sliced her open and stitched her up,
0:40:21 > 0:40:24so he could submit a claim to insurers.
0:40:24 > 0:40:27He hadn't conducted any actual surgery on her knee.
0:40:32 > 0:40:35But this Big Apple surgeon had bitten off more than he could chew
0:40:35 > 0:40:39and it would be his sheer greed which would expose his lies.
0:40:41 > 0:40:45Other surgeons at his company averaged 30 procedures per month.
0:40:45 > 0:40:47Insurers' records showed Paulos
0:40:47 > 0:40:49was doing nearly as many in a single day.
0:40:52 > 0:40:53Naturally suspicious,
0:40:53 > 0:40:55insurers took a closer look at the billing invoices
0:40:55 > 0:40:57they'd been receiving.
0:40:57 > 0:41:01This revealed he had falsified an alarming amount of documents.
0:41:02 > 0:41:05Deeper investigations into procedures performed on patients
0:41:05 > 0:41:08uncovered unusual amounts of repeated surgeries,
0:41:08 > 0:41:11which didn't make any sense.
0:41:12 > 0:41:15Paulos tried to claim the billing discrepancies
0:41:15 > 0:41:17were a result of clerical error.
0:41:17 > 0:41:18He even tried to blame his wife
0:41:18 > 0:41:22for incorrectly transcribing patient records.
0:41:22 > 0:41:24It would do him no good.
0:41:24 > 0:41:27In July 2011, he was fired from his employer,
0:41:27 > 0:41:31subsequently arrested and charged with one count of health care fraud.
0:41:35 > 0:41:37Between 2006 and 2011,
0:41:37 > 0:41:40it was estimated that Paulos had personally profited
0:41:40 > 0:41:44to the tune of 7.5 million through his sickening scam.
0:41:50 > 0:41:53Under interview, Paulos admitted, from 2008,
0:41:53 > 0:41:55after only two years in the job,
0:41:55 > 0:41:59he falsified records almost every time he performed surgery.
0:42:02 > 0:42:04Paulos pleaded guilty to healthcare fraud
0:42:04 > 0:42:07at White Plains Federal Court before a packed gallery.
0:42:08 > 0:42:09Proceedings were watched
0:42:09 > 0:42:13by a handful of patients he had unnecessarily operated on.
0:42:14 > 0:42:17During the trial, Paulos read a statement to the court...
0:42:17 > 0:42:22"I wish I could tell you I had noble motives for this, but I do not.
0:42:22 > 0:42:25"I did this out of greed and insecurity."
0:42:28 > 0:42:31He was sentenced to 4.5 years behind bars
0:42:31 > 0:42:33and ordered to pay costs of 5.5 million
0:42:33 > 0:42:36to the insurers he had defrauded.
0:42:37 > 0:42:40But the criminal trial was just the beginning.
0:42:41 > 0:42:45Now that he's been convicted, some 260 of his ex-patients
0:42:45 > 0:42:48are bringing individual lawsuits against him
0:42:48 > 0:42:51for all manner of abuses suffered under the knife
0:42:51 > 0:42:52of Dr Paulos.
0:43:00 > 0:43:04From organised criminal gangs to exaggerated household claims,
0:43:04 > 0:43:07insurance fraud hits all of us in the pocket.
0:43:07 > 0:43:09But instead of getting away with it,
0:43:09 > 0:43:14more and more of these fraudsters are being claimed and shamed.