0:00:05 > 0:00:09Insurance fraud has reached epidemic levels in the UK.
0:00:09 > 0:00:14It is costing us more than £1.3 billion every year.
0:00:14 > 0:00:17That's almost £3.6 million every day.
0:00:19 > 0:00:24Deliberate crashes, bogus personal injuries, even phantom pets.
0:00:26 > 0:00:29The fraudsters are risking more and more to make a quick killing,
0:00:29 > 0:00:33and every year it is adding around £50 to your insurance bill.
0:00:33 > 0:00:36But insurers are fighting back,
0:00:36 > 0:00:39exposing just under 15 fake claims every hour.
0:00:39 > 0:00:41Armed with covert surveillance systems...
0:00:41 > 0:00:44Subject out of vehicle.
0:00:44 > 0:00:46..sophisticated data analysis techniques...
0:00:48 > 0:00:51..and a number of highly skilled police units...
0:00:51 > 0:00:53Police, stay where you are!
0:00:53 > 0:00:55..they're catching the criminals red-handed.
0:00:55 > 0:00:57Just don't lie to us.
0:00:58 > 0:01:01All those conmen, scammers, and cheats on the fiddle
0:01:01 > 0:01:04are now caught in the act and claimed and shamed.
0:01:10 > 0:01:14Today, a gang of fraudsters finally gets busted.
0:01:14 > 0:01:16The chances of actually being caught,
0:01:16 > 0:01:18as far as they were concerned, was nil.
0:01:18 > 0:01:19They hadn't been caught to date
0:01:19 > 0:01:22and there's no reason why somebody's going to knock on their door now.
0:01:22 > 0:01:24A fake claim backfires.
0:01:24 > 0:01:27In some ways, they have potentially shot themselves in the foot
0:01:27 > 0:01:30for what is quite a short-term, quite a small gain.
0:01:30 > 0:01:33And a claimant "doth protest too much".
0:01:44 > 0:01:48These days, there is a real determination to stamp out fraud.
0:01:48 > 0:01:49Security has been improved,
0:01:49 > 0:01:53insurers are more aware, and legal loopholes have been closed.
0:01:53 > 0:01:57But the biggest change is that there is now a specialised police unit.
0:02:00 > 0:02:02Ifed is the City of London Police's
0:02:02 > 0:02:04Insurance Fraud Enforcement Department,
0:02:04 > 0:02:06a dedicated team of detectives
0:02:06 > 0:02:09committed to stopping insurance fraudsters.
0:02:09 > 0:02:13There's ever more sophisticated detection tools
0:02:13 > 0:02:14being used by the industry.
0:02:14 > 0:02:17We are getting more and more cases every day.
0:02:19 > 0:02:22This elite squad has prevented millions of pounds being paid out
0:02:22 > 0:02:24to criminals in fraudulent claims.
0:02:26 > 0:02:29From now on, insurance cheats need to look over their shoulders.
0:02:30 > 0:02:34It's all fraud, it's all crime, and it can all lead to prison.
0:02:34 > 0:02:37Police! Don't move! Stay where you are.
0:02:38 > 0:02:41Simon Styles is an Ifed financial investigator.
0:02:41 > 0:02:45He recently worked on a complex case involving motor insurance.
0:02:46 > 0:02:50Early 2012, there was about 15 different insurers
0:02:50 > 0:02:53found that there was a pattern linked to credit cards being used
0:02:53 > 0:02:56and compromised, the same bank accounts that were being used,
0:02:56 > 0:02:59and the same details of vehicles being used in accidents.
0:02:59 > 0:03:04The case was referred to Ifed and an investigation was launched.
0:03:04 > 0:03:07It soon became clear that these were no ordinary fraudsters.
0:03:07 > 0:03:11They had gone to great lengths to cover their tracks.
0:03:11 > 0:03:13In the beginning of this investigation,
0:03:13 > 0:03:15we didn't know who was involved.
0:03:15 > 0:03:18We had the instances, but we didn't have the suspects.
0:03:18 > 0:03:22One thing they did know was that the gang had targeted
0:03:22 > 0:03:24the most vulnerable members of society.
0:03:24 > 0:03:30This criminal gang was operating by opening insurance policies
0:03:30 > 0:03:34by use of credit cards from unsuspecting members of the public,
0:03:34 > 0:03:37elderly women or, in fact, ladies who were deceased.
0:03:38 > 0:03:41After using the stolen identities to take out motor insurance,
0:03:41 > 0:03:44they then moved to the next stage of the scam.
0:03:45 > 0:03:48And so what they would then do was to put together an accident
0:03:48 > 0:03:50and make an accident claim report to the insurer,
0:03:50 > 0:03:52stating that they had had an accident
0:03:52 > 0:03:55and giving details of the other driver.
0:03:55 > 0:03:56But these were all made up.
0:03:56 > 0:03:59They used random houses, random names, random cars,
0:03:59 > 0:04:02just to legitimise their claim.
0:04:02 > 0:04:05Once they had invented an accident,
0:04:05 > 0:04:08they were then able to make money from selling the details on.
0:04:08 > 0:04:11This was targeting solicitors in the main,
0:04:11 > 0:04:14and the referral fee.
0:04:14 > 0:04:17So if they put together a claim with the driver
0:04:17 > 0:04:21and two passengers, they would get £700 per claim.
0:04:21 > 0:04:25So those three claims, they would pocket £2,100.
0:04:25 > 0:04:27And they would do that by producing an invoice
0:04:27 > 0:04:29to the unsuspecting solicitor
0:04:29 > 0:04:32who would readily pay that money to take the case on.
0:04:34 > 0:04:37The law has now changed in England and Wales, but at the time,
0:04:37 > 0:04:40solicitors paid big money for referrals
0:04:40 > 0:04:42on the assumption that they would recoup their costs
0:04:42 > 0:04:45down the line when the claim was paid out by insurers.
0:04:45 > 0:04:48By the time they found out there were no accidents,
0:04:48 > 0:04:50it was too late.
0:04:51 > 0:04:54This gang wasn't interested in the claims going forward
0:04:54 > 0:04:56because the accident didn't happen.
0:04:56 > 0:04:59What they're interested in is referral payments,
0:04:59 > 0:05:01and that is what they were focused on
0:05:01 > 0:05:02and that's what they got.
0:05:02 > 0:05:05£167,000 that this gang received.
0:05:05 > 0:05:10They'd been freely lining their pockets for a year and a half.
0:05:10 > 0:05:13But with Ifed on the case, the net was about to close in.
0:05:13 > 0:05:17As a financial investigator, it's always about following the money.
0:05:17 > 0:05:21Everything out of this investigation was false,
0:05:21 > 0:05:25or forged, or altered, to hide the suspects' trail.
0:05:25 > 0:05:28The only thing is true and, in my experience always is,
0:05:28 > 0:05:29is a bank account.
0:05:29 > 0:05:31It's got to be opened by two forms of identification,
0:05:31 > 0:05:33usually a passport or a utility bill,
0:05:33 > 0:05:36which usually shows the identity of that individual.
0:05:36 > 0:05:39This occasion, it did. It showed the identity of Mr Shad.
0:05:39 > 0:05:41He was one of our main suspects.
0:05:41 > 0:05:44In any event, it showed the money going in and the money going out.
0:05:44 > 0:05:49Once they had pinpointed one person, the rest were soon identified.
0:05:49 > 0:05:52The other main player was Israr Hussain.
0:05:52 > 0:05:54At this stage, the gang didn't suspect a thing.
0:05:57 > 0:05:58The chances of actually being caught,
0:05:58 > 0:06:01as far as they were concerned, the gang were concerned, was nil.
0:06:01 > 0:06:03They hadn't been caught to date, and there was no reason
0:06:03 > 0:06:05why someone's going to knock on their door now.
0:06:05 > 0:06:07But that all changed.
0:06:07 > 0:06:11Ifed decided it was time to move in and arrest the main suspects.
0:06:11 > 0:06:15Joining Simon on the raid is DC Declan Malone.
0:06:15 > 0:06:18This morning, we are off to an address in Keighley, West Yorkshire,
0:06:18 > 0:06:21which is the home address of the main suspect,
0:06:21 > 0:06:25where he's setting up a fake claims management company
0:06:25 > 0:06:28and getting the referral fee back from solicitors
0:06:28 > 0:06:31for these accidents that have never occurred.
0:06:31 > 0:06:34They've changed, since the law's changed
0:06:34 > 0:06:36earlier on this month,
0:06:36 > 0:06:40where referral fees aren't being paid in England and Wales
0:06:40 > 0:06:42but they're still being paid for in Scotland.
0:06:42 > 0:06:47So it's suspected that we might be getting some evidence
0:06:47 > 0:06:51with regard to claims that have been made to Scottish solicitors.
0:06:53 > 0:06:55It's one of six search warrants
0:06:55 > 0:06:57that are being issued simultaneously.
0:06:57 > 0:06:59We'll just stop short of the premises
0:06:59 > 0:07:02to let the others know that we're in the vicinity
0:07:02 > 0:07:06so all of the warrants can be executed at the same time.
0:07:06 > 0:07:07Just pull up here.
0:07:07 > 0:07:12Some six addresses were visited on the day of the raid,
0:07:12 > 0:07:14April 23rd 2013.
0:07:14 > 0:07:15Coming!
0:07:15 > 0:07:18Quiet, please. Quiet, please.
0:07:18 > 0:07:22When they arrive, they aren't exactly given a warm welcome.
0:07:22 > 0:07:24- What?- BLEEP
0:07:24 > 0:07:28KNOCKING, THEN SEVERAL VOICES SHOUTING
0:07:28 > 0:07:31Come down, please, and talk to the police.
0:07:33 > 0:07:3550 officers attended these addresses
0:07:35 > 0:07:38and I attended one address, in Keighley,
0:07:38 > 0:07:41where the main subject, Hussain, resided.
0:07:41 > 0:07:45Fortunately, he's at home and is promptly dealt with.
0:07:45 > 0:07:48I am arresting you on suspicion of conspiracy to defraud.
0:07:48 > 0:07:50You do not have to say anything, but it may harm your defence
0:07:50 > 0:07:52if you do not mention when questioned
0:07:52 > 0:07:55something that you later rely on in court.
0:07:55 > 0:07:57What a morning, yeah? What a morning, eh?
0:07:57 > 0:08:00Hussain is then removed to a local police station
0:08:00 > 0:08:03for further questioning.
0:08:03 > 0:08:06Coordinating the multiple raids is DCI Dave Wood.
0:08:06 > 0:08:10The latest update is that we set out this morning, after the briefing,
0:08:10 > 0:08:13to pick up six suspects at the various addresses.
0:08:13 > 0:08:18And so far, as of this moment, we have five of those six in custody.
0:08:18 > 0:08:20A sixth suspect is currently outstanding,
0:08:20 > 0:08:23but enquiries are under way to track him down,
0:08:23 > 0:08:25as the clock ticks on,
0:08:25 > 0:08:29so we're hopeful that he'll be in custody before close of play today.
0:08:29 > 0:08:31What we'll do is just work systematically.
0:08:31 > 0:08:33So if you go to the very top
0:08:33 > 0:08:36and we'll start working our way down from there.
0:08:36 > 0:08:39With the house clear, the search can begin in earnest.
0:08:42 > 0:08:45You don't know where people hide things,
0:08:45 > 0:08:48so you have to go through everything, really.
0:08:48 > 0:08:51You don't know, when you go into an address, what you are going to find.
0:08:51 > 0:08:53I think you have got to be open and be methodical in your approach.
0:08:53 > 0:08:56Doesn't matter how long you're there for.
0:08:56 > 0:08:58You've got to do the job properly.
0:08:58 > 0:09:01What I tend to do is be as sensitive as possible and look at things
0:09:01 > 0:09:04and if I don't need them, put them back exactly where I have found it
0:09:04 > 0:09:07so there's no disruption to their lives.
0:09:09 > 0:09:12That methodical approach pays off an hour into the search,
0:09:12 > 0:09:15when Simon makes an important discovery.
0:09:16 > 0:09:20I'm just going through what seems to be the hub of the operation here.
0:09:20 > 0:09:22And I'm going through some piles here.
0:09:23 > 0:09:26One of note, here, is a vehicle registration number.
0:09:26 > 0:09:28This relates to a vehicle
0:09:28 > 0:09:31that is currently sat on the driveway of these premises,
0:09:31 > 0:09:34that I know from my investigation has been used,
0:09:34 > 0:09:37or at least the registration number and details have been used,
0:09:37 > 0:09:38in contrived accidents.
0:09:38 > 0:09:41It links that vehicle to this address.
0:09:41 > 0:09:43That is vital evidence.
0:09:44 > 0:09:46I will be interested to look in the vehicle,
0:09:46 > 0:09:48assume that there would be documentation
0:09:48 > 0:09:50relating to the contrived accidents.
0:09:50 > 0:09:53This Toyota motorcar does actually feature itself in the inquiry.
0:09:53 > 0:09:55As you can see, as we walk round it,
0:09:55 > 0:09:58there are some minor nicks, which you'd expect on a car of its age.
0:09:58 > 0:10:00But there would appear to be no substantial damage
0:10:00 > 0:10:03to indicate that it has been involved in
0:10:03 > 0:10:04any road traffic accidents.
0:10:04 > 0:10:07Also, the vehicle isn't registered to the man that lives here.
0:10:07 > 0:10:11I'm not saying that's an offence, to have it parked outside his house,
0:10:11 > 0:10:13but again, it's another line of inquiry we will be pursuing
0:10:13 > 0:10:15as the investigation goes on.
0:10:20 > 0:10:24Uniformed officers then perform a thorough search of the car.
0:10:24 > 0:10:28As predicted, it yields plenty of potential evidence.
0:10:30 > 0:10:31There is a slight irony,
0:10:31 > 0:10:33in that criminals are very keen on their crime prevention.
0:10:33 > 0:10:35We can't fault them on that.
0:10:35 > 0:10:37If we're reducing burglaries, it's a good thing.
0:10:37 > 0:10:39I'm not necessarily sure that's the reason they've got it,
0:10:39 > 0:10:42but I'd only be surmising, and I shouldn't really do that.
0:10:44 > 0:10:46Back inside, Simon is still hard at work.
0:10:47 > 0:10:50I'm continuing the search in this office. I found a piece of paper
0:10:50 > 0:10:52that was found on the floor, just by the bin here.
0:10:52 > 0:10:55And what it's got is a couple of e-mail addresses,
0:10:55 > 0:10:57and one is a firm of solicitors
0:10:57 > 0:11:00and one an accident management company in Glasgow.
0:11:00 > 0:11:03That's something we don't know about.
0:11:03 > 0:11:08It looks as though referrals have finished in England and Wales,
0:11:08 > 0:11:11but have started or are continuing in Scotland.
0:11:11 > 0:11:15And this may well be a new claims management company
0:11:15 > 0:11:20set up to try and deal with the unsuspecting solicitors in Scotland.
0:11:21 > 0:11:24The Scottish connection is significant
0:11:24 > 0:11:28as, in Scotland, referral fees are still legal.
0:11:28 > 0:11:30He's got a contingency plan.
0:11:30 > 0:11:33He's got two driving licences in his own name,
0:11:33 > 0:11:36and also, he's done the same with passports,
0:11:36 > 0:11:38and both British passports
0:11:38 > 0:11:40in his own name with the correct details.
0:11:42 > 0:11:46Having multiple forms of ID is a classic tactic
0:11:46 > 0:11:50used by fraudsters in case they need to leave the country in a hurry.
0:11:50 > 0:11:52As we looked through the front window,
0:11:52 > 0:11:55we could see, on the front passenger seat, some paperwork.
0:11:55 > 0:11:57That documentation was relating to an accident
0:11:57 > 0:11:59that occurred in November last year,
0:11:59 > 0:12:01so clearly we're interested in that
0:12:01 > 0:12:03and the circumstances behind it.
0:12:03 > 0:12:05That will form part of the investigation,
0:12:05 > 0:12:07and those papers are now part of the evidential chain.
0:12:07 > 0:12:10They've been seized, bagged, and exhibited
0:12:10 > 0:12:12by the officer that found them.
0:12:12 > 0:12:14Still to come...
0:12:14 > 0:12:17A sword isn't the only disturbing discovery.
0:12:17 > 0:12:19The officers have found a handgun,
0:12:19 > 0:12:21so they have called out the local police,
0:12:21 > 0:12:22West Yorkshire's firearms team.
0:12:22 > 0:12:26And the diagnosis isn't good for an overseas medical claim.
0:12:26 > 0:12:28Our investigator visited the hospital
0:12:28 > 0:12:30and spoke with one of the doctors,
0:12:30 > 0:12:32who immediately confirmed
0:12:32 > 0:12:35that the customer was never treated at this hospital.
0:12:39 > 0:12:42We in the UK are a nation of pet lovers.
0:12:42 > 0:12:46It's estimated there are almost 60 million pets in the country.
0:12:46 > 0:12:49More and more owners are turning to pet insurance
0:12:49 > 0:12:52to cover them for vet bills and other costs.
0:12:54 > 0:12:58Simon Wheeler is the managing director of Agria Pet Insurance.
0:13:01 > 0:13:04His sector has seen a steady rise in the last few years,
0:13:04 > 0:13:07but it's still a relatively new area of the industry.
0:13:08 > 0:13:12Pet insurance isn't like motor insurance or household insurance,
0:13:12 > 0:13:14so people don't buy that every day.
0:13:14 > 0:13:17It's very common for people who have bought a policy from us
0:13:17 > 0:13:19to ring up to clarify a few points.
0:13:19 > 0:13:22You know, they've read their terms and conditions,
0:13:22 > 0:13:24they're not sure of some of the wording.
0:13:24 > 0:13:28Like any insurance product, pet insurance comes with certain rules.
0:13:28 > 0:13:31Within the terms and conditions we're very, very happy to pay out.
0:13:31 > 0:13:35For instance, problems that happen within periods of cover
0:13:35 > 0:13:37within the benefit levels.
0:13:37 > 0:13:40Sometimes, however, things just aren't covered.
0:13:40 > 0:13:44As with any financial product, it pays to read the small print.
0:13:44 > 0:13:48Agria recently dealt with a case of an unfortunate Chihuahua puppy.
0:13:50 > 0:13:52The first we heard from the policyholder
0:13:52 > 0:13:54was at the end of the first week of September.
0:13:54 > 0:13:57He'd insured his dog probably about a week before,
0:13:57 > 0:13:59and obviously received his policy documents
0:13:59 > 0:14:01and his certificate of insurance,
0:14:01 > 0:14:03his terms and conditions, in the post.
0:14:03 > 0:14:05He probably read his terms and conditions
0:14:05 > 0:14:07and seen that there were other benefits,
0:14:07 > 0:14:09in addition to the ones he had taken.
0:14:09 > 0:14:11He also now wanted to include death cover
0:14:11 > 0:14:15and cover should the dog be lost or stolen and not found.
0:14:16 > 0:14:19In that instance, he'd have the refund of the purchase price,
0:14:19 > 0:14:23which for his Chihuahua was £900.
0:14:23 > 0:14:26A few weeks passed, and on 30th September,
0:14:26 > 0:14:29they heard from the policyholder again.
0:14:30 > 0:14:35He sadly rang us and told us that he'd come down that morning
0:14:35 > 0:14:38and the puppy was dead in the kitchen.
0:14:38 > 0:14:40They didn't know what it had died of,
0:14:40 > 0:14:43so obviously a very sad course of events.
0:14:43 > 0:14:46He also informed us that the neighbour had buried the puppy
0:14:46 > 0:14:47for his wife at the same time.
0:14:47 > 0:14:52Not that unusual, but probably with an experienced assessor,
0:14:52 > 0:14:55might have set the odd slight alarm bell ringing.
0:15:27 > 0:15:31The customer wanted to put in a claim for the £900 purchase price
0:15:31 > 0:15:35of the puppy, but first he needed to gather the relevant paperwork.
0:15:37 > 0:15:41So the next stage was that round about 22nd/23rd October,
0:15:41 > 0:15:45the policyholder approached the veterinary practice
0:15:45 > 0:15:49to have a death claim form filled in, and they sent
0:15:49 > 0:15:54the veterinary practice a photograph of the dead puppy in the kitchen.
0:15:54 > 0:15:58So far, everything was proceeding in line with standard practice.
0:15:58 > 0:16:01At this stage, there was nothing to indicate that
0:16:01 > 0:16:03there was any problem at all with the claim.
0:16:03 > 0:16:05The veterinary practice submitted the claim form to us
0:16:05 > 0:16:07and they actually sent the photograph as well.
0:16:07 > 0:16:09So proof that the dog was dead, sadly.
0:16:11 > 0:16:13Now, photographs make great evidence,
0:16:13 > 0:16:16but there is more to them than meets the eye.
0:16:16 > 0:16:17Even a simple selfie...
0:16:17 > 0:16:19CAMERA CLICKS
0:16:19 > 0:16:22..as innocent and often cringeworthy as they may be,
0:16:22 > 0:16:24they contain a wealth of information.
0:16:24 > 0:16:26This phone is so smart,
0:16:26 > 0:16:29the photo's digital file now has stored metadata,
0:16:29 > 0:16:32such as its location and the time it was taken.
0:16:32 > 0:16:35And it was metadata from the photograph of the puppy
0:16:35 > 0:16:38that gave Agria pause for thought.
0:16:39 > 0:16:40One of the things the assessor did
0:16:40 > 0:16:43was actually look at the properties of the photograph,
0:16:43 > 0:16:45which actually wasn't taken on 30th September.
0:16:45 > 0:16:48It was taken on 5th September,
0:16:48 > 0:16:51actually before the additional benefit had been added.
0:16:51 > 0:16:53So, you know, a huge discrepancy there
0:16:53 > 0:16:57between when the policyholder said the puppy had died
0:16:57 > 0:17:00and actually when the photograph of the dead puppy was taken,
0:17:00 > 0:17:03so actually before the death benefit was added.
0:17:03 > 0:17:07The photograph proved that the puppy had died earlier than stated,
0:17:07 > 0:17:10meaning the customer wasn't entitled to compensation.
0:17:12 > 0:17:17In effect, this meant that the policyholder was fraudulently
0:17:17 > 0:17:21trying to have us pay out the purchase price for the puppy.
0:17:21 > 0:17:23In reality, the puppy had died
0:17:23 > 0:17:26before they had even added that cover to the policy,
0:17:26 > 0:17:28so it was an absolute known event,
0:17:28 > 0:17:30it was something that had happened already,
0:17:30 > 0:17:32and so a dead cert if they could get away with it.
0:17:34 > 0:17:38Agria decided to discuss their concerns with the customer.
0:17:38 > 0:17:40We made contact with the policyholder
0:17:40 > 0:17:44and we talked them through the fraud clauses in the terms and conditions,
0:17:44 > 0:17:48so the clauses that say that we expect policyholders
0:17:48 > 0:17:51to not try and vary the details of the claim
0:17:51 > 0:17:53to fit into periods of cover.
0:17:53 > 0:17:56And at that point, yes, the policyholder came clean
0:17:56 > 0:18:00that the dog had died earlier, and we declined the claim.
0:18:00 > 0:18:03But there were further consequences to come.
0:18:04 > 0:18:08The policyholder had another dog insured with us, another Chihuahua,
0:18:08 > 0:18:13and part of the terms and conditions state that if we suspect somebody
0:18:13 > 0:18:15of fraud, if they had other policies with us, we will,
0:18:15 > 0:18:17as a matter of course, cancel those down.
0:18:17 > 0:18:20So in some ways they had potentially shot themselves in the foot,
0:18:20 > 0:18:23for what is quite a short-term, quite a small gain.
0:18:23 > 0:18:28Any attempt to present a shaggy dog story when making a claim
0:18:28 > 0:18:29will be found out.
0:18:29 > 0:18:33Insurers are getting much, much cleverer at identifying fraud.
0:18:33 > 0:18:36If an owner thinks there is an opportunity to make some money
0:18:36 > 0:18:39dishonestly from an insurance company, they can rest assured that
0:18:39 > 0:18:42the insurance company will have been presented with that multiple times
0:18:42 > 0:18:45or identified it and have ways of identifying it in future.
0:18:45 > 0:18:48So the chances are you will be caught out, and usually,
0:18:48 > 0:18:51it's significantly to your disadvantage.
0:18:58 > 0:19:03Getting ill while you are abroad is most people's worst nightmare.
0:19:03 > 0:19:05But fraudsters see it as an opportunity.
0:19:05 > 0:19:08They assume that the further away something happens,
0:19:08 > 0:19:12the less likely it is to be investigated.
0:19:12 > 0:19:13Big mistake.
0:19:15 > 0:19:16But things have changed,
0:19:16 > 0:19:19as Simon Cook, Cega's head of special investigations,
0:19:19 > 0:19:21knows all too well.
0:19:21 > 0:19:25He recently worked on the case of a traveller who was struck down
0:19:25 > 0:19:27by a serious illness on a trip to Nigeria.
0:19:29 > 0:19:33The customer contacted our medical emergency helplines to tell us
0:19:33 > 0:19:35that he was in Nigeria, and unfortunately,
0:19:35 > 0:19:38for the last eight days, he had been in hospital,
0:19:38 > 0:19:40where he had been diagnosed with malaria.
0:19:41 > 0:19:43Malaria is a tropical disease
0:19:43 > 0:19:46that can be fatal if not treated properly.
0:19:46 > 0:19:50Initially the patient didn't provide any details about his condition.
0:19:50 > 0:19:52We didn't find this too unusual,
0:19:52 > 0:19:56because he had been in hospital for eight days with malaria.
0:19:56 > 0:20:00The next stage for Cega was to contact the hospital.
0:20:00 > 0:20:02We tried to make contact with the doctor,
0:20:02 > 0:20:04but couldn't get through to him.
0:20:04 > 0:20:07We also tried to get in contact with the administration staff,
0:20:07 > 0:20:10but there was simply no answer from the hospital.
0:20:10 > 0:20:13We could understand why the doctor might not be available,
0:20:13 > 0:20:15because he would be treating patients,
0:20:15 > 0:20:19but not to actually get hold of anyone at the hospital
0:20:19 > 0:20:21was particularly strange.
0:20:21 > 0:20:25Also strange was the cost of the treatment, according to the patient.
0:20:25 > 0:20:30And he had already paid £1,850 sterling for his medical treatment.
0:20:30 > 0:20:32The costs being claimed by the customer
0:20:32 > 0:20:36were completely disproportionate to what we would expect from
0:20:36 > 0:20:38a reputable hospital in Nigeria.
0:20:38 > 0:20:40Two days before his flight home,
0:20:40 > 0:20:44the customer appeared to have made a remarkable recovery.
0:20:44 > 0:20:47He contacted Cega to say he had been discharged
0:20:47 > 0:20:50and would be returning to the UK as planned.
0:20:50 > 0:20:53We referred the case through to our medical team, who stated
0:20:53 > 0:20:56it was a little bit unusual that the customer would be deemed
0:20:56 > 0:21:00fit to travel so soon after being discharged from hospital,
0:21:00 > 0:21:03where he was diagnosed with malaria.
0:21:03 > 0:21:07The customer subsequently sent in paperwork to support his claim.
0:21:07 > 0:21:10The customer provided us with various documents,
0:21:10 > 0:21:13such as a medical report, a booking invoice.
0:21:13 > 0:21:17But he had also provided us with a couple of photographs of himself
0:21:17 > 0:21:19in a hospital bed.
0:21:19 > 0:21:22There were question marks, though, about the documents.
0:21:22 > 0:21:26We noted there were various spelling mistakes in the medical report
0:21:26 > 0:21:28that he provided, which we wouldn't expect from
0:21:28 > 0:21:30a reputable hospital in Nigeria.
0:21:30 > 0:21:35But of even more cause for concern were the photographs.
0:21:35 > 0:21:37We have absolutely no understanding
0:21:37 > 0:21:40why the customer sent these photographs through to us,
0:21:40 > 0:21:43because we didn't ask for photos of him in a hospital bed,
0:21:43 > 0:21:46as that would be completely unethical.
0:21:46 > 0:21:50The customer intended the photos to put his claim in the clear,
0:21:50 > 0:21:53but they actually moved it to the critical list.
0:21:53 > 0:21:55We referred them over to our medical team, and they stated
0:21:55 > 0:21:58that it certainly appeared that the cannula
0:21:58 > 0:22:03had been Sellotaped to his arm, as opposed to inserted into his arm.
0:22:03 > 0:22:05A cannula is a tube that is inserted into the body
0:22:05 > 0:22:08to deliver or sometimes remove fluids.
0:22:10 > 0:22:13If the customer was genuinely unwell with malaria,
0:22:13 > 0:22:17he certainly wouldn't have a cannula Sellotaped to his hand.
0:22:17 > 0:22:19This wasn't just a sticking point -
0:22:19 > 0:22:22it called the whole claim into question.
0:22:22 > 0:22:25Based on the information we had received from the customer,
0:22:25 > 0:22:27we did have serious concerns,
0:22:27 > 0:22:30which led to us appointing one of our overseas investigators
0:22:30 > 0:22:32to actually go out to the hospital
0:22:32 > 0:22:36and interview the doctor or the hospital staff.
0:22:36 > 0:22:39His evidence effectively put the claim out of its misery.
0:22:41 > 0:22:43Our investigator visited the hospital
0:22:43 > 0:22:45and spoke with one of the doctors,
0:22:45 > 0:22:48who immediately confirmed that the documents were false
0:22:48 > 0:22:51and that the customer was never treated at this hospital.
0:22:51 > 0:22:54But Cega decided to give the customer one last chance
0:22:54 > 0:22:56to tell his side of the story.
0:22:56 > 0:22:58He didn't really have much to say,
0:22:58 > 0:23:03apart from he was going to complete his own investigations in Nigeria.
0:23:03 > 0:23:05At this point, we were wholly satisfied
0:23:05 > 0:23:07that the claim submitted was fraudulent.
0:23:08 > 0:23:11And that meant that there were consequences for the customer.
0:23:11 > 0:23:14He couldn't just walk away.
0:23:14 > 0:23:16We declined the claim in full.
0:23:16 > 0:23:20The customer actually agreed to pay our investigation fee back,
0:23:20 > 0:23:21so we still don't know what happened
0:23:21 > 0:23:25about his own investigations on this occasion.
0:23:25 > 0:23:29Far from stinging the company for an undeserved malaria pay-out,
0:23:29 > 0:23:31the customer has now been hit in the pocket.
0:23:32 > 0:23:35It just proves that where there are concerns with the claim,
0:23:35 > 0:23:37no matter where in the world
0:23:37 > 0:23:39the incident is said to have taken place,
0:23:39 > 0:23:42we will investigate these claims thoroughly.
0:23:48 > 0:23:50Still to come...
0:23:50 > 0:23:52a slip and trip claim evaporates...
0:23:52 > 0:23:54In terms of defending the claim,
0:23:54 > 0:23:58it was quite clear to us that the reason that the floor was wet
0:23:58 > 0:24:01in the showers was because he had just come out of the shower himself.
0:24:01 > 0:24:05..and Ifed's raid uncovers more than they were bargaining for.
0:24:05 > 0:24:07At a separate address,
0:24:07 > 0:24:10they found a selection of baseball bats and balaclavas.
0:24:15 > 0:24:19Now, we've all dropped the odd plate or mug and thought nothing of it.
0:24:19 > 0:24:21Some more than others.
0:24:21 > 0:24:23But smashing a top-of-the-range appliance
0:24:23 > 0:24:25is another matter entirely.
0:24:25 > 0:24:27Without insurance cover, you're potentially looking at
0:24:27 > 0:24:29a pay-out that could break the bank.
0:24:31 > 0:24:35Kayleigh Farrell is the operations manager at i-Cog Claims Management.
0:24:35 > 0:24:39She recently dealt with a case involving a household contents claim
0:24:39 > 0:24:42as a result of an unlucky accident.
0:24:42 > 0:24:46The lady's children had been playing in the living room.
0:24:46 > 0:24:49There was a knock at the front door, and she had ordered a pizza.
0:24:49 > 0:24:52Therefore, she had departed the room itself
0:24:52 > 0:24:54and gone and collected the pizza.
0:24:54 > 0:24:57While she was making the payment, she had heard a loud bang,
0:24:57 > 0:25:00and all of a sudden, her children had gone quiet.
0:25:01 > 0:25:05When the woman returned to the living room, all became clear.
0:25:06 > 0:25:09They had knocked the unit which held the television.
0:25:09 > 0:25:11That resulted in the television falling onto the floor.
0:25:13 > 0:25:16The set was broken and the claimant wanted a pay-out
0:25:16 > 0:25:19so she could purchase a replacement.
0:25:19 > 0:25:22On paper, the account was quite feasible.
0:25:22 > 0:25:26However, the main concern we had was that she took the policy out
0:25:26 > 0:25:29on a midweek evening, and within 24 hours,
0:25:29 > 0:25:31she had actually made the claim.
0:25:31 > 0:25:34The timing left a bad taste in the mouth,
0:25:34 > 0:25:36and further investigation was needed.
0:25:36 > 0:25:39The team re-examined the initial sales call from the customer.
0:25:41 > 0:25:46She asked the handler whether accidental damage to a television,
0:25:46 > 0:25:48caused by children, would be covered.
0:25:48 > 0:25:51This, to us, was of high concern.
0:25:51 > 0:25:54And their concern was only intensified
0:25:54 > 0:25:56by the next part of the call.
0:25:56 > 0:25:58The claimant also asked how soon
0:25:58 > 0:26:00she could make a claim on the policy itself.
0:26:00 > 0:26:05And, hey presto, just 24 hours later, she then made a claim.
0:26:05 > 0:26:08There could only be one conclusion.
0:26:08 > 0:26:10This quite clearly suggested to us
0:26:10 > 0:26:13that the incident had actually occurred prior to the claimant
0:26:13 > 0:26:15taking out the policy.
0:26:15 > 0:26:19In other words, the woman hadn't had insurance when the TV was broken.
0:26:19 > 0:26:22She'd subsequently taken out a policy
0:26:22 > 0:26:23and then attempted to claim on it
0:26:23 > 0:26:27by saying the damage had happened after she'd purchased cover.
0:26:27 > 0:26:32What's more, she had also amended the value of the claim upwards.
0:26:32 > 0:26:36So the claimant had informed us that the television was worth 400.
0:26:36 > 0:26:40At a later stage, she informed us that it was £1,000.
0:26:40 > 0:26:43Not many televisions more than double in value in the space
0:26:43 > 0:26:45of a few days. At this point,
0:26:45 > 0:26:49Kayleigh decided to discuss her concerns with the claimant.
0:26:51 > 0:26:53And when we informed the claimant that we had listened
0:26:53 > 0:26:56to the sales call, where she specifically asked
0:26:56 > 0:27:00whether the damage would be covered if it was caused by children,
0:27:00 > 0:27:04we then asked her, within 24 hours, how that damage had occurred,
0:27:04 > 0:27:08she simply explained to us that it was an omen,
0:27:08 > 0:27:09because it was Friday 13th.
0:27:23 > 0:27:27We were heavily surprised by the claimant's answering in this.
0:27:27 > 0:27:29It didn't make any sense to us.
0:27:29 > 0:27:33In fact, nothing about the woman's account made any sense,
0:27:33 > 0:27:36and there were further concerns about the timeframe.
0:27:36 > 0:27:39The claimant had initially informed us the damage had happened
0:27:39 > 0:27:43in the morning. However, she then obviously relayed a story
0:27:43 > 0:27:46that she had collected the pizza within the evening.
0:27:46 > 0:27:48She also claimed that she had taken
0:27:48 > 0:27:52the broken TV to a repair shop for assessment.
0:27:52 > 0:27:56She had been informed that it was unrepairable,
0:27:56 > 0:27:58it was a total write-off.
0:27:58 > 0:28:01The timeframe she provided didn't allow enough time
0:28:01 > 0:28:04for her to actually take the television to a company.
0:28:24 > 0:28:27When Kayleigh suggested that the damage had occurred
0:28:27 > 0:28:31earlier than claimed, the woman's reaction was striking.
0:28:31 > 0:28:34The claimant became almost like she had lost self-control.
0:28:34 > 0:28:37She started gabbling to us and repeating words,
0:28:37 > 0:28:41especially stating that the television was, in fact, working
0:28:41 > 0:28:43when she took the policy out.
0:28:54 > 0:28:58In Kayleigh's expedience, the woman's response was significant.
0:28:58 > 0:29:02She almost said it too often, and it was quite clear at that point
0:29:02 > 0:29:04that she was aware that we knew.
0:29:09 > 0:29:11With all the evidence on her side,
0:29:11 > 0:29:14Kayleigh wasn't about to be fobbed off.
0:29:14 > 0:29:16I obviously didn't let it go,
0:29:16 > 0:29:20and I believe that, really, she became quite tired of lying.
0:29:20 > 0:29:23See, one of the interesting things about lying
0:29:23 > 0:29:25is that it requires a lot of effort,
0:29:25 > 0:29:27sometimes resulting in stress, anxiety.
0:29:27 > 0:29:29In turn, it can take its toll on the body.
0:29:29 > 0:29:33After a while, the person telling the lie starts to become weary,
0:29:33 > 0:29:36and that's when they tend to fess up.
0:29:45 > 0:29:47Just as Kayleigh had suspected,
0:29:47 > 0:29:51the damage had occurred before the woman had taken out insurance.
0:29:51 > 0:29:54I believe the claimant was quite relieved
0:29:54 > 0:29:56once she had become truthful with myself
0:29:56 > 0:29:58and that she wouldn't be further questioned.
0:30:14 > 0:30:17The claimant seemed quite surprised
0:30:17 > 0:30:20and quite happily said that it wasn't fraud.
0:30:20 > 0:30:23That, to us, made it quite clear that she wasn't aware
0:30:23 > 0:30:26of the consequences of what she had actually done.
0:30:26 > 0:30:30But if she wasn't aware then, she is now.
0:30:30 > 0:30:34The claimant is clearly now not insured by that company,
0:30:34 > 0:30:37and she also was sent a letter to inform her
0:30:37 > 0:30:39that the police may be involved.
0:30:39 > 0:30:43In this case, the claimant had bitten off more than she could chew
0:30:43 > 0:30:46by cooking up an unconvincing cover story.
0:30:46 > 0:30:50She had lied, she'd been untruthful and she wasn't on cover at the time.
0:30:50 > 0:30:54Fraud is a criminal offence and it will be dealt with seriously.
0:30:59 > 0:31:03Now we've returned to Keighley, where Ifed are continuing to search
0:31:03 > 0:31:04the home of Israr Hussain,
0:31:04 > 0:31:08one of the key players in a gang suspected of fraudulently pocketing
0:31:08 > 0:31:12referral fees for road traffic accidents that never happened.
0:31:13 > 0:31:16Previously, Israr Hussain was arrested
0:31:16 > 0:31:17and taken for further questioning.
0:31:19 > 0:31:20They've already found a car
0:31:20 > 0:31:22that featured in several insurance claims...
0:31:23 > 0:31:27..and a small piece of evidence turned out to have a big impact.
0:31:28 > 0:31:31A piece of paper that was found on the floor in the office,
0:31:31 > 0:31:33and what it has got is a couple of e-mail addresses...
0:31:33 > 0:31:36one an accident management company in Glasgow.
0:31:36 > 0:31:38That is something we don't know about.
0:31:38 > 0:31:39I found a piece of paper
0:31:39 > 0:31:42that didn't seem to me at that time worth anything.
0:31:42 > 0:31:45It didn't show anything that was going to be of value.
0:31:45 > 0:31:49But I took the decision on that day to take it, and I am pleased I did.
0:31:49 > 0:31:52The piece of paper had an e-mail address on it
0:31:52 > 0:31:55which Simon traced to a solicitors' practice in Glasgow.
0:31:55 > 0:31:58So I rang them up and asked them, had they been victims?
0:31:58 > 0:32:00They did not know that they had been,
0:32:00 > 0:32:02and it was shown that they were,
0:32:02 > 0:32:04and that was a vital piece of evidence
0:32:04 > 0:32:07that we subsequently used in a criminal trial.
0:32:07 > 0:32:10But the raid yields more than just paperwork.
0:32:11 > 0:32:13It's a ceremonial sword.
0:32:16 > 0:32:18In the wrong hands, deadly.
0:32:18 > 0:32:20So it is upsetting and annoying to see,
0:32:20 > 0:32:23especially as that's so close to where all the children are running,
0:32:23 > 0:32:25next to their bedrooms.
0:32:25 > 0:32:27And that's not the only weapon they find.
0:32:27 > 0:32:30DCI Dave Wood receives a shocking update
0:32:30 > 0:32:33from one of the other raid locations.
0:32:33 > 0:32:35The officers have found a handgun.
0:32:35 > 0:32:37They're not sure exactly what it is and what it isn't,
0:32:37 > 0:32:38so they've called out the local police,
0:32:38 > 0:32:41West Yorkshire's firearms team, to come and make it safe
0:32:41 > 0:32:43and identify exactly what the weapon is.
0:32:43 > 0:32:45I believe it was found in one of the bedrooms,
0:32:45 > 0:32:48but it's just come through to me, that's all I know at the moment.
0:32:48 > 0:32:50At the first location,
0:32:50 > 0:32:54the raid is wrapping up and the haul is being packed away for analysis.
0:32:54 > 0:32:56But there's one more revelation.
0:32:56 > 0:32:58At a separate address,
0:32:58 > 0:33:02they found a selection of baseball bats and balaclavas
0:33:02 > 0:33:06which we obviously suspect to be gang-related paraphernalia.
0:33:06 > 0:33:09The raids had been a huge success, and the evidence collected
0:33:09 > 0:33:12laid bare the true extent of the fraud.
0:33:12 > 0:33:16Just to show you the scale of the events, say there's 300 claims,
0:33:16 > 0:33:19there were seven bank accounts identified
0:33:19 > 0:33:21that received over £167,000,
0:33:21 > 0:33:25which would result in 105 payments into that account.
0:33:25 > 0:33:28There were ten claims management companies that they set up.
0:33:28 > 0:33:3435 insurers were targeted in this 18-month period.
0:33:34 > 0:33:37The sheer magnitude was startling.
0:33:37 > 0:33:39But they had reached the end of the road.
0:33:41 > 0:33:43Six people arrested, six people were interviewed
0:33:43 > 0:33:44and six people attended court.
0:33:44 > 0:33:48The case was due to go to trial at Bradford Crown Court,
0:33:48 > 0:33:49but at the last minute,
0:33:49 > 0:33:52the defendants appeared to have a reality check.
0:33:52 > 0:33:55In fact, due to the overwhelming evidence
0:33:55 > 0:33:57that we presented to the courts,
0:33:57 > 0:34:01the main instigators in this organised gang, this scam,
0:34:01 > 0:34:02pleaded guilty.
0:34:02 > 0:34:06The sentences that were handed out reflected the seriousness
0:34:06 > 0:34:09of the £167,000 fraud.
0:34:09 > 0:34:13Two of them, Hussain and Shad,
0:34:13 > 0:34:15received four and a half years' imprisonment.
0:34:15 > 0:34:17To me, it was a great result.
0:34:17 > 0:34:21Simon has a warning for any would-be fraudsters.
0:34:21 > 0:34:23The people like this gang in Bradford
0:34:23 > 0:34:26who think they can get away with this, targeting people
0:34:26 > 0:34:30who cannot look after themselves or whatever,
0:34:30 > 0:34:32we will do something about it.
0:34:32 > 0:34:35We knocked on the door, they were unsuspecting,
0:34:35 > 0:34:37they didn't expect that we were going to be turning up, we did,
0:34:37 > 0:34:41and as a result of our efforts, they're now sitting in prison.
0:34:46 > 0:34:50Defending false insurance claims is important for commercial companies,
0:34:50 > 0:34:54as they want to avoid passing on costs to customers like you and me.
0:34:54 > 0:34:57But it is arguably even more important
0:34:57 > 0:34:59when it comes to protecting taxpayers' money.
0:35:03 > 0:35:05This is something that Jennifer Willis,
0:35:05 > 0:35:10acting governor of HMP Wakefield, takes very seriously.
0:35:10 > 0:35:12Wakefield is a Category A prison.
0:35:12 > 0:35:15It holds approximately 740 offenders
0:35:15 > 0:35:18and it forms part of the high security estate.
0:35:18 > 0:35:19Recently, a prisoner was injured
0:35:19 > 0:35:22in what appeared to be an unfortunate accident.
0:35:24 > 0:35:26Originally, he stated that he had fallen in the showers
0:35:26 > 0:35:28on an accumulation of water.
0:35:43 > 0:35:47There was never any doubt that he had genuinely been hurt as a result
0:35:47 > 0:35:49of his tumble in the prison showers.
0:35:49 > 0:35:51The injuries sustained were serious,
0:35:51 > 0:35:54in that there was a fracture to the right wrist.
0:35:54 > 0:35:56We ensured that the individual concerned received the right
0:35:56 > 0:36:00medical treatment, which included a visit to an outside hospital
0:36:00 > 0:36:03to ensure that the right care and support was delivered.
0:36:03 > 0:36:06Following the incident, all the relevant steps were taken.
0:36:06 > 0:36:11When an accident occurs, we document exactly what has happened and why,
0:36:11 > 0:36:14to see if there are any causes or reasons that we can then do
0:36:14 > 0:36:17to mitigate that incident happening again in the future.
0:36:17 > 0:36:19Generally speaking, after an accident,
0:36:19 > 0:36:21that's the end of the matter.
0:36:21 > 0:36:23But not in this case.
0:36:23 > 0:36:25The individual alleged his injuries
0:36:25 > 0:36:27were not the result of an unfortunate accident -
0:36:27 > 0:36:30instead, the prison was to blame.
0:36:30 > 0:36:33This, he claimed, was due to negligence on the part
0:36:33 > 0:36:36of the prison service, due to water being on the floor
0:36:36 > 0:36:39and the flooring being recently refurnished.
0:36:39 > 0:36:42Quite some claim.
0:36:42 > 0:36:45The individual had taken a shower, slipped on wet flooring
0:36:45 > 0:36:48and then alleged that the prison was at fault.
0:36:48 > 0:36:49And it wasn't cheap.
0:36:51 > 0:36:55The initial claim was submitted for £10,500.
0:36:55 > 0:36:58As far as the prison was concerned, there was no case to answer.
0:36:58 > 0:37:02We demonstrated to the claimant's solicitors that we were satisfied
0:37:02 > 0:37:04that we had robust systems in place,
0:37:04 > 0:37:06there were no witnesses to this event,
0:37:06 > 0:37:08there was no evidence that the flooring had been changed
0:37:08 > 0:37:10and that this wasn't, in fact, an accident.
0:37:10 > 0:37:15However, the solicitors continued to proceed with a claim of negligence
0:37:15 > 0:37:17against the prison service.
0:37:17 > 0:37:20The case then proceeded to court.
0:37:20 > 0:37:22In terms of defending the claim,
0:37:22 > 0:37:25it was quite clear to us that the reason that the floor was wet
0:37:25 > 0:37:29in the showers was because he had just come out of the shower himself
0:37:29 > 0:37:33and there was no negligence on behalf of the service.
0:37:33 > 0:37:36The claimant's case was unsteady from the start.
0:37:36 > 0:37:40There were a number of elements that were contradictory during this case.
0:37:40 > 0:37:41First of all, during the court case,
0:37:41 > 0:37:46the claimant withdrew the claim that the floor surface was inappropriate.
0:37:46 > 0:37:51Also, there were inconsistencies around where he had dried himself,
0:37:51 > 0:37:54and he changed the statement about the floor being wet
0:37:54 > 0:37:55when entering the shower
0:37:55 > 0:37:58and identified that it was, in fact, dry
0:37:58 > 0:38:02until he came out of the shower, and then it was subsequently wet.
0:38:02 > 0:38:05In addition to this, there was also some question around
0:38:05 > 0:38:08the length of time, based on medical evidence,
0:38:08 > 0:38:10that he took to recover
0:38:10 > 0:38:12as a consequence of the injury sustained,
0:38:12 > 0:38:18which called into question the validity of the case presented.
0:38:18 > 0:38:21So much so that the court ruled against him.
0:38:21 > 0:38:24Accidents happen and we need to make sure that we treat people decently.
0:38:24 > 0:38:27However, there was no compensation issued in this claim
0:38:27 > 0:38:29and actually, more than that,
0:38:29 > 0:38:33we were able to recoup the costs of £7,250 for the case
0:38:33 > 0:38:35to go to court in the first place.
0:38:35 > 0:38:39Ultimately, we are the ones who pay for false, negligent claims.
0:38:39 > 0:38:41But Jennifer and her colleagues
0:38:41 > 0:38:43are determined to protect the public purse.
0:38:43 > 0:38:46It's taxpayers' money that we're dealing with
0:38:46 > 0:38:49and we will robustly defend any claims of this type.
0:38:54 > 0:38:56We all make mistakes from time to time.
0:38:56 > 0:38:59The best way to handle it is to hold your hands up,
0:38:59 > 0:39:00learn from it and move on.
0:39:00 > 0:39:03But fraudsters see things very differently.
0:39:03 > 0:39:06In their world, two wrongs DO make a right,
0:39:06 > 0:39:08and mistakes are just an opportunity
0:39:08 > 0:39:10to swindle their way to an undeserved pay-out.
0:39:13 > 0:39:16John Beadle is insurer RSA's counter-fraud manager.
0:39:16 > 0:39:20They recently dealt with a customer who was claiming for compensation.
0:39:21 > 0:39:24So this is one of our commercial customers,
0:39:24 > 0:39:28where we insured her tanning salon.
0:39:28 > 0:39:32Unfortunately, a neighbour's property had a leak,
0:39:32 > 0:39:35which came into our insured's premises
0:39:35 > 0:39:38and caused damage to the sunbeds.
0:39:38 > 0:39:42The customer's determination to get her business up and running again
0:39:42 > 0:39:45was soon overshadowed by a major problem.
0:39:46 > 0:39:49The sunbeds were badly damaged and needed replacement,
0:39:49 > 0:39:52but unfortunately, she was under-insured
0:39:52 > 0:39:56in the sense that she didn't have enough cover
0:39:56 > 0:39:58to actually replace the beds as she wanted.
0:39:59 > 0:40:03It is up to everyone to assess how much their possessions are worth
0:40:03 > 0:40:06when an insurance policy is taken out.
0:40:06 > 0:40:10What your insurer will ask you is how much you would like to cover
0:40:10 > 0:40:13your premises for and your contents for, and depending on that,
0:40:13 > 0:40:16of course, it dictates the cost of your premium.
0:40:16 > 0:40:20People need to be careful that they don't try and save money
0:40:20 > 0:40:25on their premium and leave themselves without enough cover
0:40:25 > 0:40:30to replace or repair any goods that are damaged in an accident.
0:40:32 > 0:40:34But this is what the customer did
0:40:34 > 0:40:37and she was left counting the cost of a smaller pay-out.
0:40:37 > 0:40:41Ultimately, she ended up getting second-hand replacements
0:40:41 > 0:40:42instead of new.
0:40:42 > 0:40:44The tanning salon returned to business,
0:40:44 > 0:40:47but then something strange happened.
0:40:47 > 0:40:51A relatively short while after this claim was settled,
0:40:51 > 0:40:54another leak occurred in the premises
0:40:54 > 0:40:58which caused further damage to the sunbeds.
0:40:58 > 0:41:01Either this was an unfortunate coincidence
0:41:01 > 0:41:04or something more troubling was about to come to light.
0:41:05 > 0:41:10A few alarm bells began to ring and we carried out an investigation,
0:41:10 > 0:41:14and it soon became apparent that the story didn't stack up,
0:41:14 > 0:41:16and we had enough evidence
0:41:16 > 0:41:20that this claim had actually been fraudulently made.
0:41:22 > 0:41:24The customer sent a letter to the insurers to try to tell
0:41:24 > 0:41:29her side of the story... but it didn't wash.
0:41:29 > 0:41:32RSA then spoke to the customer directly.
0:41:32 > 0:41:36When the claimant was confronted with our doubts about the legitimacy
0:41:36 > 0:41:41of the claim, she came clean and admitted that she had lied
0:41:41 > 0:41:44in order to obtain money from us
0:41:44 > 0:41:48to make up the shortfall from the previous claim.
0:41:48 > 0:41:52She had been caught red-handed and attempted to limit the damage.
0:41:52 > 0:41:56She did try to just withdraw her claim when it became clear
0:41:56 > 0:41:58that she had committed fraud,
0:41:58 > 0:42:02and that might be that she didn't realise the consequences.
0:42:02 > 0:42:06Unfortunately, her sunbed scam had left her exposed.
0:42:07 > 0:42:10The case was passed to Ifed.
0:42:12 > 0:42:16Following their investigation, she was charged with fraud.
0:42:16 > 0:42:20She appeared in court, where she pleaded guilty
0:42:20 > 0:42:24and was sentenced to 100 hours' community service,
0:42:24 > 0:42:28and she also had to pay some significant costs as well.
0:42:28 > 0:42:31If she had accepted her mistake at the beginning,
0:42:31 > 0:42:32then nothing more would have happened,
0:42:32 > 0:42:36but greed led her on and she got burnt.
0:42:36 > 0:42:42I would tell people, be very careful before you are tempted to do this,
0:42:42 > 0:42:46because there is a very strong chance you will be caught,
0:42:46 > 0:42:49and when you are, there are some real consequences for you.
0:42:55 > 0:42:58Insurance fraud in this country costs all of us money,
0:42:58 > 0:43:01but the days of no-questions-asked pay-outs are numbered.
0:43:01 > 0:43:05Insurers are using ever more sophisticated technology
0:43:05 > 0:43:08to identify, track and prosecute fraudsters,
0:43:08 > 0:43:12and courts are using new powers to put these criminals behind bars.