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 > 0:00:23Deliberate crashes, bogus personal injuries,
0:00:23 > 0:00:24even phantom pets.
0:00:25 > 0:00:29The fraudsters are risking more and more to make a quick killing,
0:00:29 > 0:00:34and every year it's 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 > 0:00:42Armed with covert surveillance systems...
0:00:42 > 0:00:44That's the subject out the vehicle.
0:00:44 > 0:00:46..sophisticated data analysis techniques...
0:00:48 > 0:00:51- Police!- ..and a number of highly skilled police units...
0:00:51 > 0:00:53Police, stand back! Stay where you are!
0:00:53 > 0:00:55..they're catching the criminals red-handed.
0:00:55 > 0:00:58Just don't lie to us.
0:00:58 > 0:00:59All those con men, scammers
0:00:59 > 0:01:02and cheats on the fiddle are now caught in the act
0:01:02 > 0:01:04and claimed and shamed.
0:01:10 > 0:01:15Today, a woman claiming she can't work stretches the truth
0:01:15 > 0:01:16as well as her body.
0:01:16 > 0:01:19I think I might have struggled to have done
0:01:19 > 0:01:21some of the exercises that she did.
0:01:22 > 0:01:25A doctor's outrageous holiday scam is prescribed
0:01:25 > 0:01:27a double dose of justice.
0:01:27 > 0:01:31The General Medical Council took a very dim view of it,
0:01:31 > 0:01:35and as a result of their proceedings, Sharma was struck off.
0:01:35 > 0:01:37And an attempt to deceive insurers
0:01:37 > 0:01:40with a fake helicopter rescue crash-lands.
0:01:41 > 0:01:44After our agents contacts the air traffic control tower
0:01:44 > 0:01:46they realised that no flights had taken off that day.
0:01:51 > 0:01:52If you've ever been hurt at work,
0:01:52 > 0:01:55you'll know the prospect of losing your livelihood
0:01:55 > 0:01:57can be a frightening thing.
0:01:57 > 0:01:59Most of us will do anything to get healthy again
0:01:59 > 0:02:02and get back to the day job,
0:02:02 > 0:02:04but there are those who see this as a chance
0:02:04 > 0:02:05to take an extended holiday,
0:02:05 > 0:02:08often fabricating or exaggerating their condition
0:02:08 > 0:02:12in the false belief that insurers will continue to pay out.
0:02:15 > 0:02:19It's estimated that we spend around a third of our lives working.
0:02:19 > 0:02:22Obviously, some jobs are more hazardous than others,
0:02:22 > 0:02:26but the law requires all employers to have insurance.
0:02:28 > 0:02:31John Beadle is RSA's UK counter fraud manager.
0:02:31 > 0:02:34He was passed one claim to review
0:02:34 > 0:02:37involving a common but debilitating workplace injury.
0:02:38 > 0:02:42This lady worked for a top-end clothing retailer
0:02:42 > 0:02:46and she claimed that she'd had two accidents at work.
0:02:46 > 0:02:49The first where she lifted a heavy box
0:02:49 > 0:02:53and the second where she had to retrieve something
0:02:53 > 0:02:55in a confined space.
0:02:55 > 0:02:58She was claiming in excess of £100,000.
0:03:00 > 0:03:04A huge claim, but her alleged injuries were significant.
0:03:04 > 0:03:08She had, or developed, frozen shoulder,
0:03:08 > 0:03:11she also had an arthroscopy,
0:03:11 > 0:03:16and her medical expert found that she only had 10% of movement
0:03:16 > 0:03:18in her left shoulder,
0:03:18 > 0:03:22which obviously would impact the way that she could live her life.
0:03:22 > 0:03:26And make the simplest of daily tasks a real challenge.
0:03:27 > 0:03:28To process the claim quickly,
0:03:28 > 0:03:31John's team carried out some routine checks.
0:03:33 > 0:03:36But on examining her medical records,
0:03:36 > 0:03:39we found that, indeed, just before this accident,
0:03:39 > 0:03:42she had had problems with her left shoulder.
0:03:42 > 0:03:46Which suggested although her recent mishap may have worsened
0:03:46 > 0:03:49the existing injury, it wasn't the cause.
0:03:49 > 0:03:52That would dramatically affect the claim.
0:03:52 > 0:03:57In normal circumstances, you would expect people to tell you the truth,
0:03:57 > 0:04:00and clearly this was the first evidence that we'd had
0:04:00 > 0:04:04that this lady wasn't being completely forthright with us
0:04:04 > 0:04:07and there was a pre-existing injury.
0:04:07 > 0:04:11Bearing in mind she was claiming in excess of £100,000,
0:04:11 > 0:04:14this was a key fact.
0:04:14 > 0:04:16If there was a pre-existing injury,
0:04:16 > 0:04:18it would have some impact on
0:04:18 > 0:04:22the level of compensation that might be considered,
0:04:22 > 0:04:26accepting that the injuries at work were in fact genuine.
0:04:26 > 0:04:30And this was something John was very keen to investigate.
0:04:30 > 0:04:32So having had our suspicion aroused,
0:04:32 > 0:04:37we thought we would get some surveillance evidence of the lady.
0:04:37 > 0:04:40This would either confirm or indeed deny
0:04:40 > 0:04:43whether or not she did have an incapacitating injury.
0:04:43 > 0:04:47And this period of surveillance would prove very worthwhile.
0:04:50 > 0:04:55Yeah, somebody who has only got 10% of their movement,
0:04:55 > 0:04:58you would expect to see very difficult
0:04:58 > 0:05:00going about their normal lives -
0:05:00 > 0:05:07not able to drive or to carry anything.
0:05:07 > 0:05:09Yeah, that is what you would expect,
0:05:09 > 0:05:11but the reality was very different.
0:05:11 > 0:05:17The surveillance showed that she appeared to be mobile
0:05:17 > 0:05:20and walking quite freely
0:05:20 > 0:05:24and using her arms in a normal fashion.
0:05:24 > 0:05:28And the claimant's next act would show she was all about the gain
0:05:28 > 0:05:30and there didn't seem to be too much pain.
0:05:30 > 0:05:34You can imagine our absolute amazement
0:05:34 > 0:05:38when the surveillance people actually obtained
0:05:38 > 0:05:40footage of her in a gym
0:05:40 > 0:05:44where she was doing a full BodyPump exercise
0:05:44 > 0:05:51which included lifting weights above her head on a barbell.
0:05:51 > 0:05:55OK, let's see that supposedly injured shoulder in action
0:05:55 > 0:05:56one more time.
0:05:59 > 0:06:00It's impressive.
0:06:00 > 0:06:02I hope she stretched -
0:06:02 > 0:06:04wouldn't want to pick up a genuine injury.
0:06:04 > 0:06:09Other exercises which were extremely vexing on those shoulders
0:06:09 > 0:06:11and, in fact, I think I might have struggled
0:06:11 > 0:06:13to have done some of the exercises that she did.
0:06:15 > 0:06:19So, she was fit enough to work out, but not actually work.
0:06:19 > 0:06:23And it seemed this claimant was in tiptop condition.
0:06:23 > 0:06:28It did show her living a completely normal life
0:06:28 > 0:06:32with no apparent restrictions in her movement whatsoever -
0:06:32 > 0:06:35she was driving as though it was completely normal.
0:06:35 > 0:06:39This type of scam never gets any easier to stomach.
0:06:39 > 0:06:44It is very frustrating when you see some of this type of footage
0:06:44 > 0:06:49where it is such a blatant and obvious lie
0:06:49 > 0:06:53that there is no incapacity at all.
0:06:53 > 0:06:58As the claimant's head, shoulders, knees, and toes had been shown
0:06:58 > 0:06:59to be working just fine,
0:06:59 > 0:07:01her case was reassessed.
0:07:02 > 0:07:05We reached a point in our investigation
0:07:05 > 0:07:08where we clearly had the surveillance footage
0:07:08 > 0:07:14and we also sought the advice of another medical expert
0:07:14 > 0:07:16who, having viewed the surveillance evidence,
0:07:16 > 0:07:19found that there was no incapacity at all.
0:07:19 > 0:07:24And we served this on to the defence solicitors
0:07:24 > 0:07:29and made them a very small offer in final settlement of the claim.
0:07:29 > 0:07:34The claimant was looking for a pay-out of over £100,000.
0:07:34 > 0:07:37Instead, she was offered a fraction of that amount,
0:07:37 > 0:07:40and odds were that she wouldn't even get that.
0:07:40 > 0:07:44We made an application to the court
0:07:44 > 0:07:49that this should be treated as a case of fundamental dishonesty.
0:07:49 > 0:07:51But it's unlikely that she will get any of that money
0:07:51 > 0:07:55because they'll be required to pay our costs in this case.
0:07:55 > 0:07:58And if the claimant thought she'd had an opportunity
0:07:58 > 0:08:00to take early retirement,
0:08:00 > 0:08:02she was sorely mistaken.
0:08:02 > 0:08:07Insurers aren't stupid and this is a really good demonstration
0:08:07 > 0:08:11of the level of scrutiny that you will be put to
0:08:11 > 0:08:14if we have suspicions about your claim.
0:08:20 > 0:08:25Still to come, a fighter's personal injury claim is knocked back.
0:08:25 > 0:08:27Not only should he not have been fighting but it was suggested
0:08:27 > 0:08:32his condition was an ability sufficient to win a fight.
0:08:36 > 0:08:39Fraudsters exist in all walks of life,
0:08:39 > 0:08:40often where you'd least expect.
0:08:40 > 0:08:43But one thing they all have in common
0:08:43 > 0:08:45is that their deception starts with a lie.
0:08:45 > 0:08:48It's the length scammers are willing to go to
0:08:48 > 0:08:50in order to commit fraud that separates them.
0:08:50 > 0:08:53While some insurance cheats will chicken out and hold their hands up,
0:08:53 > 0:08:57there are others who will quite frankly do or say anything
0:08:57 > 0:08:59to collect the cash.
0:08:59 > 0:09:04Protecting yourself with travel insurance is just good common sense,
0:09:04 > 0:09:07wherever you're spending your summer holidays.
0:09:07 > 0:09:09Insurers Aviva offer policies
0:09:09 > 0:09:12to cover most eventualities when abroad.
0:09:12 > 0:09:15Well, apart from those made up.
0:09:16 > 0:09:20Their head of fraud, Tom Gardiner, was presented with multiple claims
0:09:20 > 0:09:24from one customer who'd reportedly suffered some horrific misfortune.
0:09:25 > 0:09:30In 2012, Dr Sharma made two travel insurance claims.
0:09:30 > 0:09:34The first was for missing a flight
0:09:34 > 0:09:36from India to the UK
0:09:36 > 0:09:38which he said was as a result of a road traffic accident.
0:09:38 > 0:09:43Dr Narendra Sharma claimed to have spent £600 on replacement flights,
0:09:43 > 0:09:46but the true cost of this failed airport run
0:09:46 > 0:09:48was reported to the call handler.
0:10:07 > 0:10:09A tragic accident.
0:10:10 > 0:10:13But being a trusted GP here in the UK,
0:10:13 > 0:10:17Dr Sharma understood the importance of getting the paperwork in order,
0:10:17 > 0:10:19despite the awful circumstances.
0:10:20 > 0:10:23In support of Sharma's first claim for the missed flight,
0:10:23 > 0:10:25he had presented two documents.
0:10:25 > 0:10:27One was a death certificate,
0:10:27 > 0:10:32and also a recovery invoice following the damage to his car.
0:10:32 > 0:10:35Aviva used their on-the-ground investigators to validate the claim,
0:10:35 > 0:10:39which threw up a shocking revelation.
0:10:39 > 0:10:41What was revealed quite quickly
0:10:41 > 0:10:43from our local agent's inquiries in India
0:10:43 > 0:10:49was that the recovery company simply didn't exist,
0:10:49 > 0:10:53the officials had confirmed that the death certificate was entirely bogus
0:10:53 > 0:10:56and also that the police had no record
0:10:56 > 0:10:58of attending a road traffic accident,
0:10:58 > 0:11:01let alone a fatal road traffic accident.
0:11:01 > 0:11:05So, with no record of the accident or the fatality,
0:11:05 > 0:11:07the evidence suggested Dr Sharma had lied
0:11:07 > 0:11:10so he could make a false insurance claim.
0:11:10 > 0:11:13It was quite clear that what on the face of it
0:11:13 > 0:11:17was a tragic incident resulting in a genuine claim
0:11:17 > 0:11:19was clearly anything but that.
0:11:19 > 0:11:21OK, so far, we've established
0:11:21 > 0:11:24that the good Dr Sharma had faked his mother-in-law's death
0:11:24 > 0:11:25in a fictitious road accident
0:11:25 > 0:11:27and supplied forged documents
0:11:27 > 0:11:30just so he could make a fraudulent travel insurance claim
0:11:30 > 0:11:32for missed flights.
0:11:32 > 0:11:34If that wasn't extraordinary enough,
0:11:34 > 0:11:36remember the second insurance claim?
0:11:36 > 0:11:41Dr Sharma telephoned Aviva to notify his second claim.
0:11:41 > 0:11:46That was for a cancellation of a holiday in Spain,
0:11:46 > 0:11:48which he attributed to a family illness.
0:11:48 > 0:11:52And that was for accommodation costs of a approximately £59.
0:11:53 > 0:11:58And the reported illness went well beyond a sudden bout of flu.
0:11:58 > 0:12:00Dr Sharma explained the family member's diagnosis
0:12:00 > 0:12:02to the call handler.
0:12:18 > 0:12:21Sympathetic to the alleged circumstance,
0:12:21 > 0:12:23the information is taken at face value.
0:12:23 > 0:12:27I think suspicions were raised in the original telephone call.
0:12:27 > 0:12:32Sharma seemed to change his story quite quickly
0:12:32 > 0:12:39and his accommodation costs went from £59 to then include flights.
0:12:39 > 0:12:44And when Dr Sharma thinks he could potentially end up with nothing,
0:12:44 > 0:12:46he ups the ante.
0:13:07 > 0:13:10So, Dr Sharma was now claiming in excess of £600
0:13:10 > 0:13:12for cancelled flights,
0:13:12 > 0:13:15but by the time supporting documents were received,
0:13:15 > 0:13:17this figure had changed a little.
0:13:17 > 0:13:19When we then received the invoices,
0:13:19 > 0:13:24the accommodation costs weren't £59, there were £959
0:13:24 > 0:13:27and the flights were in excess of £1,000.
0:13:27 > 0:13:29Quite the jump.
0:13:29 > 0:13:30The first thing Tom's team did
0:13:30 > 0:13:33was to attempt to validate Sharma's paperwork,
0:13:33 > 0:13:37but it wasn't exactly what this doctor had ordered.
0:13:37 > 0:13:43Neither the airline or the holiday company could support or recognise
0:13:43 > 0:13:47the two invoices that Sharma had presented.
0:13:47 > 0:13:52Damning evidence that this was also a completely fabricated claim.
0:13:52 > 0:13:57And it appeared that the on-call doctor had decided to go off-duty.
0:13:57 > 0:13:59Sharma was presented with this evidence -
0:13:59 > 0:14:02he no longer communicated with us.
0:14:02 > 0:14:05I suspect that he realised, then, that the game was up
0:14:05 > 0:14:09and rather hoped that that would be an end to the matter.
0:14:09 > 0:14:11Given the body of proof Tom had,
0:14:11 > 0:14:14Dr Sharma was hoping in vain.
0:14:14 > 0:14:16It was clear that on both claims
0:14:16 > 0:14:18fraudulent invoices had been submitted,
0:14:18 > 0:14:22so both claims were repudiated.
0:14:22 > 0:14:24We also put together our evidence
0:14:24 > 0:14:26and reported the matter to the police.
0:14:27 > 0:14:31Dr Sharma had been willing to fake the death of his mother-in-law,
0:14:31 > 0:14:32forge her death certificate,
0:14:32 > 0:14:34and tell the most terrible lies
0:14:34 > 0:14:37in a sickening attempt to fraudulently claim
0:14:37 > 0:14:39on his travel insurance.
0:14:40 > 0:14:43But the game was up and he was about to feel the full weight of the law.
0:14:43 > 0:14:46As a result of the police taking on the case,
0:14:46 > 0:14:49Dr Sharma was prosecuted and pleaded guilty
0:14:49 > 0:14:52and he received six months' community service.
0:14:53 > 0:14:56A good result for Tom and the team at Aviva,
0:14:56 > 0:15:00but the consequences were far from over for Dr Sharma.
0:15:00 > 0:15:03Following the prosecution, we were deeply concerned
0:15:03 > 0:15:07about Sharma's behaviour and the position he held,
0:15:07 > 0:15:09so we brought that to the attention
0:15:09 > 0:15:12of the General Medical Council as well.
0:15:12 > 0:15:14As you might have guessed,
0:15:14 > 0:15:16they weren't exactly impressed by his conduct.
0:15:16 > 0:15:20The General Medical Council took a very dim view of it
0:15:20 > 0:15:25and as a result of their proceedings, Sharma was struck off.
0:15:26 > 0:15:28So from respected pillar of the community,
0:15:28 > 0:15:32to disgraced insurance cheat with a community service order.
0:15:32 > 0:15:36He had it all but threw it away with his attempted fraud.
0:15:38 > 0:15:40I think what's difficult to rationalise
0:15:40 > 0:15:43is that someone in Dr Sharma's position
0:15:43 > 0:15:46was prepared to go to such lengths.
0:15:46 > 0:15:50This case perfectly demonstrates insurers' ability
0:15:50 > 0:15:53to identify and stop fraud.
0:16:00 > 0:16:02Whether you dream of climbing Mount Everest
0:16:02 > 0:16:04or sailing the high seas,
0:16:04 > 0:16:07travel insurance gives you invaluable protection
0:16:07 > 0:16:10should anything go wrong on your big trip.
0:16:10 > 0:16:14There are, though, some sly scammers who think being half a world away
0:16:14 > 0:16:16makes it easier to make a fraudulent claim.
0:16:16 > 0:16:18But in today's global village,
0:16:18 > 0:16:21insurance cheats can be detected anywhere.
0:16:23 > 0:16:26Whatever destination you're jetting off to,
0:16:26 > 0:16:28there'll be a policy to cover your adventure.
0:16:30 > 0:16:33Mathew Crawford-Thomas is the fraud manager for Collinson Group.
0:16:36 > 0:16:39He was handed one case involving a customer who had suffered
0:16:39 > 0:16:44a potentially life-threatening incident in Nepal.
0:16:44 > 0:16:45At the initial telephone call,
0:16:45 > 0:16:49we were advised that our insured was suffering with altitude sickness
0:16:49 > 0:16:52and needed repatriating into Kathmandu, and the only way
0:16:52 > 0:16:55this could be accomplished was via helicopter rescue.
0:16:55 > 0:16:58The customer was rushed into hospital,
0:16:58 > 0:17:01but his potentially life-saving ride came at quite a cost.
0:17:03 > 0:17:05The claim was submitted for
0:17:05 > 0:17:11a helicopter rescue from Hilsa in Nepal to Kathmandu for US 18,400.
0:17:11 > 0:17:13At this particular moment of the claim,
0:17:13 > 0:17:15we hadn't actually heard from the insured person
0:17:15 > 0:17:18as we were dealing directly with the rescue company.
0:17:18 > 0:17:21Not exactly loose change,
0:17:21 > 0:17:24but Matt wouldn't have to wait long to hear from the claimant.
0:17:24 > 0:17:27We received a telephone call from the insured the next day,
0:17:27 > 0:17:30after he was dropped off at the hospital, advising us that
0:17:30 > 0:17:34he wanted to leave and for us to guarantee payment to the hospital.
0:17:34 > 0:17:37A suspiciously fast recovery
0:17:37 > 0:17:42for a man requiring an emergency air evacuation just 24 hours ago.
0:18:11 > 0:18:14The claimant's medical report was received and reviewed.
0:18:14 > 0:18:18This was the first big cause for concern.
0:18:18 > 0:18:21Upon receiving the medical report from the hospital,
0:18:21 > 0:18:25it transpired that he had little or no symptoms of altitude sickness,
0:18:25 > 0:18:26therefore we started to worry
0:18:26 > 0:18:30whether or not the helicopter rescue was in fact necessary.
0:18:31 > 0:18:36By this point, the combined claim total was in excess of 20,000,
0:18:36 > 0:18:37or £15,000.
0:18:39 > 0:18:43And one party were especially keen to get paid.
0:18:43 > 0:18:45At this particular moment in time,
0:18:45 > 0:18:47not only were we dealing with the insured person,
0:18:47 > 0:18:50but we also had to deal with the helicopter rescue company
0:18:50 > 0:18:51asking for their money as well.
0:19:25 > 0:19:29And, judging by the amount of money the rescue company were asking for,
0:19:29 > 0:19:33they must have been operating their first-class service that day.
0:19:33 > 0:19:36When the bill came in at 18,400,
0:19:36 > 0:19:40we felt that this bill in itself was far too much money.
0:19:40 > 0:19:43A bill of this nature for the trip that he had received
0:19:43 > 0:19:45is circa 10,000 US.
0:19:45 > 0:19:48There was clear evidence that we needed to ask more questions
0:19:48 > 0:19:50of the helicopter rescue company.
0:19:50 > 0:19:55So they were attempting to charge nearly £15,000
0:19:55 > 0:19:59for a flight that normally costs around £7,500.
0:19:59 > 0:20:00Matt needed to get to the bottom of this
0:20:00 > 0:20:04and turned to his boots on the ground for assistance.
0:20:04 > 0:20:08We employed the services of an agent in Nepal to investigate this matter.
0:20:08 > 0:20:14And it didn't take the agent long to identify a gaping hole in the claim.
0:20:16 > 0:20:18After our agents contacted the air traffic control tower,
0:20:18 > 0:20:22they realised that no flight had taken off that day.
0:20:22 > 0:20:27With this claim crash-landing, the claimant also proved untraceable.
0:20:27 > 0:20:30Hilsa in Nepal is a restricted area
0:20:30 > 0:20:32and you need to have a permit issued.
0:20:32 > 0:20:36Upon checking the records, no permit was ever issued to our insured.
0:20:36 > 0:20:40The local investigation strongly suggested this flight of fancy
0:20:40 > 0:20:44had been concocted by the claimant and the rescue company.
0:20:46 > 0:20:50And in the absence of any payment, extreme measures were taken.
0:20:50 > 0:20:53The helicopter rescue company had actually secured
0:20:53 > 0:20:57the insured's passport as identification verification.
0:20:57 > 0:21:01However, they were refusing to give it back to the insured until
0:21:01 > 0:21:03such times as we had paid the bill.
0:21:03 > 0:21:05Armed with this information,
0:21:05 > 0:21:08the rescue company had a few facts pointed out to them.
0:21:48 > 0:21:51The rescue company are getting desperate.
0:21:51 > 0:21:54They knew the longer the claim went on, the more likely
0:21:54 > 0:21:57it would be found to be false and they'd be left empty-handed.
0:21:57 > 0:21:59Claiming to be withholding the customer's passport
0:21:59 > 0:22:01is an interesting move
0:22:01 > 0:22:04because the evidence suggested the rescue never even happened
0:22:04 > 0:22:07and the claimant was complicit in the deception,
0:22:07 > 0:22:11but the posturing and threats would keep on coming.
0:22:11 > 0:22:14Throughout the course of this investigation, the helicopter rescue
0:22:14 > 0:22:20company employed several tactics to attempt to make us pay the 18,400.
0:22:20 > 0:22:22Determined to keep up the pressure,
0:22:22 > 0:22:25Matt's team received another call from the rescue company.
0:22:41 > 0:22:46Unsurprisingly, Matt declined to take the company's kind offer
0:22:46 > 0:22:48and it would appear to be their last-ditch attempt
0:22:48 > 0:22:50at extorting a payment.
0:22:50 > 0:22:52Our agents, once armed with all the evidence,
0:22:52 > 0:22:56put it to the rescue company and their response was,
0:22:56 > 0:23:00due to a technical error, they are withdrawing their claim.
0:23:00 > 0:23:03So they'd finally thrown in the towel
0:23:03 > 0:23:08and it was down to Matt and his team's refusal to be pressurised.
0:23:08 > 0:23:11During the life cycle of this claim, the helicopter rescue company
0:23:11 > 0:23:15and the insured contacted us on numerous occasions.
0:23:15 > 0:23:19At no point did we budge with regards to guaranteeing any payment
0:23:19 > 0:23:22until a full investigation had been finished.
0:23:27 > 0:23:29Day-to-day life can be dangerous, can't it?
0:23:29 > 0:23:33From busy roads to packed high streets and kamikaze cyclists,
0:23:33 > 0:23:37there's no end of potential ways to run into trouble.
0:23:37 > 0:23:40If you have an accident that wasn't your fault, then you're entitled
0:23:40 > 0:23:44to make a personal injury claim and seek fair compensation.
0:23:44 > 0:23:45But crafty insurance cheats
0:23:45 > 0:23:49don't concern themselves with minor details like who was at fault. No.
0:23:49 > 0:23:52Instead, they just make up an accident
0:23:52 > 0:23:55all in an effort to make a quick buck.
0:23:57 > 0:24:01Over three million people are injured in accidents every year.
0:24:01 > 0:24:03In the home, at work or outdoors.
0:24:04 > 0:24:07The vast majority of claims are genuine.
0:24:07 > 0:24:10The rest are dealt with by people like Scott Clayton,
0:24:10 > 0:24:12a fraud manager for insurers Zurich.
0:24:12 > 0:24:15He was asked to look over one customer's claim
0:24:15 > 0:24:17just as a matter of routine.
0:24:19 > 0:24:22We received a claim for personal injury from this claimant
0:24:22 > 0:24:24who said that whilst walking along the road,
0:24:24 > 0:24:28his foot had been caught in a grate that didn't have a lid on it.
0:24:30 > 0:24:32Probably worth around about £4,500,
0:24:32 > 0:24:35so not an inconsiderable sum of money.
0:24:35 > 0:24:39On the surface, it seemed like a fairly minor injury,
0:24:39 > 0:24:43but the grate in question had really done a number on the claimant.
0:24:43 > 0:24:46Well, the injuries that the claimant said that he'd sustained
0:24:46 > 0:24:49were a fractured ankle,
0:24:49 > 0:24:52which is pretty nasty, and also damage to his knee,
0:24:52 > 0:24:54so you can see almost how he's had his foot caught,
0:24:54 > 0:24:58twisted. Quite an unpleasant experience.
0:24:58 > 0:25:00Due to the extent of his injuries,
0:25:00 > 0:25:04the claimant alleged he couldn't work for at least six months
0:25:04 > 0:25:07and had to undergo an intensive recovery programme.
0:25:07 > 0:25:10As a result of the accident, he went through a period of
0:25:10 > 0:25:14rehabilitation and had medical treatment as well as six rounds
0:25:14 > 0:25:18of physiotherapy to get himself back on his feet as quickly as possible.
0:25:18 > 0:25:21But this claimant had more reason than most
0:25:21 > 0:25:23to need full use of his feet.
0:25:24 > 0:25:27Our suspicions were arisen when we looked at the medical report and saw
0:25:27 > 0:25:31that his occupation was a mixed martial arts instructor and fighter.
0:25:31 > 0:25:34So we would validate that just to check whether
0:25:34 > 0:25:37there was any activity in the period that he was recovering.
0:25:37 > 0:25:42And some online checks revealed some truly jaw-dropping video evidence.
0:25:42 > 0:25:44The investigation found that
0:25:44 > 0:25:46he had actually fought three months after the accident,
0:25:46 > 0:25:51so during the time that he was "recovering" from a nasty injury,
0:25:51 > 0:25:53he was physically able to engage
0:25:53 > 0:25:56in what we consider to be highly physical activity,
0:25:56 > 0:26:00and he won, which tends to suggest that he was in good condition.
0:26:02 > 0:26:04Well, he must have been in peak condition
0:26:04 > 0:26:08to survive one of the most brutal forms of professional fighting.
0:26:08 > 0:26:12The discovery left this punchy pretender's claim on the ropes.
0:26:14 > 0:26:16Not only should he not have been fighting
0:26:16 > 0:26:20because he was apparently off work with a serious injury,
0:26:20 > 0:26:24but it would suggest his condition was...and ability was sufficient
0:26:24 > 0:26:28to win a fight, therefore it cast doubt over the whole claim.
0:26:28 > 0:26:32With the claim on its last legs, in came the knockout blow.
0:26:32 > 0:26:34Our research found that not only
0:26:34 > 0:26:36had he fought three months after the accident,
0:26:36 > 0:26:39but he'd also fought again eight months after the accident,
0:26:39 > 0:26:43so our conclusion was that he was perfectly fit and well to fight,
0:26:43 > 0:26:47maintain his occupation and lifestyle, and we therefore
0:26:47 > 0:26:50consulted with his solicitors and told them what we had found.
0:26:50 > 0:26:53Given the evidence, his solicitors were none too keen
0:26:53 > 0:26:57to go another round with Zurich in pursuit of this claim.
0:26:57 > 0:26:59We heard nothing from his solicitors,
0:26:59 > 0:27:02despite a couple of reminders, and then latterly
0:27:02 > 0:27:05they told us that they had actually discontinued the claim.
0:27:05 > 0:27:09So, in other words, we had found out the truth and the claim had
0:27:09 > 0:27:10gone away as a result of it.
0:27:10 > 0:27:14The claimant severely underestimated his opponent in this case.
0:27:14 > 0:27:17He probably thought that this was a claim that we would pay and
0:27:17 > 0:27:21there wouldn't be any problems, but when you put things on the internet,
0:27:21 > 0:27:24then they're for everybody to see. And in this case, he was caught out.
0:27:24 > 0:27:27And if any potential fraudster fancies their chances with
0:27:27 > 0:27:32a false claim, they'll come up against a zero-tolerance attitude.
0:27:32 > 0:27:33We check all claims.
0:27:33 > 0:27:36We want to make sure that we're paying money out correctly
0:27:36 > 0:27:38and to people who are deserving of it.
0:27:38 > 0:27:41Where we find information that suggests a fraud,
0:27:41 > 0:27:45then we will look into it thoroughly because it's just not fair
0:27:45 > 0:27:48for people to try and exploit the system this way.
0:27:52 > 0:27:56None of us likes paying more than we have to for everyday services.
0:27:56 > 0:28:00From organised criminal gangs to exaggerated household claims,
0:28:00 > 0:28:03insurance fraud hits all of us in the pocket.
0:28:03 > 0:28:05But instead of getting away with it,
0:28:05 > 0:28:09more and more of these fraudsters have been claimed and shamed.