Episode 10 Claimed and Shamed

Insurance fraud has reached epidemic levels in the UK.

It's costing us more than £1.3 billion every year -

that's almost 3.6 million every day.

Deliberate crashes, bogus personal injuries,

even phantom pets.

The fraudsters are risking more and more to make a quick killing,

and every year it's adding around £50 to your insurance bill.

But insurers are fighting back -

exposing just under 15 fake claims every hour.

Armed with covert surveillance systems...

That's the subject out the vehicle.

..sophisticated data analysis techniques...

-Police!

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

Police, stand back! Stay where you are!

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

Just don't lie to us.

All those con men, scammers

and cheats on the fiddle are now caught in the act

and claimed and shamed.

Today, a woman claiming she can't work stretches the truth

as well as her body.

I think I might have struggled to have done

some of the exercises that she did.

A doctor's outrageous holiday scam is prescribed

a double dose of justice.

The General Medical Council took a very dim view of it,

and as a result of their proceedings, Sharma was struck off.

And an attempt to deceive insurers

with a fake helicopter rescue crash-lands.

After our agents contacts the air traffic control tower

they realised that no flights had taken off that day.

If you've ever been hurt at work,

you'll know the prospect of losing your livelihood

can be a frightening thing.

Most of us will do anything to get healthy again

and get back to the day job,

but there are those who see this as a chance

to take an extended holiday,

often fabricating or exaggerating their condition

in the false belief that insurers will continue to pay out.

It's estimated that we spend around a third of our lives working.

Obviously, some jobs are more hazardous than others,

but the law requires all employers to have insurance.

John Beadle is RSA's UK counter fraud manager.

He was passed one claim to review

involving a common but debilitating workplace injury.

This lady worked for a top-end clothing retailer

and she claimed that she'd had two accidents at work.

The first where she lifted a heavy box

and the second where she had to retrieve something

in a confined space.

She was claiming in excess of £100,000.

A huge claim, but her alleged injuries were significant.

She had, or developed, frozen shoulder,

she also had an arthroscopy,

and her medical expert found that she only had 10% of movement

in her left shoulder,

which obviously would impact the way that she could live her life.

And make the simplest of daily tasks a real challenge.

To process the claim quickly,

John's team carried out some routine checks.

But on examining her medical records,

we found that, indeed, just before this accident,

she had had problems with her left shoulder.

Which suggested although her recent mishap may have worsened

the existing injury, it wasn't the cause.

That would dramatically affect the claim.

In normal circumstances, you would expect people to tell you the truth,

and clearly this was the first evidence that we'd had

that this lady wasn't being completely forthright with us

and there was a pre-existing injury.

Bearing in mind she was claiming in excess of £100,000,

this was a key fact.

If there was a pre-existing injury,

it would have some impact on

the level of compensation that might be considered,

accepting that the injuries at work were in fact genuine.

And this was something John was very keen to investigate.

So having had our suspicion aroused,

we thought we would get some surveillance evidence of the lady.

This would either confirm or indeed deny

whether or not she did have an incapacitating injury.

And this period of surveillance would prove very worthwhile.

Yeah, somebody who has only got 10% of their movement,

you would expect to see very difficult

going about their normal lives -

not able to drive or to carry anything.

Yeah, that is what you would expect,

but the reality was very different.

The surveillance showed that she appeared to be mobile

and walking quite freely

and using her arms in a normal fashion.

And the claimant's next act would show she was all about the gain

and there didn't seem to be too much pain.

You can imagine our absolute amazement

when the surveillance people actually obtained

footage of her in a gym

where she was doing a full BodyPump exercise

which included lifting weights above her head on a barbell.

OK, let's see that supposedly injured shoulder in action

one more time.

It's impressive.

I hope she stretched -

wouldn't want to pick up a genuine injury.

Other exercises which were extremely vexing on those shoulders

and, in fact, I think I might have struggled

to have done some of the exercises that she did.

So, she was fit enough to work out, but not actually work.

And it seemed this claimant was in tiptop condition.

It did show her living a completely normal life

with no apparent restrictions in her movement whatsoever -

she was driving as though it was completely normal.

This type of scam never gets any easier to stomach.

It is very frustrating when you see some of this type of footage

where it is such a blatant and obvious lie

that there is no incapacity at all.

As the claimant's head, shoulders, knees, and toes had been shown

to be working just fine,

her case was reassessed.

We reached a point in our investigation

where we clearly had the surveillance footage

and we also sought the advice of another medical expert

who, having viewed the surveillance evidence,

found that there was no incapacity at all.

And we served this on to the defence solicitors

and made them a very small offer in final settlement of the claim.

The claimant was looking for a pay-out of over £100,000.

Instead, she was offered a fraction of that amount,

and odds were that she wouldn't even get that.

We made an application to the court

that this should be treated as a case of fundamental dishonesty.

But it's unlikely that she will get any of that money

because they'll be required to pay our costs in this case.

And if the claimant thought she'd had an opportunity

to take early retirement,

she was sorely mistaken.

Insurers aren't stupid and this is a really good demonstration

of the level of scrutiny that you will be put to

if we have suspicions about your claim.

Still to come, a fighter's personal injury claim is knocked back.

Not only should he not have been fighting but it was suggested

his condition was an ability sufficient to win a fight.

Fraudsters exist in all walks of life,

often where you'd least expect.

But one thing they all have in common

is that their deception starts with a lie.

It's the length scammers are willing to go to

in order to commit fraud that separates them.

While some insurance cheats will chicken out and hold their hands up,

there are others who will quite frankly do or say anything

to collect the cash.

Protecting yourself with travel insurance is just good common sense,

wherever you're spending your summer holidays.

Insurers Aviva offer policies

to cover most eventualities when abroad.

Well, apart from those made up.

Their head of fraud, Tom Gardiner, was presented with multiple claims

from one customer who'd reportedly suffered some horrific misfortune.

In 2012, Dr Sharma made two travel insurance claims.

The first was for missing a flight

from India to the UK

which he said was as a result of a road traffic accident.

Dr Narendra Sharma claimed to have spent £600 on replacement flights,

but the true cost of this failed airport run

was reported to the call handler.

A tragic accident.

But being a trusted GP here in the UK,

Dr Sharma understood the importance of getting the paperwork in order,

despite the awful circumstances.

In support of Sharma's first claim for the missed flight,

he had presented two documents.

One was a death certificate,

and also a recovery invoice following the damage to his car.

Aviva used their on-the-ground investigators to validate the claim,

which threw up a shocking revelation.

What was revealed quite quickly

from our local agent's inquiries in India

was that the recovery company simply didn't exist,

the officials had confirmed that the death certificate was entirely bogus

and also that the police had no record

of attending a road traffic accident,

let alone a fatal road traffic accident.

So, with no record of the accident or the fatality,

the evidence suggested Dr Sharma had lied

so he could make a false insurance claim.

It was quite clear that what on the face of it

was a tragic incident resulting in a genuine claim

was clearly anything but that.

OK, so far, we've established

that the good Dr Sharma had faked his mother-in-law's death

in a fictitious road accident

and supplied forged documents

just so he could make a fraudulent travel insurance claim

for missed flights.

If that wasn't extraordinary enough,

remember the second insurance claim?

Dr Sharma telephoned Aviva to notify his second claim.

That was for a cancellation of a holiday in Spain,

which he attributed to a family illness.

And that was for accommodation costs of a approximately £59.

And the reported illness went well beyond a sudden bout of flu.

Dr Sharma explained the family member's diagnosis

to the call handler.

Sympathetic to the alleged circumstance,

the information is taken at face value.

I think suspicions were raised in the original telephone call.

Sharma seemed to change his story quite quickly

and his accommodation costs went from £59 to then include flights.

And when Dr Sharma thinks he could potentially end up with nothing,

he ups the ante.

So, Dr Sharma was now claiming in excess of £600

for cancelled flights,

but by the time supporting documents were received,

this figure had changed a little.

When we then received the invoices,

the accommodation costs weren't £59, there were £959

and the flights were in excess of £1,000.

Quite the jump.

The first thing Tom's team did

was to attempt to validate Sharma's paperwork,

but it wasn't exactly what this doctor had ordered.

Neither the airline or the holiday company could support or recognise

the two invoices that Sharma had presented.

Damning evidence that this was also a completely fabricated claim.

And it appeared that the on-call doctor had decided to go off-duty.

Sharma was presented with this evidence -

he no longer communicated with us.

I suspect that he realised, then, that the game was up

and rather hoped that that would be an end to the matter.

Given the body of proof Tom had,

Dr Sharma was hoping in vain.

It was clear that on both claims

fraudulent invoices had been submitted,

so both claims were repudiated.

We also put together our evidence

and reported the matter to the police.

Dr Sharma had been willing to fake the death of his mother-in-law,

forge her death certificate,

and tell the most terrible lies

in a sickening attempt to fraudulently claim

on his travel insurance.

But the game was up and he was about to feel the full weight of the law.

As a result of the police taking on the case,

Dr Sharma was prosecuted and pleaded guilty

and he received six months' community service.

A good result for Tom and the team at Aviva,

but the consequences were far from over for Dr Sharma.

Following the prosecution, we were deeply concerned

about Sharma's behaviour and the position he held,

so we brought that to the attention

of the General Medical Council as well.

As you might have guessed,

they weren't exactly impressed by his conduct.

The General Medical Council took a very dim view of it

and as a result of their proceedings, Sharma was struck off.

So from respected pillar of the community,

to disgraced insurance cheat with a community service order.

He had it all but threw it away with his attempted fraud.

I think what's difficult to rationalise

is that someone in Dr Sharma's position

was prepared to go to such lengths.

This case perfectly demonstrates insurers' ability

to identify and stop fraud.

Whether you dream of climbing Mount Everest

or sailing the high seas,

travel insurance gives you invaluable protection

should anything go wrong on your big trip.

There are, though, some sly scammers who think being half a world away

makes it easier to make a fraudulent claim.

But in today's global village,

insurance cheats can be detected anywhere.

Whatever destination you're jetting off to,

there'll be a policy to cover your adventure.

Mathew Crawford-Thomas is the fraud manager for Collinson Group.

He was handed one case involving a customer who had suffered

a potentially life-threatening incident in Nepal.

At the initial telephone call,

we were advised that our insured was suffering with altitude sickness

and needed repatriating into Kathmandu, and the only way

this could be accomplished was via helicopter rescue.

The customer was rushed into hospital,

but his potentially life-saving ride came at quite a cost.

The claim was submitted for

a helicopter rescue from Hilsa in Nepal to Kathmandu for US 18,400.

At this particular moment of the claim,

we hadn't actually heard from the insured person

as we were dealing directly with the rescue company.

Not exactly loose change,

but Matt wouldn't have to wait long to hear from the claimant.

We received a telephone call from the insured the next day,

after he was dropped off at the hospital, advising us that

he wanted to leave and for us to guarantee payment to the hospital.

A suspiciously fast recovery

for a man requiring an emergency air evacuation just 24 hours ago.

The claimant's medical report was received and reviewed.

This was the first big cause for concern.

Upon receiving the medical report from the hospital,

it transpired that he had little or no symptoms of altitude sickness,

therefore we started to worry

whether or not the helicopter rescue was in fact necessary.

By this point, the combined claim total was in excess of 20,000,

or £15,000.

And one party were especially keen to get paid.

At this particular moment in time,

not only were we dealing with the insured person,

but we also had to deal with the helicopter rescue company

asking for their money as well.

And, judging by the amount of money the rescue company were asking for,

they must have been operating their first-class service that day.

When the bill came in at 18,400,

we felt that this bill in itself was far too much money.

A bill of this nature for the trip that he had received

is circa 10,000 US.

There was clear evidence that we needed to ask more questions

of the helicopter rescue company.

So they were attempting to charge nearly £15,000

for a flight that normally costs around £7,500.

Matt needed to get to the bottom of this

and turned to his boots on the ground for assistance.

We employed the services of an agent in Nepal to investigate this matter.

And it didn't take the agent long to identify a gaping hole in the claim.

After our agents contacted the air traffic control tower,

they realised that no flight had taken off that day.

With this claim crash-landing, the claimant also proved untraceable.

Hilsa in Nepal is a restricted area

and you need to have a permit issued.

Upon checking the records, no permit was ever issued to our insured.

The local investigation strongly suggested this flight of fancy

had been concocted by the claimant and the rescue company.

And in the absence of any payment, extreme measures were taken.

The helicopter rescue company had actually secured

the insured's passport as identification verification.

However, they were refusing to give it back to the insured until

such times as we had paid the bill.

Armed with this information,

the rescue company had a few facts pointed out to them.

The rescue company are getting desperate.

They knew the longer the claim went on, the more likely

it would be found to be false and they'd be left empty-handed.

Claiming to be withholding the customer's passport

is an interesting move

because the evidence suggested the rescue never even happened

and the claimant was complicit in the deception,

but the posturing and threats would keep on coming.

Throughout the course of this investigation, the helicopter rescue

company employed several tactics to attempt to make us pay the 18,400.

Determined to keep up the pressure,

Matt's team received another call from the rescue company.

Unsurprisingly, Matt declined to take the company's kind offer

and it would appear to be their last-ditch attempt

at extorting a payment.

Our agents, once armed with all the evidence,

put it to the rescue company and their response was,

due to a technical error, they are withdrawing their claim.

So they'd finally thrown in the towel

and it was down to Matt and his team's refusal to be pressurised.

During the life cycle of this claim, the helicopter rescue company

and the insured contacted us on numerous occasions.

At no point did we budge with regards to guaranteeing any payment

until a full investigation had been finished.

Day-to-day life can be dangerous, can't it?

From busy roads to packed high streets and kamikaze cyclists,

there's no end of potential ways to run into trouble.

If you have an accident that wasn't your fault, then you're entitled

to make a personal injury claim and seek fair compensation.

But crafty insurance cheats

don't concern themselves with minor details like who was at fault. No.

Instead, they just make up an accident

all in an effort to make a quick buck.

Over three million people are injured in accidents every year.

In the home, at work or outdoors.

The vast majority of claims are genuine.

The rest are dealt with by people like Scott Clayton,

a fraud manager for insurers Zurich.

He was asked to look over one customer's claim

just as a matter of routine.

We received a claim for personal injury from this claimant

who said that whilst walking along the road,

his foot had been caught in a grate that didn't have a lid on it.

Probably worth around about £4,500,

so not an inconsiderable sum of money.

On the surface, it seemed like a fairly minor injury,

but the grate in question had really done a number on the claimant.

Well, the injuries that the claimant said that he'd sustained

were a fractured ankle,

which is pretty nasty, and also damage to his knee,

so you can see almost how he's had his foot caught,

twisted. Quite an unpleasant experience.

Due to the extent of his injuries,

the claimant alleged he couldn't work for at least six months

and had to undergo an intensive recovery programme.

As a result of the accident, he went through a period of

rehabilitation and had medical treatment as well as six rounds

of physiotherapy to get himself back on his feet as quickly as possible.

But this claimant had more reason than most

to need full use of his feet.

Our suspicions were arisen when we looked at the medical report and saw

that his occupation was a mixed martial arts instructor and fighter.

So we would validate that just to check whether

there was any activity in the period that he was recovering.

And some online checks revealed some truly jaw-dropping video evidence.

The investigation found that

he had actually fought three months after the accident,

so during the time that he was "recovering" from a nasty injury,

he was physically able to engage

in what we consider to be highly physical activity,

and he won, which tends to suggest that he was in good condition.

Well, he must have been in peak condition

to survive one of the most brutal forms of professional fighting.

The discovery left this punchy pretender's claim on the ropes.

Not only should he not have been fighting

because he was apparently off work with a serious injury,

but it would suggest his condition was...and ability was sufficient

to win a fight, therefore it cast doubt over the whole claim.

With the claim on its last legs, in came the knockout blow.

Our research found that not only

had he fought three months after the accident,

but he'd also fought again eight months after the accident,

so our conclusion was that he was perfectly fit and well to fight,

maintain his occupation and lifestyle, and we therefore

consulted with his solicitors and told them what we had found.

Given the evidence, his solicitors were none too keen

to go another round with Zurich in pursuit of this claim.

We heard nothing from his solicitors,

despite a couple of reminders, and then latterly

they told us that they had actually discontinued the claim.

So, in other words, we had found out the truth and the claim had

gone away as a result of it.

The claimant severely underestimated his opponent in this case.

He probably thought that this was a claim that we would pay and

there wouldn't be any problems, but when you put things on the internet,

then they're for everybody to see. And in this case, he was caught out.

And if any potential fraudster fancies their chances with

a false claim, they'll come up against a zero-tolerance attitude.

We check all claims.

We want to make sure that we're paying money out correctly

and to people who are deserving of it.

Where we find information that suggests a fraud,

then we will look into it thoroughly because it's just not fair

for people to try and exploit the system this way.

None of us likes paying more than we have to for everyday services.

From organised criminal gangs to exaggerated household claims,

insurance fraud hits all of us in the pocket.

But instead of getting away with it,

more and more of these fraudsters have been claimed and shamed.