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Insurance fraud has reached epidemic levels in the UK. | 0:00:05 | 0:00:09 | |
It's costing us more than £1.3 billion every year - | 0:00:09 | 0:00:14 | |
that's almost 3.6 million every day. | 0:00:14 | 0:00:17 | |
Deliberate crashes, bogus personal injuries, | 0:00:19 | 0:00:23 | |
even phantom pets. | 0:00:23 | 0:00:24 | |
The fraudsters are risking more and more to make a quick killing, | 0:00:25 | 0:00:29 | |
and every year it's adding around £50 to your insurance bill. | 0:00:29 | 0:00:34 | |
But insurers are fighting back - | 0:00:34 | 0:00:36 | |
exposing just under 15 fake claims every hour. | 0:00:36 | 0:00:39 | |
Armed with covert surveillance systems... | 0:00:39 | 0:00:42 | |
That's the subject out the vehicle. | 0:00:42 | 0:00:44 | |
..sophisticated data analysis techniques... | 0:00:44 | 0:00:46 | |
-Police! -..and a number of highly skilled police units... | 0:00:48 | 0:00:51 | |
Police, stand back! Stay where you are! | 0:00:51 | 0:00:53 | |
..they're catching the criminals red-handed. | 0:00:53 | 0:00:55 | |
Just don't lie to us. | 0:00:55 | 0:00:58 | |
All those con men, scammers | 0:00:58 | 0:00:59 | |
and cheats on the fiddle are now caught in the act | 0:00:59 | 0:01:02 | |
and claimed and shamed. | 0:01:02 | 0:01:04 | |
Today, a woman claiming she can't work stretches the truth | 0:01:10 | 0:01:15 | |
as well as her body. | 0:01:15 | 0:01:16 | |
I think I might have struggled to have done | 0:01:16 | 0:01:19 | |
some of the exercises that she did. | 0:01:19 | 0:01:21 | |
A doctor's outrageous holiday scam is prescribed | 0:01:22 | 0:01:25 | |
a double dose of justice. | 0:01:25 | 0:01:27 | |
The General Medical Council took a very dim view of it, | 0:01:27 | 0:01:31 | |
and as a result of their proceedings, Sharma was struck off. | 0:01:31 | 0:01:35 | |
And an attempt to deceive insurers | 0:01:35 | 0:01:37 | |
with a fake helicopter rescue crash-lands. | 0:01:37 | 0:01:40 | |
After our agents contacts the air traffic control tower | 0:01:41 | 0:01:44 | |
they realised that no flights had taken off that day. | 0:01:44 | 0:01:46 | |
If you've ever been hurt at work, | 0:01:51 | 0:01:52 | |
you'll know the prospect of losing your livelihood | 0:01:52 | 0:01:55 | |
can be a frightening thing. | 0:01:55 | 0:01:57 | |
Most of us will do anything to get healthy again | 0:01:57 | 0:01:59 | |
and get back to the day job, | 0:01:59 | 0:02:02 | |
but there are those who see this as a chance | 0:02:02 | 0:02:04 | |
to take an extended holiday, | 0:02:04 | 0:02:05 | |
often fabricating or exaggerating their condition | 0:02:05 | 0:02:08 | |
in the false belief that insurers will continue to pay out. | 0:02:08 | 0:02:12 | |
It's estimated that we spend around a third of our lives working. | 0:02:15 | 0:02:19 | |
Obviously, some jobs are more hazardous than others, | 0:02:19 | 0:02:22 | |
but the law requires all employers to have insurance. | 0:02:22 | 0:02:26 | |
John Beadle is RSA's UK counter fraud manager. | 0:02:28 | 0:02:31 | |
He was passed one claim to review | 0:02:31 | 0:02:34 | |
involving a common but debilitating workplace injury. | 0:02:34 | 0:02:37 | |
This lady worked for a top-end clothing retailer | 0:02:38 | 0:02:42 | |
and she claimed that she'd had two accidents at work. | 0:02:42 | 0:02:46 | |
The first where she lifted a heavy box | 0:02:46 | 0:02:49 | |
and the second where she had to retrieve something | 0:02:49 | 0:02:53 | |
in a confined space. | 0:02:53 | 0:02:55 | |
She was claiming in excess of £100,000. | 0:02:55 | 0:02:58 | |
A huge claim, but her alleged injuries were significant. | 0:03:00 | 0:03:04 | |
She had, or developed, frozen shoulder, | 0:03:04 | 0:03:08 | |
she also had an arthroscopy, | 0:03:08 | 0:03:11 | |
and her medical expert found that she only had 10% of movement | 0:03:11 | 0:03:16 | |
in her left shoulder, | 0:03:16 | 0:03:18 | |
which obviously would impact the way that she could live her life. | 0:03:18 | 0:03:22 | |
And make the simplest of daily tasks a real challenge. | 0:03:22 | 0:03:26 | |
To process the claim quickly, | 0:03:27 | 0:03:28 | |
John's team carried out some routine checks. | 0:03:28 | 0:03:31 | |
But on examining her medical records, | 0:03:33 | 0:03:36 | |
we found that, indeed, just before this accident, | 0:03:36 | 0:03:39 | |
she had had problems with her left shoulder. | 0:03:39 | 0:03:42 | |
Which suggested although her recent mishap may have worsened | 0:03:42 | 0:03:46 | |
the existing injury, it wasn't the cause. | 0:03:46 | 0:03:49 | |
That would dramatically affect the claim. | 0:03:49 | 0:03:52 | |
In normal circumstances, you would expect people to tell you the truth, | 0:03:52 | 0:03:57 | |
and clearly this was the first evidence that we'd had | 0:03:57 | 0:04:00 | |
that this lady wasn't being completely forthright with us | 0:04:00 | 0:04:04 | |
and there was a pre-existing injury. | 0:04:04 | 0:04:07 | |
Bearing in mind she was claiming in excess of £100,000, | 0:04:07 | 0:04:11 | |
this was a key fact. | 0:04:11 | 0:04:14 | |
If there was a pre-existing injury, | 0:04:14 | 0:04:16 | |
it would have some impact on | 0:04:16 | 0:04:18 | |
the level of compensation that might be considered, | 0:04:18 | 0:04:22 | |
accepting that the injuries at work were in fact genuine. | 0:04:22 | 0:04:26 | |
And this was something John was very keen to investigate. | 0:04:26 | 0:04:30 | |
So having had our suspicion aroused, | 0:04:30 | 0:04:32 | |
we thought we would get some surveillance evidence of the lady. | 0:04:32 | 0:04:37 | |
This would either confirm or indeed deny | 0:04:37 | 0:04:40 | |
whether or not she did have an incapacitating injury. | 0:04:40 | 0:04:43 | |
And this period of surveillance would prove very worthwhile. | 0:04:43 | 0:04:47 | |
Yeah, somebody who has only got 10% of their movement, | 0:04:50 | 0:04:55 | |
you would expect to see very difficult | 0:04:55 | 0:04:58 | |
going about their normal lives - | 0:04:58 | 0:05:00 | |
not able to drive or to carry anything. | 0:05:00 | 0:05:07 | |
Yeah, that is what you would expect, | 0:05:07 | 0:05:09 | |
but the reality was very different. | 0:05:09 | 0:05:11 | |
The surveillance showed that she appeared to be mobile | 0:05:11 | 0:05:17 | |
and walking quite freely | 0:05:17 | 0:05:20 | |
and using her arms in a normal fashion. | 0:05:20 | 0:05:24 | |
And the claimant's next act would show she was all about the gain | 0:05:24 | 0:05:28 | |
and there didn't seem to be too much pain. | 0:05:28 | 0:05:30 | |
You can imagine our absolute amazement | 0:05:30 | 0:05:34 | |
when the surveillance people actually obtained | 0:05:34 | 0:05:38 | |
footage of her in a gym | 0:05:38 | 0:05:40 | |
where she was doing a full BodyPump exercise | 0:05:40 | 0:05:44 | |
which included lifting weights above her head on a barbell. | 0:05:44 | 0:05:51 | |
OK, let's see that supposedly injured shoulder in action | 0:05:51 | 0:05:55 | |
one more time. | 0:05:55 | 0:05:56 | |
It's impressive. | 0:05:59 | 0:06:00 | |
I hope she stretched - | 0:06:00 | 0:06:02 | |
wouldn't want to pick up a genuine injury. | 0:06:02 | 0:06:04 | |
Other exercises which were extremely vexing on those shoulders | 0:06:04 | 0:06:09 | |
and, in fact, I think I might have struggled | 0:06:09 | 0:06:11 | |
to have done some of the exercises that she did. | 0:06:11 | 0:06:13 | |
So, she was fit enough to work out, but not actually work. | 0:06:15 | 0:06:19 | |
And it seemed this claimant was in tiptop condition. | 0:06:19 | 0:06:23 | |
It did show her living a completely normal life | 0:06:23 | 0:06:28 | |
with no apparent restrictions in her movement whatsoever - | 0:06:28 | 0:06:32 | |
she was driving as though it was completely normal. | 0:06:32 | 0:06:35 | |
This type of scam never gets any easier to stomach. | 0:06:35 | 0:06:39 | |
It is very frustrating when you see some of this type of footage | 0:06:39 | 0:06:44 | |
where it is such a blatant and obvious lie | 0:06:44 | 0:06:49 | |
that there is no incapacity at all. | 0:06:49 | 0:06:53 | |
As the claimant's head, shoulders, knees, and toes had been shown | 0:06:53 | 0:06:58 | |
to be working just fine, | 0:06:58 | 0:06:59 | |
her case was reassessed. | 0:06:59 | 0:07:01 | |
We reached a point in our investigation | 0:07:02 | 0:07:05 | |
where we clearly had the surveillance footage | 0:07:05 | 0:07:08 | |
and we also sought the advice of another medical expert | 0:07:08 | 0:07:14 | |
who, having viewed the surveillance evidence, | 0:07:14 | 0:07:16 | |
found that there was no incapacity at all. | 0:07:16 | 0:07:19 | |
And we served this on to the defence solicitors | 0:07:19 | 0:07:24 | |
and made them a very small offer in final settlement of the claim. | 0:07:24 | 0:07:29 | |
The claimant was looking for a pay-out of over £100,000. | 0:07:29 | 0:07:34 | |
Instead, she was offered a fraction of that amount, | 0:07:34 | 0:07:37 | |
and odds were that she wouldn't even get that. | 0:07:37 | 0:07:40 | |
We made an application to the court | 0:07:40 | 0:07:44 | |
that this should be treated as a case of fundamental dishonesty. | 0:07:44 | 0:07:49 | |
But it's unlikely that she will get any of that money | 0:07:49 | 0:07:51 | |
because they'll be required to pay our costs in this case. | 0:07:51 | 0:07:55 | |
And if the claimant thought she'd had an opportunity | 0:07:55 | 0:07:58 | |
to take early retirement, | 0:07:58 | 0:08:00 | |
she was sorely mistaken. | 0:08:00 | 0:08:02 | |
Insurers aren't stupid and this is a really good demonstration | 0:08:02 | 0:08:07 | |
of the level of scrutiny that you will be put to | 0:08:07 | 0:08:11 | |
if we have suspicions about your claim. | 0:08:11 | 0:08:14 | |
Still to come, a fighter's personal injury claim is knocked back. | 0:08:20 | 0:08:25 | |
Not only should he not have been fighting but it was suggested | 0:08:25 | 0:08:27 | |
his condition was an ability sufficient to win a fight. | 0:08:27 | 0:08:32 | |
Fraudsters exist in all walks of life, | 0:08:36 | 0:08:39 | |
often where you'd least expect. | 0:08:39 | 0:08:40 | |
But one thing they all have in common | 0:08:40 | 0:08:43 | |
is that their deception starts with a lie. | 0:08:43 | 0:08:45 | |
It's the length scammers are willing to go to | 0:08:45 | 0:08:48 | |
in order to commit fraud that separates them. | 0:08:48 | 0:08:50 | |
While some insurance cheats will chicken out and hold their hands up, | 0:08:50 | 0:08:53 | |
there are others who will quite frankly do or say anything | 0:08:53 | 0:08:57 | |
to collect the cash. | 0:08:57 | 0:08:59 | |
Protecting yourself with travel insurance is just good common sense, | 0:08:59 | 0:09:04 | |
wherever you're spending your summer holidays. | 0:09:04 | 0:09:07 | |
Insurers Aviva offer policies | 0:09:07 | 0:09:09 | |
to cover most eventualities when abroad. | 0:09:09 | 0:09:12 | |
Well, apart from those made up. | 0:09:12 | 0:09:15 | |
Their head of fraud, Tom Gardiner, was presented with multiple claims | 0:09:16 | 0:09:20 | |
from one customer who'd reportedly suffered some horrific misfortune. | 0:09:20 | 0:09:24 | |
In 2012, Dr Sharma made two travel insurance claims. | 0:09:25 | 0:09:30 | |
The first was for missing a flight | 0:09:30 | 0:09:34 | |
from India to the UK | 0:09:34 | 0:09:36 | |
which he said was as a result of a road traffic accident. | 0:09:36 | 0:09:38 | |
Dr Narendra Sharma claimed to have spent £600 on replacement flights, | 0:09:38 | 0:09:43 | |
but the true cost of this failed airport run | 0:09:43 | 0:09:46 | |
was reported to the call handler. | 0:09:46 | 0:09:48 | |
A tragic accident. | 0:10:07 | 0:10:09 | |
But being a trusted GP here in the UK, | 0:10:10 | 0:10:13 | |
Dr Sharma understood the importance of getting the paperwork in order, | 0:10:13 | 0:10:17 | |
despite the awful circumstances. | 0:10:17 | 0:10:19 | |
In support of Sharma's first claim for the missed flight, | 0:10:20 | 0:10:23 | |
he had presented two documents. | 0:10:23 | 0:10:25 | |
One was a death certificate, | 0:10:25 | 0:10:27 | |
and also a recovery invoice following the damage to his car. | 0:10:27 | 0:10:32 | |
Aviva used their on-the-ground investigators to validate the claim, | 0:10:32 | 0:10:35 | |
which threw up a shocking revelation. | 0:10:35 | 0:10:39 | |
What was revealed quite quickly | 0:10:39 | 0:10:41 | |
from our local agent's inquiries in India | 0:10:41 | 0:10:43 | |
was that the recovery company simply didn't exist, | 0:10:43 | 0:10:49 | |
the officials had confirmed that the death certificate was entirely bogus | 0:10:49 | 0:10:53 | |
and also that the police had no record | 0:10:53 | 0:10:56 | |
of attending a road traffic accident, | 0:10:56 | 0:10:58 | |
let alone a fatal road traffic accident. | 0:10:58 | 0:11:01 | |
So, with no record of the accident or the fatality, | 0:11:01 | 0:11:05 | |
the evidence suggested Dr Sharma had lied | 0:11:05 | 0:11:07 | |
so he could make a false insurance claim. | 0:11:07 | 0:11:10 | |
It was quite clear that what on the face of it | 0:11:10 | 0:11:13 | |
was a tragic incident resulting in a genuine claim | 0:11:13 | 0:11:17 | |
was clearly anything but that. | 0:11:17 | 0:11:19 | |
OK, so far, we've established | 0:11:19 | 0:11:21 | |
that the good Dr Sharma had faked his mother-in-law's death | 0:11:21 | 0:11:24 | |
in a fictitious road accident | 0:11:24 | 0:11:25 | |
and supplied forged documents | 0:11:25 | 0:11:27 | |
just so he could make a fraudulent travel insurance claim | 0:11:27 | 0:11:30 | |
for missed flights. | 0:11:30 | 0:11:32 | |
If that wasn't extraordinary enough, | 0:11:32 | 0:11:34 | |
remember the second insurance claim? | 0:11:34 | 0:11:36 | |
Dr Sharma telephoned Aviva to notify his second claim. | 0:11:36 | 0:11:41 | |
That was for a cancellation of a holiday in Spain, | 0:11:41 | 0:11:46 | |
which he attributed to a family illness. | 0:11:46 | 0:11:48 | |
And that was for accommodation costs of a approximately £59. | 0:11:48 | 0:11:52 | |
And the reported illness went well beyond a sudden bout of flu. | 0:11:53 | 0:11:58 | |
Dr Sharma explained the family member's diagnosis | 0:11:58 | 0:12:00 | |
to the call handler. | 0:12:00 | 0:12:02 | |
Sympathetic to the alleged circumstance, | 0:12:18 | 0:12:21 | |
the information is taken at face value. | 0:12:21 | 0:12:23 | |
I think suspicions were raised in the original telephone call. | 0:12:23 | 0:12:27 | |
Sharma seemed to change his story quite quickly | 0:12:27 | 0:12:32 | |
and his accommodation costs went from £59 to then include flights. | 0:12:32 | 0:12:39 | |
And when Dr Sharma thinks he could potentially end up with nothing, | 0:12:39 | 0:12:44 | |
he ups the ante. | 0:12:44 | 0:12:46 | |
So, Dr Sharma was now claiming in excess of £600 | 0:13:07 | 0:13:10 | |
for cancelled flights, | 0:13:10 | 0:13:12 | |
but by the time supporting documents were received, | 0:13:12 | 0:13:15 | |
this figure had changed a little. | 0:13:15 | 0:13:17 | |
When we then received the invoices, | 0:13:17 | 0:13:19 | |
the accommodation costs weren't £59, there were £959 | 0:13:19 | 0:13:24 | |
and the flights were in excess of £1,000. | 0:13:24 | 0:13:27 | |
Quite the jump. | 0:13:27 | 0:13:29 | |
The first thing Tom's team did | 0:13:29 | 0:13:30 | |
was to attempt to validate Sharma's paperwork, | 0:13:30 | 0:13:33 | |
but it wasn't exactly what this doctor had ordered. | 0:13:33 | 0:13:37 | |
Neither the airline or the holiday company could support or recognise | 0:13:37 | 0:13:43 | |
the two invoices that Sharma had presented. | 0:13:43 | 0:13:47 | |
Damning evidence that this was also a completely fabricated claim. | 0:13:47 | 0:13:52 | |
And it appeared that the on-call doctor had decided to go off-duty. | 0:13:52 | 0:13:57 | |
Sharma was presented with this evidence - | 0:13:57 | 0:13:59 | |
he no longer communicated with us. | 0:13:59 | 0:14:02 | |
I suspect that he realised, then, that the game was up | 0:14:02 | 0:14:05 | |
and rather hoped that that would be an end to the matter. | 0:14:05 | 0:14:09 | |
Given the body of proof Tom had, | 0:14:09 | 0:14:11 | |
Dr Sharma was hoping in vain. | 0:14:11 | 0:14:14 | |
It was clear that on both claims | 0:14:14 | 0:14:16 | |
fraudulent invoices had been submitted, | 0:14:16 | 0:14:18 | |
so both claims were repudiated. | 0:14:18 | 0:14:22 | |
We also put together our evidence | 0:14:22 | 0:14:24 | |
and reported the matter to the police. | 0:14:24 | 0:14:26 | |
Dr Sharma had been willing to fake the death of his mother-in-law, | 0:14:27 | 0:14:31 | |
forge her death certificate, | 0:14:31 | 0:14:32 | |
and tell the most terrible lies | 0:14:32 | 0:14:34 | |
in a sickening attempt to fraudulently claim | 0:14:34 | 0:14:37 | |
on his travel insurance. | 0:14:37 | 0:14:39 | |
But the game was up and he was about to feel the full weight of the law. | 0:14:40 | 0:14:43 | |
As a result of the police taking on the case, | 0:14:43 | 0:14:46 | |
Dr Sharma was prosecuted and pleaded guilty | 0:14:46 | 0:14:49 | |
and he received six months' community service. | 0:14:49 | 0:14:52 | |
A good result for Tom and the team at Aviva, | 0:14:53 | 0:14:56 | |
but the consequences were far from over for Dr Sharma. | 0:14:56 | 0:15:00 | |
Following the prosecution, we were deeply concerned | 0:15:00 | 0:15:03 | |
about Sharma's behaviour and the position he held, | 0:15:03 | 0:15:07 | |
so we brought that to the attention | 0:15:07 | 0:15:09 | |
of the General Medical Council as well. | 0:15:09 | 0:15:12 | |
As you might have guessed, | 0:15:12 | 0:15:14 | |
they weren't exactly impressed by his conduct. | 0:15:14 | 0:15:16 | |
The General Medical Council took a very dim view of it | 0:15:16 | 0:15:20 | |
and as a result of their proceedings, Sharma was struck off. | 0:15:20 | 0:15:25 | |
So from respected pillar of the community, | 0:15:26 | 0:15:28 | |
to disgraced insurance cheat with a community service order. | 0:15:28 | 0:15:32 | |
He had it all but threw it away with his attempted fraud. | 0:15:32 | 0:15:36 | |
I think what's difficult to rationalise | 0:15:38 | 0:15:40 | |
is that someone in Dr Sharma's position | 0:15:40 | 0:15:43 | |
was prepared to go to such lengths. | 0:15:43 | 0:15:46 | |
This case perfectly demonstrates insurers' ability | 0:15:46 | 0:15:50 | |
to identify and stop fraud. | 0:15:50 | 0:15:53 | |
Whether you dream of climbing Mount Everest | 0:16:00 | 0:16:02 | |
or sailing the high seas, | 0:16:02 | 0:16:04 | |
travel insurance gives you invaluable protection | 0:16:04 | 0:16:07 | |
should anything go wrong on your big trip. | 0:16:07 | 0:16:10 | |
There are, though, some sly scammers who think being half a world away | 0:16:10 | 0:16:14 | |
makes it easier to make a fraudulent claim. | 0:16:14 | 0:16:16 | |
But in today's global village, | 0:16:16 | 0:16:18 | |
insurance cheats can be detected anywhere. | 0:16:18 | 0:16:21 | |
Whatever destination you're jetting off to, | 0:16:23 | 0:16:26 | |
there'll be a policy to cover your adventure. | 0:16:26 | 0:16:28 | |
Mathew Crawford-Thomas is the fraud manager for Collinson Group. | 0:16:30 | 0:16:33 | |
He was handed one case involving a customer who had suffered | 0:16:36 | 0:16:39 | |
a potentially life-threatening incident in Nepal. | 0:16:39 | 0:16:44 | |
At the initial telephone call, | 0:16:44 | 0:16:45 | |
we were advised that our insured was suffering with altitude sickness | 0:16:45 | 0:16:49 | |
and needed repatriating into Kathmandu, and the only way | 0:16:49 | 0:16:52 | |
this could be accomplished was via helicopter rescue. | 0:16:52 | 0:16:55 | |
The customer was rushed into hospital, | 0:16:55 | 0:16:58 | |
but his potentially life-saving ride came at quite a cost. | 0:16:58 | 0:17:01 | |
The claim was submitted for | 0:17:03 | 0:17:05 | |
a helicopter rescue from Hilsa in Nepal to Kathmandu for US 18,400. | 0:17:05 | 0:17:11 | |
At this particular moment of the claim, | 0:17:11 | 0:17:13 | |
we hadn't actually heard from the insured person | 0:17:13 | 0:17:15 | |
as we were dealing directly with the rescue company. | 0:17:15 | 0:17:18 | |
Not exactly loose change, | 0:17:18 | 0:17:21 | |
but Matt wouldn't have to wait long to hear from the claimant. | 0:17:21 | 0:17:24 | |
We received a telephone call from the insured the next day, | 0:17:24 | 0:17:27 | |
after he was dropped off at the hospital, advising us that | 0:17:27 | 0:17:30 | |
he wanted to leave and for us to guarantee payment to the hospital. | 0:17:30 | 0:17:34 | |
A suspiciously fast recovery | 0:17:34 | 0:17:37 | |
for a man requiring an emergency air evacuation just 24 hours ago. | 0:17:37 | 0:17:42 | |
The claimant's medical report was received and reviewed. | 0:18:11 | 0:18:14 | |
This was the first big cause for concern. | 0:18:14 | 0:18:18 | |
Upon receiving the medical report from the hospital, | 0:18:18 | 0:18:21 | |
it transpired that he had little or no symptoms of altitude sickness, | 0:18:21 | 0:18:25 | |
therefore we started to worry | 0:18:25 | 0:18:26 | |
whether or not the helicopter rescue was in fact necessary. | 0:18:26 | 0:18:30 | |
By this point, the combined claim total was in excess of 20,000, | 0:18:31 | 0:18:36 | |
or £15,000. | 0:18:36 | 0:18:37 | |
And one party were especially keen to get paid. | 0:18:39 | 0:18:43 | |
At this particular moment in time, | 0:18:43 | 0:18:45 | |
not only were we dealing with the insured person, | 0:18:45 | 0:18:47 | |
but we also had to deal with the helicopter rescue company | 0:18:47 | 0:18:50 | |
asking for their money as well. | 0:18:50 | 0:18:51 | |
And, judging by the amount of money the rescue company were asking for, | 0:19:25 | 0:19:29 | |
they must have been operating their first-class service that day. | 0:19:29 | 0:19:33 | |
When the bill came in at 18,400, | 0:19:33 | 0:19:36 | |
we felt that this bill in itself was far too much money. | 0:19:36 | 0:19:40 | |
A bill of this nature for the trip that he had received | 0:19:40 | 0:19:43 | |
is circa 10,000 US. | 0:19:43 | 0:19:45 | |
There was clear evidence that we needed to ask more questions | 0:19:45 | 0:19:48 | |
of the helicopter rescue company. | 0:19:48 | 0:19:50 | |
So they were attempting to charge nearly £15,000 | 0:19:50 | 0:19:55 | |
for a flight that normally costs around £7,500. | 0:19:55 | 0:19:59 | |
Matt needed to get to the bottom of this | 0:19:59 | 0:20:00 | |
and turned to his boots on the ground for assistance. | 0:20:00 | 0:20:04 | |
We employed the services of an agent in Nepal to investigate this matter. | 0:20:04 | 0:20:08 | |
And it didn't take the agent long to identify a gaping hole in the claim. | 0:20:08 | 0:20:14 | |
After our agents contacted the air traffic control tower, | 0:20:16 | 0:20:18 | |
they realised that no flight had taken off that day. | 0:20:18 | 0:20:22 | |
With this claim crash-landing, the claimant also proved untraceable. | 0:20:22 | 0:20:27 | |
Hilsa in Nepal is a restricted area | 0:20:27 | 0:20:30 | |
and you need to have a permit issued. | 0:20:30 | 0:20:32 | |
Upon checking the records, no permit was ever issued to our insured. | 0:20:32 | 0:20:36 | |
The local investigation strongly suggested this flight of fancy | 0:20:36 | 0:20:40 | |
had been concocted by the claimant and the rescue company. | 0:20:40 | 0:20:44 | |
And in the absence of any payment, extreme measures were taken. | 0:20:46 | 0:20:50 | |
The helicopter rescue company had actually secured | 0:20:50 | 0:20:53 | |
the insured's passport as identification verification. | 0:20:53 | 0:20:57 | |
However, they were refusing to give it back to the insured until | 0:20:57 | 0:21:01 | |
such times as we had paid the bill. | 0:21:01 | 0:21:03 | |
Armed with this information, | 0:21:03 | 0:21:05 | |
the rescue company had a few facts pointed out to them. | 0:21:05 | 0:21:08 | |
The rescue company are getting desperate. | 0:21:48 | 0:21:51 | |
They knew the longer the claim went on, the more likely | 0:21:51 | 0:21:54 | |
it would be found to be false and they'd be left empty-handed. | 0:21:54 | 0:21:57 | |
Claiming to be withholding the customer's passport | 0:21:57 | 0:21:59 | |
is an interesting move | 0:21:59 | 0:22:01 | |
because the evidence suggested the rescue never even happened | 0:22:01 | 0:22:04 | |
and the claimant was complicit in the deception, | 0:22:04 | 0:22:07 | |
but the posturing and threats would keep on coming. | 0:22:07 | 0:22:11 | |
Throughout the course of this investigation, the helicopter rescue | 0:22:11 | 0:22:14 | |
company employed several tactics to attempt to make us pay the 18,400. | 0:22:14 | 0:22:20 | |
Determined to keep up the pressure, | 0:22:20 | 0:22:22 | |
Matt's team received another call from the rescue company. | 0:22:22 | 0:22:25 | |
Unsurprisingly, Matt declined to take the company's kind offer | 0:22:41 | 0:22:46 | |
and it would appear to be their last-ditch attempt | 0:22:46 | 0:22:48 | |
at extorting a payment. | 0:22:48 | 0:22:50 | |
Our agents, once armed with all the evidence, | 0:22:50 | 0:22:52 | |
put it to the rescue company and their response was, | 0:22:52 | 0:22:56 | |
due to a technical error, they are withdrawing their claim. | 0:22:56 | 0:23:00 | |
So they'd finally thrown in the towel | 0:23:00 | 0:23:03 | |
and it was down to Matt and his team's refusal to be pressurised. | 0:23:03 | 0:23:08 | |
During the life cycle of this claim, the helicopter rescue company | 0:23:08 | 0:23:11 | |
and the insured contacted us on numerous occasions. | 0:23:11 | 0:23:15 | |
At no point did we budge with regards to guaranteeing any payment | 0:23:15 | 0:23:19 | |
until a full investigation had been finished. | 0:23:19 | 0:23:22 | |
Day-to-day life can be dangerous, can't it? | 0:23:27 | 0:23:29 | |
From busy roads to packed high streets and kamikaze cyclists, | 0:23:29 | 0:23:33 | |
there's no end of potential ways to run into trouble. | 0:23:33 | 0:23:37 | |
If you have an accident that wasn't your fault, then you're entitled | 0:23:37 | 0:23:40 | |
to make a personal injury claim and seek fair compensation. | 0:23:40 | 0:23:44 | |
But crafty insurance cheats | 0:23:44 | 0:23:45 | |
don't concern themselves with minor details like who was at fault. No. | 0:23:45 | 0:23:49 | |
Instead, they just make up an accident | 0:23:49 | 0:23:52 | |
all in an effort to make a quick buck. | 0:23:52 | 0:23:55 | |
Over three million people are injured in accidents every year. | 0:23:57 | 0:24:01 | |
In the home, at work or outdoors. | 0:24:01 | 0:24:03 | |
The vast majority of claims are genuine. | 0:24:04 | 0:24:07 | |
The rest are dealt with by people like Scott Clayton, | 0:24:07 | 0:24:10 | |
a fraud manager for insurers Zurich. | 0:24:10 | 0:24:12 | |
He was asked to look over one customer's claim | 0:24:12 | 0:24:15 | |
just as a matter of routine. | 0:24:15 | 0:24:17 | |
We received a claim for personal injury from this claimant | 0:24:19 | 0:24:22 | |
who said that whilst walking along the road, | 0:24:22 | 0:24:24 | |
his foot had been caught in a grate that didn't have a lid on it. | 0:24:24 | 0:24:28 | |
Probably worth around about £4,500, | 0:24:30 | 0:24:32 | |
so not an inconsiderable sum of money. | 0:24:32 | 0:24:35 | |
On the surface, it seemed like a fairly minor injury, | 0:24:35 | 0:24:39 | |
but the grate in question had really done a number on the claimant. | 0:24:39 | 0:24:43 | |
Well, the injuries that the claimant said that he'd sustained | 0:24:43 | 0:24:46 | |
were a fractured ankle, | 0:24:46 | 0:24:49 | |
which is pretty nasty, and also damage to his knee, | 0:24:49 | 0:24:52 | |
so you can see almost how he's had his foot caught, | 0:24:52 | 0:24:54 | |
twisted. Quite an unpleasant experience. | 0:24:54 | 0:24:58 | |
Due to the extent of his injuries, | 0:24:58 | 0:25:00 | |
the claimant alleged he couldn't work for at least six months | 0:25:00 | 0:25:04 | |
and had to undergo an intensive recovery programme. | 0:25:04 | 0:25:07 | |
As a result of the accident, he went through a period of | 0:25:07 | 0:25:10 | |
rehabilitation and had medical treatment as well as six rounds | 0:25:10 | 0:25:14 | |
of physiotherapy to get himself back on his feet as quickly as possible. | 0:25:14 | 0:25:18 | |
But this claimant had more reason than most | 0:25:18 | 0:25:21 | |
to need full use of his feet. | 0:25:21 | 0:25:23 | |
Our suspicions were arisen when we looked at the medical report and saw | 0:25:24 | 0:25:27 | |
that his occupation was a mixed martial arts instructor and fighter. | 0:25:27 | 0:25:31 | |
So we would validate that just to check whether | 0:25:31 | 0:25:34 | |
there was any activity in the period that he was recovering. | 0:25:34 | 0:25:37 | |
And some online checks revealed some truly jaw-dropping video evidence. | 0:25:37 | 0:25:42 | |
The investigation found that | 0:25:42 | 0:25:44 | |
he had actually fought three months after the accident, | 0:25:44 | 0:25:46 | |
so during the time that he was "recovering" from a nasty injury, | 0:25:46 | 0:25:51 | |
he was physically able to engage | 0:25:51 | 0:25:53 | |
in what we consider to be highly physical activity, | 0:25:53 | 0:25:56 | |
and he won, which tends to suggest that he was in good condition. | 0:25:56 | 0:26:00 | |
Well, he must have been in peak condition | 0:26:02 | 0:26:04 | |
to survive one of the most brutal forms of professional fighting. | 0:26:04 | 0:26:08 | |
The discovery left this punchy pretender's claim on the ropes. | 0:26:08 | 0:26:12 | |
Not only should he not have been fighting | 0:26:14 | 0:26:16 | |
because he was apparently off work with a serious injury, | 0:26:16 | 0:26:20 | |
but it would suggest his condition was...and ability was sufficient | 0:26:20 | 0:26:24 | |
to win a fight, therefore it cast doubt over the whole claim. | 0:26:24 | 0:26:28 | |
With the claim on its last legs, in came the knockout blow. | 0:26:28 | 0:26:32 | |
Our research found that not only | 0:26:32 | 0:26:34 | |
had he fought three months after the accident, | 0:26:34 | 0:26:36 | |
but he'd also fought again eight months after the accident, | 0:26:36 | 0:26:39 | |
so our conclusion was that he was perfectly fit and well to fight, | 0:26:39 | 0:26:43 | |
maintain his occupation and lifestyle, and we therefore | 0:26:43 | 0:26:47 | |
consulted with his solicitors and told them what we had found. | 0:26:47 | 0:26:50 | |
Given the evidence, his solicitors were none too keen | 0:26:50 | 0:26:53 | |
to go another round with Zurich in pursuit of this claim. | 0:26:53 | 0:26:57 | |
We heard nothing from his solicitors, | 0:26:57 | 0:26:59 | |
despite a couple of reminders, and then latterly | 0:26:59 | 0:27:02 | |
they told us that they had actually discontinued the claim. | 0:27:02 | 0:27:05 | |
So, in other words, we had found out the truth and the claim had | 0:27:05 | 0:27:09 | |
gone away as a result of it. | 0:27:09 | 0:27:10 | |
The claimant severely underestimated his opponent in this case. | 0:27:10 | 0:27:14 | |
He probably thought that this was a claim that we would pay and | 0:27:14 | 0:27:17 | |
there wouldn't be any problems, but when you put things on the internet, | 0:27:17 | 0:27:21 | |
then they're for everybody to see. And in this case, he was caught out. | 0:27:21 | 0:27:24 | |
And if any potential fraudster fancies their chances with | 0:27:24 | 0:27:27 | |
a false claim, they'll come up against a zero-tolerance attitude. | 0:27:27 | 0:27:32 | |
We check all claims. | 0:27:32 | 0:27:33 | |
We want to make sure that we're paying money out correctly | 0:27:33 | 0:27:36 | |
and to people who are deserving of it. | 0:27:36 | 0:27:38 | |
Where we find information that suggests a fraud, | 0:27:38 | 0:27:41 | |
then we will look into it thoroughly because it's just not fair | 0:27:41 | 0:27:45 | |
for people to try and exploit the system this way. | 0:27:45 | 0:27:48 | |
None of us likes paying more than we have to for everyday services. | 0:27:52 | 0:27:56 | |
From organised criminal gangs to exaggerated household claims, | 0:27:56 | 0:28:00 | |
insurance fraud hits all of us in the pocket. | 0:28:00 | 0:28:03 | |
But instead of getting away with it, | 0:28:03 | 0:28:05 | |
more and more of these fraudsters have been claimed and shamed. | 0:28:05 | 0:28:09 |