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 > 0:00:18That's almost 3.6 million every day.
0:00:20 > 0:00:24Deliberate crashes, bogus personal injuries, even phantom pets.
0:00:25 > 0:00:29The fraudsters are risking more and more to make a quick killing
0:00:29 > 0:00:33and, every year, it's adding around £50 to your insurance bill.
0:00:33 > 0:00:35But insurers are fighting back,
0:00:35 > 0:00:39exposing just under 15 fake claims every hour.
0:00:39 > 0:00:42Armed with covert surveillance systems...
0:00:42 > 0:00:44Subject out of the vehicle.
0:00:44 > 0:00:47..sophisticated data analysis techniques...
0:00:47 > 0:00:51- Police!- ..and a number of highly-skilled police units...
0:00:51 > 0:00:53Police! Don't move! 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 > 0:01:02are now caught in the act
0:01:02 > 0:01:05and claimed and shamed.
0:01:10 > 0:01:13Today, a man claiming he can't work
0:01:13 > 0:01:17has his supposedly injured back to the wall.
0:01:17 > 0:01:20And you can see him spending hours working on a car,
0:01:20 > 0:01:24bending down, bending over, and he's not in any pain at all.
0:01:25 > 0:01:28A woman who misses her flight tries to stage a cover-up.
0:01:30 > 0:01:34They didn't even provide a taxi for the customer to get to the airport.
0:01:43 > 0:01:47And a claimant's alleged trip isn't caught on camera.
0:01:47 > 0:01:50As can be seen from the CCTV footage,
0:01:50 > 0:01:54no incident's taken place, no-one's fallen over.
0:01:59 > 0:02:02The famous adventurer Thomas Edison once said,
0:02:02 > 0:02:07"there is no substitute for hard work." Simple, but true.
0:02:07 > 0:02:10Most of us know this and apply these principles every day,
0:02:10 > 0:02:12but not insurance cheats.
0:02:12 > 0:02:16They'll take any opportunity to get something for nothing.
0:02:16 > 0:02:19In fact, some fraudsters are so dedicated,
0:02:19 > 0:02:23you could almost call it a career.
0:02:23 > 0:02:27Whether you're a banker, builder, or bus driver, your employer
0:02:27 > 0:02:30will have insurance to protect both you and them
0:02:30 > 0:02:32in the event of an accident.
0:02:33 > 0:02:36Zurich provides exactly this type of cover,
0:02:36 > 0:02:39and it's fraud manager Scott Clayton's job
0:02:39 > 0:02:42to investigate claims that don't quite add up.
0:02:42 > 0:02:44His team recently dealt with a personal injury case
0:02:44 > 0:02:46that raised suspicions.
0:02:48 > 0:02:50This chap had suggested that he'd fallen at work.
0:02:50 > 0:02:53Whilst he was pushing a caravan during the course of his employment,
0:02:53 > 0:02:56he'd slipped on some liquid on the floor.
0:02:56 > 0:02:59According to the claimant, this simple slip
0:02:59 > 0:03:00had done a lot of damage.
0:03:02 > 0:03:06So, he injured his back, his lower leg and was suggesting
0:03:06 > 0:03:09that he had some type of chronic pain syndrome injury.
0:03:09 > 0:03:13The claimant's condition had a huge impact on his day-to-day life.
0:03:15 > 0:03:18He couldn't function properly, he couldn't go to work, he couldn't
0:03:18 > 0:03:22carry out the activities that he could normally do, so, as a result
0:03:22 > 0:03:25of the accident, he was alleging that he was quite severely disabled.
0:03:25 > 0:03:28With ongoing symptoms as severe as this,
0:03:28 > 0:03:31Zurich were looking at a huge pay-out.
0:03:31 > 0:03:32The value of this claim,
0:03:32 > 0:03:34when you consider the compensation for his injury,
0:03:34 > 0:03:37his previous loss of earnings, his future loss of earnings,
0:03:37 > 0:03:41care, it was round about half a million pounds.
0:03:41 > 0:03:44But before a penny of the half a million pounds was paid,
0:03:44 > 0:03:48Scott needed to put some concerns about the claim to rest.
0:03:48 > 0:03:52We had suspicions about this claim, because this chap
0:03:52 > 0:03:54was suggesting that he was severely injured.
0:03:54 > 0:03:57And the medical records didn't really tally up in terms of his
0:03:57 > 0:03:59future prognosis and what was wrong,
0:03:59 > 0:04:03so we decided to put him under surveillance and find out
0:04:03 > 0:04:06exactly what he was able to and not able to do.
0:04:06 > 0:04:10The medical report suggested that the claimant stopped work due
0:04:10 > 0:04:15to a stress-related illness rather than his physical condition.
0:04:15 > 0:04:19So the surveillance would establish whether or not this was the case.
0:04:19 > 0:04:23There's an element of satisfaction, but surprise when you get
0:04:23 > 0:04:27surveillance footage through that's as revealing as this.
0:04:31 > 0:04:34So, in this particular case, you can see that he's
0:04:34 > 0:04:35loading a cement mixer,
0:04:35 > 0:04:39it would appear as if he's doing some sort of building work.
0:04:42 > 0:04:44But it's certainly manual labour,
0:04:44 > 0:04:46and for someone who's got a significant back injury,
0:04:46 > 0:04:49that completely contradicts what we're seeing in the medical reports.
0:04:49 > 0:04:52With the foundations of this case crumbling,
0:04:52 > 0:04:55his next act would leave the claim all washed up.
0:04:55 > 0:04:57We can see the claimant working as,
0:04:57 > 0:04:59it would appear to be a car valeter.
0:05:01 > 0:05:04And you can see him spending hours working on a car,
0:05:04 > 0:05:08bending down, bending over and he's not in any pain at all.
0:05:08 > 0:05:10This is somebody who doesn't appear to be injured
0:05:10 > 0:05:12or suffering in any way.
0:05:14 > 0:05:17For somebody who's trying to claim half a million pounds,
0:05:17 > 0:05:20this surveillance evidence blows his claim out of the water,
0:05:20 > 0:05:24- so it just goes to show how crucial it can be.- Too right.
0:05:24 > 0:05:27But Scott wanted to be absolutely sure they hadn't just caught
0:05:27 > 0:05:30the claimant on a good day.
0:05:30 > 0:05:33Because we carried out three separate periods of surveillance
0:05:33 > 0:05:36over a number of dates, then it's clear, unequivocally,
0:05:36 > 0:05:39that this person isn't injured anywhere near
0:05:39 > 0:05:42the extent that he claims he was on that day.
0:05:42 > 0:05:45It was the conclusive proof Scott needed.
0:05:45 > 0:05:49The claimant was as fit as an insurance fiddler.
0:05:49 > 0:05:52The surveillance evidence was absolutely dynamite,
0:05:52 > 0:05:57because it provides us with a true account of this person's disability,
0:05:57 > 0:05:59which, in this case, proved that
0:05:59 > 0:06:02there was nothing really wrong with him.
0:06:02 > 0:06:03The team at Zurich believe
0:06:03 > 0:06:05they have their claimant bang to rights,
0:06:05 > 0:06:08and Scott had to decide his next move.
0:06:08 > 0:06:12Armed with this evidence, we had to make a call in terms of the
0:06:12 > 0:06:15true value of the claim against what he was claiming.
0:06:15 > 0:06:18We assessed the true value to be round about £5,000,
0:06:18 > 0:06:23but by that time, we'd incurred so much costs and solicitors fees,
0:06:23 > 0:06:24as had he,
0:06:24 > 0:06:28which would ultimately completely dwarf any settlement figure.
0:06:28 > 0:06:32The combined costs at this point were close to £100,000.
0:06:32 > 0:06:34With this in mind,
0:06:34 > 0:06:37the surveillance footage was passed on to the claimant's solicitors.
0:06:37 > 0:06:40I can only imagine the shock that they were under
0:06:40 > 0:06:43when they saw the footage, because clearly it displays somebody
0:06:43 > 0:06:45who's submitting a fraudulent claim.
0:06:45 > 0:06:50Unsurprisingly, the video evidence wasn't contested, but there was
0:06:50 > 0:06:54no way the claimant was walking away from this scot-free.
0:06:54 > 0:06:57He was caught. The penalties for being caught were severe,
0:06:57 > 0:07:00because he had to pay our legal costs, his legal costs...
0:07:02 > 0:07:07We estimated our cost to be in the region of £36,000.
0:07:07 > 0:07:10Well, that's not it, because he's got his own solicitor's costs
0:07:10 > 0:07:15to pay as well, which we believe are in the region of £40,000.
0:07:15 > 0:07:17If the claimant had been honest,
0:07:17 > 0:07:19he would've received fair compensation,
0:07:19 > 0:07:22instead of facing a bill of around £80,000,
0:07:22 > 0:07:26and the threat of going to court.
0:07:26 > 0:07:29He could've settled this claim for £5,000 long ago
0:07:29 > 0:07:31and it would've been done and dusted,
0:07:31 > 0:07:32but instead, he decided to lie,
0:07:32 > 0:07:35exaggerate the effects of this injury and ultimately try
0:07:35 > 0:07:38and achieve a life-changing sum of money.
0:07:38 > 0:07:43When it comes to this type of claim, Scott's position is crystal clear.
0:07:43 > 0:07:46This is an example of gross exaggeration,
0:07:46 > 0:07:49a £5,000 claim that he was suggesting was worth half a million,
0:07:49 > 0:07:52they don't come more bullish than that.
0:07:58 > 0:08:00Still to come...
0:08:00 > 0:08:03A lorry driver fabricates an illness to claim loss of earnings
0:08:03 > 0:08:05on a made-up career.
0:08:06 > 0:08:10He had signed fake doctors' notes,
0:08:10 > 0:08:12he had pretended to be managers,
0:08:12 > 0:08:16owners of haulage companies all to try and claim this £56,000.
0:08:21 > 0:08:23From foreign currency to vaccinations,
0:08:23 > 0:08:26there is a lot to remember when you're going abroad.
0:08:26 > 0:08:29Choosing an appropriate travel insurance policy
0:08:29 > 0:08:31is top of most travellers' lists.
0:08:31 > 0:08:34Unfortunately, there are people out there who don't bother with
0:08:34 > 0:08:38the right level of cover and attempted to lie about
0:08:38 > 0:08:41the circumstances of a claim when something goes wrong.
0:08:41 > 0:08:43This, quite simply, is fraud.
0:08:45 > 0:08:48Simon Cook is head of special investigations
0:08:48 > 0:08:51for travel services provider CEGA.
0:08:51 > 0:08:55It's his job to spot the holiday scams from the genuine claims.
0:08:55 > 0:08:59One of the cases that landed on his desk involved a customer
0:08:59 > 0:09:03who'd run into trouble returning from France.
0:09:03 > 0:09:04For this particular claim,
0:09:04 > 0:09:09the customer contacted us to make a claim for missed departure.
0:09:09 > 0:09:13Unfortunately, the taxi that she was travelling in to the airport
0:09:13 > 0:09:17got caught in heavy traffic, so she couldn't catch her scheduled flight.
0:09:17 > 0:09:21The value of the claim was around £500 for a new flight.
0:09:21 > 0:09:23A real holiday headache.
0:09:23 > 0:09:26But thankfully, that's what insurance is for.
0:09:26 > 0:09:29In order to consider a claim for missed departure,
0:09:29 > 0:09:31we just need some form of independent proof
0:09:31 > 0:09:35to substantiate the circumstances that the customer presented to us.
0:09:35 > 0:09:37An understandable request,
0:09:37 > 0:09:39and the claimant promptly provided it.
0:09:41 > 0:09:44In support of the claim, the customer provided us with an e-mail,
0:09:44 > 0:09:48purportedly from the taxi company confirming that they were
0:09:48 > 0:09:52stuck in traffic and they couldn't get to the airport on time.
0:09:52 > 0:09:55It seemed like a straightforward claim to process.
0:09:55 > 0:09:59But the proof provided was sending a few different messages.
0:09:59 > 0:10:02We were immediately concerned with the e-mail that we received
0:10:02 > 0:10:05from the customer to support the claim,
0:10:05 > 0:10:07as it was riddled with irregularities
0:10:07 > 0:10:09and grammatical errors.
0:10:12 > 0:10:15The claimant was contacted by a member of Simon's team
0:10:15 > 0:10:18to clear up the confusion.
0:10:52 > 0:10:55Not convinced by the claimant's story,
0:10:55 > 0:10:58Simon's team continued with their enquiries.
0:10:58 > 0:11:00After speaking with the customer about this,
0:11:00 > 0:11:02we decided to speak with the taxi company,
0:11:02 > 0:11:06who then told us that they didn't actually issue the e-mail.
0:11:07 > 0:11:08Worrying information.
0:11:08 > 0:11:12Armed with this knowledge, the claimant is questioned further.
0:11:42 > 0:11:44We disclosed the evidence to the customer.
0:11:44 > 0:11:48She professed that a French driver had in fact sent her the e-mail,
0:11:48 > 0:11:52which could account for the grammatical errors.
0:12:10 > 0:12:14Simon's team got back in touch with the owner of the transfer firm
0:12:14 > 0:12:18and this revealed more shocking information.
0:12:18 > 0:12:23It was evident that the customer had in fact contacted this taxi company
0:12:23 > 0:12:26and asked them to provide her with falsified evidence
0:12:26 > 0:12:28to support her insurance claim.
0:12:28 > 0:12:32They didn't even provide a taxi for the customer to get to the airport.
0:12:32 > 0:12:35Despite the claimant's robust denial,
0:12:35 > 0:12:38the evidence clearly suggested that, after the taxi firm had
0:12:38 > 0:12:42refused to fabricate an e-mail to validate her bogus story,
0:12:42 > 0:12:45she'd just gone ahead and done it herself anyway.
0:12:45 > 0:12:49And it was this forged e-mail that was forwarded on to Simon's team.
0:13:28 > 0:13:32While somebody had edited the e-mail before it was received by CEGA,
0:13:32 > 0:13:35reviewing the evidence suggested the claimant
0:13:35 > 0:13:37was attempting an elaborate scam.
0:13:39 > 0:13:42The e-mails confirmed that the customer had tried to get the
0:13:42 > 0:13:45taxi company to falsely give her some information in writing
0:13:45 > 0:13:47to support her claim.
0:13:47 > 0:13:50Despite the claimant firmly denying this information,
0:13:50 > 0:13:54Simon was certain about one key fact.
0:13:55 > 0:14:00We have no idea what the true reason was why the customer missed
0:14:00 > 0:14:03her international flight home, but what we do know is that
0:14:03 > 0:14:06it definitely didn't have anything to do with
0:14:06 > 0:14:08a taxi getting caught up in heavy traffic.
0:14:09 > 0:14:11Given the overwhelming evidence,
0:14:11 > 0:14:14Simon's next decision would be straightforward.
0:14:14 > 0:14:17The final correspondence we had with the customer was explaining
0:14:17 > 0:14:21that we weren't satisfied that the e-mail she provided to us
0:14:21 > 0:14:25was genuine and that was borne out by the fact that the taxi company
0:14:25 > 0:14:27had said they didn't issue it and she didn't even have
0:14:27 > 0:14:30a taxi booked with them to travel to the airport.
0:14:30 > 0:14:32The claim was declined in full.
0:14:32 > 0:14:35And this was relayed to the claimant.
0:14:58 > 0:15:02The situation is that her claim had been deemed to be false.
0:15:03 > 0:15:05She wouldn't be receiving a penny
0:15:05 > 0:15:07and was lucky to avoid further action.
0:15:07 > 0:15:11Providing a false device in support of an insurance claim
0:15:11 > 0:15:13is simply not acceptable.
0:15:21 > 0:15:24Whether it's a closed road or noisy builders next door,
0:15:24 > 0:15:28most of us have experienced the inconvenience of maintenance works.
0:15:28 > 0:15:32However, for fraudsters, these things can be seen as an opportunity
0:15:32 > 0:15:35to make a bogus personal injury claim.
0:15:35 > 0:15:38Whether it be slips, trips...
0:15:40 > 0:15:42..or motoring mishaps.
0:15:42 > 0:15:46Insurers Allianz deal with these claims on a daily basis.
0:15:46 > 0:15:49And their fraud manager, Mihir Pandya,
0:15:49 > 0:15:53is an expert at weeding out the spurious ones from the genuine.
0:15:53 > 0:15:56He was asked to look into a case from a commercial customer
0:15:56 > 0:16:00worth several thousand pounds.
0:16:00 > 0:16:04We were contacted by our policyholder,
0:16:04 > 0:16:06who owned a local convenience store,
0:16:06 > 0:16:11telling us that a customer a month prior had fallen
0:16:11 > 0:16:16into a trench that was outside his store and injured himself.
0:16:16 > 0:16:20Oh, dear. Not what you'd expect when you're picking up a pint of milk.
0:16:20 > 0:16:23Once Allianz had spoken to the shop owner
0:16:23 > 0:16:26it seemed like an open-and-shut case.
0:16:26 > 0:16:29The owner of the local convenience store confirmed
0:16:29 > 0:16:32that there were indeed works going on outside.
0:16:32 > 0:16:34There was a trench.
0:16:34 > 0:16:39It had been dug out for some work to be done to a water mains connection.
0:16:39 > 0:16:43But what he told us was that there were barriers placed there daily,
0:16:43 > 0:16:45but on occasion, those barriers would be moved.
0:16:45 > 0:16:47And if those barriers weren't in position
0:16:47 > 0:16:50warning passers-by to the hazard,
0:16:50 > 0:16:55then the shop owner would be liable for the claimant's injuries.
0:16:55 > 0:17:00The alleged injuries sustained were a broken left big toe,
0:17:00 > 0:17:04bruising and swelling to the feet and also unspecified injuries
0:17:04 > 0:17:06to the individual's knee.
0:17:08 > 0:17:11It looked like Allianz would be paying out.
0:17:12 > 0:17:15Well, that was until the claimant's medical records were received.
0:17:18 > 0:17:21Now, within the medical notes, there was indication
0:17:21 > 0:17:27that the individual had history of falling over
0:17:27 > 0:17:33and there were pre-existing injuries being alluded to within the report.
0:17:33 > 0:17:36There was no mention of the alleged incident
0:17:36 > 0:17:38or that he had fallen into a trench.
0:17:38 > 0:17:41Odd that, considering the alleged injuries
0:17:41 > 0:17:43were the direct result of the accident.
0:17:44 > 0:17:47And further examination would leave the claimant
0:17:47 > 0:17:49without a leg to stand on.
0:17:50 > 0:17:54It was also apparent that the individual had not sustained
0:17:54 > 0:17:57injuries by falling into a trench.
0:17:57 > 0:18:00There was indeed confirmation within that report that, three days
0:18:00 > 0:18:04prior to the alleged incident date, he'd dropped something heavy on his
0:18:04 > 0:18:07foot, which was probably the reason why he sustained a broken toe.
0:18:08 > 0:18:12Allianz had all the proof they needed to make a decision.
0:18:12 > 0:18:17On the back of the information that we had in our possession, we felt
0:18:17 > 0:18:21confident we had enough information to decline the claim, which we did.
0:18:23 > 0:18:25But that wouldn't be the last Allianz
0:18:25 > 0:18:27would hear from the claimant.
0:18:28 > 0:18:33We thought that was the end of the matter, but six months later,
0:18:33 > 0:18:38we received communication from the claimant's solicitors telling us
0:18:38 > 0:18:41that they would be prepared to accept a far reduced offer.
0:18:42 > 0:18:45As far as we were concerned, nothing had changed,
0:18:45 > 0:18:48so we maintained our position and refused to pay the claim.
0:18:48 > 0:18:52But the claimant obviously thought three time's a charm.
0:18:53 > 0:18:57Surprisingly, the claimant still wanted to pursue the claim
0:18:57 > 0:19:00and threatened to take us to court.
0:19:00 > 0:19:03We weren't going to just roll over,
0:19:03 > 0:19:06so we accepted that action
0:19:06 > 0:19:11and a trial date was set for December 2015.
0:19:12 > 0:19:15Solicitors Keoghs were instructed to defend the claim.
0:19:17 > 0:19:20Insurance law expert, Nina Dayal, took the case on.
0:19:21 > 0:19:24And there was one piece of crucial evidence to be examined.
0:19:24 > 0:19:28Fundamentally to this case, the policyholder had preserved
0:19:28 > 0:19:33the CCTV footage which was going to provide a defence to the case.
0:19:34 > 0:19:37Keen to see the incident for themselves, they reviewed the
0:19:37 > 0:19:41footage from the day the claimant was alleged to have fallen.
0:19:41 > 0:19:44The CCTV evidence is quite clear.
0:19:44 > 0:19:48It shows a number of people walking past without any incident.
0:19:48 > 0:19:52There are walkers, cyclists, people pushing prams.
0:19:52 > 0:19:57But no claimant having a fall in the manner described and alleged.
0:19:57 > 0:20:02But he had succeeded in framing himself for a false claim.
0:20:03 > 0:20:06As can be seen from the CCTV footage,
0:20:06 > 0:20:09no incident has taken place, no-one has fallen over.
0:20:11 > 0:20:12It was damning evidence
0:20:12 > 0:20:16and all attention turned to the forthcoming day in court.
0:20:16 > 0:20:21Prior to the trial, the claimant's solicitors
0:20:21 > 0:20:25removed themselves off the court's record.
0:20:25 > 0:20:27Consequently, the claimant was left without
0:20:27 > 0:20:31any legal representation days before the trial.
0:20:31 > 0:20:35A telling decision and the claimant would soon follow suit.
0:20:37 > 0:20:40The trial on the 7th December was vacated
0:20:40 > 0:20:42and re-enlisted for a hearing.
0:20:42 > 0:20:45The claimant was given the opportunity to attend,
0:20:45 > 0:20:46but failed to do so.
0:20:46 > 0:20:49Consequently, his claim was struck out.
0:20:49 > 0:20:52The judge reviewed the evidence extensively
0:20:52 > 0:20:57and made no hesitation in making a finding that the claimant
0:20:57 > 0:20:59was fundamentally dishonest.
0:20:59 > 0:21:05The claimant was ordered to pay a sum of £15,468.90.
0:21:07 > 0:21:10This case clearly shows that, for those considering pulling
0:21:10 > 0:21:14a personal injury scam, it just isn't worth it.
0:21:14 > 0:21:18This was a really brazen attempt by the claimant
0:21:18 > 0:21:23and the fact that he took this to court to try and take us on
0:21:23 > 0:21:26would suggest he wasn't very bright.
0:21:29 > 0:21:33Now, an insurance policy can cover the cost of unforeseen problems.
0:21:33 > 0:21:36Everything from car accidents to medical bills while you're abroad
0:21:36 > 0:21:39and even lost income from unemployment.
0:21:39 > 0:21:42But while for most of us making a claim is a last resort,
0:21:42 > 0:21:45there are fraudsters out there who view these policies
0:21:45 > 0:21:47as a way to fund an early retirement.
0:21:49 > 0:21:51Insurers Cardif Pinnacle offer cover to customers
0:21:51 > 0:21:53looking for peace of mind.
0:21:56 > 0:22:00What they don't provide or tolerate is insurance cheats looking
0:22:00 > 0:22:02to cash in on a policy with a fraudulent claim.
0:22:03 > 0:22:06Any suspect cases are investigated
0:22:06 > 0:22:09and, if necessary, referred to the City of London Police's
0:22:09 > 0:22:11Insurance Fraud Enforcement Department.
0:22:13 > 0:22:18DC Jamie Kirk was passed one case that needed a detective's eye.
0:22:19 > 0:22:22Mark Downes accepted two income protection policies
0:22:22 > 0:22:25with Cardif Pinnacle.
0:22:25 > 0:22:28These were in case he was unable to work.
0:22:28 > 0:22:30So, if he was unable to work, they would provide
0:22:30 > 0:22:33a level of cover to cover his salary.
0:22:33 > 0:22:37The total claim that would have been paid out over the course of a year
0:22:37 > 0:22:40would have been to the sum of £56,000.
0:22:40 > 0:22:42And it wouldn't be long before Downes
0:22:42 > 0:22:44would have to call upon these policies.
0:22:46 > 0:22:51He made claims on these very shortly after having accepted the policies.
0:22:51 > 0:22:56One of those actually showed that he had been not working
0:22:56 > 0:22:59at the time he accepted one of those policies.
0:22:59 > 0:23:03So Cardif Pinnacle were immediately suspicious.
0:23:03 > 0:23:04It was only a matter of months
0:23:04 > 0:23:07between taking out the insurance cover
0:23:07 > 0:23:10and first attempting to make a claim on medical grounds.
0:23:10 > 0:23:14With both the policies that Mark Downes had with Cardif Pinnacle,
0:23:14 > 0:23:18he was claiming that he was suffering from ulcerated colitis.
0:23:18 > 0:23:22Which is a particularly nasty enlarging of the bowels and colon.
0:23:22 > 0:23:25And upon looking into Downes's work history,
0:23:25 > 0:23:27it appeared he had been less than truthful.
0:23:29 > 0:23:33Mark Downes had claimed that he was working for a Dutch haulage company.
0:23:33 > 0:23:37He also claimed that he owned a Dutch haulage company.
0:23:37 > 0:23:40He always claimed to be a managing director,
0:23:40 > 0:23:42even the owner of the company.
0:23:42 > 0:23:46We spoke to the actual managing director, who assured us that
0:23:46 > 0:23:49Mark Downes was not a manager, although he had worked there,
0:23:49 > 0:23:52albeit some years before the claim was ever submitted.
0:23:54 > 0:23:59So he was claiming loss of earnings on a job he didn't even have.
0:24:00 > 0:24:03Downes had also submitted evidence alleging
0:24:03 > 0:24:05he owned numerous haulage companies.
0:24:06 > 0:24:10But when detectives checked out the office at addresses provided,
0:24:10 > 0:24:12no trace of the businesses could be found.
0:24:14 > 0:24:18Mark Downes had previously been a lorry driver,
0:24:18 > 0:24:20and that was the business he knew,
0:24:20 > 0:24:23which is the reason I believe why he kept claiming to be
0:24:23 > 0:24:29the manager or the owner or someone senior in various haulage companies.
0:24:29 > 0:24:33In support of his £56,000 claim, Downes had also submitted
0:24:33 > 0:24:37medical records reportedly from his examining doctors.
0:24:39 > 0:24:40They were able to tell us
0:24:40 > 0:24:43that they hadn't ever provided these doctors notes.
0:24:43 > 0:24:45The doctors notes were fraudulent.
0:24:45 > 0:24:48They hadn't operated from the various places
0:24:48 > 0:24:51that he stated GP surgeries were.
0:24:51 > 0:24:55And they also were able to tell us that he wasn't suffering from
0:24:55 > 0:24:57the illness that he was claiming from either.
0:24:57 > 0:25:00Mark Downes's lies had been exposed
0:25:00 > 0:25:04along with the fake documents he had been providing to his insurer.
0:25:04 > 0:25:06His attempted scam had failed.
0:25:07 > 0:25:11There was an awful lot of evidence against Mark Downes.
0:25:11 > 0:25:14We were able to show that the claims he had made were
0:25:14 > 0:25:19completely fraudulent, that he had pretended to be at doctors.
0:25:19 > 0:25:23He had signed fake doctors' notes.
0:25:23 > 0:25:25He had pretended to be managers,
0:25:25 > 0:25:28owners of haulage companies.
0:25:28 > 0:25:31All to try and claim £56,000.
0:25:31 > 0:25:34And it wouldn't be long before this assurance cheat would have
0:25:34 > 0:25:36to answer for his actions.
0:25:38 > 0:25:42Mark Downes was arrested at his home address in Kent.
0:25:42 > 0:25:44His house was searched
0:25:44 > 0:25:47where we found various documentation,
0:25:47 > 0:25:50fraudulent doctors' notes
0:25:50 > 0:25:54and other documentation relating to the insurance claim.
0:25:54 > 0:25:58Despite the overwhelming body of evidence, there would be
0:25:58 > 0:25:59no confession.
0:26:01 > 0:26:03He was interviewed
0:26:03 > 0:26:06where he denied that the claim was fraudulent.
0:26:06 > 0:26:10He stated that it was all a genuine claim, that all the doctors' notes
0:26:10 > 0:26:13were genuine and maintained his innocence throughout.
0:26:13 > 0:26:17With Downes in custody and facing multiple fraud charges,
0:26:17 > 0:26:20his case took an unexpected turn.
0:26:20 > 0:26:23After Mark Downes's initial arrest
0:26:23 > 0:26:26and his first interview, he was bailed.
0:26:26 > 0:26:32It was after that point that we spoke to another insurance company.
0:26:32 > 0:26:37We were able to identify two almost identical policies to
0:26:37 > 0:26:39the two policies he'd taken out with Cardif Pinnacle.
0:26:39 > 0:26:43And exactly the same fraud had been going on with Shepherds Friendly.
0:26:43 > 0:26:46Things were going from bad to worse for Mark Downes
0:26:46 > 0:26:51and the full extent of his attempted fraud had been revealed.
0:26:51 > 0:26:54He clearly thought he was never ever going to get caught and
0:26:54 > 0:26:59he thought he was going to get £56,000 from Cardif Pinnacle
0:26:59 > 0:27:03and a further £40,000 from Shepherds Friendly, which again
0:27:03 > 0:27:06he was not entitled to as it was a completely made up set of claims.
0:27:06 > 0:27:10With false claims totalling nearly £100,000,
0:27:10 > 0:27:13Downes was charged with 12 counts of fraud.
0:27:13 > 0:27:15He pled guilty at trial...
0:27:17 > 0:27:20..and was sentenced to 14 months in prison.
0:27:20 > 0:27:24The 14-month custodial sentence, which Mark Downes received,
0:27:24 > 0:27:29I feel reflects the level of fraud,
0:27:29 > 0:27:31the fact that he was pretending to be a doctor
0:27:31 > 0:27:36and it reflects the amount that he stood to make, almost £100,000.
0:27:36 > 0:27:38If Downes hadn't been stopped when he was,
0:27:38 > 0:27:41the consequences could have been grave.
0:27:41 > 0:27:47Mark Downes has previous convictions for fraud and like offences.
0:27:47 > 0:27:52I believe, if we hadn't been able to catch him on this occasion,
0:27:52 > 0:27:56he would still be out committing fraud right now.
0:28:00 > 0:28:05From organised criminal gangs to exaggerated household claims,
0:28:05 > 0:28:07insurance fraud hits all of us in the pocket.
0:28:07 > 0:28:09But instead of getting away with it,
0:28:09 > 0:28:14more and more of these fraudsters are being claimed and shamed.