Series which sees insurance fraudsters caught on camera. Secret filming reveals a man's injuries are grossly exaggerated and a fraudster fakes a serious illness.
Browse content similar to Episode 3. Check below for episodes and series from the same categories and more!
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...
Subject out of the vehicle.
..sophisticated data analysis techniques...
-..and a number of highly-skilled police units...
Police! Don't move! Stay where you are!
..they're catching the criminals red-handed.
Just don't lie to us.
All those conmen, scammers and cheats on the fiddle
are now caught in the act
and claimed and shamed.
Today, a man claiming he can't work
has his supposedly injured back to the wall.
And you can see him spending hours working on a car,
bending down, bending over, and he's not in any pain at all.
A woman who misses her flight tries to stage a cover-up.
They didn't even provide a taxi for the customer to get to the airport.
And a claimant's alleged trip isn't caught on camera.
As can be seen from the CCTV footage,
no incident's taken place, no-one's fallen over.
The famous adventurer Thomas Edison once said,
"there is no substitute for hard work." Simple, but true.
Most of us know this and apply these principles every day,
but not insurance cheats.
They'll take any opportunity to get something for nothing.
In fact, some fraudsters are so dedicated,
you could almost call it a career.
Whether you're a banker, builder, or bus driver, your employer
will have insurance to protect both you and them
in the event of an accident.
Zurich provides exactly this type of cover,
and it's fraud manager Scott Clayton's job
to investigate claims that don't quite add up.
His team recently dealt with a personal injury case
that raised suspicions.
This chap had suggested that he'd fallen at work.
Whilst he was pushing a caravan during the course of his employment,
he'd slipped on some liquid on the floor.
According to the claimant, this simple slip
had done a lot of damage.
So, he injured his back, his lower leg and was suggesting
that he had some type of chronic pain syndrome injury.
The claimant's condition had a huge impact on his day-to-day life.
He couldn't function properly, he couldn't go to work, he couldn't
carry out the activities that he could normally do, so, as a result
of the accident, he was alleging that he was quite severely disabled.
With ongoing symptoms as severe as this,
Zurich were looking at a huge pay-out.
The value of this claim,
when you consider the compensation for his injury,
his previous loss of earnings, his future loss of earnings,
care, it was round about half a million pounds.
But before a penny of the half a million pounds was paid,
Scott needed to put some concerns about the claim to rest.
We had suspicions about this claim, because this chap
was suggesting that he was severely injured.
And the medical records didn't really tally up in terms of his
future prognosis and what was wrong,
so we decided to put him under surveillance and find out
exactly what he was able to and not able to do.
The medical report suggested that the claimant stopped work due
to a stress-related illness rather than his physical condition.
So the surveillance would establish whether or not this was the case.
There's an element of satisfaction, but surprise when you get
surveillance footage through that's as revealing as this.
So, in this particular case, you can see that he's
loading a cement mixer,
it would appear as if he's doing some sort of building work.
But it's certainly manual labour,
and for someone who's got a significant back injury,
that completely contradicts what we're seeing in the medical reports.
With the foundations of this case crumbling,
his next act would leave the claim all washed up.
We can see the claimant working as,
it would appear to be a car valeter.
And you can see him spending hours working on a car,
bending down, bending over and he's not in any pain at all.
This is somebody who doesn't appear to be injured
or suffering in any way.
For somebody who's trying to claim half a million pounds,
this surveillance evidence blows his claim out of the water,
-so it just goes to show how crucial it can be.
But Scott wanted to be absolutely sure they hadn't just caught
the claimant on a good day.
Because we carried out three separate periods of surveillance
over a number of dates, then it's clear, unequivocally,
that this person isn't injured anywhere near
the extent that he claims he was on that day.
It was the conclusive proof Scott needed.
The claimant was as fit as an insurance fiddler.
The surveillance evidence was absolutely dynamite,
because it provides us with a true account of this person's disability,
which, in this case, proved that
there was nothing really wrong with him.
The team at Zurich believe
they have their claimant bang to rights,
and Scott had to decide his next move.
Armed with this evidence, we had to make a call in terms of the
true value of the claim against what he was claiming.
We assessed the true value to be round about £5,000,
but by that time, we'd incurred so much costs and solicitors fees,
as had he,
which would ultimately completely dwarf any settlement figure.
The combined costs at this point were close to £100,000.
With this in mind,
the surveillance footage was passed on to the claimant's solicitors.
I can only imagine the shock that they were under
when they saw the footage, because clearly it displays somebody
who's submitting a fraudulent claim.
Unsurprisingly, the video evidence wasn't contested, but there was
no way the claimant was walking away from this scot-free.
He was caught. The penalties for being caught were severe,
because he had to pay our legal costs, his legal costs...
We estimated our cost to be in the region of £36,000.
Well, that's not it, because he's got his own solicitor's costs
to pay as well, which we believe are in the region of £40,000.
If the claimant had been honest,
he would've received fair compensation,
instead of facing a bill of around £80,000,
and the threat of going to court.
He could've settled this claim for £5,000 long ago
and it would've been done and dusted,
but instead, he decided to lie,
exaggerate the effects of this injury and ultimately try
and achieve a life-changing sum of money.
When it comes to this type of claim, Scott's position is crystal clear.
This is an example of gross exaggeration,
a £5,000 claim that he was suggesting was worth half a million,
they don't come more bullish than that.
Still to come...
A lorry driver fabricates an illness to claim loss of earnings
on a made-up career.
He had signed fake doctors' notes,
he had pretended to be managers,
owners of haulage companies all to try and claim this £56,000.
From foreign currency to vaccinations,
there is a lot to remember when you're going abroad.
Choosing an appropriate travel insurance policy
is top of most travellers' lists.
Unfortunately, there are people out there who don't bother with
the right level of cover and attempted to lie about
the circumstances of a claim when something goes wrong.
This, quite simply, is fraud.
Simon Cook is head of special investigations
for travel services provider CEGA.
It's his job to spot the holiday scams from the genuine claims.
One of the cases that landed on his desk involved a customer
who'd run into trouble returning from France.
For this particular claim,
the customer contacted us to make a claim for missed departure.
Unfortunately, the taxi that she was travelling in to the airport
got caught in heavy traffic, so she couldn't catch her scheduled flight.
The value of the claim was around £500 for a new flight.
A real holiday headache.
But thankfully, that's what insurance is for.
In order to consider a claim for missed departure,
we just need some form of independent proof
to substantiate the circumstances that the customer presented to us.
An understandable request,
and the claimant promptly provided it.
In support of the claim, the customer provided us with an e-mail,
purportedly from the taxi company confirming that they were
stuck in traffic and they couldn't get to the airport on time.
It seemed like a straightforward claim to process.
But the proof provided was sending a few different messages.
We were immediately concerned with the e-mail that we received
from the customer to support the claim,
as it was riddled with irregularities
and grammatical errors.
The claimant was contacted by a member of Simon's team
to clear up the confusion.
Not convinced by the claimant's story,
Simon's team continued with their enquiries.
After speaking with the customer about this,
we decided to speak with the taxi company,
who then told us that they didn't actually issue the e-mail.
Armed with this knowledge, the claimant is questioned further.
We disclosed the evidence to the customer.
She professed that a French driver had in fact sent her the e-mail,
which could account for the grammatical errors.
Simon's team got back in touch with the owner of the transfer firm
and this revealed more shocking information.
It was evident that the customer had in fact contacted this taxi company
and asked them to provide her with falsified evidence
to support her insurance claim.
They didn't even provide a taxi for the customer to get to the airport.
Despite the claimant's robust denial,
the evidence clearly suggested that, after the taxi firm had
refused to fabricate an e-mail to validate her bogus story,
she'd just gone ahead and done it herself anyway.
And it was this forged e-mail that was forwarded on to Simon's team.
While somebody had edited the e-mail before it was received by CEGA,
reviewing the evidence suggested the claimant
was attempting an elaborate scam.
The e-mails confirmed that the customer had tried to get the
taxi company to falsely give her some information in writing
to support her claim.
Despite the claimant firmly denying this information,
Simon was certain about one key fact.
We have no idea what the true reason was why the customer missed
her international flight home, but what we do know is that
it definitely didn't have anything to do with
a taxi getting caught up in heavy traffic.
Given the overwhelming evidence,
Simon's next decision would be straightforward.
The final correspondence we had with the customer was explaining
that we weren't satisfied that the e-mail she provided to us
was genuine and that was borne out by the fact that the taxi company
had said they didn't issue it and she didn't even have
a taxi booked with them to travel to the airport.
The claim was declined in full.
And this was relayed to the claimant.
The situation is that her claim had been deemed to be false.
She wouldn't be receiving a penny
and was lucky to avoid further action.
Providing a false device in support of an insurance claim
is simply not acceptable.
Whether it's a closed road or noisy builders next door,
most of us have experienced the inconvenience of maintenance works.
However, for fraudsters, these things can be seen as an opportunity
to make a bogus personal injury claim.
Whether it be slips, trips...
..or motoring mishaps.
Insurers Allianz deal with these claims on a daily basis.
And their fraud manager, Mihir Pandya,
is an expert at weeding out the spurious ones from the genuine.
He was asked to look into a case from a commercial customer
worth several thousand pounds.
We were contacted by our policyholder,
who owned a local convenience store,
telling us that a customer a month prior had fallen
into a trench that was outside his store and injured himself.
Oh, dear. Not what you'd expect when you're picking up a pint of milk.
Once Allianz had spoken to the shop owner
it seemed like an open-and-shut case.
The owner of the local convenience store confirmed
that there were indeed works going on outside.
There was a trench.
It had been dug out for some work to be done to a water mains connection.
But what he told us was that there were barriers placed there daily,
but on occasion, those barriers would be moved.
And if those barriers weren't in position
warning passers-by to the hazard,
then the shop owner would be liable for the claimant's injuries.
The alleged injuries sustained were a broken left big toe,
bruising and swelling to the feet and also unspecified injuries
to the individual's knee.
It looked like Allianz would be paying out.
Well, that was until the claimant's medical records were received.
Now, within the medical notes, there was indication
that the individual had history of falling over
and there were pre-existing injuries being alluded to within the report.
There was no mention of the alleged incident
or that he had fallen into a trench.
Odd that, considering the alleged injuries
were the direct result of the accident.
And further examination would leave the claimant
without a leg to stand on.
It was also apparent that the individual had not sustained
injuries by falling into a trench.
There was indeed confirmation within that report that, three days
prior to the alleged incident date, he'd dropped something heavy on his
foot, which was probably the reason why he sustained a broken toe.
Allianz had all the proof they needed to make a decision.
On the back of the information that we had in our possession, we felt
confident we had enough information to decline the claim, which we did.
But that wouldn't be the last Allianz
would hear from the claimant.
We thought that was the end of the matter, but six months later,
we received communication from the claimant's solicitors telling us
that they would be prepared to accept a far reduced offer.
As far as we were concerned, nothing had changed,
so we maintained our position and refused to pay the claim.
But the claimant obviously thought three time's a charm.
Surprisingly, the claimant still wanted to pursue the claim
and threatened to take us to court.
We weren't going to just roll over,
so we accepted that action
and a trial date was set for December 2015.
Solicitors Keoghs were instructed to defend the claim.
Insurance law expert, Nina Dayal, took the case on.
And there was one piece of crucial evidence to be examined.
Fundamentally to this case, the policyholder had preserved
the CCTV footage which was going to provide a defence to the case.
Keen to see the incident for themselves, they reviewed the
footage from the day the claimant was alleged to have fallen.
The CCTV evidence is quite clear.
It shows a number of people walking past without any incident.
There are walkers, cyclists, people pushing prams.
But no claimant having a fall in the manner described and alleged.
But he had succeeded in framing himself for a false claim.
As can be seen from the CCTV footage,
no incident has taken place, no-one has fallen over.
It was damning evidence
and all attention turned to the forthcoming day in court.
Prior to the trial, the claimant's solicitors
removed themselves off the court's record.
Consequently, the claimant was left without
any legal representation days before the trial.
A telling decision and the claimant would soon follow suit.
The trial on the 7th December was vacated
and re-enlisted for a hearing.
The claimant was given the opportunity to attend,
but failed to do so.
Consequently, his claim was struck out.
The judge reviewed the evidence extensively
and made no hesitation in making a finding that the claimant
was fundamentally dishonest.
The claimant was ordered to pay a sum of £15,468.90.
This case clearly shows that, for those considering pulling
a personal injury scam, it just isn't worth it.
This was a really brazen attempt by the claimant
and the fact that he took this to court to try and take us on
would suggest he wasn't very bright.
Now, an insurance policy can cover the cost of unforeseen problems.
Everything from car accidents to medical bills while you're abroad
and even lost income from unemployment.
But while for most of us making a claim is a last resort,
there are fraudsters out there who view these policies
as a way to fund an early retirement.
Insurers Cardif Pinnacle offer cover to customers
looking for peace of mind.
What they don't provide or tolerate is insurance cheats looking
to cash in on a policy with a fraudulent claim.
Any suspect cases are investigated
and, if necessary, referred to the City of London Police's
Insurance Fraud Enforcement Department.
DC Jamie Kirk was passed one case that needed a detective's eye.
Mark Downes accepted two income protection policies
with Cardif Pinnacle.
These were in case he was unable to work.
So, if he was unable to work, they would provide
a level of cover to cover his salary.
The total claim that would have been paid out over the course of a year
would have been to the sum of £56,000.
And it wouldn't be long before Downes
would have to call upon these policies.
He made claims on these very shortly after having accepted the policies.
One of those actually showed that he had been not working
at the time he accepted one of those policies.
So Cardif Pinnacle were immediately suspicious.
It was only a matter of months
between taking out the insurance cover
and first attempting to make a claim on medical grounds.
With both the policies that Mark Downes had with Cardif Pinnacle,
he was claiming that he was suffering from ulcerated colitis.
Which is a particularly nasty enlarging of the bowels and colon.
And upon looking into Downes's work history,
it appeared he had been less than truthful.
Mark Downes had claimed that he was working for a Dutch haulage company.
He also claimed that he owned a Dutch haulage company.
He always claimed to be a managing director,
even the owner of the company.
We spoke to the actual managing director, who assured us that
Mark Downes was not a manager, although he had worked there,
albeit some years before the claim was ever submitted.
So he was claiming loss of earnings on a job he didn't even have.
Downes had also submitted evidence alleging
he owned numerous haulage companies.
But when detectives checked out the office at addresses provided,
no trace of the businesses could be found.
Mark Downes had previously been a lorry driver,
and that was the business he knew,
which is the reason I believe why he kept claiming to be
the manager or the owner or someone senior in various haulage companies.
In support of his £56,000 claim, Downes had also submitted
medical records reportedly from his examining doctors.
They were able to tell us
that they hadn't ever provided these doctors notes.
The doctors notes were fraudulent.
They hadn't operated from the various places
that he stated GP surgeries were.
And they also were able to tell us that he wasn't suffering from
the illness that he was claiming from either.
Mark Downes's lies had been exposed
along with the fake documents he had been providing to his insurer.
His attempted scam had failed.
There was an awful lot of evidence against Mark Downes.
We were able to show that the claims he had made were
completely fraudulent, that he had pretended to be at doctors.
He had signed fake doctors' notes.
He had pretended to be managers,
owners of haulage companies.
All to try and claim £56,000.
And it wouldn't be long before this assurance cheat would have
to answer for his actions.
Mark Downes was arrested at his home address in Kent.
His house was searched
where we found various documentation,
fraudulent doctors' notes
and other documentation relating to the insurance claim.
Despite the overwhelming body of evidence, there would be
He was interviewed
where he denied that the claim was fraudulent.
He stated that it was all a genuine claim, that all the doctors' notes
were genuine and maintained his innocence throughout.
With Downes in custody and facing multiple fraud charges,
his case took an unexpected turn.
After Mark Downes's initial arrest
and his first interview, he was bailed.
It was after that point that we spoke to another insurance company.
We were able to identify two almost identical policies to
the two policies he'd taken out with Cardif Pinnacle.
And exactly the same fraud had been going on with Shepherds Friendly.
Things were going from bad to worse for Mark Downes
and the full extent of his attempted fraud had been revealed.
He clearly thought he was never ever going to get caught and
he thought he was going to get £56,000 from Cardif Pinnacle
and a further £40,000 from Shepherds Friendly, which again
he was not entitled to as it was a completely made up set of claims.
With false claims totalling nearly £100,000,
Downes was charged with 12 counts of fraud.
He pled guilty at trial...
..and was sentenced to 14 months in prison.
The 14-month custodial sentence, which Mark Downes received,
I feel reflects the level of fraud,
the fact that he was pretending to be a doctor
and it reflects the amount that he stood to make, almost £100,000.
If Downes hadn't been stopped when he was,
the consequences could have been grave.
Mark Downes has previous convictions for fraud and like offences.
I believe, if we hadn't been able to catch him on this occasion,
he would still be out committing fraud right now.
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 are being claimed and shamed.
Ore Oduba presents a series which sees insurance fraudsters caught on camera.
Secret filming reveals a man's injuries are grossly exaggerated, a holidaymaker concocts an elaborate story to cover the cost of missed flights and a fraudster fakes a serious illness to claim for loss of earnings for a job he never had.