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