Episode 3 Claimed and Shamed


Episode 3

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.


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Transcript


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Insurance fraud has reached epidemic levels in the UK.

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

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That's almost 3.6 million every day.

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Deliberate crashes, bogus personal injuries, even phantom pets.

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

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

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But insurers are fighting back,

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exposing just under 15 fake claims every hour.

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Armed with covert surveillance systems...

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Subject out of the vehicle.

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..sophisticated data analysis techniques...

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-Police!

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

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Police! Don't move! Stay where you are!

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

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Just don't lie to us.

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All those conmen, scammers and cheats on the fiddle

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are now caught in the act

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and claimed and shamed.

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Today, a man claiming he can't work

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has his supposedly injured back to the wall.

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And you can see him spending hours working on a car,

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bending down, bending over, and he's not in any pain at all.

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A woman who misses her flight tries to stage a cover-up.

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They didn't even provide a taxi for the customer to get to the airport.

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And a claimant's alleged trip isn't caught on camera.

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As can be seen from the CCTV footage,

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no incident's taken place, no-one's fallen over.

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The famous adventurer Thomas Edison once said,

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"there is no substitute for hard work." Simple, but true.

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Most of us know this and apply these principles every day,

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but not insurance cheats.

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They'll take any opportunity to get something for nothing.

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In fact, some fraudsters are so dedicated,

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you could almost call it a career.

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Whether you're a banker, builder, or bus driver, your employer

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will have insurance to protect both you and them

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in the event of an accident.

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Zurich provides exactly this type of cover,

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and it's fraud manager Scott Clayton's job

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to investigate claims that don't quite add up.

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His team recently dealt with a personal injury case

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that raised suspicions.

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This chap had suggested that he'd fallen at work.

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Whilst he was pushing a caravan during the course of his employment,

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he'd slipped on some liquid on the floor.

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According to the claimant, this simple slip

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had done a lot of damage.

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So, he injured his back, his lower leg and was suggesting

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that he had some type of chronic pain syndrome injury.

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The claimant's condition had a huge impact on his day-to-day life.

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He couldn't function properly, he couldn't go to work, he couldn't

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carry out the activities that he could normally do, so, as a result

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of the accident, he was alleging that he was quite severely disabled.

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With ongoing symptoms as severe as this,

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Zurich were looking at a huge pay-out.

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The value of this claim,

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when you consider the compensation for his injury,

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his previous loss of earnings, his future loss of earnings,

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care, it was round about half a million pounds.

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But before a penny of the half a million pounds was paid,

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Scott needed to put some concerns about the claim to rest.

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We had suspicions about this claim, because this chap

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was suggesting that he was severely injured.

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And the medical records didn't really tally up in terms of his

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future prognosis and what was wrong,

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so we decided to put him under surveillance and find out

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exactly what he was able to and not able to do.

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The medical report suggested that the claimant stopped work due

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to a stress-related illness rather than his physical condition.

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So the surveillance would establish whether or not this was the case.

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There's an element of satisfaction, but surprise when you get

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surveillance footage through that's as revealing as this.

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So, in this particular case, you can see that he's

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loading a cement mixer,

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it would appear as if he's doing some sort of building work.

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But it's certainly manual labour,

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and for someone who's got a significant back injury,

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that completely contradicts what we're seeing in the medical reports.

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With the foundations of this case crumbling,

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his next act would leave the claim all washed up.

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We can see the claimant working as,

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it would appear to be a car valeter.

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And you can see him spending hours working on a car,

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bending down, bending over and he's not in any pain at all.

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This is somebody who doesn't appear to be injured

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or suffering in any way.

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For somebody who's trying to claim half a million pounds,

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this surveillance evidence blows his claim out of the water,

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-so it just goes to show how crucial it can be.

-Too right.

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But Scott wanted to be absolutely sure they hadn't just caught

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the claimant on a good day.

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Because we carried out three separate periods of surveillance

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over a number of dates, then it's clear, unequivocally,

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that this person isn't injured anywhere near

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the extent that he claims he was on that day.

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It was the conclusive proof Scott needed.

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The claimant was as fit as an insurance fiddler.

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The surveillance evidence was absolutely dynamite,

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because it provides us with a true account of this person's disability,

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which, in this case, proved that

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there was nothing really wrong with him.

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The team at Zurich believe

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they have their claimant bang to rights,

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and Scott had to decide his next move.

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Armed with this evidence, we had to make a call in terms of the

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true value of the claim against what he was claiming.

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We assessed the true value to be round about £5,000,

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but by that time, we'd incurred so much costs and solicitors fees,

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as had he,

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which would ultimately completely dwarf any settlement figure.

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The combined costs at this point were close to £100,000.

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With this in mind,

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the surveillance footage was passed on to the claimant's solicitors.

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I can only imagine the shock that they were under

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when they saw the footage, because clearly it displays somebody

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who's submitting a fraudulent claim.

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Unsurprisingly, the video evidence wasn't contested, but there was

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no way the claimant was walking away from this scot-free.

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He was caught. The penalties for being caught were severe,

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because he had to pay our legal costs, his legal costs...

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We estimated our cost to be in the region of £36,000.

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Well, that's not it, because he's got his own solicitor's costs

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to pay as well, which we believe are in the region of £40,000.

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If the claimant had been honest,

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he would've received fair compensation,

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instead of facing a bill of around £80,000,

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and the threat of going to court.

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He could've settled this claim for £5,000 long ago

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and it would've been done and dusted,

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but instead, he decided to lie,

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exaggerate the effects of this injury and ultimately try

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and achieve a life-changing sum of money.

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When it comes to this type of claim, Scott's position is crystal clear.

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This is an example of gross exaggeration,

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a £5,000 claim that he was suggesting was worth half a million,

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they don't come more bullish than that.

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Still to come...

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A lorry driver fabricates an illness to claim loss of earnings

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on a made-up career.

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He had signed fake doctors' notes,

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he had pretended to be managers,

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owners of haulage companies all to try and claim this £56,000.

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From foreign currency to vaccinations,

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there is a lot to remember when you're going abroad.

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Choosing an appropriate travel insurance policy

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is top of most travellers' lists.

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Unfortunately, there are people out there who don't bother with

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the right level of cover and attempted to lie about

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the circumstances of a claim when something goes wrong.

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This, quite simply, is fraud.

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Simon Cook is head of special investigations

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for travel services provider CEGA.

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It's his job to spot the holiday scams from the genuine claims.

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One of the cases that landed on his desk involved a customer

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who'd run into trouble returning from France.

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For this particular claim,

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the customer contacted us to make a claim for missed departure.

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Unfortunately, the taxi that she was travelling in to the airport

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got caught in heavy traffic, so she couldn't catch her scheduled flight.

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The value of the claim was around £500 for a new flight.

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A real holiday headache.

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But thankfully, that's what insurance is for.

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In order to consider a claim for missed departure,

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we just need some form of independent proof

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to substantiate the circumstances that the customer presented to us.

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An understandable request,

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and the claimant promptly provided it.

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In support of the claim, the customer provided us with an e-mail,

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purportedly from the taxi company confirming that they were

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stuck in traffic and they couldn't get to the airport on time.

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It seemed like a straightforward claim to process.

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But the proof provided was sending a few different messages.

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We were immediately concerned with the e-mail that we received

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from the customer to support the claim,

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as it was riddled with irregularities

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and grammatical errors.

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The claimant was contacted by a member of Simon's team

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to clear up the confusion.

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Not convinced by the claimant's story,

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Simon's team continued with their enquiries.

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After speaking with the customer about this,

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we decided to speak with the taxi company,

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who then told us that they didn't actually issue the e-mail.

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Worrying information.

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Armed with this knowledge, the claimant is questioned further.

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We disclosed the evidence to the customer.

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She professed that a French driver had in fact sent her the e-mail,

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which could account for the grammatical errors.

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Simon's team got back in touch with the owner of the transfer firm

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and this revealed more shocking information.

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It was evident that the customer had in fact contacted this taxi company

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and asked them to provide her with falsified evidence

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to support her insurance claim.

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They didn't even provide a taxi for the customer to get to the airport.

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Despite the claimant's robust denial,

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the evidence clearly suggested that, after the taxi firm had

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refused to fabricate an e-mail to validate her bogus story,

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she'd just gone ahead and done it herself anyway.

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And it was this forged e-mail that was forwarded on to Simon's team.

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While somebody had edited the e-mail before it was received by CEGA,

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reviewing the evidence suggested the claimant

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was attempting an elaborate scam.

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The e-mails confirmed that the customer had tried to get the

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taxi company to falsely give her some information in writing

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to support her claim.

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Despite the claimant firmly denying this information,

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Simon was certain about one key fact.

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We have no idea what the true reason was why the customer missed

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her international flight home, but what we do know is that

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it definitely didn't have anything to do with

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a taxi getting caught up in heavy traffic.

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Given the overwhelming evidence,

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Simon's next decision would be straightforward.

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The final correspondence we had with the customer was explaining

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that we weren't satisfied that the e-mail she provided to us

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was genuine and that was borne out by the fact that the taxi company

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had said they didn't issue it and she didn't even have

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a taxi booked with them to travel to the airport.

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The claim was declined in full.

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And this was relayed to the claimant.

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The situation is that her claim had been deemed to be false.

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She wouldn't be receiving a penny

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and was lucky to avoid further action.

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Providing a false device in support of an insurance claim

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is simply not acceptable.

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Whether it's a closed road or noisy builders next door,

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most of us have experienced the inconvenience of maintenance works.

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However, for fraudsters, these things can be seen as an opportunity

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to make a bogus personal injury claim.

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Whether it be slips, trips...

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..or motoring mishaps.

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Insurers Allianz deal with these claims on a daily basis.

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And their fraud manager, Mihir Pandya,

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is an expert at weeding out the spurious ones from the genuine.

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He was asked to look into a case from a commercial customer

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worth several thousand pounds.

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We were contacted by our policyholder,

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who owned a local convenience store,

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telling us that a customer a month prior had fallen

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into a trench that was outside his store and injured himself.

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Oh, dear. Not what you'd expect when you're picking up a pint of milk.

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Once Allianz had spoken to the shop owner

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it seemed like an open-and-shut case.

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The owner of the local convenience store confirmed

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that there were indeed works going on outside.

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There was a trench.

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It had been dug out for some work to be done to a water mains connection.

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But what he told us was that there were barriers placed there daily,

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but on occasion, those barriers would be moved.

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And if those barriers weren't in position

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warning passers-by to the hazard,

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then the shop owner would be liable for the claimant's injuries.

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The alleged injuries sustained were a broken left big toe,

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bruising and swelling to the feet and also unspecified injuries

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to the individual's knee.

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It looked like Allianz would be paying out.

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Well, that was until the claimant's medical records were received.

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Now, within the medical notes, there was indication

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that the individual had history of falling over

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and there were pre-existing injuries being alluded to within the report.

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There was no mention of the alleged incident

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or that he had fallen into a trench.

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Odd that, considering the alleged injuries

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were the direct result of the accident.

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And further examination would leave the claimant

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without a leg to stand on.

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It was also apparent that the individual had not sustained

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injuries by falling into a trench.

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There was indeed confirmation within that report that, three days

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prior to the alleged incident date, he'd dropped something heavy on his

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foot, which was probably the reason why he sustained a broken toe.

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Allianz had all the proof they needed to make a decision.

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On the back of the information that we had in our possession, we felt

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confident we had enough information to decline the claim, which we did.

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But that wouldn't be the last Allianz

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would hear from the claimant.

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We thought that was the end of the matter, but six months later,

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we received communication from the claimant's solicitors telling us

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that they would be prepared to accept a far reduced offer.

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As far as we were concerned, nothing had changed,

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so we maintained our position and refused to pay the claim.

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But the claimant obviously thought three time's a charm.

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Surprisingly, the claimant still wanted to pursue the claim

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and threatened to take us to court.

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We weren't going to just roll over,

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so we accepted that action

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and a trial date was set for December 2015.

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Solicitors Keoghs were instructed to defend the claim.

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Insurance law expert, Nina Dayal, took the case on.

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And there was one piece of crucial evidence to be examined.

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Fundamentally to this case, the policyholder had preserved

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the CCTV footage which was going to provide a defence to the case.

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Keen to see the incident for themselves, they reviewed the

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footage from the day the claimant was alleged to have fallen.

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The CCTV evidence is quite clear.

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It shows a number of people walking past without any incident.

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There are walkers, cyclists, people pushing prams.

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But no claimant having a fall in the manner described and alleged.

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But he had succeeded in framing himself for a false claim.

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As can be seen from the CCTV footage,

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no incident has taken place, no-one has fallen over.

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It was damning evidence

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and all attention turned to the forthcoming day in court.

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Prior to the trial, the claimant's solicitors

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removed themselves off the court's record.

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Consequently, the claimant was left without

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any legal representation days before the trial.

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A telling decision and the claimant would soon follow suit.

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The trial on the 7th December was vacated

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and re-enlisted for a hearing.

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The claimant was given the opportunity to attend,

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but failed to do so.

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Consequently, his claim was struck out.

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The judge reviewed the evidence extensively

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and made no hesitation in making a finding that the claimant

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was fundamentally dishonest.

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The claimant was ordered to pay a sum of £15,468.90.

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This case clearly shows that, for those considering pulling

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a personal injury scam, it just isn't worth it.

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This was a really brazen attempt by the claimant

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and the fact that he took this to court to try and take us on

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would suggest he wasn't very bright.

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Now, an insurance policy can cover the cost of unforeseen problems.

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Everything from car accidents to medical bills while you're abroad

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and even lost income from unemployment.

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But while for most of us making a claim is a last resort,

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there are fraudsters out there who view these policies

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as a way to fund an early retirement.

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Insurers Cardif Pinnacle offer cover to customers

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looking for peace of mind.

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What they don't provide or tolerate is insurance cheats looking

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to cash in on a policy with a fraudulent claim.

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Any suspect cases are investigated

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and, if necessary, referred to the City of London Police's

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Insurance Fraud Enforcement Department.

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DC Jamie Kirk was passed one case that needed a detective's eye.

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Mark Downes accepted two income protection policies

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with Cardif Pinnacle.

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These were in case he was unable to work.

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So, if he was unable to work, they would provide

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a level of cover to cover his salary.

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The total claim that would have been paid out over the course of a year

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would have been to the sum of £56,000.

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And it wouldn't be long before Downes

0:22:400:22:42

would have to call upon these policies.

0:22:420:22:44

He made claims on these very shortly after having accepted the policies.

0:22:460:22:51

One of those actually showed that he had been not working

0:22:510:22:56

at the time he accepted one of those policies.

0:22:560:22:59

So Cardif Pinnacle were immediately suspicious.

0:22:590:23:03

It was only a matter of months

0:23:030:23:04

between taking out the insurance cover

0:23:040:23:07

and first attempting to make a claim on medical grounds.

0:23:070:23:10

With both the policies that Mark Downes had with Cardif Pinnacle,

0:23:100:23:14

he was claiming that he was suffering from ulcerated colitis.

0:23:140:23:18

Which is a particularly nasty enlarging of the bowels and colon.

0:23:180:23:22

And upon looking into Downes's work history,

0:23:220:23:25

it appeared he had been less than truthful.

0:23:250:23:27

Mark Downes had claimed that he was working for a Dutch haulage company.

0:23:290:23:33

He also claimed that he owned a Dutch haulage company.

0:23:330:23:37

He always claimed to be a managing director,

0:23:370:23:40

even the owner of the company.

0:23:400:23:42

We spoke to the actual managing director, who assured us that

0:23:420:23:46

Mark Downes was not a manager, although he had worked there,

0:23:460:23:49

albeit some years before the claim was ever submitted.

0:23:490:23:52

So he was claiming loss of earnings on a job he didn't even have.

0:23:540:23:59

Downes had also submitted evidence alleging

0:24:000:24:03

he owned numerous haulage companies.

0:24:030:24:05

But when detectives checked out the office at addresses provided,

0:24:060:24:10

no trace of the businesses could be found.

0:24:100:24:12

Mark Downes had previously been a lorry driver,

0:24:140:24:18

and that was the business he knew,

0:24:180:24:20

which is the reason I believe why he kept claiming to be

0:24:200:24:23

the manager or the owner or someone senior in various haulage companies.

0:24:230:24:29

In support of his £56,000 claim, Downes had also submitted

0:24:290:24:33

medical records reportedly from his examining doctors.

0:24:330:24:37

They were able to tell us

0:24:390:24:40

that they hadn't ever provided these doctors notes.

0:24:400:24:43

The doctors notes were fraudulent.

0:24:430:24:45

They hadn't operated from the various places

0:24:450:24:48

that he stated GP surgeries were.

0:24:480:24:51

And they also were able to tell us that he wasn't suffering from

0:24:510:24:55

the illness that he was claiming from either.

0:24:550:24:57

Mark Downes's lies had been exposed

0:24:570:25:00

along with the fake documents he had been providing to his insurer.

0:25:000:25:04

His attempted scam had failed.

0:25:040:25:06

There was an awful lot of evidence against Mark Downes.

0:25:070:25:11

We were able to show that the claims he had made were

0:25:110:25:14

completely fraudulent, that he had pretended to be at doctors.

0:25:140:25:19

He had signed fake doctors' notes.

0:25:190:25:23

He had pretended to be managers,

0:25:230:25:25

owners of haulage companies.

0:25:250:25:28

All to try and claim £56,000.

0:25:280:25:31

And it wouldn't be long before this assurance cheat would have

0:25:310:25:34

to answer for his actions.

0:25:340:25:36

Mark Downes was arrested at his home address in Kent.

0:25:380:25:42

His house was searched

0:25:420:25:44

where we found various documentation,

0:25:440:25:47

fraudulent doctors' notes

0:25:470:25:50

and other documentation relating to the insurance claim.

0:25:500:25:54

Despite the overwhelming body of evidence, there would be

0:25:540:25:58

no confession.

0:25:580:25:59

He was interviewed

0:26:010:26:03

where he denied that the claim was fraudulent.

0:26:030:26:06

He stated that it was all a genuine claim, that all the doctors' notes

0:26:060:26:10

were genuine and maintained his innocence throughout.

0:26:100:26:13

With Downes in custody and facing multiple fraud charges,

0:26:130:26:17

his case took an unexpected turn.

0:26:170:26:20

After Mark Downes's initial arrest

0:26:200:26:23

and his first interview, he was bailed.

0:26:230:26:26

It was after that point that we spoke to another insurance company.

0:26:260:26:32

We were able to identify two almost identical policies to

0:26:320:26:37

the two policies he'd taken out with Cardif Pinnacle.

0:26:370:26:39

And exactly the same fraud had been going on with Shepherds Friendly.

0:26:390:26:43

Things were going from bad to worse for Mark Downes

0:26:430:26:46

and the full extent of his attempted fraud had been revealed.

0:26:460:26:51

He clearly thought he was never ever going to get caught and

0:26:510:26:54

he thought he was going to get £56,000 from Cardif Pinnacle

0:26:540:26:59

and a further £40,000 from Shepherds Friendly, which again

0:26:590:27:03

he was not entitled to as it was a completely made up set of claims.

0:27:030:27:06

With false claims totalling nearly £100,000,

0:27:060:27:10

Downes was charged with 12 counts of fraud.

0:27:100:27:13

He pled guilty at trial...

0:27:130:27:15

..and was sentenced to 14 months in prison.

0:27:170:27:20

The 14-month custodial sentence, which Mark Downes received,

0:27:200:27:24

I feel reflects the level of fraud,

0:27:240:27:29

the fact that he was pretending to be a doctor

0:27:290:27:31

and it reflects the amount that he stood to make, almost £100,000.

0:27:310:27:36

If Downes hadn't been stopped when he was,

0:27:360:27:38

the consequences could have been grave.

0:27:380:27:41

Mark Downes has previous convictions for fraud and like offences.

0:27:410:27:47

I believe, if we hadn't been able to catch him on this occasion,

0:27:470:27:52

he would still be out committing fraud right now.

0:27:520:27:56

From organised criminal gangs to exaggerated household claims,

0:28:000:28:05

insurance fraud hits all of us in the pocket.

0:28:050:28:07

But instead of getting away with it,

0:28:070:28:09

more and more of these fraudsters are being claimed and shamed.

0:28:090:28:14

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.