Episode 6 Claimed and Shamed

SKIDDING AND CRASH

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...

That's the subject out of the vehicle.

..sophisticated data analysis techniques...

SKIDDING AND CRASH

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

Police! 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's grossly exaggerated insurance claim

is scuppered as he can't help showing off to his mates.

He was actually bragging that he was in line for quite a large payout.

A woman gets confused by her own version of events.

The customer firstly said she had reported it,

then she hadn't reported it, but now she had reported it again.

And a man discovers it's hard to prove you've suffered an injury

when you've slept through the entire accident.

This bus could have been attacked by a T Rex

and this guy wouldn't have even woken up.

Have you ever had that feeling

when you think you might be being followed?

Not nice, is it? Well, if you're committing insurance fraud,

that might not just be your imagination.

More and more companies are using expert surveillance gatherers

when they suspect someone is trying to defraud them.

QBE is an insurance company that looks after many large businesses.

Rob Smith-Wright is one of their claims managers.

Something that Rob and his team have to deal with

are personal injury claims from people that work for his policyholders.

If someone is hurt just doing their job, then they deserve compensation.

Rob recalls a case involving a mechanic, injured at work.

The circumstances of this incident were that the claimant was

working for our policyholder.

He was required to lift some heavy equipment and as he did so,

he felt a pop in his back and sustained an injury.

This was potentially a very nasty injury indeed,

especially for someone who has a physical job.

Initially, QBE offered £35,000 in compensation.

However, the man wasn't happy with the figure, saying it should

have been much higher due to the severity of his injuries.

The claimant's account of his injuries suggested that

he was living quite a severely disabled lifestyle.

He was unable to walk, he had to use crutches, he was unable to drive.

He also had issues with personal hygiene, relying on family members.

All in all, he painted a picture of someone who was suffering

severe pain and had a very large degree of disability.

When we looked at the claim and we started to put

a valuation on the symptoms that we were told,

we would have had a valuation of around £400,000.

However, it later came through the court that when he submitted

his schedule of damages, that he was looking at near on £800,000.

Not much short of £1 million,

but then, this man was maintaining

that his life had been ruined by his injuries

and he no longer had the ability to make a living.

With such a discrepancy between the £35,000 QBE had initially

felt the man was entitled to and the £800,000 he wanted,

they felt they needed to investigate further.

And something they found gave them pause for thought.

Our initial suspicions arose after the receipt of the medical records,

which detailed the claimant's visit to his own physician,

whereby he was diagnosed with a muscular injury.

Furthermore, the physiotherapist's records also detailed

muscular injury to the lower back with no pain radiating down to his legs.

So no pain radiating down to his legs, yet he was claiming

he couldn't walk, drive or have a bath without assistance.

The team were confused.

They had enough concerns to justify some secret filming of the injured man.

So when the surveillance came in, the natural expectation would

be to see someone who was struggling to walk and was unable to drive.

But the surveillance footage showed something very different.

So the first period of surveillance that we undertook on the claimant

did show him in fact walking, using a crutch, rather than crutches

but the mobility that he was displaying was far greater than he

was alleging that he could undertake and furthermore, and rather

more concerning, was that the claimant was actually driving a car

and it was a manual transmission, so that would have required quite

a bit of movement over and above what he was suggesting he could do.

The man clearly had been injured but he seemed much more able than he was claiming.

Not long after this initial surveillance,

QBE were surprised to receive reports from medical experts

which seemed to confirm the claimant's version of the extent of his injuries.

One medical expert went so far as to say that the level of

symptoms that he was displaying was that on par with someone who

had suffered a significant spinal injury.

Also, the claimant's own account of his lifestyle

maintained that things are getting worse, not better.

He now suggested that he considered himself completely disabled.

He was using a wheelchair, again wasn't able to work,

wasn't able to drive -

pretty much suggesting that

this injury had completely changed his life.

The team at QBE had to know.

If the claimant was suffering as much as he and now his medical

expert suggested, then, of course, he deserved full compensation.

But so far in their own investigations,

they hadn't seen this.

They decided to conduct some more secret filming.

And once again, the man was seen to be much more able than he was claiming.

Here, you can see the claimant again driving and in fact,

everything here indicates that this man

has mobility far in excess of what he's telling anyone

and any other medical experts that he can actually do.

We are very much of the opinion that we have someone who's grossly

exaggerating their claim to a fraudulent degree and clearly,

this man is attempting to maximise the amount of compensation

that he is reasonably due.

QBE contacted the medical experts that he'd used and showed them the footage.

The medical experts pretty much came back and said that

he had been inconsistent in his account.

Clearly he was able to do much more and generally speaking,

they were unable to rely on anything that he had told them.

It wasn't looking good for the claimant.

In fact, his story that he was severely disabled really didn't stand up.

What's more, QBE uncovered further damning evidence from people that knew him.

One of the witness statements was actually quite revealing

in that the property that the claimant had rented,

he'd actually disclosed that he was in the process of

making an injury claim, so much so to the point that

he was actually bragging that he was in line for quite a large payout.

QBE had seen and heard enough.

They disclosed their evidence to the injured man and his solicitors,

who promptly dropped his case,

leaving the man to fend for himself.

The claimant decided he would be happy to accept the earlier

offer from QBE of £35,000 after all.

Our immediate reaction to that request from the claimant

to accept the early offer...was immediately rejected.

The case went to court.

However, the claimant repeatedly failed to appear.

QBE knew that any attempt to get the man to pay their court costs

would be futile.

However, they needed to get legal permission to reject the claim.

We then made an application to the court, asking them to strike out the

claim, due to the inconsistencies and the clear fraudulent nature.

The court agreed and the claim was struck out under an abuse of

process of the court's timetable.

The man didn't receive a penny.

This is a cautionary tale,

as he had been genuinely injured and did deserve some compensation.

But his greed got the better of him.

And by exaggerating his injuries to such an extent,

he's ended up with nothing.

Still to come -

an absent-minded claimant lies to his insurance company,

forgetting the fact he's already told them the truth.

The vital piece of evidence was the telephone call

where the claimant confirmed he wasn't injured.

Now, many of us will know that feeling,

getting off an aeroplane after a long-haul flight.

You're exhausted, jet-lagged, and basically,

already feel as if you need another holiday.

But as you walk through the airport, do you ever get that growing panic

that you might have left something on the plane?

It's easily done but if you do lose something whilst travelling,

then there are companies like CEGA,

who can assist you in getting the value of your items back.

Simon Cook heads up their special investigations team

and recalls just such a case.

The claim we initially received was for a lost iPad

which was left on an aircraft.

The customer said she had been using her iPad on the plane on the

way back from overseas and she had accidentally left it in the

seat pocket in front of her.

CEGA had no reason to doubt the claim, as it's such

a common and easy mistake to make.

However, there was one thing that didn't quite add up.

Once we reviewed the claim for the iPad,

we noted that it was a 3G model. However, once we checked the

national database, we noted that it hadn't been blocked.

We'd expect any lost items such as this or a mobile phone to be

blocked with the network provider, to stop unauthorised usage.

Perhaps this was just an oversight by the customer.

Simon and his team waited for the paperwork to come in, to look

into the case further.

Around two weeks after the customer first contacted us,

we received a claim documentation and we became very concerned to

note that she had now introduced a new claim for a lost bag, having

never mentioned anything about this claim when she first contacted us.

The total value of both claims was around £800.

So not a huge amount but that didn't matter to Simon and his team,

whose suspicions were now further roused by their customer's

sudden memory of a lost bag which she had said had contained

some make-up and a pair of boots.

They contacted the airport where the woman said she'd reported her losses.

The lost-and-found department were extremely helpful and explained to

us that they did actually have a report for the lost iPad

but confirmed they had never ever received a report

for the loss of a bag.

When we asked the customer about this point, she was adamant

that she had reported the lost bag to the airport.

It was the customer's word against the airport's.

So Simon and his team felt they needed to do more investigation.

Once we explained to the customer that, at present,

we weren't happy with both the claims submitted,

which meant that we wouldn't be able to pay the claims at present,

she decided to make a formal complaint about the fact that we

WERE going to make further enquiries and wouldn't settle the claim.

Following procedure,

a CEGA complaints operator spoke to the customer.

He asked her again about the loss report

she had submitted to the airport.

CEGA were confused.

The customer was now admitting that she HADN'T reported the lost boots

and make-up to the airport, despite earlier being adamant that she had.

But the plot was about to thicken.

Shortly after speaking to the complaints operator,

the customer sent in an e-mail purportedly from the airport,

confirming that she HAD lost the bag.

From our perspective, we were even more concerned now,

because the customer firstly said she had reported it,

then she hadn't reported it, but now she had reported it again,

because she had sent us this document through.

The e-mail contained a genuine airport report of the

lost bag and crucially,

the date on it was the same date she'd reported the lost iPad.

Perhaps Simon and his team had got it wrong after all.

Suddenly, their customer had hard evidence that proved she had

indeed lost and duly reported her bag as missing,

along with the iPad.

They got back in touch with the airport to clarify matters.

The lost-and-found department at the airport told us that they

did in fact have two reports -

one for the iPad and one for the lost bag.

However, it was concerning to note that the lost-bag report was

only actually made after the day that she made the complaint to us,

which was approximately six weeks after the date of the alleged loss.

It seemed as though their customer,

after putting down the phone to the complaints operator,

e-mailed the airport to report her bag as missing.

And Simon had a good idea about the mystery of the date on the form.

Her e-mail been sent into them in a format called PDF -

an electronic copy of a document, rather than an original file.

Why would the customer need to send us this e-mail in PDF format?

She could simply just go into her e-mail, push forward, put our e-mail

address in and then it comes to us as the original e-mail.

It was evident to us that the customer had sent us an

e-mail in PDF format, because she had changed the actual true date

that she reported the lost bag to the airport.

The clouds were definitely beginning to darken over this customer's claim.

But there was a final twist

that would launch it into turbulent skies.

During the call with the airport's lost-and-found department,

we were actually told that the iPad had been found on the aircraft

and they actually had e-mail communications between the

customer and the airport, so she could have the iPad returned to her.

This all predated the customer even contacting us to make the claim.

Her story crash-landed and CEGA had heard enough.

Due to the level of evidence that we obtained,

we actually declined both the claims in full

and this matter was in fact referred to the City of London police.

In addition to this,

the customer did in fact admit to fabricating the lost-bag claim.

Now, memory's a funny thing, isn't it?

I can remember moments that happened ten years ago

but often haven't got a clue what happened last week.

I've even been known to forget my lines for this show.

Here's a story, though, that may well stick in the mind.

You would think,

given the meticulous nature of insurance companies,

anyone attempting to defraud them would understand the

importance of attention to detail,

but many of these would-be fraudsters find it difficult

to remember exactly what lies they've told and to whom.

BLM are a firm of solicitors that represent many insurance companies

who require legal assistance to fight fraud.

Simon Hammond is a partner at the firm and recalls a case which,

at first, seemed totally run of the mill.

The claim that was received was originally for minor vehicle damage

following a road traffic accident.

The driver had collided into the rear of the claimant's vehicle.

The value of the entirety of the damage

just to the vehicle was just in excess of £600.

This relatively small amount of money was duly paid out

to the claimant for the damage to his car.

There were no injuries to the man and it was case closed...

or so they thought.

Two and a half years later, the claimant got back in touch to say

he had been injured in the collision and was still suffering.

The claimant alleged that he had suffered soft tissue injuries to his

neck and back.

The injuries had affected his life,

his day-to-day work life and home life.

He'd had to cancel meetings, he had two weeks away from work

and he alleged he was continuing to suffer whilst going about his

day-to-day activities.

The insurance company found it a little suspicious that it had

taken the man two and a half years to tell them about his injuries,

but they did seem significant, so they carefully went through

the medical report.

It became apparent there was further suspicions in the case

because, on notifying the claim,

the claimant alleged he had suffered neck injuries,

whereby, upon his GP report being served,

he only was suffering back injuries.

So there was a minor inconsistency on the doctor's report -

but really not enough to prove one way or the other whether this

claimant's injuries were genuine.

Luckily for BLM, insurance companies are extremely thorough.

They keep their records in good order

and they keep them for many years.

The vital piece of evidence which the insurer had in this particular

case was the telephone call,

which was recorded 13 days post the accident,

where the claimant confirmed he wasn't injured.

By this point, court proceedings were underway.

The forgetful claimant was trying to fleece the insurance company

out of thousands of pounds in compensation for injuries

he'd admitted he'd never had.

Once BLM had gathered all of the evidence,

we immediately served that upon the claimant,

showing him the call recording that confirmed he wasn't injured.

The outcome of the case

was the claimant discontinued his proceedings.

That would seem to indicate that he was caught out -

in which he was claiming for items he wasn't entitled to.

The insurance industry as a whole is seeing more and more of these

types of late claims,

which often come in years after the actual incident has taken place.

They are naturally suspicious of them,

especially given that many such claims are initiated by cold calls.

You know, the ones that ask you

if you've been recently involved in an accident.

The industry is working very hard with the regulators

to try and stamp out the nuisance calls

which the public are receiving,

which is no doubt encouraging and facilitating potentially

fraudulent claims being made.

With any luck, then,

we'll all stop receiving those annoying calls very soon.

Night buses - it's always an experience taking one.

But whether you're at the end of a big night out or about to

start an early shift at work,

for many of us, they're a vital service.

FirstGroup have a fleet of over 6,500 buses on the UK's roads,

including many services that run through the night,

so it will come as no surprise that FirstGroup

see their share of claims from passengers.

While the majority of these are straightforward,

some aren't quite as clear-cut.

When a suspicious claim does come in,

it usually end ups on the desk of Lee Ingram.

One of our buses was involved in an incident in the

very early hours of a summer morning.

The claimant said that he was an upstairs passenger on a bus.

He admits he was drunk.

He'd fallen asleep when the bus had hit some bollards -

this has caused him to be jerked forward in his seat.

The claimant alleged soft tissue injuries to his upper back,

his lower back.

He also said that he was suffering from travel anxiety caused by

post-traumatic stress.

There were a number of other passengers on the bus -

it's a little bit strange that none of them were injured

and yet this one person claims that he was injured as a result.

At first glance, this incident

certainly was a bit of a head-scratcher.

Multiple injuries, post-traumatic stress,

yet only one injured passenger,

who was claiming a whopping £16,000 in compensation.

As always, Lee and his team investigated further

and it wasn't long before the legitimacy of the claim

was cast in serious doubt.

We were initially concerned about this claim when certain

inconsistencies came out in the medical report.

We'd already had a report from a physiotherapist saying that

this gentleman had had his treatment

and he was now 100% recovered from his injuries.

Now the medical report had said

that he was still suffering from his injuries.

When we went to the police and asked them for a report of this incident,

they advised that they had been told about the accident

but they had it down as a damage-only situation.

If there had been an injury,

the police would have recorded that injury

and turned up at the scene of the event.

Unlike many companies who find themselves faced with

personal injury claims, FirstGroup are in a fortunate position

because, in cases like this, they have the ultimate eyewitness.

Based on the issues with the medical evidence,

the physio report, the police situation,

we decided that the CCTV was well worth looking at.

With at least a dozen cameras fitted to FirstGroup's buses,

the CCTV would show Lee and his team

the freak accident that left one unlucky passenger with a string of

injuries and everyone else on the bus completely unscathed.

When we looked at the CCTV, all we were expecting to see

was this bus hitting some bollards, coming to a very abrupt stop

and the claimant being sort of moved forward in his seat

and clear signs of him being injured.

Given the claimant's list of injuries, it's a fair assumption.

However, unfortunately for the claimant,

it couldn't be further from what the cameras actually captured.

When we looked at the CCTV,

it showed a very different set of events.

The bus didn't hit bollards at all.

It hit a small road sign, which had flipped up and hit the windscreen.

The claimant was upstairs asleep.

The impact does cause a slight movement -

it's certainly no more than every time he comes around from his sleep.

It's certainly not enough to have caused him the whiplash and

the travel anxiety and the... the disaster that he is alleging.

So let's get this straight.

The bus never collided with any bollards,

the claimant hadn't suffered any movement to cause the injuries

he was claiming for and, on top of that,

he was barely conscious when the so-called accident

had even happened.

The only thing that was clear from the footage

is that the claimant was dreaming when it came to his claim.

When we've got evidence such as CCTV,

it's often easy to see where a physical injury

could have been caused.

When it comes to psychological injuries,

it's not always as apparent.

Post-traumatic stress is very serious in itself...

It's caused normally by what would be deemed a life-threatening

situation or a very serious set of events.

Of course, to experience that, you do have to be conscious

for it to actually have an effect on you.

This bus could have been attacked by a T Rex

and this guy wouldn't have even woken up.

Unsurprisingly, it didn't take Lee and his team long to decide

what their next course of action would be.

Once we looked at the CCTV footage, we very quickly went back

to the claimant's solicitors

and told them we weren't going to pay this.

But if the claim itself wasn't shocking enough,

the reaction of the passenger's solicitors

was even more jaw-dropping.

Surprisingly, shortly after repudiating the claim,

we received a county court claim form from the claimant's solicitors.

We were under the impression that the CCTV was quite clear.

Armed with what can only be described as concrete evidence,

FirstGroup were more than happy to see this case through.

There's no way we're not going to defend this claim to trial.

We definitely thought we had the correct evidence,

we were satisfied that the claim was questionable in itself,

and we therefore instructed Horwich Farrelly Solicitors

to defend our position.

Mark Hudson at Horwich Farrelly took up the case.

The first thing that we did was to review the file of papers

and, upon doing so, we noted that the incident involved

a collision between a bus,

a double-decker bus, and a small road sign.

So, on that basis, we were highly cynical.

Upon watching the CCTV footage, this confirmed beyond any doubt at all

that this claimant simply was not injured and, moreover,

was just telling lies about what happened to him at the time.

But despite the overwhelming evidence, the case went to court.

Not surprisingly, the claimant was fairly awful in cross examination.

There were so many inconsistencies that he really didn't know

how to deal with the questioning that came at him from the

barrister representing FirstGroup.

And, well, it doesn't take a legal eagle to guess what happened next.

The judge was completely unwilling to accept that this incident

either or could or did cause injury.

The judge therefore dismissed the claim in its entirety.

It was another victory for FirstGroup,

but sadly an all too familiar sequence of events

and Lee is under no illusion as to what the future will hold

when it comes to dishonest opportunists.

I don't think that this type of claim will ever completely go away.

It would have been quite easy for us to pay the claim at an early stage,

cut our losses and walk away.

That is absolutely against what FirstGroup do.

When we are satisfied that we've got the evidence

and a claim, in our opinion, is questionable,

we will defend it to the ends of the earth...

and this is exactly what's happened in this claim.

Unlike the claimant in this one, you won't catch us napping.

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.