Episode 7 Claimed and Shamed

Insurance fraud has reached epidemic levels in the UK.

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

That's almost 3.6 million every day.

Deliberate crashes, bogus personal injuries, even phantom pets.

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

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

But insurers are fighting back,

exposing just under 15 fake claims every hour.

Armed with covert surveillance systems...

Subject out of the vehicle.

..sophisticated data analysis techniques...

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

Police! Stay where you are!

..they are 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.

A serving prisoner's phoney claim is easy to unlock.

It's not often that you're faced with evidence that's this clear

that someone has entirely fabricated a claim.

A man's expensive tastes leads to his undoing.

He must've had a lot of room service. That's all I'll say.

And an insurance company cries foul, when a footballer attempts to score

with a claim.

He also played against a rival during that four-week period,

in which he scored a goal.

When insurance fraud is committed against large, private companies,

it's important there are systems in place to detect it and stamp it out.

Otherwise, it's ultimately the customers that pay the price.

However, when a fraudulent attack is made on a state-run system,

it's arguably even more important that it's discovered

and stopped before any money is paid out

to avoid a situation where taxpayers -

that's you and I - are funding fraud.

Foston Hall in Derbyshire is a women's-only prison.

Joanne Riley, a litigation specialist at the prison,

recalls a case where one of the prisoners

put in a personal injury claim.

The initial claim was for an accident

that she alleged happened in her cell on D Wing.

She alleged that she was moving a cupboard with a cellmate

and, whilst moving the cupboard,

the uneven floor made the cupboard fall and it injured her face.

Her alleged injuries were quite minor. It was nothing

that required any hospitalisation or any time to see a doctor.

Even so, prisons have a responsibility

for the wellbeing of their prisoners

and, with an uneven floor being cited as the cause of the accident,

Foston Hall could well have been liable.

As with all such claims,

they began to investigate thoroughly before paying out.

There didn't seem to be any reason why there would be any problem.

It was only, in further investigation,

when I looked to see if there was any reports

that the floor was uneven that I discovered there was nothing

logged anywhere with the maintenance

department to say there had been any problems at any time with

the flooring on the D Wing room that she was located in.

By now, the prisoner's solicitors had officially started legal proceedings

against Foston Hall.

However, suspicious that the claim wasn't entirely genuine,

Joanne encouraged her supervisor, Carl Davis, to investigate further.

Carl's first port of call was to examine a book called a wing diary.

It is used by staff to record

everything that happens at the prison.

And it immediately revealed an inconsistency.

The claimant had reported to staff she'd received injuries

on the 24th of October.

The staff had reported that to our healthcare department,

and they had made notes in the wing diary, to that effect.

When we received notification from the claimant's solicitors,

the claimant's solicitors were alleging that the incident

actually took place on the 31st of October.

That gave us some concern.

It wasn't looking good for the prisoner's claim.

However, nothing could have prepared Carl and his team

for what they found next.

At Foston Hall, all phone calls made by the prisoners are recorded.

So, staff at the prison looked through the transcript

from the phone calls this prisoner had made. And one stood out.

It was to her father,

and they immediately passed on their findings to Carl.

The claimant was clearly heard to state that she had not received

the injuries as a result of an accident moving furniture,

but she had received the injuries as a result of a fight

with another prisoner.

During that telephone call,

the claimant conspired with her father

to ask the father to contact his solicitors, on her behalf,

so she could commence making a claim

against the prison service for injuries

which clearly had not happened in the way she was describing.

They had the proof they needed

that this inmate had made up

the whole story of how she'd got her injuries.

They gathered together all the evidence they found

and handed it over to the GLD, the government's legal department.

Henry Ripley, a deputy director at GLD,

knew he had a strong case on his hands.

So, the telephone recording revealed

that she'd been in a fight with a prisoner,

that she had sustained injuries

and, ultimately, that she was looking to pin those injuries

on the prison

by bringing a claim that really had no basis whatsoever,

simply in the hope of securing some compensation.

It's not often that you are faced with evidence that is this clear,

that someone has entirely fabricated a claim,

so our reaction was one of surprise.

Ultimately, we took the decision very quickly this had to be evidence

which would firmly back up our position

and enable us to defend the claim.

And therefore, the step we took next was to alert

the claimant's solicitors to this crucial piece of evidence,

with a view to this claim proceeding no further.

What happened next came as no surprise.

As a result of the evidence we put to the claimant's solicitors,

she took the right decision.

She didn't proceed with her claim and, as a result,

the public purse was saved from paying compensation

on a wrongful basis.

The last thing taxpayers want to see -

public money spent on compensating

prisoners for claims that aren't justified.

And so this provides a really positive message

to the wider public that such claims are being taken seriously,

investigated properly and action taken, where dubious claims

are being brought.

An evil woman puts a 1 million price tag on her husband's life.

Travelling to far-flung corners of the world is now more possible

than ever, whether you're heading for the plains of the Serengeti

or the lava fields of Iceland.

But, of course, your dream holiday you'd been looking forward to

can quickly become one you would much rather forget,

if you have an accident or are the victim of a crime.

You can never be prepared for every eventuality,

but companies like CEGA provide travel insurance,

to help out if something awful does happen whilst you're overseas.

Simon Cook, head of special investigations,

remembers a particularly horrific ordeal

involving a man who was visiting Tanzania.

The customer contacted our medical emergency helpline,

to tell us he had been involved in an armed robbery, unfortunately.

He had also told us that he had his personal possessions stolen

in the robbery.

It must be one of the most frightening things imaginable,

to be held up at gunpoint. And, what's more,

the armed robber had physically assaulted the man.

It sounded like a very violent attack,

because the customer was an in-patient in hospital

for two weeks, so he must have been badly injured.

The man was claiming £1,000 for his stolen possessions

and £6,000 for his hospital bills.

Simon and his team are experts in international medical provision and,

to them, this seemed expensive for a Tanzanian hospital.

They waited for the paperwork to arrive.

The customer only provided three documents for a two-week stay

in hospital. This just seems a little unusual.

You would expect to see a lot more documents than that.

They decided to investigate further and, as standard procedure,

they contacted the man, to ask him to sign a form,

giving them permission to examine his claim in more detail.

The customer duly signed the form, but we were concerned to note that,

when he sent the form back to us, he stated in writing that he had now

appointed a solicitor to deal with this matter.

It is very unusual for a customer making a genuine claim

to make threats of legal action.

At this point, we were even more concerned with the claim

that was presented to us.

When Simon and his team have doubts over a customer's claim,

they will conduct a full investigation.

And distance is no barrier.

Due to our concerns with the claim, we decided to appoint

our on-the-ground investigator in Tanzania,

just to ensure that the claim presented was, in fact,

valid and covered by the terms and conditions of the policy.

Yeah, they've got on-the-ground agents everywhere.

And this one wasted no time.

He headed straight to the hospital,

where the customer had been laid up for two weeks.

The first thing that he noted was that the hospital doesn't deal

in US dollars, which was the currency that the customer

had claimed he'd paid the hospital in.

Further investigations with the hospital staff revealed that

the customer's name was not listed anywhere in their official records

and that he hadn't actually been treated there.

So, he'd never even been inside the hospital.

The agent was going great guns.

Next, he headed to a hotel where the customer had stayed

and later submitted the bill to CEGA, as part of his claim.

We established that the hotel charge a maximum of 35 per night,

which was obviously concerning for us because the customer

had paid 135 per night.

He must have had a lot of room service -

that's all I would say on that.

However, it did seem that, at least, this time,

the customer had connections with the hotel.

When we questioned the hotel manager,

we actually established that he was good friends with our customer,

but he then proceeded to tell us that the customer had provided us

with a fraudulent invoice and he didn't actually stay at the hotel.

Who needs friends(?)

I bet that particular friend is off the Christmas card list.

The Tanzania agent had one final place to go.

We then proceeded to visit the police station.

We spoke to one of the officers there who immediately told us that

the crime reference number provided on the report wasn't in the same

format as their genuine crime numbers.

Further to this, the police officer that we spoke with said the person

allegedly who signed the police report didn't, in fact, work at

the police station and they don't even have a lieutenant as a rank

within that station.

As far as CEGA was concerned, it was case closed.

Armed with the evidence that we had obtained through

our overseas investigation, we contacted the customer by telephone,

to give him the opportunity to be open and honest with us

about the actual claim.

'Unsurprisingly, the customer said he had nothing further to add

'to the situation and he was making a genuine claim.'

However, the on-the-ground work done by their agent had provided

irrefutable proof to the contrary.

It was entirely evident from our investigation that the claim

was completely fraudulent.

We weren't satisfied that any aspect of it was genuine.

As far as we are concerned, the armed robbery simply didn't occur.

Simon and his team stuck to their guns and refused to pay out a penny.

They never heard from their customer again.

Now, on this show, we look at lots of examples

of people committing insurance fraud.

With individual claims, more often than not,

there is some truth behind the incident.

Say, a bag was stolen, but the contents are a little exaggerated.

Or an accident at work did happen, but the employee

wasn't as badly hurt as he maintained.

It's all fraud and it is all illegal,

but at least there was some grains of truth to the story.

Well, the next case we're going to look at involved lies so blatant,

and told without a care for the consequences,

that one of the highest legal offices in the land

felt it necessary to intervene.

Richard Hiscocks works at Aviva, as their Director of Casualty Claims.

Back in October 2013,

a member of the team received a call to say that one of their

policyholders had caused a minor accident.

So, we first became aware of this case when our insured

had reversed into the claimant in a fast-food restaurant

drive-through. They'd overshot the place where you speak your order

into the microphone, reversed up gently and nudged the car behind,

which was driven by Gary Burnett, the claimant,

who then claimed that he had shoulder and neck injuries,

which prevented him from fulfilling his normal life.

Gary Burnett was claiming £2,000 for his whiplash injuries,

but, from the word go, his story of the accident at the drive-through

left a bad taste in the mouth.

We were immediately suspicious because this is what we call

a low-speed impact. Our customer had told us that the speed at which

he was reversing was very slight. The vehicle damage supported that

and, actually, it is most unusual to get injury when the speed

of the impact is so slight.

They had photos from their insured driver that showed how little damage

there was to either vehicle.

We decided that, in the light of this evidence,

the claim was spurious and we have a duty, in that case,

to defend our customers. And, so, we decided we weren't going to pay

this claim. He then proceeded to litigate against us,

which meant the claim went to trial, for him to prove that he was injured

and that we should have been paying him compensation.

Aviva enlisted their solicitors, Horwich Farrelly,

to fight the litigation against them.

David Scott represented them.

So, when Horwich Farrelly got the case,

we looked at the evidence presented by the insured driver,

which were some very good photographs taken at the scene,

which show virtually no damage to either of the cars.

We also spoke in detail to the insured driver,

who told us that this was a very, very minor accident.

He reversed back a small distance into very, very minor contact with

the front of the claimant's car. So, based on that, we decided

to investigate this further,

as we believed it to be a potentially dishonest claim.

Gary Burnett made his living as a window cleaner

and also played football semi-professionally.

He maintained that his injuries were affecting his ability

to earn a living.

The claimant had told his medical expert

that the whiplash injuries were pretty severe.

So they caused him to have time off work as a window cleaner

and they also stopped him from playing football.

He went on to say, in an official legal statement,

that he hadn't been able to train or play for a whole month.

But, unfortunately, for Burnett, a social media search revealed

that this was a total lie.

The Twitter account of the claimant was one that was publicly available

and showed the claimant had played football during this

four-week period that he said he couldn't play at all.

# Here we go, here we go, here we go

# Here we go, here we go Here we go-o... #

It showed he played against Kendal Town the day after the accident.

# Here we go, here we go! #

He'd also played against a rival during that four-week period,

in which he had scored a goal.

# Here we go, here we go, here we go

# Here we go, here we go, here we go

# Here we go, here we go! #

He was very proud of his achievements.

Those tweets were to be a game changer.

FULL-TIME WHISTLE

They proved undisputedly what Aviva and Horwich Farrelly

had suspected all along. Gary Burnett had, in no way,

been injured as a result of the collision at the drive-through.

Once we'd completed our investigations,

we served all of this evidence on the claimant's solicitors.

On receiving that, the claimant abandoned his claim.

He discontinued his claim completely and wanted to walk away.

We reviewed the case with Aviva and we were happy we had enough evidence

that - in fact, significant evidence - to show this was

a dishonest claim, so we decided to take it on and take this case

to a County Court, to present the case to a district judge,

to find that this claim was fundamentally dishonest.

Gary Burnett wasn't going to be able to simply walk away from this.

On the day of the court hearing, perhaps knowing he was beaten,

Burnett decided not to attend.

The fact that the claimant didn't turn up to the initial civil hearing

probably did hinder his defence to it,

but the judge was satisfied that, based on the evidence presented,

that there was more than enough to find that the claim

was fundamentally dishonest. The outcome of the civil case

was that the claim was abandoned completely by Mr Burnett

and he was ordered to repay Aviva's legal costs of £11,000.

Burnett didn't receive a penny of the £2,000 he had claimed

from Aviva in compensation.

And he now faces an £11,000 bill.

It was 1-0 to Aviva,

but this match wasn't over.

The civil judge, in a bold move, decided to refer this case up to

the Attorney General's Office.

The Attorney General is the main legal adviser to the government.

They, along with the Solicitor General,

work to ensure the justice system is properly served

and the public interest looked after.

Within the last 12 months, we have taken in the region

of 400 cases to trial and this is the first one of those 400 cases

that was referred to the Attorney General.

This was a fact that it was such a brazen lie by the claimant to say,

not only to the medical expert, but also to Aviva,

also to the court, as well, that he was unable to play football.

It was a very, very serious lie. The court thought it was serious

enough to refer that on to the Attorney General,

-to consider prosecution.

-The Attorney General's Office

decided that Gary Burnett was guilty of contempt of court -

a criminal offence.

Contempt of court is where someone disrespects court proceedings

and makes a trial unfair by their actions.

Gary Burnett had told one too many lies.

Our Solicitor General, Robert Buckland QC, explains.

Well, it was very serious. The court that dealt with

the contempt case made him subject to a four-month sentence

of imprisonment, suspended for a year.

Because the court viewed it as essential to send a clear message

to the public at large that this sort of deliberate, systematic

dishonesty, that was fundamental to the case that he brought

in the County Court, will not be tolerated,

because it undermines the integrity of the civil justice system.

Burnett's blatant attempt to defraud Aviva had left him with a hefty bill

to pay and now a permanent criminal record.

This footballer's case had been used to illustrate how committed

the justice system is to tackling insurance fraud.

The system of insurance and the costs of insurance premiums

and the rising cost of premiums, if people make false claims,

is clearly a matter of public interest.

And, as a guardian of the public interest,

I think it is incumbent upon this office to get involved,

where we see such serious cases.

For Aviva's solicitors, Horwich Farrelly, this was a landmark case,

which they believe will act as a strong deterrent.

'We are very satisfied with the outcome of the case.

'Mr Burnett presented what was clearly a dishonest claim

'from the outset. This is the first of its kind,'

where the Attorney General has not only taken on the case,

but successfully prosecuted the claimant for contempt of court

and for insurance fraud.

It shows that the insurance industry now has the backing

of the government and has the backing of people like

the Attorney General in prosecuting dishonest claimants,

regardless of the value of the claim.

It is extraordinary the lengths serious fraudsters will go

for financial gain. Most draw the line at causing actual physical harm

to others, in order to make a buck. The key word there is "most"

because there are some who will, literally, stop at nothing

to line their own pockets.

North Port is an affluent residential district in Florida.

It was home to Janine Jones and her husband, Matthew Riley Smith.

Janine, who was once a corrections officer at the local county jail,

was now up to no good herself.

She and Matthew had a profitable, but totally illegal, scam going on.

They were renting out abandoned and foreclosed homes

to unsuspecting tenants across North Port.

The scheme was making them rich. Rich beyond their wildest dreams.

But there was a problem. Someone had got wind of what they were doing -

a handyman who worked for them, called John Chamberlain.

And he was threatening to expose them.

Janine needed a way to make sure John kept quiet

and decided that the only way to shut him up for good

was to hire a hit man.

But Janine didn't stop there.

She also decided she'd had enough of sharing her ill-gotten gains

with husband Matthew and she decided she would

have him executed, as well.

Janine took out a life insurance policy worth 1 million

on Matthew and prepared to meet with the hit man.

The meeting was facilitated by a middle woman,

who'd organised it to take place in a car.

Incredibly, what you're seeing is the actual footage

-from that first meeting.

-Hello.

-How you doing?

-How are you?

To start off, Janine shows the hit man a photo of her first

intended victim, John.

She appears to have no remorse about the fact she's about to have

someone's father killed.

The conversation turns to her husband, Matthew.

The talk soon gets serious.

And, extraordinarily, she tells the hit man how she would like

the first murder to happen.

Just a warning, this does make for disturbing viewing.

The hit man next asks her how she wants her husband's murder

to happen.

There seemed no end to Janine's maliciousness.

She had now suggested ways of killing two men -

one her own husband - without showing the slightest emotion.

In John's case, her motive was to stop him talking to the police

about her illegal property scam.

And, in her husband's case,

it was to get a 1 million pay-out from his life insurance.

This was an evil, greedy woman.

However, unbeknownst to Janine,

the middle woman who had organised the meeting

had, in reality, sold her out to the police.

So, Janine had just revealed her wicked plan not to a hit man,

but to an undercover cop.

The middle woman, who was helping the police, arranged to meet her

just once more, under the guise of wanting to finalise

all the details of the first murder.

This time, they met in a local diner.

As Janine calmly ate her meal,

no-one could have imagined what was being discussed.

Fortunately, for her employee John and her husband Matthew,

this was as far as Janine's hideous plan got.

Waiting outside the diner were several police officers,

who immediately arrested her.

In June 2014,

Janine Jones was sentenced to life in prison,

for trying to get two men killed.

But there was a menacing twist.

A few years earlier, Janine's first husband Max

had died under mysterious circumstances.

And it had to be more than a coincidence that, when he died,

Janine received a life insurance pay-out for, you guessed it,

1 million.

Max's family and the police believe that Janine had a hand in his death.

But it's hard to prove, as Janine had Max's body

quickly cremated after he died.

Whether it's exaggerating real injuries,

totally making up a story for a dodgy claim,

or masterminding insurance fraud on an industrial scale,

insurers are coming down hard on the people who think they can make

a quick buck with their scams and cons.

But the fraudsters need to think again, as more of them than

ever before are being caught in the act,

and claimed and shamed.