Episode 9 Claimed and Shamed


Episode 9

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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 vehicle.

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..sophisticated data analysis techniques...

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..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 con men, 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 claimant's sickly sham is caught on camera.

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He comes out from seeing the specialist.

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He's unable to stand properly.

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He then walks round to the driver's seat with no apparent injury

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and drives the car away.

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A policyholder frames herself for a false claim with her phoney story.

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The identity of the seller was the same pawnbroking shop

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that the claimant worked in.

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And a cyclist's claim he was hit by a bus runs out of road.

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What you actually see is him hit a drain cover,

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the bike flips rather spectacularly, I might add,

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and then he hits the floor.

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Exaggerating or making up a personal injury claim is quite simply fraud

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and insurance cheats will often go to ridiculous lengths

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to convince the world they're hurt,

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sometimes delivering Oscar-worthy performances.

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But there'll be no awards when insurers catch on to the con.

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With thousands of motor-related whiplash claims

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made every year in the UK,

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insurers pay out millions of pounds in compensation.

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When genuine, it can be a painful and debilitating injury.

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When false, it's just a costly pain in the neck.

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John Beadle is RSA's UK counter-fraud manager

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and has witnessed the act of every blagger,

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charlatan and swindler who's tried to pull a fast one.

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He was asked to investigate what looked like an everyday claim.

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So, this gentleman had a genuine road-traffic accident

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where the driver of the car that we insured ran into the back of him.

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TYRES SCREECH

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Clearly, we admitted liability in this case and he reported

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that he was suffering from severe

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neck and back injuries

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and recurring headaches.

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These alleged injuries had reportedly left the claimant

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in a desperate situation.

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This gentleman said that his normal way of life was severely restricted,

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that he couldn't undertake any normal activity

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and he submitted a claim

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of £400,000,

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which is extremely high for what was

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a relatively straightforward rear-shunt car accident.

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Suspiciously high for what was reportedly a bad case of whiplash.

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And whilst I'm not a medical expert,

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it is very unusual for a straightforward whiplash injury

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to turn into a long-term incapacity, such as was being claimed here.

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In this case, this gentleman's injuries didn't appear

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to be getting any better and indeed to be getting worse

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and that initially aroused some suspicion.

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Well, there was one way RSA could find out

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just how bad the claimant's condition really was.

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So, we put some surveillance on this gentleman

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to enable us to gauge the actual level of incapacity

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that he was suffering from.

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The footage the surveillance team captured

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would prove incredibly revealing.

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Well, this gentleman had severe incapacity to his neck,

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his back and severe headaches.

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So, I would have expected to see his injuries related to how he was -

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difficulty in walking, unable to drive and so forth.

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What John actually saw was a little different.

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And in the first period of surveillance, as you can see,

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there is no apparent incapacity at all

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and he appears to be leading a normal life.

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Yup, looks as though he hasn't got a care in the world.

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It gets interesting when he starts to attend

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the medical specialists.

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As you can see here, where he's in Harley Street,

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and he comes out from seeing the specialist,

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he's unable to stand properly

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and is supporting himself by gripping hold of the railings,

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while he waits for his car to arrive.

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But the claimant would soon drop the act.

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He then slowly makes his way to the car

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and gets into the passenger seat

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and a relatively short distance away,

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the car stops, he gets out of the passenger seat,

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walks round to the driver's seat with no apparent injury

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and drives the car away.

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He may still have a slight limp,

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but it's a far cry from the scene of agony he performed

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just a few yards up the road.

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And he's clearly perfectly able to drive.

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This is absolute blatant exaggeration.

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He's presenting a severe level of incapacity

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to the medical specialists and then carrying on as normal

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as soon as he's away from those premises.

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It still makes me very angry

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that these people are so brazen in their attempts to obtain money,

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which they're clearly not entitled to.

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Caught on camera, the claimant's dash for cash

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was about to take a real blow.

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So, we presented this evidence to the defence solicitors

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and made a greatly reduced offer

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in settlement of the claim,

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aligned to what we would normally expect for a minor whiplash injury.

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So, the claimant was offered a few thousand pounds

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as opposed to the £400,000 he was originally after.

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But anything he received

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would potentially be dwarfed by what he owed.

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We also sent our evidence to the Department of Works and Pensions

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because this gentleman had also been claiming incapacity benefit

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and, no doubt, they would wish to speak to him

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about repaying that amount that they'd advanced him.

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No doubt that'll be an interesting conversation for the claimant.

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And this type of case is a constant scourge for insurers.

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It's difficult when you get people like this

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which clearly are grossly exaggerating the level of injury

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and incapacity which they have

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and are trying to dishonestly obtain almost an obscene sum of money.

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And the consequences of these exaggerated claims

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don't just affect insurance companies.

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These people, if they get away with it,

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are costing us all money because it adds to the cost of insurance

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in the sense of the premium that we all pay for our policies.

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So, it impacts everybody.

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Still to come, some travellers try and extend their trip

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with a case of alleged illness.

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This individual's daughter was supposedly very sick

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and very ill from both ends

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and all he did was contact a doctor on the beach.

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Now, for most of us, our mobile phones

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are part of our everyday lives.

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But their shrinking size and the fact we're constantly

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popping them in and out of our pockets or bags

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means they're prone to getting misplaced.

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Fortunately, there are insurance policies

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to cover us in the event our phones are lost,

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damaged or stolen.

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But as with every other type of insurance,

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not all claims are as straightforward

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as they first appear.

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For many, the modern smartphone barely leaves our side,

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day or night.

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So, if your device gets damaged or lost,

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it can feel like a disaster.

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Thankfully, there are people like Andy Morris

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who could have us selfie-ing again

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before the latest app update is obsolete.

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Assurant had recently replaced one customer's handset

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after a reported phone faux pas.

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This particular claim

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is for a high-end smartphone, a Samsung S7 Edge,

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which has a value of over £630.

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This claimant claimed that she had lost the phone

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while taking a selfie.

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Whoops! The claimant promptly reported the loss,

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revealing the phone wasn't the only thing

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in a bit of a state at the time.

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And even if the claimant could have held a conversation,

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her phone would have allegedly been pretty useless.

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This individual hadn't actually activated the phone

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and had only used it for selfie purposes.

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I mean, we all love a good selfie, but really?

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It seems quite unusual that somebody

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would spend that amount of money on a high-end smartphone

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and not use the telephone or data features that come with it.

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As with any claim,

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Andy's team ran standard usage checks on the claimant's handset,

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which revealed some sobering news.

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During the claims process,

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despite the claimant saying she'd never used it,

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or never registered the device with a network,

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we had evidence that the device was being used to make telephone calls.

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Initially, when we discussed the fact

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that we had usage information with the claimant,

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they stuck to their story.

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Concerned the handset was being used by somebody else,

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the call handler double-checked

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what the phone was being used for by the claimant.

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So, our sloshed selfie-er was adamant

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she hadn't been sending or receiving from the handset.

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But mobile phone data never lies,

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which means that someone had been.

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So, one of the things that our claims team did

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was track down the person who had been using the phone.

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What that demonstrated is that they had bought it,

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purchased this device brand-new and in the box.

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This suggested the claimant hadn't lost her phone

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and was sending all the signals of a false claim.

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When we spoke to the consumer who'd purchased the phone,

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the identity of the seller was the same pawnbroking shop

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that the claimant worked in

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and actually purchased the device from the claimant themselves.

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The call handler begins to quiz the claimant about her employment,

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which isn't well received.

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The evidence the Assurant claims team had

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strongly suggested the claimant was trying to pull a fast one.

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This piece of evidence confirmed to us that it's irrefutable.

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The claimant had sold the device to the user.

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The user had unknowingly and unwittingly purchased the device,

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but then, actually, the claimant was telling us a very different story.

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The call handler continues to question the claimant.

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So, when we presented that evidence,

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our claimant immediately hung up and we rejected the claim.

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The reaction from the claimant spoke volumes.

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On several occasions during this claim,

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we gave the opportunity of the claimant

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of providing additional information.

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Unfortunately, she rejected that opportunity.

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The claimant didn't get a replacement device

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or any monetary gain.

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Now, making the most of an opportunity when it presents itself

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is usually the right thing to do.

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But those who try and milk a situation

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to make bogus insurance claims

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will find their shameless opportunism anything but rewarded.

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FirstGroup operate public bus services across the UK

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and know all too well what happens

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when bikes and buses are vying for the same piece of tarmac.

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Lee Ingram is their fraud manager

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and sees a lot of personal injury cases

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involving these two modes of transport.

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We initially received a report of a claim

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where a bus had come into contact with a cyclist.

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The cyclist had been knocked from his bike

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and subsequently sustained injury and damage to his bicycle.

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Whenever a bus and a cyclist come together,

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it's a potentially fatal accident.

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Luckily, in this case, the claimant wasn't seriously injured.

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The circumstances as told to us were

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that the cyclist was travelling along in the cycle lane

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when a bus has overtaken the cycle and sort of veered towards him,

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causing him to hit the bus and be thrown to the floor.

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This particular claim would have been valued at around about £5,000,

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including legal costs.

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From the sounds of it, the claimant had had a lucky escape.

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Nevertheless, he was still pretty beaten up.

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The cyclist alleged that he'd sustained soft tissue injuries

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to his neck, his elbows, his left ankle and his knees.

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He had to go to A&E.

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Not surprisingly, he had hit the floor rather hard

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after being hit by a bus.

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FirstGroup take all claims extremely seriously

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and this one was treated just like any other.

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So, Lee and his team began to investigate.

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The initial claim that was submitted to us

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gave the claimant's version of events.

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Again, we would go on what he said

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until we had evidence to sort of say otherwise,

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so the next thing to do then is check the CCTV footage,

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which we always do in all cases.

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When we looked at the footage,

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we were expecting to see just a minor coming together of the bus

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and the cyclist and for him to be thrown off of his bike

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and then hit the road.

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But the circumstances were a little different

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to what had been originally described by the claimant.

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What you actually see is him hit a drain cover,

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then he hits the kerb, then he hits the bus,

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the bike flips rather spectacularly, I might add,

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and then he hits the floor.

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So, you can see how he's been injured,

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but the actual liability for that happening

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wasn't down to the bus driver.

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And this cyclist's opportunism

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didn't stop at tight gaps on the road.

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Yeah, he's sort of bent the truth a bit

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to try and fit in with some circumstances

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that may have entitled him to compensation.

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Well, after viewing the footage,

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no amount of bending, exaggerating or embellishing

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would alter Lee's position.

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Once we'd established the true facts of the situation

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by looking at the CCTV footage,

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we quickly sent that off to the claimant's solicitors,

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telling them we were repudiating the claim in full.

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We subsequently received a quite quick response from them

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telling us that they were no longer instructed

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and that their client had withdrawn his claim.

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Lee's stance on picking up the tab

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for other people's mistakes is crystal clear.

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People have a responsibility to look after themselves.

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I see plenty of instances where someone does something very stupid

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and then looks for someone else to blame it on.

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If you think you're entitled to make a claim

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just cos you've failed to take into account a drain cover, on your bike.

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Now, going away is a chance to relax,

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unwind and have a bit of fun.

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Sadly, though, all getaways must come to an end.

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However, there are holiday-makers

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who appear to see their travel insurance policy

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as the answer to extending that holiday feeling

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that little bit longer.

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Sun, sea, adventure, culture, wildlife.

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We all want different things from our great escape.

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But one thing we all need wherever we venture is travel insurance.

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Collinson Group offer a range of travel services

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to help protect holiday-makers, should something go wrong.

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Mathew Crawford-Thomas is their fraud manager

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and an expert at sniffing out spurious claims.

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He was handed one case to investigate

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which appeared to be just bad luck.

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We received a medical expenses claim for £1,400 for cancelled flights

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to return home due to being ill whilst in Goa.

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There's nothing worse than being ill and stuck in a foreign country.

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Due to the remote location,

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it was the policyholder's mum who sounded the alarm.

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The insured's mother rang up the day they were due to fly home.

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She confirmed to us that her son's daughter

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was suffering with severe vomiting and diarrhoea

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and couldn't return home on their due flight.

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It soon became clear that any chance the claimant

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and his allegedly ill daughter had of returning home

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had gone down the pan.

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We offered as much help as they required.

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However, it would appear that the insured

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had already cancelled his flights

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and was prepared to sit this one out.

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But this was far from the first time

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Mat had been presented with this type of case.

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We receive claims from faraway countries.

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Obviously, they're in Goa,

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people eat the food, drink the water.

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Sometimes, they get vomiting and diarrhoea.

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A severe case of this is not only extremely unpleasant,

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but also potentially dangerous without the appropriate treatment,

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which is exactly what first raised Mat's concerns

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after he listened to the call from the claimant.

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We were originally suspicious about the claim

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after listening to the telephone call.

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This individual's daughter was supposedly very sick

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and very ill from both ends

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and all he did was contact a doctor on the beach.

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One would think that you would take your own daughter to a hospital.

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So, the person the claimant sought medical help from on the beach

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was reportedly a qualified doctor.

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After listening to the telephone call from the insured

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directly from Goa, it was farcical.

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I'm a father myself.

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If my daughter was as ill as she was,

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I would have taken her directly to a hospital.

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And when evidence to support the case came in,

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it did nothing to ease Mat's suspicions.

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Once the claim form was received,

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it was received with little or no documentation.

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All we received was one letter from a doctor

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confirming that she was not fit to fly due to sickness and diarrhoea.

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There were no accommodation costs, no medical costs, nothing at all.

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Our next step was to employ the services of our agents in India

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to make contact with the doctor directly.

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This course of action would flush out the real truth

0:22:540:22:57

behind the alleged illness.

0:22:570:22:59

As soon as our agents contacted the doctor,

0:22:590:23:01

the doctor gave up the ghost.

0:23:010:23:03

He apologised profusely over the telephone

0:23:030:23:06

to say that his daughter had come into his facility

0:23:060:23:09

and offered him 500 rupees to write a letter

0:23:090:23:12

to say that they couldn't make their flight.

0:23:120:23:14

So, the doctor confirmed the illness was a complete fabrication

0:23:140:23:18

and offered a full retraction of the not fit to fly note

0:23:180:23:22

he had previously issued to the claimant's daughter.

0:23:220:23:24

We sent a letter to the insured confirming that we'd found out

0:23:240:23:28

that his daughter had in fact paid the beach doctor 500 rupees

0:23:280:23:32

for him to write the letter

0:23:320:23:33

and the fact that we had a letter from the doctor

0:23:330:23:36

retracting that statement and we weren't prepared to pay his claim.

0:23:360:23:39

To date, we've received no response from the insured.

0:23:390:23:42

Now, thanks to the robust approach

0:23:480:23:50

of insurance companies and the government,

0:23:500:23:52

the days of cashing in with a bogus whiplash claim

0:23:520:23:55

are well and truly gone.

0:23:550:23:57

For some insurance cheats, though, the penny hasn't dropped,

0:23:570:24:00

and they continue to try it on in the hope their scam will pay off.

0:24:000:24:05

But, frankly, it's often the carelessness of these chancers

0:24:050:24:08

that enables insurers to catch them out.

0:24:080:24:12

For every motor accident reported in the UK,

0:24:120:24:15

there are 2.7 whiplash claims as a result.

0:24:150:24:19

That is a huge amount of personal injury claims

0:24:190:24:22

insurers like Aviva have to deal with every year.

0:24:220:24:25

Some claims will be completely genuine.

0:24:260:24:30

And the others are referred

0:24:300:24:32

to Aviva's director of casualty claims,

0:24:320:24:34

Richard Hiscocks, to investigate.

0:24:340:24:36

He was handed one case that needed his well-trained eye.

0:24:360:24:41

We heard about this claim when the claimant alleged

0:24:410:24:45

that he'd been injured

0:24:450:24:47

after our customer reversed into him in a petrol forecourt.

0:24:470:24:50

The claimant had a medical report

0:24:500:24:53

that said they had moderate whiplash to the neck and back

0:24:530:24:57

with a prognosis period of nine months.

0:24:570:25:00

A seemingly minor accident,

0:25:000:25:02

but with the alleged injuries worth several thousand pounds,

0:25:020:25:05

the claimant would have to allay some serious concerns

0:25:050:25:08

before he saw any money.

0:25:080:25:11

The claimant said in his claim that he'd begun to feel the pain

0:25:110:25:15

within an hour of the accident happening,

0:25:150:25:18

although he hadn't sought medical attention for two months.

0:25:180:25:21

And that is a little bit suspicious.

0:25:210:25:23

One of the first things that alerted us to the fact

0:25:230:25:26

that maybe not everything was right with this claim.

0:25:260:25:29

That's a long time to wait

0:25:290:25:30

for someone who's stated to be in a significant amount of pain.

0:25:300:25:35

And it appeared the claimant's injuries

0:25:350:25:37

weren't slowing him down at all.

0:25:370:25:40

It was interesting that, on social media,

0:25:410:25:43

the claimant had said that in the three weeks after the incident,

0:25:430:25:47

when he was allegedly seriously injured,

0:25:470:25:50

that he'd worked uninterrupted in his manual job.

0:25:500:25:53

With moderate whiplash, you'd expect some curtailment of normal life,

0:25:530:25:59

so you'd expect some physical activities to be difficult.

0:25:590:26:02

Yeah, that is what you would expect.

0:26:020:26:04

But the claimant was about to see his case lose all momentum,

0:26:040:26:08

unlike him.

0:26:080:26:09

He also put on social media about two months after the incident

0:26:110:26:16

that he'd run in the St Helen's 10K race,

0:26:160:26:18

which you wouldn't necessarily expect he could do at all.

0:26:180:26:22

The claimant may have been a competitive distance runner,

0:26:220:26:25

but his dash for cash was about to end.

0:26:250:26:28

So, we were obviously surprised to find that somebody

0:26:280:26:31

who was so injured was so active,

0:26:310:26:33

which led us to the conclusion that this was a spurious claim

0:26:330:26:38

and we have a duty to defend our customers in those cases,

0:26:380:26:41

so we declined to pay this claim.

0:26:410:26:43

But this guy was determined to get his claim over the finish line.

0:26:430:26:48

After we said we were not going to pay this claim,

0:26:480:26:51

the claimant's solicitors served notice on us

0:26:510:26:55

at which point we provided them with the evidence that we had.

0:26:550:26:58

The claimant's solicitors came off record at that point

0:26:580:27:01

and said they no longer wanted to represent the claimant.

0:27:010:27:03

A telling decision,

0:27:030:27:05

but Aviva were still keen to pursue the claimant

0:27:050:27:08

so the case proceeded to court.

0:27:080:27:11

The judge agreed that the claimant had been fundamentally dishonest,

0:27:110:27:16

which is a really good outcome for us.

0:27:160:27:18

It means that our version of events, and more importantly,

0:27:180:27:21

the version of events of our customer,

0:27:210:27:24

were believed and vindicated.

0:27:240:27:26

And there were certainly no medals on offer

0:27:260:27:28

when the judge made his final ruling.

0:27:280:27:31

We were awarded costs of £9,213,

0:27:310:27:35

so instead of getting compensation

0:27:350:27:38

and making a few thousand pounds out of it,

0:27:380:27:41

he was actually out of pocket by over £9,000.

0:27:410:27:43

From organised criminal gangs to exaggerated household claims,

0:27:500:27:54

insurance fraud hits all of us in the pocket.

0:27:540:27:57

But instead of getting away with it,

0:27:570:27:59

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

0:27:590:28:03

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