0:00:05 > 0:00:09Insurance fraud has reached epidemic levels in the UK.
0:00:09 > 0:00:14It's costing us more than £1.3 billion every year.
0:00:14 > 0:00:17That's almost 3.6 million every day.
0:00:19 > 0:00:25Deliberate crashes, bogus personal injuries, even phantom pets.
0:00:25 > 0:00:29The fraudsters are risking more and more to make a quick killing.
0:00:29 > 0:00:33And, every year, it's adding around £50 to your insurance bill.
0:00:33 > 0:00:35But insurers are fighting back,
0:00:35 > 0:00:39exposing just under 15 fake claims every hour.
0:00:39 > 0:00:42Armed with covert surveillance systems,...
0:00:42 > 0:00:44Subject out of the vehicle.
0:00:44 > 0:00:46..sophisticated data analysis techniques,
0:00:49 > 0:00:51..and a number of highly skilled police units,...
0:00:51 > 0:00:53Police! Stay where you are!
0:00:53 > 0:00:55..they're catching the criminals red-handed.
0:00:55 > 0:00:57Don't lie to us!
0:00:58 > 0:01:01All those conmen, scammers, and cheats on the fiddle
0:01:01 > 0:01:03are now caught in the act and Claimed And Shamed.
0:01:10 > 0:01:13A husband and wife team of fraudsters
0:01:13 > 0:01:15get some unwelcome visitors.
0:01:15 > 0:01:18Police officers. Can you come to the door, please?
0:01:18 > 0:01:20A man has a serious accident
0:01:20 > 0:01:23but finds the whole thing strangely amusing.
0:01:32 > 0:01:35And a personal injury scam is scuppered
0:01:35 > 0:01:37when a claimant mixes up his dates.
0:01:37 > 0:01:41We only had to contact the employers and they were able to give us
0:01:41 > 0:01:44information that completely contradicted
0:01:44 > 0:01:46the employee's version of events.
0:01:50 > 0:01:53Insurance companies are a meticulous lot.
0:01:53 > 0:01:56They will comb through every detail of a claim
0:01:56 > 0:01:59to ensure that everything is as it should be.
0:01:59 > 0:02:01As long as you've done nothing wrong, there's nothing
0:02:01 > 0:02:05to worry about but if you are defrauding your insurance provider,
0:02:05 > 0:02:07it is more than likely that you'll get found out.
0:02:07 > 0:02:10It might not happen right away but, eventually,
0:02:10 > 0:02:13they will find you and come after you.
0:02:14 > 0:02:18Fraud is a crime and the police are getting wise to it.
0:02:18 > 0:02:21When an insurance company detects fraudsters,
0:02:21 > 0:02:23they'll hand them over to IFED.
0:02:24 > 0:02:28In 2012, the Insurance Fraud Enforcement Department was set up.
0:02:28 > 0:02:30They are a dedicated police squad,
0:02:30 > 0:02:33specialising in bringing those committing insurance fraud
0:02:33 > 0:02:35to justice.
0:02:35 > 0:02:38To date, they've convicted over 200 fraudsters.
0:02:40 > 0:02:43Simon Styles is IFED's financial investigator.
0:02:43 > 0:02:47In 2014, he and the team were given a case to investigate
0:02:47 > 0:02:50by a health insurance provider called Simplyhealth.
0:02:51 > 0:02:55They wanted IFED to look into two of their policyholders.
0:02:55 > 0:02:58Mr Rehman Khan and his wife Shagufta.
0:02:58 > 0:03:01Simplyhealth had made some rather startling discoveries
0:03:01 > 0:03:05about what this seemingly ordinary couple were up to.
0:03:05 > 0:03:08The Khans had a joint policy since 2002
0:03:08 > 0:03:11and they made a number of legitimate claims,
0:03:11 > 0:03:14as well as fraudulent claims, over a ten-year period.
0:03:14 > 0:03:18And it was only an internal audit ten years into their policy
0:03:18 > 0:03:22that Simplyhealth realised something was wrong.
0:03:22 > 0:03:25They found that 300 claims had been made on the policy
0:03:25 > 0:03:27over the period of time.
0:03:27 > 0:03:30As a result of the audit and further investigations,
0:03:30 > 0:03:33it was discovered that 245 of those claims were fraudulent.
0:03:33 > 0:03:39These 245 fraudulent claims added up to over £18,000
0:03:39 > 0:03:42that had been handed out to the Khans by Simplyhealth.
0:03:44 > 0:03:47The type of claims that were made by Mr and Mrs Khan,
0:03:47 > 0:03:50over a ten-year period, were low-level claims.
0:03:50 > 0:03:53A claims handler receiving that on their desk
0:03:53 > 0:03:54wouldn't really bat an eyelid.
0:03:54 > 0:03:58Unfortunately, these claims just slipped through the net.
0:03:58 > 0:04:02So, by keeping each individual amount low, often under £100,
0:04:02 > 0:04:06Mr and Mrs Khan's fake claims went unnoticed.
0:04:06 > 0:04:09What's more, some of the health care that the Khans were claiming for
0:04:09 > 0:04:10was genuine.
0:04:10 > 0:04:13There were some 25 different companies
0:04:13 > 0:04:16that have been visited by the Khans..
0:04:16 > 0:04:19They had all said that the Khan family had attended there,
0:04:19 > 0:04:22at some point in the past ten years, but on minimal occasions.
0:04:22 > 0:04:27And not a number of occasions that the Khans had claimed they did.
0:04:27 > 0:04:30IFED suspected that the Khans had been using real invoices
0:04:30 > 0:04:33as templates to produce fake ones.
0:04:33 > 0:04:36They were also pretty sure that the couple weren't going to stop
0:04:36 > 0:04:38putting in more claims any time soon.
0:04:40 > 0:04:43We knew that we quickly had to speak to both Mr and Mrs Khan
0:04:43 > 0:04:46to make sure that we would stop any more fraudulent activity
0:04:46 > 0:04:51because the level and period of time and number of claims,
0:04:51 > 0:04:55we knew that they would continue their criminal activity.
0:04:55 > 0:04:59IFED needed to act fast to stop the Khans
0:04:59 > 0:05:00but they needed hard evidence
0:05:00 > 0:05:02to prove that the couple had been committing fraud.
0:05:02 > 0:05:06And the only way to get this was to raid the Khans' home.
0:05:09 > 0:05:156.30 AM, Simon, along with Detective Sergeant Tom Hill are on the move.
0:05:15 > 0:05:20We're going to arrest two members of the same family
0:05:20 > 0:05:24who have been committing health insurance fraud
0:05:24 > 0:05:26over a ten-year period.
0:05:26 > 0:05:31By submitting fake, or altered, invoices for medical care.
0:05:31 > 0:05:34From various hospitals and
0:05:34 > 0:05:37other, sort of, health care providers.
0:05:38 > 0:05:43Mr and Mrs Khan have no idea that a police unit is closing in
0:05:43 > 0:05:45and officers hope that, by raiding early in the morning,
0:05:45 > 0:05:48they've got more chance of them being in
0:05:48 > 0:05:51and the IFED officers are out in force.
0:05:51 > 0:05:54There's another team going to another address
0:05:54 > 0:05:57and it will be a simultaneous arrest, if all goes to plan.
0:05:58 > 0:06:02As with any raid, the police never know how suspects will react
0:06:02 > 0:06:04and are trained to be vigilant.
0:06:05 > 0:06:08It's just a question of securing entry,
0:06:08 > 0:06:11in the first case, and making sure the premises is secure
0:06:11 > 0:06:15and all the people inside are accounted for, for our own safety.
0:06:16 > 0:06:19A few miles away, the second IFED team has arrived
0:06:19 > 0:06:22at the address of the other suspect.
0:06:22 > 0:06:25With raids like this, speed and surprise are everything.
0:06:30 > 0:06:32Once alerted, suspects may wake a run for it.
0:06:32 > 0:06:34So, with the exits covered,
0:06:34 > 0:06:37the occupants of both houses are given a rude awakening.
0:06:37 > 0:06:40Police officers. Can you come to the door, please?
0:06:45 > 0:06:46Good morning.
0:06:46 > 0:06:49Detective Inspector Ben Flanagan from the City of London Police.
0:06:49 > 0:06:51- Are you Rehman Khan?- Yeah. - Do you mind if we come in?
0:06:51 > 0:06:54I'll speak to you. I'll tell you what's happening. OK?
0:06:54 > 0:06:58- Who else is in the house?- My wife. - Your wife. Well, get them down.
0:06:58 > 0:07:01- Are they upstairs?- Yeah. - And I'll speak to you all at once.
0:07:01 > 0:07:03- They're going to have to wake up. - Police.
0:07:03 > 0:07:06The police are in luck, both Rehman and Shagufta are in.
0:07:06 > 0:07:09Would you like to take a seat? I'll explain exactly what's happening.
0:07:09 > 0:07:11Yeah, sure.
0:07:12 > 0:07:15OK. We're detectives from the City of London Police.
0:07:15 > 0:07:18Insurance Fraud Enforcement Department.
0:07:18 > 0:07:21We've received an allegation from an insurance company,
0:07:21 > 0:07:24a crime has been reported to us of fraud,
0:07:24 > 0:07:27against Simplyhealth insurance
0:07:27 > 0:07:29OK?
0:07:29 > 0:07:32So, because of that allegation, I'm going to arrest you, OK?
0:07:32 > 0:07:34On suspicion of conspiracy to defraud.
0:07:34 > 0:07:36You do not have to say anything but it may harm your defence
0:07:36 > 0:07:38if you do not mention, when questioned,
0:07:38 > 0:07:40something which you later rely on in court.
0:07:40 > 0:07:42Anything you do say may be given evidence.
0:07:42 > 0:07:46So we can search the premises. We can interview you.
0:07:48 > 0:07:50And, then, we'll take it from there.
0:07:50 > 0:07:54Understandably shocked, Mr Khan claims that he's heard nothing
0:07:54 > 0:07:56about this from his insurance company.
0:07:56 > 0:07:59I'm ready to sort this out if there is a problem,
0:07:59 > 0:08:02- but they should talk to me first. - OK.
0:08:02 > 0:08:05Well, they say they have and there is a problem
0:08:05 > 0:08:07and it's been reported as a crime,
0:08:07 > 0:08:09so I'm going to deal with it now, as a police officer. OK?
0:08:09 > 0:08:12The case is now in the hands of IFED,
0:08:12 > 0:08:16which means the investigation will be run by its rules.
0:08:16 > 0:08:18To see if the Khans are willing to cooperate,
0:08:18 > 0:08:23Simon asks them to help him to locate any potential evidence.
0:08:23 > 0:08:25As I say, we're going to search your whole house.
0:08:25 > 0:08:28It simplifies it, if you can tell us where any documentation
0:08:28 > 0:08:33in relation to any claims that you may have made are.
0:08:33 > 0:08:37Is there anything down here? Or is it all upstairs? No. It's upstairs.
0:08:37 > 0:08:40Whenever I go on searches, such as these, I always ask
0:08:40 > 0:08:43the occupant, as I did with Mr Khan, where the documentation was.
0:08:43 > 0:08:48He indicated various sideboards and cupboards and things
0:08:48 > 0:08:49around the building,
0:08:49 > 0:08:52but it gives you an idea but you never take that for granted.
0:08:52 > 0:08:54You've always got to search everything
0:08:54 > 0:08:57where you suspect it may be because, unfortunately, criminals do lie.
0:08:57 > 0:09:01So, the team embark on a systematic search of the entire property.
0:09:01 > 0:09:05We're looking for computer equipment
0:09:05 > 0:09:07which may have been used to manufacture
0:09:07 > 0:09:09fraudulent receipts and invoices.
0:09:09 > 0:09:12We're looking for paperwork in relation to these insurance claims
0:09:12 > 0:09:15that are believed to be fraudulent.
0:09:15 > 0:09:17They soon find a number of memory sticks and laptops
0:09:17 > 0:09:20which may have vital information stored on them.
0:09:20 > 0:09:23Everything is bagged up and labelled,
0:09:23 > 0:09:26ready to be taken away and examined by IFED's investigators.
0:09:29 > 0:09:33But it was a seemingly unassuming file that no-one was looking for
0:09:33 > 0:09:35that was to be crucial in cracking the case.
0:09:35 > 0:09:39Tucked away in one of the Khans' cupboards
0:09:39 > 0:09:43were several ink stamps and one had the word PAID on it.
0:09:45 > 0:09:47We'll have that.
0:09:47 > 0:09:48You never know what you're going to find
0:09:48 > 0:09:50when you go through the front door.
0:09:50 > 0:09:53You'd love to find little pieces of nuggets that you use
0:09:53 > 0:09:55that's going to assist in your prosecution.
0:09:55 > 0:09:58Having a stamp with the word PAID on it,
0:09:58 > 0:10:01which was exactly the one we believed was used
0:10:01 > 0:10:05in the fraudulent invoices, where successful claims have been made,
0:10:05 > 0:10:07finding something like that was immensely useful
0:10:07 > 0:10:11and it's very satisfying when you find something like that.
0:10:11 > 0:10:14The police search was proving to be a great success.
0:10:14 > 0:10:17Simon turned his attention to the Khans' bank statements
0:10:17 > 0:10:18found at their house.
0:10:18 > 0:10:22Part of my job as a financial investigator is to establish what
0:10:22 > 0:10:26bank accounts people have, but also to see what lifestyle they've got.
0:10:26 > 0:10:29What it does show is that there's an income into the accounts
0:10:29 > 0:10:32far in excess of what they could have legitimately have earned.
0:10:32 > 0:10:35All the time, I'm totting it up to see their outgoings
0:10:35 > 0:10:41and the incoming. And does it make sense, or is there a gap?
0:10:41 > 0:10:44Which would possibly suggest that they're living
0:10:44 > 0:10:48from the proceeds of criminal activity.
0:10:49 > 0:10:51As the search continues,
0:10:51 > 0:10:55Simon finds yet more of the Khans' financial paperwork to investigate.
0:10:55 > 0:10:59Just shown that this individual was on disability living allowance
0:10:59 > 0:11:02and, therefore, is not working.
0:11:02 > 0:11:08It was interesting to come across an instant access ISA.
0:11:08 > 0:11:10There's a number of credits into the account,
0:11:10 > 0:11:13over the last three or four years.
0:11:13 > 0:11:16The latest credit was in May of last year of £2,000,
0:11:16 > 0:11:20which shows the current balance is just over £4,000.
0:11:20 > 0:11:22Which is interesting.
0:11:22 > 0:11:25Something that I'll certainly put to her later in interview.
0:11:25 > 0:11:30As to how she's able to accumulate £4,000 in an ISA.
0:11:30 > 0:11:35More in-depth investigations reveal what Simon had suspected.
0:11:35 > 0:11:39The unaccounted money found in the Khans many bank accounts
0:11:39 > 0:11:42matched the exact amount that had been paid out
0:11:42 > 0:11:45by Simplyhealth from the fraudulent claims.
0:11:45 > 0:11:48Simplyhealth paid out £18,000
0:11:48 > 0:11:50and I found that the bank accounts
0:11:51 > 0:11:55relating to the Khans had received £18,500.
0:11:55 > 0:11:59So, this put the Khans right in the middle of this fraud.
0:11:59 > 0:12:03With the raid at the Khans' house nearly complete,
0:12:03 > 0:12:04at the other address,
0:12:04 > 0:12:08the officers have found something which they believe could be vital.
0:12:08 > 0:12:11IFED's Ben Flanagan calls to give the news.
0:12:11 > 0:12:15We found details of a safety deposit box here.
0:12:16 > 0:12:19So I'm thinking that there may well be documents
0:12:19 > 0:12:22relating to this offence, or cash from it,
0:12:22 > 0:12:24in the box.
0:12:26 > 0:12:29With the searches at both properties over, Mr and Mrs Khan
0:12:29 > 0:12:32along with the evidence seized are taken back to the station.
0:12:33 > 0:12:36But the most important thing now
0:12:36 > 0:12:39is that IFED gets its hands on the safety deposit box,
0:12:39 > 0:12:42which could contain important evidence.
0:12:42 > 0:12:44Still to come....
0:12:44 > 0:12:46IFED hit the jackpot.
0:12:46 > 0:12:50You can see, it would appear that we've got items of jewellery.
0:12:51 > 0:12:53We'll be seizing all of this.
0:12:53 > 0:12:57And Esure deal with a particularly hapless driver.
0:12:57 > 0:13:02It was simply inconceivable that one individual could be so unlucky
0:13:02 > 0:13:07to be involved in five separate road traffic accidents in 10 months.
0:13:11 > 0:13:14Now, when it comes to submitting an insurance claim,
0:13:14 > 0:13:17it's our responsibility to give an honest account of the details
0:13:17 > 0:13:19surrounding the claim,
0:13:19 > 0:13:22as failure to do so is quite simply fraud.
0:13:22 > 0:13:23However, for some people,
0:13:23 > 0:13:27the temptation of getting their hands on a hefty pay-out
0:13:27 > 0:13:30can be enough to make them exaggerate, overstate,
0:13:30 > 0:13:31or even downright lie.
0:13:33 > 0:13:36The team at i-Cog claims management are highly trained
0:13:36 > 0:13:39to tell the difference between people who are making up a story
0:13:39 > 0:13:41and those who are telling the truth,
0:13:41 > 0:13:44as CEO Tara Shelton explains.
0:13:45 > 0:13:47What is often missed to the untrained ear
0:13:47 > 0:13:52is that when someone's actually under a position of stress
0:13:52 > 0:13:53the heart beats faster.
0:13:53 > 0:13:57Breathing changes. Voice pitch changes.
0:13:57 > 0:14:02That's the level of detail that we actually listen at.
0:14:02 > 0:14:04This unique skill set enables the team to identify
0:14:04 > 0:14:08suspicious claims that might otherwise be undetected.
0:14:11 > 0:14:14Operations manager Kayleigh Farrell recalls
0:14:14 > 0:14:18a recent case involving a man who'd had a nasty car accident.
0:14:18 > 0:14:23So, the policyholder was driving along a main country road
0:14:23 > 0:14:26when he approached the corner, he lost control of his vehicle
0:14:26 > 0:14:29and collided with a telegraph pole
0:14:29 > 0:14:32and that had flipped his car into a nearby field.
0:14:32 > 0:14:34This had caused the vehicle to be a total loss,
0:14:34 > 0:14:38which resulted in £11,000 worth of claim.
0:14:38 > 0:14:40A terrifying incident.
0:14:40 > 0:14:43And quite possible to lose control for just a split second
0:14:43 > 0:14:45on a dark country road.
0:14:45 > 0:14:48However, something about the story had raised alarm bells
0:14:48 > 0:14:51with the driver's own insurance company,
0:14:51 > 0:14:53so they enlisted the expertise of i-Cog.
0:14:53 > 0:14:56The i-Cog call handler wanted to hear the driver explain
0:14:56 > 0:15:00the detail of his ordeal in his own words.
0:15:46 > 0:15:52The driver was claiming his memories of the whole incident were a blur.
0:15:52 > 0:15:55All he remembered was trying to turn his headlights to full beam
0:15:55 > 0:15:58but his car was plunged into darkness
0:15:58 > 0:16:00and he careered off the road.
0:16:13 > 0:16:14To start off the conversation,
0:16:14 > 0:16:17the handler just simply asked the claimant what exactly had happened.
0:16:17 > 0:16:20However, he provided an extremely vague account
0:16:20 > 0:16:23of what seemed to be quite a traumatic incident,
0:16:23 > 0:16:25involving the vehicle itself.
0:16:25 > 0:16:29In my experience, there would be a full account of exactly what
0:16:29 > 0:16:33had happened, they'd be able to provide much information,
0:16:33 > 0:16:36of exactly what they'd seen, exactly what they'd heard,
0:16:36 > 0:16:40and even down to what they'd smelled during the collision of the vehicle.
0:17:03 > 0:17:06The team at i-Cog regularly speak to people
0:17:06 > 0:17:08who've had traumatic experiences.
0:17:08 > 0:17:12But there was something about this man's account that jumped out.
0:17:12 > 0:17:15The claimant appeared to have absolutely no emotion,
0:17:15 > 0:17:18regarding the collision itself.
0:17:18 > 0:17:21You know, he showed absolutely no fear of what had happened.
0:17:21 > 0:17:23It wasn't traumatic to him.
0:17:23 > 0:17:26You know, he'd rolled his vehicle, it had been a complete loss
0:17:26 > 0:17:28and, yet, he had no emotion whatsoever
0:17:28 > 0:17:31when he was informing us of what had happened.
0:18:05 > 0:18:09The claimant's behaviour throughout the account was inappropriate.
0:18:09 > 0:18:10He was laughing on many occasions
0:18:10 > 0:18:13where it didn't seem to be necessary to laugh.
0:18:13 > 0:18:17If I'd been driving a car, crashed into a telegraph pole,
0:18:17 > 0:18:19been flipped over and landed upside down,
0:18:19 > 0:18:22I know I wouldn't be laughing about it.
0:18:22 > 0:18:25Even if I'd lost my memory, as this guy was claiming he had,
0:18:25 > 0:18:28I would still feel totally traumatised.
0:18:28 > 0:18:30As I'm sure you probably would too.
0:18:30 > 0:18:32Yet, this man seemed to be showing no real emotion
0:18:32 > 0:18:35about his ordeal at all.
0:19:29 > 0:19:33The i-Cog operator had been paying close attention to every word
0:19:33 > 0:19:36of the account the claimant was giving.
0:19:36 > 0:19:39They'd noticed one important inconsistency.
0:19:39 > 0:19:42His mobile phone, that he said had gone missing,
0:19:42 > 0:19:46mysteriously reappeared later on in the story.
0:20:41 > 0:20:44When the handler informed the claimant that, in fact,
0:20:44 > 0:20:46his account did not make any sense
0:20:46 > 0:20:48he also agreed with her that it didn't.
0:20:48 > 0:20:50That is highly concerning,
0:20:50 > 0:20:54as to why the claimant would think his account didn't make any sense.
0:20:54 > 0:20:56And that is why we also believe it was fabricated.
0:21:18 > 0:21:20The i-Cog operator had given the caller every opportunity
0:21:20 > 0:21:25to provide some concrete facts but there were none forthcoming.
0:21:25 > 0:21:28For us, after leaving the conversation,
0:21:28 > 0:21:31it was quite clear in our discussions that the claimant
0:21:31 > 0:21:34may not have actually been involved in the collision at all.
0:21:34 > 0:21:37Or, if he was, he may have been drinking alcohol
0:21:37 > 0:21:40and, clearly, departed the scene for that reason.
0:21:44 > 0:21:47The lack of detail provided by the caller meant that Kayleigh
0:21:47 > 0:21:50and her team felt it necessary to recommend to the insurance
0:21:50 > 0:21:55company to investigate further before paying out a penny.
0:21:55 > 0:21:58The claim is now with the fraud department of the insurance
0:21:58 > 0:22:01company and is being further investigated with the police.
0:22:01 > 0:22:03For the team at i-Cog,
0:22:03 > 0:22:06cases of potential insurance fraud are never a joke.
0:22:11 > 0:22:15For some, the workplace can be a precarious environment.
0:22:15 > 0:22:18If you're unlucky enough to have an accident that could have been
0:22:18 > 0:22:22prevented by your employer, you can seek fair compensation.
0:22:22 > 0:22:25However, this protection is sometimes exploited by those
0:22:25 > 0:22:27who are prepared to exaggerate injuries
0:22:27 > 0:22:31or even make them up in the hope of cashing in.
0:22:32 > 0:22:35Unfortunately, no amount of health and safety
0:22:35 > 0:22:38can make an environment completely risk-free.
0:22:38 > 0:22:42Mihir Pandya is Allianz's counter-fraud manager
0:22:42 > 0:22:46and an expert at sniffing out the bona fide claims from the bogus.
0:22:46 > 0:22:50He was given one seemingly everyday case to investigate.
0:22:50 > 0:22:56This claim first came to light when we received a claim for
0:22:56 > 0:22:59personal injury from one of our customer's employees.
0:22:59 > 0:23:02Our customer owned a petrol station.
0:23:02 > 0:23:05The reserve that we had for the claim,
0:23:05 > 0:23:09on receiving the circumstances, was set at £50,000.
0:23:09 > 0:23:12That's a whopping claim total.
0:23:12 > 0:23:15You'd expect the claimant to have suffered some serious injuries.
0:23:15 > 0:23:20The employee alleged that he had injured his wrist
0:23:20 > 0:23:24when moving a delivery of cartons which were covered in ice.
0:23:24 > 0:23:29His version of the events was that whilst moving the delivery of
0:23:29 > 0:23:33cartons, the cartons slipped, he tried to catch the cartons,
0:23:33 > 0:23:36and being covered in ice, that's when they injured his wrist.
0:23:36 > 0:23:39It sounded like an unfortunate accident,
0:23:39 > 0:23:42but the claimant also proved to be rather slippery.
0:23:42 > 0:23:47It became apparent really early on that this was actually quite
0:23:47 > 0:23:50an amateurish attempt at committing fraud.
0:23:50 > 0:23:54We only had to contact the employers and they were able to give us
0:23:54 > 0:23:57information that completely contradicted
0:23:57 > 0:23:59the employee's version of events.
0:23:59 > 0:24:02He must've been suffering with brain freeze well,
0:24:02 > 0:24:05as the claimants timings were a little off.
0:24:05 > 0:24:11The information that the employer provided us was that the employee
0:24:11 > 0:24:15didn't start his shift till 11pm.
0:24:15 > 0:24:19And delivery would have been made in the afternoon and would have
0:24:19 > 0:24:23been dealt with in the afternoon by another employee.
0:24:23 > 0:24:26Yeah, the claimant really should have picked a day
0:24:26 > 0:24:30he was actually working, just to make his story more convincing.
0:24:30 > 0:24:33In our opinion, there was no way that the employee suffered the
0:24:33 > 0:24:35injury that he was claiming for.
0:24:35 > 0:24:39It was very clear from the information that we had that
0:24:39 > 0:24:41this injury just didn't occur.
0:24:41 > 0:24:47Yet the claimant continued to insist that the injury had occurred
0:24:47 > 0:24:50and he decided to take us to court.
0:24:50 > 0:24:54A very bold, some might say foolish move by the claimant,
0:24:54 > 0:24:56given the evidence against him.
0:24:56 > 0:24:59But Allianz were willing to go all the way.
0:24:59 > 0:25:02We were very surprised that he took this course of action,
0:25:02 > 0:25:08but, in our minds, we were confident that we would win this in court.
0:25:10 > 0:25:11During the court hearing,
0:25:11 > 0:25:16we were able to present to the court the number of inconsistencies,
0:25:16 > 0:25:20the information and the evidence that we had.
0:25:20 > 0:25:22And, halfway through the hearing,
0:25:22 > 0:25:27the claimant suddenly decided that he needed an interpreter.
0:25:27 > 0:25:31Which, for us, was the first time that we discovered that
0:25:31 > 0:25:35he had issues with speaking English.
0:25:35 > 0:25:40The claimant had previously managed to communicate perfectly well.
0:25:40 > 0:25:44His sudden loss of the lingo was rather convenient.
0:25:44 > 0:25:48The claimant didn't fare at all well during the hearing
0:25:48 > 0:25:52and his credibility was seriously undermined.
0:25:52 > 0:25:56For example, he had put forward details of a witness that had
0:25:56 > 0:26:00apparently seen the accident occur and he didn't turn up.
0:26:00 > 0:26:04And also, the employer had very, very good records
0:26:04 > 0:26:06with regards to the day in question,
0:26:06 > 0:26:10which also undermined the claimant's version of events.
0:26:10 > 0:26:14But the claimant's silence wouldn't help his cause.
0:26:14 > 0:26:17Ultimately, the claimant lost this in court.
0:26:17 > 0:26:20And not only were we not required
0:26:20 > 0:26:23to pay anything towards the alleged injury,
0:26:23 > 0:26:28the claimant himself was ordered to pay over 12,000 back in costs.
0:26:29 > 0:26:32So, instead of receiving a tidy pay-out he didn't deserve, the
0:26:32 > 0:26:36claimant received a large bill of court costs and a slap on the wrist.
0:26:37 > 0:26:42This was a very cynical and opportunistic attempt by the claimant.
0:26:42 > 0:26:45But the fact that we wouldn't roll over and we were prepared to
0:26:45 > 0:26:50go all the way into court to deal with this really does demonstrate
0:26:50 > 0:26:53that we will protect our honest policyholders
0:26:53 > 0:26:56by making sure we do not pay out fraudulent claims.
0:27:03 > 0:27:04Coming up...
0:27:04 > 0:27:08Some revealing CCTV footage proves to be comedy gold.
0:27:09 > 0:27:12He's pacing around. He's very agitated.
0:27:12 > 0:27:14I watched this back at triple speed
0:27:14 > 0:27:17and I could hear the Benny Hill music playing in the background.
0:27:21 > 0:27:25Now, if you drive, then you have to have car insurance.
0:27:25 > 0:27:27it is simply not an option.
0:27:27 > 0:27:30And if you're unlucky enough to have an accident that is undisputedly
0:27:30 > 0:27:34your fault, it becomes clear why car insurance is so essential.
0:27:34 > 0:27:38Especially if you've caused a lot of damage to another car
0:27:38 > 0:27:41and, even worse, caused injuries to other people.
0:27:42 > 0:27:47This exact scenario happened to a man who'd had his car insured with esure.
0:27:47 > 0:27:51For argument's sake, let's call him Mr A.
0:27:51 > 0:27:54Mr A had driven into the back of someone at a set of traffic lights
0:27:54 > 0:27:58and conscientiously called his insurers to report the accident.
0:28:19 > 0:28:22The case was referred to a specialist insurance law firm,
0:28:22 > 0:28:23Horwich Farrelly.
0:28:23 > 0:28:27On the face of it, this was a run-of-the-mill road traffic
0:28:27 > 0:28:30accident that esure see all too frequently.
0:28:30 > 0:28:33The policyholder of esure was wholly at fault.
0:28:33 > 0:28:36That policyholder freely admitted liability.
0:28:38 > 0:28:40A seemingly honest customer,
0:28:40 > 0:28:43but then it's hard to make out an accident isn't your fault
0:28:43 > 0:28:46when you've driven into a stationary vehicle.
0:28:46 > 0:28:51Unfortunately for Mr A, the car he'd crashed into was full of people.
0:29:06 > 0:29:10There were four people in the other car and all of them claimed
0:29:10 > 0:29:13to have been injured and wanted compensation.
0:29:13 > 0:29:16The first request to come in was from the driver.
0:29:16 > 0:29:18This was a claim for personal injury,
0:29:18 > 0:29:22valued at approximately £4,000,
0:29:22 > 0:29:26as well as a claim for vehicle damage in the sum of 4,250.
0:29:26 > 0:29:30This wasn't an unusually high amount for such a crash,
0:29:30 > 0:29:33but something Mr A had said on that initial phone call
0:29:33 > 0:29:35had immediately raised suspicions.
0:29:42 > 0:29:45Esure felt it was highly unlikely for a crash like this
0:29:45 > 0:29:48to have been reported just minutes after impact.
0:29:48 > 0:29:51Surely the five people involved would have got out,
0:29:51 > 0:29:54exchanged details, made sure no-one was seriously injured
0:29:54 > 0:29:57and pulled in somewhere safe before making a call.
0:29:57 > 0:30:00They decided to investigate Mr A further
0:30:00 > 0:30:03and were shocked at their findings.
0:30:03 > 0:30:05Just two weeks earlier, he had put in
0:30:05 > 0:30:09a claim for another accident that he also said was his fault.
0:30:12 > 0:30:14Whilst this claim was being investigated,
0:30:14 > 0:30:18a third and further claim was intimated against esure,
0:30:18 > 0:30:22with the policyholder once again freely admitting fault.
0:30:22 > 0:30:26So, Mr A had been in three accidents that he admitted
0:30:26 > 0:30:30were his fault in the space of just eight weeks.
0:30:30 > 0:30:32And all had injured several people.
0:30:32 > 0:30:34Either he was a terrible driver
0:30:34 > 0:30:37or something more sinister was going on.
0:30:37 > 0:30:40Esure carefully monitored Mr A for nearly a year,
0:30:40 > 0:30:45and in that time, he was involved in a total of five claims.
0:30:45 > 0:30:50It was simply inconceivable that one individual could be so unlucky
0:30:50 > 0:30:55to be involved in five separate road traffic accidents in ten months.
0:30:55 > 0:30:57So what was going on?
0:30:57 > 0:31:01Well, Ronan and his team had a good idea.
0:31:01 > 0:31:03The policyholder had been offering inducements
0:31:03 > 0:31:06to stage road traffic accidents.
0:31:06 > 0:31:10He had accepted a policy with esure and had staged a number of
0:31:10 > 0:31:12different road traffic accidents
0:31:12 > 0:31:15as well as another with a different insurer.
0:31:15 > 0:31:18So, with five separate collisions in ten months,
0:31:18 > 0:31:22esure and Horwich Farrelly suspected that Mr A had been paying people
0:31:22 > 0:31:25to take part in deliberate car accidents.
0:31:25 > 0:31:29In this case, they think Mr A paid the other driver to agree to
0:31:29 > 0:31:32being crashed into so that he could put in a claim for thousands from
0:31:32 > 0:31:34Mr A's insurance company.
0:31:34 > 0:31:37It was believed that if esure had paid out,
0:31:37 > 0:31:40Mr A would get a large cut.
0:31:40 > 0:31:46Esure refused to pay out the £8,250, but the driver, perhaps under
0:31:46 > 0:31:51pressure from Mr A, was insistent, and he took esure to court.
0:31:51 > 0:31:54The driver of the vehicle Mr A had crashed into
0:31:54 > 0:31:57found himself in front of a judge.
0:31:57 > 0:32:01At trial, the claimant was cross-examined thoroughly by a barrister.
0:32:01 > 0:32:06His evidence was completely undermined and began to unravel.
0:32:06 > 0:32:10The claimant gave evidence as to his route on the day of the accident.
0:32:10 > 0:32:13He had suggested he was going from a shopping centre to his own house.
0:32:13 > 0:32:17The judge, knowing the area well, was able to identify,
0:32:17 > 0:32:19after hearing our evidence,
0:32:19 > 0:32:22that this route was extremely unlikely and would have taken
0:32:22 > 0:32:26the claimant away from the route that he should have been travelling.
0:32:26 > 0:32:28There were other inconsistencies
0:32:28 > 0:32:30in the driver's account of the accident.
0:32:30 > 0:32:33And, for the judge, the case was clear-cut.
0:32:33 > 0:32:37The judge found that this claim was fundamentally dishonest,
0:32:37 > 0:32:41that the claimant changed his case to suit his needs,
0:32:41 > 0:32:45and the case was riddled with inconsistencies.
0:32:45 > 0:32:49There was no way that the judge believed any aspects of the claim
0:32:49 > 0:32:51that was pursued.
0:32:51 > 0:32:54The driver of the car didn't receive a penny
0:32:54 > 0:32:57of the £8,250 he was claiming.
0:32:57 > 0:32:59But the judge went further,
0:32:59 > 0:33:02ordering him to pay £13,000 to esure
0:33:02 > 0:33:04to cover their costs.
0:33:04 > 0:33:07In my view, this is the worst type of fraud.
0:33:07 > 0:33:13This is not opportunistic, but completely staged and planned
0:33:13 > 0:33:17road traffic accident fraud, something that has been
0:33:17 > 0:33:20a blight of the insurance industry for many years.
0:33:24 > 0:33:28OK, let's return to North London now, where Ifed are continuing
0:33:28 > 0:33:31to search the home of Rehman and Shagufta Khan,
0:33:31 > 0:33:37who are suspected of making no less than 245 fraudulent health insurance claims.
0:33:37 > 0:33:41So far, officers have seized several items, including laptops and
0:33:41 > 0:33:44memory sticks, which could all be key in proving the Khans' guilt.
0:33:44 > 0:33:48Crucially, they also found a rubber stamp that they believe
0:33:48 > 0:33:52was being used by the Khans to make their fake invoices look real.
0:33:53 > 0:33:55We have a "paid" one.
0:33:55 > 0:33:59- Can have that. You got a bag with you?- Yeah.
0:33:59 > 0:34:02So I'm going to seize them as evidence of the offence.
0:34:02 > 0:34:04The operation's gone well.
0:34:04 > 0:34:07But there's still more work to be done, as the team that raided
0:34:07 > 0:34:10the other property made an interesting discovery that
0:34:10 > 0:34:11needs to be investigated.
0:34:11 > 0:34:15We've found details of a safety deposit box here.
0:34:16 > 0:34:20The Khans are being taken to the police station for questioning.
0:34:20 > 0:34:22After obtaining a warrant,
0:34:22 > 0:34:25another team head off to check out the deposit box.
0:34:28 > 0:34:31Traditionally, items of high value are stored in these boxes,
0:34:31 > 0:34:36so the Ifed team are keen to discover exactly what's inside.
0:34:36 > 0:34:40It would appear that we've got items of jewellery.
0:34:41 > 0:34:45Little ingots here, look. Fine gold, 10g. Ten-gram ingots, look.
0:34:45 > 0:34:47We will be seizing all of this.
0:34:47 > 0:34:51The box is packed full of items which look to be very valuable
0:34:51 > 0:34:56and could be vital evidence in the investigation against Mr and Mrs Khan.
0:34:56 > 0:34:59This haul could be worth a fortune.
0:34:59 > 0:35:00Until we get that appraised,
0:35:00 > 0:35:03we're not going to know exactly what the value of that is.
0:35:03 > 0:35:05But it will be very interesting because, obviously,
0:35:05 > 0:35:09they're going to have to account for those items.
0:35:09 > 0:35:12And they're going to have to prove to us that those items were obtained
0:35:12 > 0:35:15legitimately and not as the result of any criminal activity.
0:35:15 > 0:35:18Unfortunately, the Khans were unwilling to assist the police
0:35:18 > 0:35:21in their investigations, as Simon Styles recalls.
0:35:23 > 0:35:25Both Mr and Mrs Khan were arrested and taken to
0:35:25 > 0:35:28a local police station, where they were later interviewed.
0:35:28 > 0:35:31They gave various different accounts of it,
0:35:31 > 0:35:34but no admissions relating to what they had actually done.
0:35:34 > 0:35:38Apart from setting up adjustment policies and making claims.
0:35:38 > 0:35:41But they were in denial and, unfortunately,
0:35:41 > 0:35:45it meant that we were doing a lot more work than we needed to do.
0:35:47 > 0:35:51Two years later, and it's the day Simon Styles and his team
0:35:51 > 0:35:54have been waiting for - the Khans are at the Old Bailey.
0:35:54 > 0:35:57To get to today, the day of sentencing,
0:35:57 > 0:36:01has meant that a lot of hard work has been undertaken by Ifed.
0:36:01 > 0:36:04These individuals were arrested in January, 2014,
0:36:04 > 0:36:08so it's taken over two years to get where we are.
0:36:08 > 0:36:12The investigation was much bigger and lengthier due to
0:36:12 > 0:36:14Shagufta and Rehmen Khan saying "no comment"
0:36:14 > 0:36:17in two interviews that took place post-arrest.
0:36:18 > 0:36:23There was 25 individual companies that had to be spoken to
0:36:23 > 0:36:25and statements taken from them.
0:36:25 > 0:36:28I looked at maybe ten or 11 bank accounts belonging to the
0:36:28 > 0:36:31Khan family to see where the money had gone to.
0:36:31 > 0:36:32So it was an extensive investigation
0:36:32 > 0:36:36and a lot of painstaking work went into it.
0:36:36 > 0:36:39But this hard work paid off.
0:36:39 > 0:36:42The haul of jewellery found in the safety deposit box
0:36:42 > 0:36:44proved to be a red herring.
0:36:44 > 0:36:47However, the evidence the team found during the raids and the
0:36:47 > 0:36:52strength of the case Ifed put together against Rehman and Shagufta Khan was overwhelming,
0:36:52 > 0:36:55and the couple did eventually admit their guilt.
0:36:55 > 0:36:59I've just come out from the Central Criminal Court, Court 2,
0:36:59 > 0:37:02where Rehman and Shagufta Khan
0:37:02 > 0:37:04were given 12 months' prison sentence.
0:37:04 > 0:37:08The judge said because of the length of time that they'd actually
0:37:08 > 0:37:11committed these offences, which was over ten-year period,
0:37:11 > 0:37:15and nearly £19,000 they stole, the judge said he had no choice
0:37:15 > 0:37:17but to give them a period of imprisonment.
0:37:17 > 0:37:21There's one final bizarre twist to this tale.
0:37:21 > 0:37:25The Khans obviously thought that if they were to pay most of the money back,
0:37:25 > 0:37:26the judge would go easy on them.
0:37:26 > 0:37:27He didn't.
0:37:27 > 0:37:31But the couple had already handed Simon a large wad of cash.
0:37:31 > 0:37:33It is very, very unusual.
0:37:33 > 0:37:35I've never seen that before and never heard of it happening.
0:37:35 > 0:37:40It's £15,000. I'm leaving here now to bank it and that goes back to the victim of crime.
0:37:40 > 0:37:42And that is great news.
0:37:42 > 0:37:45An excellent result.
0:37:45 > 0:37:49Simplyhealth will be getting most of their money back and the
0:37:49 > 0:37:56fraudsters who stole £18,500 from them over ten years are behind bars.
0:38:04 > 0:38:07Now, I consider myself to be pretty relaxed behind the wheel,
0:38:07 > 0:38:11but even I can feel the rage start to bubble...
0:38:11 > 0:38:13when I see roadworks approaching -
0:38:13 > 0:38:16the inevitable lane closures, temporary lights that take an age
0:38:16 > 0:38:20to change, and worst of all, traffic jams.
0:38:20 > 0:38:22But imagine if, while stuck in roadworks traffic,
0:38:22 > 0:38:25you were hit by a ten-tonne bus.
0:38:28 > 0:38:32Lee Ingram works as a claims team manager for FirstGroup.
0:38:32 > 0:38:35With a fleet of over 6,300 buses
0:38:35 > 0:38:37driving around 40 UK cities,
0:38:37 > 0:38:40there's bound to be the odd accident.
0:38:40 > 0:38:43And it is Lee's job to manage the claims that come in.
0:38:43 > 0:38:46He recalls a case involving an accident which took place at
0:38:46 > 0:38:49some dreaded roadworks.
0:38:49 > 0:38:52The claimant in this case is saying that as they were stationary,
0:38:52 > 0:38:55waiting to merge in at roadworks, we've gone past them
0:38:55 > 0:38:58and collided with their stationary vehicle.
0:38:58 > 0:39:00So, essentially, we've changed lanes into their car.
0:39:00 > 0:39:02A clear-cut case, then.
0:39:02 > 0:39:06If the car was stationary, then the bus driver must be at fault.
0:39:06 > 0:39:09FirstGroup would have to pay out.
0:39:09 > 0:39:10When the repair invoice actually came in,
0:39:10 > 0:39:14we're looking at a really minor scuff to the car -
0:39:14 > 0:39:16slight damage to a wheel trim.
0:39:16 > 0:39:21And the bus, the cost of possibly polishing out a scuff on the
0:39:21 > 0:39:24paintwork and £4 for a new bottle of white spirit.
0:39:24 > 0:39:28The repair costs were so low to both vehicles that even
0:39:28 > 0:39:31a bottle of white spirit had been listed.
0:39:31 > 0:39:34So imagine Lee's shock when the people in the car
0:39:34 > 0:39:35said they'd been badly injured.
0:39:35 > 0:39:38Something about the claim smelt a bit off.
0:39:38 > 0:39:42Despite what would appear to be a fairly innocuous collision,
0:39:42 > 0:39:47we still received a claim in the value of around about £10,000,
0:39:47 > 0:39:50which would have been for the injuries themselves
0:39:50 > 0:39:51and solicitors' fees.
0:39:52 > 0:39:54You may be wondering how they got to such
0:39:54 > 0:39:57a large amount of money for such a tiny collision.
0:39:57 > 0:40:01Well, it was because the car driver and passenger were claiming
0:40:01 > 0:40:03they had suffered whiplash injuries,
0:40:03 > 0:40:07bad back and neck pains from the impact of the bus.
0:40:07 > 0:40:09Lee wasn't entirely convinced,
0:40:09 > 0:40:13and with nearly every one of his buses fitted with CCTV,
0:40:13 > 0:40:15he knew he could take a look at the footage to help him
0:40:15 > 0:40:19understand exactly what had happened.
0:40:19 > 0:40:22When we look at the CCTV, we're expecting to see
0:40:22 > 0:40:27a bus striking into the side of a stationary car, causing it to move.
0:40:29 > 0:40:31For someone to have whiplash injuries, there will have had
0:40:31 > 0:40:34to have been a moment of impact between the two vehicles.
0:40:34 > 0:40:38So, Lee was on the hunt for the footage which showed this.
0:40:38 > 0:40:39Here comes the bus now.
0:40:39 > 0:40:43I mean, it's just going to brush the wing of this vehicle.
0:40:43 > 0:40:47Now, look for movement in the vehicle, because if you can see it,
0:40:47 > 0:40:51can you let me know? Because I can't see that vehicle move.
0:40:51 > 0:40:53So I don't think it happens.
0:40:53 > 0:40:54And if there's no movement in that car,
0:40:54 > 0:40:57then I don't know how either of those people are injured.
0:40:57 > 0:41:00But there was something else seen in the footage
0:41:00 > 0:41:03that turned the injury claim into one big joke.
0:41:03 > 0:41:05If you watch this man closely,
0:41:05 > 0:41:08he has put in a claim for soft tissue injuries
0:41:08 > 0:41:11to his shoulders and his neck.
0:41:11 > 0:41:16And yet, he doesn't stop sort of flapping and gesticulating.
0:41:16 > 0:41:20He's moving, he's pacing around. He's very agitated.
0:41:20 > 0:41:24I watched this back at triple speed and I could hear the Benny Hill
0:41:24 > 0:41:25music playing in the background.
0:41:25 > 0:41:28THE BENNY HILL SHOW THEME PLAYS
0:41:36 > 0:41:40No wonder he's injured. I was exhausted just watching him.
0:41:40 > 0:41:44Not only did the CCTV show that it was unlikely that the driver and
0:41:44 > 0:41:48passenger had suffered any serious injuries, it also went further
0:41:48 > 0:41:52to show that, actually, the bus driver didn't do anything wrong.
0:41:52 > 0:41:55Throughout this claim, the third party's solicitors were alleging
0:41:55 > 0:41:59that we'd changed lanes into their client's stationary vehicle.
0:41:59 > 0:42:03When we look back at the CCTV footage, we can clearly see
0:42:03 > 0:42:06that the bus has just continued on its straight course.
0:42:06 > 0:42:09But, due to the position of the roadworks,
0:42:09 > 0:42:12the vehicles do actually come together.
0:42:12 > 0:42:15But there's certainly no sudden veering from the direction
0:42:15 > 0:42:16the bus was travelling in.
0:42:16 > 0:42:20The footage had brought the entire claim to a grinding halt.
0:42:20 > 0:42:24We had already received a claim for the repairs to the car
0:42:24 > 0:42:26from their insurers.
0:42:26 > 0:42:30Once we'd seen the CCTV footage, we sent it on to them, told them
0:42:30 > 0:42:34what it showed, and we promptly received a reimbursing cheque
0:42:34 > 0:42:39for the bottle of white spirit and the damage caused to our bus.
0:42:39 > 0:42:43He even got the money back for the turps,
0:42:43 > 0:42:46which must have boosted Lee's spirits no end.
0:42:49 > 0:42:53From people chancing their luck by exaggerating their injuries to
0:42:53 > 0:42:58organised criminal gangs, insurance fraud hits all of us in the pocket.
0:42:58 > 0:43:01But, instead of getting away with it,
0:43:01 > 0:43:05more and more of these fraudsters are being claimed and shamed.