Episode 4 Claimed and Shamed


Download Subtitles

SRT

ASS


Episode 4

Series which sees insurance fraudsters caught on camera. Secret filming catches out a woman claiming that she is too injured to work.


Similar Content

Browse content similar to Episode 4. Check below for episodes and series from the same categories and more!

Transcript


LineFromTo

Insurance fraud has reached epidemic levels in the UK.

0:00:050:00:09

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

0:00:090:00:14

that's almost 3.6 million every day.

0:00:140:00:17

Deliberate crashes, bogus personal injuries,

0:00:190:00:23

even phantom pets.

0:00:230:00:24

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

0:00:250:00:29

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

0:00:290:00:34

But insurers are fighting back -

0:00:340:00:36

exposing just under 15 fake claims every hour.

0:00:360:00:39

Armed with covert surveillance systems...

0:00:390:00:42

That's the subject out the vehicle.

0:00:420:00:44

..sophisticated data analysis techniques...

0:00:440:00:46

-Police!

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

0:00:480:00:51

Police, stand back! Stay where you are!

0:00:510:00:53

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

0:00:530:00:55

Just don't lie to us.

0:00:550:00:57

All those conmen, scammers

0:00:570:00:59

and cheats on the fiddle are now caught in the act...

0:00:590:01:02

and claimed and shamed.

0:01:020:01:04

Today, a woman claiming she can't work stretches the truth

0:01:100:01:15

as well as her body.

0:01:150:01:16

I think I might have struggled to have done

0:01:160:01:19

some of the exercises that she did.

0:01:190:01:21

A doctor's outrageous holiday scam is prescribed

0:01:220:01:25

a double dose of justice.

0:01:250:01:27

The General Medical Council took a very dim view of it,

0:01:270:01:31

and as a result of their proceedings, Sharma was struck off.

0:01:310:01:35

And a conman forges insurance certificates

0:01:350:01:38

to keep his delivery vans working.

0:01:380:01:41

No vehicle on the road put there by Randall was insured.

0:01:410:01:44

There was no cover for anybody.

0:01:440:01:46

The implications were vast.

0:01:460:01:48

If you've ever been hurt at work,

0:01:530:01:54

you'll know the prospect of losing your livelihood

0:01:540:01:57

can be a frightening thing.

0:01:570:01:59

Most of us will do anything to get healthy again

0:01:590:02:01

and get back to the day job,

0:02:010:02:03

but there are those who see this as a chance

0:02:030:02:05

to take an extended holiday,

0:02:050:02:07

often fabricating or exaggerating their condition

0:02:070:02:10

in the false belief that insurers will continue to pay out.

0:02:100:02:14

It's estimated that we spend around a third of our lives working.

0:02:170:02:21

Obviously, some jobs are more hazardous than others,

0:02:210:02:24

but the law requires all employers to have insurance.

0:02:240:02:28

John Beadle is RSA's UK counter fraud manager.

0:02:300:02:33

He was passed one claim to review

0:02:330:02:35

involving a common but debilitating workplace injury.

0:02:350:02:39

This lady worked for a top-end clothing retailer

0:02:400:02:44

and she claimed that she'd had two accidents at work.

0:02:440:02:48

The first where she lifted a heavy box

0:02:480:02:51

and the second where she had to retrieve something

0:02:510:02:55

in a confined space.

0:02:550:02:57

She was claiming in excess of £100,000.

0:02:570:03:00

A huge claim, but her alleged injuries were significant.

0:03:010:03:06

She had, or developed, frozen shoulder,

0:03:060:03:09

she also had an arthroscopy,

0:03:090:03:13

and her medical expert found that she only had 10% of movement

0:03:130:03:18

in her left shoulder,

0:03:180:03:20

which obviously would impact the way that she could live her life.

0:03:200:03:24

And make the simplest of daily tasks a real challenge.

0:03:240:03:28

To process the claim quickly,

0:03:290:03:30

John's team carried out some routine checks.

0:03:300:03:33

But on examining her medical records,

0:03:350:03:38

we found that, indeed, just before this accident,

0:03:380:03:41

she had had problems with her left shoulder.

0:03:410:03:44

Which suggested although her recent mishap may have worsened

0:03:440:03:48

the existing injury, it wasn't the cause.

0:03:480:03:51

That would dramatically effect the claim.

0:03:510:03:54

In normal circumstances, you would expect people to tell you the truth,

0:03:540:03:59

and clearly this was the first evidence that we'd had

0:03:590:04:02

that this lady wasn't being completely forthright with us

0:04:020:04:06

and there was a pre-existing injury.

0:04:060:04:09

Bearing in mind she was claiming in excess of £100,000,

0:04:090:04:13

this was a key fact.

0:04:130:04:16

If there was a pre-existing injury,

0:04:160:04:18

it would have some impact on

0:04:180:04:20

the level of compensation that might be considered,

0:04:200:04:23

accepting that the injuries at work were in fact genuine.

0:04:230:04:28

And this was something John was very keen to investigate.

0:04:280:04:31

So having had our suspicion aroused,

0:04:310:04:34

we thought we would get some surveillance evidence of the lady.

0:04:340:04:38

This would either confirm or indeed deny

0:04:380:04:42

whether or not she did have an incapacitating injury.

0:04:420:04:45

And this period of surveillance would prove very worthwhile.

0:04:450:04:49

Yeah, somebody who has only got 10% of their movement,

0:04:510:04:56

you would expect to see very difficult

0:04:560:05:00

going about their normal lives -

0:05:000:05:02

not able to drive or to carry anything.

0:05:020:05:08

Yeah, that is what you would expect,

0:05:080:05:11

but the reality was very different.

0:05:110:05:13

The surveillance showed that she appeared to be mobile

0:05:130:05:19

and walking quite freely

0:05:190:05:22

and using her arms in a normal fashion.

0:05:220:05:26

And the claimant's next act would show she was all about the gain

0:05:260:05:29

and there didn't seem to be too much pain.

0:05:290:05:32

You can imagine our absolute amazement

0:05:320:05:36

when the surveillance people actually obtained

0:05:360:05:40

footage of her in a gym,

0:05:400:05:42

where she was doing a full body pump exercise,

0:05:420:05:46

which included lifting weights above her head on a barbell.

0:05:460:05:53

OK, let's see that supposedly injured shoulder in action

0:05:530:05:57

one more time.

0:05:570:05:58

It's impressive.

0:06:010:06:02

I hope she stretched -

0:06:020:06:04

wouldn't want to pick up a genuine injury.

0:06:040:06:06

Other exercises which were extremely vexing on those shoulders

0:06:060:06:11

and, in fact, I think I might have struggled

0:06:110:06:13

to have done some of the exercises that she did.

0:06:130:06:15

So, she was fit enough to work out, but not actually work.

0:06:170:06:21

And it seemed this claimant was in tip-top condition.

0:06:210:06:25

It did show her living a completely normal life

0:06:250:06:30

with no apparent restrictions in her movement whatsoever -

0:06:300:06:34

she was driving as though it was completely normal.

0:06:340:06:37

This type of scam never gets any easier to stomach.

0:06:370:06:41

It is very frustrating when you see some of this type of footage,

0:06:410:06:45

where it is such a blatant and obvious lie

0:06:450:06:51

that there is no incapacity at all.

0:06:510:06:55

As the claimant's head, shoulders, knees, and toes had been shown

0:06:550:06:59

to be working just fine,

0:06:590:07:01

her case was reassessed.

0:07:010:07:03

We reached a point in our investigation

0:07:040:07:07

where we clearly had the surveillance footage

0:07:070:07:09

and we also sought the advice of another medical expert,

0:07:090:07:16

who, having viewed the surveillance evidence,

0:07:160:07:18

found that there was no incapacity at all.

0:07:180:07:20

And we served this onto the defence solicitors

0:07:200:07:26

and made them a very small offer in final settlement of the claim.

0:07:260:07:31

The claimant was looking for a pay-out of over £100,000.

0:07:310:07:35

Instead, she was offered a fraction of that amount,

0:07:350:07:39

and odds were that she wouldn't even get that.

0:07:390:07:42

We made an application to the court

0:07:420:07:46

that this should be treated as a case of fundamental dishonesty.

0:07:460:07:51

But it's unlikely that she will get any of that money

0:07:510:07:53

because they'll be required to pay our costs in this case.

0:07:530:07:57

And if the claimant thought she'd had an opportunity

0:07:570:08:00

to take early retirement,

0:08:000:08:01

she was sorely mistaken.

0:08:010:08:04

Insurers aren't stupid and this is a really good demonstration

0:08:040:08:09

of the level of scrutiny that you will be put to

0:08:090:08:13

if we have suspicions about your claim.

0:08:130:08:16

Later, a claimant who throws himself down some stairs

0:08:220:08:26

looking for a pay-out is tripped up.

0:08:260:08:29

The claimant approaches the first step,

0:08:290:08:31

appears to look to the left

0:08:310:08:33

and purposefully places his left foot onto a substance,

0:08:330:08:37

grabs onto the handrail and falls down the stairs.

0:08:370:08:40

And an attempt to deceive insurers

0:08:400:08:43

with a fake helicopter rescue crash lands.

0:08:430:08:46

After our agents contacted the air traffic control tower,

0:08:460:08:49

they realised that no flights had taken off that day.

0:08:490:08:52

Fraudsters exist in all walks of life,

0:08:560:08:59

often where you'd least expect.

0:08:590:09:01

But one thing they all have in common

0:09:010:09:03

is that their deception starts with a lie.

0:09:030:09:06

It's the length scammers are willing to go to

0:09:060:09:08

in order to commit fraud that separates them.

0:09:080:09:10

While some insurance cheats will chicken out and hold their hands up,

0:09:100:09:14

there are others who will quite frankly do or say anything

0:09:140:09:17

to collect the cash.

0:09:170:09:20

Protecting yourself with travel insurance is just good common sense,

0:09:200:09:24

wherever you're spending your summer holidays.

0:09:240:09:27

Insurers Aviva offer policies

0:09:270:09:29

to cover most eventualities when abroad.

0:09:290:09:33

Well, apart from those made up.

0:09:330:09:35

Their head of fraud, Tom Gardiner, was presented with multiple claims

0:09:370:09:40

from one customer who'd reportedly suffered some horrific misfortune.

0:09:400:09:45

In 2012, Dr Sharma made two travel insurance claims.

0:09:460:09:50

The first was for missing a flight

0:09:500:09:54

from India to the UK,

0:09:540:09:56

which he said was as a result of a road traffic accident.

0:09:560:09:58

Dr Narendra Sharma claimed to have spent £600 on replacement flights,

0:09:580:10:04

but the true cost of this failed airport run

0:10:040:10:06

was reported to the call handler.

0:10:060:10:09

A tragic accident.

0:10:280:10:30

But being a trusted GP here in the UK,

0:10:310:10:33

Dr Sharma understood the importance of getting the paperwork in order,

0:10:330:10:37

despite the awful circumstances.

0:10:370:10:39

In support of Sharma's first claim for the missed flight,

0:10:410:10:43

he had presented two documents.

0:10:430:10:45

One was a death certificate,

0:10:450:10:47

and also a recovery invoice following the damage to his car.

0:10:470:10:52

Aviva used their on-the-ground investigators to validate the claim,

0:10:520:10:56

which threw up a shocking revelation.

0:10:560:10:59

What was revealed quite quickly

0:10:590:11:01

from our local agent's enquiries in India

0:11:010:11:04

was that the recovery company simply didn't exist,

0:11:040:11:09

the officials had confirmed that the death certificate was entirely bogus

0:11:090:11:14

and also that the police had no record

0:11:140:11:16

of attending a road traffic accident,

0:11:160:11:18

let alone a fatal road traffic accident.

0:11:180:11:21

So, with no record of the accident or the fatality,

0:11:210:11:25

the evidence suggested Dr Sharma had lied

0:11:250:11:28

so he could make a false insurance claim.

0:11:280:11:31

It was quite clear that what on the face of it

0:11:310:11:33

was a tragic incident resulting in a genuine claim

0:11:330:11:37

was clearly anything but that.

0:11:370:11:39

OK, so far, we've established

0:11:390:11:41

that the good Dr Sharma had faked his mother-in-law's death

0:11:410:11:44

in a fictitious road accident

0:11:440:11:46

and supplied forged documents

0:11:460:11:48

just so he could make a fraudulent travel insurance claim

0:11:480:11:51

for missed flights.

0:11:510:11:52

If that wasn't extraordinary enough,

0:11:520:11:54

remember the second insurance claim?

0:11:540:11:57

Dr Sharma telephoned Aviva to notify his second claim.

0:11:570:12:01

That was for a cancellation of a holiday in Spain,

0:12:010:12:06

which he attributed to a family illness.

0:12:060:12:08

And that was for accommodation costs of a approximately £59.

0:12:080:12:12

And the reported illness went well beyond a sudden bout of flu.

0:12:130:12:18

Dr Sharma explained the family member's diagnosis

0:12:180:12:21

to the call handler.

0:12:210:12:23

Sympathetic to the alleged circumstance,

0:12:380:12:41

the information is taken at face value.

0:12:410:12:44

I think suspicions were raised in the original telephone call.

0:12:440:12:47

Sharma seemed to change his story quite quickly

0:12:470:12:52

and his accommodation costs went from £59 to then include flights.

0:12:520:13:00

And when Dr Sharma thinks he could potentially end up with nothing,

0:13:000:13:04

he ups the ante.

0:13:040:13:06

So, Dr Sharma was now claiming in excess of £600

0:13:270:13:30

for cancelled flights,

0:13:300:13:32

but by the time supporting documents were received,

0:13:320:13:35

this figure had changed a little.

0:13:350:13:38

When we then received the invoices,

0:13:380:13:40

the accommodation costs weren't £59, there were £959

0:13:400:13:44

and the flights were in excess of £1,000.

0:13:440:13:47

Quite the jump.

0:13:470:13:49

The first thing Tom's team did

0:13:490:13:51

was to attempt to validate Sharma's paperwork,

0:13:510:13:53

but it wasn't exactly what this doctor had ordered.

0:13:530:13:57

Neither the airline or the holiday company could support or recognise

0:13:570:14:03

the two invoices that Sharma had presented.

0:14:030:14:07

Damning evidence that this was also a completely fabricated claim.

0:14:070:14:12

And it appeared that the on-call doctor had decided to go off-duty.

0:14:120:14:17

Sharma was presented with this evidence -

0:14:170:14:19

he no longer communicated with us.

0:14:190:14:22

I suspect that he realised, then, that the game was up

0:14:220:14:25

and rather hoped that that would be an end to the matter.

0:14:250:14:29

Given the body of proof Tom had,

0:14:290:14:31

Dr Sharma was hoping in vain.

0:14:310:14:34

It was clear that on both claims

0:14:340:14:36

fraudulent invoices had been submitted,

0:14:360:14:39

so both claims were repudiated.

0:14:390:14:42

Also put together our evidence and reported the matter to the police.

0:14:420:14:46

Dr Sharma had been willing to fake the death of his mother-in-law,

0:14:480:14:51

forge her death certificate,

0:14:510:14:52

and tell the most terrible lies

0:14:520:14:54

in a sickening attempt to fraudulently claim

0:14:540:14:57

on his travel insurance.

0:14:570:14:59

But the game was up and he was about to feel the full weight of the law.

0:15:000:15:05

As a result of the police taking on the case,

0:15:050:15:07

Dr Sharma was prosecuted and pleaded guilty

0:15:070:15:10

and he received six months' community service.

0:15:100:15:12

A good result for Tom and the team at Aviva,

0:15:140:15:16

but the consequences were far from over for Dr Sharma.

0:15:160:15:20

Following the prosecution, we were deeply concerned

0:15:200:15:24

about Sharma's behaviour and the position he held,

0:15:240:15:28

so we brought that to the attention of the General Medical Council as well.

0:15:280:15:32

As you might have guessed,

0:15:320:15:34

they weren't exactly impressed by his conduct.

0:15:340:15:37

The General Medical Council took a very dim view of it

0:15:370:15:40

and as a result of their proceedings, Sharma was struck off.

0:15:400:15:45

So from respected pillar of the community,

0:15:460:15:49

to disgraced insurance cheat with a community service order.

0:15:490:15:53

He had it all but threw it away with his attempted fraud.

0:15:530:15:57

I think what's difficult to rationalise

0:15:590:16:01

is that someone in Dr Sharma's position

0:16:010:16:03

was prepared to go to such lengths.

0:16:030:16:06

This case perfectly demonstrates insurers' ability

0:16:070:16:10

to identify and stop fraud.

0:16:100:16:14

I think what this case shows is firstly that insurance fraud

0:16:160:16:19

isn't just a motor insurance problem.

0:16:190:16:22

And, secondly, that fraudsters do come from all walks of life.

0:16:220:16:27

It is a well-known fact that when you get behind the wheel of a vehicle,

0:16:320:16:35

insurance is compulsory.

0:16:350:16:38

However, there are fraudsters who choose to ignore this fact,

0:16:380:16:41

with some scammers letting unsuspected drivers belt up

0:16:410:16:44

knowing full well they're not covered.

0:16:440:16:47

But if you have an accident in an uninsured vehicle,

0:16:470:16:50

then you'll be left to carry the can for all costs incurred.

0:16:500:16:54

With close to 30 million cars on UK roads,

0:16:550:16:59

there's always a risk of being involved in an accident.

0:16:590:17:02

Mihir Pandya is a fraud manager for Allianz

0:17:030:17:06

and knows a thing or two about dealing with bogus insurance claims.

0:17:060:17:11

He received one call regarding a supposed customer of theirs.

0:17:110:17:14

This case first came to light when Motor Insurers' Bureau contacted us.

0:17:150:17:20

And they were dealing with a claim where an individual

0:17:200:17:24

had been hit in their car by another individual

0:17:240:17:30

who they believe was uninsured.

0:17:300:17:32

But when the MIB contacted this person,

0:17:320:17:35

they presented them with a certificate of insurance,

0:17:350:17:39

which was purporting to be from Allianz Insurance.

0:17:390:17:42

The Motor Insurers' Bureau provide compensation to victims

0:17:420:17:45

involved in accidents with uninsured drivers.

0:17:450:17:48

The call was an everyday occurrence

0:17:480:17:51

but the policy was far from ordinary.

0:17:510:17:53

We looked at the insurance certificate,

0:17:550:17:57

we checked our systems,

0:17:570:17:59

and we couldn't find any trace of this policyholder.

0:17:590:18:02

He was insured by Allianz Insurance a couple of years before

0:18:020:18:07

but not at the time when the MIB contacted us.

0:18:070:18:09

Concerned by the lack of a valid policy,

0:18:110:18:13

Allianz looked into the alleged customer's records.

0:18:130:18:16

Mark Randall was a company director of two courier companies,

0:18:160:18:21

based in the West Midlands.

0:18:210:18:23

They would do a lot of work for larger courier companies

0:18:230:18:25

and service their postcodes.

0:18:250:18:27

This type of business would require fleet and freight

0:18:280:18:31

liability insurance for multiple vehicles.

0:18:310:18:33

But examining the paperwork revealed an alarming truth.

0:18:330:18:37

We did our own checks and we couldn't find any suggestion

0:18:380:18:43

that Mr Randall was still insured with Allianz.

0:18:430:18:45

So we looked at the document and very quickly became evident

0:18:450:18:50

that the document was forged.

0:18:500:18:52

Randall was operating illegally and it was time to pass the case over

0:18:530:18:58

to the boys in blue at the City of London Police's

0:18:580:19:01

insurance fraud enforcement department.

0:19:010:19:03

Simon Styles is Ifed's financial investigator

0:19:070:19:10

and was part of the team that took on the case.

0:19:100:19:12

Allianz's enquiries had already established

0:19:140:19:16

that Randall was running an entire fleet of commercial vehicles

0:19:160:19:19

without insurance, using forged policies.

0:19:190:19:22

And putting all of his unknowing workforce at risk.

0:19:230:19:28

And the terrifying consequences for every single employee on the payroll

0:19:280:19:32

were all too clear to Simon.

0:19:320:19:34

No driver and no vehicle on the road put there by Randall was insured.

0:19:340:19:39

There was no cover for anybody if they hit anybody or injured anybody.

0:19:390:19:43

The implications were vast.

0:19:430:19:47

And for that reason, Ifed didn't hesitate to take the next step.

0:19:470:19:51

From the stage that we had received

0:19:510:19:54

a referral from Allianz,

0:19:540:19:56

we confirmed what had already been told to us,

0:19:560:19:59

that the certificates that had been provided were false.

0:19:590:20:02

And then we decided to knock on the door of Mark Randall.

0:20:020:20:05

Detectives paid Randall a visit.

0:20:060:20:08

They were looking for any evidence to prove

0:20:080:20:10

he had been faking certificates and supplying them to insurers.

0:20:100:20:14

When you go through the door of a suspect

0:20:140:20:16

in possession of a search warrant,

0:20:160:20:18

you don't know what you're going to find.

0:20:180:20:19

And on this occasion, we found evidence of another courier company

0:20:190:20:23

that we didn't know anything about.

0:20:230:20:25

Of course, alarm bells were ringing and rightly so.

0:20:250:20:28

What was coming through loud and clear

0:20:290:20:31

was that Randall was running the same insurance scam

0:20:310:20:33

with a second company.

0:20:330:20:36

It's unusual to have two companies set up by the same person

0:20:360:20:40

doing the same thing.

0:20:400:20:42

And if in the first instance they were falsifying documents

0:20:420:20:45

to get hold of the contract, ie, providing false insurance,

0:20:450:20:50

they were very much likely to have done it a second time.

0:20:500:20:52

And we were proved right.

0:20:520:20:54

The faked certificates weren't just used to keep his vans on the road

0:20:540:20:57

at a reduced cost, they were keeping his business afloat.

0:20:570:21:02

Mark Randall had a contract with UPS

0:21:020:21:04

and had been working with them legitimately for a couple of years.

0:21:040:21:08

He ran into difficulties

0:21:080:21:10

and was not able to pay the premiums on his insurance.

0:21:100:21:15

And therefore, would he have notified UPS,

0:21:150:21:18

that contract would have been cancelled.

0:21:180:21:21

Randall's scam had begun as a desperate attempt

0:21:210:21:24

to save his failing business,

0:21:240:21:26

but having got away with it this long, he continued to push his luck.

0:21:260:21:30

Under the guise of the second company,

0:21:300:21:32

he secured another lucrative delivery contract

0:21:320:21:35

from an international distributor.

0:21:350:21:37

Once again, supplying fabricated insurance documents.

0:21:370:21:41

The contract was with Yodel.

0:21:410:21:43

Randall had to provide two certificates of insurance.

0:21:430:21:47

Both of those were false and had Yodel known about it,

0:21:470:21:51

they wouldn't have employed him and no contract would have been agreed.

0:21:510:21:54

Striking this deal would keep the revenue rolling in

0:21:540:21:57

for quite some time.

0:21:570:21:59

From the date that he first produced a fraudulent insurance cover,

0:21:590:22:03

to the date of the accident when it all came to light,

0:22:030:22:07

he made just over £750,000.

0:22:070:22:10

His fleet of delivery vehicles may have brought in £750,000,

0:22:100:22:15

however, these vans should never have been on the road

0:22:150:22:18

in the first place.

0:22:180:22:19

To fulfil the contract, he needed insurance cover.

0:22:210:22:24

He may well say that it went on legitimate wages

0:22:240:22:26

and hire of the vehicles,

0:22:260:22:28

but he wouldn't have had that money if he'd told them

0:22:280:22:31

that the certificates were false.

0:22:310:22:33

And Simon remains certain that what started as a desperate attempt

0:22:330:22:37

to save his business soon turned into pure greed.

0:22:370:22:40

Whether Randall knew or not what the implications were,

0:22:410:22:45

he set out to make money.

0:22:450:22:47

He didn't pay for any of these policies.

0:22:470:22:50

Ultimately, Randall's disregard for the law

0:22:500:22:52

and willingness to put his own employees at risk

0:22:520:22:54

in uninsured vehicles wouldn't pay off.

0:22:540:22:57

When he was interviewed...

0:22:570:23:00

showed remorse.

0:23:000:23:01

He understood what had caught up with him.

0:23:010:23:03

He did plead guilty from the outset.

0:23:030:23:06

And he tried to explain what the situation was.

0:23:080:23:11

His business, too much for him and his financial position he was in.

0:23:110:23:16

Due to the large sums of money that passed through both Randall's

0:23:160:23:19

companies off the back of this scam, that was a little hard to swallow.

0:23:190:23:24

Freight liability operators' insurance can be expensive,

0:23:240:23:27

but Randall was earning and had received a lot of money.

0:23:270:23:30

It didn't all go in insurance.

0:23:320:23:34

I don't know where it went to, only Randall knows that.

0:23:340:23:37

The case proceeded to court and justice was delivered.

0:23:370:23:40

He was sentenced at Wolverhampton Crown Court

0:23:400:23:43

where he received 16 months imprisonment,

0:23:430:23:46

suspended for two years.

0:23:460:23:48

And he was ordered by the judge to be banned

0:23:480:23:50

from holding a directorship for five years.

0:23:500:23:53

This courier conman had been made to pay for his crimes,

0:23:530:23:57

but Simon's job wasn't over yet.

0:23:570:23:59

As despite the big profits Randall made by duping his staff

0:24:010:24:04

to drive uninsured, they ended up unemployed.

0:24:040:24:07

I'm attempting to trace where that money would have gone to.

0:24:100:24:13

He owes, at the moment, nearly £350,000.

0:24:130:24:17

Some of it's gone on holidays, some on living the high life.

0:24:170:24:20

If you've still got the money, it's still stashed somewhere,

0:24:210:24:24

I'll get it and repay the victims.

0:24:240:24:26

Randall thought he could cheat the system and come out on top.

0:24:260:24:30

He was gravely mistaken and now has to face the consequences.

0:24:300:24:34

The question is, was it worth taking the risk?

0:24:350:24:38

I would say no.

0:24:380:24:40

He had a choice to make and I think he made the wrong one.

0:24:400:24:42

Whether you dream of climbing Mount Everest

0:24:490:24:51

or sailing the high seas,

0:24:510:24:53

travel insurance gives you invaluable protection

0:24:530:24:56

should anything go wrong on your big trip.

0:24:560:24:58

There are, though, some sly scammers who think being half a world away

0:24:580:25:02

makes it easier to make a fraudulent claim.

0:25:020:25:05

But in today's global village,

0:25:050:25:07

insurance cheats can be detected anywhere.

0:25:070:25:10

Whatever destination you're jetting off to,

0:25:120:25:14

there'll be a policy to cover your adventure.

0:25:140:25:17

Mathew Crawford-Thomas is the fraud manager for Collinson Group.

0:25:180:25:23

He was handed one case involving a customer who had suffered

0:25:250:25:28

a potentially life-threatening incident in Nepal.

0:25:280:25:32

At the initial telephone call,

0:25:320:25:34

we were advised that our insured was suffering with altitude sickness

0:25:340:25:37

and needed repatriating into Kathmandu, and the only way

0:25:370:25:41

this could be accomplished was via helicopter rescue.

0:25:410:25:44

The customer was rushed into hospital,

0:25:440:25:46

but his potentially life-saving ride came at quite a cost.

0:25:460:25:50

The claim was submitted for

0:25:520:25:53

a helicopter rescue from Hilsa in Nepal to Kathmandu for US18,400.

0:25:530:25:59

At this particular moment of the claim,

0:25:590:26:01

we hadn't actually heard from the insured person

0:26:010:26:04

as we were dealing directly with the rescue company.

0:26:040:26:07

Not exactly loose change,

0:26:070:26:09

but Matt wouldn't have to wait long to hear from the claimant.

0:26:090:26:13

We received a telephone call from the insured the next day,

0:26:130:26:16

after he was dropped off at the hospital, advising us that

0:26:160:26:19

he wanted to leave and for us to guarantee payment to the hospital.

0:26:190:26:23

A suspiciously fast recovery

0:26:230:26:25

for a man requiring an emergency air evacuation just 24 hours ago.

0:26:250:26:30

The claimant's medical report was received and reviewed.

0:27:000:27:03

This was the first big cause for concern.

0:27:030:27:07

Upon receiving the medical report from the hospital,

0:27:070:27:10

it transpired that he had little or no symptoms of altitude sickness,

0:27:100:27:14

therefore we started to worry

0:27:140:27:15

whether or not the helicopter rescue was in fact necessary.

0:27:150:27:19

By this point, the combined claim total was in excess of 20,000,

0:27:200:27:25

or £15,000.

0:27:250:27:26

And one party were especially keen to get paid.

0:27:280:27:32

At this particular moment in time,

0:27:320:27:34

not only were we dealing with the insured person,

0:27:340:27:36

but we also had to deal with the helicopter rescue company

0:27:360:27:38

asking for their money as well.

0:27:380:27:41

And, judging by the amount of money the rescue company were asking for,

0:28:140:28:17

they must have been operating their first-class service that day.

0:28:170:28:22

When the bill came in at 18,400,

0:28:220:28:25

we felt that this bill in itself was far too much money.

0:28:250:28:29

A bill of this nature for the trip that he had received

0:28:290:28:32

is circa 10,000 US.

0:28:320:28:34

There was clear evidence that we needed to ask more questions

0:28:340:28:37

of the helicopter rescue company.

0:28:370:28:39

So they were attempting to charge nearly £15,000

0:28:390:28:44

for a flight that normally costs around £7,500.

0:28:440:28:47

Matt needed to get to the bottom of this

0:28:470:28:50

and turned to his boots on the ground for assistance.

0:28:500:28:53

We employed the services of an agent in Nepal to investigate this matter.

0:28:530:28:57

And it didn't take the agent long to identify a gaping hole in the claim.

0:28:570:29:03

After our agents contacted the air traffic control tower,

0:29:040:29:07

they realised that no flight had taken off that day.

0:29:070:29:10

With this claim crash-landing, the claimant also proved untraceable.

0:29:100:29:16

Hilsa in Nepal is a restricted area

0:29:160:29:18

and you need to have a permit issued.

0:29:180:29:21

Upon checking the records, no permit was ever issued to our insured.

0:29:210:29:24

The local investigation strongly suggested this flight of fancy

0:29:240:29:29

had been concocted by the claimant and the rescue company.

0:29:290:29:32

And in the absence of any payment, extreme measures were taken.

0:29:340:29:39

The helicopter rescue company had actually secured

0:29:390:29:42

the insured's passport as identification verification.

0:29:420:29:46

However, they were refusing to give it back to the insured until

0:29:460:29:50

such times as we had paid the bill.

0:29:500:29:52

Armed with this information,

0:29:520:29:54

the rescue company had a few facts pointed out to them.

0:29:540:29:57

The rescue company are getting desperate.

0:30:370:30:40

They knew the longer the claim went on, the more likely

0:30:400:30:42

it would be found to be false and they'd be left empty-handed.

0:30:420:30:46

Claiming to be withholding the customer's passport is an interesting move

0:30:460:30:49

because the evidence suggested the rescue never even happened

0:30:490:30:53

and the claimant was complicit in the deception,

0:30:530:30:56

but the posturing and threats would keep on coming.

0:30:560:31:00

Throughout the course of this investigation, the helicopter rescue

0:31:000:31:03

company employed several tactics to attempt to make us pay the 18,400.

0:31:030:31:09

Determined to keep up the pressure,

0:31:090:31:10

Matt's team received another call from the rescue company.

0:31:100:31:14

Unsurprisingly, Matt declined to take the company's kind offer

0:31:300:31:34

and it would appear to be their last-ditch attempt at extorting a payment.

0:31:340:31:38

Our agents, once armed with all the evidence,

0:31:380:31:41

put it to the rescue company and their response was,

0:31:410:31:45

due to a technical error, they are withdrawing their claim.

0:31:450:31:49

So they'd finally thrown in the towel

0:31:490:31:52

and it was down to Matt and his team's refusal to be pressurised.

0:31:520:31:56

During the life cycle of this claim, the helicopter rescue company

0:31:560:32:00

and the insured contacted us on numerous occasions.

0:32:000:32:04

At no point did we budge with regards to guaranteeing any payment

0:32:040:32:08

until a full investigation had been finished.

0:32:080:32:11

Still to come, a fighter's personal injury claim is knocked back.

0:32:170:32:22

Not only should he not have been fighting, but it would suggest

0:32:220:32:25

that his condition and ability was sufficient to win a fight.

0:32:250:32:29

"Mind your head," "Caution - wet floor," "Beware - man-eating lion."

0:32:330:32:38

We have all observed public warning signs on our travels.

0:32:380:32:41

Their purpose is simple - to alert you to potential danger.

0:32:410:32:44

Wherever they are, all businesses have a duty to make their premises safe.

0:32:440:32:49

But insurance cheats think faking or exaggerating incidents

0:32:490:32:53

to fraudulently claim against them is a guaranteed earner.

0:32:530:32:56

This couldn't be further from the truth.

0:32:560:32:59

Whether you're shopping, eating, socialising or just out and about,

0:33:020:33:07

most locations will have some level of insurance cover in place

0:33:070:33:10

to protect them and you.

0:33:100:33:12

Insurers Aviva have a lot of commercial clients

0:33:150:33:18

and received one claim from a customer

0:33:180:33:21

which they quickly passed on to solicitors BLM to investigate.

0:33:210:33:24

Brian Connolly took on the case.

0:33:270:33:29

And didn't waste any time sinking his teeth into this claim,

0:33:300:33:34

which occurred in a busy restaurant.

0:33:340:33:37

The claim itself was for personal injuries

0:33:400:33:42

arising from a slip and fall down a set of stairs.

0:33:420:33:45

The claimant alleged that he slipped

0:33:450:33:47

on a substance which was on the second or third step.

0:33:470:33:50

He claimed that as a result of that,

0:33:510:33:53

he fell down the stairs, holding on to the rail,

0:33:530:33:56

it couldn't hold his weight, and he fell down backwards.

0:33:560:33:59

Potentially a life-threatening accident.

0:33:590:34:03

The client immediately called an ambulance to assist the claimant

0:34:030:34:06

as he required immediate medical attention and

0:34:060:34:09

it did appear that he was injured.

0:34:090:34:10

It was unknown what injuries the claimant had suffered

0:34:100:34:13

and it wasn't until a few weeks after the incident

0:34:130:34:16

BLM were contacted.

0:34:160:34:17

When the letter of claim arrived,

0:34:170:34:19

it allowed me to confirm that the claimant lived 65 miles away

0:34:190:34:23

from where the accident actually happened, which I found was

0:34:230:34:26

quite unusual considering he was only going there for a cup of tea.

0:34:260:34:29

Must have been a decent cuppa!

0:34:310:34:33

The claim totalled over £38,000,

0:34:330:34:36

which was hardly surprising, given the claimant's condition.

0:34:360:34:40

The claimant alleged that he sustained a number of injuries,

0:34:400:34:43

to include head injuries, post-traumatic stress, headaches,

0:34:430:34:47

hip injuries, back injuries,

0:34:470:34:48

neck injuries and an increase in epileptic episodes.

0:34:480:34:52

With the claimant's medical report reading like an A to Z of injuries,

0:34:520:34:56

the alleged impact on his day-to-day life was huge.

0:34:560:34:59

He had ongoing problems with his back. This was affecting his work,

0:35:010:35:05

his lifestyle and on a daily and ongoing basis.

0:35:050:35:08

But it was the circumstances of the accident

0:35:090:35:12

which first gave cause for concern.

0:35:120:35:15

What first aroused the insurer and BLM's suspicion

0:35:150:35:18

was the nature of the fall down the stairwell.

0:35:180:35:21

Luckily, there was a dependable eyewitness Brian could count on.

0:35:210:35:25

BLM undertook deep analysis of the CCTV footage,

0:35:250:35:29

not only of the accident itself but the events that took place

0:35:290:35:32

both before and after the accident had happened.

0:35:320:35:36

And this deep analysis would prove very revealing.

0:35:360:35:40

The claimant approaches the first step,

0:35:400:35:42

appears to look to the left

0:35:420:35:44

and purposely place his left foot onto a substance,

0:35:440:35:48

grabs onto the handrail

0:35:480:35:50

and falls down the stairs.

0:35:500:35:52

Anyone would think he was trying to fall down the stairs.

0:35:520:35:55

Let's have another look.

0:35:550:35:56

He's certainly no Hollywood stuntman.

0:35:590:36:01

And the two individuals the claimant provided

0:36:010:36:04

as eyewitnesses to support his claim

0:36:040:36:06

didn't seem that surprised by his tea-time tumble.

0:36:060:36:09

After the accident occurs,

0:36:100:36:12

the two witnesses get up from where they were seated.

0:36:120:36:15

They walk along, quite slowly, to the top of the stairwell

0:36:150:36:18

and walk down to where the claimant has fallen.

0:36:180:36:21

There was one very obvious conclusion

0:36:210:36:23

to be drawn from the footage.

0:36:230:36:25

In my opinion, the claimant probably did sustain some injuries, but

0:36:250:36:30

this was an alleged staged accident.

0:36:300:36:32

And further investigation revealed

0:36:340:36:36

this wasn't a solo effort.

0:36:360:36:38

The investigation revealed that the witnesses,

0:36:380:36:41

as identified by the claimant,

0:36:410:36:43

were actually known to the claimant.

0:36:430:36:45

They were actually family members.

0:36:450:36:47

And there was another telling piece of evidence established

0:36:480:36:52

at the time of the accident.

0:36:520:36:54

What was crucial in our case was that a waitress asked the witnesses

0:36:540:36:58

whether they knew the claimant and they both said no.

0:36:580:37:01

This was a good old-fashioned lie,

0:37:030:37:05

which only served to strengthen Aviva's case.

0:37:050:37:08

It was significant that we could identify

0:37:080:37:12

the witnesses knew the claimant

0:37:120:37:14

and that then we could alleged that one of the witnesses

0:37:140:37:17

had purposely put a substance on the floor, causing the claimant to slip.

0:37:170:37:20

A strong allegation,

0:37:200:37:22

but the claimant's response supported the suspicion.

0:37:220:37:26

We prepared the case very robustly

0:37:260:37:29

and the morning of trial, the claimant's solicitor confirmed

0:37:290:37:32

that the claimant no longer wanted to proceed with the case

0:37:320:37:35

and the case was struck out and we were awarded our full costs.

0:37:350:37:38

So, the claimant had opted to take another dive

0:37:400:37:43

rather than see it through to court.

0:37:430:37:45

BLM's online checks had proved vital

0:37:470:37:50

connecting the dots of this investigation.

0:37:500:37:53

The social media searches not only helped us to confirm that

0:37:530:37:56

the claimant knew the witnesses, but, actually, ironically,

0:37:560:37:59

one of the witnesses was wearing exactly the same outfit

0:37:590:38:03

as he was on the CCTV.

0:38:030:38:05

Well, when you're being captured on camera aiding an attempted fraud,

0:38:050:38:08

it is important to look your best.

0:38:080:38:10

It's my opinion that the claimant became aware of the fact

0:38:110:38:15

that we knew that this was a staged accident

0:38:150:38:18

and no longer wanted to proceed with the case.

0:38:180:38:20

Day-to-day life can be dangerous, can't it?

0:38:250:38:28

From busy roads to packed high streets and kamikaze cyclists,

0:38:280:38:32

there's no end of potential ways to run into trouble.

0:38:320:38:35

If you have an accident that wasn't your fault, then you're entitled

0:38:350:38:38

to make a personal injury claim and seek fair compensation.

0:38:380:38:42

But crafty insurance cheats

0:38:420:38:44

don't concern themselves with minor details like who was at fault. No.

0:38:440:38:48

Instead, they just make up an accident

0:38:480:38:50

all in an effort to make a quick buck.

0:38:500:38:52

Over three million people are injured in accidents every year.

0:38:550:38:58

In the home, at work or outdoors.

0:38:580:39:01

The vast majority of claims are genuine.

0:39:020:39:05

The rest are dealt with by people like Scott Clayton,

0:39:050:39:08

a fraud manager for insurers Zurich.

0:39:080:39:10

He was asked to look over one customer's claim

0:39:100:39:13

just as a matter of routine.

0:39:130:39:15

We received a claim for personal injury from this claimant

0:39:160:39:20

who said that whilst walking along the road,

0:39:200:39:22

his foot had been caught in a grate that didn't have a lid on it.

0:39:220:39:25

Probably worth around about £4,500,

0:39:280:39:30

so not an inconsiderable sum of money.

0:39:300:39:33

On the surface, it seemed like a fairly minor injury,

0:39:330:39:36

but the grate in question had really done a number on the claimant.

0:39:360:39:41

Well, the injuries that the claimant said that he'd sustained

0:39:410:39:44

were a fractured ankle,

0:39:440:39:46

which is pretty nasty, and also damage to his knee,

0:39:460:39:50

so you can see almost how he's had his foot caught,

0:39:500:39:52

twisted. Quite an unpleasant experience.

0:39:520:39:56

Due to the extent of his injuries,

0:39:560:39:58

the claimant alleged he couldn't work for at least six months

0:39:580:40:02

and had to undergo an intensive recovery programme.

0:40:020:40:05

As a result of the accident, he went through a period of

0:40:050:40:07

rehabilitation and had medical treatment as well as six rounds

0:40:070:40:11

of physiotherapy to get himself back on his feet as quickly as possible.

0:40:110:40:15

But this claimant had more reason than most

0:40:150:40:18

to need full use of his feet.

0:40:180:40:20

Our suspicions were arisen when we looked at the medical report and saw

0:40:210:40:25

that his occupation was a mixed martial arts instructor and fighter.

0:40:250:40:29

So we would validate that just to check whether

0:40:290:40:31

there was any activity in the period that he was recovering.

0:40:310:40:35

And some online checks revealed some truly jaw-dropping video evidence.

0:40:350:40:40

The investigation found that

0:40:400:40:41

he had actually fought three months after the accident,

0:40:410:40:44

so during the time that he was "recovering" from a nasty injury,

0:40:440:40:49

he was physically able to engage

0:40:490:40:50

in what we consider to be highly physical activity,

0:40:500:40:54

and he won, which tends to suggest that he was in good condition.

0:40:540:40:57

Well, he must have been in peak condition

0:41:000:41:02

to survive one of the most brutal forms of professional fighting.

0:41:020:41:06

The discovery left this punchy pretender's claim on the ropes.

0:41:060:41:10

Not only should he not have been fighting

0:41:110:41:14

because he was apparently off work with a serious injury,

0:41:140:41:17

but it would suggest his condition was...and ability was sufficient

0:41:170:41:22

to win a fight, therefore it cast doubt over the whole claim.

0:41:220:41:25

With the claim on its last legs, in came the knockout blow.

0:41:250:41:30

Our research found that not only

0:41:300:41:32

had he fought three months after the accident,

0:41:320:41:34

but he'd also fought again eight months after the accident,

0:41:340:41:37

so our conclusion was that he was perfectly fit and well to fight,

0:41:370:41:41

maintain his occupation and lifestyle, and we therefore

0:41:410:41:44

consulted with his solicitors and told them what we had found.

0:41:440:41:48

Given the evidence, his solicitors were none too keen

0:41:480:41:51

to go another round with Zurich in pursuit of this claim.

0:41:510:41:54

We heard nothing from his solicitors,

0:41:540:41:57

despite a couple of reminders, and then latterly

0:41:570:42:00

they told us that they had actually discontinued the claim.

0:42:000:42:03

So, in other words, we had found out the truth and the claim had

0:42:030:42:06

gone away as a result of it.

0:42:060:42:08

The claimant severely underestimated his opponent in this case.

0:42:080:42:12

He probably thought that this was a claim that we would pay and

0:42:120:42:15

there wouldn't be any problems, but when you put things on the internet,

0:42:150:42:18

then they're for everybody to see. And in this case, he was caught out.

0:42:180:42:22

And if any potential fraudster fancies their chances with

0:42:220:42:25

a false claim, they'll come up against a zero-tolerance attitude.

0:42:250:42:29

We check all claims.

0:42:290:42:31

We want to make sure that we're paying money out correctly

0:42:310:42:34

and to people who are deserving of it.

0:42:340:42:36

Where we find information that suggests a fraud,

0:42:360:42:39

then we will look into it thoroughly because it's just not fair

0:42:390:42:42

for people to try and exploit the system this way.

0:42:420:42:45

None of us likes paying more than we have to for everyday services.

0:42:490:42:53

From organised criminal gangs to exaggerated household claims,

0:42:530:42:57

insurance fraud hits all of us in the pocket.

0:42:570:43:00

But instead of getting away with it,

0:43:000:43:03

more and more of these fraudsters have been claimed and shamed.

0:43:030:43:07

Claimed and Shamed is back for its eighth series, exposing even more insurance fraudsters lying on the phone or caught out on camera. The series highlights the extraordinary and often ridiculous lengths some people go to in order to try and receive a bumper payout.

Secret filming reveals a woman claiming she's too injured to work is as fit as an insurance fiddler, a doctor fakes a family member's death to avoid paying for replacement flights, and a professional fighter's bid for compensation is knocked back. The Insurance Fraud Enforcement Department catch up with the owner of a courier company who sent his unsuspecting delivery drivers out on UK roads without insurance in an effort to save money, while compensation is off the menu for a man caught throwing himself down some restaurant stairs in an outrageous personal injury stunt, and a traveller's claim for a helicopter rescue that never happened fails to get off the ground.