Episode 10 Claimed and Shamed

Insurance fraud in the UK has hit epidemic levels.

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

That's almost £3.6 million every day.

Deliberate crashes, bogus personal injuries, even phantom pets.

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

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

But insurers are fighting back,

exposing just under 15 fake claims every hour.

Armed with covert surveillance systems...

Subject, out of the vehicle.

..sophisticated data analysis techniques...

-Police!

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

Police! Don't move, stay where you are.

..they are catching the criminals red-handed.

Just don't lie to us.

All those conmen, scammers and cheats on the fiddle

are now caught in the act

and Claimed And Shamed.

Today... Modern technology is the undoing of

an opportunistic fraudster.

We were able to review the metadata and we found that the images had

actually been produced nearly two weeks after

they were reported as stolen.

A claim for stolen luggage is lost in translation.

Our Italian colleague told us that the words used were more in line

with someone taking the words off an internet translation service.

And justice is served on a gang who made the mistake of thinking

insurance fraud is easy money.

It is the most ill-planned,

the most badly thought through

enterprise probably that's been caught on

camera in a case of this type.

Being burgled is an awful experience.

Knowing that a stranger has been in your home is one thing but when

irreplaceable possessions are taken, that really hurts.

Now, whilst an insurance policy

can't cover the loss of sentimental items,

it can provide reimbursement to pay for the things that can be replaced.

However, not all burglary claims are as they first appear.

With almost 700,000 burglaries a year in England and Wales alone,

it's one of the most common home insurance claims.

However, it is also one of the types of insurance that sees more than its

fair share of grossly exaggerated or opportunistic claims.

Lloyds Banking Group dealt with a

claim from one of their policyholders,

a Mr Field who had been unfortunate enough to become another victim of

this terrible crime.

A customer reported that when he

returned home from work around lunchtime,

he found that his front door had either been jemmied or kicked in.

He went into the house and he found

that most of the rooms in the home had

been ransacked and that a number of items had been stolen.

Unfortunately for Mr Field, the thieves had expensive taste.

Multiple items had been stolen,

primarily jewellery and there was a mixture of ladies' jewellery,

gentlemen's jewellery, children's jewellery.

The customer was particularly upset that some of his late parents'

jewellery had gone missing, including their wedding rings.

Other items that were reported,

there was a vintage Omega watch, laptops,

an iPad and a mobile phone.

The estimated value of the items stolen was approximately £17,000.

It was a considerably large claim but as far as Lloyds were concerned,

nothing to worry about.

When we first received the claim, everything appeared in order.

The description of the items and the description of the nature of damage

appeared that a burglary had in fact happened.

Keen to get Mr Field and his family back to normality,

Lloyds began to process the claim.

As part of reviewing the claim,

we always ask and work with our customers to help us understand the

value of the items, give us some descriptions of them,

details of their age, where they acquired them.

Types of evidence that they can help us to

validate the claim would include things like receipt, manuals,

boxes perhaps, any valuations on jewellery,

but also photographic evidence as well that they can provide us with,

just to get an idea of the type of goods and their descriptions.

It was at this point in the claims

process that things began to unravel.

When we received some photographic evidence relating to items of

jewellery that had been reported stolen,

we were able to review the metadata that sits behind those digital

photographs and we found that

12 of the images had actually been produced

nearly two weeks after they were reported as stolen.

Metadata is the information that is attached to every digital photo and

most crucially for insurers,

it includes the date that the photo was taken.

So, when they receive photos that were taken after the items were

allegedly stolen, it begs the question,

"Were they ever stolen at all?".

Understandably, Lloyds wanted some answers.

Once we had identified that there were potential challenges over the

photographs and how genuine the burglary was,

we arranged one of our agents to meet with the customer.

We explained to him that we had some concerns about how the photographs

had been produced and provided to us.

The customer explained to us that he

had actually used a memory stick that

he had found in the property because the photographs were originally

contained on a laptop which had been stolen.

He then used the memory stick in one of his friend's laptops and he

downloaded those images onto the laptop and then transferred them

onto his mobile phone and then supplied them to us.

He maintained that the

photographs had not been taken after the burglary.

Mr Field may have thought he had a rational explanation but as Dave

explains, the information embedded in the photos was from the date they

were taken, regardless of how many times they had been copied on to

different devices.

It didn't make any sense to us at the time

because the metadata behind the digital photographs

was still showing that they were taken nearly

two weeks after the reported burglary.

So not only had the customer lied about the £17,000 worth

of possessions that had been stolen,

but he had then taken photographs of the items

a substantial time after the alleged burglary and then he lied again,

to try and cover up the real date the photos were taken.

With discrepancies as big as those, there was only one conclusion.

As a result of the inquiries we completed and a lack of explanation

that was plausible to us by the customer,

we declined the claim and we cancelled the policy invoking the

fraud condition.

But Lloyds weren't prepared to leave the case there.

We reported the matter to the

Insurance Fraud Enforcement Department

and charges were brought against the customer to which he pleaded guilty.

He was required to reimburse the monies that we had already paid him

in part settlement of the claim. He was also fined £200.

With over £1,500 for the part settlement plus the fine of £200,

this guy will be paying back his debts for long time,

making him rue the day he tried to defraud his insurance company.

The vast majority of claims that we deal with are genuine in origin.

Unfortunately, a limited number of those claims are either fictitious

or they are exaggerated but we

remain committed to identifying those claims

and only paying the honest and genuine ones.

Later...

In the USA, the woman who was prepared to

kill her own husband for money.

And time is called on a personal injury claim, thanks to CCTV.

There is no evidence here that the shutters fell on him as he walked

through the doors.

This suggests that, in fact, there was no accident.

Travelling abroad can be a stressful experience.

Not only have you got all your luggage but you are also constantly

having to get things in and out of your bag,

like your passport, boarding pass,

hotel details, currency...

You get the idea. With so much going on,

it's easy to misplace a few things and that's where a travel insurance

policy can come into its own.

Despite the stress,

for most of us going on holiday is a real treat we look forward to.

And something we want to be able to look back on,

so a camera is crucial.

But carrying one around with you can be a precarious business.

CEGA is a Charles Taylor company

that provides travel claims services.

But as their head of technical claims explains,

not every claim they deal with is entirely above board.

Whilst on holiday in Italy,

the customer was taking a taxi and when he disembarked from the taxi,

he accidentally left his camera bag in the vehicle.

Now I am not sure that is strictly true.

Ordinarily, we would expect the

customer to provide us with a police report

to support the claim. On this occasion,

he had been to the police station and it was closed.

So, according to the claimant, not only is Italy in

a state of disrepair,

but the police stations are closed too.

Fortunately for him, CEGA are prepared to accept

an alternative to a police statement.

So, that is precisely what the claimant did.

When the claim documentation was received,

we noted that the customer

had provided us with a copy of the receipt

for the camera and a loss report which was

from the taxi company in Italy.

Due to the international nature of our business,

we have a lot of linguists that work within CEGA and on this occasion,

we passed the loss report over to an Italian speaker.

But the translation of the letter wasn't quite what Simon

and his team had been expecting.

Our Italian colleague told us that the words used within

the loss report didn't appear to

have been written by an Italian national.

They were more in line with someone taking the words off

an internet translation service.

Unless the taxi company was employing backpackers looking to

improve their Italian, the poor language used in the letter was

a real cause for concern.

As a result of the issues with the loss report,

our Italian colleague contacted the taxi company in question to discuss

whether the loss report originated from them.

But rather than allaying any concerns with the claim,

the phone call raised them even further.

The outcome of the conversation was that the taxi company

had never even heard of the customer,

nor had they issued this loss report.

So had something been lost in translation or was this claim

just a load of baloney?

It was at this point that the entire claim's validity was called into

question because we didn't understand how the customer could have obtained

a loss report from this taxi company when they had no record of him.

There was only one way Simon and his team were going to get any answers.

We decided that we needed to discuss these concerns with the customer

because, at this point,

we thought there might be some form of explanation he could provide.

Finally, the truth had come out.

Although the next part of this tale is slightly easier to predict.

This explanation was also not accepted because the bottom line was

the taxi company had no record of this incident.

You would be hardly surprised to hear that we weren't prepared to

accept the claim and the claim was declined in full.

Despite the forged loss report and numerous versions of events,

Simon and his team had exposed the allegedly stolen camera as a

clumsy attempt to cash in.

We prove on a daily basis that travel insurance is not

an easy target for fraudsters.

And we will go to great lengths to investigate claims.

Now, whiplash injuries have become

synonymous with car insurance claims,

so much so that many people are under the misconception that simply

being involved in a car accident, regardless of how it happened,

automatically gives them the right to make a personal injury claim,

citing whiplash as the reason.

Well, as this next story demonstrates,

that simply isn't the case.

For many of us, buses are an essential form of transport.

But for some unscrupulous individuals,

they're a target for bogus insurance claims.

Law firm Keoghs recently dealt with a case on behalf of Key Claims And

Administration Services,

which turned out to be an organised personal injury fraud on an

unprecedented scale.

There was a double-decker bus doing its usual routes

from Pontefract to Wakefield.

And during the course of that route, unusually,

19 people got on a bus at Ferrybridge

when normally nobody gets on the bus at Ferrybridge.

And during the course of the journey,

the bus was hit in the rear by a Nissan Micra.

Very quickly after that,

every one of the passengers who got on the bus intimated a claim against

the insurers of the Micra.

So it seems pretty straightforward.

The passengers were injured in the collision which was clearly the

car's fault and decided to claim compensation.

Our estimated value of the total claims was around £140,000

so a very significant sum.

If those claims had moved into litigation and solicitors had been

involved on both sides to defend the claims,

then you're talking about a quarter of a million or more.

All in, it was a pretty hefty set of claims but as the passengers were

saying they'd been badly injured, it all seemed to stack up.

Nevertheless, there was something about the accident that just

didn't seem right.

What was unusual about it was the number of claims that were made and

the speed with which they were made.

They contacted the bus company who

gave them the CCTV footage of the accident.

You can see everybody getting on the bus, all 19 piling on.

How they get on is quite noticeable, you know, this is not a quiet,

shy and retiring bunch of people, as you can see.

How they're dressed is very distinctive.

Taste in clothes aside,

it was once the group had boarded the bus that their action seemed a

little suspicious.

You'll see that there's a degree of preparation,

what appears to be preparation going on.

For example, there's somebody looking out of the back window and

they seem to be looking out, signalling.

There's a Nissan Micra that catches up to the bus and then spends a

couple of miles, actually, trying to keep pace with the bus

in a quite comical situation.

But there was nothing funny about what happened next.

From the passengers' reactions, it looked like a significant crash.

Then Damien spotted something unusual.

If you look at the paper cup here...

It doesn't move at all on impact.

And yet you'll see one of the

defendants flings themselves forward as if

they've been catapulted out of their seat

by a really significant collision.

Something definitely wasn't right.

Just have a look at this honest

passenger who had nothing to do with the fraud.

While the gang are all holding their necks,

this passenger doesn't seem

aware that anything has happened to the bus.

As you will see, the occupants of

the top deck start to pile downstairs,

holding their necks.

Rubbing their shoulders in a comical and laughable way.

First, they get off, come past the driver.

One of the defendants actually stole

three £5 notes from the driver's cab,

which was outrageous.

This contortionist certainly doesn't paint the picture of someone that

has just been injured in a crash.

The driver was threatened.

It was a very unpleasant incident.

It appeared that making money was their ultimate aim,

either by robbing the bus driver or by staging a fraudulent accident.

Then they all go outside and here is the other thing,

the cameras show that not one of the people on the bus goes to speak to

the driver of the Nissan. Either to ask if they are all right or to

remonstrate with them, which is what you would do. If the driver of a car

had hit the back of the bus you were on, and you had been injured,

you wouldn't speak to the driver of the bus, who is innocent,

you would speak to the driver of the other car.

Everything about the footage pointed towards this being a planned

collision and it was no coincidence

that every single member of the group

claimed for soft tissue injuries to the neck, back and shoulders,

otherwise known as whiplash.

To see this level of injuries, this volume of injuries,

you would normally expect for it to be a really quite significant

accident. Not a minor tap in rear, which is what this was.

Through investigation,

law firm Keoghs were able to link the people in the Nissan Micra with

the claimants on the bus, suggesting this was no accident.

It quickly became clear they had failed to admit they had any

connection to each other.

When insurers spoke to the driver of the Nissan,

no pre-accident associations where admitted.

In fact, they were denied.

And the reason that that's significant is because

they don't want us to know that they're all in it together.

They want it to look like an innocent accident.

With all the evidence gathered, the case proceeded to court.

But this lot weren't prepared to give up just yet.

Various attempts were made by defendants through their barristers

to strike out parts of the evidence.

Various attempts to say, in fact,

that they had no knowledge of these claims,

that they'd been contacted by a claims management company and that

the claims had been advanced on

their behalf without their knowledge.

It was unbelievable the lengths these cheats would go to to get away

with it. But with the substantial evidence that had been gathered,

the judge wasn't taking any nonsense.

During the course of the case, the judge, having seen the CCTV footage,

described the acting on the bus as bizarre and pathetic,

and, paraphrasing what the judge said,

that it was clear that they all knew

what was going on. That they were all in it together.

And that they were all therefore, in that sense, equally culpable.

In the end, these fraudsters realised

they had no choice but to give in.

And every single one of them pleaded guilty.

However, the judge was determined to make an example of them.

Custodial sentences of 29 years and four months were handed down,

and the vast majority of those sentences were immediate custodial

sentences of up to two-and-a-half years.

And this was a real shock for these defendants.

All of the gang were sentenced,

with the longest jail term going to Stephen Sankey, who got 21 months.

David Southern, the gang member who also stole money from the driver's

cab, got 18 months.

And Richard Harper, the driver of the Micra,

got 12 months and was disqualified from driving for three years.

Ultimately, it was a diabolically poor attempt to swindle money out of

an insurance company by deliberately causing an accident.

And, once again, those caught cheating the system

have been rumbled.

When you look at it in the round, it is the most ill-planned,

the most badly thought through enterprise probably that's been

caught on camera in a case of this type. It's pathetic.

No BAFTAs for this lot, no.

Now, for many of us, heading down to the pub is a British tradition.

In my humble opinion,

catching up with a few friends and having a couple of drinks can be a

fantastic way to unwind at the end of the day.

But the last thing any of us expect when popping down the local is to

sustain a serious injury.

Nowadays, CCTV cameras can be seen pretty much everywhere.

On buses,

trains,

on the high street,

and also in pubs and bars up and down the country.

These all-seeing eyes can be the difference in cases where it's one

person's word against another's.

Leandro Kelly is part of the JD Wetherspoon legal department

and knows all too well how important CCTV can be.

We received a claim for compensation from a customer who says that,

while he was walking through the doors of our pub,

the door shutter system activated and hit him in his head.

The claimant said that he had bruises to his neck and his back and

that he also lost his balance as a result of the accident.

Now, depending on your tipple,

it isn't unreasonable to expect

a sore head after visiting the local pub.

However, this poor chap hadn't even had a drink.

The claim was valued up to £5,000 for physical injury and the claimant

also claimed the cost of care that he received because of his injuries.

So a nasty and unfortunate accident.

But nothing to set alarm bells ringing.

The claim had all the hallmarks of a genuine claim.

The claimant instructed his solicitors

the same month that the accident took place.

And he also was medically examined a few months after that.

So we thought that this would be a fairly straightforward case,

although we know we had to investigate it further.

However, when JD Wetherspoon looked into the circumstances of the

accident, a rather interesting discrepancy cropped up.

The first thing we did was to speak to the pub.

We spoke to the pub manager,

because if this involved a part of the premises that was defective or

wasn't working, we needed to make sure that he or she was aware of it

and whether or not they had taken steps to remedy it.

And if, in fact, they were aware of the incident happening because of

this. When we spoke to our staff members,

they did recall that this customer came up and said that he had almost

been hit. But when we received the claimant's actual claim form,

he said that he had been hit by the shutters.

Well, if you've almost been hit, then you have no claim.

But if you had been hit, you do have claim.

What had initially appeared to be a routine claim was beginning to sound

rather suspicious.

For customer safety, JD Wetherspoon pubs are fitted with CCTV cameras.

So perhaps they would know the answer to what really happened.

Looking at the CCTV footage, I'd expect to see that,

while the claimant was walking through the doors,

the shutters activated and dropped on him.

Yeah, that is what you would expect to see.

The only problem is, the footage tells a slightly different story.

No, your eyes aren't deceiving you, the claimant isn't there,

because he didn't even pass through the doorway.

There's no evidence yet that the shutters fell on him as he walked

through the doors. This suggests that the accident doesn't happen as

he says it happens. In fact, there was no accident.

Immediately, JD Wetherspoon knew this was an open and shut case.

Even if the shutters were falling,

there wouldn't have been enough time for them to hit him because the

shutters move so slow that, walking through the door,

there would have been no contact.

With crystal clear evidence that there was no accident and this was

an opportunistic attempt,

JD Wetherspoon were expecting this claim to be retracted.

And significantly quicker than the shutters on their pub door.

Based on all the evidence that we gathered,

we invited the claimant's solicitor to withdraw the claim.

The claimant's solicitor didn't withdraw the claim,

so we made a formal application to court to ask the court to dismiss

the claimant's claim, and also to make a finding that the claimant was

being fundamentally dishonest in trying to make a

personal injury claim where

there was no evidence of an accident.

By continuing to pursue his claim,

the claimant was playing a dangerous game as the punishment for

fundamental dishonesty is far more than a slap on the wrist.

If someone is found fundamentally dishonest in court,

it means that they were trying to make a claim simply to

get compensation.

It is taken very seriously by the court and the claimants can be

ordered to pay all the cost of all of the court proceedings,

including our costs.

Luckily for the claimant, JD Wetherspoon called time

on the court case.

The claimant has now entered into a back payment plan where he's having

to pay us back our costs in the amount of about £5,000.

It seemed clear to us that this claimant was trying to make a quick

buck but he learned a rather expensive lesson

that insurance fraud doesn't pay.

Still to come...

..a woman attempts to claim compensation two and a half years

after saying she was perfectly OK.

This was a claim presented arising out of a road traffic accident.

The claimant, in actual fact,

presented no evidence to support her claim whatsoever.

Now, on this programme,

we try to highlight the depths that some fraudsters will sink to

in order to get their hands on a pay-out.

Quite frankly, it's unbelievable.

But that's especially true in America, where everything is bigger.

Over there, insurance fraud is estimated to cost a

staggering 40 billion per year.

But while many fraudsters will only go so far as telling lies,

there are some who will stop at nothing if it means

getting what they want.

In Columbus, Indiana,

Alan and Tammy Duval were the picture-perfect couple.

After a whirlwind romance, they were married in just 12 weeks

which, although not unusual,

did spark concerns amongst some members of Alan's family.

However, none of them could have possibly predicted

the events that would unfold.

On the 24th of August 2007, Tammy made an urgent 911 call.

She told the operator she had returned home from work to find Alan

dead in a chair in the back yard.

Initially, it looked as though he had died of alcohol poisoning.

But on closer inspection,

it transpired Alan and Tammy weren't the happy couple they had once been.

In fact, they had separated a few months earlier and Alan had warned

his family that, if anything were to happen to him,

they should be suspicious of Tammy.

Following his death, Alan's family went straight to the police,

who immediately requested an autopsy.

The toxicology report said that

Alan's blood had a morphine concentration

of around 100 times that of a therapeutic dose.

The same amount of morphine was also found to be missing from the

nursing home where Tammy worked.

But how had Alan ingested so much morphine without realising?

It turned out that the evening before his death,

Tammy had made Alan her infamous dirt pudding as a special treat,

laced with the morphine she had stolen, it was a deadly dessert.

But why would Tammy want her estranged husband dead?

Investigations revealed that she had recently encouraged Alan to take out

a 100,000 life-insurance policy.

Tammy was the sole beneficiary.

What made this sickening plot even worse

was the policy had been obtained

through an insurance agent that

Tammy had been having an affair with.

So not only had Tammy Duval killed her husband by giving him a lethal

dose of morphine, but she had also taken out a life insurance policy so

she could make a profit out of his death.

And, as if that wasn't bad enough,

she'd also been cheating on him the entire time.

Following Alan's death,

the insurance agent advised Tammy not to attempt to cash in the policy

as Alan had died during the policy's grace period,

and any claims would look suspicious.

Tammy ignored him and submitted a claim for payment anyway.

As the investigation continued,

it was discovered that an ex-boyfriend

of Tammy's had once claimed that

she had tried to poison him with a tainted pudding as well.

Tammy Duval was arrested and later charged with murder,

six counts of insurance fraud, and

three counts of obstruction of justice.

She was sentenced to 61.5 years in prison.

Although justice had been served,

nothing can bring back the victim of this diabolical crime.

Now, many of us will be familiar

with the recorded message we hear when we

phone an insurance company telling us that the call is being recorded.

There are a number of reasons why insurers record phone calls,

and this next case demonstrates one of the most important.

BLM are a legal firm who represent many insurance companies.

Naomi Grant is one of their fraud partners who

recently dealt with a case

that was two and a half years in the making.

This was a claim presented arising out of a road traffic accident in

December 2012.

The defendant had been following the claimant out of the junction.

She stopped suddenly and the defendant drove

into collision with the rear of her vehicle.

So a classic prang which was duly followed with a classic claim.

Fairly straightforward claim in itself,

the claim for vehicle damage and hire came in for just under £2,000.

As a matter of course, the insurer

got in touch with their policyholder.

About four days after the accident,

the insurance company telephoned the claimant to really just check she

was OK and a standard question in that call was to ask the claimant

whether she had suffered any injury.

There were no suspicious circumstances at all, no concerns,

and after the claimant had confirmed that she wasn't injured,

the vehicle damage claim was quickly resolved and the matter closed down.

Ordinarily, that would be the end of it.

But not in this case.

So it was really quite surprising

to the insurance company when in May 2015,

some 30 months after the initial accident,

the insurance company were presented with a claims notification form in

which the claimant alleged that she had suffered a whiplash injury which

she claimed she was still suffering from and had been suffering from

since the point of the accident.

She also claimed that she had been referred by the hospital for an MRI

scan and that the MRI had revealed that she had arthritis which the

claimant was trying to say was directly related to the accident.

So after initially confirming that she was absolutely fine,

the woman was now claiming that,

for the past two and a half years she had been in so much pain that it

was having a huge impact on her life.

That's some U-turn.

These injuries would have been quite dramatic,

would have affected her life quite significantly.

To say that she was still suffering some two years after the accident.

So you would expect the claimant to really go into evidence that,

with medical reports, a copy of an MRI scan,

so that's what the insurance company asked for.

It's a fair assumption.

But, of course, a full medical history

wouldn't be a problem considering

the numerous appointments the woman must have attended

over the past two years.

Despite her assertions of injury, the claimant, in actual fact,

presented no evidence to support a claim whatsoever.

It is really surprising that the claimant didn't present any evidence

when given the opportunity to do so.

Had somebody been genuinely injured,

then you would fully expect them to

freely attend for medical examinations

and happily present the evidence to support their injury.

So the fact that, in this claim,

the claimant didn't present any of

that evidence in itself speaks volumes.

On the other hand, BLM did have one piece of rock solid evidence.

That same phone call the insurance company had made

four days after the accident.

Faced with the evidence of her own voice,

the claimant sensibly decided not to pursue the claim.

The key to the successful defence of

this claim really was that phone call

made by the insurance company to the claimant

four days after the accident.

What appeared at the time to be a routine phone call and a

routine line of questioning to ask

whether the claimant had been injured,

really proved so beneficial when it came to defeating a very spurious

injury claim presented some 30 months later.

For Naomi, exaggerated claims

are something she is all too familiar with.

Quite often, claims that come in late,

people hope that enough time

has passed that the claim just won't get queried.

Unfortunately, that's not the case where claims are presented

so long after the event.

Insurance companies will look at those in a lot more detail,

especially where there's no evidence presented

to support the allegations that are made.

From organised criminal gangs to exaggerated household claims,

insurance fraud hits all of us in the pocket.

But instead of getting away with it,

more and more of these fraudsters are being Claimed And Shamed.