Episode 2 Claimed and Shamed


Episode 2

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Transcript


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Insurance fraud in the UK has hit epidemic levels.

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

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That's almost £3.6 million every day.

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Deliberate crashes, bogus personal injuries,

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even phantom pets.

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

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

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But insurers are fighting back,

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exposing under just 15 fake claims every hour.

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Armed with covert surveillance systems...

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That's the subject out the vehicle.

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..sophisticated data analysis techniques...

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POLICE!

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

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Police, don't move! Stay where you are!

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

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Just don't lie to us.

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All those conmen, scammers and cheats on the fiddle

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are now caught in the act and claimed and shamed.

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Suspicious car damage gives forensic investigators cause for concern.

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Our engineer alerted us to his concerns that the damage

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didn't seem to be consistent with the accident circumstances,

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and he suspected that the damage may have actually been exaggerated.

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A severe case of amnesia catches out a convicted criminal.

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He struggled as to whether he'd fallen down 12 steps or two steps.

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He was also in difficulties when presented with

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his medical and employment history.

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..and a puppy owner's failure to get his facts straight

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rings alarm bells.

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His father had categorically advised him that the puppy

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had injured itself at ten o'clock -

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that was well and truly after the policy had been set up.

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Fraudsters will often exaggerate the details of an accident, or the

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damage caused to their vehicle, in order to try and get more money out

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of their insurance company.

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But it is a big risk, because if they're caught,

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not only will they end up out of pocket,

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but they could also be adding a criminal record

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to their list of credentials.

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There are over 25 million cars on Britain's roads,

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so it's no wonder that car crashes are pretty common.

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But even if the crashes themselves are genuine,

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the claims being made to insurers may not be.

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Simon Roylance has been working at insurance company LV for five years,

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and is always on the lookout for bogus claims.

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Our customer contacted us to advise that he'd been involved in an

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accident. He'd just reserved out of a parking bay at some shops.

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He was stationary at this point,

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giving way to another vehicle, when a van driver,

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who was also parked in one of the parking bays,

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didn't see his car and reversed into the passenger side rear.

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During this call, our customer told us that the vehicle had sustained

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quite significant damage.

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Wow. That is an awful lot for one collision,

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and it wasn't just the customer's Mercedes

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that had taken a hard knock.

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The customer said that he and his wife were in the vehicle at

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the time, and that they were both injured in the accident.

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They both had back pain, and he said that they'd also woken up

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the next morning with pain in the neck.

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So, all in all, a pretty bad 24 hours for this couple,

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but at least they were safe in the knowledge

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that their Mercedes was insured.

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As is the case with most motor insurance claims for damage,

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the vehicle involved is inspected before any money is paid out.

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The standard procedure in a case like this is for an engineer to take

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a look at the damage to the vehicle,

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and then assess whether it's repairable

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or whether the car needs to be written off.

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The engineer was provided with photographs of the damaged Mercedes,

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and was quick to come to a decision.

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In this case, the damage was so great that our engineer said that it

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was actually a write-off,

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with a value of around £13,500.

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So, a fair amount of money,

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but on closer inspection of the case details,

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something didn't seem quite right.

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It was at this point that our engineer alerted us to his concerns

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that the damage didn't seem to be consistent

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with the accident circumstances, and he suspected that

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the damage may have actually been exaggerated.

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The engineer then referred that into the Claims Crime Prevention Team

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for further investigation.

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They spoke to our customer again,

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just to go over the accident circumstances and make sure

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we were clear on what actually happened.

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The claimant was describing exactly the kind of accident that happens

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all too often in these types of parking areas,

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but the sheer volume of the damage to the Mercedes still

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didn't look like it'd been caused by a single impact

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with the Citroen van.

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LV decided to get forensic collision expert Brian Henderson involved,

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to look at the photographs and give his verdict on the case.

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What we expect is, if you look at the damage to one vehicle,

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you are expecting to see damage

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of a similar magnitude and at a similar height,

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to the damage on the other, because the two must match up.

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What we actually found was a surprise.

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There was considerable damage to the rear nearside,

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and indeed rear of the Mercedes ML.

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The damage extended all the way up to the roof,

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the glass was broken

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in the rear nearside window.

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And, indeed, there were considerable indentations in the roof,

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which was clearly outwith the height of the damage to the Citroen.

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But what was even more suspicious than the fact that the Citroen had

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hit the Mercedes higher than was physically possible,

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were the shapes of the marks on the bodywork.

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There were numerous areas where the vehicle

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had been struck with a hammer.

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I can only presume that that was to try and give the picture that

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perhaps there was more damage caused.

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It appeared that the claimant saw this as an opportunity to have his

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car written off, and had repeatedly hit it with a hammer

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to make sure it couldn't be repaired.

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It's not the most subtle

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of claims put forward

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that we've seen in 23-24 years that I've been doing this.

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It was rather simplistic in its approach, to be fair.

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Brian was 100% certain that the damage to the Mercedes couldn't have

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been caused by a single impact with the van, and reported his findings

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back to the insurance company.

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Shortly after we received the report from the forensic collision

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investigator, we received a phone call from our customer,

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asking what the progress had been on his claim.

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During that call we advised our customer that we didn't believe

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all of the damage to his vehicle was related to this accident,

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and that we wouldn't be settling his claim.

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Suspecting the claim was fraudulent, LV reported it to the police.

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After being interviewed by the police,

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our customer admitted an offence of fraud by false representation,

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and he was given a police caution for this.

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This means that he's now got a criminal record.

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He agreed to pay £1,000 compensation

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to LV and, in addition to all this,

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he'd also smashed up his £13,500 Mercedes.

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This man's attempt to go at it hammer and tongs had not only

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damaged his precious car,

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but left his bank balance in the red.

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It was another victory for the insurers,

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but one which left a bitter taste in their mouths.

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Whilst the majority of claims are genuine,

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false claims such as this are a problem.

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They drive up the premiums for everyone,

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and ultimately everybody foots the bill for that.

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The insurance industry and the police, though, are determined to

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tackle this kind of behaviour.

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And anyone caught committing this kind of fraud

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can expect prosecution, maybe even a criminal record.

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Now, when it comes to motor insurance claims, it's becoming

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increasingly common that the damage caused in a crash

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just doesn't match up with the description of the accident itself.

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As we've just seen, insurance companies are turning to forensic

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experts to examine the vehicles involved in suspicious claims,

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and determine if the given circumstances are correct

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or whether the claimant is trying to pull a fast one.

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Now, if, like me, you're wondering how these experts can tell

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the difference between a real crash and one that's been exaggerated,

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or even made up entirely, then now's your chance to find out.

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We are a forensic investigation company dealing with engineering

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motor vehicles, in particular.

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And we provide expert evidence on

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all manner of things - collisions, mechanical failures,

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fires - for the benefit of the court, ultimately.

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The experts at GBB all have mechanical engineering degrees

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or equivalent.

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Right the way up through to doctorates of engineering.

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We all have different specialisms.

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Mine happens to be relating to low speed and whiplash.

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Brian and his team had given the claimant's version of events,

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and were asked to match these up with the actual damage to the vehicles.

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Well, in any claim, we try to think that actually the matter

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is legitimate, for starters,

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and we will try and look for evidence to support the fact

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that it is legitimate.

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If we then cannot find that,

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we look for the evidence to try and support that it is fraudulent.

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With fraudulent claims becoming increasingly frequent,

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GBB set up their own unique crash testing programme,

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so they can better understand how the vehicles involved in a crash

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interact with each other.

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We are very, very good now at determining how damage was caused.

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So, in other words, at the moment that the other two vehicles come

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together, we are very, very good at being able to tell you

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precisely how they came together. The angle that they came together,

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what they were doing at the moments that they came together.

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Over the years, they've seen certain trends emerge when

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it comes to fraudulent claims.

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We initially used to get staged collisions.

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So, individual collisions with numerous people in them,

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so that actually it was a single high-value claim.

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What we find now with organised frauds is, particularly, is

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a series of lower value claims,

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perhaps in the hope that they're not investigated as rigorously as

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a higher value claim would be.

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With thorough testing of their own vehicles in accident reconstructions,

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they're able to catch out the fraudsters,

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no matter what their game is.

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I think the current trend towards slam-ons and so forth,

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and inducing collisions from others, is a very, very dangerous practice.

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I don't think for one minute any regard is given.

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Frankly, it's reckless.

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And it's only by good luck that somebody's not seriously injured

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in some of these cases.

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A victim's statement holds the key to a dubious claim.

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Every year, insurance companies receive around 130,000

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fraudulent claims.

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With figures steadily increasing,

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insurers are investing millions of pounds to identify

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these claims and catch the people behind them.

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However, when fraudulent claims are made against a state-run system,

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it means the cost of fraud is being funded by us - the taxpayers.

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The UK is home to 150 prisons,

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housing around 86,000 prisoners.

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But if you think this would be the last place to find a fraudulent

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claim, then you'd be sorely mistaken.

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Richard Vince is responsible for eight high security prisons

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in England and Wales.

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He knows just how common fraud in prisons can be,

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and the wider impact this can have.

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Fraudulent claims within prisons are a problem,

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in the same way that fraudulent claims made outside a prison is a problem.

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You know, that comes at a cost to society within the prison service.

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But this isn't the only reason why claims made in prisons need to be investigated.

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It's important to fight the claims from two perspectives, really.

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The first is, it's ongoing criminality from somebody who is

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already in prison for criminality.

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And secondly, it comes at a cost to the public purse,

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and that detracts

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valuable resource away from the ambitious reform programmes

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that we're under way at the moment,

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and our ability to reduce reoffending.

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And that has a very direct impact on public safety.

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Sarah McCracken deals with litigation for the high security prisons,

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and worked on a case at HMP Manchester back in 2012.

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The initial claim that came in was that the prisoner had slipped

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on a wet patch on the stairs.

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He'd fallen, hurting his lower back and his elbow.

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He was claiming of chronic back pain

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that was continued right up until the date

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that he put the claim in.

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Also, his injury to his elbow was quite serious as well,

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by all accounts.

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An unfortunate accident resulting in quite serious injuries,

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a claim that was likely to cost the prison service around £3,000.

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When the claim first came in,

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we treated it as an absolutely genuine claim,

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we had no reason to believe at that stage

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that there was anything untoward.

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The prison service began an investigation, which looked into

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the allegations made by the prisoner.

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As he had been injured in the fall,

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the first step was to have a look at his medical records.

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In this case, two medical experts were consulted.

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One was a GP, one was an orthopaedic consultant.

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The GP's report was extremely helpful towards the claimant's case.

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He did think that the injury was consistent with a slip on water,

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and the pain that he was still in was as a direct result of that accident.

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It looked like the prison service would be paying out for the claim.

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Until an interesting discrepancy popped up.

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The claimant had stated to the GP that he was unable to work.

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We knew from our own prison records that he was currently working

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and employed as a wing cleaner.

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The prisoner had claimed his injuries were so severe he'd been

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unable to work.

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Yet records show that he had continued with his prison job

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after the accident had taken place.

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And when the orthopaedic consultant's report came back,

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it cast a shadow over the case.

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He was able to interrogate the background medical evidence,

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and found that the claimant did have a quite extensive history

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of lower back pain and Sciatica.

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The consultant had spotted that the back pain had been a problem for

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some time before the accident.

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So, the prison service decided to investigate,

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and got their solicitors involved.

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There were a few things that caused us to pause and think further

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investigations were necessary.

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Firstly, the accident location.

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It appeared unlikely that anyone would have been in that location,

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and therefore that liquid could have been spilt

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since it was last cleaned.

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In addition, the claimant was in fact a cleaner within the prison.

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To some extent, therefore,

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it was his responsibility to ensure that the location was clean.

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It's also the case that he perhaps should have been better able

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to identify the hazard in this particular location,

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if it had been there.

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Henry and his team then turned to the prison staff to see if they

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could shed any light on the matter.

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We took two witness statements from two prison officers.

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The first officer was an officer who the claimant said he'd spoken to

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after the accident took place.

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That officer had no recollection of that conversation.

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The second prison officer we approached gave a helpful statement

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in relation to the accident location.

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Essentially backing up our version of events

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that this was not a location that was likely to have been

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accessed by anyone else overnight whilst prisoners

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were locked in their cells, or in the period since the location

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was last cleaned.

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So, let me see if I've got this straight.

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One, the prisoner was claiming he was unable to work due to his injuries,

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yet he continued to be employed by the prison service as a cleaner.

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Two, he had a history of back pain

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that started long before the accident had occurred.

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And three, on the day of the accident,

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the prisoner was the first person to use the staircase,

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making it extremely unlikely there was even any liquid

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for him to slip on.

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Looking at all the evidence,

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there appeared to be very little to support the claimant's case.

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And therefore, we thought we were in a very strong position to take

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this case to trial.

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13 months after the claim had been made,

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a hearing took place at Manchester Civil Justice Centre.

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It's fair to say that the claimant was not strong in his evidence

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at trial. He struggled as to whether he'd fallen down 12 steps,

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or two steps.

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He was also in difficulties when presented with his

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medical and employment history,

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to such an extent that his own barrister later described him

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as a poor historian.

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The claim was dismissed,

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and the prisoner was ordered to pay £9,000 in legal costs

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to the Prison Service.

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In this case, we thought it was the right result,

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that it was entirely in line with the evidence the judge had seen,

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and that he took the right decision in dismissing the claim and finding

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no fault on the part of the Prison Service.

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So, a great result all-round.

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And if the legal costs weren't a big enough price to pay,

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three years after his release, this con artist really got his comeuppance.

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Despite claiming he couldn't work after the accident,

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he was later employed as a builder.

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He was climbing a ladder when he was the victim of a genuine accident.

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The ladder slipped, causing him to crash to the ground.

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He was hurt but not badly.

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Now, I'm not sure if you believe in karma, but,

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after watching this,

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I think I might just be convinced.

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All right, let's talk rear-end shunts.

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Which, if you're wondering, isn't an elaborate dance move.

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No, that's when one car hits another from behind.

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Now, when this type of accident occurs, it's almost always

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presumed the driver who crashed into the car in front

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is at fault for not driving at a safe stopping distance.

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But some fraudsters see these collisions as the perfect opportunity to

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pull a fast one on insurers.

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Insurance companies pay out around £28.6 million

0:21:210:21:25

in motor claims every day,

0:21:250:21:27

many of which are accidents involving rear-end collisions.

0:21:270:21:30

Whilst the majority of these are innocent mistakes,

0:21:320:21:34

some are far from accidental.

0:21:340:21:36

Allan Peak is a fraud manager at Markerstudy Insurance.

0:21:380:21:42

He received a call from a customer reporting a rather suspicious crash.

0:21:420:21:46

Our policyholder's version of events was that he was stationary

0:21:480:21:53

at traffic lights behind this vehicle.

0:21:530:21:56

The third party vehicle commenced on to the roundabout.

0:21:560:22:00

Our policyholder followed.

0:22:000:22:02

And then, suddenly, the third party brakes quite heavily.

0:22:020:22:05

The policyholder also brakes.

0:22:050:22:08

He was unable to stop in time, and he collided with the rear

0:22:080:22:11

of the claimant's vehicle at around 10mph.

0:22:110:22:14

After the collision, the policyholder spoke with

0:22:160:22:20

the third party, asked directly, "Why did you stop?"

0:22:200:22:24

There was no reason for them to stop quite so suddenly.

0:22:240:22:27

And the third-party passenger suggested that there was some

0:22:270:22:30

sat nav-related reason for that stop.

0:22:300:22:34

Now, I might be out of the loop,

0:22:360:22:38

but since when did a Sat Nav order a driver to make an emergency stop?

0:22:380:22:42

The policyholder was suspicious,

0:22:440:22:46

and immediately called his insurance company.

0:22:460:22:48

They then received a claim from the couple in the car in front.

0:23:190:23:23

But when asked for their account of the accident, the circumstances

0:23:230:23:27

they gave were completely different.

0:23:270:23:30

The third-party's version of events was that they were simply stationary

0:23:300:23:34

at the traffic lights for four or five seconds,

0:23:340:23:36

when our policyholder collided with the rear of the vehicle.

0:23:360:23:39

Hang on, I thought the accident happened on the roundabout,

0:23:410:23:45

not at the traffic lights?

0:23:450:23:46

And as for the claim itself,

0:23:470:23:48

it was far greater than the insurers had expected.

0:23:480:23:51

The claimant's version suggested a fairly significant impact

0:23:540:23:57

was sufficient to write the vehicle off

0:23:570:24:00

and cause personal injury to both occupants of the vehicle.

0:24:000:24:03

The insurers then asked for evidence to support the personal injury

0:24:040:24:08

claims, and subsequently received a report from an independent GP.

0:24:080:24:12

In the report, the claimant stated on a scale of one to ten,

0:24:130:24:17

her pain had been an eight.

0:24:170:24:19

She said that for eight weeks, sleep was disturbed to

0:24:190:24:23

the extent she had take sleeping pills.

0:24:230:24:25

She claimed that she was very anxious to the extent that she was

0:24:250:24:28

no longer able to drive a vehicle.

0:24:280:24:30

And she was unable to attend the scene of the accident again

0:24:300:24:34

because it gave her nightmares.

0:24:340:24:36

Well, that is a pretty big statement to make for someone whose car was

0:24:360:24:40

crashed into - and remember, at a low speed.

0:24:400:24:44

Overall, we estimated the value of the claims for injury

0:24:440:24:47

to be between £2,000 and £3,000 each.

0:24:470:24:50

So, along with the claims for vehicle damage and travel expenses,

0:24:500:24:53

we were looking at a claim that included third-party solicitor costs

0:24:530:24:57

of up to around £22,000 in total for both claimants.

0:24:570:25:01

Markerstudy then involved their own lawyers, DWF Solicitors,

0:25:040:25:08

and asked them to investigate the allegations of fraud.

0:25:080:25:12

From the outset of this, it's quite clear there's a discrepancy

0:25:120:25:15

in the two accounts that have been provided.

0:25:150:25:18

Ordinarily, we would assume that any person who drives into the rear

0:25:180:25:21

of someone else would naturally be at fault for the accident.

0:25:210:25:25

That's generally an accepted principle.

0:25:250:25:27

The quirk to this case is that the defendant's suggesting that

0:25:270:25:30

the claimant has stopped deliberately. So, actually,

0:25:300:25:33

the defendant is alleging that the claimant driver is at fault for

0:25:330:25:35

the collision. Obviously, that's not what the claimant is saying.

0:25:350:25:38

The claimant is saying "No, you've hit me in the rear,

0:25:380:25:40

"therefore, you should be held at fault."

0:25:400:25:42

To get to the bottom of exactly who was at fault,

0:25:420:25:45

the solicitors turned to a witness who had been following both vehicles

0:25:450:25:48

at the time of the accident.

0:25:480:25:50

The independent witness was supportive of the defendant's

0:25:500:25:54

version of events. He had the fortunate view of being in a lorry,

0:25:540:25:58

so he could see in front of both vehicles,

0:25:580:26:01

and was able to say quite clearly that the claimant

0:26:010:26:03

had stopped without apparent reason,

0:26:030:26:05

and not only that, stopped very abruptly,

0:26:050:26:08

which again supported the broad principle of our defendant

0:26:080:26:11

saying that he had been deliberately induced.

0:26:110:26:13

DWF had now gathered enough evidence

0:26:150:26:18

to prove that the couple in front were at fault,

0:26:180:26:22

and decided to take the case to court.

0:26:220:26:24

But on the day of the trial, the claimant failed to turn up.

0:26:240:26:28

The big inference we were able to draw from their lack of attendance

0:26:280:26:32

was that we'd hit the nail on the head,

0:26:320:26:34

and the allegations obviously had merit and weight.

0:26:340:26:36

The claim ended up being dismissed at hearing.

0:26:360:26:39

The judge granted the defendants nearly £7,000

0:26:390:26:42

in respect of their own costs,

0:26:420:26:44

which were incurred during the defence of the claim.

0:26:440:26:47

A superb result all round.

0:26:480:26:50

In terms of the overall outcome of the case, we were very, very pleased

0:26:500:26:54

that Markerstudy avoided having to make any payments.

0:26:540:26:56

We were also confident that had a judge considered the case

0:26:560:27:00

and listened to the claimant's evidence,

0:27:000:27:02

then a judge would have found for us and established

0:27:020:27:05

that the claim had been induced.

0:27:050:27:07

Unfortunately, cases like this are becoming more and more common,

0:27:070:27:11

and it's the innocent victims who end up suffering the most.

0:27:110:27:15

It's vital for us to come combat this type of fraud and to identify

0:27:150:27:19

as many of these cases as we possibly can, and to subsequently defend them,

0:27:190:27:22

for a number of reasons. Most importantly of all, actually,

0:27:220:27:26

these type of collisions are putting innocent motorists at risk.

0:27:260:27:30

This was a minor impact,

0:27:310:27:32

but how much would it take for one of these to go wrong and for

0:27:320:27:35

serious damage and injury to be caused to an innocent motorist?

0:27:350:27:38

Still to come...

0:27:440:27:45

A conniving couple are caught out when they make a comedy of errors.

0:27:450:27:50

She showed little or no emotion in regard to the fact that

0:27:500:27:53

he'd just been held at knife-point and had numerous items of

0:27:530:27:56

significant value stolen from her home.

0:27:560:27:59

We are a nation of pet lovers,

0:28:040:28:06

with around 20% of us insuring our furry friends.

0:28:060:28:10

And it's no wonder why, as recent rises in vets' fees

0:28:100:28:13

means insurance companies are now paying out

0:28:130:28:16

£1.8 million in claims every single day.

0:28:160:28:21

Agria is one of the world's leading pet insurers,

0:28:230:28:26

and is well aware of the problem of insurance fraud.

0:28:260:28:29

So, before getting the cheque-book out,

0:28:290:28:31

they check and validate every claim that comes in.

0:28:310:28:34

Simon Wheeler, Agria's managing director,

0:28:370:28:39

tells us about a tricky case

0:28:390:28:41

they dealt with that concerns a poorly pup.

0:28:410:28:43

We received a call from our policyholder, who advised us

0:28:450:28:48

that his new Border terrier puppy

0:28:480:28:50

had had an accident in the evening, had broken its leg,

0:28:500:28:54

and they'd had to rush it to the out of hours emergency vets.

0:28:540:28:57

It looked like a clear-cut case.

0:30:030:30:05

The accident had happened before the policy had started,

0:30:050:30:08

so, unfortunately, the customer wasn't covered.

0:30:080:30:11

We then had yet another call from the owner, two hours later,

0:30:110:30:15

and he'd revised some of his facts.

0:30:150:30:17

He'd made a phone call to the vet,

0:30:170:30:19

and he'd made a phone call to his father, and his father had

0:30:190:30:22

categorically advised him that the puppy had injured

0:30:220:30:25

itself at ten o'clock and, so, no,

0:30:250:30:28

that was well and truly after the policy had been set up.

0:30:280:30:30

So, having initially claimed that the puppy broke its leg around 9pm,

0:30:420:30:46

the policyholder had now changed his story to say that it had happened

0:30:460:30:50

around 10pm, conveniently, after the policy had been put in place,

0:30:500:30:55

and when the insurance had become valid.

0:30:550:30:58

So, the next we heard from the policyholder was when the claim came through.

0:30:580:31:02

A claim for £1,100.

0:31:020:31:04

On the claim form were all the latest set of details.

0:31:040:31:08

The next step in the process was that we contacted the breeder,

0:31:090:31:12

just to verify what had been said in the claim form.

0:31:120:31:15

And the details they gave us exactly matched the details in the claim form.

0:31:150:31:20

They were like a script, down to the letter.

0:31:200:31:22

Could the owner and the breeder have spoken to align their stories?

0:31:260:31:30

Or was the insurance company barking up the wrong tree?

0:31:300:31:34

Agria decided to make contact with the vet to see if they had any

0:31:340:31:38

record of the timings for the evening in question.

0:31:380:31:41

If the owner was telling the truth,

0:31:410:31:43

the vet's record would show the consultation happening after 10pm.

0:31:430:31:48

The sequence of events would be,

0:31:490:31:51

animal was injured at about ten o'clock,

0:31:510:31:53

the owner would try to find an out-of-hours vet,

0:31:530:31:56

would go to the out of hours, the vet would see the animal,

0:31:560:32:00

and then probably write up the notes, the consult notes,

0:32:000:32:02

after treatment had been given.

0:32:020:32:04

The note was written up at 10.23pm,

0:32:050:32:08

so effectively tying in, possibly.

0:32:080:32:12

It was after the insurance had been set up but at a very, very short

0:32:120:32:16

timescale, so we needed to investigate further.

0:32:160:32:19

The insurers weren't going to let sleeping dogs lie,

0:32:190:32:23

and still needed proof of the time the owner had called the vets.

0:32:230:32:27

There was only one way of finding out.

0:32:270:32:29

Although we asked for phone records for the whole evening,

0:32:540:32:57

what the policyholder sent through

0:32:570:33:00

was a very precise, cropped phone record

0:33:000:33:02

that started at 10.01 and went onwards.

0:33:020:33:06

That period between nine and ten,

0:33:060:33:08

the potential contentious period, was completely missing.

0:33:080:33:13

And when we pushed the policyholder for the rest of the telephone records,

0:33:130:33:17

there were lots of excuses made why we couldn't have those.

0:33:170:33:20

Those phone records between nine and ten would have given us sufficient

0:34:300:34:34

evidence to say, "Yes, this is, of course, a valid claim."

0:34:340:34:36

In the absence of anything,

0:34:360:34:39

the doubt and suspicion very much is that the incident occurred

0:34:390:34:42

at nine o'clock,

0:34:420:34:43

and there were records on that phone bill that didn't,

0:34:430:34:46

didn't tie in with the revised story.

0:34:460:34:49

So, the final contact with the customer was that we e-mailed

0:34:510:34:54

them and asked for the full telephone records for that day,

0:34:540:34:59

and despite that e-mail, despite the conversation we'd had with them,

0:34:590:35:03

those records were never forthcoming,

0:35:030:35:06

so complete radio silence from the policyholder.

0:35:060:35:08

There is sufficient doubt for us to reject the claim.

0:35:080:35:11

The policyholder hasn't come forth with sufficient evidence to prove

0:35:110:35:14

that the changed story is actually the factual story,

0:35:140:35:18

so we rejected the claim.

0:35:180:35:21

Considering how easy it would have been to validate the claim had

0:35:210:35:24

the policyholder provided the earlier phone records,

0:35:240:35:27

their refusal to do so strongly suggested that this was indeed

0:35:270:35:32

a spurious claim.

0:35:320:35:34

Fraud isn't acceptable in any guise.

0:35:340:35:37

In this instance, it was a clumsy attempt to defraud us of money,

0:35:370:35:40

where the breeder made mistakes, where the new owner made mistakes.

0:35:400:35:44

Our claims assessors are hugely skilled at identifying fraud

0:35:440:35:48

in a much more sophisticated way.

0:35:480:35:50

Most claims come in, nothing changes,

0:35:500:35:53

the facts are clear and we pay the claims.

0:35:530:35:55

In instances like this, where times are changing -

0:35:550:35:58

huge indicators of fraud and then when they can't be backed up with

0:35:580:36:01

evidence, no, absolutely, they'll be outed every time.

0:36:010:36:04

Unfortunately, there are fraudsters out there who will sink

0:36:100:36:13

to diabolical depths to get their hands on a pay-out.

0:36:130:36:17

Even if it means concocting elaborate accounts

0:36:170:36:20

of traumatic events that never even happened.

0:36:200:36:22

But many of these criminals often make careless

0:36:220:36:25

mistakes, and when they're caught out,

0:36:250:36:28

the consequences of their actions

0:36:280:36:30

can be far greater than they ever imagined.

0:36:300:36:33

Tom Wilson is a Counter Fraud Manager at AXA,

0:36:370:36:40

and recently dealt with a rather distressing case.

0:36:400:36:43

So, on this occasion, we had a claim coming from Paul and Zoe Sizurk.

0:36:450:36:49

It was a household claim, where they claimed that they'd been held

0:36:490:36:53

at knife-point in their home,

0:36:530:36:55

whilst balaclava-clad thieves stole £17,000 worth of jewellery,

0:36:550:37:00

cash and a number of other items.

0:37:000:37:02

To be held at knife-point in your own home must be a pretty harrowing ordeal.

0:37:020:37:08

Everything, quick! Hurry up!

0:37:080:37:10

So it was important that they dealt with the Sizurks' claim as

0:37:100:37:14

quickly and efficiently as possible.

0:37:140:37:16

From the outset, with any claim that's reported to us,

0:37:170:37:20

we treat them as genuine

0:37:200:37:21

unless there's reason to suggest otherwise.

0:37:210:37:23

In this particular instance,

0:37:230:37:25

the concern that was initially raised was when we spoke to Zoe

0:37:250:37:28

on the phone when she reported the incident.

0:37:280:37:30

She showed little or no emotion in regards to the fact that she'd just

0:37:320:37:36

been held at knife-point and had numerous items of significant value

0:37:360:37:39

stolen from her home.

0:37:390:37:40

Zoe was obviously concerned about the missing cash and jewellery,

0:38:340:38:39

but didn't paint a picture of a woman who'd just been robbed

0:38:390:38:42

at knife-point.

0:38:420:38:43

With claims of this nature, it's our standard practice

0:38:430:38:46

to appoint one of our partner loss adjusters,

0:38:460:38:49

who would attend upon the premises of the customer

0:38:490:38:52

to run through the details of what happened, what was stolen, etc.

0:38:520:38:55

When our adjuster met with Zoe, she asked her what happened.

0:38:580:39:02

At no point did she mention that her and her husband had been held at

0:39:020:39:05

knife-point in their home whilst these thieves ransacked the house

0:39:050:39:09

and stole this jewellery.

0:39:090:39:11

Something really odd, given the experience

0:39:110:39:13

that they alleged to have been through.

0:39:130:39:15

You would've thought that it's the first thing that they'd mention.

0:39:150:39:19

Already, the circumstances seem a little suspicious,

0:39:190:39:23

but AXA were prepared to give the Sizurks the benefit of the doubt.

0:39:230:39:27

It was only when Zoe listed the items that had been stolen

0:39:270:39:30

to the loss adjuster that the true nature of the claim became apparent.

0:39:300:39:35

More alarming was that during the course of the meeting,

0:39:360:39:39

some of the items she claimed that had been stolen,

0:39:390:39:42

she was actually wearing.

0:39:420:39:43

Hold on - you'd think if someone was claiming for stolen jewellery,

0:39:480:39:51

surely they wouldn't wear it during an interview

0:39:510:39:54

with the person handling the claim.

0:39:540:39:57

So, the loss adjuster reported back, and investigators decided to

0:39:570:40:01

interview Zoe's husband to try and suss out whether the claim

0:40:010:40:05

could in any way be genuine.

0:40:050:40:08

Our adjuster contacted us to advise us of the concerns.

0:40:080:40:12

We arranged to meet with Paul, Zoe's husband,

0:40:120:40:15

to get his account as well, and during that meeting,

0:40:150:40:18

Zoe was present and, again,

0:40:180:40:20

Paul didn't mention the robbery at all and it wasn't until Zoe

0:40:200:40:23

prompted him that he mentioned it.

0:40:230:40:25

Although the couple's story matched up,

0:40:260:40:29

the insurers still didn't know if the robbery had actually taken place,

0:40:290:40:33

and, even if it had, £17,000 worth of goods

0:40:330:40:36

was a lot to be claiming for.

0:40:360:40:39

With incidents of this nature,

0:40:390:40:41

we would always ask for proof of purchase.

0:40:410:40:43

We need to ensure that the items being claimed

0:40:430:40:46

were actually purchased in the first instance

0:40:460:40:48

and were owned by the customer.

0:40:480:40:50

On this occasion, a number of the items she claimed to have been

0:40:500:40:53

stolen, they just couldn't provide proof of purchase for.

0:40:530:40:56

So, following the concerns that we identified,

0:40:590:41:02

and the clear discrepancies,

0:41:020:41:03

we put these to Zoe and Paul and they weren't able to provide

0:41:030:41:08

a reasonable explanation as to these discrepancies,

0:41:080:41:10

and that led to us making a decision to not pay the claim.

0:41:100:41:14

AXA contacted the police,

0:41:140:41:16

who later arrested the couple at their home.

0:41:160:41:19

Yet again, Zoe was wearing some of the pieces

0:41:190:41:21

of jewellery she claimed had been taken in the robbery.

0:41:210:41:25

Following the arrest of Paul and Zoe, the police charged them

0:41:250:41:28

with fraud by false representation.

0:41:280:41:31

Both pled guilty to the charge and a hearing date for their sentencing was set.

0:41:310:41:35

But when that date arrived - yup, you guessed it -

0:41:350:41:39

Paul and Zoe didn't turn up to court.

0:41:390:41:41

They were arrested at Manchester Airport,

0:41:430:41:45

where they were trying to flee the country,

0:41:450:41:47

but there was no escaping the long arm of the law.

0:41:470:41:50

On that date, they attended the sentencing hearing

0:41:500:41:53

and were both handed down 16 months behind bars.

0:41:530:41:56

The fact that they didn't attend the sentencing hearing that was

0:42:000:42:03

originally set, and were then later arrested at the airport,

0:42:030:42:06

suggested they had no intention of attending the hearing,

0:42:060:42:09

and my view is that that probably contributed to the

0:42:090:42:12

very serious nature of the sentence they did eventually receive.

0:42:120:42:16

Ultimately, this couple discovered that crime really doesn't pay.

0:42:170:42:22

The outcome of the custodial sentence - brilliant result.

0:42:220:42:25

It goes to show that the courts are prepared to hand out some

0:42:250:42:28

fairly hard sentences to would-be fraudsters,

0:42:280:42:31

and it should act as a deterrent for anybody considering

0:42:310:42:33

submitting a fraudulent claim.

0:42:330:42:35

Whether it's exaggerating real injuries,

0:42:410:42:43

totally making up a story for a dodgy claim

0:42:430:42:46

or masterminding insurance fraud on an industrial scale,

0:42:460:42:49

the law is coming down hard on the people who think they can

0:42:490:42:53

make a quick buck with their insurance scams and cons.

0:42:530:42:56

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

0:42:560:42:59

ever before are being caught in the act and claimed and shamed.

0:42:590:43:03

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