Episode 3 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...

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

Police! Don't move. Stay where you are.

..they're 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.

A couple are all shook up

as they fail to get their stories straight...

In terms of the person they were visiting,

neither of them knew really who it was.

They could only say that it was Elvis from Enfield.

..a would-be fraudster can't handle the pressure

when questioned by his insurers...

When we pushed further,

the customer actually admitted that they had taken the policy out

after the incident actually happened.

..and a bogus travel insurance claim runs out of steam

thanks to some shocking spelling.

There was a glaringly obvious spelling mistake

where the doctor had referred to what he believed should have been

"wheezing" but he had put "whezzing".

Nowadays, for many of us,

there is one thing that is almost always by our side,

apart from a four-legged friend, maybe.

I'm of course talking about our mobile phones.

With smartphones enabling us to do everything

from making a simple phone call to online shopping,

catching up with e-mails and working on the go,

for many of us, these are an omnipresent companion.

But as good as they are, their delicate nature

can sometimes be their undoing.

Mobile phone insurance policies can protect our hi-tech handsets

in the event of disaster.

However, they aren't something that can be taken out

as and when required.

Someone who's had plenty of experience of this

kind of fraudulent behaviour is Simon Powell at insurers Endsleigh.

The customer took out a policy online.

They then made a claim online.

But due to the circumstances,

this was a claim with a bit of a difference.

Along with some friends, they'd been along to Thorpe Park for the day.

They've been on a ride called Tidal Wave.

The customer had their mobile phone in their pocket and during the ride,

water had come over the side,

got onto the customer's lap and as a result of that,

the customer comes off the ride, and the phone has got water damage.

Top-of-the-range smartphones and water

are a particularly precarious combination

so unlike the people on the ride,

the phone wasn't OK once it had dried out.

Took it along to the repair shop

because it wasn't working, and the repair shop confirmed

that it was beyond economical repair.

So, we had a claim for a damaged phone

which was brand-new and worth £619.

Now, the theme park enthusiasts amongst us will know that

rides like this one are designed to give people a proper drenching.

So, with the claimant's version of events sounding plausible enough,

Endsleigh began to settle the claim.

It seemed legitimate. There was nothing around

the accident circumstances or incident circumstances that lacked

any credibility at all.

You know, it is quite clear that this just looked as though it was

something that happened during a normal day out with their friends.

Well, that's that, then.

Um, hold that thought.

So, the suspicions weren't around the incident circumstances.

It was more in terms of the fraud indicators that we had in place

in the background that confirmed that the policy was taken out

the day before the incident.

Of course, it's not impossible and it does happen,

but needing to make a claim so soon after taking out an insurance policy

is a rare occurrence, so when it does happen,

insurers will usually make some additional checks to ensure that

everything is above board, and that's exactly what Endsleigh did.

On the further investigation,

we also looked at the details that the customer provided

when they took out the policy.

And there was one real discrepancy around it,

which related to the contact details.

Because the customer hadn't put on their permanent mobile number,

and the number that they were actually making the claim for

on the inception details, they had actually put forward a temporary number.

And that was something that we needed to investigate further.

As the policy had been taken out with a new temporary phone number

the customer was using after their phone had been broken,

it suggested that the policy was also taken out

after the accident had taken place.

All this was pointing to a potentially fraudulent claim.

If you're taking out a policy,

you would expect to take out a policy with the telephone number,

the contact number of the mobile phone that you're

actually taking the policy out for.

And yet, when we went back to check the details

on this particular customer,

the inception details they provided when they took out,

as the contact number, was the new temporary number that they provided.

With this discrepancy raising a serious question

about the validity of the claim, a member of Simon's team

called the claimant to find out whether the phone

had been damaged before or after the policy had been taken out.

When questioned in terms of,

"Why would you provide a temporary number

"when you're actually taking out a policy,

"as opposed to your permanent number?",

the customer could not answer that. And when we pushed further,

the customer actually admitted that they had taken the policy out

after the incident actually happened.

Based on that, we declined the claim and we cancelled the policy.

The claimant's attempts to take his insurers for a ride...

..had backfired badly.

This appeared to be a customer that had made an opportunist-type claim,

you know, an incident potentially had happened but they didn't have a

policy in force.

Now, on this occasion, we declined the claim

and we cancelled the policy but quite clearly,

with this type of thing, they can be taken further and indeed

we could have taken criminal proceedings on this type of case.

At least one person can see right through a man's blatant attempt

to cash in...

The pub manager was very surprised.

In fact, his words were, he felt that he was "trying it on".

And a clairvoyant claiming to magically predict her own accident.

She was allegedly heard to say to another colleague,

that there was a claim to be made here if someone tripped over this.

Every year, around 186,000 people are injured on Britain's roads,

from minor cases of whiplash to broken bones

and life-threatening injuries.

The possibility of an accident being caused deliberately

in order to claim compensation money from insurance companies

is almost unthinkable, but sadly,

it's a problem that's becoming all too common for insurers.

In order to fight these fraudulent claims,

insurance companies are working closely with legal firms

and the police to try and combat the problem together.

Back in 2016,

law firm Keoghs work with insurers Axa to get to the bottom

of a motor insurance claim from a couple involved

in a rear-end collision on a visit to London.

It was in the north of London on a dual carriageway,

the Watford Way. It was the middle of the day, about one o'clock.

The insured driver had just been doing his normal daily duties,

carrying out deliveries, and he was on his way to his next delivery.

As he was driving along the dual carriageway,

not the car in front of him,

but the one in front of that, suddenly veered across,

causing the car in front of him to slam its brakes on.

And despite trying to stop,

the insured driver was unable to stop going into the back

of the claimant's vehicle.

The driver of the car in front claimed for vehicle damage,

the recovery and storage of his car,

the hire cost of a replacement vehicle and personal injuries.

The two passengers, his wife and a friend,

claimed for injury and subsequent physiotherapy treatment.

The driver's claim, that was just over £20,000 in itself,

and the two injury claims were probably worth

over £5,000 between them.

In total for the damages, just over £25,000.

Then, of course, there were the lawyers' costs on top of that.

They were probably about the same again,

so Axa's exposure in terms of the total of the third-party claims

was about £50,000.

Axa looked at the claims themselves to validate the legitimacy of them,

and in parallel to that, the insured raised their concerns,

and it was those combinations of factors

that caused this to be a claim that was scrutinised in more detail.

It was a pretty big bill for the insurance company to foot,

so before paying out, they decided to look into the claim

in more detail.

Luckily, the delivery van that had crashed into the rear

of the Mercedes was fitted with a dashboard camera,

and investigators were able to view the footage from the crash.

As the parties are proceeding along the dual carriageway,

there's a service station to the left-hand side

which is linked to a retail park.

At first, it appears as though the Mercedes and the car in front of it

are going to go straight past that service station.

Then at the very last moment,

the third car swerves violently into the service station and that causes

the claimant to absolutely slam his brakes on,

and that goes into the back of the Mercedes at quite a forceful collision.

It looks like your everyday rear-end collision,

but when investigators rewound the video

to look at the build-up to the incident,

they noticed something rather suspicious.

About a minute before the impact,

the dash cam shows the van approaching a junction.

You can clearly see the Mercedes and the third party car

in the middle lane as the traffic begins to slow.

And it's very clear there's a distinct movement by the claimant

and the blue car, the unidentified blue car.

They both switch lanes for no apparent reason, and to me,

that was the point at which they had targeted the insured.

It looked like the two vehicles were working together

to stage an accident, something which insurance fraud investigators

see time and time again.

The claimants will always contend that it was a vehicle they'd

never seen. They had no connection to it.

We will always, of course, try and prove the contrary,

try and link them, cos if we can link those two vehicles,

the people in those vehicles,

then clearly, we can show that it's part of a joint enterprise.

Unfortunately, in this instance, we weren't able to do that.

Although the cab cam footage is very clear in terms of the Mercedes,

we weren't able to identify the registration mark from the blue car.

With that avenue closed,

the next step is to look at the backgrounds of the claimants

to see if they had any previous dealings with insurance fraud.

One of the passengers, it was uncovered that he had

a previous history of involvement in credit card fraud.

He had got a conviction for that some years previously.

That kind of raised the question of the sort of individuals that we were dealing with.

With the case for fraud looking strong,

Axa decided to reject the claims.

But the driver and his wife refused to accept the rejection,

so court proceedings were issued against them.

At court, the couple were questioned separately

and asked for their version of events on the day.

They suggested that they were travelling to London

to see the sick child of a friend of the third claimant.

but neither of them knew anything about that individual.

We therefore probed around the third claimant himself.

The husband said he was just a friend of a friend, an association,

not very tightly connected to them.

They were just doing him a favour.

The wife said that it was a family member that used to live with them.

You'd think you'd be able to tell the difference between a friend

and a family member.

In terms of the person they were visiting,

neither of them knew really who it was.

They could only say that it was Elvis from Enfield,

a friend of the third claimant.

They didn't know where he lived. They didn't know his full name.

They only knew him as Elvis.

They didn't know which hospital they'd allegedly just been to.

They didn't know the name of the child.

They didn't know what was wrong,

why the child was poorly and in hospital.

It seems like this couple had failed to conjure up

even the most basic of stories.

Perhaps they could do better when it came to their injury claim.

In the witness box, they said that the only injuries they'd sustained

was a minor injury to the neck and lower back, a whiplash type injury.

Yet when presented with the written medical report served earlier

in the court proceedings,

that had listed whole variety of additional injuries

to their arms, legs, all sorts of things that they said had occurred

as a result of the collision.

When we put those inconsistencies to them,

they tried very clearly to distance themselves from the medical reports.

They just said that the medical reports were wrong.

It now appeared that they couldn't even remember the injuries

that they'd reported during their medical examination.

One of the most expensive parts of the claim was for the recovery

of the damaged car.

The husband and wife both said they had rung a claims management company

to recover the vehicle, but that's as far as their stories tallied.

The husband said that the claims management company came out

to the service station and recovered his car from there and took it away.

He said that they had to stay at the service station

until they rang a friend that travelled from Birmingham

to pick them up, and that they travelled from the service station

straight back home.

The wife's version was completely different.

She said that the claims management company came to the scene

and took them from there to their offices

where her husband completed a whole host of paperwork

and that they'd stayed at the offices until the friend

had come from Birmingham to take them home.

Just totally different versions that couldn't be reconciled.

Just when the insurers thought this case

couldn't get any more ridiculous,

one final piece of evidence came to light

regarding the couple's children.

The expectation had been

that following an incident of this nature,

she would have instantly been in contact with the aunt

that she said was looking after her children.

But she made no comment on that. She said that she didn't make contact.

She didn't attempt to make contact.

And that was despite one of her youngest children

being aged less than one. A baby.

To us, it spoke volumes.

They didn't contact the aunt, the carer,

because they knew they were always going to be back late.

That had been the arrangements in place,

because this was a pre-planned, pre-prepared event.

So to recap, the couple couldn't decide

if their passenger was a friend or family member.

They didn't know where the friend they were visiting lived

or what was wrong with his child.

Their stories didn't match on which route they'd taken home

after the accident and they didn't even contact their children's carer

to let her know if they'd been involved in a crash.

Got it.

Having heard all of the evidence, the judge was entirely satisfied

that this was a fraudulent claim.

That it was a pre-planned event and that these were claimants

who had deliberately set out that day to induce an accident.

The judge found the couple to have been fundamentally dishonest

and threw the case out of court.

It was a very positive outcome, both for Axa and for their policyholder.

The claimants received nothing.

But in addition, Axa had paid out for damage to their insured's

vehicle and we counterclaimed for that.

We put in a claim to say that because this was a fraudulent claim

and because the accident wasn't the fault of the insured driver,

we should be reimbursed the sum in terms of that vehicle damage,

and we were awarded those sums.

The case was closed, but for James,

the fight against fraud is a never-ending battle.

It's vital that insurers and their partners tackle

fraud of this nature. It's insidious,

it's targeting innocent members of the public,

and this is a real classic example of an engaged customer

who felt they were the victim and that they were supported

by their insurers, and this is exactly the sort of case

that insurers can fight,

do fight and are becoming ever more successful in fighting.

Now, when we go to work,

it's our employers' responsibility to provide a safe environment.

So, if we have an accident,

the chances are we're covered by their insurance policy.

With this in mind,

fraudsters have been known to go to great lengths

to stage fake accidents, in the hope of receiving compensation.

But what many of these opportunists don't realise

is that insurance companies have a wealth of techniques

they can employ to determine whether a claim is genuine or not.

In addition to providing car and home insurance policies,

Allianz also insure a range of businesses.

Mark Merrix is the fraud manager there, and knows the importance

of validating each claim that comes in.

He recently received a claim from a woman injured in a shop.

The claimant was the manager of the stationery store,

and it was alleged that, whilst carrying a box

which weighed about 22kg,

she tripped over a wire.

This allegedly caused her to tumble down two steps,

which caused her to sustain injuries to her shoulder, ribs,

her left elbow and her left knee.

It appeared to be a genuine workplace accident,

unfortunately resulting in minor injuries.

She consulted her GP the day after the accident,

and the GP said she needed to take three weeks off work

to recover from her symptoms.

To support her claim,

her lawyers instructed a medical expert for an opinion.

Based upon the opinion of the expert,

the claimant was expecting to recover fully from her injuries

within six weeks of the accident.

Although these weren't serious injuries,

the woman was set to receive around £1,500 in compensation.

When an insurance company receives a claim,

it carries out a basic checks to ensure the claim is genuine.

But when Allianz began their enquiries,

they stumbled across a surprising piece of information.

Our initial validation checks established that four years prior

to this accident, she had in fact intimated a claim

against her local county council

for a tripping incident,

where she sustained a personal injury.

Upon further investigation with their insurers,

we soon established that when challenged,

the claim was promptly withdrawn.

This raised some serious concerns for our handler,

and therefore as a result,

we decided to pursue further investigations into this case.

Allianz turned to the woman's colleagues to see if they could

back up her story.

The witness evidence that Allianz obtained

from the claimant's own colleagues supported the fact

that she'd identified this potential tripping hazard

some four hours before the actual accident took place.

She was allegedly heard to say to another colleague

that there was a claim to be made here if someone tripped over this.

Combined with the discovery of her previous tripping claim that had

been withdrawn as soon as it was challenged, the witness evidence

from this latest claim raised serious concerns.

Allianz then received digital photos of the wire that she had allegedly

tripped over and were able to analyse the data behind the photos

to see the dates and time at which they were taken.

Using this information,

we were able to support the witness evidence that indicated that these

photos were taken four hours prior to the accident taking place.

With the evidence in their favour, Allianz turned to their solicitors,

DAC Beachcroft, to investigate the claim further.

We asked the claimant to formally

say when she had taken the photographs.

We asked her to reply with a signed statement of truth,

which means that she has to sign that piece of paper and say that she

honestly believes that that is true. Having done that,

we were then in a position to disclose a photograph

with a description of when they had been taken.

At that point, the claimant' stated timing was clearly at odds

with the evidence that we had produced.

With the woman clearly lying about the time she'd taken

the photographs, there was only one conclusion.

DAC Beachcroft and Allianz decided together that we would then plead

that the claim was fraudulent and it was at that point that the claimant

got cold feet and tried to withdraw from the claim.

The fact that the claimant wanted to withdraw her claim clearly showed

that she'd been rumbled. She knew that we then had the evidence

that we could use against her and she knew that she was in danger

of a finding of fundamental dishonesty or fraud.

If any part of the claim was found to be fundamentally dishonest,

then the judge would be able to throw the entire case out of court.

At the hearing, the judge found the claim to be fundamentally dishonest,

as a result of which the claimant was ordered to pay Allianz's costs

just shy of £18,000.

The claimant took a risk.

She thought that it was worth having a go and seeing if she could make

herself some money. It clearly shows that that wasn't worth it,

because she's ended up with an award against her which is many times the

value of the original claim.

The outcome of the case sent a clear message to would-be fraudsters.

It's really important that people understand that what seems like an

opportunity and what seems like an easy win really isn't an easy win.

We need fraudsters to understand that they will have to pay for their

action and so, if they make that claim, having seen an opportunity,

there will be consequences.

Now, as we demonstrate on this programme,

fraudulent insurance claims take many different forms,

from deliberate slips and trips to staged car accidents to exaggerated

travel insurance claims and even bogus bus crush injuries.

We've seen them all. It's all fraud and it's all illegal.

But what if what's being claimed for never even happened?

Yeah, you guessed it, same story.

In the case of an accident,

you never know when disaster might strike.

But depending on the circumstances,

it's possible that you could be entitled to compensation for your injuries.

Pub chain JD Wetherspoon recently dealt with a claim from a cyclist

that brought a whole new meaning to the saying "one for the road."

We received a claim for compensation from a member of the public who says

that they were injured following an accident at one of our pubs.

With thousands of customers passing through the doors of their pubs

every day, the occasional injury is inevitable.

However, the circumstances of this one stuck out a little bit.

The claimant said that while he was riding his bicycle along the

perimeter fence of our beer garden,

there was a metal bar sticking out of the fence and he rode over that

metal bar, fell off his bike and that he sustained some broken ribs

and cuts and bruises.

Never mind a tipple, this poor chap was claiming he had had a massive

topple and it sounded as though it was a very painful landing.

But to the trained eye, immediately something wasn't quite right.

The claim didn't seem legitimate.

Any time we receive a claim that involves broken bones fractures,

it automatically puts the claim in a particular value bracket.

We estimated if there were proven broken bones or fractures,

we'd be looking well into the thousands of pounds.

However, the claimant specifically said that he wanted to claim £625

for ten days off work.

Ordinarily, with claims for personal injury,

damages are determined with the help of medical reports and legal advice.

But this guy knew exactly what he wanted.

However, to have such a precise amount specified by a claimant that

was in fact so far off what the claim should have been worth sounded

more like an opportunistic demand.

We spoke to the pub manager to find out whether he or other of the

member of staff had witnessed an accident or had anyone come into the

pub to say that that they had been injured following an accident.

The pub manager didn't recall anyone reporting a serious incident,

except for the claimant who said that there was a metal bar sticking

out of the fence. When he went to investigate this fence,

he didn't see any metal bar sticking out.

More importantly, he didn't see that the claimant showed any signs of

physical injury or was in any pain at all.

So far, the pub manager's comments weren't exactly backing up the

cyclist's version of events.

The pub manager was very surprised.

In fact, his words were, he felt that he was "trying it on."

But we take every claim seriously

and we investigated it very seriously.

As verdicts go, the pub manager's was rather damning,

but there was another source of evidence that Leandro

was able to call upon - CCTV.

For customers' safety,

JD Wetherspoon pubs are fitted with cameras and, as luck would have it,

the entire "accident" had been caught on film.

Looking at the CCTV footage, we'd expect to see the claimant

falling off his bike and hurting himself.

Just a warning, this doesn't make for easy viewing.

We can see the claimant riding past the beer garden...

And the crash is coming...

-Oh!

-He parks his bike up, gets off.

Here, we can see him attempting to reach through the garden fence.

But what's really telling is that he's looking around.

We don't think that he knows he's being filmed but we certainly can

tell from these actions that he's trying to see whether there's anyone

around who might see him. He gets back on his bike again,

he cycles off.

We can't see any fall at all.

Exactly what the cyclist was doing was anybody's guess but three things

were crystal clear -

he had never fallen off his bike,

he hadn't injured himself, and he was trying to get his hands on a

pay-out that he wasn't entitled to.

When we are investigating personal injury claims,

and we are investigating what we feel our fraudulent claims,

CCTV footage is one of the most important pieces of evidence.

Whereas we might have statements from witnesses or individuals,

CCTV footage is real time.

There's no way that you can argue with what video footage

is showing us.

Confident the CCTV was the ace up their sleeves,

Leandro and his team were still keen

to see whether the cyclist could back up his claim.

We also asked the claimant to send us evidence of his physical injuries

and also evidence to prove that he lost earnings due to his time off work.

The claimant sent us some medical evidence but the medical evidence

showed no evidence of any broken ribs.

We never received any evidence of his loss of earnings,

certainly any evidence to show that he'd lost £625.

So no proof of broken bones, no proof of loss of earnings.

Oh, and no accident.

This claim was sinking faster than a cold pint on a hot day.

It was clear that this claimant had a lot of questions to answer.

I contacted the claimant personally by phone.

We spoke about the alleged accident.

He was very confident that he was riding his bike along the garden fence,

that he fell off as a result of a metal bar that was sticking out.

He said he went to a walk-in centre,

and he was told that he had broken ribs.

When I confronted the claimant, however, with the fact the pub

manager said that there was no damage to the fence,

he didn't seem to be in any pain,

we also had CCTV footage that didn't show him falling off his bike,

the claimant politely ended the conversation and thanked me

for my time.

And with that, time was called on this claim.

But even though the right result had been reached,

spurious and fictitious claims like these are a constant headache.

It's very sad, because there are people who have accidents with very

serious injuries and a lot of the resources that we can use to

investigate those claims and try to resolve them quickly and efficiently

are diverted to investigating fraudulent claims and at the end of

the day, it's those genuine claimants who do suffer.

Still to come...

a conniving couple discover the consequences of committing insurance

-fraud.

-Caution will stay on their records for four years, they get

fingerprinted, they get their mugshots taken, so it's...

It's a criminal act and they are treated like criminals.

Insurance companies receive thousands of claims every day,

resulting in millions of pounds paid out to policyholders.

Now, to ensure that the claim is genuine, insurers will ask for

evidence to back up the information they're being

provided with, but when that evidence looks a bit dodgy,

it alerts insurers to the possibility that the claim itself

also isn't as legitimate as it may first appear.

Some fraudsters think that by carefully forging documents in an

attempt to prove their claim, they won't be found out.

But it's often simple mistakes that leave them caught without a leg to

stand on. Cega, a Charles Taylor company,

receives hundreds of travel insurance claims on a daily basis.

They recently dealt with the case where a policyholder was claiming

compensation for an illness she'd picked up abroad.

We received the claim for medical treatment from the customer who

unfortunately got unwell while she was in India.

The infection was so severe for the woman, it meant a two-day stay

in hospital with the cost of treatment working out

to be just over £700.

When we receive claims like this,

we do need a certain level of documentation to support the claim,

such as a medical report and an invoice to show how much was paid

for the treatment.

But when the customer provided the receipts for the treatment,

something didn't seem quite right.

Firstly, we noted that the customer had paid for the treatment

in pounds sterling when she was in India,

so we would expect her to pay in Indian rupees.

Cega are well versed in dealing with claims where medical treatment has

been given abroad so they've got a good idea

of what's legit and what's not.

And this claim was showing signs of trouble from the start.

This was a very high amount to have paid for two-day inpatient treatment

in hospital and we are fully aware of that, due to the nature

of our business and the amount of medical claims that we

review from India.

With the amount the woman was claiming looking unrealistic,

the company then turned to the medical report she'd given them,

which didn't exactly look like the real deal either.

The most alarming thing that we noted from the medical documentation

that the customer had provided was that there was a glaringly obvious

spelling mistake, where the doctor had referred to what we believe

should have been "wheezing" and he had put "whezzing".

You certainly wouldn't expect a highly skilled doctor to misspell

the word "wheezing" when he's writing a medical report.

Yeah, it is clear there was some dodgy dealings going on but Cega

weren't going to get to the bottom of this case while they were some

5,000 miles away from where it happened.

As we deal with international claims daily, we have to have this

international network of overseas investigators who

can conduct enquiries in any part of the world.

Due to the concerns with this claim, we decided to appoint one of our

international investigators to conduct

on-the-ground enquiries in India to validate the claim.

They started by checking out the doctor's details

on the medical report.

The first thing our investigator did

was check with the Indian Medical Council to see whether the doctor

was licensed to practise medicine.

Unfortunately, there was no trace of the doctor, which just aroused

our suspicion further.

As the doctor's name wasn't on the list,

it meant he wasn't legally allowed to practise medicine in India,

rendering the medical report next to useless.

Perhaps the investigator would have more luck with the hospital the

woman claimed to have been treated at.

We had previously been told by the customer that the hospital provided

catering facilities and that she had also had x-rays, so we were very

surprised to hear from the hospital that they don't have catering

facilities and they also don't even own an X-ray machine.

With the claim looking dodgier by the day,

the final port of call was to look at the customer's hospital records.

Our investigator visited the hospital and spoke with the hospital staff

who checked their official records, and to our astonishment,

the customer wasn't listed anywhere as being an inpatient

within the hospital. In fact, she wasn't in the records at all.

The case was clear-cut.

The woman had never even visited the hospital.

She hadn't received any medical treatment and all the documents

she'd provided had been false.

A member of Simon's team then spoke to the customer and she eventually

admitted she'd made the whole thing up.

Based on all the evidence that we had obtained in this investigation,

we had no option but to formally repudiate the claim and invoke the

fraud condition set out in the policy.

So no need to cough up any compensation money this time

and they never heard from the customer again.

Maybe next time this woman will think more carefully about trying to

claim for false treatment while abroad.

The outcome of this investigation demonstrates to people who feel they

need to make a fraudulent claim that it doesn't actually matter where in

the world you are, we will unearth the fraud.

Now, I'm sure every motorist would agree that being hit by another car

is one of the most infuriating aspects of driving,

but even more so when instead of stopping, the other driver keeps on

going and flees the scene. Thankfully, in situations like this,

car insurance policies have got us covered.

The money we receive is intended to pay for repairs,

but a hefty pay-out can make some people very greedy indeed.

While many of us hope to never claim on our car insurance,

there are some people out there who view these policies as an easy way

to make money that they can profit from time and time again.

Someone who knows only too well about these dodgy dealings

is Susan Evans at insurance company Admiral.

In June 2014, we get a report of an accident.

We had our policyholder on the phone saying that the BMW had been parked

up and a neighbour had reported that somebody had driven into it.

Thankfully, they'd got their registration number and they wanted

to make a claim for the damage that had been occasioned to the BMW.

It seems like a straightforward claim and during the initial phone call,

the claims handler was keen to get to the bottom of exactly what had happened.

The value of the claim that came in was about £5,200,

so quite a bit of damage had been occasioned to the car.

As with any claim, the insurance company needed to validate

the information they received

but when they looked up the policyholder's records,

they found a surprising result.

So, this particular case,

we had to look and we could see that there had been an earlier claim on

the same vehicle for very, very similar damage.

The car was hit whilst parked and unattended.

With the new claims sounding suspiciously like deja vu,

Admiral handed the case over to their fraud team,

who looked up the third-party's registration number to determine

who they were insured with.

As luck would have it, on this particular occasion,

the third party vehicle,

so the vehicle that was alleged to have caused the damage,

was also insured with Admiral,

so we had a direct way to contact the other party that was involved,

because he was also one of our policyholders.

They rang the other customer

and arranged to inspect the alleged damage to his car.

He was very obliging, allowed us to examine his vehicle and from the

forensic inspection that we

made to that car, we could see that the car had never ever come into

contact with the other vehicle.

So we measured the distance of the damage from the floor,

the heights of the vehicles, and it was quite clear that

that car had not caused the damage to the BMW.

With alarm bells ringing,

they decided to pay a visit to the claimant himself.

Whilst there, the policy holder confirmed that the original damage

in the original accident in 2011 had never been repaired.

But he'd driven round in the car in its damaged state since then and

he'd decided to make another claim

for exactly the same damage against his insurers.

The truth had finally come out in a confession from the couple.

The whole story about their neighbour witnessing another

motorist hitting their car whilst doing a U-turn and driving off

was entirely made up.

It was all so they could attempt to claim again for the damage they'd

already been compensated for but had never bothered to repair.

Understandably, Admiral were not impressed.

On the basis of that evidence, there was no claim for us to pay.

We repudiated it as the evidence was so strong that the vehicles had

never come into contact with one another and the damage had never

been repaired from the original accident in 2011.

Claim was closed, system was closed down and we didn't think that we

were going to hear from the individuals again.

But just when they thought it was game over for these chancers,

a year and a half later, they tried their luck again.

And lo and behold, in January 2016,

we get a phone call from the policyholder,

saying he wants to repair his vehicle, the same damage as we've

already said we're not going to be dealing with.

Unbelievably, the customers were trying to claim for the damage

a third time, despite already receiving a pay-out

for the first claim.

Suffice to say, this needed to be stopped,

so Admiral reported their findings to the City of London Police's

insurance fraud enforcement department, who,

after arresting and interviewing the couple,

issued them with a police caution.

They subsequently arrested the two individuals and they were

cautioned. And the caution will stay on their records for four years.

They get fingerprinted, the get their mugshots taken,

so it's a criminal act and they are treated like criminals.

It goes to show that when it comes to insurance fraud,

persistence doesn't pay off.

I don't think the policyholders realised the gravity of what they

were doing or indeed the consequences,

and the punishments that come as a result of committing insurance fraud

and the general public needs reminding that it is a crime and

there are punishments that fit that crime.

Whether it's exaggerating real injuries, totally making up a story

for a dodgy claim, or masterminding insurance fraud

on an industrial scale,

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

a quick buck with their insurance scams and cons. But the fraudsters

need to think again, as more of them than ever before

are being caught in the act and claimed and shamed.