Episode 5 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...

That's the subject out of the vehicle.

..sophisticated data analysis techniques...

Police!

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

Police! 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.

Today, a motorist is caught red-handed when he tries to claim for the same

damage twice.

The evidence that we found in relation to the seat belt is irrefutable.

When it's locked in position,

it is locked and that's the end of the matter.

A claimant comes clean after a dirty attempt to deceive her insurers.

And a holiday-maker is caught trying to use her travel insurance policy

to fund a makeover.

There was clear discrepancies with what she'd told us had happened to what

actually had happened.

Now for a car owner,

how frustrating is it when you return to your car only to discover that

someone somehow has scratched it?

Well, whether the damage is great or small, in a situation like that,

you'd hope the other party would have the decency to leave their details.

But, unfortunately, that isn't always case.

Collisions with a parked car take place perhaps more often than you'd

think. And when they do,

an insurance policy is there to protect the innocent party.

Insurers Admiral are well versed in dealing with claims relating to

vehicles that have been involved in accidents and recently had a call with

a man who alleged his car had been the victim of a bump in the night.

We had a claim from a policy owner on the phone for the damage to his

Mercedes-Benz. It was supposedly hit whilst parked by another vehicle.

The man can't have been pleased to have returned to his car

and found it so badly damaged.

The only consolation was that he hadn't been in it

at the time of the collision.

The claim was worth about £25,500 in relation to the damage that was

caused to the car, which rendered the car a write-off.

So, a pretty hefty claim - but as the car was so badly damaged,

it wasn't even driveable, nothing seemed untoward.

When the claim came into us,

it seemed perfectly genuine and we looked at it and decided that it was

one that we needed to fast-track through to payment.

But when Admiral began to process the claim,

it quickly became apparent that it was anything but genuine.

We had the vehicle examined to see...

to have a look at the damage to the vehicle.

And we also checked the online database that we have, to find out

the history of the vehicle and what's happened to the car during its life.

When Admiral checked,

we found that the Mercedes-Benz that we were being asked to repair was

actually logged as a previous write-off.

Now, if the car had been written off in a previous accident, then how could

it possibly have been involved in another crash?

Admiral had hit a brick wall with the claim.

So they turned to a forensic engineer to inspect the damage and see

whether it matched the policy holder's version of events.

In the initial instance, we were sent a number of photographs,

very limited photographs, really, from the assessor who went to value it.

And it was our initial examination of those images

that set the alarm bells ringing for us, really.

We didn't feel that it supported the claimant's case.

The man had alleged that his vehicle had been hit while it was parked in

a lay-by. But the photos told a very different story.

The image of the front of the Mercedes shows that there's considerable

frontal damage - and I mean considerable, this wasn't a bit of a bump,

this was a hefty collision.

We were able to determine from that that actually the impact came from

the driver's side at an angle of about 45 degrees so, in other words,

if the vehicle was parked up in a lay-by,

then this was a very unusual collision because of the angle

that it would have had to have been hit by.

It seemed highly unlikely that the damage had occurred in the way the man

had described. But to find out exactly what had happened,

the engineers needed to see the damaged car for themselves.

When the vehicle was examined,

we found that the driver's seat belt was locked.

And there were friction burns upon the webbing of the seat belt which

indicated that, at the time of this collision, the vehicle was being driven.

The evidence that we found in relation to the seat belt is irrefutable.

It's how it works, the seat-belt tensioner is fired milliseconds before

the airbag goes off.

When it's locked in position,

it is locked and that is the end of the matter.

So, not only did it seem unlikely that the car had been parked in a

lay-by, but now investigators had concrete evidence that it was actually

being driven at the time of the crash.

And that wasn't all they discovered.

The front of the Mercedes contained evidence of concrete or brick dust

or stone or something similar and traces of wood, so it was clear that this

Mercedes had in fact crashed through a wall and collided with either a

tree or some other wooden feature.

The truth had been uncovered and this was clearly an attempt to submit

a fraudulent claim.

Not only that, but he was trying to claim for the same accident twice.

As far as Admiral were concerned, there was only one option.

Once we got all the evidence together,

we told him that we would not be dealing with his claim because we

believed that it was fraudulent

and that a repudiation letter was on its way.

I wouldn't say that the phone call would've been what we would've

expected. If the claim had been genuine,

he would've been very annoyed that we'd repudiated the claim so we did

think the reaction that we had probably confirmed that we were right in

our suspicions that the claim was fraudulent.

The claim had been stopped, but Admiral needed to ensure

this didn't happen again.

We took it to the Insurance Fraud Enforcement Department

and he was subsequently given a caution.

By attempting to claim compensation money that he simply wasn't entitled

to, this man now has a criminal record.

In these situations, honesty is definitely the best policy.

Be honest with your insurers because we do have the

Insurance Fraud Enforcement Department

sitting there, should we find a fraudulent claim and

they will help us with the prosecution.

Later, a large-scale bogus injury scam is scuppered as the claimants fail

to clock the CCTV cameras.

Very interesting that the bus driver was adamant that the two women who

were claiming personal injury weren't even in the car at the time,

the car was stationary, parked,

unattended and they weren't anywhere near it.

A serial fraudster's bogus burglary claims are busted when greed gets

the better of him.

We found that some of the items allegedly stolen during the course of the

recent burglary were also featured in the previous linked claims.

Insurance companies have heard it all when it comes to claims for

compensation, but, as far-fetched as many genuine claims might sound,

the golden rule is to always tell the truth because if you don't,

then not only could it invalidate your policy but it could also land you

with a criminal conviction for fraud.

With nearly everyone in the UK owning a mobile phone,

specific policies covering phone loss and theft are becoming more and more common.

Insurance company Assurant offer cover for some of the UK's top

mobile phone providers.

They recently received a call from a customer who wanted to make a claim

on her policy.

So, this particular claimant was claiming for a high-end Samsung device

valued at about £350.

It's fair to say that the claimant wasn't too happy about her loss.

Whilst it's not unusual for a lot of our customers to drop their handsets

in the toilet, what's really unusual about this case is the claimant said

that they'd lost the handset and it was flushed away through the system.

Although her story sounded a bit dodgy,

the insurance company were prepared to give her the benefit of the doubt.

Upon receiving the circumstances of this particular claim,

our agent asked verification questions,

where this particular claimant offered to send in photographs of the

particular toilet, which she claimed was a bog-standard toilet.

The customer duly sent in these rather fetching photos of the toilet in

question. It might not be the cleanest of facilities but she was right

about it being bog-standard.

The insurance team then needed to know if it was physically possible

for the phone to disappear down the toilet.

And when they looked into the likelihood of that happening,

they reached a unanimous verdict.

Our investigations uncovered that it was physically impossible for

a 14cm phone to be flushed through an 11 centimetre piping

which had a u-bend in it.

Now, I can't say I envy the person testing that claim out but there was

no denying that this customer's story was fast going down the pan.

Assurant than phoned the woman to give her another chance to come clean.

It looked like this chancer was sticking to her story so the

insurance company decided to set her straight.

The truth had finally been flushed out and the woman was incredibly

fortunate the matter hadn't been taken any further.

If she had've continued with the original story,

we would've declined the claim and this particular claimant would've been

identified as a future potential fraudster for providing misleading

information to us.

This was a case of attempted fraud that wasn't even necessary.

What's unusual about this claimant is she had a valid claim,

she should've just claimed and stuck to the facts.

She didn't need to make up a story.

By lying to her insurer,

the woman could've easily ended up empty-handed or, worse still,

with a caution or even a conviction for insurance fraud.

Fraud costs the UK insurance industry nearly £200 billion and just to put

into that context,

that's nearly £3,000 for every one of us living in the UK and that's why

it's vital as a firm and as an industry we detect and stop fraud.

Coming home to discover that you've been burgled is a horrible feeling.

In addition to the loss of your most valuable and sentimental possessions,

the experience can leave you feeling vulnerable in your own home,

knowing that a stranger has been in there, rummaging through your lives.

Now, although it can't take away the unpleasantness of a break-in,

a home contents insurance policy can help us to get back on our feet by

covering the cost of the possessions that can be replaced.

But there are some people who see these policies as a quick way of making

a few quid.

RSA is an insurance company that provides cover for our personal

belongings should the worst happen and recently dealt with a case

involving a burglary.

This was a claim we had from our customer, a Mr Solomon Lahr.

He had apparently had a burglary and he'd suffered various loss of items

in the burglary to the value of about £6,000.

As with many burglaries,

the things that had been stolen were mostly jewellery and electrical

items. As far as RSA were concerned,

it was a routine claim and promptly began the process of getting their

policy holder back on his feet.

Mr Lahr produced to us a number of boxes and receipts from the items which

were allegedly stolen and the actual break-in was witnessed by a passer-by.

But because he was claiming for high-value goods, RSA decided to

pay Mr Lahr visit.

But, in doing so, they came across a rather alarming fact.

When we visited the premises,

bearing in mind that the break-in had allegedly been spotted by a

passer-by, we found that the window through which access was gained,

which was now boarded up, was at the rear of the premises,

so it would've been physically impossible for a passer-by from the street

to have witnessed the event,

unless they'd actually been in the garden of the property.

Unsurprisingly, this revelation immediately raised concerns

and it wasn't long before RSA uncovered more evidence

that suggested this wasn't your average burglary.

We also noticed through our automated fraud detection machinery

some links between this claim and several other claims

in different names and at different addresses.

When we looked into the claims that were linked,

we found the mobile telephone numbers matched and indeed we found that

some of the items allegedly stolen during the course of the recent

burglary were also featured in the previous linked claims.

With all of the evidence leading back to Mr Lahr,

it was crystal clear he had been submitting claim after claim under

different aliases.

RSA then turned their attention to the other claims Mr Lahr was linked to.

Ultimately, we found nine claims

all linked by various factors spread over

a period of time and we thought this was a deliberate and persistent set

of dishonest claims that had been presented by this gentleman.

But unfortunately for Mr Lahr,

he wasn't able to keep track of his numerous identities and eventually

slipped up.

There was one incident where actually he rather forgot his own aliases and

in chasing us up for progress on his latest claim as Mr Lahr,

he actually used the same e-mail

he'd sent to us on another claim under a different name.

With the total of these claims amounting to thousands of

pounds, RSA decided to refer the case to the City of London Police's

Insurance Fraud Enforcement Department for further investigation.

IFED soon discovered the full extent of this fraudster's crimes

and it's fair to say he'd been busy.

IFED'S investigation established

that this gentleman's true name was

a Mr Ugwu.

He had, in addition to the nine claims he had pursued against RSA using

various aliases,

he had also pursued 22 other claims against other insurers,

again using different aliases.

So, this gentleman invented essentially 31 separate claims

across a number of insurers

and this was a very persistent and widespread fraud.

Mr Ugwu was arrested at his home address, where officers found yet more

damning evidence.

They found a number of items there related to the series of claims that

he'd made, including equipment for producing fraudulent receipts

and his fingerprints were over a number of related documents

across all of the claims that he had made.

Mr Ugwu was clearly a serial fraudster.

His claims were all planned, albeit carelessly,

in an attempt to cash in - but ultimately his sloppiness and greed had been

his undoing.

He was charged and appeared at Bolton Crown Court where he pleaded guilty

and I think he was extremely fortunate to receive a six-month

prison sentence, suspended for two years.

He was also ordered to do 60 hours unpaid community work and from our

perspective, he was ordered to pay back the £3,700 that we had paid to him

on two of the claims that he had pursued with us.

It was a clear message to anyone who thinks insurance policies are an

easy way to cash in.

I think in the past, people might have thought insurers

were a soft touch

and you could get away with this type of behaviour,

but we now use quite sophisticated technology

to spot this type of activity.

You will be caught and if you are caught,

then the consequences to you can be quite dire.

It's an added expense that none of us particularly enjoys paying,

but, for peace of mind, a travel insurance policy is a holiday essential.

However, just like any other type of insurance,

there are terms and conditions.

And whether it's a case of lost luggage or a medical emergency,

you need to be aware of exactly what your policy does and does not cover.

Collinson Group offer many different insurance products,

from personal accident to car and home emergency,

and recently received a call from a woman

who wanted to claim on her travel policy.

The claim originally submitted to us was for medical expenses incurred

whilst on holiday in India.

Our insured had claimed that she had a tooth extracted due to an immense pain

she was receiving in one of her teeth.

It sounded like the holiday from hell but her ordeal only got worse.

Whilst in hospital,

she unfortunately contracted a very bad chest infection so, all in all,

this lady was having a very bad time of it.

The woman claimed she had spent three days in hospital amounting to a bill

of around £1,000.

Upon receipt of the claim from our policy holder,

all the documentation received appeared genuine.

She'd sent as all the relevant receipts from the dentist.

She'd sent her submission and discharge notes from the hospital and proof of

payment to both facilities.

With all the boxes ticked, everything appeared to be above board.

But, on closer inspection of the documents,

the legitimacy of the entire claim was thrown into doubt.

After we received a medical report from our policy holder,

there was clear discrepancies with what she had told us had happened to

what actually had happened.

The doctor has written that she had actually had bilateral implants done

the previous day.

It was an allergic reaction to the medicine taken for this as the reason

why she presented herself to hospital.

The woman had originally said the medicine she reacted to was pain relief

for an emergency tooth extraction,

rather than any form of dental implant surgery.

With the circumstances of the claim looking suspicious,

it was referred to the fraud department, who instructed an overseas

investigator to look into the case.

His findings shed a bit more light on what exactly had happened.

Our fraud investigation team actually found out that she had had previous

treatment a year before but, due to time constraints,

she was asked to come back a year later.

It was at this point that the tooth that was meant to be fixed had

actually created an infection and it was an allergic reaction to the

medicine that he gave her that made her visit the hospital with all these

terrible things that she told us over the phone.

As the hospital visit was a result of planned treatment,

the woman wasn't covered under her travel insurance policy.

Once we'd received all the information, we made contact with the insured

via a letter. It basically said to her that she had attempted to claim for

medical expenses - however, it was clear that this was, in no way,

a medical emergency.

This claim was 100% pre-planned,

pre-existing and her claim was declined accordingly.

It was a great result for Collinson Group in their ongoing fight against

fraud and is a valuable reminder that insurance policies are not blanket

cover and will only pay out on the claims that they are specifically

intended for.

Some people believe that a travel insurance product is actually a

private medical policy.

It isn't. It is for unplanned and medical emergencies and needs to be

treated that way.

Still to come... A dog breeder can't get her facts straight.

Now, as this series aims to demonstrate,

fraudulent insurance claims aren't always as straightforward to detect

as you might think. And, in fact,

cracking some cases can take months or even years of investigation,

but when it comes to sorting the wheat from the chaff,

there's one source of evidence almost never fails.

CCTV cameras are part of public furniture pretty much everywhere we go

these days.

Whether it be on public transport, in shops or car parks,

more often than not, all angles are covered.

These all-seeing eyes can be crucial in the fight against insurance fraud.

Zurich recently dealt with a claim resulting from an incident that

happened between a bus and a parked car.

We insure a bus company and we received a claim suggesting that one of

their buses, whilst driving along...

The engine hatch had become open.

A passer-by had notified that to the driver and then the driver was then

approached by a woman suggesting that the bus had actually collided with

her vehicle.

The woman alleged that the engine hatch had caught the near side

of her parked car and was claiming for damage to the vehicle.

Initially, it seemed like a straightforward case.

We thought, at that point, we would repair the vehicle or pay for the

repairs to the vehicle and that would be the end of the claim.

However, what transpired was that we actually received a personal injury

claim from the owner of the vehicle, who suggested that when the bus

collided with her she was thrown about the car.

Not only that, we also got a personal injury claim from her mother, who was

also suggesting she was in the vehicle at the time.

The injuries were the classic whiplash-type soft tissue injuries that we

see a lot in claims of this nature.

Zurich became suspicious as the injury claim was submitted several weeks

after the damage claim and hadn't been mentioned at all in previous conversations.

Once we got the personal injury claim,

we were very keen to establish exactly what information our policy holder had -

because clearly he was on the scene and he could say exactly what had happened.

But when they spoke to the bus company,

a very different story emerged.

Well, very interestingly, the bus driver was adamant that the two women

who were claiming personal injury weren't even in the car at the time.

The car was stationary, parked,

unattended and they were not anywhere near it.

So if they weren't actually sitting in the vehicle how could they have

been injured?

Luckily, the bus was fitted with multiple CCTV cameras that had recorded

the whole thing.

We managed to secure CCTV footage from the bus, which was crucial,

because this type of footage provides you

with categoric insight in terms of what happened.

The recording clearly shows the bus approaching the parked car

on the left.

Then a passer-by signalling to the bus driver,

telling him that his engine hatch is open.

But, above all else, one thing stuck out like a sore thumb.

So what is clear in the footage is that the woman was definitely

outside the vehicle at the time of the alleged collision.

Well, not only was she not in the vehicle,

she's not sustained any injury whatsoever as a result of this incident,

so it was a complete fabrication.

It's unclear, in terms of the image of the passenger seat,

but we subsequently learned through the footage that the other woman

-wasn't in the car either.

-By closely watching the footage,

investigators could see that the damage the woman claimed had been done to

her car was also completely made up,

as it was clearly visible before the bus

had come into contact with the car.

Zurich knew exactly what was going on here.

Once we had the CCTV footage,

and we could prove that these women weren't in the car,

then the claims were clearly repudiated.

There was no way we were going to pay them

and we referred the case to IFED.

IFED is the City of London Police's Insurance Fraud Enforcement Department.

IFED's investigations reaffirmed the fact that these two women weren't in

the car and, when questioned,

they both admitted that and received cautions as a result.

We were really pleased with the outcome because it shows that somebody who

brazenly attempts to claim personal injury for an incident they're not

entitled to should expect to receive justice.

Now with criminal records to their names,

these women learned first-hand that the days of personal injury claims

providing a means to easy money are long gone.

It still surprises me that in this day and age, where there is CCTV footage

all over the place, particularly in public transport,

that they think they can get away with submitting personal injury claims

in situations that were just fabricated.

As any dog owner will tell you,

bringing home a new puppy can be an exciting but stressful experience.

With the chewing and the training and everything else,

a pet insurance policy is probably the last thing on an owner's mind

but should disaster strike when cover isn't in place, vets fees can burn

a very big hole in our pockets.

Fortunately, there are policies out there specifically designed for those

first few weeks as owners find their feet with their new companions.

Some companies offer dog breeder insurance policies.

These are taken out by the breeder then transferred to the new owner

when the puppy is sold.

The breeder has a grace period from the date of sale to activate the

policy, but, until they do so, the pup won't be covered.

Agria insure over 100,000 pets and know just how useful pet insurance

can be when a pup gets sick.

They recently had a case where a breeder wanted to take out an insurance

policy for a puppy she'd sold a few days previously.

We received a call from the breeder insuring a French Bulldog puppy,

a little boy puppy.

When she called, the breeder was in a bit of a fluster.

So the policy had been set up and it had been made clear to the breeder

that it didn't cover any pre-existing issues.

But, as the breeder had ended the call by saying all was OK with the

puppy, presumably that wasn't a problem.

30 minutes after the policy was set up by the breeder,

we received another telephone call from the same number

from a person who didn't identify herself but posed some hypothetical questions to us.

Although the woman didn't give her name,

the suspiciously similar voice combined with the same telephone number

strongly suggested that this was the same person.

There are no prizes for guessing what happened next.

The very next day, we received a telephone call from the policy holder,

the new puppy owner, who said, believe it or not,

we've got to make a claim already.

The very small French Bulldog puppy had been attacked by a very large

German Shepherd dog and had sustained serious bite wounds.

The puppy's new owner was claiming over £1,800 for treatment it received

at the vets the previous day.

But, before they could pay their claim, Agria

needed to establish exactly when the incident had happened.

So they contacted the vets to see if it was before or after the policy had been set up.

So when we got the veterinary history back, we looked at that in

detail and it was very precise about what had happened,

so the animal was seen on the same day that the policy was set up.

The animal was taken into the practice at 3:30,

seen by a vet at four o'clock and then,

when we compare that to our system records,

the policy wasn't set up until about an hour and a half later, at 5:30.

It was crystal clear that the breeder had incepted the policy after the

incident had happened,

meaning the owner wasn't covered for the £1,800 bill.

Agria called the breeder and gave her one last chance to get her facts straight.

This sounds like a classic case of avoiding the question.

Perhaps she'd do better when answering the next one.

We then went on in the phone call to question the breeder about her statement,

very early on when she activated the insurance, that the puppy had had a

problem, had had an incident,

and something had happened to the puppy and we asked her what that was

and why she said that.

That's not what she said on the original call.

At this point, Agri had heard enough of the woman leading them on.

So the breeder had sold the puppy but had forgotten to activate the free

five-week policy that's offered to new owners.

The puppy had then been attacked.

The new owners had taken her to the vet and

subsequently asked the breeder for the policy details to cover the cost

of the treatment. It was at that point the breeder had called Agria

to activate the cover,

knowing full well that the puppy had already been attacked.

But now they'd been found out and the puppy's new owners had become the

victims, thanks to the breeder's incompetence.

It seemed the breeder had nothing more to say and had finally admitted

defeat. Sadly,

it's the kind of story that Simon sees all too often and shows just how

important it is for a new owner to make sure insurance has been properly

set up by the breeder before a puppy is taken home.

It's really important that we treat it as fraud and try and identify

fraud and eradicate fraud from all of our processes.

It's not good enough that something happens and then someone tries to

insure against it. That's completely against the principle of insurance.

You take out insurance against the probability of something happening

in the future.

From organised criminal gangs to exaggerated household claims,

insurance fraud hits all of us in the pocket.

But, instead of getting away with it,

more and more of these fraudsters are being claimed and shamed.