0:00:06 > 0:00:10Insurance fraud in the UK has hit epidemic levels.
0:00:10 > 0:00:14It's costing us more than £1.3 billion every year.
0:00:14 > 0:00:17That's almost £3.6 million every day.
0:00:19 > 0:00:24Deliberate crashes, bogus personal injuries, even phantom pets.
0:00:26 > 0:00:29The fraudsters are risking more and more to make a quick killing,
0:00:29 > 0:00:33and every year it's adding around £50 to your insurance bill.
0:00:33 > 0:00:36But insurers are fighting back,
0:00:36 > 0:00:39exposing just under 15 fake claims every hour.
0:00:39 > 0:00:41Armed with covert surveillance systems...
0:00:41 > 0:00:44That's the subject out the vehicle.
0:00:44 > 0:00:47..sophisticated data analysis techniques...
0:00:47 > 0:00:49Police!
0:00:49 > 0:00:51..and a number of highly skilled police units...
0:00:51 > 0:00:53Police, stand back! Stay where you are!
0:00:53 > 0:00:56..they're catching the criminals red-handed.
0:00:56 > 0:00:58Just don't lie to us.
0:00:58 > 0:01:01All those con men, scammers and cheats on the fiddle
0:01:01 > 0:01:04are now caught in the act and claimed and shamed.
0:01:11 > 0:01:14A large-scale bogus injury scam is scuppered,
0:01:14 > 0:01:17as the claimants fail to clock the CCTV cameras...
0:01:19 > 0:01:22I think it's probably fair to assume that most or all of these
0:01:22 > 0:01:2660 claimants thought that this would be a fairly easy ride
0:01:26 > 0:01:30and that they would get some compensation reasonably quickly.
0:01:30 > 0:01:33..social media is the undoing of a bride-to-be's claim
0:01:33 > 0:01:35for a lost engagement ring...
0:01:44 > 0:01:47..and a con artist is caught in the act when he tries to repeat
0:01:47 > 0:01:49a previous claim.
0:01:49 > 0:01:51The passer-by that witnessed the accident actually stopped
0:01:51 > 0:01:55at the scene and informed us that he'd been involved
0:01:55 > 0:01:57in a very similar accident at the same location
0:01:57 > 0:02:01with the same third party only three months before.
0:02:06 > 0:02:09Now, with the volume of traffic on the roads constantly on the up,
0:02:09 > 0:02:12more and more of us are leaving our cars at home and turning
0:02:12 > 0:02:14to public transport to get around.
0:02:14 > 0:02:17But as convenient as it is sitting back and leaving
0:02:17 > 0:02:20the stress of navigating the city streets to someone else,
0:02:20 > 0:02:23taking to the roads always presents a risk,
0:02:23 > 0:02:26even when there is a trained professional behind the wheel.
0:02:33 > 0:02:36For many of us who live or work in built-up cities,
0:02:36 > 0:02:38buses are the preferred mode of transport
0:02:38 > 0:02:41and can often save us valuable time.
0:02:42 > 0:02:47But just like any other vehicles, buses are susceptible to accidents,
0:02:47 > 0:02:50and with up to 75 passengers on board at any one time,
0:02:50 > 0:02:53that can generate a lot of personal injury claims.
0:02:56 > 0:02:58With a fleet of over 6,000 buses,
0:02:58 > 0:03:01First Group are no stranger to multiple claims,
0:03:01 > 0:03:04but they recently dealt with one batch that turned out to be
0:03:04 > 0:03:06the result of foul play.
0:03:09 > 0:03:12One of our buses was involved in a very minor collision.
0:03:12 > 0:03:14Our bus was travelling in slow-moving traffic
0:03:14 > 0:03:18when the vehicle in front had to brake for amber traffic lights.
0:03:18 > 0:03:21Unfortunately, our bus was a little too close and collided
0:03:21 > 0:03:24with the rear of the Ford Fiesta.
0:03:24 > 0:03:26The bus was full of football supporters on their way
0:03:26 > 0:03:31to a Leeds United match, and the car contained an elderly couple.
0:03:31 > 0:03:34Thankfully, the bus was travelling at less than 10mph
0:03:34 > 0:03:36when the collision happened.
0:03:36 > 0:03:39The incident itself was relatively minor.
0:03:39 > 0:03:43There was scuffing to our bus and minor damage to the Ford Fiesta.
0:03:43 > 0:03:46So, we dealt with the repairs to the Ford Fiesta
0:03:46 > 0:03:47and that was the end of it.
0:03:47 > 0:03:50Or so they thought.
0:03:50 > 0:03:53Within days, we started receiving injury claims.
0:03:53 > 0:03:55The first one or two, obviously suspicious,
0:03:55 > 0:03:57because it was a very minor accident.
0:03:57 > 0:04:00However, they kept coming and, within a few weeks,
0:04:00 > 0:04:02we had over 40 claims.
0:04:02 > 0:04:05On one day alone, we received 25 claims,
0:04:05 > 0:04:08much to the dismay of the file handler on the case,
0:04:08 > 0:04:12and then within six months we had 60 claims, which was absolutely absurd.
0:04:14 > 0:04:19So, a minor rear-end shunt that had left an elderly couple in a tiny car
0:04:19 > 0:04:23completely unscathed had resulted in a staggering number of claims
0:04:23 > 0:04:25from the football supporters,
0:04:25 > 0:04:27amounting to £500,000
0:04:27 > 0:04:31in injury compensation and legal costs.
0:04:31 > 0:04:34And nearly every one of them was claiming the same thing.
0:04:34 > 0:04:37We were not surprised to find that most of the claimants that were
0:04:37 > 0:04:40pursuing the claims were claiming that they had soft tissue injuries,
0:04:40 > 0:04:43but some of the claims that they were presenting to us
0:04:43 > 0:04:45were completely absurd.
0:04:46 > 0:04:50We had nightmares, flashbacks, we had fear of travel,
0:04:50 > 0:04:52we had severe psychological trauma,
0:04:52 > 0:04:55and probably the worst was the severe panic attacks
0:04:55 > 0:04:58that one claimant allegedly suffered on a daily basis.
0:04:59 > 0:05:04The list of injuries and ailments was simply astonishing.
0:05:04 > 0:05:07So, First Group immediately launched a full investigation,
0:05:07 > 0:05:10and it wasn't long before they discovered an alarming trend
0:05:10 > 0:05:11with the claims.
0:05:12 > 0:05:16One of the things we did find rather surprising is we had 60 claimants,
0:05:16 > 0:05:21and 55 were represented by the same solicitor, which is highly unusual.
0:05:21 > 0:05:22With a multiple claim,
0:05:22 > 0:05:26you'd expect to see the individuals represented by
0:05:26 > 0:05:28various different solicitors.
0:05:28 > 0:05:32Suspecting they'd been the target of a large-scale attempt at fraud,
0:05:32 > 0:05:35First Group stepped up their investigation
0:05:35 > 0:05:38and turned to the CCTV footage recorded on the bus
0:05:38 > 0:05:40at the time of the accident.
0:05:41 > 0:05:45As expected, it clearly shows the bus following the Fiesta,
0:05:45 > 0:05:48the Fiesta coming to a sharp halt at the traffic lights,
0:05:48 > 0:05:51the bus not quite stopping in time
0:05:51 > 0:05:53and gently nudging the Fiesta.
0:05:55 > 0:05:58However, it's when you switch to the cameras inside the bus
0:05:58 > 0:06:02that things start to look suspicious.
0:06:02 > 0:06:03So, looking at the CCTV footage,
0:06:03 > 0:06:07you can clearly see that this accident is very minor.
0:06:07 > 0:06:10You can see that there's hardly any movement to any of the passengers.
0:06:10 > 0:06:14Certainly, none of the passengers were thrown down the bus.
0:06:14 > 0:06:17Bizarrely, you can see individuals patting each other on the backs.
0:06:17 > 0:06:19You can see them laughing.
0:06:19 > 0:06:21This certainly doesn't look like a bus full
0:06:21 > 0:06:23of 60 seriously injured people.
0:06:25 > 0:06:28It was clear the collision was extremely minor,
0:06:28 > 0:06:31and there was no way the bus passengers could have sustained
0:06:31 > 0:06:33the injuries they were claiming for.
0:06:33 > 0:06:36All 60 claims were repudiated.
0:06:36 > 0:06:38The case was closed and investigators thought
0:06:38 > 0:06:40it was all over.
0:06:43 > 0:06:46But some of the football supporters were in the mood
0:06:46 > 0:06:48for some extra time,
0:06:48 > 0:06:51and were determined to pursue their claims with the bus company.
0:06:52 > 0:06:55Four of the claimants decided they wanted their day in court,
0:06:55 > 0:06:57so they issued county court proceedings,
0:06:57 > 0:06:59which we were more than happy with.
0:06:59 > 0:07:02We've dealt with numerous claims like this and we were confident
0:07:02 > 0:07:03of a successful outcome.
0:07:03 > 0:07:07So, we instructed our fraud experts and also one of our top barristers
0:07:07 > 0:07:09to represent us in court.
0:07:10 > 0:07:12First Group turned to Horwich Farrelly,
0:07:12 > 0:07:15a legal firm specialising in insurance claims,
0:07:15 > 0:07:17to help defend the case.
0:07:19 > 0:07:22And it was soon clear to them that the football supporters
0:07:22 > 0:07:24didn't have a leg to stand on.
0:07:25 > 0:07:28All four of the claimants who proceeded to trial
0:07:28 > 0:07:30performed poorly in the witness box.
0:07:30 > 0:07:34The inconsistencies in their evidence were fairly easily
0:07:34 > 0:07:37exposed by cross-examination.
0:07:41 > 0:07:43During the CCTV recording,
0:07:43 > 0:07:45one of the claimants can be seen clutching his neck
0:07:45 > 0:07:49as the bus hits the car. Yet, when presenting his claim,
0:07:49 > 0:07:52it seems he forgot to get his facts straight.
0:07:53 > 0:07:57This particular claimant's case was that he didn't feel any pain
0:07:57 > 0:07:59or symptoms until the following day.
0:07:59 > 0:08:02On that basis, unsurprisingly,
0:08:02 > 0:08:05he was asked why he was clutching his neck
0:08:05 > 0:08:07immediately after the accident,
0:08:07 > 0:08:11and his response to the judge was to check if he was OK.
0:08:11 > 0:08:14The judge just found that to be bizarre and implausible.
0:08:16 > 0:08:19When viewing the CCTV after the collision,
0:08:19 > 0:08:22it also looked like some of the supporters already had thoughts
0:08:22 > 0:08:25of compensation in the forefront of their minds.
0:08:27 > 0:08:31The footage shows all of the passengers disembarking the bus.
0:08:31 > 0:08:34And whilst doing so, it can be seen
0:08:34 > 0:08:39that five or six are taking pictures on their cellphones
0:08:39 > 0:08:43of the bus driver, the front of the bus and the rear of the Ford Fiesta.
0:08:45 > 0:08:49The fact that so many people were taking photographs
0:08:49 > 0:08:53certainly gives the viewer the notion
0:08:53 > 0:08:56that many of these passengers were immediately alive
0:08:56 > 0:08:58to the prospect of compensation claims.
0:09:00 > 0:09:05The judge had no hesitation in showing the claimants the red card.
0:09:05 > 0:09:07All four claims were dismissed.
0:09:07 > 0:09:11Two of the claimants were found to be fundamentally dishonest.
0:09:11 > 0:09:15They were ordered to pay legal costs of just over £7,000
0:09:15 > 0:09:19and just under £5,000 respectively.
0:09:19 > 0:09:23It was a superb result for Horwich Farrelly and First Group,
0:09:23 > 0:09:26and a harsh lesson for the football fans who thought they could
0:09:26 > 0:09:28cheat their way to an easy win.
0:09:29 > 0:09:33I think it's probably fair to assume that most or all of these
0:09:33 > 0:09:3760 claimants thought that this would be a fairly easy ride
0:09:37 > 0:09:41and that they would get some compensation reasonably quickly.
0:09:41 > 0:09:46I don't think any of them realised the efforts that First Group
0:09:46 > 0:09:49and ourselves would go to in defending these claims.
0:09:53 > 0:09:56And for anyone else who thinks bus companies are an easy touch
0:09:56 > 0:10:00when it comes to compensation, Julie has a few words of advice.
0:10:01 > 0:10:04For anyone thinking of pursuing a fraudulent claim
0:10:04 > 0:10:07against our company, don't do it. If we catch you - and we will -
0:10:07 > 0:10:09we will push for the toughest penalties,
0:10:09 > 0:10:12and this could have serious financial implications
0:10:12 > 0:10:14or even custodial sentences.
0:10:21 > 0:10:24In America, it's the end of the road for the doctor
0:10:24 > 0:10:27behind one of the largest fake prescription scams in US history.
0:10:34 > 0:10:38Nowadays, social media has become a huge part of our lives.
0:10:38 > 0:10:40In fact, around 32 million of us -
0:10:40 > 0:10:43that's half the population of the UK -
0:10:43 > 0:10:44have an online account.
0:10:44 > 0:10:46Some are more secure than others,
0:10:46 > 0:10:50but many allow your basic details to be seen by anyone.
0:10:50 > 0:10:54Which is all well and good, so long as you don't have anything to hide.
0:10:57 > 0:11:00Social media is being used more and more
0:11:00 > 0:11:02when it comes to verifying claims.
0:11:04 > 0:11:07Often people are caught out when posts on their online account
0:11:07 > 0:11:10don't back up what they have told the insurers.
0:11:13 > 0:11:16i-Cog are a claims management company that deal with cases
0:11:16 > 0:11:18on behalf of insurers,
0:11:18 > 0:11:20and recently dealt with a case regarding
0:11:20 > 0:11:23a missing piece of jewellery.
0:11:26 > 0:11:30The claim that we received from the insurers was for a ring
0:11:30 > 0:11:33that had been lost while the policyholder was swimming
0:11:33 > 0:11:35at the beach with a friend.
0:11:35 > 0:11:39The claim was potentially worth £1,362.
0:11:40 > 0:11:43The first thing they did was to call the claimant
0:11:43 > 0:11:45to go through the facts.
0:12:27 > 0:12:29So, this wasn't your average ring.
0:12:29 > 0:12:33Designed by her partner, and with a truly distinctive look,
0:12:33 > 0:12:36it's no wonder the claimant was upset after she had lost it.
0:12:59 > 0:13:03Fair enough. Many people wait years for a proposal,
0:13:03 > 0:13:05so to then lose your engagement ring
0:13:05 > 0:13:07might make you feel lost without it.
0:13:07 > 0:13:10So, picking up any old replacement sounded plausible enough...
0:13:10 > 0:13:12..but there was a problem.
0:13:14 > 0:13:19We do get claims like this quite often for rings that are lost.
0:13:19 > 0:13:23However, the insurer had raised some concerns about this claim.
0:13:24 > 0:13:27The insurer, as standard, did some background checking,
0:13:27 > 0:13:29including some social media checks.
0:13:29 > 0:13:32They found a post of an engagement ring
0:13:32 > 0:13:36on the insured's Instagram account.
0:13:37 > 0:13:38Nothing surprising there.
0:13:38 > 0:13:41After all, what bride-to-be wouldn't want to show off their new
0:13:41 > 0:13:45bling to friends and family?
0:13:45 > 0:13:49The post was posted after the date of loss.
0:13:49 > 0:13:52Ah. Surely there was a rational explanation?
0:13:52 > 0:13:57We find it incredibly unusual that a ring could appear
0:13:57 > 0:14:00on a social media site after the date that it was lost.
0:14:01 > 0:14:05In which case, time to confront the claimant.
0:14:54 > 0:14:56She immediately told us that
0:14:56 > 0:14:59she didn't use Instagram very often.
0:14:59 > 0:15:02She was unsure of what I was referring to.
0:15:02 > 0:15:05And it wasn't until we went through the post that she put on there,
0:15:05 > 0:15:08word for word, that she then came up with an account
0:15:08 > 0:15:10of why she put that there.
0:15:27 > 0:15:31So, the woman was claiming that the picture she had posted
0:15:31 > 0:15:34of the beautiful and unique ring was, in fact,
0:15:34 > 0:15:37the cheap and cheerful replacement she'd picked up on the high street.
0:15:51 > 0:15:54Unsurprisingly, for both i-Cog and the woman's insurers,
0:15:54 > 0:15:57it just didn't make sense.
0:16:29 > 0:16:31Never mind pathetic.
0:16:31 > 0:16:33I'd say it sounds rather suspicious.
0:16:34 > 0:16:37This did not seem like a plausible account at all.
0:16:38 > 0:16:42Very strange that you would put a photo of a ring up
0:16:42 > 0:16:45and tell people that it is an engagement ring if it wasn't.
0:16:47 > 0:16:50As if the explanation wasn't dubious enough,
0:16:50 > 0:16:53as cheap and cheerful replacement rings go,
0:16:53 > 0:16:55this one really looked the part.
0:17:10 > 0:17:13Little did the claimant realise
0:17:13 > 0:17:15i-Cog had done their homework.
0:17:15 > 0:17:17Not only did they know where her original engagement ring
0:17:17 > 0:17:20had come from, but crucially they also knew
0:17:20 > 0:17:22exactly what it looked like.
0:17:53 > 0:17:56Her husband-to-be must have been kicking himself
0:17:56 > 0:17:58when he discovered she had found a ring
0:17:58 > 0:18:02in a high-street costume jewellery shop that was identical
0:18:02 > 0:18:06to the one he had designed and paid a small fortune for.
0:18:07 > 0:18:09In my experience with jewellery claims,
0:18:09 > 0:18:11it is unlikely that she would have been able to find
0:18:11 > 0:18:15a piece of costume jewellery from a store just on the high street
0:18:15 > 0:18:19that would have been similar enough in design
0:18:19 > 0:18:21for the one that she says is her engagement ring.
0:18:23 > 0:18:26But the woman was adamant the ring on her social media account
0:18:26 > 0:18:29really was the cheap replacement she'd rushed out and bought.
0:18:38 > 0:18:40So, all she needed was the receipt,
0:18:40 > 0:18:43or a letter from the shop where she'd bought the cheap replacement,
0:18:43 > 0:18:46and her claim would be settled.
0:18:46 > 0:18:49So, a couple of days later the insured sent us an e-mail.
0:18:49 > 0:18:52In that, she confirmed that she couldn't find a receipt
0:18:52 > 0:18:56or purchase order for the substitute ring,
0:18:56 > 0:19:00and as such she would like to withdraw the claim.
0:19:00 > 0:19:03The fact that the woman had given up so quickly
0:19:03 > 0:19:07on a claim worth over £1,300 spoke volumes.
0:19:08 > 0:19:11So, the claim could have been easily validated.
0:19:11 > 0:19:14We asked for proof of purchase for the ring.
0:19:14 > 0:19:16She was unable to provide this,
0:19:16 > 0:19:19which seems unusual because she had bought it from
0:19:19 > 0:19:21a big name on the high street,
0:19:21 > 0:19:24and they are usually, in my experience, very helpful,
0:19:24 > 0:19:27especially when it is only a couple of weeks before.
0:19:27 > 0:19:31It also seems very unusual that she would walk away from a claim
0:19:31 > 0:19:34for such a sentimental and valuable item.
0:19:35 > 0:19:38It appeared she thought her insurance company
0:19:38 > 0:19:39wouldn't check up on her.
0:19:39 > 0:19:42But like many would-be fraudsters before her,
0:19:42 > 0:19:45the post on her online account had been her undoing.
0:19:47 > 0:19:50We would always do checking on social media.
0:19:51 > 0:19:54We have various sites that we check.
0:19:54 > 0:19:57People tend to live their lives through social media now,
0:19:57 > 0:20:01so it really is a good insight for the insurers to do those checks,
0:20:01 > 0:20:04because unfortunately some people will live their life
0:20:04 > 0:20:08through their posts, and sometimes this can catch them out.
0:20:13 > 0:20:17Being involved in a car accident is never a pleasant experience,
0:20:17 > 0:20:20but if you've been involved in an accident that wasn't your fault,
0:20:20 > 0:20:23then sometimes you need to be able to prove it.
0:20:23 > 0:20:27CCTV or dashcam footage can provide irrefutable evidence,
0:20:27 > 0:20:32but unfortunately they are a luxury not many of us have access to.
0:20:32 > 0:20:34Instead, we are reliant on eyewitness evidence
0:20:34 > 0:20:37to help determine exactly what happened
0:20:37 > 0:20:39and where the blame should lie.
0:20:41 > 0:20:44When insurance companies receive claims,
0:20:44 > 0:20:48the details are always validated before any money is paid.
0:20:48 > 0:20:50This usually involves taking statements from the drivers
0:20:50 > 0:20:52and any witnesses,
0:20:52 > 0:20:55looking at the damage to the cars and, where necessary,
0:20:55 > 0:20:59examining medical reports relating to any injuries.
0:21:03 > 0:21:05AXA's Tom Wilson knows all too well
0:21:05 > 0:21:08that some cases are easier to validate than others,
0:21:08 > 0:21:11and that a single piece of evidence can be the crucial difference
0:21:11 > 0:21:15between establishing whether a claim is genuine or fraudulent.
0:21:17 > 0:21:20So, a customer reported to us that he'd been involved in a collision
0:21:20 > 0:21:23with a Mr Khan. Mr Khan was rounding a bend
0:21:23 > 0:21:25and our customer went into the rear of him...
0:21:27 > 0:21:29..causing damage to both vehicles.
0:21:32 > 0:21:36The value of our customer's vehicle damage was about £4,500.
0:21:36 > 0:21:38And the value of Mr Khan's vehicle damage,
0:21:38 > 0:21:40as a result of this vehicle becoming a total loss,
0:21:40 > 0:21:43was £8,500.
0:21:43 > 0:21:46With a total value of £13,000,
0:21:46 > 0:21:50this was significantly more than a gentle rear-end shunt,
0:21:50 > 0:21:52so the claim was thoroughly investigated.
0:21:54 > 0:21:57Initially, the circumstances would appear genuine.
0:21:57 > 0:22:00However, from the outset our customer made it clear
0:22:00 > 0:22:02that he believed that the BMW had slammed his brakes on
0:22:02 > 0:22:05for no apparent reason, which caused our customer to go into
0:22:05 > 0:22:07the rear of the vehicle.
0:22:07 > 0:22:10He believed he was the victim of a crash for cash
0:22:10 > 0:22:13and that Mr Khan had induced this accident.
0:22:13 > 0:22:16Crash for cash is when someone deliberately causes a collision
0:22:16 > 0:22:20so they can cash in on the other party's insurance policy.
0:22:20 > 0:22:25This is a practice often favoured by serial fraudsters or criminal gangs,
0:22:25 > 0:22:29who induce accidents with innocent road users in order to profit
0:22:29 > 0:22:31from fraudulent insurance claims.
0:22:31 > 0:22:35With just one claim potentially worth thousands of pounds,
0:22:35 > 0:22:38crash for cash is a big problem that costs the insurance industry
0:22:38 > 0:22:42around £340 million a year.
0:22:45 > 0:22:48In this case, AXA's policyholder needed proof that he really had
0:22:48 > 0:22:51been the victim of a crash for cash scam,
0:22:51 > 0:22:55and as luck would have it, he had exactly that.
0:22:55 > 0:22:58The real key piece of information was a passer-by that witnessed
0:22:58 > 0:23:02the accident actually stopped at the scene and informed us that
0:23:02 > 0:23:06he'd been involved in a very similar accident at the same location
0:23:06 > 0:23:08with the same third party only three months before.
0:23:11 > 0:23:13That clearly gives us cause for concern.
0:23:14 > 0:23:18They say lightning never strikes twice in the same place,
0:23:18 > 0:23:22but the eyewitness was alleging that, just a matter of weeks before,
0:23:22 > 0:23:25a near-identical crash had happened in the same way
0:23:25 > 0:23:28on exactly the same stretch of road.
0:23:28 > 0:23:31Coupled with the fact that our customer alleged that this guy
0:23:31 > 0:23:33had slammed his brakes on for no reason,
0:23:33 > 0:23:36it just builds a bigger picture about the credibility of this person
0:23:36 > 0:23:41and actually the validity of the accident circumstances itself.
0:23:41 > 0:23:44The police had attended the scene of the accident and also noticed
0:23:44 > 0:23:46something rather suspicious.
0:23:46 > 0:23:50The third-party vehicle, the BMW, was recovered by a recovery truck,
0:23:50 > 0:23:53but when the recovery truck turned up, it was full of people already.
0:23:53 > 0:23:57So, the driver of the BMW caught a lift with a vehicle that was waiting
0:23:57 > 0:24:00a little way down the road. And it was suspected that that vehicle
0:24:00 > 0:24:02had been waiting there all along.
0:24:03 > 0:24:05It would suggest that the incident was planned,
0:24:05 > 0:24:07that it was premeditated,
0:24:07 > 0:24:09and that he was waiting there because he knew the accident
0:24:09 > 0:24:12was going to take place at this location.
0:24:15 > 0:24:17With the policyholder's suspicions,
0:24:17 > 0:24:19the witness statement and information from the police
0:24:19 > 0:24:22all pointing towards a fraudulent claim,
0:24:22 > 0:24:26the insurance company was in no doubt of what to do next.
0:24:26 > 0:24:30We informed the insurer of Mr Khan that we believed it to be
0:24:30 > 0:24:33a deliberate action and believed it to be an induced accident,
0:24:33 > 0:24:35and we weren't going to be paying his claim,
0:24:35 > 0:24:37so we rejected his claim on that basis.
0:24:40 > 0:24:42Legal action was taken against Mr Khan,
0:24:42 > 0:24:45and the case proceeded to court.
0:24:45 > 0:24:47So, Mr Khan was required to attend a hearing,
0:24:47 > 0:24:50where he was found guilty of conspiracy to defraud
0:24:50 > 0:24:52and fraud by misrepresentation,
0:24:52 > 0:24:55and he was sentenced to 20 months behind bars.
0:25:00 > 0:25:02The sentence handed down in this particular case
0:25:02 > 0:25:05was a strong sentence, and to receive a custodial sentence,
0:25:05 > 0:25:08primarily, for Mr Khan, is a great result.
0:25:08 > 0:25:12It sends the message of a deterrent to would-be fraudsters
0:25:12 > 0:25:15that if you do try and you get caught, and we will catch you,
0:25:15 > 0:25:18that you could end up with a prison sentence.
0:25:20 > 0:25:23With another fraudster caught and punished for his actions,
0:25:23 > 0:25:25it was a great result for AXA,
0:25:25 > 0:25:28and showed just how important it is in cases like these
0:25:28 > 0:25:30for witnesses to come forward.
0:25:32 > 0:25:34In respect of our investigation, the witness being there
0:25:34 > 0:25:38was absolutely key to being able to prove that this was a fraud.
0:25:38 > 0:25:39Had he not been present,
0:25:39 > 0:25:42it would effectively be our customer's word against the word
0:25:42 > 0:25:46of the third party, so it would make it very difficult for us
0:25:46 > 0:25:48to prove that it was an induced accident.
0:25:53 > 0:25:55Still to come:
0:25:55 > 0:25:58a motorist's attempt to exaggerate his claim backfires
0:25:58 > 0:26:01when he makes a basic mistake.
0:26:01 > 0:26:05He categorically denied that he'd suffered any injury when asked.
0:26:15 > 0:26:18As we've seen in many cases on this programme,
0:26:18 > 0:26:21fraudsters will go to extreme lengths to get their hands
0:26:21 > 0:26:24on a pay-out, from deliberately causing an accident
0:26:24 > 0:26:27to claiming for medical treatment they never even received.
0:26:27 > 0:26:30But if you think we've got it bad in the UK,
0:26:30 > 0:26:33the depths some fraudsters go to across the pond
0:26:33 > 0:26:35is simply astonishing.
0:26:37 > 0:26:41In America, the largest type of insurance fraud by far
0:26:41 > 0:26:43is scams against health care insurers.
0:26:45 > 0:26:47The exact size of the problem is unknown,
0:26:47 > 0:26:51but it is likely to be tens of billions of dollars a year.
0:26:53 > 0:26:55Out of all the people we trust,
0:26:55 > 0:26:57doctors are usually high on the list.
0:26:57 > 0:27:00But sadly, as many of these cases have proved,
0:27:00 > 0:27:03not all medical experts are running practices
0:27:03 > 0:27:05that are entirely above board.
0:27:18 > 0:27:21In Miami, Florida, Fernando Mendez-Villamil
0:27:21 > 0:27:23qualified as a doctor in 1998
0:27:23 > 0:27:26and set up his own psychiatric practice,
0:27:26 > 0:27:30treating patients for conditions such as ADHD, schizophrenia,
0:27:30 > 0:27:33depression and narcolepsy.
0:27:35 > 0:27:37But just four years later,
0:27:37 > 0:27:40he began defrauding the government health care providers in a scam
0:27:40 > 0:27:43that would last for the next 14 years
0:27:43 > 0:27:47and cost the US government millions of dollars.
0:27:49 > 0:27:53His plan involved staffing his office with low-paid workers
0:27:53 > 0:27:56who would carry out the tasks he gave them without question.
0:27:59 > 0:28:01His scheme was simple.
0:28:01 > 0:28:03People who wanted to get disability benefits
0:28:03 > 0:28:06but who didn't actually have a mental health problem
0:28:06 > 0:28:09would pay him around 1,500.
0:28:09 > 0:28:12In exchange, he would give them a false diagnosis,
0:28:12 > 0:28:15along with fake medical records and prescriptions,
0:28:15 > 0:28:18so they could apply for the benefits.
0:28:21 > 0:28:25These people would then attend a disability determination interview,
0:28:25 > 0:28:28where they would be questioned about their alleged mental illness.
0:28:29 > 0:28:33Mendez-Villamil would prepare them for these interviews,
0:28:33 > 0:28:34telling them how to respond,
0:28:34 > 0:28:37so it looked like they were genuinely suffering
0:28:37 > 0:28:39from severe mental health issues.
0:28:41 > 0:28:43He would then submit false claims to the government
0:28:43 > 0:28:46health insurance programmes, Medicare and Medicaid,
0:28:46 > 0:28:48for appointments that never took place,
0:28:48 > 0:28:51and prescriptions that weren't actually necessary.
0:28:56 > 0:28:58While all this was going on,
0:28:58 > 0:29:01he continued to treat legitimate patients at his practice.
0:29:01 > 0:29:04But he even preyed on these innocent victims too,
0:29:04 > 0:29:07by giving over-the-top diagnoses
0:29:07 > 0:29:10and prescribing excessive amounts of medication.
0:29:12 > 0:29:15By 2004, he had earned the title of the most prolific
0:29:15 > 0:29:17drug provider in Florida,
0:29:17 > 0:29:21issuing some 62,000 prescriptions a year,
0:29:21 > 0:29:25costing 12.2 million.
0:29:25 > 0:29:27That's over 1,000 prescriptions a week.
0:29:29 > 0:29:33But his epic attempt at fraud didn't go unnoticed.
0:29:33 > 0:29:36Three years later, Medicaid received a complaint
0:29:36 > 0:29:39from a private investigator called Ken Kramer.
0:29:40 > 0:29:42Kramer had noticed that Mendez-Villamil
0:29:42 > 0:29:45was prescribing a huge and totally disproportionate amount
0:29:45 > 0:29:48of anti-psychotic drugs to children.
0:29:50 > 0:29:53The information was passed on to the US Senate,
0:29:53 > 0:29:56who made the prescription records available to the public.
0:29:56 > 0:30:02By that time, he had an astounding 96,000 mental health patients
0:30:02 > 0:30:04on his books.
0:30:05 > 0:30:06When questioned, Mendez-Villamil
0:30:06 > 0:30:09insisted that the number of prescriptions he was issuing
0:30:09 > 0:30:12was normal for this volume of patients.
0:30:12 > 0:30:14But the authorities thought otherwise.
0:30:19 > 0:30:22Medicaid terminated him as a health care provider,
0:30:22 > 0:30:26meaning he could no longer claim any money from them.
0:30:26 > 0:30:28But that didn't stop this fraudster.
0:30:28 > 0:30:31He continued to submit claims to Medicare,
0:30:31 > 0:30:34who cover those aged over 65
0:30:34 > 0:30:36and young people with disabilities.
0:30:37 > 0:30:39Some of his patients were as young as three,
0:30:39 > 0:30:42and were being prescribed huge amounts of medication
0:30:42 > 0:30:44for no apparent reason.
0:30:46 > 0:30:49The notes on their medical reports also frequently
0:30:49 > 0:30:53contradicted each other, a clear sign that something wasn't right.
0:30:54 > 0:30:56Not only was Mendez-Villamil
0:30:56 > 0:30:58helping thousands of people to fraudulently
0:30:58 > 0:31:00receive disability benefit,
0:31:00 > 0:31:03but he was also claiming money from health care providers
0:31:03 > 0:31:06that he wasn't owed. And on top of that,
0:31:06 > 0:31:08he was flooding the streets of Florida with drugs
0:31:08 > 0:31:11that should never have been prescribed.
0:31:11 > 0:31:13He needed to be stopped.
0:31:14 > 0:31:16In 2013, Mendez-Villamil
0:31:16 > 0:31:19was struck off Medicare's list of providers.
0:31:19 > 0:31:23He received a 15,000 fine from the Florida Board of Medicine
0:31:23 > 0:31:28and was asked to reimburse the state more than 22,000 in costs.
0:31:31 > 0:31:34Unfazed by this attempt to put a stop to his illegal scam,
0:31:34 > 0:31:37he came up with yet another plan.
0:31:38 > 0:31:43This time, he targeted immigrants who wanted to become US citizens.
0:31:43 > 0:31:46In exchange for a 1,000 cash fee,
0:31:46 > 0:31:49he would diagnose them with a false mental illness so they wouldn't have
0:31:49 > 0:31:53to adhere to all of the country's strict immigration rules.
0:31:54 > 0:31:58But he had gone too far, and the law had caught up with him.
0:32:02 > 0:32:03In January 2016,
0:32:03 > 0:32:07he was accused of running one of the largest fake prescription schemes
0:32:07 > 0:32:10in US history, and was immediately arrested.
0:32:13 > 0:32:15His home and valuable possessions were seized,
0:32:15 > 0:32:18including a rather unusual collection of paintings
0:32:18 > 0:32:22estimated to be worth around 500,000.
0:32:22 > 0:32:25He later pleaded guilty to conspiracy to commit
0:32:25 > 0:32:28health care fraud, to make false statements in immigration matters
0:32:28 > 0:32:30and to defrauding the US government.
0:32:34 > 0:32:38Overall, his scam had cost the Citizenship and Immigration Services
0:32:38 > 0:32:40over 800,000,
0:32:40 > 0:32:45the United States disability system more than 20 million
0:32:45 > 0:32:49and health care providers Medicare and Medicaid over 29 million.
0:32:53 > 0:32:58Mendez-Villamil was sentenced to 12 years and seven months in prison,
0:32:58 > 0:33:02and ordered to pay back costs of over 50 million.
0:33:12 > 0:33:15Although justice had finally been served,
0:33:15 > 0:33:17this was a man who had abused his position
0:33:17 > 0:33:20to an unimaginable degree.
0:33:20 > 0:33:24It will also take some time to identify the thousands of patients
0:33:24 > 0:33:26he has given false diagnoses to,
0:33:26 > 0:33:29who are still out there defrauding the US government.
0:33:38 > 0:33:42Temptation. It can come in various forms, but for many of us
0:33:42 > 0:33:45the promise of free money is something that is
0:33:45 > 0:33:48very hard to turn down. Now, if you own a phone,
0:33:48 > 0:33:51then the chances are that at some point you've received a call
0:33:51 > 0:33:54telling you that there is a pot of cash with your name on it
0:33:54 > 0:33:57waiting for you to collect as compensation
0:33:57 > 0:33:59for the accident you were involved in...
0:33:59 > 0:34:03..sometimes even if you haven't been in an accident.
0:34:03 > 0:34:06Well, this next case highlights the potential pitfalls of pursuing
0:34:06 > 0:34:09a claim that you simply aren't entitled to.
0:34:12 > 0:34:16BLM are a legal firm who represent a number of insurance companies.
0:34:16 > 0:34:19One of their partners, Naomi Grant, dealt with a case
0:34:19 > 0:34:22from a particularly persistent claimant who was determined
0:34:22 > 0:34:24to get what he thought he was owed.
0:34:26 > 0:34:29The insurers in this case were initially just presented with
0:34:29 > 0:34:31a straightforward claim for vehicle damage
0:34:31 > 0:34:34arising out of a road traffic accident.
0:34:34 > 0:34:37Both parties were travelling in opposite directions
0:34:37 > 0:34:40along a fairly narrow country road, and in the process,
0:34:40 > 0:34:44they came into collision with one another.
0:34:44 > 0:34:47The initial incident wasn't suspicious in any way.
0:34:47 > 0:34:50At first presentation, this was just a claim for vehicle damage.
0:34:50 > 0:34:53So, an unfortunate coming together of two cars,
0:34:53 > 0:34:55but thankfully no-one was injured,
0:34:55 > 0:34:57and it was a straightforward claim to process.
0:34:57 > 0:35:01As a routine part of dealing with the vehicle damage claim,
0:35:01 > 0:35:05the claimant made a telephone call to the insurance company
0:35:05 > 0:35:07about two months after the initial accident.
0:35:49 > 0:35:52So, with the exception of the ill feeling between the two parties,
0:35:52 > 0:35:55this was a simple matter of repairing the vehicles
0:35:55 > 0:35:57and closing the case...
0:35:59 > 0:36:02..or so the insurance company thought.
0:36:02 > 0:36:05Eight months after the initial accident,
0:36:05 > 0:36:09the insurance company received a claim notification form
0:36:09 > 0:36:13from a firm of solicitors appointed on behalf of the claimant,
0:36:13 > 0:36:15and at that point the claimant alleged
0:36:15 > 0:36:17that he'd suffered personal injury.
0:36:17 > 0:36:20Although eight months might sound like a long time,
0:36:20 > 0:36:24with many genuine claims this is actually quite a regular occurrence.
0:36:25 > 0:36:29It's not uncommon for people to present claims quite some time
0:36:29 > 0:36:31after the accident.
0:36:31 > 0:36:34The law in England and Wales is that a person has three years
0:36:34 > 0:36:37from the date of an accident before they have to actually
0:36:37 > 0:36:40issue court proceedings to bring their claim.
0:36:40 > 0:36:44So, technically the claimant in this matter did nothing wrong.
0:36:44 > 0:36:47"Technically" being the key word there,
0:36:47 > 0:36:50because it was at this point that things began to unravel.
0:36:51 > 0:36:55The claimant had indicated that he had suffered personal injury,
0:36:55 > 0:36:58but he didn't present any other evidence to go with that,
0:36:58 > 0:37:01so the claim then had to be reopened and looked at again,
0:37:01 > 0:37:05which caused the insurance company to go back through their call log
0:37:05 > 0:37:08to locate the call when he categorically denied
0:37:08 > 0:37:11that he'd suffered any injury when asked.
0:37:18 > 0:37:20That immediately aroused their suspicions.
0:37:20 > 0:37:23The insurance company therefore disclosed a copy
0:37:23 > 0:37:25of that call recording to the solicitors,
0:37:25 > 0:37:28who appeared to go away and discontinue the claim,
0:37:28 > 0:37:31so again the file was closed down.
0:37:32 > 0:37:35It looked as though this chap had tried to submit a cheeky claim
0:37:35 > 0:37:37in the hope of some easy money,
0:37:37 > 0:37:41but his underhanded attempt had been scuppered by his own voice
0:37:41 > 0:37:43on the original call recording,
0:37:43 > 0:37:47where he'd said he was completely unscathed by the car accident.
0:37:49 > 0:37:51With evidence as conclusive as that,
0:37:51 > 0:37:53most people would leave it there.
0:37:53 > 0:37:56But it soon transpired this fella wasn't most people.
0:37:59 > 0:38:03The bigger surprise was that some 18 months after the accident,
0:38:03 > 0:38:08he re-presented his claim through a second firm of solicitors,
0:38:08 > 0:38:12again maintaining that he had been injured.
0:38:12 > 0:38:15The call recording was again immediately disclosed,
0:38:15 > 0:38:19but the claimant insisted that he'd suffered an injury,
0:38:19 > 0:38:23and this time went on to get a medical examination
0:38:23 > 0:38:27and a medical report to detail all of his alleged injuries.
0:38:27 > 0:38:30Either this was someone who firmly believed in the phrase
0:38:30 > 0:38:34"third time lucky" or he was being given some very poor advice.
0:38:36 > 0:38:40But at least this time he had some documents to back up his claim.
0:38:40 > 0:38:44The medical report stated that he'd suffered a neck injury,
0:38:44 > 0:38:47which he said he had suffered from for five months.
0:38:47 > 0:38:52He also claimed that he had been affected in his domestic duties,
0:38:52 > 0:38:56so he was unable to clean, cook or shop.
0:38:56 > 0:38:58He couldn't carry out any leisure activities,
0:38:58 > 0:39:00he was unable to play football,
0:39:00 > 0:39:03and he claimed he was unable to sleep properly.
0:39:03 > 0:39:07So, from no injuries at all to a list of ailments that added up
0:39:07 > 0:39:10to a pretty hefty claim for compensation.
0:39:10 > 0:39:15So, all in all, the claim was valued in the region of £8,000.
0:39:15 > 0:39:18Now, given this man categorically said he was uninjured,
0:39:18 > 0:39:21it will come as no surprise that the insurance company
0:39:21 > 0:39:24had no intention of paying this claim.
0:39:24 > 0:39:27So, they instructed BLM to defend it all the way,
0:39:27 > 0:39:30which they duly did.
0:39:31 > 0:39:34We were able to prepare a robust defence,
0:39:34 > 0:39:35referring to the phone call,
0:39:35 > 0:39:38which really set out all the facts.
0:39:38 > 0:39:41And that defence quite categorically stated that this was
0:39:41 > 0:39:45a fraudulent claim in the eyes of the insurance company.
0:39:45 > 0:39:47Sounds like a pretty one-sided fight,
0:39:47 > 0:39:50but with the prospect of a pay-out on the line,
0:39:50 > 0:39:52this guy wasn't one to give in easily.
0:39:53 > 0:39:56The claimant in this matter actually continued with his claim
0:39:56 > 0:39:58for quite a long time,
0:39:58 > 0:40:01despite having been presented with all the evidence,
0:40:01 > 0:40:04which was quite irrefutable, early on.
0:40:04 > 0:40:06In a further twist to the tale,
0:40:06 > 0:40:09two months before the matter was due to be listed for trial,
0:40:09 > 0:40:13the claimant then made the sensible decision to discontinue his claim.
0:40:15 > 0:40:17But if he thought that was the end of the matter,
0:40:17 > 0:40:20then he was in for a very nasty surprise indeed.
0:40:21 > 0:40:23In common with many people,
0:40:23 > 0:40:25the claimant in this instance really thought that
0:40:25 > 0:40:29by discontinuing his claim he could just run away from everything
0:40:29 > 0:40:33and drop his claim and that would be an end to the matter.
0:40:34 > 0:40:37Unfortunately for him, that wasn't to be the case.
0:40:37 > 0:40:40The insurance company in this matter had spent a considerable amount
0:40:40 > 0:40:44of time, effort and resource in having to defend not only his claim
0:40:44 > 0:40:47but to pursue the claim against him,
0:40:47 > 0:40:50and in the judgment that was recognised by the judge,
0:40:50 > 0:40:54who actually awarded the insurance company a sum
0:40:54 > 0:40:56towards their own investigation costs.
0:40:58 > 0:41:02The claimant was also ordered to pay a sum of money by way of damages,
0:41:02 > 0:41:06to punish him for what he'd done in bringing the claims.
0:41:06 > 0:41:08And he was ordered to pay a considerable amount
0:41:08 > 0:41:10in respect of costs.
0:41:10 > 0:41:14So, in total, for what he thought he could walk away from,
0:41:14 > 0:41:17he ended up with a judgment of over £15,000.
0:41:17 > 0:41:20The catalyst for many personal injury claims brought
0:41:20 > 0:41:24a long time after accidents are phone calls from companies
0:41:24 > 0:41:27telling people they're entitled to compensation.
0:41:27 > 0:41:29At best, these calls are irritating,
0:41:29 > 0:41:34but at worst, they can be a gateway to a whole host of problems.
0:41:34 > 0:41:36I think there's quite a huge,
0:41:36 > 0:41:40growing problem at the moment with cold calling
0:41:40 > 0:41:44and people being approached and pressurised into bringing claims,
0:41:44 > 0:41:46even where they haven't been injured.
0:41:46 > 0:41:49They are assured that this money is there for the taking, it is there,
0:41:49 > 0:41:51there is a cheque with their name on it,
0:41:51 > 0:41:56all they have to do is fill in a couple of forms and it is theirs.
0:41:56 > 0:41:57It's not that straightforward.
0:41:57 > 0:41:59You do still have to prove your claim.
0:41:59 > 0:42:02You've got to prove your injury.
0:42:02 > 0:42:04As this case demonstrates,
0:42:04 > 0:42:07it's important to remember that it's the claimant who will ultimately
0:42:07 > 0:42:11be held accountable for dishonest or opportunistic claims,
0:42:11 > 0:42:15which can result in huge cost orders and even prison sentences.
0:42:17 > 0:42:20The advice to anybody who is receiving these phone calls
0:42:20 > 0:42:23is really be honest, be truthful.
0:42:23 > 0:42:27Not all of the companies that phone you offering sums of money,
0:42:27 > 0:42:30offering compensation, have your best interests at heart.
0:42:30 > 0:42:33So, at the end of the day, be honest when you're presenting a claim.
0:42:39 > 0:42:41Whether it's exaggerating real injuries,
0:42:41 > 0:42:43totally making up a story for a dodgy claim
0:42:43 > 0:42:47or masterminding insurance fraud on an industrial scale,
0:42:47 > 0:42:50the law is coming down hard on the people who think
0:42:50 > 0:42:53they can make a quick buck with their insurance scams and cons.
0:42:53 > 0:42:56But the fraudsters need to think again,
0:42:56 > 0:42:59as more of them than ever before are being caught in the act,
0:42:59 > 0:43:03and claimed and shamed.