Episode 7 Claimed and Shamed


Episode 7

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Transcript


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Insurance fraud in the UK has hit epidemic levels.

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

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That's almost £3.6 million every day.

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Deliberate crashes, bogus personal injuries, even phantom pets.

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

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

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But insurers are fighting back,

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exposing just under 15 fake claims every hour.

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Armed with covert surveillance systems...

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That's the subject out the vehicle.

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..sophisticated data analysis techniques...

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Police!

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

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Police, stand back! Stay where you are!

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

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Just don't lie to us.

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All those con men, scammers and cheats on the fiddle

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are now caught in the act and claimed and shamed.

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A large-scale bogus injury scam is scuppered,

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as the claimants fail to clock the CCTV cameras...

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I think it's probably fair to assume that most or all of these

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60 claimants thought that this would be a fairly easy ride

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and that they would get some compensation reasonably quickly.

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..social media is the undoing of a bride-to-be's claim

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for a lost engagement ring...

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..and a con artist is caught in the act when he tries to repeat

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a previous claim.

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The passer-by that witnessed the accident actually stopped

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at the scene and informed us that he'd been involved

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in a very similar accident at the same location

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with the same third party only three months before.

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Now, with the volume of traffic on the roads constantly on the up,

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more and more of us are leaving our cars at home and turning

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to public transport to get around.

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But as convenient as it is sitting back and leaving

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the stress of navigating the city streets to someone else,

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taking to the roads always presents a risk,

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even when there is a trained professional behind the wheel.

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For many of us who live or work in built-up cities,

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buses are the preferred mode of transport

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and can often save us valuable time.

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But just like any other vehicles, buses are susceptible to accidents,

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and with up to 75 passengers on board at any one time,

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that can generate a lot of personal injury claims.

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With a fleet of over 6,000 buses,

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First Group are no stranger to multiple claims,

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but they recently dealt with one batch that turned out to be

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the result of foul play.

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One of our buses was involved in a very minor collision.

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Our bus was travelling in slow-moving traffic

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when the vehicle in front had to brake for amber traffic lights.

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Unfortunately, our bus was a little too close and collided

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with the rear of the Ford Fiesta.

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The bus was full of football supporters on their way

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to a Leeds United match, and the car contained an elderly couple.

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Thankfully, the bus was travelling at less than 10mph

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when the collision happened.

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The incident itself was relatively minor.

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There was scuffing to our bus and minor damage to the Ford Fiesta.

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So, we dealt with the repairs to the Ford Fiesta

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and that was the end of it.

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Or so they thought.

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Within days, we started receiving injury claims.

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The first one or two, obviously suspicious,

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because it was a very minor accident.

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However, they kept coming and, within a few weeks,

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we had over 40 claims.

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On one day alone, we received 25 claims,

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much to the dismay of the file handler on the case,

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and then within six months we had 60 claims, which was absolutely absurd.

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So, a minor rear-end shunt that had left an elderly couple in a tiny car

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completely unscathed had resulted in a staggering number of claims

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from the football supporters,

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amounting to £500,000

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in injury compensation and legal costs.

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And nearly every one of them was claiming the same thing.

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We were not surprised to find that most of the claimants that were

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pursuing the claims were claiming that they had soft tissue injuries,

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but some of the claims that they were presenting to us

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were completely absurd.

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We had nightmares, flashbacks, we had fear of travel,

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we had severe psychological trauma,

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and probably the worst was the severe panic attacks

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that one claimant allegedly suffered on a daily basis.

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The list of injuries and ailments was simply astonishing.

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So, First Group immediately launched a full investigation,

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and it wasn't long before they discovered an alarming trend

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with the claims.

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One of the things we did find rather surprising is we had 60 claimants,

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and 55 were represented by the same solicitor, which is highly unusual.

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With a multiple claim,

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you'd expect to see the individuals represented by

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various different solicitors.

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Suspecting they'd been the target of a large-scale attempt at fraud,

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First Group stepped up their investigation

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and turned to the CCTV footage recorded on the bus

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at the time of the accident.

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As expected, it clearly shows the bus following the Fiesta,

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the Fiesta coming to a sharp halt at the traffic lights,

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the bus not quite stopping in time

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and gently nudging the Fiesta.

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However, it's when you switch to the cameras inside the bus

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that things start to look suspicious.

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So, looking at the CCTV footage,

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you can clearly see that this accident is very minor.

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You can see that there's hardly any movement to any of the passengers.

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Certainly, none of the passengers were thrown down the bus.

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Bizarrely, you can see individuals patting each other on the backs.

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You can see them laughing.

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This certainly doesn't look like a bus full

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of 60 seriously injured people.

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It was clear the collision was extremely minor,

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and there was no way the bus passengers could have sustained

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the injuries they were claiming for.

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All 60 claims were repudiated.

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The case was closed and investigators thought

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it was all over.

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But some of the football supporters were in the mood

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for some extra time,

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and were determined to pursue their claims with the bus company.

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Four of the claimants decided they wanted their day in court,

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so they issued county court proceedings,

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which we were more than happy with.

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We've dealt with numerous claims like this and we were confident

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of a successful outcome.

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So, we instructed our fraud experts and also one of our top barristers

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to represent us in court.

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First Group turned to Horwich Farrelly,

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a legal firm specialising in insurance claims,

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to help defend the case.

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And it was soon clear to them that the football supporters

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didn't have a leg to stand on.

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All four of the claimants who proceeded to trial

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performed poorly in the witness box.

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The inconsistencies in their evidence were fairly easily

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exposed by cross-examination.

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During the CCTV recording,

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one of the claimants can be seen clutching his neck

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as the bus hits the car. Yet, when presenting his claim,

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it seems he forgot to get his facts straight.

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This particular claimant's case was that he didn't feel any pain

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or symptoms until the following day.

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On that basis, unsurprisingly,

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he was asked why he was clutching his neck

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immediately after the accident,

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and his response to the judge was to check if he was OK.

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The judge just found that to be bizarre and implausible.

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When viewing the CCTV after the collision,

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it also looked like some of the supporters already had thoughts

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of compensation in the forefront of their minds.

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The footage shows all of the passengers disembarking the bus.

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And whilst doing so, it can be seen

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that five or six are taking pictures on their cellphones

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of the bus driver, the front of the bus and the rear of the Ford Fiesta.

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The fact that so many people were taking photographs

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certainly gives the viewer the notion

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that many of these passengers were immediately alive

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to the prospect of compensation claims.

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The judge had no hesitation in showing the claimants the red card.

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All four claims were dismissed.

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Two of the claimants were found to be fundamentally dishonest.

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They were ordered to pay legal costs of just over £7,000

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and just under £5,000 respectively.

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It was a superb result for Horwich Farrelly and First Group,

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and a harsh lesson for the football fans who thought they could

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cheat their way to an easy win.

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I think it's probably fair to assume that most or all of these

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60 claimants thought that this would be a fairly easy ride

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and that they would get some compensation reasonably quickly.

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I don't think any of them realised the efforts that First Group

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and ourselves would go to in defending these claims.

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And for anyone else who thinks bus companies are an easy touch

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when it comes to compensation, Julie has a few words of advice.

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For anyone thinking of pursuing a fraudulent claim

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against our company, don't do it. If we catch you - and we will -

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we will push for the toughest penalties,

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and this could have serious financial implications

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or even custodial sentences.

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In America, it's the end of the road for the doctor

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behind one of the largest fake prescription scams in US history.

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Nowadays, social media has become a huge part of our lives.

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In fact, around 32 million of us -

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that's half the population of the UK -

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have an online account.

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Some are more secure than others,

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but many allow your basic details to be seen by anyone.

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Which is all well and good, so long as you don't have anything to hide.

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Social media is being used more and more

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when it comes to verifying claims.

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Often people are caught out when posts on their online account

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don't back up what they have told the insurers.

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i-Cog are a claims management company that deal with cases

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on behalf of insurers,

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and recently dealt with a case regarding

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a missing piece of jewellery.

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The claim that we received from the insurers was for a ring

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that had been lost while the policyholder was swimming

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at the beach with a friend.

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The claim was potentially worth £1,362.

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The first thing they did was to call the claimant

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to go through the facts.

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So, this wasn't your average ring.

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Designed by her partner, and with a truly distinctive look,

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it's no wonder the claimant was upset after she had lost it.

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Fair enough. Many people wait years for a proposal,

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so to then lose your engagement ring

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might make you feel lost without it.

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So, picking up any old replacement sounded plausible enough...

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..but there was a problem.

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We do get claims like this quite often for rings that are lost.

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However, the insurer had raised some concerns about this claim.

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The insurer, as standard, did some background checking,

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including some social media checks.

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They found a post of an engagement ring

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on the insured's Instagram account.

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Nothing surprising there.

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After all, what bride-to-be wouldn't want to show off their new

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bling to friends and family?

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The post was posted after the date of loss.

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Ah. Surely there was a rational explanation?

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We find it incredibly unusual that a ring could appear

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on a social media site after the date that it was lost.

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In which case, time to confront the claimant.

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She immediately told us that

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she didn't use Instagram very often.

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She was unsure of what I was referring to.

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And it wasn't until we went through the post that she put on there,

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word for word, that she then came up with an account

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of why she put that there.

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So, the woman was claiming that the picture she had posted

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of the beautiful and unique ring was, in fact,

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the cheap and cheerful replacement she'd picked up on the high street.

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Unsurprisingly, for both i-Cog and the woman's insurers,

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it just didn't make sense.

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Never mind pathetic.

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I'd say it sounds rather suspicious.

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This did not seem like a plausible account at all.

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Very strange that you would put a photo of a ring up

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and tell people that it is an engagement ring if it wasn't.

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As if the explanation wasn't dubious enough,

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as cheap and cheerful replacement rings go,

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this one really looked the part.

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Little did the claimant realise

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i-Cog had done their homework.

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Not only did they know where her original engagement ring

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had come from, but crucially they also knew

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exactly what it looked like.

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Her husband-to-be must have been kicking himself

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when he discovered she had found a ring

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in a high-street costume jewellery shop that was identical

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to the one he had designed and paid a small fortune for.

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In my experience with jewellery claims,

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it is unlikely that she would have been able to find

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a piece of costume jewellery from a store just on the high street

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that would have been similar enough in design

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for the one that she says is her engagement ring.

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But the woman was adamant the ring on her social media account

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really was the cheap replacement she'd rushed out and bought.

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So, all she needed was the receipt,

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or a letter from the shop where she'd bought the cheap replacement,

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and her claim would be settled.

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So, a couple of days later the insured sent us an e-mail.

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In that, she confirmed that she couldn't find a receipt

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or purchase order for the substitute ring,

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and as such she would like to withdraw the claim.

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The fact that the woman had given up so quickly

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on a claim worth over £1,300 spoke volumes.

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So, the claim could have been easily validated.

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We asked for proof of purchase for the ring.

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She was unable to provide this,

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which seems unusual because she had bought it from

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a big name on the high street,

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and they are usually, in my experience, very helpful,

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especially when it is only a couple of weeks before.

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It also seems very unusual that she would walk away from a claim

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for such a sentimental and valuable item.

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It appeared she thought her insurance company

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wouldn't check up on her.

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But like many would-be fraudsters before her,

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the post on her online account had been her undoing.

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We would always do checking on social media.

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We have various sites that we check.

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People tend to live their lives through social media now,

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so it really is a good insight for the insurers to do those checks,

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because unfortunately some people will live their life

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through their posts, and sometimes this can catch them out.

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Being involved in a car accident is never a pleasant experience,

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but if you've been involved in an accident that wasn't your fault,

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then sometimes you need to be able to prove it.

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CCTV or dashcam footage can provide irrefutable evidence,

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but unfortunately they are a luxury not many of us have access to.

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Instead, we are reliant on eyewitness evidence

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to help determine exactly what happened

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and where the blame should lie.

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When insurance companies receive claims,

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the details are always validated before any money is paid.

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This usually involves taking statements from the drivers

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and any witnesses,

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looking at the damage to the cars and, where necessary,

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examining medical reports relating to any injuries.

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AXA's Tom Wilson knows all too well

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that some cases are easier to validate than others,

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and that a single piece of evidence can be the crucial difference

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between establishing whether a claim is genuine or fraudulent.

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So, a customer reported to us that he'd been involved in a collision

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with a Mr Khan. Mr Khan was rounding a bend

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and our customer went into the rear of him...

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..causing damage to both vehicles.

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The value of our customer's vehicle damage was about £4,500.

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And the value of Mr Khan's vehicle damage,

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as a result of this vehicle becoming a total loss,

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was £8,500.

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With a total value of £13,000,

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this was significantly more than a gentle rear-end shunt,

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so the claim was thoroughly investigated.

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Initially, the circumstances would appear genuine.

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However, from the outset our customer made it clear

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that he believed that the BMW had slammed his brakes on

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for no apparent reason, which caused our customer to go into

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the rear of the vehicle.

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He believed he was the victim of a crash for cash

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and that Mr Khan had induced this accident.

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Crash for cash is when someone deliberately causes a collision

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so they can cash in on the other party's insurance policy.

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This is a practice often favoured by serial fraudsters or criminal gangs,

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who induce accidents with innocent road users in order to profit

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from fraudulent insurance claims.

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With just one claim potentially worth thousands of pounds,

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crash for cash is a big problem that costs the insurance industry

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around £340 million a year.

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In this case, AXA's policyholder needed proof that he really had

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been the victim of a crash for cash scam,

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and as luck would have it, he had exactly that.

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The real key piece of information was a passer-by that witnessed

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the accident actually stopped at the scene and informed us that

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he'd been involved in a very similar accident at the same location

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with the same third party only three months before.

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That clearly gives us cause for concern.

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They say lightning never strikes twice in the same place,

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but the eyewitness was alleging that, just a matter of weeks before,

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a near-identical crash had happened in the same way

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on exactly the same stretch of road.

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Coupled with the fact that our customer alleged that this guy

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had slammed his brakes on for no reason,

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it just builds a bigger picture about the credibility of this person

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and actually the validity of the accident circumstances itself.

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The police had attended the scene of the accident and also noticed

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something rather suspicious.

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The third-party vehicle, the BMW, was recovered by a recovery truck,

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but when the recovery truck turned up, it was full of people already.

0:23:500:23:53

So, the driver of the BMW caught a lift with a vehicle that was waiting

0:23:530:23:57

a little way down the road. And it was suspected that that vehicle

0:23:570:24:00

had been waiting there all along.

0:24:000:24:02

It would suggest that the incident was planned,

0:24:030:24:05

that it was premeditated,

0:24:050:24:07

and that he was waiting there because he knew the accident

0:24:070:24:09

was going to take place at this location.

0:24:090:24:12

With the policyholder's suspicions,

0:24:150:24:17

the witness statement and information from the police

0:24:170:24:19

all pointing towards a fraudulent claim,

0:24:190:24:22

the insurance company was in no doubt of what to do next.

0:24:220:24:26

We informed the insurer of Mr Khan that we believed it to be

0:24:260:24:30

a deliberate action and believed it to be an induced accident,

0:24:300:24:33

and we weren't going to be paying his claim,

0:24:330:24:35

so we rejected his claim on that basis.

0:24:350:24:37

Legal action was taken against Mr Khan,

0:24:400:24:42

and the case proceeded to court.

0:24:420:24:45

So, Mr Khan was required to attend a hearing,

0:24:450:24:47

where he was found guilty of conspiracy to defraud

0:24:470:24:50

and fraud by misrepresentation,

0:24:500:24:52

and he was sentenced to 20 months behind bars.

0:24:520:24:55

The sentence handed down in this particular case

0:25:000:25:02

was a strong sentence, and to receive a custodial sentence,

0:25:020:25:05

primarily, for Mr Khan, is a great result.

0:25:050:25:08

It sends the message of a deterrent to would-be fraudsters

0:25:080:25:12

that if you do try and you get caught, and we will catch you,

0:25:120:25:15

that you could end up with a prison sentence.

0:25:150:25:18

With another fraudster caught and punished for his actions,

0:25:200:25:23

it was a great result for AXA,

0:25:230:25:25

and showed just how important it is in cases like these

0:25:250:25:28

for witnesses to come forward.

0:25:280:25:30

In respect of our investigation, the witness being there

0:25:320:25:34

was absolutely key to being able to prove that this was a fraud.

0:25:340:25:38

Had he not been present,

0:25:380:25:39

it would effectively be our customer's word against the word

0:25:390:25:42

of the third party, so it would make it very difficult for us

0:25:420:25:46

to prove that it was an induced accident.

0:25:460:25:48

Still to come:

0:25:530:25:55

a motorist's attempt to exaggerate his claim backfires

0:25:550:25:58

when he makes a basic mistake.

0:25:580:26:01

He categorically denied that he'd suffered any injury when asked.

0:26:010:26:05

As we've seen in many cases on this programme,

0:26:150:26:18

fraudsters will go to extreme lengths to get their hands

0:26:180:26:21

on a pay-out, from deliberately causing an accident

0:26:210:26:24

to claiming for medical treatment they never even received.

0:26:240:26:27

But if you think we've got it bad in the UK,

0:26:270:26:30

the depths some fraudsters go to across the pond

0:26:300:26:33

is simply astonishing.

0:26:330:26:35

In America, the largest type of insurance fraud by far

0:26:370:26:41

is scams against health care insurers.

0:26:410:26:43

The exact size of the problem is unknown,

0:26:450:26:47

but it is likely to be tens of billions of dollars a year.

0:26:470:26:51

Out of all the people we trust,

0:26:530:26:55

doctors are usually high on the list.

0:26:550:26:57

But sadly, as many of these cases have proved,

0:26:570:27:00

not all medical experts are running practices

0:27:000:27:03

that are entirely above board.

0:27:030:27:05

In Miami, Florida, Fernando Mendez-Villamil

0:27:180:27:21

qualified as a doctor in 1998

0:27:210:27:23

and set up his own psychiatric practice,

0:27:230:27:26

treating patients for conditions such as ADHD, schizophrenia,

0:27:260:27:30

depression and narcolepsy.

0:27:300:27:33

But just four years later,

0:27:350:27:37

he began defrauding the government health care providers in a scam

0:27:370:27:40

that would last for the next 14 years

0:27:400:27:43

and cost the US government millions of dollars.

0:27:430:27:47

His plan involved staffing his office with low-paid workers

0:27:490:27:53

who would carry out the tasks he gave them without question.

0:27:530:27:56

His scheme was simple.

0:27:590:28:01

People who wanted to get disability benefits

0:28:010:28:03

but who didn't actually have a mental health problem

0:28:030:28:06

would pay him around 1,500.

0:28:060:28:09

In exchange, he would give them a false diagnosis,

0:28:090:28:12

along with fake medical records and prescriptions,

0:28:120:28:15

so they could apply for the benefits.

0:28:150:28:18

These people would then attend a disability determination interview,

0:28:210:28:25

where they would be questioned about their alleged mental illness.

0:28:250:28:28

Mendez-Villamil would prepare them for these interviews,

0:28:290:28:33

telling them how to respond,

0:28:330:28:34

so it looked like they were genuinely suffering

0:28:340:28:37

from severe mental health issues.

0:28:370:28:39

He would then submit false claims to the government

0:28:410:28:43

health insurance programmes, Medicare and Medicaid,

0:28:430:28:46

for appointments that never took place,

0:28:460:28:48

and prescriptions that weren't actually necessary.

0:28:480:28:51

While all this was going on,

0:28:560:28:58

he continued to treat legitimate patients at his practice.

0:28:580:29:01

But he even preyed on these innocent victims too,

0:29:010:29:04

by giving over-the-top diagnoses

0:29:040:29:07

and prescribing excessive amounts of medication.

0:29:070:29:10

By 2004, he had earned the title of the most prolific

0:29:120:29:15

drug provider in Florida,

0:29:150:29:17

issuing some 62,000 prescriptions a year,

0:29:170:29:21

costing 12.2 million.

0:29:210:29:25

That's over 1,000 prescriptions a week.

0:29:250:29:27

But his epic attempt at fraud didn't go unnoticed.

0:29:290:29:33

Three years later, Medicaid received a complaint

0:29:330:29:36

from a private investigator called Ken Kramer.

0:29:360:29:39

Kramer had noticed that Mendez-Villamil

0:29:400:29:42

was prescribing a huge and totally disproportionate amount

0:29:420:29:45

of anti-psychotic drugs to children.

0:29:450:29:48

The information was passed on to the US Senate,

0:29:500:29:53

who made the prescription records available to the public.

0:29:530:29:56

By that time, he had an astounding 96,000 mental health patients

0:29:560:30:02

on his books.

0:30:020:30:04

When questioned, Mendez-Villamil

0:30:050:30:06

insisted that the number of prescriptions he was issuing

0:30:060:30:09

was normal for this volume of patients.

0:30:090:30:12

But the authorities thought otherwise.

0:30:120:30:14

Medicaid terminated him as a health care provider,

0:30:190:30:22

meaning he could no longer claim any money from them.

0:30:220:30:26

But that didn't stop this fraudster.

0:30:260:30:28

He continued to submit claims to Medicare,

0:30:280:30:31

who cover those aged over 65

0:30:310:30:34

and young people with disabilities.

0:30:340:30:36

Some of his patients were as young as three,

0:30:370:30:39

and were being prescribed huge amounts of medication

0:30:390:30:42

for no apparent reason.

0:30:420:30:44

The notes on their medical reports also frequently

0:30:460:30:49

contradicted each other, a clear sign that something wasn't right.

0:30:490:30:53

Not only was Mendez-Villamil

0:30:540:30:56

helping thousands of people to fraudulently

0:30:560:30:58

receive disability benefit,

0:30:580:31:00

but he was also claiming money from health care providers

0:31:000:31:03

that he wasn't owed. And on top of that,

0:31:030:31:06

he was flooding the streets of Florida with drugs

0:31:060:31:08

that should never have been prescribed.

0:31:080:31:11

He needed to be stopped.

0:31:110:31:13

In 2013, Mendez-Villamil

0:31:140:31:16

was struck off Medicare's list of providers.

0:31:160:31:19

He received a 15,000 fine from the Florida Board of Medicine

0:31:190:31:23

and was asked to reimburse the state more than 22,000 in costs.

0:31:230:31:28

Unfazed by this attempt to put a stop to his illegal scam,

0:31:310:31:34

he came up with yet another plan.

0:31:340:31:37

This time, he targeted immigrants who wanted to become US citizens.

0:31:380:31:43

In exchange for a 1,000 cash fee,

0:31:430:31:46

he would diagnose them with a false mental illness so they wouldn't have

0:31:460:31:49

to adhere to all of the country's strict immigration rules.

0:31:490:31:53

But he had gone too far, and the law had caught up with him.

0:31:540:31:58

In January 2016,

0:32:020:32:03

he was accused of running one of the largest fake prescription schemes

0:32:030:32:07

in US history, and was immediately arrested.

0:32:070:32:10

His home and valuable possessions were seized,

0:32:130:32:15

including a rather unusual collection of paintings

0:32:150:32:18

estimated to be worth around 500,000.

0:32:180:32:22

He later pleaded guilty to conspiracy to commit

0:32:220:32:25

health care fraud, to make false statements in immigration matters

0:32:250:32:28

and to defrauding the US government.

0:32:280:32:30

Overall, his scam had cost the Citizenship and Immigration Services

0:32:340:32:38

over 800,000,

0:32:380:32:40

the United States disability system more than 20 million

0:32:400:32:45

and health care providers Medicare and Medicaid over 29 million.

0:32:450:32:49

Mendez-Villamil was sentenced to 12 years and seven months in prison,

0:32:530:32:58

and ordered to pay back costs of over 50 million.

0:32:580:33:02

Although justice had finally been served,

0:33:120:33:15

this was a man who had abused his position

0:33:150:33:17

to an unimaginable degree.

0:33:170:33:20

It will also take some time to identify the thousands of patients

0:33:200:33:24

he has given false diagnoses to,

0:33:240:33:26

who are still out there defrauding the US government.

0:33:260:33:29

Temptation. It can come in various forms, but for many of us

0:33:380:33:42

the promise of free money is something that is

0:33:420:33:45

very hard to turn down. Now, if you own a phone,

0:33:450:33:48

then the chances are that at some point you've received a call

0:33:480:33:51

telling you that there is a pot of cash with your name on it

0:33:510:33:54

waiting for you to collect as compensation

0:33:540:33:57

for the accident you were involved in...

0:33:570:33:59

..sometimes even if you haven't been in an accident.

0:33:590:34:03

Well, this next case highlights the potential pitfalls of pursuing

0:34:030:34:06

a claim that you simply aren't entitled to.

0:34:060:34:09

BLM are a legal firm who represent a number of insurance companies.

0:34:120:34:16

One of their partners, Naomi Grant, dealt with a case

0:34:160:34:19

from a particularly persistent claimant who was determined

0:34:190:34:22

to get what he thought he was owed.

0:34:220:34:24

The insurers in this case were initially just presented with

0:34:260:34:29

a straightforward claim for vehicle damage

0:34:290:34:31

arising out of a road traffic accident.

0:34:310:34:34

Both parties were travelling in opposite directions

0:34:340:34:37

along a fairly narrow country road, and in the process,

0:34:370:34:40

they came into collision with one another.

0:34:400:34:44

The initial incident wasn't suspicious in any way.

0:34:440:34:47

At first presentation, this was just a claim for vehicle damage.

0:34:470:34:50

So, an unfortunate coming together of two cars,

0:34:500:34:53

but thankfully no-one was injured,

0:34:530:34:55

and it was a straightforward claim to process.

0:34:550:34:57

As a routine part of dealing with the vehicle damage claim,

0:34:570:35:01

the claimant made a telephone call to the insurance company

0:35:010:35:05

about two months after the initial accident.

0:35:050:35:07

So, with the exception of the ill feeling between the two parties,

0:35:490:35:52

this was a simple matter of repairing the vehicles

0:35:520:35:55

and closing the case...

0:35:550:35:57

..or so the insurance company thought.

0:35:590:36:02

Eight months after the initial accident,

0:36:020:36:05

the insurance company received a claim notification form

0:36:050:36:09

from a firm of solicitors appointed on behalf of the claimant,

0:36:090:36:13

and at that point the claimant alleged

0:36:130:36:15

that he'd suffered personal injury.

0:36:150:36:17

Although eight months might sound like a long time,

0:36:170:36:20

with many genuine claims this is actually quite a regular occurrence.

0:36:200:36:24

It's not uncommon for people to present claims quite some time

0:36:250:36:29

after the accident.

0:36:290:36:31

The law in England and Wales is that a person has three years

0:36:310:36:34

from the date of an accident before they have to actually

0:36:340:36:37

issue court proceedings to bring their claim.

0:36:370:36:40

So, technically the claimant in this matter did nothing wrong.

0:36:400:36:44

"Technically" being the key word there,

0:36:440:36:47

because it was at this point that things began to unravel.

0:36:470:36:50

The claimant had indicated that he had suffered personal injury,

0:36:510:36:55

but he didn't present any other evidence to go with that,

0:36:550:36:58

so the claim then had to be reopened and looked at again,

0:36:580:37:01

which caused the insurance company to go back through their call log

0:37:010:37:05

to locate the call when he categorically denied

0:37:050:37:08

that he'd suffered any injury when asked.

0:37:080:37:11

That immediately aroused their suspicions.

0:37:180:37:20

The insurance company therefore disclosed a copy

0:37:200:37:23

of that call recording to the solicitors,

0:37:230:37:25

who appeared to go away and discontinue the claim,

0:37:250:37:28

so again the file was closed down.

0:37:280:37:31

It looked as though this chap had tried to submit a cheeky claim

0:37:320:37:35

in the hope of some easy money,

0:37:350:37:37

but his underhanded attempt had been scuppered by his own voice

0:37:370:37:41

on the original call recording,

0:37:410:37:43

where he'd said he was completely unscathed by the car accident.

0:37:430:37:47

With evidence as conclusive as that,

0:37:490:37:51

most people would leave it there.

0:37:510:37:53

But it soon transpired this fella wasn't most people.

0:37:530:37:56

The bigger surprise was that some 18 months after the accident,

0:37:590:38:03

he re-presented his claim through a second firm of solicitors,

0:38:030:38:08

again maintaining that he had been injured.

0:38:080:38:12

The call recording was again immediately disclosed,

0:38:120:38:15

but the claimant insisted that he'd suffered an injury,

0:38:150:38:19

and this time went on to get a medical examination

0:38:190:38:23

and a medical report to detail all of his alleged injuries.

0:38:230:38:27

Either this was someone who firmly believed in the phrase

0:38:270:38:30

"third time lucky" or he was being given some very poor advice.

0:38:300:38:34

But at least this time he had some documents to back up his claim.

0:38:360:38:40

The medical report stated that he'd suffered a neck injury,

0:38:400:38:44

which he said he had suffered from for five months.

0:38:440:38:47

He also claimed that he had been affected in his domestic duties,

0:38:470:38:52

so he was unable to clean, cook or shop.

0:38:520:38:56

He couldn't carry out any leisure activities,

0:38:560:38:58

he was unable to play football,

0:38:580:39:00

and he claimed he was unable to sleep properly.

0:39:000:39:03

So, from no injuries at all to a list of ailments that added up

0:39:030:39:07

to a pretty hefty claim for compensation.

0:39:070:39:10

So, all in all, the claim was valued in the region of £8,000.

0:39:100:39:15

Now, given this man categorically said he was uninjured,

0:39:150:39:18

it will come as no surprise that the insurance company

0:39:180:39:21

had no intention of paying this claim.

0:39:210:39:24

So, they instructed BLM to defend it all the way,

0:39:240:39:27

which they duly did.

0:39:270:39:30

We were able to prepare a robust defence,

0:39:310:39:34

referring to the phone call,

0:39:340:39:35

which really set out all the facts.

0:39:350:39:38

And that defence quite categorically stated that this was

0:39:380:39:41

a fraudulent claim in the eyes of the insurance company.

0:39:410:39:45

Sounds like a pretty one-sided fight,

0:39:450:39:47

but with the prospect of a pay-out on the line,

0:39:470:39:50

this guy wasn't one to give in easily.

0:39:500:39:52

The claimant in this matter actually continued with his claim

0:39:530:39:56

for quite a long time,

0:39:560:39:58

despite having been presented with all the evidence,

0:39:580:40:01

which was quite irrefutable, early on.

0:40:010:40:04

In a further twist to the tale,

0:40:040:40:06

two months before the matter was due to be listed for trial,

0:40:060:40:09

the claimant then made the sensible decision to discontinue his claim.

0:40:090:40:13

But if he thought that was the end of the matter,

0:40:150:40:17

then he was in for a very nasty surprise indeed.

0:40:170:40:20

In common with many people,

0:40:210:40:23

the claimant in this instance really thought that

0:40:230:40:25

by discontinuing his claim he could just run away from everything

0:40:250:40:29

and drop his claim and that would be an end to the matter.

0:40:290:40:33

Unfortunately for him, that wasn't to be the case.

0:40:340:40:37

The insurance company in this matter had spent a considerable amount

0:40:370:40:40

of time, effort and resource in having to defend not only his claim

0:40:400:40:44

but to pursue the claim against him,

0:40:440:40:47

and in the judgment that was recognised by the judge,

0:40:470:40:50

who actually awarded the insurance company a sum

0:40:500:40:54

towards their own investigation costs.

0:40:540:40:56

The claimant was also ordered to pay a sum of money by way of damages,

0:40:580:41:02

to punish him for what he'd done in bringing the claims.

0:41:020:41:06

And he was ordered to pay a considerable amount

0:41:060:41:08

in respect of costs.

0:41:080:41:10

So, in total, for what he thought he could walk away from,

0:41:100:41:14

he ended up with a judgment of over £15,000.

0:41:140:41:17

The catalyst for many personal injury claims brought

0:41:170:41:20

a long time after accidents are phone calls from companies

0:41:200:41:24

telling people they're entitled to compensation.

0:41:240:41:27

At best, these calls are irritating,

0:41:270:41:29

but at worst, they can be a gateway to a whole host of problems.

0:41:290:41:34

I think there's quite a huge,

0:41:340:41:36

growing problem at the moment with cold calling

0:41:360:41:40

and people being approached and pressurised into bringing claims,

0:41:400:41:44

even where they haven't been injured.

0:41:440:41:46

They are assured that this money is there for the taking, it is there,

0:41:460:41:49

there is a cheque with their name on it,

0:41:490:41:51

all they have to do is fill in a couple of forms and it is theirs.

0:41:510:41:56

It's not that straightforward.

0:41:560:41:57

You do still have to prove your claim.

0:41:570:41:59

You've got to prove your injury.

0:41:590:42:02

As this case demonstrates,

0:42:020:42:04

it's important to remember that it's the claimant who will ultimately

0:42:040:42:07

be held accountable for dishonest or opportunistic claims,

0:42:070:42:11

which can result in huge cost orders and even prison sentences.

0:42:110:42:15

The advice to anybody who is receiving these phone calls

0:42:170:42:20

is really be honest, be truthful.

0:42:200:42:23

Not all of the companies that phone you offering sums of money,

0:42:230:42:27

offering compensation, have your best interests at heart.

0:42:270:42:30

So, at the end of the day, be honest when you're presenting a claim.

0:42:300:42:33

Whether it's exaggerating real injuries,

0:42:390:42:41

totally making up a story for a dodgy claim

0:42:410:42:43

or masterminding insurance fraud on an industrial scale,

0:42:430:42:47

the law is coming down hard on the people who think

0:42:470:42:50

they can make a quick buck with their insurance scams and cons.

0:42:500:42:53

But the fraudsters need to think again,

0:42:530:42:56

as more of them than ever before are being caught in the act,

0:42:560:42:59

and claimed and shamed.

0:42:590:43:03

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