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 > 0:00:44Subject out of the vehicle.
0:00:44 > 0:00:46..sophisticated data analysis techniques...
0:00:49 > 0:00:51..and a number of highly skilled police units...
0:00:51 > 0:00:53Police! Don't move. Stay where you are!
0:00:53 > 0:00:55..they're catching the criminals red-handed.
0:00:55 > 0:00:58Just don't lie to us.
0:00:58 > 0:01:01All those conmen, scammers and cheats on the fiddle
0:01:01 > 0:01:04are now caught in the act and claimed and shamed.
0:01:12 > 0:01:16..a chancer's ruse is rumbled when CCTV footage comes to light...
0:01:17 > 0:01:21We were completely shocked that the claimant had the nerve to submit
0:01:21 > 0:01:24a personal injury claim when it was quite clear that he wasn't even
0:01:24 > 0:01:27in the car and he couldn't possibly have been injured.
0:01:27 > 0:01:30..a woman's holiday hoax is exposed thanks to her
0:01:30 > 0:01:32childish counterfeit skills...
0:01:34 > 0:01:36My daughter could have completed them considerably better,
0:01:36 > 0:01:38and she's eight years old.
0:01:38 > 0:01:41..and it's bad news for a burglary claim
0:01:41 > 0:01:43when insurers clock a fatal flaw.
0:01:43 > 0:01:46Our agent recognised headlines in that newspaper,
0:01:46 > 0:01:50and thought that they were more recent than the photograph
0:01:50 > 0:01:52could potentially have been taken.
0:01:56 > 0:01:59The most common and expensive type of insurance fraud
0:01:59 > 0:02:01is bogus car claims.
0:02:01 > 0:02:04Now, many of these claims start out as genuine cases,
0:02:04 > 0:02:07but when unscrupulous claimants see an opportunity
0:02:07 > 0:02:09to line their pockets,
0:02:09 > 0:02:12the temptation to exaggerate or even make up
0:02:12 > 0:02:15entirely fictitious circumstances can be too great.
0:02:15 > 0:02:17Thinking they can get away with it,
0:02:17 > 0:02:21they'll go to extreme lengths to prove their case is genuine,
0:02:21 > 0:02:25refusing to give up even when faced with the hard evidence
0:02:25 > 0:02:27that says otherwise.
0:02:30 > 0:02:33Simon Roylance heads up the claims crime prevention team
0:02:33 > 0:02:37at LV Insurance, and recently dealt with a case where one claimant
0:02:37 > 0:02:40went above and beyond to prove their case was genuine.
0:02:42 > 0:02:45Our customer contacted us to advise that she'd been in an accident
0:02:45 > 0:02:47in a car park.
0:02:47 > 0:02:50She said that as she was reversing from a parking bay,
0:02:50 > 0:02:53she made contact with the front of another vehicle
0:02:53 > 0:02:55that was parked in a bay opposite.
0:02:55 > 0:02:59This vehicle was owned and allegedly driven by the claimant.
0:03:00 > 0:03:04So, all in all, this was pretty much the most common type of car accident
0:03:04 > 0:03:08that motor insurers see on a daily basis.
0:03:08 > 0:03:10Whilst there was no damage to our customer's vehicle,
0:03:10 > 0:03:14we did offer to deal with repairs to the third-party vehicle.
0:03:14 > 0:03:15We got this in to a repairer,
0:03:15 > 0:03:19and dealt with the claim in the sum of about £1,100.
0:03:20 > 0:03:23But if LV thought they had settled the claim and the case was closed,
0:03:23 > 0:03:25then they were wrong.
0:03:25 > 0:03:27At around the same time, we received a letter
0:03:27 > 0:03:30from a solicitor stating that the claimant
0:03:30 > 0:03:33had sustained injuries in the accident
0:03:33 > 0:03:36to his neck, back and arms.
0:03:36 > 0:03:39These appear to be typical kind of whiplash injuries that we see
0:03:39 > 0:03:41in road traffic accidents.
0:03:42 > 0:03:45Once again, this was all standard stuff.
0:03:45 > 0:03:49LV's policyholder had admitted she had reversed into another car,
0:03:49 > 0:03:52and the impact must have injured the man behind the wheel of the car
0:03:52 > 0:03:54she had hit.
0:03:54 > 0:03:57As this guy was now claiming for injuries on top of the repairs
0:03:57 > 0:04:00to his car, LV decided to give their policyholder
0:04:00 > 0:04:03a quick call to see if her account
0:04:03 > 0:04:06suggested the impact was sufficient to have injured him.
0:05:11 > 0:05:12When we spoke to our customer,
0:05:12 > 0:05:16she was really quite adamant that the claimant wasn't even in the car
0:05:16 > 0:05:19at the time, and she did seem very certain about this.
0:05:21 > 0:05:24As discrepancies in versions of events go,
0:05:24 > 0:05:26this one was a whopper.
0:05:26 > 0:05:29Fortunately, there was a sure-fire way of establishing
0:05:29 > 0:05:33who was telling the truth and who was not.
0:05:33 > 0:05:37The car park was covered by CCTV cameras, and as luck would have it,
0:05:37 > 0:05:41they captured the entire sequence of events.
0:05:41 > 0:05:44On the right of the picture, you've got the store.
0:05:44 > 0:05:48Just in front of the store is the claimant's car, which is parked up.
0:05:48 > 0:05:51In the parking bay opposite is our customer's vehicle,
0:05:51 > 0:05:54and you see that she soon starts to reverse manoeuvre
0:05:54 > 0:05:56out of her parking bay.
0:05:56 > 0:05:58She keeps reversing,
0:05:58 > 0:06:01and makes slight contact with the front of the claimant's vehicle.
0:06:02 > 0:06:05But as you can see throughout this time,
0:06:05 > 0:06:07the claimant has been stood alongside his car.
0:06:07 > 0:06:09He's not been in the vehicle.
0:06:09 > 0:06:12And you can actually see him trying to catch our customer's attention
0:06:12 > 0:06:14after she's collided with his car.
0:06:14 > 0:06:18The footage provided indisputable proof that LV's policyholder
0:06:18 > 0:06:20was telling the truth,
0:06:20 > 0:06:24and that the man was attempting to make a fraudulent claim.
0:06:24 > 0:06:28When we first looked at the CCTV footage,
0:06:28 > 0:06:31we were completely shocked that the claimant had the nerve to submit
0:06:31 > 0:06:34a personal injury claim when it was quite clear that he wasn't even
0:06:34 > 0:06:37in the car, and he couldn't possibly have been injured.
0:06:38 > 0:06:41We advised the claimant's solicitors that we wouldn't be making
0:06:41 > 0:06:44any payments, because we didn't accept that their client
0:06:44 > 0:06:47was in the vehicle at the time of the accident.
0:06:47 > 0:06:49With evidence like that,
0:06:49 > 0:06:53LV would be forgiven for thinking it was case closed.
0:06:53 > 0:06:55Well, think again.
0:06:55 > 0:06:58We were then completely taken aback a few months later
0:06:58 > 0:07:02to receive a medical report from the claimant's solicitor
0:07:02 > 0:07:05stating that he had been to see his GP twice since the accident
0:07:05 > 0:07:08regarding neck and back pain,
0:07:08 > 0:07:12and furthermore it said that it had taken 18 months to recover
0:07:12 > 0:07:15from his injuries. But we already knew that he wasn't in the car
0:07:15 > 0:07:17in the first place.
0:07:17 > 0:07:20Claiming it would take 18 months to recover from injuries
0:07:20 > 0:07:24he'd never sustained, this guy had more front than Brighton.
0:07:24 > 0:07:27But LV had heard enough.
0:07:27 > 0:07:30We then contacted the claimant's solicitors and made it clear
0:07:30 > 0:07:33to them that we didn't accept that their client was in the vehicle
0:07:33 > 0:07:35at the time, and so we wouldn't be making any payments
0:07:35 > 0:07:37for his compensation claim.
0:07:39 > 0:07:42But they weren't prepared to leave it there, and referred the case
0:07:42 > 0:07:44to the insurance fraud enforcement department
0:07:44 > 0:07:46at the City of London Police.
0:07:46 > 0:07:49IFED went out to interview the claimant.
0:07:49 > 0:07:52Initially, he stuck to his story, but when they showed him the CCTV,
0:07:52 > 0:07:57he eventually admitted that he'd made the whole thing up.
0:07:57 > 0:08:01The consequences for the claimant where that we repudiated
0:08:01 > 0:08:05his injury claim, worth up to around 5,000 in full.
0:08:06 > 0:08:10As a result of IFED's investigation, he received a police caution,
0:08:10 > 0:08:12and he's now got a criminal record.
0:08:12 > 0:08:15Justice had been served.
0:08:15 > 0:08:18But this case is a stark reminder of how unscrupulous
0:08:18 > 0:08:20some people really are.
0:08:20 > 0:08:23Whilst most claims are genuine,
0:08:23 > 0:08:26it's not uncommon for us to come across examples
0:08:26 > 0:08:30of opportunistic fraud like this, where a claimant has
0:08:30 > 0:08:35spotted an opportunity in the most trivial of circumstances
0:08:35 > 0:08:37to gain for their own personal benefit.
0:08:45 > 0:08:48..an opportunist is caught out when his friends and family
0:08:48 > 0:08:51fail to side with his story...
0:08:51 > 0:08:54The witness evidence indicated that he had actually tried to slide down
0:08:54 > 0:08:58the banister, and he hadn't fallen down something that was
0:08:58 > 0:09:00defective in any way.
0:09:00 > 0:09:03..and a man attempting to cash in from a housing fire
0:09:03 > 0:09:06sees his claim go up in smoke.
0:09:06 > 0:09:10We actually found that he had only just purchased the property
0:09:10 > 0:09:15last year, and therefore was not the legitimate owner of the premises
0:09:15 > 0:09:19when it burned down in 2014.
0:09:24 > 0:09:28Now, holidays are usually a time for us to relax and soak up the sun,
0:09:28 > 0:09:31but if the worst should happen and we become ill,
0:09:31 > 0:09:34then medical treatment abroad can be costly.
0:09:34 > 0:09:37Travel insurance is there to put our minds at rest,
0:09:37 > 0:09:40with policies covering everything from minor ailments
0:09:40 > 0:09:41to surgical procedures.
0:09:41 > 0:09:45But as if being away on holiday isn't enough of a treat,
0:09:45 > 0:09:48there are some people out there who will use the experience
0:09:48 > 0:09:51to try and pocket some extra cash at the expense
0:09:51 > 0:09:53of their travel insurance policy.
0:09:56 > 0:10:00Matthew Crawford-Thomas is a fraud manager at Collinson Group.
0:10:02 > 0:10:05His team recently dealt with a claim from a customer
0:10:05 > 0:10:08who had unfortunately succumbed to a rather common complaint
0:10:08 > 0:10:11when travelling abroad.
0:10:11 > 0:10:14We received the claim from the insured for circa £1,400
0:10:14 > 0:10:19for medical expenses whilst in Zimbabwe for sickness and diarrhoea.
0:10:19 > 0:10:21As with many other forms of insurance,
0:10:21 > 0:10:23before the claim could be processed,
0:10:23 > 0:10:26the insurer needed some form of proof that the treatment
0:10:26 > 0:10:28had actually taken place.
0:10:29 > 0:10:32We asked the administration team to supply us with
0:10:32 > 0:10:34the original documentation.
0:10:34 > 0:10:37After looking at the scans on our computer system,
0:10:37 > 0:10:40it appeared that the documentation had actually been altered.
0:10:41 > 0:10:43With his fraud radar on high alert,
0:10:43 > 0:10:46Matthew employed a trick of the trade...
0:10:46 > 0:10:50..a large magnifying glass known as a linen tester.
0:10:50 > 0:10:53Originally used to check the quality of woven fabrics,
0:10:53 > 0:10:57they are now used in the insurance industry to allow investigators
0:10:57 > 0:11:00to closely examine documents and check they're legitimate.
0:11:01 > 0:11:04Upon looking at the documents through the linen tester,
0:11:04 > 0:11:06it was evident that additional sums
0:11:06 > 0:11:08had been added to the receipts.
0:11:09 > 0:11:12The three receipts that we concentrated on mainly
0:11:12 > 0:11:15was for a taxi fare for less than seven miles,
0:11:15 > 0:11:18yet it was for 200 US dollars.
0:11:18 > 0:11:21The second receipt was from the Zimbabwean government,
0:11:21 > 0:11:24which clearly was only for 4, and had been written,
0:11:24 > 0:11:27"104".
0:11:27 > 0:11:31And the third receipt was a receipt from the Zimbabwe hospital,
0:11:31 > 0:11:34which after picking the Tippex off, clearly showed an amount of
0:11:34 > 0:11:374 rather than the 150 that she originally claimed for.
0:11:37 > 0:11:41Wowzer. That's quite the increase.
0:11:41 > 0:11:44It appeared that the amount on all eight receipts the woman had sent
0:11:44 > 0:11:46to the insurance company had been altered,
0:11:46 > 0:11:49boosting her claim to hundreds of dollars more
0:11:49 > 0:11:52than she was entitled to.
0:11:52 > 0:11:54It was time to phone the suspected forger
0:11:54 > 0:11:57and challenge her on the dodgily doctored receipts.
0:13:18 > 0:13:22The customer was insistent that she hadn't doctored the receipts,
0:13:22 > 0:13:25yet the insurance company could clearly see that the amounts
0:13:25 > 0:13:28on the receipts had been changed.
0:13:28 > 0:13:31As far as Collinson were concerned, it was an easy decision.
0:13:50 > 0:13:53Despite the strong evidence against her,
0:13:53 > 0:13:57this customer still refused to admit the receipts weren't genuine.
0:13:57 > 0:14:02So, Matthew and his team dug a little deeper into her past.
0:14:02 > 0:14:04Once we'd found out that the insured's claim
0:14:04 > 0:14:06was in fact fraudulent, we looked through our system,
0:14:06 > 0:14:10and, lo and behold, found another claim for the individual.
0:14:10 > 0:14:13We duly then retrieved the documents from our administration department,
0:14:13 > 0:14:17and again found these to be doctored.
0:14:17 > 0:14:21Just a year previously, the woman had been on another holiday
0:14:21 > 0:14:26to Zimbabwe, and had claimed for medical expenses for that trip, too.
0:14:26 > 0:14:28Only the first time, she hadn't been so greedy,
0:14:28 > 0:14:32and had successfully received a pay-out of nearly £300.
0:14:34 > 0:14:37With her first claim also showing signs of fraud,
0:14:37 > 0:14:39it was time to share the good news with the claimant,
0:14:39 > 0:14:42and take back what she wasn't entitled to.
0:15:39 > 0:15:44It had taken a while, but the woman had been well and truly busted.
0:15:44 > 0:15:46But incredibly, despite being found out,
0:15:46 > 0:15:50she seemed hell-bent on keeping her policy in place,
0:15:50 > 0:15:53just in case she wanted to do it again.
0:15:53 > 0:15:56In another telephone call, she contacted us to say that
0:15:56 > 0:15:59is her policy still valid, as she was going on holiday again?
0:15:59 > 0:16:01Yet she'd already said to us that she didn't have enough money
0:16:01 > 0:16:04to pay us back, so where she's getting her money from,
0:16:04 > 0:16:07God only knows.
0:16:07 > 0:16:09The insurers then wrote to the woman,
0:16:09 > 0:16:13declining both claims and stating the repayment costs.
0:16:13 > 0:16:16They never heard from her again.
0:16:16 > 0:16:20The downfall for the insured person on this occasion were the documents.
0:16:20 > 0:16:22They were a killer.
0:16:22 > 0:16:24My daughter could have completed them considerably better,
0:16:24 > 0:16:27and she's eight years old.
0:16:27 > 0:16:31This leads me to believe that this was not an opportunistic fraud,
0:16:31 > 0:16:35this was a cold, calculated effort to defraud insurers.
0:16:36 > 0:16:39With two instances of fraud to her name,
0:16:39 > 0:16:42the woman was fortunate to escape prosecution.
0:16:42 > 0:16:44Next time, she might not be so lucky.
0:16:46 > 0:16:48This type of fraud is not uncommon
0:16:48 > 0:16:50within the travel insurance industry,
0:16:50 > 0:16:53and I would say to anyone that attempting to make a claim
0:16:53 > 0:16:56with my company for this particular type of fraud,
0:16:56 > 0:16:58I would say, not on my watch!
0:17:03 > 0:17:06Most household insurance claims are genuine.
0:17:06 > 0:17:08They should be pretty simple.
0:17:08 > 0:17:10The person claiming has suffered a loss
0:17:10 > 0:17:12and wants to be compensated for it.
0:17:12 > 0:17:15But even when claims start out as honest losses,
0:17:15 > 0:17:17some people get carried away,
0:17:17 > 0:17:20exaggerating the value of items or adding things to the list
0:17:20 > 0:17:23that weren't stolen or damaged in the first place.
0:17:30 > 0:17:31In order to settle claims of theft,
0:17:31 > 0:17:34insurance companies usually require proof of ownership
0:17:34 > 0:17:37such as receipts or guarantees.
0:17:37 > 0:17:39But this is where fraudsters are often caught out,
0:17:39 > 0:17:43by making simple mistakes that can end up invalidating
0:17:43 > 0:17:45their whole claim.
0:17:48 > 0:17:52Dave Berry deals with home insurance at Lloyds Banking Group,
0:17:52 > 0:17:56and knows only too well that not every claim is entirely above board.
0:17:58 > 0:18:03A customer reported that he had taken his dogs out for a walk.
0:18:03 > 0:18:06He did that just before he was going to come back home to watch
0:18:06 > 0:18:08a live game of football on the telly.
0:18:08 > 0:18:10When he got back home,
0:18:10 > 0:18:13he saw that his kitchen window had been forced open.
0:18:13 > 0:18:15He went into the house,
0:18:15 > 0:18:17also found that his patio doors were wide open
0:18:17 > 0:18:19and that he'd been burgled.
0:18:20 > 0:18:22After police had attended the crime scene,
0:18:22 > 0:18:25the customer phoned Lloyds to make a claim.
0:19:26 > 0:19:30There was no doubt this was hugely upsetting for the family involved.
0:19:30 > 0:19:33Not only had their home been invaded,
0:19:33 > 0:19:37but they were now around £15,000 out of pocket.
0:19:39 > 0:19:42When we first received the claim, everything appeared in order.
0:19:42 > 0:19:46We still needed to go through the process of identifying the value
0:19:46 > 0:19:48of the items and their age so that
0:19:48 > 0:19:51we could make sure the correct value was placed on the claim.
0:19:53 > 0:19:55As is the case with any claim for valuables,
0:19:55 > 0:19:59Lloyds needed proof that the family had owned them in the first place.
0:19:59 > 0:20:03To help us validate the value of the claim and ownership of the items,
0:20:03 > 0:20:07we ask our customers to provide whatever evidence of ownership
0:20:07 > 0:20:10they might have retained. That could include manuals for electrical goods
0:20:10 > 0:20:12or guarantees. It could include boxes.
0:20:12 > 0:20:16It could include photographs, purchase receipts,
0:20:16 > 0:20:19bank statements showing that they've paid cash for items,
0:20:19 > 0:20:22a whole range of items are available that we will consider
0:20:22 > 0:20:26to help us assess the value of the claim.
0:20:26 > 0:20:29The customer gathered a variety of receipts and photographs
0:20:29 > 0:20:32to give to his insurance company.
0:20:32 > 0:20:34As the claim was so large,
0:20:34 > 0:20:38Lloyds decided to visit the customer at home to go through the evidence
0:20:38 > 0:20:41and put a final value on the items he was claiming for.
0:20:42 > 0:20:44Our agents met with the customer,
0:20:44 > 0:20:47and were discussing the value of the claim and looking at
0:20:47 > 0:20:50the documentation that had been provided to them
0:20:50 > 0:20:52in support of the claim.
0:20:52 > 0:20:55One of those items was a photograph of the customer wearing a watch,
0:20:55 > 0:20:58the watch that had been reported stolen.
0:20:58 > 0:21:01The customer hadn't kept the receipt for the watch,
0:21:01 > 0:21:04so had provided a photo of him wearing it instead.
0:21:04 > 0:21:07But on closer inspection, the agent spotted something
0:21:07 > 0:21:10that didn't seem quite right.
0:21:10 > 0:21:12In the foreground of that photograph, though,
0:21:12 > 0:21:15there was a copy of a newspaper.
0:21:15 > 0:21:19Our agent recognised the headlines in that newspaper,
0:21:19 > 0:21:22and thought that they were more recent
0:21:22 > 0:21:25than the photograph could potentially have been taken.
0:21:25 > 0:21:28When they made some enquiries into the date on which
0:21:28 > 0:21:30that newspaper headline had appeared,
0:21:30 > 0:21:33they had in fact been printed on the 8th of August,
0:21:33 > 0:21:37which was some four days after the burglary was said to have occurred.
0:21:39 > 0:21:42That indicated to us that because the photograph had been taken
0:21:42 > 0:21:45after the burglary, that in fact the watch hasn't been stolen
0:21:45 > 0:21:46at the time.
0:21:46 > 0:21:51This revelation threw the validity of the entire claim into question.
0:21:51 > 0:21:53Had the burglary even taken place,
0:21:53 > 0:21:56or was the customer trying to claim for additional items
0:21:56 > 0:21:58that hadn't been stolen?
0:21:58 > 0:22:02We reported the matter to the insurance fraud enforcement department.
0:22:02 > 0:22:04They interviewed the claimant,
0:22:04 > 0:22:08and he admitted that he had exaggerated the claim,
0:22:08 > 0:22:13that the watch hadn't been stolen, and as a result of that admission,
0:22:13 > 0:22:16IFED agreed to deal with the matter by way of a police caution.
0:22:18 > 0:22:22Many cases of insurance fraud start out as genuine claims,
0:22:22 > 0:22:25but when some people see an opportunity to cash in,
0:22:25 > 0:22:29the temptation to exaggerate their claim for a bumper pay-out
0:22:29 > 0:22:31is just too great to resist.
0:22:33 > 0:22:37It is possible that customers who do submit a fraudulent claim
0:22:37 > 0:22:39don't realise that if they're caught,
0:22:39 > 0:22:41there could be serious repercussions.
0:22:41 > 0:22:43It could mean that their policy's cancelled.
0:22:43 > 0:22:45It could mean the matter's reported to the police,
0:22:45 > 0:22:47and if it is reported to the police,
0:22:47 > 0:22:49that could result in either a custodial sentence,
0:22:49 > 0:22:52a police caution, and on a longer term basis,
0:22:52 > 0:22:55make it more difficult to secure financial products.
0:23:01 > 0:23:04Accidents are part and parcel of everyday life.
0:23:04 > 0:23:07In some cases, it genuinely isn't our fault -
0:23:07 > 0:23:09a wet floor without a hazard sign,
0:23:09 > 0:23:12or a trailing cable across a walkway.
0:23:12 > 0:23:15Of course, sometimes we only have ourselves to blame.
0:23:15 > 0:23:18However, there are some unscrupulous people out there who think
0:23:18 > 0:23:21they can cheat the system by pointing the finger
0:23:21 > 0:23:23in the wrong direction.
0:23:25 > 0:23:29Nowadays, insurance companies have a plethora of hi-tech tools
0:23:29 > 0:23:33at their disposal to combat spurious claims,
0:23:33 > 0:23:36but sometimes it's good old-fashioned eyewitness accounts
0:23:36 > 0:23:38that separate the wheat from the chaff
0:23:38 > 0:23:40when it comes to solving tricky cases.
0:23:43 > 0:23:47Ben McBean is a claims controller at insurance company QBE,
0:23:47 > 0:23:51and recently dealt with a case where a night out went disastrously wrong.
0:23:53 > 0:23:56The first thing we received on this claim were allegations
0:23:56 > 0:23:59from the claimant that he was a visitor
0:23:59 > 0:24:01to our insured nightclub's premises.
0:24:07 > 0:24:11As he was descending the stairs, because the banister was so low,
0:24:11 > 0:24:15he actually fell over the banister, and he fell a height of about
0:24:15 > 0:24:1824 feet, straight to the ground.
0:24:23 > 0:24:25The injuries that he sustained as a result of the fall
0:24:25 > 0:24:28were a broken hip,
0:24:28 > 0:24:31a fractured pelvis,
0:24:31 > 0:24:35various broken ribs, and potentially a fractured leg.
0:24:36 > 0:24:39He said that he could be in hospital for four months,
0:24:39 > 0:24:43and obviously he wouldn't be able to work during this time.
0:24:43 > 0:24:45A devastating accident,
0:24:45 > 0:24:49and the last thing you'd expect to happen on a night out.
0:24:49 > 0:24:52At first glance, it seemed like a legitimate claim.
0:24:52 > 0:24:54Somebody who'd fallen a significant height
0:24:54 > 0:24:57and sustain some really serious injuries.
0:24:57 > 0:25:01Initially, we reserved £30,000 against the claim for the costs
0:25:01 > 0:25:04and potential damages that we may have to pay out.
0:25:06 > 0:25:10As it was a significant claim, QBE started to investigate,
0:25:10 > 0:25:13and asked the claimant for proof to back up his story.
0:25:15 > 0:25:18The evidence that the claimant provided was by way of
0:25:18 > 0:25:19medical experts' reports,
0:25:19 > 0:25:24and also he got engineering evidence to look mainly at the set-up
0:25:24 > 0:25:27in the nightclub, whether the handrail for the banister,
0:25:27 > 0:25:31whether that was the right height, and whether there were any defects.
0:25:32 > 0:25:36QBE also carried out some detective work of their own,
0:25:36 > 0:25:39and contacted the nightclub where the incident took place
0:25:39 > 0:25:42to see if their account of the fall matched the claimant's.
0:25:44 > 0:25:48The manager of the venue completed an accident report form
0:25:48 > 0:25:52that he sent to us, which informed us that at the scene,
0:25:52 > 0:25:55the claimant had actually apologised
0:25:55 > 0:25:57for causing such a hassle.
0:26:00 > 0:26:03You wouldn't really expect somebody who had sustained
0:26:03 > 0:26:06really significant injuries to first think of apologising
0:26:06 > 0:26:09for causing hassle to the owner of a nightclub.
0:26:11 > 0:26:14It's certainly not the reaction you'd expect,
0:26:14 > 0:26:17but it was when QBE were presented with the witness accounts
0:26:17 > 0:26:20that the man's story really hit the skids.
0:26:21 > 0:26:25The witness evidence from the accident scene indicated
0:26:25 > 0:26:28that he'd actually try to slide down the banister,
0:26:28 > 0:26:30and he hadn't fallen down something
0:26:30 > 0:26:32that was defective in any way.
0:26:37 > 0:26:40Essentially, the whole case comes down to whether he slid down
0:26:40 > 0:26:43the banister or whether he fell because it was defective,
0:26:43 > 0:26:46either there was a fault with it or it wasn't constructed
0:26:46 > 0:26:48at the right height to start with.
0:26:50 > 0:26:54They is a world of difference between a faulty banister
0:26:54 > 0:26:57and a schoolboy prank gone wrong.
0:26:57 > 0:27:00Obviously, once we'd identified that potentially we were dealing with
0:27:00 > 0:27:02someone who may have lied to us,
0:27:02 > 0:27:05we had to do some social media investigation.
0:27:08 > 0:27:11On doing that, we'd identified quite a few comments from his friends
0:27:11 > 0:27:15and family around his judgment being poor,
0:27:15 > 0:27:19that he'd actually slid down the banister instead of fallen,
0:27:19 > 0:27:22and they'd also called him various names such as muppet,
0:27:22 > 0:27:25cretin and various other expletives.
0:27:26 > 0:27:30With the evidence on social media backing up the eyewitness accounts,
0:27:30 > 0:27:34QBE had no doubt that they were dealing with a fraudulent claim.
0:27:37 > 0:27:40We decided we had sufficient evidence to run this to trial,
0:27:40 > 0:27:44so we indicated to the claimant and his legal representatives
0:27:44 > 0:27:46that we were going to defend it,
0:27:46 > 0:27:49and produced the evidence that we had.
0:27:49 > 0:27:52Surprisingly, they still decided to continue to trial with it.
0:27:54 > 0:27:56Once the case had reached court,
0:27:56 > 0:27:59yet more damning evidence came out of the woodwork.
0:28:01 > 0:28:03At trial, quite interestingly,
0:28:03 > 0:28:07we identified that there were A&E records which indicated
0:28:07 > 0:28:09he'd actually slid down the banister,
0:28:09 > 0:28:11which the claimant contested.
0:28:11 > 0:28:14He said that maybe somebody had just made that up,
0:28:14 > 0:28:18and hadn't recorded precisely what he actually said.
0:28:18 > 0:28:21Right. So, with the eyewitness accounts,
0:28:21 > 0:28:24his friends and family on social media
0:28:24 > 0:28:26and now the A&E records all saying
0:28:26 > 0:28:29the claimant had slid down the banister,
0:28:29 > 0:28:33it'll come as no surprise that the judge was reluctant
0:28:33 > 0:28:35to give him the benefit of the doubt.
0:28:36 > 0:28:40The judge said of the claimant that he didn't believe
0:28:40 > 0:28:43that his recollection was a true account of what actually happened,
0:28:43 > 0:28:46and that was being quite charitable to him.
0:28:46 > 0:28:48The claim was struck out of court,
0:28:48 > 0:28:51and this chancer's attempt to cash in on his own recklessness
0:28:51 > 0:28:54had well and truly crashed out.
0:28:57 > 0:29:00QBE were very pleased with the outcome from the trial because,
0:29:00 > 0:29:03whilst unfortunately somebody sustained
0:29:03 > 0:29:06quite significant injuries, which we would never wish upon anyone,
0:29:06 > 0:29:10you can't allow people just to point blame at innocent people
0:29:10 > 0:29:13who aren't responsible.
0:29:13 > 0:29:17Sadly, claims like this are becoming more and more common,
0:29:17 > 0:29:20and it's honest policyholders that end up paying the price,
0:29:20 > 0:29:23as insurers are forced to pass on the cost of dishonest claims
0:29:23 > 0:29:26in the form of increased premiums.
0:29:27 > 0:29:31Unfortunately, all the media used by solicitors
0:29:31 > 0:29:35to create this whole "where there's blame, there's a claim" mentality
0:29:35 > 0:29:39has created what ends up being a lot of fraudulent claims.
0:29:39 > 0:29:43And insurers are spending a lot of time and money to defend them.
0:29:49 > 0:29:53Still to come, a bus passenger fails to get his facts straight
0:29:53 > 0:29:56when making a personal injury claim.
0:29:56 > 0:29:59Shy of an American wrestler boarding the bus and body-slamming
0:29:59 > 0:30:01the claimant to the floor, it couldn't have been
0:30:01 > 0:30:03a lot more different to what we were told.
0:30:07 > 0:30:11Buying property is a tricky and expensive business,
0:30:11 > 0:30:13but if you play your cards right,
0:30:13 > 0:30:16it can save you a lot of money in the long run.
0:30:16 > 0:30:19Buildings insurance is usually put in place from the date of exchange,
0:30:19 > 0:30:22and is there to protect the owner or owners should the property
0:30:22 > 0:30:25fall victim to a fire or flood.
0:30:25 > 0:30:29The good news is if your property is damaged, you're usually covered.
0:30:29 > 0:30:32The bad news is some scammers see this
0:30:32 > 0:30:34as an easy way of cashing in
0:30:34 > 0:30:37by pretending they're the legal owner of a property
0:30:37 > 0:30:40when in fact they never completed their purchase.
0:30:41 > 0:30:44RSA is an insurance company that provides everything
0:30:44 > 0:30:47from home and pet insurance
0:30:47 > 0:30:49to policies for multinational businesses.
0:30:51 > 0:30:55John Beadle is head of financial crime and counter fraud there,
0:30:55 > 0:30:58and recently handled a case with an audacious individual.
0:30:59 > 0:31:03A gentleman successfully bought a house
0:31:03 > 0:31:05at auction for £35,000.
0:31:07 > 0:31:11He paid a 10% deposit, £3,500,
0:31:11 > 0:31:15and insured the house with us at RSA.
0:31:15 > 0:31:19Unfortunately, six days after he purchased the house,
0:31:19 > 0:31:20there was a catastrophic fire
0:31:20 > 0:31:25at the premises, which virtually gutted it.
0:31:27 > 0:31:30A fire is a homeowner's worst nightmare.
0:31:31 > 0:31:34But it's times like these where a house insurance policy
0:31:34 > 0:31:36can really come to the rescue.
0:31:38 > 0:31:41The claim was originally registered with us
0:31:41 > 0:31:45by this gentleman under his household policy,
0:31:45 > 0:31:49but the sale actually didn't go through,
0:31:49 > 0:31:52and he had his £3,500 deposit
0:31:52 > 0:31:56he'd paid the auction house refunded,
0:31:56 > 0:31:58and he withdrew the claim.
0:31:59 > 0:32:03A lucky escape that thankfully hadn't left the man out of pocket.
0:32:04 > 0:32:08RSA assumed they would hear nothing more from their customer,
0:32:08 > 0:32:10and closed the files on the case.
0:32:12 > 0:32:16As far as we were concerned, that was the end of the matter.
0:32:16 > 0:32:19Um, but we were quite surprised when,
0:32:19 > 0:32:22some two years later,
0:32:22 > 0:32:27the gentleman then resurrected his claim,
0:32:27 > 0:32:32which had now been set at £78,000
0:32:32 > 0:32:36for complete refurbishment of the premises.
0:32:37 > 0:32:40Now, the last time RSA had heard from the man,
0:32:40 > 0:32:44his purchase of the property had fallen through, and he walked away.
0:32:44 > 0:32:48So, how could he be claiming on it now?
0:32:48 > 0:32:50This seemed rather strange,
0:32:50 > 0:32:53to have heard nothing for two years,
0:32:53 > 0:32:55and then have this claim for this
0:32:55 > 0:32:58vast amount of money restated.
0:32:58 > 0:33:01So, we began looking into the circumstances.
0:33:02 > 0:33:05RSA checked the Land Registry records for the property
0:33:05 > 0:33:09to see whether the claimant had actually been the legal owner
0:33:09 > 0:33:10when the fire took place.
0:33:12 > 0:33:14We've actually found that he had
0:33:14 > 0:33:18only just purchased the property last year,
0:33:18 > 0:33:21and therefore was not the legitimate owner of the premises
0:33:21 > 0:33:25when it burned down in 2014.
0:33:27 > 0:33:31RSA discover that their customer had purchased the damage property
0:33:31 > 0:33:36two years after the fire at a reduced price of just £18,000,
0:33:36 > 0:33:41yet here he was claiming £78,000 refurbishment.
0:33:44 > 0:33:47Now, as we all know, insurance doesn't work like that,
0:33:47 > 0:33:51and because the man didn't own the property at the time of the blaze,
0:33:51 > 0:33:54he wasn't entitled to claim for the damage caused by it.
0:33:55 > 0:33:58Put simply,
0:33:58 > 0:34:03we didn't pay the claim, and had no intention of doing so,
0:34:03 > 0:34:06and this gentleman will have to fund
0:34:06 > 0:34:08the refurbishment of the house
0:34:08 > 0:34:11that he's purchased out of his own funds.
0:34:11 > 0:34:13Sounds fair enough to me,
0:34:13 > 0:34:16but the sad reality is that when it comes to insurance cheats,
0:34:16 > 0:34:20what's fair and right simply doesn't come into it.
0:34:20 > 0:34:22But as this case demonstrates,
0:34:22 > 0:34:26insurers are not a soft touch.
0:34:26 > 0:34:30I think this was probably quite calculated
0:34:30 > 0:34:34in the sense that when he did purchase the house,
0:34:34 > 0:34:36now for a much reduced cost
0:34:36 > 0:34:39because of the extent of the damage to it,
0:34:39 > 0:34:43he thought he could just simply resurrect a two-year-old claim,
0:34:43 > 0:34:48and that we would just pay that claim without any sort of checks.
0:34:48 > 0:34:51Of course, he soon learned that, actually,
0:34:51 > 0:34:54a simple check at the Land Registry would show
0:34:54 > 0:34:57that he wasn't the owner of the premises.
0:34:58 > 0:35:02As John explains, dishonest and opportunistic claims like these
0:35:02 > 0:35:04affect all of us.
0:35:04 > 0:35:07The point I'm trying to get across to people is
0:35:07 > 0:35:09if you have a genuine claim,
0:35:09 > 0:35:13we want to help you to get back on your feet,
0:35:13 > 0:35:17or reinstate your damaged or your lost property
0:35:17 > 0:35:19as quickly as possible.
0:35:19 > 0:35:22People who try and invent claims
0:35:22 > 0:35:26or exaggerate claims
0:35:26 > 0:35:29just cause us a lot of time,
0:35:29 > 0:35:31trouble and effort,
0:35:31 > 0:35:33and of course cost us money,
0:35:33 > 0:35:36which ultimately impacts all our honest customers.
0:35:36 > 0:35:38So, my message is don't do it.
0:35:38 > 0:35:40You'll get caught.
0:35:40 > 0:35:43And leave us alone to service our honest customers.
0:35:48 > 0:35:51Now, with Britain's roads getting more and more crowded,
0:35:51 > 0:35:54many of us are turning to public transport to get around.
0:35:54 > 0:35:57So, it's no wonder that over 12 million bus journeys
0:35:57 > 0:36:00are made in the UK every day.
0:36:00 > 0:36:03But the last thing we expect when we hop on board
0:36:03 > 0:36:05is to end up sustaining an injury.
0:36:08 > 0:36:11In the event that an accident does occur,
0:36:11 > 0:36:14most buses are now fitted with CCTV cameras,
0:36:14 > 0:36:17which can provide crucial evidence.
0:36:17 > 0:36:21They're often used to prove genuine claims are just that,
0:36:21 > 0:36:24but they also play a vital role in identifying the claims
0:36:24 > 0:36:26which aren't so clear-cut.
0:36:29 > 0:36:34Lee Ingram at First Group knows only too well how important CCTV can be,
0:36:34 > 0:36:38especially in cases where it's one person's word against another.
0:36:40 > 0:36:43This was a claim that was submitted to us by a firm of solicitors
0:36:43 > 0:36:46on behalf of a couple that had boarded one of our buses.
0:36:46 > 0:36:50It was a disabled couple, a lady in a wheelchair, a guy with a stick.
0:36:50 > 0:36:52They've got on the bus.
0:36:52 > 0:36:56He's helped his wife to the disabled and buggy access area.
0:36:56 > 0:36:58He's then gone back to scan his ticket, and as he's walking
0:36:58 > 0:37:01back to his seat, he's saying that the bus has pulled away,
0:37:01 > 0:37:04causing him to fall over and hit his head off one of the seats.
0:37:06 > 0:37:10When the claim was reported through to our customer services,
0:37:10 > 0:37:14his partner had advised that he'd sustained a cut to his eye.
0:37:14 > 0:37:17Now, we did a follow-up call from our customer services,
0:37:17 > 0:37:20and at that time, we were told that the day after the accident,
0:37:20 > 0:37:23he'd actually been admitted to hospital following difficulty
0:37:23 > 0:37:25standing and speaking.
0:37:25 > 0:37:28So, he'd been taken in with a concussion, a severe concussion,
0:37:28 > 0:37:30and kept in for a week.
0:37:30 > 0:37:33So, some quite serious injuries at that time.
0:37:34 > 0:37:38First Group take passenger safety incredibly seriously,
0:37:38 > 0:37:41and with a nasty injury to one of their passengers,
0:37:41 > 0:37:44they were potentially facing a five figure pay-out.
0:37:46 > 0:37:50This claim would have been valued in the region of £10,000,
0:37:50 > 0:37:52including the injuries themselves
0:37:52 > 0:37:55and the legal costs for pursuing the claim.
0:37:55 > 0:37:57From the facts that Lee had been given,
0:37:57 > 0:38:00this appeared to be a clear-cut case.
0:38:00 > 0:38:02There are safety protocols in place to protect passengers,
0:38:02 > 0:38:05and if they'd been broken, then First Group were liable.
0:38:09 > 0:38:12Initial indication would suggest that this was a legitimate claim.
0:38:12 > 0:38:15The bus driver should really have waited for any people
0:38:15 > 0:38:18with disabilities to be seated before they pull away.
0:38:18 > 0:38:20It's definitely something that we would want to look into
0:38:20 > 0:38:22for that reason alone.
0:38:24 > 0:38:28Lee's first port of call was to contact the bus driver.
0:38:28 > 0:38:31When we asked our driver for their version of what actually happened,
0:38:31 > 0:38:33the driver said,
0:38:33 > 0:38:36"I don't recall actually moving away
0:38:36 > 0:38:40"from that stop when that person fell over."
0:38:41 > 0:38:44With the disabled passenger claiming the bus had driven off
0:38:44 > 0:38:47and the bus driver alleging the bus had remained stationary,
0:38:47 > 0:38:52there was only one way of finding out whose account was the real one.
0:38:52 > 0:38:54You've guessed it - CCTV.
0:38:57 > 0:39:00But while the bus's trusty all-seeing eye has been
0:39:00 > 0:39:03the deciding factor in hundreds of claims over the years,
0:39:03 > 0:39:06even a veteran like Lee was surprised by this case.
0:39:08 > 0:39:11When I looked at the CCTV on this one,
0:39:11 > 0:39:13it's a little bit of an eye-opener.
0:39:13 > 0:39:16Shy of an American wrestler boarding the bus and body-slamming
0:39:16 > 0:39:18the claimant to the floor,
0:39:18 > 0:39:21it couldn't have been a lot more different to what we were told.
0:39:23 > 0:39:27So, we can see the couple now, that they do board the bus.
0:39:27 > 0:39:30She goes to sit down in the disabled area.
0:39:32 > 0:39:35He's telling us that he's scanned his ticket, gone to sit down.
0:39:43 > 0:39:47He's clearly forgotten lesson 101 on how to sit on a chair properly,
0:39:47 > 0:39:50and he's failed spectacularly.
0:39:51 > 0:39:53He's fallen off, spun round,
0:39:53 > 0:39:56hit his head off the chair opposite.
0:39:56 > 0:39:59Getting up, he's managed to hit his head again on the chair behind.
0:40:03 > 0:40:05So, quite a serious fall indeed,
0:40:05 > 0:40:07but if you look at the footage again...
0:40:09 > 0:40:11..there's a rather large inconsistency
0:40:11 > 0:40:15with the claimant's version of events...
0:40:15 > 0:40:17..and that's putting it mildly,
0:40:17 > 0:40:20because the bus is stationary the entire time.
0:40:22 > 0:40:24He's clearly injured, and you can see how he's been injured,
0:40:24 > 0:40:27but to say that's caused by the bus pulling away
0:40:27 > 0:40:30is outrageous.
0:40:30 > 0:40:33There is no way that the bus has moved.
0:40:33 > 0:40:35That's not what caused him to fall at all.
0:40:35 > 0:40:37It's the fact that he can't sit on a chair properly.
0:40:40 > 0:40:43Based on what we'd seen in the CCTV footage
0:40:43 > 0:40:45and what our driver had told us,
0:40:45 > 0:40:49we can only conclude that this was an unfortunate accident,
0:40:49 > 0:40:52and that this claimant was making an opportunist attempt
0:40:52 > 0:40:55to make a claim for compensation
0:40:55 > 0:40:57just because they've fallen over on the bus.
0:40:57 > 0:40:59We're not going to pay those sorts of claims.
0:40:59 > 0:41:04You need to show that someone has been negligent to be successful.
0:41:04 > 0:41:06There was no negligence in this incident at all.
0:41:07 > 0:41:09With evidence as compelling as this,
0:41:09 > 0:41:12weighing up what to do with this claim
0:41:12 > 0:41:15was one of the easiest decisions of Lee's career.
0:41:18 > 0:41:21The CCTV, hand-in-hand with the driver's statement
0:41:21 > 0:41:24clearly saying that she hadn't moved away,
0:41:24 > 0:41:26causing this person to fall over,
0:41:26 > 0:41:29makes it really easy to repudiate claims like this.
0:41:29 > 0:41:32We sent the CCTV to the claimant's solicitors.
0:41:32 > 0:41:35A week later, we received a letter from them saying
0:41:35 > 0:41:37that they closed their file.
0:41:37 > 0:41:40We never heard again from the claimant, and to be honest,
0:41:40 > 0:41:42we don't expect to.
0:41:42 > 0:41:46In light of the evidence, I'd say that's a fair assumption.
0:41:46 > 0:41:49They say the camera never lies, but in this case,
0:41:49 > 0:41:52it had actually exposed their lies.
0:41:54 > 0:41:57I'm happy with the result of this particular case.
0:41:57 > 0:41:59Not only did we not pay the claim anyway,
0:41:59 > 0:42:01because we shouldn't have paid it,
0:42:01 > 0:42:04these circumstances were preposterous,
0:42:04 > 0:42:08but we've been in a position to support our driver and back her up,
0:42:08 > 0:42:10because she did absolutely nothing wrong.
0:42:10 > 0:42:14It's not nice to be investigated, and she's been exonerated,
0:42:14 > 0:42:15quite rightly so.
0:42:17 > 0:42:20But as satisfying as it is to crack cases like these,
0:42:20 > 0:42:23it also highlights the depths some people will go
0:42:23 > 0:42:27in the hope of some easy money.
0:42:27 > 0:42:30These sorts of claims are ridiculous.
0:42:30 > 0:42:33To allege something has happened that is clearly different
0:42:33 > 0:42:36to what's actually happened just so you can make a claim
0:42:36 > 0:42:38is actually disgraceful.
0:42:38 > 0:42:40People shouldn't be allowed to get away with this,
0:42:40 > 0:42:43which is why we investigate claims the way we do.
0:42:43 > 0:42:46We will eventually find out that you're not telling the truth.
0:42:46 > 0:42:48We're going to turn your claim down, and on occasion,
0:42:48 > 0:42:51we will send these off for prosecution as well.
0:42:55 > 0:42:59Insurance fraud in this country costs all of us money,
0:42:59 > 0:43:02but the days of no-questions-asked pay-outs are numbered.
0:43:02 > 0:43:06Insurers are using ever more sophisticated technology
0:43:06 > 0:43:09to identify, track and prosecute fraudsters,
0:43:09 > 0:43:11and courts are using new powers
0:43:11 > 0:43:15to put these criminals behind bars.