Episode 8 Claimed and Shamed


Episode 8

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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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Subject out of the vehicle.

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..sophisticated data analysis techniques...

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

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Police! Don't move. 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 conmen, 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 chancer's ruse is rumbled when CCTV footage comes to light...

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We were completely shocked that the claimant had the nerve to submit

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a personal injury claim when it was quite clear that he wasn't even

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in the car and he couldn't possibly have been injured.

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..a woman's holiday hoax is exposed thanks to her

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childish counterfeit skills...

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My daughter could have completed them considerably better,

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and she's eight years old.

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..and it's bad news for a burglary claim

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when insurers clock a fatal flaw.

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Our agent recognised headlines in that newspaper,

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and thought that they were more recent than the photograph

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could potentially have been taken.

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The most common and expensive type of insurance fraud

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is bogus car claims.

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Now, many of these claims start out as genuine cases,

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but when unscrupulous claimants see an opportunity

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to line their pockets,

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the temptation to exaggerate or even make up

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entirely fictitious circumstances can be too great.

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Thinking they can get away with it,

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they'll go to extreme lengths to prove their case is genuine,

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refusing to give up even when faced with the hard evidence

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that says otherwise.

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Simon Roylance heads up the claims crime prevention team

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at LV Insurance, and recently dealt with a case where one claimant

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went above and beyond to prove their case was genuine.

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Our customer contacted us to advise that she'd been in an accident

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in a car park.

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She said that as she was reversing from a parking bay,

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she made contact with the front of another vehicle

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that was parked in a bay opposite.

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This vehicle was owned and allegedly driven by the claimant.

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So, all in all, this was pretty much the most common type of car accident

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that motor insurers see on a daily basis.

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Whilst there was no damage to our customer's vehicle,

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we did offer to deal with repairs to the third-party vehicle.

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We got this in to a repairer,

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and dealt with the claim in the sum of about £1,100.

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But if LV thought they had settled the claim and the case was closed,

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then they were wrong.

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At around the same time, we received a letter

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from a solicitor stating that the claimant

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had sustained injuries in the accident

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to his neck, back and arms.

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These appear to be typical kind of whiplash injuries that we see

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in road traffic accidents.

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Once again, this was all standard stuff.

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LV's policyholder had admitted she had reversed into another car,

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and the impact must have injured the man behind the wheel of the car

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she had hit.

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As this guy was now claiming for injuries on top of the repairs

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to his car, LV decided to give their policyholder

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a quick call to see if her account

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suggested the impact was sufficient to have injured him.

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When we spoke to our customer,

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she was really quite adamant that the claimant wasn't even in the car

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at the time, and she did seem very certain about this.

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As discrepancies in versions of events go,

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this one was a whopper.

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Fortunately, there was a sure-fire way of establishing

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who was telling the truth and who was not.

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The car park was covered by CCTV cameras, and as luck would have it,

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they captured the entire sequence of events.

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On the right of the picture, you've got the store.

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Just in front of the store is the claimant's car, which is parked up.

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In the parking bay opposite is our customer's vehicle,

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and you see that she soon starts to reverse manoeuvre

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out of her parking bay.

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She keeps reversing,

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and makes slight contact with the front of the claimant's vehicle.

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But as you can see throughout this time,

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the claimant has been stood alongside his car.

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He's not been in the vehicle.

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And you can actually see him trying to catch our customer's attention

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after she's collided with his car.

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The footage provided indisputable proof that LV's policyholder

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was telling the truth,

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and that the man was attempting to make a fraudulent claim.

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When we first looked at the CCTV footage,

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we were completely shocked that the claimant had the nerve to submit

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a personal injury claim when it was quite clear that he wasn't even

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in the car, and he couldn't possibly have been injured.

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We advised the claimant's solicitors that we wouldn't be making

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any payments, because we didn't accept that their client

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was in the vehicle at the time of the accident.

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With evidence like that,

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LV would be forgiven for thinking it was case closed.

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Well, think again.

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We were then completely taken aback a few months later

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to receive a medical report from the claimant's solicitor

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stating that he had been to see his GP twice since the accident

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regarding neck and back pain,

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and furthermore it said that it had taken 18 months to recover

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from his injuries. But we already knew that he wasn't in the car

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in the first place.

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Claiming it would take 18 months to recover from injuries

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he'd never sustained, this guy had more front than Brighton.

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But LV had heard enough.

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We then contacted the claimant's solicitors and made it clear

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to them that we didn't accept that their client was in the vehicle

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at the time, and so we wouldn't be making any payments

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for his compensation claim.

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But they weren't prepared to leave it there, and referred the case

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to the insurance fraud enforcement department

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at the City of London Police.

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IFED went out to interview the claimant.

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Initially, he stuck to his story, but when they showed him the CCTV,

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he eventually admitted that he'd made the whole thing up.

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The consequences for the claimant where that we repudiated

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his injury claim, worth up to around 5,000 in full.

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As a result of IFED's investigation, he received a police caution,

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and he's now got a criminal record.

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Justice had been served.

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But this case is a stark reminder of how unscrupulous

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some people really are.

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Whilst most claims are genuine,

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it's not uncommon for us to come across examples

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of opportunistic fraud like this, where a claimant has

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spotted an opportunity in the most trivial of circumstances

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to gain for their own personal benefit.

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..an opportunist is caught out when his friends and family

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fail to side with his story...

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The witness evidence indicated that he had actually tried to slide down

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the banister, and he hadn't fallen down something that was

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defective in any way.

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..and a man attempting to cash in from a housing fire

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sees his claim go up in smoke.

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We actually found that he had only just purchased the property

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last year, and therefore was not the legitimate owner of the premises

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when it burned down in 2014.

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Now, holidays are usually a time for us to relax and soak up the sun,

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but if the worst should happen and we become ill,

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then medical treatment abroad can be costly.

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Travel insurance is there to put our minds at rest,

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with policies covering everything from minor ailments

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to surgical procedures.

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But as if being away on holiday isn't enough of a treat,

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there are some people out there who will use the experience

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to try and pocket some extra cash at the expense

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of their travel insurance policy.

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Matthew Crawford-Thomas is a fraud manager at Collinson Group.

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His team recently dealt with a claim from a customer

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who had unfortunately succumbed to a rather common complaint

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when travelling abroad.

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We received the claim from the insured for circa £1,400

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for medical expenses whilst in Zimbabwe for sickness and diarrhoea.

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As with many other forms of insurance,

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before the claim could be processed,

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the insurer needed some form of proof that the treatment

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had actually taken place.

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We asked the administration team to supply us with

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the original documentation.

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After looking at the scans on our computer system,

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it appeared that the documentation had actually been altered.

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With his fraud radar on high alert,

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Matthew employed a trick of the trade...

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..a large magnifying glass known as a linen tester.

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Originally used to check the quality of woven fabrics,

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they are now used in the insurance industry to allow investigators

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to closely examine documents and check they're legitimate.

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Upon looking at the documents through the linen tester,

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it was evident that additional sums

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had been added to the receipts.

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The three receipts that we concentrated on mainly

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was for a taxi fare for less than seven miles,

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yet it was for 200 US dollars.

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The second receipt was from the Zimbabwean government,

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which clearly was only for 4, and had been written,

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"104".

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And the third receipt was a receipt from the Zimbabwe hospital,

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which after picking the Tippex off, clearly showed an amount of

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4 rather than the 150 that she originally claimed for.

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Wowzer. That's quite the increase.

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It appeared that the amount on all eight receipts the woman had sent

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to the insurance company had been altered,

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boosting her claim to hundreds of dollars more

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than she was entitled to.

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It was time to phone the suspected forger

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and challenge her on the dodgily doctored receipts.

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The customer was insistent that she hadn't doctored the receipts,

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yet the insurance company could clearly see that the amounts

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on the receipts had been changed.

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As far as Collinson were concerned, it was an easy decision.

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Despite the strong evidence against her,

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this customer still refused to admit the receipts weren't genuine.

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So, Matthew and his team dug a little deeper into her past.

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Once we'd found out that the insured's claim

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was in fact fraudulent, we looked through our system,

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and, lo and behold, found another claim for the individual.

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We duly then retrieved the documents from our administration department,

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and again found these to be doctored.

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Just a year previously, the woman had been on another holiday

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to Zimbabwe, and had claimed for medical expenses for that trip, too.

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Only the first time, she hadn't been so greedy,

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and had successfully received a pay-out of nearly £300.

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With her first claim also showing signs of fraud,

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it was time to share the good news with the claimant,

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and take back what she wasn't entitled to.

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It had taken a while, but the woman had been well and truly busted.

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But incredibly, despite being found out,

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she seemed hell-bent on keeping her policy in place,

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just in case she wanted to do it again.

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In another telephone call, she contacted us to say that

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is her policy still valid, as she was going on holiday again?

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Yet she'd already said to us that she didn't have enough money

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to pay us back, so where she's getting her money from,

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God only knows.

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The insurers then wrote to the woman,

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declining both claims and stating the repayment costs.

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They never heard from her again.

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The downfall for the insured person on this occasion were the documents.

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They were a killer.

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My daughter could have completed them considerably better,

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and she's eight years old.

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This leads me to believe that this was not an opportunistic fraud,

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this was a cold, calculated effort to defraud insurers.

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With two instances of fraud to her name,

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the woman was fortunate to escape prosecution.

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Next time, she might not be so lucky.

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This type of fraud is not uncommon

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within the travel insurance industry,

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and I would say to anyone that attempting to make a claim

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with my company for this particular type of fraud,

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I would say, not on my watch!

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Most household insurance claims are genuine.

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They should be pretty simple.

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The person claiming has suffered a loss

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and wants to be compensated for it.

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But even when claims start out as honest losses,

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some people get carried away,

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exaggerating the value of items or adding things to the list

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that weren't stolen or damaged in the first place.

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In order to settle claims of theft,

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insurance companies usually require proof of ownership

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such as receipts or guarantees.

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But this is where fraudsters are often caught out,

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by making simple mistakes that can end up invalidating

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their whole claim.

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Dave Berry deals with home insurance at Lloyds Banking Group,

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and knows only too well that not every claim is entirely above board.

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A customer reported that he had taken his dogs out for a walk.

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He did that just before he was going to come back home to watch

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a live game of football on the telly.

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When he got back home,

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he saw that his kitchen window had been forced open.

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He went into the house,

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also found that his patio doors were wide open

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and that he'd been burgled.

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After police had attended the crime scene,

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the customer phoned Lloyds to make a claim.

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There was no doubt this was hugely upsetting for the family involved.

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Not only had their home been invaded,

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but they were now around £15,000 out of pocket.

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When we first received the claim, everything appeared in order.

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We still needed to go through the process of identifying the value

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of the items and their age so that

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we could make sure the correct value was placed on the claim.

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As is the case with any claim for valuables,

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Lloyds needed proof that the family had owned them in the first place.

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To help us validate the value of the claim and ownership of the items,

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we ask our customers to provide whatever evidence of ownership

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they might have retained. That could include manuals for electrical goods

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or guarantees. It could include boxes.

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It could include photographs, purchase receipts,

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bank statements showing that they've paid cash for items,

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a whole range of items are available that we will consider

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to help us assess the value of the claim.

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The customer gathered a variety of receipts and photographs

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to give to his insurance company.

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As the claim was so large,

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Lloyds decided to visit the customer at home to go through the evidence

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and put a final value on the items he was claiming for.

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Our agents met with the customer,

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and were discussing the value of the claim and looking at

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the documentation that had been provided to them

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in support of the claim.

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One of those items was a photograph of the customer wearing a watch,

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the watch that had been reported stolen.

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The customer hadn't kept the receipt for the watch,

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so had provided a photo of him wearing it instead.

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But on closer inspection, the agent spotted something

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that didn't seem quite right.

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In the foreground of that photograph, though,

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there was a copy of a newspaper.

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Our agent recognised the headlines in that newspaper,

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and thought that they were more recent

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than the photograph could potentially have been taken.

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When they made some enquiries into the date on which

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that newspaper headline had appeared,

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they had in fact been printed on the 8th of August,

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which was some four days after the burglary was said to have occurred.

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That indicated to us that because the photograph had been taken

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after the burglary, that in fact the watch hasn't been stolen

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at the time.

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This revelation threw the validity of the entire claim into question.

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Had the burglary even taken place,

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or was the customer trying to claim for additional items

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that hadn't been stolen?

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We reported the matter to the insurance fraud enforcement department.

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They interviewed the claimant,

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and he admitted that he had exaggerated the claim,

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that the watch hadn't been stolen, and as a result of that admission,

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IFED agreed to deal with the matter by way of a police caution.

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Many cases of insurance fraud start out as genuine claims,

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but when some people see an opportunity to cash in,

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the temptation to exaggerate their claim for a bumper pay-out

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is just too great to resist.

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It is possible that customers who do submit a fraudulent claim

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don't realise that if they're caught,

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there could be serious repercussions.

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It could mean that their policy's cancelled.

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It could mean the matter's reported to the police,

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and if it is reported to the police,

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that could result in either a custodial sentence,

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a police caution, and on a longer term basis,

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make it more difficult to secure financial products.

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Accidents are part and parcel of everyday life.

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In some cases, it genuinely isn't our fault -

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a wet floor without a hazard sign,

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or a trailing cable across a walkway.

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Of course, sometimes we only have ourselves to blame.

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However, there are some unscrupulous people out there who think

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they can cheat the system by pointing the finger

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in the wrong direction.

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Nowadays, insurance companies have a plethora of hi-tech tools

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at their disposal to combat spurious claims,

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but sometimes it's good old-fashioned eyewitness accounts

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that separate the wheat from the chaff

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when it comes to solving tricky cases.

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Ben McBean is a claims controller at insurance company QBE,

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and recently dealt with a case where a night out went disastrously wrong.

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The first thing we received on this claim were allegations

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from the claimant that he was a visitor

0:23:560:23:59

to our insured nightclub's premises.

0:23:590:24:01

As he was descending the stairs, because the banister was so low,

0:24:070:24:11

he actually fell over the banister, and he fell a height of about

0:24:110:24:15

24 feet, straight to the ground.

0:24:150:24:18

The injuries that he sustained as a result of the fall

0:24:230:24:25

were a broken hip,

0:24:250:24:28

a fractured pelvis,

0:24:280:24:31

various broken ribs, and potentially a fractured leg.

0:24:310:24:35

He said that he could be in hospital for four months,

0:24:360:24:39

and obviously he wouldn't be able to work during this time.

0:24:390:24:43

A devastating accident,

0:24:430:24:45

and the last thing you'd expect to happen on a night out.

0:24:450:24:49

At first glance, it seemed like a legitimate claim.

0:24:490:24:52

Somebody who'd fallen a significant height

0:24:520:24:54

and sustain some really serious injuries.

0:24:540:24:57

Initially, we reserved £30,000 against the claim for the costs

0:24:570:25:01

and potential damages that we may have to pay out.

0:25:010:25:04

As it was a significant claim, QBE started to investigate,

0:25:060:25:10

and asked the claimant for proof to back up his story.

0:25:100:25:13

The evidence that the claimant provided was by way of

0:25:150:25:18

medical experts' reports,

0:25:180:25:19

and also he got engineering evidence to look mainly at the set-up

0:25:190:25:24

in the nightclub, whether the handrail for the banister,

0:25:240:25:27

whether that was the right height, and whether there were any defects.

0:25:270:25:31

QBE also carried out some detective work of their own,

0:25:320:25:36

and contacted the nightclub where the incident took place

0:25:360:25:39

to see if their account of the fall matched the claimant's.

0:25:390:25:42

The manager of the venue completed an accident report form

0:25:440:25:48

that he sent to us, which informed us that at the scene,

0:25:480:25:52

the claimant had actually apologised

0:25:520:25:55

for causing such a hassle.

0:25:550:25:57

You wouldn't really expect somebody who had sustained

0:26:000:26:03

really significant injuries to first think of apologising

0:26:030:26:06

for causing hassle to the owner of a nightclub.

0:26:060:26:09

It's certainly not the reaction you'd expect,

0:26:110:26:14

but it was when QBE were presented with the witness accounts

0:26:140:26:17

that the man's story really hit the skids.

0:26:170:26:20

The witness evidence from the accident scene indicated

0:26:210:26:25

that he'd actually try to slide down the banister,

0:26:250:26:28

and he hadn't fallen down something

0:26:280:26:30

that was defective in any way.

0:26:300:26:32

Essentially, the whole case comes down to whether he slid down

0:26:370:26:40

the banister or whether he fell because it was defective,

0:26:400:26:43

either there was a fault with it or it wasn't constructed

0:26:430:26:46

at the right height to start with.

0:26:460:26:48

They is a world of difference between a faulty banister

0:26:500:26:54

and a schoolboy prank gone wrong.

0:26:540:26:57

Obviously, once we'd identified that potentially we were dealing with

0:26:570:27:00

someone who may have lied to us,

0:27:000:27:02

we had to do some social media investigation.

0:27:020:27:05

On doing that, we'd identified quite a few comments from his friends

0:27:080:27:11

and family around his judgment being poor,

0:27:110:27:15

that he'd actually slid down the banister instead of fallen,

0:27:150:27:19

and they'd also called him various names such as muppet,

0:27:190:27:22

cretin and various other expletives.

0:27:220:27:25

With the evidence on social media backing up the eyewitness accounts,

0:27:260:27:30

QBE had no doubt that they were dealing with a fraudulent claim.

0:27:300:27:34

We decided we had sufficient evidence to run this to trial,

0:27:370:27:40

so we indicated to the claimant and his legal representatives

0:27:400:27:44

that we were going to defend it,

0:27:440:27:46

and produced the evidence that we had.

0:27:460:27:49

Surprisingly, they still decided to continue to trial with it.

0:27:490:27:52

Once the case had reached court,

0:27:540:27:56

yet more damning evidence came out of the woodwork.

0:27:560:27:59

At trial, quite interestingly,

0:28:010:28:03

we identified that there were A&E records which indicated

0:28:030:28:07

he'd actually slid down the banister,

0:28:070:28:09

which the claimant contested.

0:28:090:28:11

He said that maybe somebody had just made that up,

0:28:110:28:14

and hadn't recorded precisely what he actually said.

0:28:140:28:18

Right. So, with the eyewitness accounts,

0:28:180:28:21

his friends and family on social media

0:28:210:28:24

and now the A&E records all saying

0:28:240:28:26

the claimant had slid down the banister,

0:28:260:28:29

it'll come as no surprise that the judge was reluctant

0:28:290:28:33

to give him the benefit of the doubt.

0:28:330:28:35

The judge said of the claimant that he didn't believe

0:28:360:28:40

that his recollection was a true account of what actually happened,

0:28:400:28:43

and that was being quite charitable to him.

0:28:430:28:46

The claim was struck out of court,

0:28:460:28:48

and this chancer's attempt to cash in on his own recklessness

0:28:480:28:51

had well and truly crashed out.

0:28:510:28:54

QBE were very pleased with the outcome from the trial because,

0:28:570:29:00

whilst unfortunately somebody sustained

0:29:000:29:03

quite significant injuries, which we would never wish upon anyone,

0:29:030:29:06

you can't allow people just to point blame at innocent people

0:29:060:29:10

who aren't responsible.

0:29:100:29:13

Sadly, claims like this are becoming more and more common,

0:29:130:29:17

and it's honest policyholders that end up paying the price,

0:29:170:29:20

as insurers are forced to pass on the cost of dishonest claims

0:29:200:29:23

in the form of increased premiums.

0:29:230:29:26

Unfortunately, all the media used by solicitors

0:29:270:29:31

to create this whole "where there's blame, there's a claim" mentality

0:29:310:29:35

has created what ends up being a lot of fraudulent claims.

0:29:350:29:39

And insurers are spending a lot of time and money to defend them.

0:29:390:29:43

Still to come, a bus passenger fails to get his facts straight

0:29:490:29:53

when making a personal injury claim.

0:29:530:29:56

Shy of an American wrestler boarding the bus and body-slamming

0:29:560:29:59

the claimant to the floor, it couldn't have been

0:29:590:30:01

a lot more different to what we were told.

0:30:010:30:03

Buying property is a tricky and expensive business,

0:30:070:30:11

but if you play your cards right,

0:30:110:30:13

it can save you a lot of money in the long run.

0:30:130:30:16

Buildings insurance is usually put in place from the date of exchange,

0:30:160:30:19

and is there to protect the owner or owners should the property

0:30:190:30:22

fall victim to a fire or flood.

0:30:220:30:25

The good news is if your property is damaged, you're usually covered.

0:30:250:30:29

The bad news is some scammers see this

0:30:290:30:32

as an easy way of cashing in

0:30:320:30:34

by pretending they're the legal owner of a property

0:30:340:30:37

when in fact they never completed their purchase.

0:30:370:30:40

RSA is an insurance company that provides everything

0:30:410:30:44

from home and pet insurance

0:30:440:30:47

to policies for multinational businesses.

0:30:470:30:49

John Beadle is head of financial crime and counter fraud there,

0:30:510:30:55

and recently handled a case with an audacious individual.

0:30:550:30:58

A gentleman successfully bought a house

0:30:590:31:03

at auction for £35,000.

0:31:030:31:05

He paid a 10% deposit, £3,500,

0:31:070:31:11

and insured the house with us at RSA.

0:31:110:31:15

Unfortunately, six days after he purchased the house,

0:31:150:31:19

there was a catastrophic fire

0:31:190:31:20

at the premises, which virtually gutted it.

0:31:200:31:25

A fire is a homeowner's worst nightmare.

0:31:270:31:30

But it's times like these where a house insurance policy

0:31:310:31:34

can really come to the rescue.

0:31:340:31:36

The claim was originally registered with us

0:31:380:31:41

by this gentleman under his household policy,

0:31:410:31:45

but the sale actually didn't go through,

0:31:450:31:49

and he had his £3,500 deposit

0:31:490:31:52

he'd paid the auction house refunded,

0:31:520:31:56

and he withdrew the claim.

0:31:560:31:58

A lucky escape that thankfully hadn't left the man out of pocket.

0:31:590:32:03

RSA assumed they would hear nothing more from their customer,

0:32:040:32:08

and closed the files on the case.

0:32:080:32:10

As far as we were concerned, that was the end of the matter.

0:32:120:32:16

Um, but we were quite surprised when,

0:32:160:32:19

some two years later,

0:32:190:32:22

the gentleman then resurrected his claim,

0:32:220:32:27

which had now been set at £78,000

0:32:270:32:32

for complete refurbishment of the premises.

0:32:320:32:36

Now, the last time RSA had heard from the man,

0:32:370:32:40

his purchase of the property had fallen through, and he walked away.

0:32:400:32:44

So, how could he be claiming on it now?

0:32:440:32:48

This seemed rather strange,

0:32:480:32:50

to have heard nothing for two years,

0:32:500:32:53

and then have this claim for this

0:32:530:32:55

vast amount of money restated.

0:32:550:32:58

So, we began looking into the circumstances.

0:32:580:33:01

RSA checked the Land Registry records for the property

0:33:020:33:05

to see whether the claimant had actually been the legal owner

0:33:050:33:09

when the fire took place.

0:33:090:33:10

We've actually found that he had

0:33:120:33:14

only just purchased the property last year,

0:33:140:33:18

and therefore was not the legitimate owner of the premises

0:33:180:33:21

when it burned down in 2014.

0:33:210:33:25

RSA discover that their customer had purchased the damage property

0:33:270:33:31

two years after the fire at a reduced price of just £18,000,

0:33:310:33:36

yet here he was claiming £78,000 refurbishment.

0:33:360:33:41

Now, as we all know, insurance doesn't work like that,

0:33:440:33:47

and because the man didn't own the property at the time of the blaze,

0:33:470:33:51

he wasn't entitled to claim for the damage caused by it.

0:33:510:33:54

Put simply,

0:33:550:33:58

we didn't pay the claim, and had no intention of doing so,

0:33:580:34:03

and this gentleman will have to fund

0:34:030:34:06

the refurbishment of the house

0:34:060:34:08

that he's purchased out of his own funds.

0:34:080:34:11

Sounds fair enough to me,

0:34:110:34:13

but the sad reality is that when it comes to insurance cheats,

0:34:130:34:16

what's fair and right simply doesn't come into it.

0:34:160:34:20

But as this case demonstrates,

0:34:200:34:22

insurers are not a soft touch.

0:34:220:34:26

I think this was probably quite calculated

0:34:260:34:30

in the sense that when he did purchase the house,

0:34:300:34:34

now for a much reduced cost

0:34:340:34:36

because of the extent of the damage to it,

0:34:360:34:39

he thought he could just simply resurrect a two-year-old claim,

0:34:390:34:43

and that we would just pay that claim without any sort of checks.

0:34:430:34:48

Of course, he soon learned that, actually,

0:34:480:34:51

a simple check at the Land Registry would show

0:34:510:34:54

that he wasn't the owner of the premises.

0:34:540:34:57

As John explains, dishonest and opportunistic claims like these

0:34:580:35:02

affect all of us.

0:35:020:35:04

The point I'm trying to get across to people is

0:35:040:35:07

if you have a genuine claim,

0:35:070:35:09

we want to help you to get back on your feet,

0:35:090:35:13

or reinstate your damaged or your lost property

0:35:130:35:17

as quickly as possible.

0:35:170:35:19

People who try and invent claims

0:35:190:35:22

or exaggerate claims

0:35:220:35:26

just cause us a lot of time,

0:35:260:35:29

trouble and effort,

0:35:290:35:31

and of course cost us money,

0:35:310:35:33

which ultimately impacts all our honest customers.

0:35:330:35:36

So, my message is don't do it.

0:35:360:35:38

You'll get caught.

0:35:380:35:40

And leave us alone to service our honest customers.

0:35:400:35:43

Now, with Britain's roads getting more and more crowded,

0:35:480:35:51

many of us are turning to public transport to get around.

0:35:510:35:54

So, it's no wonder that over 12 million bus journeys

0:35:540:35:57

are made in the UK every day.

0:35:570:36:00

But the last thing we expect when we hop on board

0:36:000:36:03

is to end up sustaining an injury.

0:36:030:36:05

In the event that an accident does occur,

0:36:080:36:11

most buses are now fitted with CCTV cameras,

0:36:110:36:14

which can provide crucial evidence.

0:36:140:36:17

They're often used to prove genuine claims are just that,

0:36:170:36:21

but they also play a vital role in identifying the claims

0:36:210:36:24

which aren't so clear-cut.

0:36:240:36:26

Lee Ingram at First Group knows only too well how important CCTV can be,

0:36:290:36:34

especially in cases where it's one person's word against another.

0:36:340:36:38

This was a claim that was submitted to us by a firm of solicitors

0:36:400:36:43

on behalf of a couple that had boarded one of our buses.

0:36:430:36:46

It was a disabled couple, a lady in a wheelchair, a guy with a stick.

0:36:460:36:50

They've got on the bus.

0:36:500:36:52

He's helped his wife to the disabled and buggy access area.

0:36:520:36:56

He's then gone back to scan his ticket, and as he's walking

0:36:560:36:58

back to his seat, he's saying that the bus has pulled away,

0:36:580:37:01

causing him to fall over and hit his head off one of the seats.

0:37:010:37:04

When the claim was reported through to our customer services,

0:37:060:37:10

his partner had advised that he'd sustained a cut to his eye.

0:37:100:37:14

Now, we did a follow-up call from our customer services,

0:37:140:37:17

and at that time, we were told that the day after the accident,

0:37:170:37:20

he'd actually been admitted to hospital following difficulty

0:37:200:37:23

standing and speaking.

0:37:230:37:25

So, he'd been taken in with a concussion, a severe concussion,

0:37:250:37:28

and kept in for a week.

0:37:280:37:30

So, some quite serious injuries at that time.

0:37:300:37:33

First Group take passenger safety incredibly seriously,

0:37:340:37:38

and with a nasty injury to one of their passengers,

0:37:380:37:41

they were potentially facing a five figure pay-out.

0:37:410:37:44

This claim would have been valued in the region of £10,000,

0:37:460:37:50

including the injuries themselves

0:37:500:37:52

and the legal costs for pursuing the claim.

0:37:520:37:55

From the facts that Lee had been given,

0:37:550:37:57

this appeared to be a clear-cut case.

0:37:570:38:00

There are safety protocols in place to protect passengers,

0:38:000:38:02

and if they'd been broken, then First Group were liable.

0:38:020:38:05

Initial indication would suggest that this was a legitimate claim.

0:38:090:38:12

The bus driver should really have waited for any people

0:38:120:38:15

with disabilities to be seated before they pull away.

0:38:150:38:18

It's definitely something that we would want to look into

0:38:180:38:20

for that reason alone.

0:38:200:38:22

Lee's first port of call was to contact the bus driver.

0:38:240:38:28

When we asked our driver for their version of what actually happened,

0:38:280:38:31

the driver said,

0:38:310:38:33

"I don't recall actually moving away

0:38:330:38:36

"from that stop when that person fell over."

0:38:360:38:40

With the disabled passenger claiming the bus had driven off

0:38:410:38:44

and the bus driver alleging the bus had remained stationary,

0:38:440:38:47

there was only one way of finding out whose account was the real one.

0:38:470:38:52

You've guessed it - CCTV.

0:38:520:38:54

But while the bus's trusty all-seeing eye has been

0:38:570:39:00

the deciding factor in hundreds of claims over the years,

0:39:000:39:03

even a veteran like Lee was surprised by this case.

0:39:030:39:06

When I looked at the CCTV on this one,

0:39:080:39:11

it's a little bit of an eye-opener.

0:39:110:39:13

Shy of an American wrestler boarding the bus and body-slamming

0:39:130:39:16

the claimant to the floor,

0:39:160:39:18

it couldn't have been a lot more different to what we were told.

0:39:180:39:21

So, we can see the couple now, that they do board the bus.

0:39:230:39:27

She goes to sit down in the disabled area.

0:39:270:39:30

He's telling us that he's scanned his ticket, gone to sit down.

0:39:320:39:35

He's clearly forgotten lesson 101 on how to sit on a chair properly,

0:39:430:39:47

and he's failed spectacularly.

0:39:470:39:50

He's fallen off, spun round,

0:39:510:39:53

hit his head off the chair opposite.

0:39:530:39:56

Getting up, he's managed to hit his head again on the chair behind.

0:39:560:39:59

So, quite a serious fall indeed,

0:40:030:40:05

but if you look at the footage again...

0:40:050:40:07

..there's a rather large inconsistency

0:40:090:40:11

with the claimant's version of events...

0:40:110:40:15

..and that's putting it mildly,

0:40:150:40:17

because the bus is stationary the entire time.

0:40:170:40:20

He's clearly injured, and you can see how he's been injured,

0:40:220:40:24

but to say that's caused by the bus pulling away

0:40:240:40:27

is outrageous.

0:40:270:40:30

There is no way that the bus has moved.

0:40:300:40:33

That's not what caused him to fall at all.

0:40:330:40:35

It's the fact that he can't sit on a chair properly.

0:40:350:40:37

Based on what we'd seen in the CCTV footage

0:40:400:40:43

and what our driver had told us,

0:40:430:40:45

we can only conclude that this was an unfortunate accident,

0:40:450:40:49

and that this claimant was making an opportunist attempt

0:40:490:40:52

to make a claim for compensation

0:40:520:40:55

just because they've fallen over on the bus.

0:40:550:40:57

We're not going to pay those sorts of claims.

0:40:570:40:59

You need to show that someone has been negligent to be successful.

0:40:590:41:04

There was no negligence in this incident at all.

0:41:040:41:06

With evidence as compelling as this,

0:41:070:41:09

weighing up what to do with this claim

0:41:090:41:12

was one of the easiest decisions of Lee's career.

0:41:120:41:15

The CCTV, hand-in-hand with the driver's statement

0:41:180:41:21

clearly saying that she hadn't moved away,

0:41:210:41:24

causing this person to fall over,

0:41:240:41:26

makes it really easy to repudiate claims like this.

0:41:260:41:29

We sent the CCTV to the claimant's solicitors.

0:41:290:41:32

A week later, we received a letter from them saying

0:41:320:41:35

that they closed their file.

0:41:350:41:37

We never heard again from the claimant, and to be honest,

0:41:370:41:40

we don't expect to.

0:41:400:41:42

In light of the evidence, I'd say that's a fair assumption.

0:41:420:41:46

They say the camera never lies, but in this case,

0:41:460:41:49

it had actually exposed their lies.

0:41:490:41:52

I'm happy with the result of this particular case.

0:41:540:41:57

Not only did we not pay the claim anyway,

0:41:570:41:59

because we shouldn't have paid it,

0:41:590:42:01

these circumstances were preposterous,

0:42:010:42:04

but we've been in a position to support our driver and back her up,

0:42:040:42:08

because she did absolutely nothing wrong.

0:42:080:42:10

It's not nice to be investigated, and she's been exonerated,

0:42:100:42:14

quite rightly so.

0:42:140:42:15

But as satisfying as it is to crack cases like these,

0:42:170:42:20

it also highlights the depths some people will go

0:42:200:42:23

in the hope of some easy money.

0:42:230:42:27

These sorts of claims are ridiculous.

0:42:270:42:30

To allege something has happened that is clearly different

0:42:300:42:33

to what's actually happened just so you can make a claim

0:42:330:42:36

is actually disgraceful.

0:42:360:42:38

People shouldn't be allowed to get away with this,

0:42:380:42:40

which is why we investigate claims the way we do.

0:42:400:42:43

We will eventually find out that you're not telling the truth.

0:42:430:42:46

We're going to turn your claim down, and on occasion,

0:42:460:42:48

we will send these off for prosecution as well.

0:42:480:42:51

Insurance fraud in this country costs all of us money,

0:42:550:42:59

but the days of no-questions-asked pay-outs are numbered.

0:42:590:43:02

Insurers are using ever more sophisticated technology

0:43:020:43:06

to identify, track and prosecute fraudsters,

0:43:060:43:09

and courts are using new powers

0:43:090:43:11

to put these criminals behind bars.

0:43:110:43:15

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