Episode 9 Claimed and Shamed

TYRES SCREECH

Insurance fraud in the UK has hit epidemic levels.

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

That's almost £3.6 million every day.

Deliberate crashes, bogus personal injuries, even phantom pets...

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

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

But insurers are fighting back,

exposing just under 15 fake claims every hour.

Armed with covert surveillance systems...

That's the subject out the vehicle.

..sophisticated data analysis techniques...

Police!

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

Police, don't move, stay where you are!

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

-Just don't lie to us!

All those conmen,

scammers and cheats on the fiddle are now caught in the act and

Claimed and Shamed.

A claimant is given a crash course in fraud.

Undercover filming exposes an insurance cheat.

There was absolutely no way that this claimant could deny any of this

footage that it wasn't him, that it didn't relate to him,

and that he hadn't committed fraud.

And a gang that risked the lives of innocent

motorists is brought to justice.

The overall financial benefit to those involved was in

the region of £1.1 million.

Now, a good catch up with old friends can make for a great night out.

The problem with that is they can get a bit messy.

Now, apart from feeling a bit fuzzy the next morning,

often the biggest headache is realising you have lost something.

One of the easiest things to lose is your mobile phone.

Fortunately, there are insurance policies specially designed for

mobiles and other hand-held devices.

Assurant offer exactly that and recently dealt with a case from what

can only be described as a party-loving policyholder.

So this claimant was a university graduate.

They'd lost the phone when they were out with their friends

celebrating, having a reunion.

They were claiming for a top of the range iPhone 7, which would have

a retail value of about £600.

She was very jovial and very chatty about the circumstances of the loss.

But in addition to her carefree attitude,

she also had a rather impressive explanation of how she had lost her phone.

Well, it certainly gives a new meaning to bottoms up.

She was telling our trained agents about the fact that that she

then logged on to Find My iPhone.

She was following it to a street but ultimately, you know, she felt that

somebody had taken the phone.

It sounded like an eventful evening.

But having lost a top of the range smartphone,

a hangover was the least of the claimant's worries.

At this point, while she was telling us this great story,

there was nothing that would lead us to believe it was a fraudulent claim at this stage.

However, as the claims handler went through the details of the loss,

something rather unusual came to light.

What was strange in this case was that the actual phone that the

particular claimant had,

they'd only updated their details one or two hours before the incident had occurred.

To lose a phone just two hours after insuring it really is unlucky.

So Assurant call the claimant for another chat.

So it appeared the claimant's cautiousness had saved her from a very expensive night out.

But as the claim was processed, alarm bells started to ring.

Our expert fraud team and our data analytics team rather surprisingly

discovered, through social media,

a tweet that this particular claimant had put out the night

before on social media.

Now, ordinarily, sharing what you're up to online isn't a problem.

But in this instance, it was a very big problem.

The reason that this particular tweet was incriminating was the fact

that it had happened before she had gone out on her all-day drinking and

the tweet had said she'd actually lost the handset the night before.

Unless the claimant had a rational explanation,

then her drink wasn't the only thing on the rocks.

So, it had been a heady cocktail of lies.

But the claimant had been rumbled.

It became clear that she felt she wasn't committing fraud.

She felt that she could claim for a completely different device

with a much greater value than her original policy details.

In reality, it was very naive.

It was a huge error of judgment on the claimant's part.

And by the end of the phone call, she really would need a stiff drink.

As conversations with insurance companies go,

it was a pretty sobering one.

Whilst we can all sympathise and relate to what happens on all-day

drinking sessions with our friends, and potentially losing our devices,

we were pleased that the claimant in this case was honest and admitted

that they had attempted to defraud us.

I'm pretty confident that she will not be attempting to commit fraud again.

The claimant in this case was extremely fortunate that the matter wasn't taken any further.

However, this is a cautionary tale that applies to all of us who have

insurance policies like this one.

What's really important is to consistently make sure that as you

change your devices and phones, and buy the latest and greatest,

just make sure the policy is up-to-date.

A fraudster's attempt at forgery is foiled.

When we then checked with the store itself,

they told us that the receipts were in fact fraudulent and didn't

come from them.

Now, opportunistic insurance fraudsters who might add a few items

to their claim form or say that what they're claiming for cost more than

it actually did, is one thing.

But what's really frightening is when you hear about insurance fraud

carried out by organised gangs.

One of the most common types is crash for cash.

There are genuine accidents on the UK's roads every day.

But crash for cash is when cars driven by fraudsters work together

to deliberately cause collisions.

The scam begins when one or two cars move in front of the victim.

The first car brakes, causing the second car to stop suddenly,

which in turn causes the innocent victim to crash into the back

of the second car.

Car one then drives away leaving the driver of car two

to cash in on a hefty insurance pay-out

at the expense of the victim's insurance company.

Induced accidents like these are a serious problem,

but the industry and the police are working together to stamp it out.

Direct Line Group were recently involved in bringing down an

operation worth over £1 million, although, initially, they had no

idea of the scale of what they were dealing with.

On face value, everything appeared to be genuine,

the boxes were ticked, so to speak.

Everything appeared as if it was an authentic claim.

And as with due processes,

the claims were settled in a timely fashion.

It wasn't until we were approached by the Metropolitan Police that our

attention was drawn to the fact that these claims that had been settled

were likely to be actually fraudulent.

The police provided Direct Line with the details of those suspected

to be involved.

Armed with those details, we were able to check our records and we

were then able to identify, yes, indeed, we had policies and claims

with those individuals concerned.

We then provided the claims details together with statements and

exhibits to the Metropolitan Police to aid them in their investigations.

It soon transpired just how serious this fraud ring was.

The actions of the fraudsters were extremely dangerous.

These individuals were totally reckless in their actions.

They were staging accidents on main arterial routes

in and around London, with total disregard to those occupants and

vehicles that they were inducing to crash, which could involve young

children, vulnerable persons,

at significant risk of personal harm.

Thankfully, nobody had been seriously injured in any of the

induced collisions, which was remarkable considering

the magnitude of this dangerous operation.

The overall financial benefit to those involved was in the region

of £1.1 million, which spanned over 300 cash for crash collisions.

Direct Line Group was fortunate, in a way,

that we had four claims exposed to this group,

but, that said, we still paid £57,000 in insurance claims.

With almost 300 induced collisions,

this was crash for cash on an industrial scale.

Through their investigations,

the police had identified the man who was behind the entire fraud.

The ringleader in this case is Mr Jamil.

Mr Jamil clearly had influence over those involved, as well as

associations to a claims management company that he was running.

Access to that claims management company would obviously give

Mr Jamil very detailed inside knowledge of an insurance claims process.

And it's with that knowledge that he was unable to subvert some of the

processes and secure successful claims.

By now, the police had identified exactly how the gang were causing

the crashes and how they were fraudulently obtaining money from them.

The staged accidents were formed predominately with three vehicles.

The first vehicle was, for all intents and purposes, a decoy vehicle.

That would then induce the second vehicle to brake heavily.

That in turn would then cause the innocent third vehicle to also brake

and collide with the rear of the second vehicle...

..with total disregard to the personal safety of the occupants

of those innocent people in the third vehicle.

Vehicle one would drive off leaving the two vehicles at the scene.

And it's these patterns that were becoming evident

to the Metropolitan Police.

In the circumstances of this organised crash,

the offending vehicle, vehicle two, would normally have the driver,

but more often than not, the insurer would then see third-party claimants

coming in at a later date who will be seeking compensation in respect

to injuries received following the impact.

And this is a term we often refer to as phantom passengers.

These are passengers that are claiming for injuries,

having been in the vehicle at the time of the accident,

when in fact they were not in the accident at all.

So in addition to vehicle damage,

the gang would profit by making personal injury claims against the

victim's insurance for passengers that weren't even in the car.

After several years thinking they had got away with it, the net

was closing in on Jamil and his accomplices.

The police were able to utilise the evidence that we had provided them

in respect of our claims.

That, together with evidence provided by other insurers,

enabled the police to securely arrest 19 individuals who they

believed were involved in the organised activities.

When the case went to trial,

numerous members of the gang were handed custodial sentences,

but it was the ringleader, Mohammad Jamil,

who the judge came down on the hardest with five years behind bars.

Five years is not an insignificant sentence for which gives

Mr Jamil time to step back and reflect on his actions and

realistically think, "Was it all worth it?"

For the police and the many insurance companies who had been

targeted by Jamil, it was an excellent result.

But most importantly, it had brought an end to the dangerous collisions

that the gang were causing to innocent members of the public.

These type of incidents have far-reaching consequences.

We were lucky we can say that the injuries were somewhat minor.

In my experience, I've actually dealt with situations such as these

where a member of the public actually lost their life.

So if I take this type of fraud exceptionally seriously,

I will put all my resources into ensuring that one,

it is identified at an early stage, two, that those who seek to

defraud the industry are held to account.

And thirdly, ensure that they receive the due punishments that they deserve.

Now, if you're unfortunate enough to have an extensive period of sickness

or a prolonged injury, that may keep you out of work,

therefore, having a serious effect on your livelihood.

In situations like that,

an income protection policy can come to the rescue.

But just like any other form of insurance,

it is open to abuse by chancers and opportunists.

I-COG is a company that specialises in validating insurance claims that

have been highlighted as suspicious.

They recently dealt with a case where an insurer suspected that one

of their policyholders was claiming money that he wasn't entitled to.

Income protection is essentially there for genuine customers to claim

against should they unfortunately suffer any injury or illness that

prevents them from working.

And what the policy is there to do is to provide them that regular

income during periods such as rehabilitation, hospital stays,

or just the fact that they are permanently or temporarily disabled.

For many, a policy like this can be a financial life-saver.

However, with this type of insurance cover, there are clear conditions.

One of the main exclusions for most income protection policies is any

form of income. So as soon as an insurer suspects that there is

undisclosed income being received, then, of course, any payments made

against that policy would be null and void.

And Tara's client suspected that was exactly the case with the claim they

referred to her.

This claimant was originally employed as a HGV driver.

He advised that through the course of his employment, he injured his

right shoulder and as a result of that, clearly wasn't able to carry

out his normal employment and therefore was off work.

Sounds plausible enough but there was a twist.

This was referred to us because the claimant had just incorporated

a business at Companies House in a completely different market.

And, of course, that was in no way synonymous with the claim form he'd presented.

Having taken on the case,

the first task was to carry out a full investigation of the claimant.

But it soon became apparent

that they were dealing with a bit of an entrepreneur.

We had a range of Companies House signatures which matched

the claim form that the claimant had presented.

We had social media profiles for the new business which was going through

its infancy, so marketing and promoting that business

was very strong.

This all tied back to the claimant.

This new business venture definitely didn't tie in with someone

completely unable to work.

And it was the claimant's online activities that had provided a lot

of the evidence.

When someone says they can't do something and, of course, on

social media they're saying something else,

naturally that's going to call into question the authenticity of the claim.

With evidence of a new company incepted in the claimant's name and

clear activity to promote it, it was time to see first-hand exactly what

he was up to on a daily basis.

As soon as we profiled everything, we very quickly moved into

a surveillance operation which was carried out for a couple of days on

all of the premises that we'd identified and the subject himself.

It wasn't long before the undercover operative hit the jackpot.

So what we have here is very active left and right movements

of the right arm, originating from the right shoulder

which clearly we'd been advised was totally impaired.

Bending, reaching up.

This isn't just a one-off movement either, this is continuous over ten

minutes, very free movement in all directions.

The reaching with both arms,

by sponging the windows and the shutters down.

At no time even showing any ounce of pain or impingement

from the shoulder at all.

In addition to it being crystal clear what he was doing,

there was also no confusion as to why he was doing it.

What we actually already knew at this stage

is this commercial premises was part of his new business start-up.

So the love and care that he's paying attention to the property by

cleaning it in such detail, before the shop even opens to the public,

you know, he's showing a lot of pride in his new business.

And now we can see him here actually stocking the shelves for the new

business within the premises.

As evidential footage goes, it was pretty much as conclusive as it gets.

I'll be honest, when I first saw the footage, I was highly entertained.

Because not only had the intelligence that we discovered

been proven to be correct, but the movements were probably freer than

myself in cleaning the outside of the premises, bending,

stretching, wash on, wash off.

It was... It was very entertaining.

But as amusing as it was to watch,

the underlying impact of the footage was very serious indeed.

What we have to remember here is whilst this is going on,

this individual is still advising his insurers that not only is he

so injured that he cannot work, but he's not receiving any other income.

And yet here we can see him sitting next to the till

and a merchant payment machine which is actually registered in his name

for the new business.

Now, remember this is still a man who's saying that he has no other

form of income. He's the sole shareholder,

the sole director of the business.

But he's still adamant that he is unable to work due to injury.

And he's quite happy to continue his charade of defrauding the insurer.

So, whichever angle you looked at it,

there was absolutely no way that this claimant could deny any of this

footage, that it wasn't him, that didn't relate to him and that

he hadn't committed fraud.

The claimant had been well and truly caught out.

His insurance company's suspicions have been confirmed and they now had

the proof they needed.

It was immediately referred back to insurers.

The payments were immediately stopped and the whole policy was voided.

But the claimant wasn't going to go down without trying to worm his way

out of it.

The claimant's immediate reaction when the evidence was

presented to him was to tell a lie and to say that he was actually

helping a friend out in the premises on that particular day

and there were no ties to him.

Well, of course, clearly we'd a complete bulletproof case that

that was not in fact true.

And the claimant eventually did acquiesce and accepted the position.

By this stage, the claimant had been paid £28,000 from his income

protection policy.

But if he thought he was able to keep it,

he had another think coming.

It was then important to do the right thing.

So a law firm that we work closely with were then instructed to recover,

through the civil process, all of the funds that he had received and

he has now paid back every penny that he was illegally paid by the insurer.

It's a cautionary tale.

The claimant had started out with a legitimate injury and a legitimate claim.

But thanks to his greed and dishonesty, he now had nothing.

Surveillance is being used more and more to identify insurance fraudsters.

But who are the people who capture the footage that's so often the

difference between missing or identifying a fraudulent claim?

We decided to find out.

As you can probably imagine, following and secretly filming

someone without being detected for hours on end is anything but easy.

But what does it take to do the job?

For those who think spending up to 14 hours at a time simply watching

and waiting is a cushy number, think again.

In the fight against insurance fraud,

undercover operatives are here to stay.

And they're no longer reserved for just the biggest cases.

Still to come - a ham-fisted attempt to cash in with a bogus claim.

It transpired that the claimant was in fact a professional boxer.

And only six weeks after the date of this accident,

he had been involved in a bout which had featured on YouTube.

In their effort to combat fraud, insurers are carrying out an

increasing amount of detective work to separate the genuine claims

from the bogus ones.

But sometimes attempts at fraud are so sloppy

that it's all too easy for insurers to catch them out.

Sadly, in this day and age, theft is an all too common occurrence and it

only takes a split-second to become a victim.

Whilst it can't take away the unpleasantness of what happened,

an insurance policy can replace our possessions like for like.

Insurers RSA recently dealt with a case from a customer in her hour of need.

Unfortunately, Ms Chadwick had been travelling on a train...

..and somebody had taken her handbag from the overhead luggage compartment.

And she had lost the contents of the handbag,

which included some electrical goods and the total value of which was

around £1,500.

So a simple and straightforward claim,

which RSA promptly began to process.

However, some routine checks about the address linked to the policy

instantly raised a few questions.

We checked to see whether there had been any previous claims and we

couldn't find any previous claims against Ms Chadwick,

but we did find there was a Mr Penhill who had made some

previous claims from the same address.

But Ms Chadwick told us that this was in fact her landlord

and therefore it didn't raise any particular suspicion.

We also asked Ms Chadwick to produce, if she could,

any receipts or anything else, photographs,

to validate the ownership of the items that she said she'd lost.

And this she did.

So far, so good. Everything appeared to be above board and with

photographs to back up the items stolen from the train,

it was full steam ahead with the claim.

Or was it?

At that point, it seemed like a genuine claim and in normal

circumstances, we would've validated the items that had been lost

and proceeded to settlement.

However, it soon transpired that these weren't normal circumstances.

Most people are probably aware that buried within the electronics,

as it were, of a photograph,

is data that will tell you when and where the photograph was taken.

Such digital information is called metadata.

In examining the photographs that had been sent to us,

we found that the metadata in the photographs,

embedded in the photographs actually told us that the photographs

post-dated the loss, so that clearly aroused our suspicion.

And it's hardly surprising it did.

After all, how was it possible to take photos of items

that had been stolen after they'd been stolen?

But if this wasn't enough of a smoking gun, RSA soon uncovered even

more evidence that suggested this was a fraudulent claim.

We co-operate with other insurers to help us combat fraud and another

insurer informed us of an interesting fact

in relation to Mr Penhill.

They had dealt with a previous claim by him and amongst the items lost

was an item of jewellery, which surprise, surprise was identical to

an item that Miss Chadwick had said she had lost.

And the two items were purchased on the same day from the same store.

What a coincidence.

A bizarre coincidence indeed.

Of course, when we then checked with the store itself,

they told us that the receipts were in fact fraudulent

and didn't come from them.

So first, we had photos of allegedly stolen items miraculously

taken after they'd been stolen.

But now RSA had uncovered a previous claim by Chadwick's landlord for

identical items purchased in the same store on the same day and both

Chadwick and Penhill's claims were backed up with nearly identical

fraudulent receipts.

And if the claim hadn't been derailed already, well,

the evidence just kept on coming.

We also found other receipts from a shop which actually closed down

three years ago and these receipts post-dated that, so, again,

these were not genuine. By this time, of course,

we'd determined we weren't going to pay this claim.

It was fraudulent.

We informed them of this fact and we reported both of them to IFED for

them to consider a criminal prosecution in this case.

IFED is the Insurance Fraud Enforcement Department.

Formed in 2012, its dedicated police unit's sole purpose is to tackle

insurance fraud and they were only too happy to take the case on.

IFED investigated the case thoroughly, and at the end of their

investigation, they charged both with fraud.

They appeared at court, where they both pleaded guilty.

Penhill was sentenced to six months imprisonment,

suspended for 18 months.

And Chadwick was given a 12 month community order,

with a supervision order.

Justice had been served after what can only be described

as a poorly-planned and executed attempt at fraud.

Yet, incredibly, it appears that at least one of the fraudsters saw

themselves as a victim.

As a bit of a footnote to this case, Miss Chadwick told us several times

during our investigation that, you know,

she was trying to give answers to our questions and accusing us

quite ironically of using underhand tactics to catch her.

I'd be quite happy to leave it to the members of the public to

determine who was using underhand tactics in this particular case.

For many of us, social media has become part of our everyday lives.

It is a brilliant and easy way of keeping in touch with friends and

family and sharing what you've been up to.

However, when it comes to identifying fraudulent or grossly

exaggerated insurance claims, social media can also have a huge part to play.

Someone who's well aware of the importance of evidence from the web

is Catherine Burt.

She's Head of Counter Fraud at law firm DAC Beachcroft,

who recently dealt with a case where social media packed quite a punch.

The claim that we received was from the driver of a car,

who said he'd been involved in a road traffic accident.

On the day in question, the chap had been driving along the road.

He'd come to a set of traffic lights and there was a car in front of him

stationary, at the traffic lights, which were on red.

He said that he'd stayed back behind that car,

a couple of car lengths away and was just sitting at the lights when the

car in front suddenly started to reverse back.

Indeed, a frightening situation to be in and one where there's only so

much you can do to stop it.

His version of events was that he tried to stop the car by pipping

his horn and shouting,

but the car picked up speed and reversed quite quickly into his car.

He said he sustained injuries to his neck and back.

He was basically claiming whiplash injuries.

But, as Catherine points out,

just because you've been in a minor coming together between two vehicles

doesn't automatically mean you'll suffer whiplash.

We found that whiplash injuries are very common in road traffic accidents,

but there is a specific amount of force required and if the force is

very minimal, it's unlikely that there would be any injury at all.

Nevertheless, the claimant was saying he'd been injured in the

collision and was seeking compensation.

He would've been expecting general damages for his injury of

approximately £2,000.

But when DAC spoke to their policyholder, her account was

significantly less dramatic than that of the man who was

claiming to have been injured.

The first suspicious point was the difference in events between the

claimant and the defendant.

She had been bringing her children home from nursery and was stopped at

the traffic lights. One of the children started to cry and she was

distracted and at that point she felt a small impact.

The other driver, the claimant, got out of his vehicle,

was quite aggressive and was claiming it had been a substantial

impact, which she didn't agree with at all.

Differing versions of events from the drivers involved in a collision

is neither new, nor surprising.

However, it was the woman who very quickly appeared to be the most reliable.

This was made more suspicious when we realised the damage to the

claimant's car had only cost £61 to repair.

As I'm sure anybody will realise, whenever you have your car repaired,

it's generally expensive.

So the parts had only cost £30.

The labour had only cost just over £30.

So it was obvious from that, that the impact hadn't been anywhere near

what the claimant said.

And the man's credibility was soon cast into even more doubt.

The claimant had said that he'd never been involved in any other

road traffic accidents and he reported that to his medical expert.

Our routine checks showed that he had in fact been involved in quite a

high number of previous road traffic accidents and he had made claims as

a result of those, so it was difficult to see how he could've

forgotten about them.

So far, we have an allegedly serious injury,

despite a minuscule amount of damage to his car and a selective memory

when it came to recalling previous accidents and claims.

But the dubious points of this case didn't end there.

During the course of the claim, we saw many inconsistencies in various documents.

Two medical reports were prepared and the claimant wasn't

consistent in what he told the medical experts.

On one occasion, we were told that the injuries would last for three

months and he confirmed that they had resolved in three months.

On one occasion, he told the medical expert that he was still suffering

symptoms after eight months.

He also served a signed witness statement,

which again contained inconsistencies.

For example, on one occasion he said his vehicle had been pushed back two

car lengths by the impact of the claim.

On another, he said at the end of the accident the tow bar from the

vehicle in front was still attached to his car.

So that clearly couldn't be true.

With so many inconsistencies, the claim was far from rock solid.

However, the next revelation really would have the claimant on the ropes.

It transpired that the claimant was in fact a professional boxer.

And only six weeks after the date of this accident,

he'd been involved in a bout which had featured on YouTube.

The footage quite clearly shows that he is perfectly able to move around.

He'd managed to survive for eight rounds and probably given quite

a good account of himself until, in the eighth round,

he was knocked out.

Unfortunately for the claimant, everything that the insurer needed

to show that his claim had been grossly exaggerated was out there

for the whole world to see.

It was very surprising to find such a contradictory piece of evidence

quite freely available on the internet.

It does seem to be the case, however, that people don't equate

the internet with something that will actually

come back to haunt them and be used as evidence against them.

Despite the video footage completely flooring his claim,

the man was determined to see it through.

During the course of the claim,

the claimant instructed three sets of solicitors.

The first two sets of solicitors withdrew from the claim

once we'd put our evidence to them.

But the third set of solicitors were prepared to take

the claim on, issue proceedings and bring it to trial.

This guy was either extremely stubborn,

or as the footage they discovered suggested,

simply didn't know when he was beaten.

Rather surprisingly the case did go to court.

We disclosed the footage of the YouTube video and the claimant's

solicitors still proceeded.

However, when it came to the day of the trial,

the claimant didn't attend court and so the judge was prepared to dismiss

the claim and made a finding of fundamental dishonesty.

This effectively means the judge didn't believe any part of the man's claim.

But if he thought by not turning up he'd escape any repercussions

for his dishonest actions, then he was in for a very nasty surprise indeed.

When the court makes a finding of fundamental dishonesty,

that means that we then have the ability to get a costs order

and enforce it against them, so that they actually have to pay the money

back and they feel it in their pocket.

And feel it he did.

The original claim made by the claimant would probably have got him

something just over £2,000.

To get that amount of money, he clearly risked quite a large penalty

and he's now ended up with an order against him for over £11,000,

being the costs that the insurers incurred in defeating the claim.

So, this boxing bully's tactics had backfired and he'd been given

a taste of his own medicine.

Only he'd been hit where it really hurts - in the pocket.

This was a case which should never have been pursued.

All of the time that is spent on investigating and

repudiating fraudulent claims could actually be spent by insurance

companies checking on the original claims and making sure they

get paid properly and quickly.

So it would be much better if we could eradicate those claims.

Insurance fraud in this country costs all of us money,

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

Insurers are using ever more sophisticated technology

to identify, track and prosecute fraudsters and courts are using new

powers to put these criminals behind bars.