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00:06Insurance fraud has reached epidemic levels in the UK.
00:09It's costing us more than £1.3 billion every year.
00:13That's almost £3.6 million every day.
00:17Deliberate crashes, bogus personal injuries, even phantom pets.
00:23The fraudsters are risking more and more to make a quick killing.
00:27And every year, it's adding around £50 to your insurance bill.
00:31But insurers are fighting back, exposing just under 15 fake claims every hour.
00:37Armed with the latest fraud-busting technology.
00:40It's a subject out of vehicle.
00:42Including covert surveillance systems, sophisticated data analysis techniques
00:47and specially trained fraud investigators.
00:50Oh, they're catching these chances red-handed.
00:54Instead of getting away with it, even more of these fraudsters are getting caught out.
01:00This is Road Claimers.
01:08Today, a devious driver hopes treacherous conditions will disguise his deliberate attempts to hit an innocent motorist.
01:16It was obvious to us that this was an opportunistic attempt to cash in.
01:20A man falsely claiming on his holiday insurance is stopped in his tracks as his deception is uncovered.
01:27We were satisfied that the medical certificate was false.
01:31Which meant that the customer must have forged the doctor's signature on the medical certificate.
01:36And the digital information in a picture catches out a chancer who claims they've lost valuable jewellery at a funeral.
01:44Is there anything you want to tell me about that, Jose?
01:47No, Jose.
01:49Okay.
01:49It's showing me that it takes us three days after you're telling me you've lost the bracelet.
01:59Freezing temperatures create icy, slippery surroundings.
02:03Wheels can't grip and cars may struggle to stop.
02:07But as we're about to witness, not all the motorists braving Sub-Zero conditions are out for the journey.
02:14The company, Markerstudy, specialises in car insurance and smelt a rat with this case.
02:20We first heard about this accident when our policyholder reported it to us on the telephone.
02:25He said that it had been behind the third-party vehicle at traffic lights and when they turned green, they
02:30both pulled away.
02:31He said that the third-party vehicle then slammed his brakes on for no apparent reason, causing the policyholder's vehicle
02:38to hit the rear of that car.
02:40The policyholder said he became immediately suspicious as there was no reason for that third-party to stop as he
02:46did.
02:46And that he had dash cam footage available that backed up his version of events.
02:51The man whose car had been hit was looking for damages.
02:55He was claiming for the damage to his vehicle and for a whiplash injury he claims that he sustained in
03:01the event.
03:02He said that at the time of the collision he was travelling at around 15 miles per hour or so
03:07and that our policyholder just collided with the rear of his car.
03:11The value of the third-party claim was around £6,000 in total, including solicitors' charges.
03:17We were also told that there was a passenger in the third-party vehicle and whilst we hadn't received a
03:22claim from that person,
03:24we fully anticipated that one would be forthcoming.
03:27With shunts like this, there can be an assumption that the driver in the car at the rear is at
03:32fault.
03:33The policyholder shared the dash cam footage with us and upon review it was quite clear that the policyholder's version
03:38of events was the correct one.
03:44It was quite clear that the third-party had pulled away from the lights and was travelling at a very
03:48low speed
03:49but decided to slam their brakes on for no apparent reason.
03:53There was nothing in front of that vehicle that would cause them to do so.
03:57When we reviewed the footage, it was obvious to us that this was an opportunistic attempt to cash in
04:03and that the third-party was trying to use the dangerous weather conditions to his advantage.
04:13The on-board camera in the policyholder's car revealed something else about the one he'd hit, which seemed to have
04:19a short circuit.
04:21What was curious from the dash cam footage was that despite braking heavily, the main brake lights on the third
04:28-party vehicle did not appear to display.
04:34The hazard lights on the car in front are working.
04:38As Mark's study was busy investigating the validity of the claim, the man who had been hit was getting impatient
04:44and ramped matters up a gear.
04:48Because we hadn't paid the claim owing to our investigation, the third-party solicitors decided to issue county court proceedings
04:54against our insured.
04:55We therefore instructed DWF solicitors to defend the matter on our behalf.
05:00Senior associate Colin Bushell dealt with the defendant, the man who'd crashed into the car.
05:05The dash cam footage was key evidence and he was intrigued by how selective the claimant's car lights appeared to
05:11be.
05:13There are instances whereby brake lights can be disengaged by claimants deliberately to assist in the fraud being carried out.
05:21Interestingly, on the claimant vehicle, there is a third brake light in the rear windscreen, which on closer inspection had
05:28been lighting up, but was obscured from the defendant because there was a lot of snow on the rear of
05:33the car.
05:36Another key feature of the case, or the facts of this matter, related to the weather and the driving conditions
05:43at the time.
05:44March 18, there was quite poor weather and there was visibly a lot of snow and slush and potentially ice
05:50on the road.
05:53Creating the conditions for a prang or greater opportunities for less honest motorists looking to make a quick buck.
05:59But this scammer didn't know he'd been filmed.
06:05Our insurer client were very keen to be proactive with the evidence.
06:10The dash cam footage from their perspective was irrefusable.
06:14The claimant unfortunately took a view that the evidence could be disputed and effectively repudiated or dismissed the footage
06:23and was happy to proceed on his version of events, i.e. he was travelling at 15 miles an hour
06:28and we crashed into the rear of his car.
06:30The crashed into claimant was clearly confident he had a good case, but DWF wasn't convinced.
06:37We were able to advise the policyholder that in our view, based on the dash cam footage alone, he had
06:44very good prospects of defending the case.
06:46And in actual fact, we could blame and pin liability on the claimant for a deliberate action.
06:52There was a chance for both parties to have their day in court.
06:56We alleged that it was fraud.
06:58So we bring a case based on the dash cam footage to say that the claimant has deliberately induced the
07:04accident for the purpose of bringing a personal injury claim.
07:06The matter proceeded to a trial and the court was asked to assess specifically the three elements, which were the
07:15vehicle damage, the excess itself and then an assessment of exemplary damages.
07:22His gamble didn't pay off, he ended up paying out.
07:27The third party was ordered to repay the full cost of damage to our policyholders' vehicle, which was around £1
07:33,600 and an award for exemplary damages of £4,000 was made together with the repayment of our full costs
07:41of the case.
07:43Without the dash cam footage, this could have had a very different outcome.
07:47The dash cam footage provided irrefutable evidence that the policyholders' version of events was correct and that this was a
07:54fraudulent claim.
07:55The old days of one person's word against another are becoming a thing of the past.
08:01Potential fraudsters should be aware that with the prevalence of dash cam footage and other technologies now,
08:07the likelihood that they'll get away with their scan is much, much lower than it perhaps used to be, so
08:13be warned.
08:19Later, chances claiming in the clink face the full force of the law, even behind bars.
08:27Claims are often fraudulent and we shouldn't be wasting taxpayers' money making a safe settlement, we should be defending.
08:36This governor's taken no prisoners.
08:48Jewelry often has sentimental value.
08:51It could have been a gift or inherited from a loved one, but chains break and rings slip off.
08:58Just make sure, unlike our next character, that you're actually claiming for the thing you've lost and don't supply evidence
09:05to incriminate yourself.
09:07Insurers will use companies to help verify such claims and ICOG handles cases that require closer scrutiny.
09:14We were initially appointed by the insurers on this claim for a gold bracelet that was missing after the policyholder
09:22went to a funeral.
09:23After the funeral, he went to the wake, took off his coat and realised his gold bracelet was missing.
09:28What a shame. On such an emotional day.
09:31The policyholder provided proof of purchase. The receipt stated he paid £725 for the item.
09:38However, we understand that that was the sale price.
09:41So the claim value was set at £1,500 as that was the cost to replace the bracelet today.
09:47A picture of the bracelet and a copy of the receipt were sent to the insurers.
09:51And it was these that made them pass on the case to ICOG.
09:55They had run some checks on the photographs provided, which showed that the date of the photograph was taken after
10:02the date of loss.
10:03The insurers' suspicions were that the policyholder still owned the item and was able to take a photo of it
10:09after the date that he claimed he lost it because he still has it.
10:14Digital photos contain a footprint known as metadata.
10:18This highlights the time, date and place the picture was taken.
10:22We looked through and reviewed the case file and we verified that the metadata was in fact after the date
10:28of loss.
10:29And that gave us the evidence we needed to discuss these concerns with the policyholder.
10:34Is there anything to ask you to start by talking me through what's happened?
10:38I was at my cousin's funeral.
10:41I had the bracelet on because I've never taken it off.
10:46Then we was in there for just over the hour, I suppose, and then we went to a football club
10:52for the wake.
10:55I took my coat off because it was a very cold day and that was when I realised that the
11:01bracelet had gone.
11:02When would have been the last time that you remember having your bracelet?
11:08When was the last time I remember seeing the bracelet?
11:11Well, that would have been when I was getting ready to go to the funeral.
11:15Okay, so what sort of time would that have been?
11:18That was probably about quarter to eleven, half ten, quarter to eleven, something like that.
11:27Okay, so around 10.30 to quarter to eleven.
11:30Yeah.
11:32And that was at home, was it?
11:34Yeah.
11:35Okay, fine.
11:36How often would you normally wear the bracelet?
11:39I never take it off, love.
11:41Never take it off at all?
11:42Never take it off.
11:43The only time I'd ever take it off was when I'd been in an hospital for an operation.
11:47Immediately after noticing that your bracelet was missing, what did you do at that point?
11:53Well, I was a little bit concerned.
11:55I sort of started walking around.
11:56My wife was walking around with me to see if we could see where it was.
12:00Very upset because it was a present for me, 60th birthday.
12:06Oh, right.
12:07So it had sentimental value, obviously.
12:10We then went back to the creme.
12:12By the time we got back to the creme, they would sort of walk those up then.
12:16So, yeah.
12:19Despite the poignant circumstances of the loss, questions had to be asked.
12:24You've sent a photo in to us of the bracelet.
12:27When was that taken?
12:30That was probably taken about three, three years ago, three, four years ago.
12:36About three, four years ago?
12:38Yeah.
12:38So I've taken, because I've got several rings, et cetera, et cetera, which we've got whilst
12:44we're on holiday.
12:45So we've got a photograph of all our jewelry.
12:50That can be a very sensible precaution.
12:54I'll be completely honest with you.
12:57There are a couple of concerns with the claim.
13:00What do you think those concerns might be?
13:04I wouldn't know whether.
13:06The photo that you sent in of the bracelet.
13:11Okay.
13:12Is there anything you want to tell me about that photo?
13:16Like what?
13:18Anything at all.
13:21I've got photos of all my jewelry.
13:25Do you know what metadata is on a digital photograph?
13:30Do I know what?
13:31Sorry?
13:31Metadata on a digital photograph.
13:35No.
13:35We gave him the opportunity to give us an honest answer about the photographs.
13:42Metadata on a digital photograph is basically like an electronic signature.
13:47Okay.
13:48So it will give various things, including the type of device used to take the photo, the
13:54date and time it was taken.
13:56Okay.
13:56It will give me the location it was taken, depending on what settings are set.
14:03Okay.
14:04Given that, is there anything you want to tell me about that photo?
14:09No danger.
14:11Okay.
14:12It's coming back is showing me that it's taken on the 19th of November, which is three days
14:17after you're telling me you've lost the bracelet.
14:21Either he still doesn't get it, or he is pretending he doesn't understand.
14:26Okay.
14:26So, have you still got the bracelet?
14:29No, I haven't.
14:31Okay.
14:31So how have you managed to take a photo of it three days after you've told me that you've
14:35lost it?
14:37Have I managed to take the photograph and I told you I've lost it?
14:40Yeah.
14:41So, the photograph is showing that it was taken on the 19th of November this year.
14:49Okay.
14:50And you're telling me that you lost the bracelet on the 16th of November.
14:55Which is three days before this photo was taken?
14:58Yes.
15:00Okay.
15:00So how have you managed to take a photo of a bracelet that you're telling me you don't
15:04have?
15:06Well, I can't answer that question.
15:07The call handler is polite, but insistent.
15:11What it looks like is that you've still got that bracelet?
15:15No, I haven't.
15:16I haven't got the bracelet.
15:17Okay.
15:18On further conversation, he then stated that his wife had actually lost her bracelet on
15:24the day of the funeral and not his.
15:27Well, I can't.
15:29To be perfectly honest with you, I haven't got the bracelet.
15:32I have lost the bracelet.
15:33That is the truth.
15:34That is on my children's life.
15:36I haven't got the bracelet.
15:37The bracelet that was actually lost at the funeral was my wife's bracelet.
15:47It was my wife's bracelet, yes.
15:52It was lost.
15:55And then, which I was going to claim for, which I didn't claim for, obviously.
16:01I have lost my bracelet.
16:04I've lost my bracelet.
16:06So I thought, well, I'll put that through and the money I got off that, I'll buy my wife
16:10another bracelet and that's the truth.
16:12Right.
16:13But insurance doesn't work in the way he wanted.
16:16He was trying to fit it in with what he now knew, we knew, which was that the date of
16:20loss was incorrect.
16:24Originally, the claim was for his bracelet.
16:27When he started to alter his account, he changed it to his wife's bracelet was lost on
16:33the day of the funeral and not his, which again causes even more concerns because now
16:39we're changing the item that's been lost.
16:42It's possible his wife did lose her bracelet.
16:44Could this have triggered thoughts of cashing in?
16:48What was the value of her bracelet, do you know?
16:52Well, the wife's bracelet, the value of that was about 425, 430, something like that, I think.
17:00OK.
17:00So could that be the reason why you've tried to claim for this license?
17:04Sorry?
17:05Could that be the reason why you've tried to claim for your bracelet instead?
17:09Compared to the original claim, that's over £1,000 less.
17:13We see that the change in value was potentially a motive for making this claim.
17:18There is a bit of a difference between her bracelet valued at £430 and his at £1,500.
17:25The one he persists in telling the call handler has gone.
17:30But I haven't got my bracelet. That's the point. I haven't got my bracelet. I have lost it.
17:35When did you lose it?
17:38It was after, obviously, it was after the 19th.
17:41But that's the bracelet you said that you don't ever take off, but you sent us a photo of it
17:45in a box.
17:47Yeah, well, I've taken a photograph of all my children, as I say anyway, so...
17:53Yeah, but this one wasn't taken three years ago. This one was taken three days after you told us it
17:58was lost.
17:58Yeah, yeah.
18:01Surely he must realise now that he's on a very sticky wicket.
18:05We've got three options that everyone has with any claim. The first option is to proceed with the claim. Proceeding
18:12with the claim comes with two potential outcomes.
18:16So, in this case, if you decided to proceed with the claim, based on the evidence that you've provided, the
18:23insurers are likely to recommend a decline on the claim, which would go down on your policy.
18:28And they'd potentially refer it over to the police to investigate further.
18:34Okay.
18:35The other option they've got, if you decide to proceed, is to just go ahead and settle the claim. In
18:41this instance, and in my experience, I doubt that would be what's happening.
18:47Your other option is to withdraw the claim. We then offer that withdrawal to the insurers, and they make a
18:55decision on whether they would be happy to accept it.
18:58As you've been honest now with me today about the circumstances, I can try and fight that for you and
19:06kind of put in a good word, if you like, with the insurers to see whether they would be happy
19:11to accept the withdrawal of the claim, and then take it no further.
19:15You know, I'd be happy to have a conversation with them based on your honesty today.
19:21Okay.
19:22So, what would you like me to do?
19:25If you had put in a claim for jewellery worth £1,500, but the bracelet loss wasn't even yours, and
19:31it was actually worth considerably less, what would you do?
19:35Perhaps he finally realises he's made a grave mistake.
19:40I'll withdraw it then, please, my love.
19:42Okay.
19:43Although the policyholder offered a withdrawal of the claim, we've returned our report with the recommendation that they invoke the
19:49fraud condition on the policy.
19:50We're obviously empathetic with the situation, with the funeral, and the account that he provided.
19:56Unfortunately, that doesn't excuse him for attempting to commit fraud.
20:06Still to come, an athlete's claim for devastating injuries caused by a pothole is scuppered, when he's caught on camera
20:14ripping it up at the rugby pitch.
20:15He wasn't a bystander or a spectator in the game.
20:20He was, you could see him tackling, you could see him passing the ball, you could see him running.
20:25It was very clearly that he was a strong participant in the game.
20:36Confined space, strict routine.
20:39Some inventive inmates may rebel against the constraints and seek out opportunities to try and cash in.
20:45In Buckinghamshire, HMP Woodhill houses remand prisoners and those with short sentences.
20:52And as we'll discover, people behind bars don't need much time or even space to pull a fast one.
20:59It's something Governor Nicola Marfly is aware of as she's taking no prisoners.
21:03Claims are often fraudulent and we shouldn't be wasting taxpayers' money making a safe settlement. We should be defending.
21:14Against this backdrop, claimants must have a watertight case if they're attempting a claim.
21:19Mick Spellman is the head of safety and segregation at HMP Woodhill and knows the prison and its inmates well.
21:26I received an email from the litigation department that there was a litigation claim against the establishment
21:31regarding a former resident here claiming that he'd slipped on wet condensation in his cell,
21:38causing lots of facial injuries and that was as a direct result of the condensation that had built up
21:44because his cell was next to the shower block on the unit that he was housed in
21:47and that there was a lack of ventilation in the cell.
21:51It sounds like the prisoner was a bit of a mess after the accident.
21:55There was some dental damage that had occurred, some nose damage as well
22:00and also some soft tissue damage around his face.
22:03But this account wasn't met with great sympathy. It was deemed a little leaky.
22:08I was very sceptical. I've never seen condensation in a cell, in any of the cells at Woodhill.
22:14I knew that wing quite well because I'd served as an officer for three years myself.
22:17I'd never seen condensation in that cell or any other.
22:22Mick believed this inmate's account was implausible, as little can slip through the net.
22:28Part of a prison officer's role is that each cell within the establishment is checked each day by a prison
22:33officer
22:34to ensure that the fabric of the cell is in good order.
22:37So we're making sure that the taps are all working as they should be,
22:41the windows open up and there's been no tampering of any wall space or holes that were in there, etc.
22:47And the expectation would be if there was any fault such as water leakage that were reported that day to
22:53works to come and repair.
22:55Mick had his own theories as to what could have caused the impression of condensation.
23:01Windows in the gel, which sit over a triangular alcove, are perspex rather than glass.
23:07When I looked at some of the photos that had been taken, which the claimant was saying was water on
23:11the inside of the cell from the perspex,
23:13when you look closely to me, it became apparent that prisoners sometimes used to burn it with a lighter, which
23:19would cause it to bubble up.
23:20So when you look closely, actually, although it may look like initially water, it was in fact burn marks.
23:25In my own experience, there was probably one of several reasons if there was a build-up of water on
23:30there,
23:31that would be where the claimant perhaps has left the windows open and it's rained and rain has then come
23:36through the window
23:37and speckled onto the back of the triangle.
23:40Some of the men do tie washing lines up inside the cell which hang over the triangle.
23:45So as a result of that, water can sometimes drip from the clothing that's drying there.
23:49And underneath the triangle, there's some hot water pipes
23:52and some of the men do actually put their clothes over the hot water pipes as well for them to
23:56dry their clothes,
23:57which could have caused water, or the claimant may have just spilled water on the triangle by accident.
24:03Given the doubts about the supposed accident, Governor Nicola was adamant the claims should be fought.
24:10Litigation were in touch with me.
24:12We then had to discuss whether or not we were going to try and defend this and straightway I said
24:17yes.
24:18The following court case threw up some interesting evidence about the slippery inmate.
24:23It became apparent that he had a pre-existing medical condition which would result in sometimes him falling onto the
24:30cell floor.
24:31And through our own medical reports, we knew that he had received injuries as a result of that.
24:37So on the rating of probability, it was probably quite likely that the facial injuries were caused as a result
24:44of his medical condition,
24:45rather than there actually being water or buildup condensation within the cell.
24:49It also appeared the prisoner had a loose grasp of dates.
24:54It was disclosed that there was discrepancies between the date of him actually having these medical falls
24:59and the date that he was claiming that it had fallen as a result of the condensation.
25:03And there was lots of confusion with regards to the claimant with the dates that were inconsistent to the reports
25:09that we had within the establishment.
25:10I was really pleased that our colleagues, our staff team were able to go to court and give compelling evidence
25:16based on their own memory of things and also the written documentation that they'd seen.
25:20The tide of truth was flowing against the accident-prone prisoner.
25:24I was thrilled to hear that it was dismissed and that saved us in the region of £15,000, saved
25:31taxpayers £15,000 and I was delighted.
25:34We will acknowledge when we get it wrong and sometimes it will be absolutely appropriate to pay compensation.
25:41But what we will not do is be a soft touch where people see us as an easy option for
25:45free cash.
25:52Flicking through brochures, deciding where to go, it's all part of the fun of planning a break.
25:58Sunshine, somewhere exotic, if you can afford it, there is so much choice.
26:03But there are those who tarnish a trip deliberately in an attempt to make a claim.
26:08Seega is a claims and travel assistance provider.
26:12Its fraud team had their work cut out catching a prolific phantom traveller and master faker.
26:18The customer took out a single trip policy with our insurer clients and he contacted our claims department
26:26as he needed to make a claim for cancellation of a trip due to the fact he had sprained his
26:31ankle.
26:35A holiday hobbling around would have been no fun, but at least the claimant was lucky enough to have travel
26:41insurance to cover his expenses.
26:44The value of the claim was approximately £4,500.
26:48The figure was linked to the fact that this was a long haul trip.
26:53What's the reason for you to play with us twice, sir?
26:56What's the reason for you to play with us twice, sir?
26:56It's consolation, man.
26:58I was due to travel last Monday.
27:04And he just said when I come last jogging.
27:08What can we start here?
27:10When did you actually have this accident?
27:13It happened to me on Sunday.
27:17I wasn't too short because I was a jogging member.
27:21I was going to run to the, you know, GP, the walking center.
27:26And I've been, um, and I can't always look from the front.
27:30The front.
27:31Okay.
27:52As part of our standard claims procedure, we asked the customer to provide us certain pieces of documentation to support
28:00the claim.
28:00For a cancellation claim, for injury, we normally need a medical certificate from the customer's GP.
28:07And also documentation to prove that the holiday has been cancelled as claimed.
28:14So that's all being logged.
28:16Um, what are there? I'll send out the claims documents to you now.
28:20Email, uh, mine.
28:22It goes out by post.
28:23No problem.
28:24I'll just advise you on the documents in case you have any questions on it.
28:28Okay.
28:29So first of all, there is a certificate that you need to give to your doctor that I'm sending you.
28:34And the doctor will have to complete that.
28:36Okay.
28:37Then you'll need to send in the booking confirmation for the flight and the accommodation.
28:43Because we need to confirm your travel date as well as the date you booked the trip.
28:48Okay.
28:48You'll also need to get a letter from the respective companies confirming you didn't attend and if there's any refund
28:57available or not.
28:59Okay.
28:59We waited a few weeks and the customer then sent through his documentation.
29:05As part of our standard claims validation process for claims of this value, our claims advisor did decide to call
29:12the booking agent to try and validate the claim.
29:15When speaking with the booking agent, our claims advisor established that the booking agent couldn't find any record of this
29:23particular booking.
29:24That was despite the fact that the booking agent double checked their internal records.
29:29The booking agent confirmed that the reference number was completely unknown to them.
29:34Alarm bells were ringing, so the handler referred the claim to Seeger's Special Investigations Unit.
29:41The investigator picked up the referral and decided to make some additional inquiries with the booking agent, but also with
29:48the airline as well.
29:50We provided the airline with the unique booking reference that was actually on the booking invoice.
29:56They confirmed to us that they had no record whatsoever of this passenger.
30:02So that's both the booking agent and the airline who have no idea who this fictitious traveller is.
30:09For the sake of completeness, we decided to contact the GP surgery where the customer's GP certificate had been sent
30:17to us,
30:18which confirmed details of his sprained ankle.
30:21We were very concerned when we received a fax from the GP surgery,
30:25confirmed that there was no way that the doctor in question could have seen the customer at the time he
30:32claimed to have been and seen the doctor,
30:35on the basis that the doctor was actually on annual leave at that time.
30:39Furthermore, the customer wasn't even a patient of this particular doctor who purportedly signed the medical certificate.
30:46Fake flight bookings and bogus visits to the doctor, the phantom traveller was really digging himself into a hole.
30:53Based on the information the GP surgery had provided to us, we were satisfied that the medical certificate was false,
31:01which meant that the customer must have forged the doctor's signature on the medical certificate.
31:09At this stage, we were wholly satisfied that all the documentation the customer provided us was indeed fraudulent.
31:16And if the tricky traveller had tried it on with Seeger, he could have form.
31:22Insurers and their representatives do share intelligence to prevent fraudulent claims.
31:28And we established that the same customer had in fact made three separate claims with three other insurers,
31:35all of which appeared to be identical to this current cancellation claim he pursued against us.
31:42The customer had also sent them fake booking agent details, fake flight details and a fake medical certificate.
31:51It was time for this fraudster to face the music.
31:53Due to the overwhelming level of evidence we had to prove this was a fraudulent cancellation claim,
32:00we refused the claim on the grounds of fraud.
32:04We contacted our insurer client with the evidence that we had obtained
32:08and they referred the matter to the police.
32:12The police collated all the evidence from the different insurance companies
32:17and the matter ended up in court.
32:20Would the outcome signal the end of this chance's spurious holiday claims?
32:25The customer ended up receiving 16 months in prison and for insurance fraud.
32:36It's clear that the customer went to great lengths to try and commit fraud
32:39against numerous different companies, but eventually justice was served.
32:52Running, cycling, in fact any competition involves sheer stamina, rigorous training and dogged determination.
33:02Our next character has them all, plus sheer audacity as he tries to cash in on a fool while still
33:09managing to compete.
33:10The insurance firm Travellers was the company who had to beat him
33:14and he certainly gave it a run for its money.
33:17Travellers were presented with a claim for our customer, a counsel,
33:20as a result of a claimant falling in a pothole whilst out jogging.
33:25The counsel admitted liability for the injuries and we made an early offer
33:30to try and compensate this gentleman for his injuries.
33:32The offer was in excess of £10,000.
33:34But the offer was turned down by the claimant's solicitors, who didn't believe it was enough.
33:40After that settlement offer was rejected, we requested the claimant's GP records.
33:46Within those records, there were notes that he was discussing with his GP about training for triathlons.
33:52This was in direct contrast to the information he provided to the medical examiner that we based our settlement from.
34:00So there were some real inconsistencies in the evidence that was provided.
34:03But after our athlete had fallen over the pothole, the unlucky man suffered another trip.
34:10The severities of the injuries sustained to the claimant were increased as a result of a fall down the stairs.
34:17He said he'd fallen and had broken his wrist and this was caused by the ankle injury that he'd sustained
34:23in our incident.
34:25He said that his ankle had given way and that had caused the fall.
34:28This case was gathering pace.
34:31It's at this stage we were presented with a care claim and a loss of earnings claim for the claimant.
34:39He said that he wasn't able to work and when he did return to work that he was only put
34:42on light duties.
34:44He also told us that his wife was providing substantial care for him on a daily basis and presented a
34:51financial claim for that as well.
34:52Overall, it was roughly £100,000 in total, covering off all the injury claim, the loss of earnings and the
35:02care claim presented by his wife.
35:05We were surprised having initially given this claim a value of roughly £10,000.
35:11For that to be increased tenfold really suggested that there was something a little bit untoward going on here.
35:19So this further raised our suspicions.
35:21Time to investigate the background of the man claiming.
35:25One of the first things we did was look on social media to see what we could find about him.
35:30We were able to see that he played for a local rugby club and that he was running triathlons and
35:36various endurance events pretty regularly throughout the time that he said that he was not capable of doing so.
35:42We actually looked through other associated accounts that were linked to him and we were able to find pictures of
35:50the claimant playing rugby.
35:52So when he says in his statement, I'm not capable of playing rugby, that gives us an opportunity to go,
35:59OK, let's go and find some evidence to discredit him and prove that he's a liar.
36:03And we were able to do so in this case.
36:06The precision outlined in the athlete's account proved very useful.
36:11In the claimant's Whitman statement, he was very specific about certain dates that he wasn't able to do things, particularly
36:18to do with playing rugby.
36:19So that really gave us an opportunity to really pin down our evidence and look for pictures of that game
36:26online.
36:27We were able to find them and it showed the claimant in full flight.
36:31He wasn't a bystander or a spectator in the game.
36:34You could see him tackling, you could see him passing the ball, you could see him running.
36:39It was very clearly that he was a strong participant in the game.
36:42What was unusual about this as well was he said the reason that he couldn't participate in the game was
36:47because he had a plaster cast on his wrist.
36:50But it very clearly shows in the evidence that we have that there was simply no plaster cast there at
36:55all.
36:56The fraud team at Travellers checked social media as a matter of course, something the claimant may not have considered.
37:03If there's some red flags that show up on the claims that are being made.
37:08And what we do is look at all open source.
37:10So it's if people have set their privacy settings to open, there's a lot of data that you can get.
37:17It's an excellent tool for us. It is surprising how much people put on social media that is available.
37:22So, and I think especially with, if people are trying to make a fraudulent claim, they forget or they don't
37:29think that maybe that that information is as easily available as it is.
37:34The social media investigations helped put Travellers on the winning side.
37:39Some of the social media investigations led us to a fitness tracking app which showed data on the claimant about
37:46his runs, about how many miles he was doing, his cycling that he was able to do.
37:53This really gave us almost a weekly and monthly update as to how much exercise the claimant was doing, which
38:01was very regular.
38:02He was training for triathlons and endurance events.
38:08We found some of the results pages from the half marathon, marathon and endurance events that the claimant was competing
38:14in.
38:15This allowed us again to get a detailed estimate of the times that he was completing the events in, the
38:21length of the events and the severity of the events that he was competing in.
38:26Someone with an injured ankle and broken wrist would surely not even be able to enter these types of events.
38:34After reviewing all the evidence, we discussed this matter with our legal teams and decided to give the claimant an
38:40opportunity to withdraw his claim.
38:42We shared the evidence that we gathered and were really surprised when the claimant decided not to withdraw his claim.
38:50So in response to the claimant's refusal to withdraw his claim, we pursued a defence for fundamental dishonesty.
38:58What this means is that whilst there was a genuine element to the claim, the exaggeration and the lies that
39:04were told were fundamental to this case being completely dishonest.
39:10Fundamental dishonesty gives us as an insurer the opportunity to discredit the whole claim and get the claim struck out.
39:19The case continued to make its way through the legal process, but not without doubts from the claimant's team.
39:25Shortly before this case went to trial, we were approached by the claimant solicitors to try and settle this matter
39:32for £50,000.
39:34This is a 50% reduction in the amount that they'd originally stated the claim was worth.
39:41This was rejected and we were determined to see this case through to trial because based on the evidence and
39:48the information that we had, we believed this was the right thing to do.
39:52We felt it was really unfair that the local counsel, who was our customer in this case, would have to
39:56pay for an exaggerated claim.
39:58It was really important to run this case to trial as we wanted justice to be served and for the
40:06claimant to be cross-examined and for the truth to be shown in this matter.
40:10Now, it was travellers showing dogged determination and the company needed it as it was thrown a curveball at the
40:1611th hour.
40:17On the day of the trial, we were approached by the claimant solicitors and they tried to settle the case
40:24for £20,000.
40:25This was a substantial reduction in the £100,000 they'd originally said the claim was worth.
40:32We rejected their offer. We were confident that our evidence would prove the claim to be dishonest and that the
40:40claimant was a liar.
40:42The finishing line was in sight.
40:45We were successful at trial. It was found that the claimant had a genuine claim, which there was never any
40:52doubt over.
40:53But it was found to be so grossly exaggerated and dishonest to such an extent that the whole claim was
41:02struck out.
41:04The claimant was ordered to pay back nearly £13,000 that we'd already paid to him over the period of
41:11the claim, which he has now done.
41:15There was an entirely genuine element to this claim. The claimant had fallen over the way that he described and
41:22we were happy to settle the claim.
41:24But ultimately, driven by greed and dishonesty, this whole claim was struck out and he was awarded nothing.
41:32The success was due to so much information about the claimant being so readily available.
41:39Social media information is really key for investigators.
41:4410 or 15 years ago, this kind of information wasn't available, but now it's commonplace for investigators to use this
41:52kind of evidence to discredit dishonest claimants.
41:56It's important for us to take these cases to trial when we have the evidence of fraud, because we want
42:02to protect our customers and we want to send a message that fraud just does not pay.
42:33Transcription by CastingWords
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