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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 Rogue Claimers.
01:08Today, fraud investigators catch out a claimant trying to cheat his way to a seven-figure payout.
01:15It's clear that this person doesn't need £1.3 million of future care.
01:19A new £1 million house building for him to ensure he can carry out his daily activities.
01:24A rumbled opportunist seeks divine intervention.
01:28I can see that that person has been using that phone.
01:31It's the day that you are claiming you have lost it.
01:33And all the correspondence of the email showing that you have sold that phone.
01:37Oh my God!
01:38And the pub umbrella is drunk and disorderly.
01:42It seems quite serious.
01:43Hit on the forehead and she also had a hit to the back of the head.
01:54What makes insurance fraud different from many other crimes is that it's often committed by individuals
02:00who are ordinarily law-abiding people.
02:02But when faced with the prospect of a payout, succumb to greed and temptation.
02:08Insurers' LV recently dealt with a case where greed got the better of a claimant by a staggering amount.
02:16The accident that was reported to us was quite a serious accident.
02:19Our policyholder was driving home one evening after work, lost concentration,
02:23veered onto the opposite side of the road and had a head-on collision with the third party.
02:29Whilst LV's policyholder was okay, the driver of the other vehicle wasn't so fortunate.
02:35This was a really nasty head-on collision.
02:37The emergency services took four hours to get the claimant out of his vehicle.
02:40He was just trapped by his legs.
02:42The fire brigade had to take the roof off the vehicle to extract him before he was transferred to hospital.
02:47It was then that the severity of the accident became clear.
02:50The claimant was very seriously in this accident.
02:53It brought bones in each of his limbs, dislocated his hip,
02:55had a fractured spine and suffered a brain injury.
02:58It was looking like the road to recovery was going to be a long one.
03:02As well as the serious physical injuries, the claimant also described psychological issues.
03:06He had a fear of travel and whenever he got in a vehicle as a passenger,
03:09he described breaking out in hot sweats.
03:11From the outset, LV was aware that this was a claim it would be paying out on.
03:16Our policyholder accepted full responsibility for the accident
03:18and based on the facts of the accident, we knew we'd have to deal with this person's care
03:22and pay their claim.
03:24The recovery for this individual was going to be very long.
03:27Even on his initial stay in hospital, he had to have surgery twice
03:30to have plates inserted into his body.
03:32They were then removed in further surgical procedures some time afterwards.
03:36In good faith, we dealt with the claim as it was presented to us.
03:38We made a substantial offer of £300,000 to sell this person's claim.
03:44We also installed a wet room in his property to allow him to wash and bathe himself.
03:48But this wasn't a claim that was going to be settled quickly.
03:52Despite making this offer, we weren't able to agree a settlement with the claimant
03:55and he proceeded to issue court proceedings against us.
03:58With claims like this, it's not uncommon for an agreement not to be reached.
04:02So at this stage, LV had no cause for concern.
04:05Within the court proceedings is something called a schedule of loss.
04:08That itemises each head of claim that the claimant wants to claim for.
04:11On this particular occasion, that added up to £1.5 million.
04:15That's five times the offer that we'd initially made him.
04:18Despite the huge difference in amounts,
04:19it was possible that LV had simply underestimated the value of the claim.
04:24Upon receiving this schedule, we now need to instruct a team of experts
04:27to understand if this figure quoted was reasonable for settlement.
04:30That includes a doctor to look at the physical injuries,
04:33a nurse to look at his requirements around the house,
04:35such as washing, cleaning and general caring for himself.
04:38We also then had to consider if his property was going to be suitable
04:41for his long-term living conditions.
04:43The claimant will also instruct similar experts,
04:45their own doctor, their own care experts
04:47and these reports will be submitted to us.
04:49At this point, there were no red flags
04:51and we're happy for the claim to proceed
04:52and we look to negotiate settlement.
04:55But that was about to change.
04:57As the claim progressed, we got given an updated schedule of loss
05:00from the claimant's solicitors.
05:01This totaled £3 million,
05:03which included £1.3 million for his ongoing care
05:07and also £1 million for building a new property.
05:10By now, we're looking at a settlement figure
05:12around ten times what we originally offered.
05:15Before moving forward any further,
05:18LV wanted concrete proof that what was being claimed for
05:21was above board.
05:22The claimant went to go and see our doctor
05:24for his full examination to take place.
05:26This included a lengthy journey to the doctor's appointment
05:28and also a detailed examination,
05:30which took around two hours to complete.
05:33This included carrying out a reflex test on the various joints.
05:37However, our expert was rather alarmed at some of the reactions.
05:40The claimant was screaming out,
05:41which is not consistent with what the doctor was of anticipated
05:44in such an examination.
05:46The doctor's report also caused LV to have a knee-jerk reaction.
05:50Upon receipt of this report,
05:52this is when we became suspicious of the claimant
05:54and decided to look into this matter further.
05:56With our concerns on this particular case
05:58and the alleged injuries,
05:59the best way to investigate this type of fraud
06:01is covert surveillance.
06:03Having the claimant followed by a team of covert investigators
06:06isn't a decision insurers take lightly.
06:09But with such a huge claim on the line, LV had to be certain.
06:14Throughout our investigations into this matter,
06:15it became clear that the claimant alleged he was bed-bound,
06:19he was unable to wash and care for himself,
06:21unable to get dressed in the morning,
06:23and he was unable to drive his vehicle.
06:25Claimants with these type of injuries
06:27will often have good days and bad days,
06:28and we accept that.
06:30Therefore, surveillance has to be carried out
06:31over a long period of time.
06:33And on this particular occasion,
06:34we looked at around eight months.
06:36Based on the claim presented to us,
06:37we didn't anticipate to see the claimant very much
06:39on the surveillance.
06:40And if we did see him,
06:42he should have been in a wheelchair with his carer.
06:44However, we were surprised when the footage came in,
06:46because we saw far more of him than we anticipated.
06:59When I first saw this footage,
07:00I couldn't believe what I was seeing.
07:02Having seen his medical report
07:03to say he couldn't get out of bed without AIDS,
07:05and now I can see him driving around
07:06and living a relatively normal life.
07:10And that's putting it lightly.
07:13Here we can see him with a small baby
07:15putting him in the back of the vehicle.
07:17As you can see,
07:17the claimant gets into the driver's seat of the car
07:19and drives away,
07:20despite having a female passenger there
07:22who could have actually been the driver.
07:28Based on his claim,
07:29his alleged fear of travel, being bed-bound,
07:31this is not what we'd have anticipated to see.
07:34With the surveillance footage painting
07:36a very different picture
07:37to the one the claimant would have LV believe,
07:40the validity of the entire claim
07:42was thrown into doubt.
07:44Given our concerns,
07:45we started to investigate
07:46all the heads of claim again.
07:48This included the wet room
07:49that we'd previously paid for
07:50to be installed at his house.
07:51This investigation revealed
07:53that the estimate was dated
07:54four months prior to the accident,
07:56and therefore this was just simply
07:58his home improvements
07:59and not a requirement for his ongoing care.
08:01And the continued periods of surveillance
08:03did nothing to alleviate LV's doubts.
08:09Here we can see the claimant
08:10getting in and out of the car unassisted.
08:15But look carefully.
08:16I think he's forgotten something.
08:25As you can see,
08:26he's gone back for his walking stick.
08:28Despite going back to the car
08:29to get his stick,
08:30he's clearly walking without it.
08:35Now he falls off the curb,
08:37stumbles,
08:38but can recover
08:38despite these alleged serious injuries
08:40and appears unfazed by it.
08:43Here we can see him at a restaurant.
08:45Two of the members of staff
08:45come to try and put some items
08:46in the back of his vehicle
08:47but are clearly struggling
08:48to open the boot.
08:53Our claimant could open it though,
08:54despite being the one allegedly injured.
08:57Out comes the claimant,
08:58opens the boot,
08:59which is not consistent
09:00with what he's told the medical expert.
09:04It's clear that this person
09:05doesn't need 1.3 million pound
09:07of future care
09:08and a new 1 million pound
09:09house building for him
09:10to ensure he can carry out
09:11his daily activities.
09:13It didn't take a fraud expert
09:15to work out what was going on.
09:17Having seen the footage,
09:18it was clear that the claimant
09:19was exaggerating his injuries
09:20and lying to us.
09:21This is not what insurance is for.
09:23We're there to make things right
09:24when things go wrong
09:25and therefore,
09:26we decided to defend this matter.
09:29Given the evidence available to us,
09:30we decided to make an application
09:32for fundamental dishonesty.
09:34This meant that even though
09:35there were genuine elements
09:35of the claim,
09:36these would be forfeited
09:37due to the gross exaggeration
09:39of the fraud.
09:41Unsurprisingly,
09:42the prospect of being
09:43cross-examined in court
09:44was something the claimant
09:45was keen to avoid.
09:47Upon hearing that we intended
09:48to make an application
09:49for fundamental dishonesty,
09:50we soon received a call
09:51from the claimant solicitors
09:52saying that he wanted
09:53to discontinue his claim.
09:55We allowed him to do that
09:56on the proviso
09:57that he paid us back
09:58our costs,
09:58which had totalled £125,000.
10:01We've already received
10:02£50,000 from the claimant
10:04and we're now pursuing
10:05the additional £75,000.
10:07The claimant had seen
10:08an opportunity to cash in,
10:09but rather than being awarded
10:11a life-changing sum of money,
10:13he now owed it.
10:14I think what's important
10:15to remember here is
10:16this is a very serious accident.
10:17There's some genuine injuries
10:19that we were happy to deal with.
10:20However,
10:20this person's greed
10:21has taken over
10:22and it's ended up costing him
10:23£125,000.
10:31Later, sparks fly over a solitaire diamond.
10:36Yeah, yeah, I'm not a moron.
10:38I said to the chap yesterday,
10:40I don't want some cheap
10:41jewellery company
10:43knocking me up something
10:45that cannot see me playing.
10:54Smartphones can be used
10:55for much more
10:56than calls and messages.
10:57So in the wrong hands,
10:59it's not just a gadget at risk,
11:01but the personal information
11:02contained within.
11:07We can protect them
11:08with security and passwords.
11:09But the next case
11:10dealt with by Assurin
11:12is a great example
11:13of the old adage,
11:14you can choose your friends,
11:15but not your family.
11:18This claimant stated
11:19that after her husband
11:20had dropped her off
11:21outside the post office,
11:22she wanted to telephone him
11:25because there was
11:25a really long queue
11:26in the post office.
11:28He told me to call him
11:29when we freeze
11:30so he can come back
11:32and he can pick us up.
11:34I said, okay.
11:35But I didn't notice
11:36there is no battery in my phone.
11:40It's about 2% battery that time.
11:43So I told my son
11:45to replace this SIM card
11:46to his mobile handset.
11:48He got a phone
11:49and he got no contract
11:51and he wasn't got a credit
11:53that time on his mobile.
11:57She took out the SIM
11:58of the phone,
11:59put it in her son's phone,
12:01telephoned her husband
12:02and when she put the phone
12:03back in her pocket,
12:05subsequently she lost it.
12:07Can you tell me
12:08the last time you were able
12:09to use that phone
12:10before it was lost?
12:11On the date
12:12when we reached
12:13to the post office
12:14that phone was in my
12:15hand
12:16and I usually put my phone
12:18into my
12:19cardigan's pocket.
12:21Yeah.
12:22The customer filled out a form
12:24for a replacement phone
12:25at the market value
12:26of £450.
12:29Each claim goes through
12:30a validation process.
12:31This involves checking
12:33the status of the phone's
12:34unique IMEI number.
12:36And the results of these checks
12:38are sometimes surprising.
12:42We were able to identify
12:44that this particular handset
12:46through its unique IMEI
12:48was still actually in use.
12:50That led to additional
12:53investigations to try and ascertain
12:55who was using the phone.
12:57The investigation team
12:59tracked down the current user
13:00who had bought the phone
13:01through an online marketplace.
13:03The actual buyer of that phone
13:05was able to produce correspondence
13:07and evidence
13:08that led us straight back
13:10to the original claimant,
13:11the lady who was in the post office.
13:14She had some questions to answer.
13:17Do you know whether or not
13:18this phone has been sold at all?
13:22No, I don't know.
13:23You don't?
13:24Do you want to explain to me
13:25how it is that I know somebody else
13:27has come to be in possession
13:28of that phone?
13:29I don't know about anything.
13:30Your phone has been sold.
13:32This number I'm talking to you on
13:34was used as the contact number
13:36of correspondence between yourself
13:38and the person who was buying the phone.
13:41The proof of purchase that you have sent to us
13:44was sent to the person who bought the phone
13:46because he has sent me a copy of that document
13:48and I have that in front of me.
13:50I have all the email correspondences
13:52between that person
13:53and the person who sold the phone,
13:54which is yourself.
13:56I can see that that person
13:57has been using that phone
13:58since the day that you are claiming
14:00you have lost it.
14:01And all the correspondence of the email
14:03showing that you have sold that phone.
14:05The claimant then was as surprised as we were.
14:16what I am going to do
14:17because I had a relative ride from back home
14:21and they just left yesterday
14:23and I am going to find out
14:25because I am not a very good computer person
14:27and I am going to do right now
14:30some investigation in my home
14:31and I will find out who got the phone
14:34and who made these things
14:35and who has been using my emails.
14:37Oh my God.
14:39Who was with you
14:40whilst you were out with your son?
14:41Was it just you and him?
14:43No, no, no, no.
14:44It's not just me and him.
14:46It was one lady and one gents
14:48that came from back home to our country
14:51and I handed over my cardigan to just one lady.
14:54Maybe they took the phone from my pocket
14:56and they've done something like this.
14:58Oh my God.
14:59I don't know how to explain the thing.
15:02Oh my God.
15:04Sorry, I'm not this kind of lady
15:06and I'm really, really, really sorry.
15:09It's definitely someone using my phone
15:11because inside the phone
15:13there was email as well
15:15and my account was everything inside.
15:19My phone all the time is open.
15:20I don't use any fingers
15:22or any password on the phone.
15:24That doesn't change the outcome of this claim.
15:26If anything, that's a life lesson
15:27that you just learnt there, isn't it?
15:29The decision has been made on the claim.
15:31It's not going to be processed
15:32or not going to accept on the basis
15:33that we have sufficient enough information
15:35to support a false blame being made.
15:37You wish to dispute that.
15:39That's your choice.
15:39Conduct your investigation.
15:41The evidence was damning
15:43and the explanation, flimsy.
15:45But the claimant sounded like
15:47she hadn't got much security in place
15:49on her phone,
15:50leaving it, and her, vulnerable.
15:53She obviously realised this
15:54and in record time
15:56had carried out her own inquiry.
15:58Within the space of 24 hours,
16:01she had performed an investigation herself.
16:05Allegedly, her sister
16:07had sold her mobile phone.
16:11She told me, yes, she got the phone
16:13and she sold that phone.
16:16Okay, so where did your sister live?
16:18She lived in Pakistan.
16:20In Pakistan.
16:21Why did your sister do that?
16:23I owed him some money
16:24but I was not giving to her.
16:27And she told me she'd done that
16:29without my permission.
16:30Okay.
16:33Oh, my God.
16:35So, have you forgiven your sister?
16:37Yes, I have.
16:39You have? Okay.
16:40I don't think I would have forgiven my sister quite so fast.
16:44Oh, yeah.
16:45As the phone has been taken
16:49and sold without your permission,
16:52that is still classed as stolen.
16:54Would you like me to log that as a theft?
16:57Or what do you want me to do with this claim?
16:59Do you want me to close it or reopen it?
17:01What do you want us to do?
17:02I have.
17:03I just want to do to close it down
17:05and the person who bought the phone,
17:08she gave me his phone number.
17:11I did contact him
17:12and she already paid for the phone
17:14so it's okay when I get the money,
17:16I will buy another one.
17:19I don't want to be classified as
17:22lost or stolen anymore
17:24and we are not going to make any claim against this phone.
17:29Okay.
17:30She had benefited the claimant herself
17:32because her sister
17:34had used the claimant's bank account details
17:37and the cash from the sale
17:39had gone into the claimant's bank account.
17:41So the claimant simply stated to us,
17:44don't worry about the claim,
17:45I'll use the money and buy a new phone.
17:49With such unusual circumstances,
17:52Assurant took no further action
17:54beyond turning down the claim.
17:56But false claims are taken very seriously
17:58and there was a sobering warning.
18:01It's not going to change the fact
18:02that we've rejected your claim.
18:05In the future,
18:06if you just need to make a claim
18:07for whatever reason in the future,
18:10then we would need you to prove your innocence
18:12in this claim.
18:13So we would require a bank statement
18:15of yours and your sisters,
18:16we would require a crime reference number
18:19and you would have to report your sister to the police.
18:24Insurance fraud in the UK is a very serious matter.
18:27It costs the UK consumer over £1.3 billion.
18:32And we are working really hard as a firm,
18:34but also collaboration across the industry
18:37to link various sources of data,
18:40to protect honest customers
18:42and to identify those fraudulent ones.
18:52A hot day, some bevvies and your best friends
18:55sounds like a recipe for a very chilled afternoon.
18:59Unless, of course, the weather takes a turn.
19:08Pub chain JD Weatherspoon was faced with an injury claim
19:11that kicked up a bit of a storm.
19:14A female customer alleged that some summer drinks
19:16had left her feeling a lot worse for wear.
19:20So they called in their legal expert,
19:22Leandro Kelly, to get to the bottom of it.
19:25We received a claim form from solicitors
19:28on behalf of a customer who attended one of our pubs.
19:32The customer said that she went into our beer garden
19:35and was having drinks with a group of friends.
19:37It was a fairly windy day.
19:40She says that one of the garden table umbrellas
19:42lifted from its base,
19:44flew two metres across the garden
19:46and landed on the table that she was sat
19:49and hit her in her head.
19:51The customer was claiming that she was hit on the forehead
19:53and that she also had a hit to the back of the head
19:56and that she was also suffering from tinnitus.
19:59Very traumatic, seemed quite serious.
20:01But the offending parasol didn't just strike once.
20:05There was also another individual
20:07who was sat around the table with our customer.
20:09She also said that she was hit in the forehead
20:12by the umbrella.
20:13Very unusual that one garden umbrella
20:15would hit two people at the same time
20:17in the same location.
20:19They were saying that they had the same injuries,
20:21they had the same side effects.
20:23They both attended hospital,
20:25they both went to their GP on the same day.
20:27Their stories matched exactly.
20:29And if carbon copy claims weren't suspicious enough,
20:33an additional fact also didn't quite add up.
20:36They even had matching dates of birth.
20:39Alarm bells started ringing.
20:41It's highly unusual that two people
20:43can suffer the exact same injuries,
20:45have the same symptoms for one accident.
20:48The details of the claim were very unusual,
20:51so J.D. Weatherspoon investigated further.
20:55Her claim form was actually valued at £18,000.
20:58We thought it was very interesting.
21:00Someone who would have had a serious knock to the head
21:03would be claiming more money
21:05because we'd expect them to be off work.
21:07We'd be expecting them to claim for care
21:09and assistance from family members.
21:11But it was very specific.
21:12It was £18,000 that the claim form was limited to.
21:16Having doubts already, Leandro dug deeper.
21:20CCTV is extremely important because it is real-time evidence.
21:24If it's caught on CCTV, there's no disputing it.
21:28So from the footage, we can see the customer
21:30and her friends coming into the garden
21:32to sit at table to have a few drinks.
21:35Check.
21:36However, we can see that the wind starts blowing
21:38and a few of the umbrellas in the garden start to move.
21:42Check.
21:42There is one umbrella that does get lifted away from its fixture.
21:47Brace yourselves, you're about to see a terrible accident.
21:51Nah, you didn't miss it.
21:55Top left-hand corner, a folded umbrella, flops over.
22:01So, not exactly the drunk and disorderly behaviour
22:04we were expecting from the brolly.
22:06If both customers were hit in the head,
22:08we'd expect to see her friends react.
22:11No one moved.
22:12No one was disturbed.
22:13They carried on drinking and having a good time.
22:17Leandro hoped this evidence would calm the legal storm
22:19that was brewing.
22:21We put this to both claimants
22:23and let them know that we thought that their claims weren't genuine.
22:27One of the customers disappeared.
22:29We never heard from that customer again.
22:32The other customer, however, decided that she wanted to proceed to court,
22:35she wanted to get compensation,
22:37she wanted her day in court
22:38and she was going to stop at nothing until she did.
22:41It was beginning to look like an expensive round for J.D. Wetherspoon.
22:45When the customer submitted her claim into court,
22:48it was very surprising that the claim had actually doubled in value
22:53from about £18,000 to £39,000.
22:57The customer had obtained medical reports from orthopaedic experts.
23:02As the trial progressed, the judge had questions.
23:06When the judge asked the customer why she said that she had the injuries
23:10that she says she had,
23:11the customer said that she was actually told by her GP
23:15that she had suffered concussion and the other injuries
23:19and that she never said that.
23:21So it looked like things were unravelling.
23:23And of course, Leandro had something that would take the wind out of her sails.
23:28When we played the CCTV footage for the court,
23:31the judge saw that the accident didn't happen as the customer said it did.
23:36The judge immediately stopped the trial.
23:38The judge found that based on the evidence, the customer was fundamentally dishonest
23:43because she'd attempted to make a claim for compensation when she wasn't injured.
23:48Having her claim thrown out by the judge was a blow.
23:51But something even more sobering was coming the claimant's way.
23:55And he actually awarded us costs in the amount of £15,000 against the customer.
24:01It's very sad. The customer wanted £39,000.
24:05She ended up having to pay us £15,000.
24:08The customer wasn't surprised. She was shell-shocked.
24:12It's almost as if she couldn't believe that this has actually happened.
24:16After the trial, Leandro contacted her solicitors.
24:20But they said she had disappeared and no longer represented her.
24:25But that's not the end of the story.
24:28We now have a county court judgement against this customer
24:31and we're actually pursuing her for that money.
24:34Our opinion is that making claims for compensation when they're not genuine is not worth it.
24:40They carry serious consequences, financially, legally.
24:46Ultimately, people can be imprisoned for making fraudulent claims.
24:55Still to come, a bump on the bumper with plenty of twists and turns.
25:00He said he could get pre-existing damage to his vehicle repaired
25:04if he agreed to participate in a sham accident.
25:16When it comes to jewellery, insurers offer policyholders a choice of either cash, repair or replace
25:23if their item gets damaged or goes missing.
25:26LMG specialises in managing claims for jewellery, watches and other valuables.
25:31And every year, 16,000 of these claims are because of accidental loss.
25:40We received the claim for the loss of a diamond ring which we'd been told had been lost while out
25:44shopping.
25:45We had no reason to believe that the claim wasn't genuine in itself.
25:49In order to support the claim, the customer sent us a photograph showing the diamond certificate
25:54and the detailed valuation of the ring.
25:56With all the paperwork in, LMG got one of its handlers to gather more information.
26:00We've been appointed just to take some details on the claim.
26:04No problem.
26:05Of course, what it's my aim to do is to talk to you about its background and description
26:08so I can help to assess what's an up-to-date value on this ring.
26:14Yes, did you not get the photograph and the valuation certificates?
26:18You know, it's quite an antique ring.
26:20But here we are.
26:21Yeah, it's £4,500 the actual valuation.
26:25Yeah.
26:250.71 carat.
26:27OK, G colour.
26:30SI1 clarity.
26:31Has it been lost while you've been out and about, has it, or...?
26:35Yes, when I was shopping.
26:37You know, it's so hard because my husband's going to be the one that's going to have to buy another
26:41antique
26:45We've got a personal jewellery service.
26:48Yeah, I've already mentioned that to me.
26:50And I said, well, I'd rather just be at my husband to replace it himself, thank you.
26:54Well, that's sort of...
26:55It's very sentimental.
26:56Yeah, absolutely.
26:57It's very, very difficult to replace.
26:59And honestly, I can't tell you, I've cried for a week.
27:01Yeah, absolutely.
27:02It's very distressing and frustrating as well, isn't it?
27:05Absolutely frustrating.
27:06And, well, leave it with us and we'll sort of, you know, get the value on there
27:11because it's got the specific diamond qualities on there, so that's brilliant.
27:18The certificate was issued three years previously.
27:21So after looking at the increased value, they had a settlement figure for the claim.
27:26Potentially, the replacement cost of the ring was £6,050.
27:30Once we'd assessed the replacement cost of the ring, we contacted the customer to discuss
27:34settlement of the claim.
27:35Just to let you know that our jewellers have valued the item on the claim now
27:40and we're in a position to discuss the replacement of the piece with you.
27:45Thirdly, let me stop you there.
27:46I already spoke to the new guy, so why are you trying to contact me
27:51after I spoke to a gentleman yesterday?
27:54It's to discuss the settlement of the claim unless...
27:57Yes?
27:59Yeah, I'm not a moron.
28:00I know the settlement has been... it's been settled, the claim, right?
28:06Was this discussed with the insurance company by any time?
28:09This was discussed yesterday and I'm getting very fed up of all these phone calls.
28:14I'm very poorly and I'm in bed.
28:16And I've got people ringing me. It's already been settled.
28:20OK, I do apologise for sort of miscommunication there.
28:24So did they discuss with you what the cash settlement figure for the claim would be?
28:29Four and a half thousand.
28:31Four and a half thousand.
28:32Was that discussed with the insurance company?
28:34I don't know. The gentleman who rang yesterday.
28:38The gentleman that spoke to me yesterday.
28:43Oh God, I can't remember your name.
28:46Whilst the claimant was adamant that everything had been settled,
28:50LMG had not been the ones to call her the previous day,
28:53so needed to find out more before closing the file.
28:57We as standard are asked by your insurance company to settle the claim on their behalf.
29:03Now, if you've spoken with another party about this and agreed settlement with them,
29:07they've not passed that information on to us.
29:08Like I said, you know, we were originally supposed to be discussing settlement with you,
29:13but if that's already been done with another person...
29:15No, no, no, listen, when you say discuss settlement, Rod,
29:20what does that mean to you?
29:22To discuss how it is you want to move forward with the claim.
29:25But it sounds like you did that with someone else yesterday,
29:28but that wasn't from our company.
29:30I'm just apologising that we have called you today.
29:33But the company you spoke with yesterday did not inform us...
29:37Listen, when you say settlement,
29:40because you're not letting anybody speak,
29:41you're just speaking your lingo over the phone to me.
29:44I said to the chap yesterday,
29:46I don't want some cheap jewellery company
29:49knocking me up something that cannot be replaced.
29:52It was my mother's ring who died of cancer.
29:55Right?
29:56No one can replace that.
29:58And I said, I am sorry that he hasn't done that.
30:01Do not apologise on behalf of somebody else,
30:04because you make yourself look stupid.
30:06All I'm asking for is whoever's told you to ring me,
30:09get them to ring me, and I will tear their head off.
30:12I'll send a report to them now for you, OK?
30:16OK, thank you.
30:17All right, thank you. Bye.
30:19The claimant's tone didn't go unnoticed,
30:22and alarm bells started to ring.
30:25When we're dealing with claims,
30:26we refer to a number of fraud indicators,
30:29and unnaturally aggressive behaviour is one of those.
30:31What we find is genuine customers submitting a genuine claim
30:35are unlikely to behave in such an aggressive manner.
30:39After that phone call,
30:40the claim was referred to our technical team
30:42for background checks.
30:44And the more they investigated,
30:45there was a distinct feeling of déjà vu.
30:48On reviewing the claim,
30:50the technical team uncovered a previous claim
30:53for the same policyholder using a different address.
30:55When we looked at the previous claim,
30:57we realised that the customer had used the exact same valuation
31:01as she had two years previously.
31:03This demonstrates that if the ring had been lost two years previously,
31:06it couldn't have been lost again.
31:08Not only that,
31:09but the claimant must have lost track of the fact
31:11that she received a settlement of £4,500.
31:16So, for this customer, the claim wasn't paid,
31:19the policy was voided,
31:20and it would be very difficult for them
31:21to get an insurance policy through any other insurer.
31:32No one is safe from being asked to foot the bill.
31:34If negligence results in some kind of injury,
31:37especially if it's serious,
31:38and that includes local councils.
31:44Scott Clayton from Zurich explains the circumstances
31:47of one particular claim that came in.
31:49It was for personal injury
31:51against a local authority that we insure.
31:53They said there was a pothole in the road,
31:55and they put their foot in it and sustained injury as a result.
32:00Sounds like a fairly plausible story so far.
32:03He suggested that he had suffered a knee injury,
32:06so it was like a tear to his ligaments.
32:08On the face of it, the claim seemed genuine
32:11because there was a defect in the road.
32:13So, if there was a defect and someone had actually tripped on it
32:16and sustained an injury then on paper,
32:18it was possibly one to pay.
32:20But just how deep would the local authority need to dig?
32:24We estimated this claim to be worth in the region of £9,000
32:27based on what he was telling us and how much he was injured.
32:31A substantial sum.
32:32So, of course, Zurich would start to make all the necessary checks
32:36before issuing any cash.
32:40As with any claim where there's personal injury alleged,
32:43we need sight of the medical records
32:45just to validate exactly what it's been claiming for is accurate.
32:49So, in this particular case, the medical records came through
32:52and it did say that there was an knee injury.
32:56With everything stacking up, it looked like things had happened,
32:59just as the claimants said.
33:01But one thing caught Scott's attention.
33:04Rather strangely, he also sent in a photograph of him in the street
33:08pointing to the pothole.
33:09A memory snap of his trip, maybe.
33:14We don't normally get that with claimants,
33:16but it certainly showed the pothole on this occasion.
33:18But if this chap thought a snap of the offending pothole
33:22would be enough to rubber stamp his claim,
33:24then he was sorely mistaken.
33:27We validate every claim
33:28and that includes looking at the injury
33:31and whether it was consistent with what was being alleged.
33:34And the knee injury in this case,
33:36actually, the suggestions were that it was more likely
33:38to have been caused playing sport.
33:40So that's when we became suspicious
33:42about what had actually caused the injury to his knee.
33:45Zurich decided to dig a little deeper.
33:48The investigations looked into the background of this claimant
33:51and we found out that he was a rugby player
33:53and quite an active rugby player.
33:55And so that was something that we wanted to explore further.
33:58Even though he played rugby,
34:00it didn't necessarily mean he hadn't been tackled by a pothole.
34:04We carried out those inquiries really so that we could get an idea
34:07of who we were dealing with.
34:09But the real dynamite moment in this case was when we found out
34:12that he was playing rugby the day after he said he'd fallen in the street.
34:17And those inquiries revealed that he actually was playing on that date,
34:21but he was taken off or substituted as a result of an injury.
34:25So that then led us to conclude that the injury had actually been caused
34:29whilst he was playing rugby.
34:30So not only did Zurich have evidence from the match reports
34:34of the claimant being subbed because of injury,
34:36it also discovered something else.
34:39We also were able to prove that he was playing rugby subsequent to his injury.
34:43So he'd recovered and was back on the playing field.
34:46So this was a fraudulent claim and it was one that we were obviously keen to put to him.
34:50And because this was a claim against a local authority,
34:53we referred the matter to the police.
34:56A call from the police was probably the last thing he was expecting.
35:00So they invited the claimant to come in for interview,
35:03at which point he admitted that he'd made an entirely fictitious claim.
35:07The chap said that he'd actually been encouraged by his pals to make a claim against the council.
35:11So he kind of blamed it on his pals.
35:14They were now on the sidelines and the claimant was sent to the sin bin.
35:19Because the claimant admitted his guilt, he received a police caution.
35:23So that will remain on his record and affect potentially any future employment
35:27or references that people may seek against them.
35:30So it's a harsh lesson that he learned.
35:42The reality is that not all collisions on the roads are accidents.
35:47And there are fraudsters out there who would deliberately cause crashes
35:50to get their hands on some whiplash cash.
35:57When a claim came in to DAC Beechcroft, it looked like a simple rear end shunt.
36:02And it was representing the shunter.
36:07The claim was for a husband and wife who said that they were travelling on the slip road on the
36:12M4
36:13heading towards London in heavy traffic.
36:15And they say that the car in front braked because of the heavy traffic.
36:19And then the car behind them, in which our insured was driving,
36:23failed to stop in time and just drove straight into the back of their vehicle.
36:30The insured's version of events was very similar.
36:32He did admit to hitting the rear of the claimant's vehicle.
36:37So it was all looking like an open and shut case for the unlucky couple.
36:41But the person who had allegedly driven into them was about to put the brakes on.
36:46And this time, early enough.
36:50The insured straight away thought that there was something suspect about the accident circumstances.
36:55And he did report that to his insurer.
36:57His version of events was that they braked for no apparent reason, inducing the accident.
37:03This was indicating it could have been a slam on.
37:09And something else wasn't right.
37:11The accident damage to both vehicles, according to the insured, was very minimal.
37:17So the insurer was very surprised when they received the vehicle damage claiming from the claimant,
37:23which was for significant damage to the rear of the vehicle.
37:26In addition to this, the couple claimed for their injuries.
37:31The personal injury claims presented by the claimant, both were reasonably modest sums.
37:36And we're only looking at a couple of thousand pounds here.
37:39The key driver for this claim was the credit hire recovering storage.
37:43The total amount amassed in higher charges was in excess of £170,000.
37:49A very steep sum for the replacement car.
37:52And it was also looking like whiplash cash wasn't the driving factor for the claimant.
37:57The whole purpose of the setup of this claim, it wasn't personal injury.
38:01It was bent metal, so accident damage and subsequent hire.
38:06At this point, DAC Beechcroft wanted to know exactly what had happened to both cars.
38:12Part of our investigations, we instructed a forensic engineer to inspect both vehicles to see whether the accident damage was
38:18consistent.
38:19And he determined that it wasn't. There was pre-existing damage to the claimant's vehicle.
38:24Having investigated, spoken to the insured and obtained forensic engineering evidence, we were pretty sure that we were dealing with
38:31a fraudulent claim.
38:33With the claimant showing no signs of doing a U-turn, DAC Beechcroft took decisive action.
38:39We felt so overwhelmingly strong about defending this case that we took it to trial.
38:45Civil court proceedings had started, and this pair of fraudsters would soon be before a judge.
38:52There were two main pieces of evidence which we used to prove that this accident had been induced.
38:57The first was the insured and his version of events.
39:00He was very clear and concise about how the accident had happened.
39:03And then the second element was the engineering evidence.
39:06We obtained forensic engineering evidence which stated that the damage to both vehicles was inconsistent with the claimant's version of
39:13events.
39:14The claimants at trial came across as really poor witnesses in terms of their recollection of the accident.
39:21He accepted under cross-examination that the majority of the damage wasn't accident-related, but still continued to ask for
39:31damages for another part of the vehicle.
39:34At this point, the judge ruled that the couple were fundamentally dishonest and ordered them to pay DAC Beechcroft's legal
39:41fees.
39:42And that wasn't all.
39:44He went further and joined in the hire company to the pleadings so that we could also pursue them for
39:51our legal fees.
39:52And the journey didn't end there.
39:55As the fraudsters had lied under oath, DAC Beechcroft wanted them to face charges for contempt of court.
40:04The claimants continued to deny they were at fault and they maintained their innocence.
40:10Two days before the hearing, they did however concede that the claims were fabricated.
40:17So what was their explanation?
40:18The claimants had signed statements of truth attached to their witness evidence.
40:23They claimed that they actually hadn't seen or read the statements before they'd signed the statement of truth.
40:30And only now did one of the claimants allege there was a third party involved.
40:35He said that he was introduced to the director of the hire company who had told him that he could
40:41get pre-existing damage to his vehicle repaired if he agreed to participate in a sham accident.
40:48And to help, he would also put somebody in the vehicle to tell him exactly when to brake to induce
40:55the accident.
40:57The couple was facing accusations of contempt of court.
41:03And when the judge made his verdict, it wasn't good news.
41:08The outcome of the case was that the second claimant, his wife, was given a six-month suspended sentence.
41:14And the first claimant was given a 12-month custodial prison sentence.
41:21There are enough tragedies on our UK roads without deliberate slam-ons being orchestrated by fraudsters who want crash cash.
41:29So prosecutions ending in jail time should be a deterrent.
41:35I think the message is getting out there, but people don't, when they do their kind of risk analysis, they
41:40just simply think,
41:41well, if I get found out, I just won't get a payment.
41:44Well, if you get found out, you'll end up going to prison.
41:46Got it.
41:49Got it.
42:01Got it.
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