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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.
00:41Including 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.
01:09Today, unscrupulous car passengers claim to be hit by a bus and hurt badly.
01:14It's hard to see how any of the injuries could have been sustained from this collision.
01:21In fact, it's impossible, not hard to see.
01:24A prisoner reports a serious injury on the treadmill, but the evidence suggests otherwise.
01:30It hadn't appeared on our computer system that he'd been in the gym.
01:33And above all else, I didn't recognise him, or none of the PE staff recognised him as a gym-goer.
01:40And a calamitous con-man forgets which side his fake injury is on.
01:45She had to tell him that he was using the wrong hand.
01:47And he switched hands with the crutch, which again, was a bit of a flag for us.
02:01Accidents in the workplace are inevitable, so employers have a duty of care and insurance in place to help those
02:08affected.
02:08But, as insurer QBE found, it's vital to check claims, as not all of them are honest.
02:16Initially, we were told by and showed that an accident had occurred involving one of the employees.
02:21And that he'd fallen 40 feet from scaffolding to the ground and then into a pit six feet below.
02:29The list of injuries was horrific.
02:33He sustained some quite significant injuries, including a broken shoulder blade, broken arm,
02:40had a heart attack at the scene, and also a broken spine.
02:45He was very lucky to have survived at all.
02:49The first tangible evidence we received were by way of GP records, almost two years after the incident occurred.
02:59This identified that he had sustained some quite significant injuries.
03:03But we also noticed that he'd been involved in a road traffic accident shortly after our incident.
03:11This was one unlucky man, but the car crash raised some questions about his work accident.
03:18The significance of the previous incident was that he said that he was struggling to do normal day-to-day
03:24activities,
03:26which inferred to us that he could actually do that before.
03:30And this was only a matter of months after the accident where he was injured at work.
03:36It appears that he was telling the insurer dealing with a road traffic accident
03:40that he was fine and perfectly fit before their accident had occurred.
03:45But to us, he was telling us that he'd been constantly injured
03:48following the incident that occurred before the road traffic accident.
03:53That immediately made us have concerns that he wasn't telling us the full truth about how he was incapacitated following
04:03the accident.
04:04We tried to gather additional evidence so we can fully understand the extent of his injuries.
04:10All we managed to get after three years with GP records.
04:13When we received a schedule of loss from him, he was after in the region of £300,000 purely for
04:22the physical injuries
04:23and in the region of £650,000 for any additional losses.
04:32Given the extent of his injuries and incapacity, the claim for almost £1 million was probably fair.
04:39But with doubts about the truthfulness of the claimant, QBE arranged its own medical examination.
04:46He presented with a much higher level of disability, including the need of a crutch,
04:53being unable to wash and dress, unable to make a hot cup of coffee due to dizziness and lethargy.
05:01He was actually saying that he was worse than he was when he'd seen his own medical experts.
05:08So this again to us was another factor which indicated that he might not be telling the truth.
05:14The multiple inconsistencies we'd seen and the picture of an improving, then deteriorating individual
05:20led us to have major concerns about what we were being told.
05:25So the next step for us was to undertake profiling and surveillance of the claimant.
05:33Given the claimant had said he needed to use a crutch and was incapable of making a cup of coffee,
05:38QBE was expecting to see a broken, injured recluse.
05:43What we actually saw was somebody who seemed to be going about his daily activities without any difficulties whatsoever.
05:51And in fact, over the many hours of surveillance that we managed to see him in,
05:57he was working, socialising and shopping.
06:04The surveillance we had showed us him walking for a number of hours along the beach with his partner and
06:11children.
06:13We also had him working up a ladder, fitting a sign to a shop.
06:19And when he went to see our medical experts, there was quite a contrasting picture
06:25where ten minutes before he went there, he was fine doing his daily activities.
06:33And then when he went to see our medical expert, he suddenly brought a crutch out
06:38and had his partner helping him get out of the car.
06:42It wasn't until he got to the other side of the road that she had to tell him that he
06:46was using the wrong hand
06:47and he switched hands with the crutch, which again was a bit of a flag for us.
06:55Just a bit.
06:57There was some definitely conscious exaggeration here that he was trying to pull the wool over our eyes
07:04and he could actually use that limb.
07:08The man who claims he can't even make a hot drink because he was unable to stand up for too
07:13long
07:14seems in perfect health as he walks along the seafront.
07:18And his dodgy right shoulder certainly isn't stopping him from working on this shopfront.
07:27Or rendering him incapable of doing the shopping.
07:32And he's even forgotten which side was injured.
07:37His partner has to remind him just in time to see the doctor.
07:44QBE now had the proof needed.
07:47Eventually, with the weight of evidence we had, we disclosed it to his solicitors
07:52and they decided that he wasn't somebody they wanted to represent
07:56so they left him to be a claimant in person.
08:00The claimant was on his own.
08:03Four years after the original incident, he tried his best efforts to have our evidence thrown out
08:10which indicated he had been fraudulent.
08:12Determined as the claimant was, QBE fought back.
08:17We decided to pursue a private prosecution for attempted fraud.
08:21So, seven years after the original incident, we were in the criminal court
08:26and he was found guilty of attempted fraud and sentenced to two years, suspended for two years.
08:33The judge said that fraud like this is not a victimless crime and that it affects the public at large.
08:41In this case, it affected the claimant too.
08:46Because of the extent of his lies, he ended up receiving nothing.
08:51I think anybody who thinks that they will get away with this sort of thing are pretty foolish
08:56because there's a lot of tools that fraud are just at hands to identify and gather the evidence of fraud.
09:04And insurers are keen to make sure that people pay for their crimes.
09:14Later, the impact of a rear end shunt is massively exaggerated.
09:19They had not suffered the injuries they had claimed.
09:23They had just used the opportunity to try to put in an excessive claim to commit fraud.
09:39Having burglars invade your home and root through your personal possessions is something no one wants to experience.
09:49Although it can't make up for the loss of sentimental items,
09:52a household contents insurance policy provides compensation for the things that can be replaced.
10:01Jewellery specialist LMG deal with many claims for stolen items.
10:06And know all too well that whilst most are genuine,
10:09for some people, a burglary is an opportunity to try and cash in.
10:18We were presented with a claim for the theft of some jewellery items during a burglary.
10:23And at that point, there didn't seem to be any particular concerns.
10:28The police officer advised us that they had gone out for an evening and it's during that time that their
10:33house was burgled.
10:34And the burglars had gone off with some pretty pricey booty.
10:38The claim was for five pieces of diamond set jewellery which consisted of a pair of earrings, a pendant and
10:45some diamond set rings.
10:47The total value of the claim was just over £7,000.
10:52As far as LMG was concerned, at this stage, it was all looking pretty standard, apart from one thing.
11:00We made contact with the policyholder or attempted to, but it was nearly three months before they actually responded to
11:07our letters and messages.
11:10This seemed unusual. The claimant had just been burgled, had lost £7,000 worth of jewellery and didn't seem to
11:18be in any kind of rush.
11:20Most people would like to try and get it sorted out as soon as possible.
11:25When the claimant finally responded, LMG asked for supporting documents to be sent in, receipts for proof of purchase, maybe
11:32even evaluation.
11:35The claimant told us that he didn't have any paperwork to support their claims, but they did have some photographs
11:40that would help us.
11:42It was not uncommon for claims to be assessed using just photographic evidence.
11:47Photographs can give us an idea of size and gauge and particularly diamond set jewellery, give us an idea of
11:54the approximate carat weight of the stones.
11:57The photographs were very clear and did show the items in detail.
12:01They were purpose taken of the actual items in boxes.
12:05The quality was good and the diamond weight and carat could be established, but there was a problem.
12:11The data show that the photographs are actually taken after the date of the alleged burglary.
12:18The burglary happened on the 17th of August and the photographs were taken on the 19th of August.
12:24It would have been physically impossible to photograph items that were supposedly nicked from your home two days earlier.
12:34One of our standard validation questions, if we're presented with photographs, is when they were taken and why.
12:41And we were advised, in this case, they were taken around ten years ago.
12:46Not only did the day-to-dates not tally, they had also tried to pass the photographs off as vintage.
12:53The photographs were definitely not taken ten years ago, as we were advised, and indeed the device they were taken
12:59on would not have been available at that time.
13:02LMG wasn't dealing with the brightest of opportunists, but opportunists nevertheless.
13:09There was no doubt that the photographs were taken after the loss, and so this was a fraudulent claim.
13:14We presented our report and all the evidence to the insurance company and suggested they did not pay out on
13:19the claim.
13:20And with that, the claim was rejected, and for LMG, it was a glittering result.
13:32First Group is one of the largest bus companies in the UK, carrying more than one and a half million
13:37passengers a day.
13:39Most buses get to their destination without problems, but some trips are hijacked by those along for more than the
13:46ride.
13:46This is a case that arose when one of our buses has overtaken a stationary car, and as it's going
13:52past, it's just managed to clip the vehicle.
13:55According to the passengers in the vehicle, the impact was of a sufficient nature to throw them around in the
14:00car and actually cause the vehicle to be shunted forwards.
14:04First Group was looking at having to fork out.
14:07The damage inflicted to the vehicle was enough to render it a write-off, so we're not talking about a
14:14small amount of damage here.
14:15With three people in the car, the range of injuries is quite wide, sort of extending from soft tissue injuries
14:23to the neck, some headaches.
14:25One of the passengers was injured by the seatbelt as it's managed to crush her left breast.
14:31There were a number of soft tissue injuries to the shoulders, basic travel anxiety, so things that we normally see
14:39from this sort of accident where passengers are now wearing seatbelts as well.
14:43Taking into account the injury claims, the cost of the claims, any elements of physio treatment that were needed, the
14:52claim would have come to £27,500 for all three claimants.
14:56First Group made checks on what happened with interesting results.
15:01With this particular one, we'd been told of quite a meaty impact and yet there was no damage at all
15:07to the bus.
15:10The bus driver said that as he was passing the car, he's misjudged the distance as he's gone by and
15:16he's just managed to clip it with the rear of his bus, just along the rear of the driver's side
15:22of the vehicle.
15:23He said it was a very minor coming together, so he was a bit surprised to find out subsequently that
15:29claims have been submitted.
15:31But they were, although they raised some serious questions.
15:35When the claims were submitted, two of the claimants had not sought any medical treatment at all.
15:42None of them had been to see their GPs, with only one of them going to seek assistance at a
15:47walk-in centre.
15:48Yet all three claimants put in claims for personal injury and said that they needed physiotherapy treatment to deal with
15:55their injuries.
15:56With the discrepancies between what actually happened in the circumstances of the accident between the driver and the third party's
16:04version of events,
16:05that coupled with the fact that the initial report said that there was no time needed off work, which suddenly
16:12changed to having to take time off.
16:13There was enough building here to justify us wanting to take a closer look at this claim.
16:19So first group got its engines rolling.
16:22We instructed a forensic engineer to have a look at the car just to see whether the damage that was
16:28being alleged was correct and could have caused the injuries.
16:31His findings were that it was a glancing blow and not the bumper to bumper impact that the third party
16:37is alleging had happened.
16:39Now the key there is that in order to sustain a soft tissue injury, you really do need some sort
16:45of transfer of energy.
16:47Otherwise you're not going to have that movement to cause the injury in the first place.
16:51The second thing that the forensic engineer has picked up is that the vehicle being written off wasn't caused by
16:58the severity of the impact.
17:00It was more to do with the fact that the vehicle was quite old and had quite a low value.
17:05You'll find that in a lot of instances if the vehicle is old and isn't worth very much, you can
17:10probably write it off by sneezing on it a lot of the time.
17:13But the vital proof to help first group fight this claim was yet to come.
17:18We also had the best evidence we can get from the CCTV footage.
17:22Once I'd reviewed the CCTV, my mind was made up much like the claimant's accident circumstances it turned out.
17:34Based on what I'm seeing here and the lack of any real movement of the vehicle,
17:39it's hard to see how any of the injuries could have been sustained from this collision.
17:46In fact, it's impossible, not hard to see.
17:49No, you haven't missed it. That was the impact the claimant said had caused so many injuries.
17:56When you watch it back, the impact is very slight.
18:00The vehicle doesn't move at all, let alone being shunted forward.
18:05That just didn't happen.
18:07We send all the evidence, the CCTV, the forensic evidence, the photos showing there's no damage to the bus.
18:13All goes on to the claimant's solicitors.
18:16Surely there's enough there for them to drop this claim.
18:19No, they litigated.
18:23Unbelievable, given the weight of evidence.
18:25But why let hard facts get in the way of justice?
18:28In this case, only one of the claimants actually issued proceedings.
18:33In multiple occupancy situations like this, that's not entirely unusual.
18:37It gives the other claimants an opportunity to test the waters and sort of evaluate the certainty of their case
18:44getting through.
18:45It also gives them the opportunity to see what sort of defence that we're going to put up for the
18:51claims to build their case for a later date.
18:54So now we've got one claim litigated, two claimants sitting in the wings, the fight is on.
19:00Given the evidence available, you'd think some sense would prevail.
19:05On the day of the trial, there were a number of tactical maneuverings carried out by the other side to
19:10try and swing things in their favour.
19:13The strangest of which was to try and ban the CCTV evidence from the trial through to trying to stop
19:19the photos showing there was no damage to the bus.
19:23First group must have been more than a tad frustrated.
19:26This went before the judge. He said he wasn't really fussed about seeing the photos of the damage to the
19:32bus, but the CCTV evidence was the most critical piece of information there was.
19:37And he said he wasn't prepared to let the trial run without seeing that.
19:41It was there, it was available. Why would he not want to see it?
19:45The credibility of their case rapidly came into question.
19:48They'd use words such as the wheel being mangled.
19:52It wasn't mangled, it was scraped.
19:55When we put that to us, he said, oh, I've chosen the wrong word.
19:58Which is a bit coincidental really, seeing as the other two claimants giving witness evidence use exactly the same word,
20:05which would suggest that they had discussed this between them before the actual trial.
20:11We looked at a medical history.
20:13No attendance at the GP following the accident, and yet every cough, sneeze, cold, bruised elbow, regular health check-ups,
20:22she would go to her GP.
20:24So she's in an RTA, gets a whiplash injury, and doesn't go to see her GP.
20:30The evidence was shaky. Then, first group called on its big guns.
20:35The final nail in the coffin was when one of the witnesses took the stand, still maintaining that the vehicle
20:40had been shunted forwards.
20:42We put the CCTV evidence and showed her that, and said, are you sure?
20:47She had to rapidly backtrack on that and say, clearly not.
20:52So, it really did show that that piece of evidence, the vehicle being shunted forward, just wasn't true.
21:00They were never going to get home on that one.
21:02And luckily for first group, the judge agreed.
21:06He came to the decision that the claim just could not stand.
21:09And he dismissed the whole case.
21:11So, all good. Case is done and dusted.
21:15No, it's not.
21:17There is no way we were going to let this person, or any of these claimants, have a free run
21:22at this claim.
21:23We went straight back to the solicitors, and said, we want to go back to court and push for a
21:28finding of fundamental dishonesty.
21:30Which would then incur quite hefty cost penalty against the claimant.
21:35You can't just let people get away with these things.
21:40The solicitors, having seen the case and the CCTV evidence, were obviously not happy about going back to court, because
21:46they didn't have a great chance of winning.
21:50So, they made us an offer for our costs, tried to haggle a little bit.
21:56We were having absolutely none of it.
21:58We wanted the full lot, or we were going back to court.
22:01And in the end, they just had to give in.
22:08Still to come, time is of the essence for a poorly pooch out for walkies.
22:155.21, the policy had been set up.
22:17But at 5.26, just five minutes later, the puppy with a broken leg was already in the veterinary practice
22:24seeking treatment.
22:32HMP Garth in Lancashire houses long-term and high-security prisoners.
22:37Its staff oversee more than 800 inmates, and know that bored prisoners can latch on to the type of scams
22:44that got them banged up in the first place.
22:47PE instructor Lee Double works with many of the men in the gym.
22:51The following case features one prisoner, who was keen to use the exercise equipment.
22:56But fraud, rather than fitness, was his end goal.
22:59Clayman said that he came into the gym, that he typed his age into a running machine, and it set
23:05off really quickly.
23:07With that, he fell but clung onto the bar on the treadmill.
23:11The treadmill carried on spinning, pulling his jogging bottoms off and his underwear off, causing abrasions to his thigh and
23:19shins.
23:19And eventually it spat him out of the machine.
23:23This sounds nasty, but Lee was skeptical.
23:27I was suspicious about the claim because I didn't recognize the prisoner's name as a gym attendee.
23:32I checked the date he'd given us, and it didn't match with the dates of the classes off of that
23:38particular wing.
23:39I checked the class list, and he had never appeared on a list, hadn't appeared on our computer system that
23:44he'd been in the gym.
23:46And above all else, I didn't recognize him, or none of the PE staff recognized him as a gym goer.
23:52So was this a phantom visit to the gym then?
23:55Prison Governor Steve Pearson acknowledges inmates can be inventive.
24:00We encounter these on a reasonably regular basis.
24:03I think sometimes there's a culture within the prisons of men almost being bored and deciding to use litigation as
24:09a hobby.
24:11I think from time to time we get people who are opportunistic, who try and push and bend the rules.
24:17And it's our job to make sure we follow our procedures to make sure that they can't do that.
24:20The story presented of the treadmill terror was full of holes.
24:25He claims that there was four members of staff on duty that day.
24:28So a question I asked him, if he was unsure how to operate that piece of equipment, why didn't he
24:34ask a member of staff how to do so?
24:37A good question. Also, if he wasn't expected at the gym, how on earth did he get there?
24:43The prisoners are escorted from their residential unit straight up to the gym, so there's no way that he could
24:49have got in without one of us knowing.
24:52The prisoners said that he actually left the wing by himself and said that the gates were open between the
24:58residential unit and the gymnasium and that he just walked in, which is impossible.
25:04So if the prisoner did somehow get himself to the gym, could he have injured himself in the way he
25:10alleged?
25:12It's highly unlikely the accident occurred how he said it would have been, because the machine takes a little while
25:18to build up to the speed that you type into it.
25:21So it doesn't go from zero straight up to your target speed. It builds up gradually.
25:27We've always got PE staff on the gym floor to hang onto a running machine while it carries on going
25:33for five minutes. It's nigh on impossible.
25:36The gym staff would have been attentive, would have stopped the machine and offered him medical help straight away.
25:42So nothing really stacked up from him telling me how he got to the gymnasium in the first place to
25:49the events inside the gym. It just wouldn't have possibly happened.
25:53But our fitness fanatic, who claims to have fallen and not just lost his jogging bottoms, but also his underwear,
26:00was undeterred and keen to complete his workout.
26:03He then said that after he received his injuries, he then went onto a row machine and continued to row
26:09for a few minutes, which just wouldn't have been impossible given the level of injuries he said he received.
26:14Healthcare would have been notified, they would have attended to him and there would have been a record on his
26:19medical history that he'd received injuries and there wasn't nothing.
26:23The prison service knew it had some strong evidence and waited for its day in court.
26:29I was invited to give my evidence and question the prisoner on what he alleged to happen in the gym
26:38and explained that there's no way that could have happened.
26:42The judge, when summing up in court, said to the prisoner that his case was very weak and had lots
26:48of holes in it and she warded in our favour.
26:52Given the inmates leaky story, the result was perhaps inevitable, but stretched prison staff have more pressing demands on their
27:00time.
27:01When the judge found in our favour, I was very pleased, but also a little bit annoyed that the case
27:06had got that far because the incident had never occurred and it put a lot of staff under a lot
27:12of stress at the time.
27:13In terms of how much money was saved, we saved, I guess, about £10,000 by defending this claim, £10
27:20,000 of taxpayers' money.
27:22Given the fact that this is the public purse and we know how stretched that can be and making sure
27:27that we spend money on stuff that's good rather than giving money on spurious claims.
27:37In the fight against fraud, insurers are using every bit of tech at their disposal.
27:42One way of monitoring a vehicle is to use an on-board system called telematics.
27:48This shows where and when it's been driven, how fast and how safely, so anything out of the ordinary is
27:55easily spotted.
27:57Ensure the Box is a company which insists on such a little black box for its policyholders.
28:03As Simon Rule, its head of financial crime, illustrates this extra layer of information can prove vital when assessing claims.
28:11A policyholder reported to us that they had driven at low speed into the back of another vehicle.
28:21Because it was such a low impact incident, the level of damage was relatively minor.
28:26As you would expect, there were some small dents and scratches to the bumper, to light clusters and a bulb
28:34had actually been dislodged as well.
28:36Based on the information it had received, Ensure the Box wasn't expecting a big claim.
28:42We were rather surprised then to receive, a few days later, a claim from the second party of the accident
28:49asking for about £4,000 worth of damages to their car to be repaired.
28:54Usefully, the policyholder had other evidence gathered within the black box of his car.
28:59We were able to tell, using the Box data, the speed prior to the accident, as well as the level
29:07of g-forces that were involved in the impact itself.
29:11And also, the Box is able to tell us, from a little gimbal that's inside there, the impact on the
29:18X, Y and Z axes.
29:20So we knew the vehicle remained upright, it was just going in a forward direction and there was no side
29:25impact.
29:26The driver claiming had no idea the insurers had so much detail about the accident.
29:31His naivety soon becomes clear.
29:35To our surprise, a further claim came through from the second party and this time it was for bodily injury.
29:43But in actual fact, it wasn't just for the driver.
29:46They now claim that there was a passenger in the car at the same time.
29:51And this person had never been mentioned in any of the details given to us by our policyholder.
29:56And the photographs didn't show anything either.
30:00So we now have received two claims from the owner of the second vehicle.
30:05We've received one for what we consider to be excessive damage to their car.
30:09And we've also now received a personal injury claim.
30:13So in total this is worth about nearly £14,000.
30:18But of course at this time we haven't received much information from the owner of the second vehicle.
30:24So we contacted them and said, well, we require further information from you to provide evidence for your substantive claim.
30:32Any results would be interesting.
30:35We actually received from their solicitors an engineer's report, which they hoped would substantiate their claim, showing excessive damage to
30:44the car,
30:44which we hadn't seen recorded through the original pictures and statement made by our own policyholder.
30:50When we examined the engineer's report, it was quite interesting because they were noting on there that the damage to
30:58the rear end of their claimant's vehicle was far more than we had seen in the photographs.
31:03And it actually had looked like they had actually created or caused further damage post-incident to actually create a
31:14value for this particular claim.
31:16Looking at the photo of the second vehicle that was taken at the time of the accident, then the photo
31:22that was sent in following the engineer's report, you could see quite a difference.
31:27And not surprisingly, Ensure the Box rejected the claim.
31:30You think this may be the end of the matter, but no.
31:34This particular crash seemed to encourage more motorists to jump on the bandwagon.
31:39We then received a claim from somebody else, a third car.
31:44This one apparently was actually in front of the party that our policyholder had hit.
31:49That was quite a shock for us to receive, so long after the incident, a new claim from a new
31:55party.
31:56The new kid on the block had ambition.
31:59The third party actually submitted a claim to us for about £1,000 worth of damage to the rear end
32:06of their vehicle.
32:07So what they were trying to tell us was that our policyholder had hit the second vehicle, which in turn
32:14had pushed into their vehicle, the third vehicle.
32:17So on this occasion, we had not just one, but two parties who thought they could use the opportunity to
32:25make excessive and exaggerated claims.
32:30So therefore to us, this now became a fraudulent claim rather than a genuine claim.
32:37All we simply do is write to the parties and inform them that in actual fact we do not believe
32:43that the incident occurred in the way in which they have described,
32:46or that the level of damage they have claimed for was actually sustained, and therefore we repudiate their claims.
32:54But this case was not going away, and the audacity of the parties involved was bold to say the least.
33:01There was a further surprise for us that we really weren't expecting from the owner of the third vehicle.
33:07Having repudiated their claim, they had then decided to go and seek legal counsel,
33:13and then decided that they wanted to sue us for the damage that they had incurred.
33:17This was the driver that was not mentioned at all during the incident.
33:22The one who provided no evidence whatsoever. A bit of a phantom really.
33:27But Insure the Box was then forced to follow his lead.
33:30As a result, we then went to the court to appear before a judge, and we were able to provide
33:35all the evidence that we had.
33:38Such a minor case that had been jumped on by opportunists ended up in court, where finally some justice was
33:45served.
33:45The judge looked at all the evidence and found in the favour of Insure the Box,
33:52and actually told that this third party, this third car owner, actually not only would not receive payment for their
33:58claim,
33:59but actually they were charged with fundamental dishonesty and ordered to pay all of our costs.
34:06It was a good and welcome result.
34:09This also sends a message to people who might feel that they can use such situations to actually exaggerate a
34:18claim and receive greater compensation than they are actually entitled to.
34:23For both of those parties involved in this case, neither of them received any payment for any claim.
34:31And in actual fact, for the third car owner, he ended up having to pay our legal costs, which far
34:38outweighed the value of his claim to us.
34:47A bouncy new puppy. Who can resist? They're enthusiastic and loyal, but sadly, their young bones are vulnerable to fractures
34:57and race.
34:58Puppies can be notoriously accident-prone, but some owners' methods of recouping vets' fees can be a tad unorthodox.
35:07Insurer Agria deals with thousands of cases each year.
35:11The first interaction in this case was with a breeder who had set up a short-term insurance policy to
35:20cover a French bulldog puppy that she'd sold to a new owner.
35:25The next interaction we have in this case is where the policyholder, so the owner of the puppy that the
35:32breeders set the insurance up for, submits a claim form and we start to assess it on the 25th of
35:37July.
35:38The claim was for lameness and the puppy had damaged its front left leg while playing in the park with
35:43other dogs on the same day that the insurance had been set up.
35:48Looking at the details of the claim, the policy was taken out on the 19th of June and the incident
35:55also occurred on the 19th of June when the puppy damaged its leg.
36:00It's difficult to know at this stage if this was fortuitous or suspicious, but it was certainly going to cost
36:06a lot.
36:07The puppy had broken its front left leg, had gone to the veterinary practice and had immediately been referred to
36:15a specialist to repair quite an awkward fracture and the bill that we received was over £3,500.
36:23It wasn't surprising that the puppy had been referred to a specialist. Depending on where the break is on the
36:28leg, it can affect how the bone grows as the puppy gets older.
36:33So being referred to a specialist and those sort of costs isn't uncommon at all.
36:37But, and there was a big but.
36:40The thing that set the alarm bells ringing really loudly was the timings in this case.
36:46So at 5.21 the policy had been set up, but at 5.26, just five minutes later, the puppy
36:52with a broken leg was already in the veterinary practice seeking treatment.
36:57With these facts, and they were definitive points in time, the claims assessor escalated the claim to our claims manager,
37:05who decided to probe further.
37:08Can I just ask you a few questions around the time of setting up the policy and the accident, if
37:14that's OK?
37:15Yeah, of course you can.
37:15So you went for a walk, did you say, with all the other puppies or just?
37:19One of the adults and two or three of the puppies.
37:23And you say you were out in the park, were you?
37:25Yeah.
37:26And can you roughly remember sort of what time of day that was?
37:29Two times, yes.
37:30So when you're out in the park and the accident happened, you say the puppy blessed, fell downstairs.
37:36What happened after that?
37:38Well, he was limping, so we all were fat.
37:43Yeah.
37:44He carried on limping and he obviously couldn't put any weight on his front leg properly.
37:51So we stayed with the puppies and the other dogs and the daughter and took him to the vets.
37:57They couldn't do anything immediately then, though.
38:00It was late.
38:01So they said take him home, watch him, and then bring him back the day after, and that's when they
38:07x-rayed and everything were done.
38:08The problem I have, you know, the policy was actually set up at 20 past five, so we've got the,
38:17you know, your daughter was in the practice at 26 minutes past five.
38:21In this situation, where the policy was taken out and five minutes later it's being used, the puppies at the
38:28vet having treatment, there's undoubtedly intent, intent by the policy holder, probably the breeder, to actually defraud an insurance company
38:37of the cost of that veterinary treatment.
38:39Aside to the fact that the policy was taken out only five minutes before the puppies started to have treatment
38:45at the vets, one of the other areas of concern was that all the veterinary bills were in the breeder's
38:53name, in the breeder's name and bills for the breeder's address.
38:58But it transpired that the breeder was a lot closer to the case than anyone had realised.
39:04Is it your daughter or you purchased the puppy from...?
39:09Yes, we did. Yeah.
39:11OK.
39:12And my daughter's had two. She started to breed him.
39:15The daughter of the policy holder was the breeder. She had provided the dog to her father and all the
39:21vet's bills and paperwork were in her name.
39:24Following this conversation, our suspicions were that the puppy was the last one in the litter and either the breeder
39:31couldn't sell it,
39:32or the breeder was keeping it to bring on herself when the injury occurred.
39:36So you were out in the park. She was setting up the policy at twenty past five.
39:41You know, in the space of five minutes, the policy was set up.
39:45Well, no. I mean, she was in the car. We must have been nearly back at the car.
39:50And she finished that off, I presume.
39:53So she was sitting in the car, decided to set up the policy.
39:57No, she sat in there. She said, I'll finish the pay for a coffee while you walk the dog.
40:02Right at what? At twenty past five?
40:05Yes.
40:07Within five minutes, broke his leg, and you're in the practice getting the puppy weighed.
40:14Well, because she's sort of saying the timing's arrived, yeah.
40:17Do you think that's possible?
40:18I don't know.
40:20That must have been a super speedy walk, a very swift accident,
40:23and presumably the vet's practice was in the park.
40:27The course of events being described was fiction.
40:31You think it's possible that within five minutes of the policy being set up,
40:37you being in the car, in the park, and the puppy hurting itself,
40:41and getting to the vets, and having the puppy weighed in five minutes?
40:45Well, I don't know. We were buying a puppy. The insurer's policy was offered by, I don't know.
40:52But you must know.
40:54Oh, well, unless one of the timings, he's on somewhere there.
40:57No, we've got our evidence from our records and evidence from the medical history from the vets.
41:04And we've got that the practice has actually also informed us that, you know, the puppy sadly fell down the
41:11stairs.
41:12I really don't know. Like I say, everybody was upset that the puppy was hurt, so...
41:17You know, I remind you, obviously, under terms and conditions of policy, that we must have accurate information.
41:25The nature of how the puppy really received its injury was in question, as well as the bionic timing of
41:32the events.
41:33You must be aware that it would have taken longer than five minutes between the puppy hurting himself and getting
41:39to and setting up the policy.
41:41Possibly, yeah.
41:43So, obviously, under our terms, I repeat to you that, you know, obviously, if we suspect or it is proven
41:47that claim involves any form of dishonesty, we are entitled to, you know, not pay a claim.
41:53So, I say, it is a concern that the information that we've been provided with isn't correct, is it?
41:59It was as I thought, as I remembered it.
42:02We will be declining this claim on those grounds.
42:05Right. Fair enough.
42:06So, I appreciate your time, but thank you very much.
42:08But I am disappointed.
42:09Okay, bye-bye.
42:13Thank you, mister.
42:15The costly vets bill of £3,500 would not be covered.
42:20And this daughter and father duo will live to regret trying to claim for an accident that happened before the
42:27policy was set up.
42:28There are various implications for the policyholder and for the breeder.
42:33So, breeder-wise, we will advise the Kennel Club that this breeder has acted fraudulently.
42:40We will also advise the Insurance Fraud Investigation Group, IFIG, that the policyholder has potentially been fraudulent and they will
42:52include that policyholder on their files.
42:55And finally, we will stop the breeder activating any more insurance policies for their new owners.
43:01So, that breeder has lost a valuable tool in their whole breeding program.
43:33So, everything is really on the ground.
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