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Rogue Claimers - Season 2 Episode 03
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00:05insurance fraud has reached epidemic levels in the UK it's costing us more
00:10than 1.3 billion pounds every year that's almost 3.6 million pounds every
00:16day deliberate crashes bogus personal injuries even phantom pets the fraudsters
00:24are risking more and more to make a quick killing and every year it's adding
00:29around 50 pounds to your insurance bill but insurers are fighting back exposing just under
00:3415 fake claims every hour armed with the latest fraud busting technology subject out the vehicle
00:41including covert surveillance systems sophisticated data analysis techniques
00:47and specially trained fraud investigators oh they're catching these chances red-handed
00:54instead of getting away with it even more of these fraudsters are getting caught out this is road
01:02claimers
01:09today unscrupulous car passengers claim to be hit by a bus and hurt badly it's hard to see how any
01:17of
01:17the injuries could have been sustained from this collision in fact it's it's impossible not hard
01:23to see a prisoner reports a serious injury on the treadmill but the evidence suggests otherwise and
01:30appeared on our computer system that he'd been in the gym and above all else I didn't recognize him
01:35or none of the PE staff recognized him as a gym goer and a calamitous con man forgets which side
01:43his fake
01:43injury is on she had to tell him he was using the wrong hand and he switched hands with the
01:49uh with the crutch which again uh was a bit of a um flag for us
02:01accidents in the workplace are inevitable so employers have a duty of care and insurance in place to help
02:07those affected but as insurer QBE found it's vital to check claims has not all of them are honest
02:16initially we were told by and showed that an accident occurred involving one of the employees
02:21and that he'd fallen 40 feet from scaffolding to the ground
02:26and then into a pit six feet below.
02:29The list of injuries was horrific.
02:33He sustained some quite significant injuries,
02:36including a broken shoulder blade, broken arm,
02:41had 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,
02:55almost 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
03:08shortly after our incident.
03:11This was one unlucky man,
03:13but the car crash raised some questions about his work accident.
03:18The significance of the previous incident was that he said
03:22that he was struggling to do normal day-to-day activities,
03:26which inferred to us that he could actually do that before.
03:30And this was only a matter of months after the accident
03:34where 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
04:00about how he was incapacitated following the accident.
04:04We tried to gather additional evidence
04:07so 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,
04:17he was after in the region of £300,000 purely for the physical injuries
04:23and in the region of £650,000 for any additional losses.
04:32Given the extent of his injuries and incapacity,
04:35the claim for almost £1 million was probably fair.
04:39But with doubts about the truthfulness of the claimant,
04:43QBE arranged its own medical examination.
04:47He presented with a much higher level of disability,
04:50including the need of a crutch,
04:54being unable to wash and dress,
04:57unable to make a hot cup of coffee due to dizziness and lethargy.
05:02He was actually saying that he was worse than he was
05:05when he'd seen his own medical experts.
05:07So this, again, to us was another factor
05:11which indicated that he might not be telling the truth.
05:14The multiple inconsistencies we'd seen
05:17and 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
05:30and surveillance of the claimant.
05:33Given the claimant had said he needed to use a crutch
05:36and was incapable of making a cup of coffee,
05:39QBE was expecting to see a broken, injured recluse.
05:43What we actually saw was somebody
05:45who seemed to be going about his daily activities
05:48without any difficulties whatsoever.
05:51And in fact, over the many hours of surveillance
05:54that 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
06:08along the beach with his partner and children.
06:13We also had him working up a ladder,
06:17fitting a sign to a shop.
06:20And when he went to see our medical expert,
06:23there was quite a contrasting picture
06:25where 10 minutes before he went there,
06:29he was fine doing his daily activities.
06:33And then when he went to see our medical expert,
06:35he 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
06:45that she had to tell him that he was using the wrong hand
06:47and he switched hands with the crutch,
06:50which again was a bit of a flag for us.
06:56Just a bit.
06:57There was some definitely conscious exaggeration here
07:01that 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
07:11because he was unable to stand up for too long
07:14seems in perfect health as he walks along the seafront.
07:19And his dodgy right shoulder
07:21certainly 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,
07:50we 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.
08:04Four years after the original incident,
08:06he tried his best efforts to have our evidence thrown out
08:10which indicated he had been fraudulent.
08:13Determined 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,
08:24we were in the criminal court
08:25and he was found guilty of attempted fraud
08:29and sentenced to two years, suspended for two years.
08:33The judge said that fraud like this is not a victimless crime
08:38and that it affects the public at large.
08:41In this case, it affected the claimant too.
08:46Because of the extent of his lies,
08:48he ended up receiving nothing.
08:51I think anybody who thinks that they will get away
08:54with this sort of thing are pretty foolish
08:56because there's a lot of tools that fraud are just as hands
09:00to identify and gather the evidence of fraud
09:04and insurers are keen to make sure
09:07that people pay for their crimes.
09:14Later, the impact of a rear-end shunt
09:17is massively exaggerated.
09:19They had not suffered the injuries they had claimed.
09:23They had just used the opportunity
09:25to try to put in an excessive claim
09:28to commit fraud.
09:39Having burglars invade your home
09:42and root through your personal possessions
09:44is 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
09:55provides compensation for the things that can be replaced.
10:01Jewelry specialist LMG
10:03deal with many claims for stolen items
10:06and know all too well that whilst most are genuine,
10:09for some people,
10:10a burglary is an opportunity to try and cash in.
10:18We were presented with a claim
10:20for the theft of some jewellery items during a burglary
10:23and at that point,
10:25there didn't seem to be any particular concerns.
10:28The policyholder advised us
10:29that they had gone out for an evening
10:31and it's during that time
10:33that their house was burgled.
10:34And the burglars had gone off
10:36with some pretty pricey booty.
10:38The claim was for five pieces of diamond-set jewellery
10:41which consisted of a pair of earrings,
10:44a pendant,
10:45and some diamond-set rings.
10:47The total value of the claim
10:48was just over £7,000.
10:52As far as LMG was concerned,
10:55at this stage,
10:56it was all looking pretty standard,
10:58apart from one thing.
11:00We made contact with the policyholder
11:02or attempted to,
11:03but it was nearly three months
11:05before they actually responded
11:06to our letters and messages.
11:10This seemed unusual.
11:12The claimant had just been burgled,
11:14had lost £7,000 worth of jewellery
11:17and didn't seem to be in any kind of rush.
11:20Most people would like to try and get it sorted out
11:23as soon as possible.
11:25When the claimant finally responded,
11:27LMG asked for support in documents to be sent in,
11:30receipts for proof of purchase,
11:32maybe even a valuation.
11:35The claimant told us
11:36that he didn't have any paperwork
11:37to support their claims,
11:39but they did have some photographs
11:40that would help us.
11:42It was not uncommon for claims to be assessed
11:44using just photographic evidence.
11:48Photographs can give us an idea
11:49of size and gauge,
11:51and particularly diamond-set jewellery
11:53gives us an idea
11:54of the approximate carat weight of the stones.
11:57The photographs were very clear
11:59and did show the items in detail.
12:01They were purpose-taken of the actual items
12:03in boxes.
12:05The quality was good,
12:07and the diamond weight and carat
12:09could be established,
12:10but there was a problem.
12:11The data show that the photographs
12:13were actually taken
12:14after the date of the alleged burglary.
12:18The burglary happened on 17 August,
12:21and the photographs were taken
12:23on 19 August.
12:24It would have been physically impossible
12:26to photograph items
12:27that were supposedly nicked from your home
12:29two days earlier.
12:34One of our standard validation questions,
12:37if we're presented with photographs,
12:39is when they were taken and why.
12:41And we were advised, in this case,
12:43they were taken around 10 years ago.
12:46Not only did the data dates not tally,
12:49they had also tried to pass
12:50the photographs off as vintage.
12:53The photographs were definitely not taken
12:5510 years ago,
12:56as we were advised.
12:58And indeed,
12:58the device they were taken on
12:59would not have been available
13:00at that time.
13:02LMG wasn't dealing
13:04with the brightest of opportunists,
13:05but opportunists, nevertheless.
13:09There was no doubt
13:10that the photographs
13:11were taken after the loss,
13:12and so this was a fraudulent claim.
13:14We presented our report
13:15and all the evidence
13:16to the insurance company
13:17and suggested they did not pay out
13:18on the claim.
13:21And with that,
13:22the claim was rejected.
13:23And for LMG,
13:24it was a glittering result.
13:32First Group is one of the largest
13:33bus companies in the UK,
13:35carrying more than
13:36one and a half million passengers a day.
13:39Most buses get to their destination
13:41without problems,
13:42but some trips are hijacked
13:44by those along for more than the ride.
13:47This is a case that arose
13:48when one of our buses
13:49has overtaken a stationary car,
13:51and as it's going past,
13:53it's just managed to clip the vehicle.
13:54According to the passengers
13:56in the vehicle,
13:57the impact was of a sufficient nature
13:59to throw them around in the car
14:01and actually cause the vehicle
14:02to be shunted forwards.
14:04First Group was looking
14:05at having to fork out.
14:07The damage inflicted to the vehicle
14:09was enough to render it a write-off,
14:12so we're not talking about
14:13a small amount of damage here.
14:15With three people in the car,
14:17the range of injuries is quite wide,
14:20sort of extending from
14:22soft tissue injuries to the neck,
14:23some headaches.
14:26One of the passengers
14:26was injured by the seatbelt
14:28as it's managed to crush
14:29her left breast.
14:31There were a number of soft tissue injuries
14:34to the shoulders,
14:36basic travel anxiety,
14:37so things that we normally see
14:39from this sort of accident
14:41where passengers are now
14:42wearing seatbelts as well.
14:44Taking into account the injury claims,
14:47the cost of the claims,
14:48any elements of physio treatment
14:51that were needed,
14:52the claim would have come
14:53to £27,500 for all three claimants.
14:57First Group made checks
14:58on what happened
14:59with interesting results.
15:01With this particular one,
15:03we'd been told
15:04of quite a meaty impact,
15:06and yet there was no damage
15:07at all to the bus.
15:10The bus driver said that
15:11as he was passing the car,
15:14he's misjudged the distance
15:15as he's gone by,
15:16and he's just managed to clip it
15:18with the rear of his bus,
15:20just along the rear
15:21of the driver's side
15:22of the vehicle.
15:23He said it was a very minor
15:24coming together,
15:26so he was a bit surprised
15:28to find out subsequently
15:29that claims had been submitted.
15:31But they were,
15:32although they raised
15:33some serious questions.
15:35When the claims were submitted,
15:37two of the claimants
15:39had not sought
15:39any medical treatment at all.
15:42None of them
15:42had been to see their GPs,
15:44with only one of them
15:45going to seek assistance
15:47at a walk-in centre.
15:48Yet all three claimants
15:50put in claims
15:50for personal injury
15:51and said that they needed
15:53physiotherapy treatment
15:54to deal with their injuries.
15:57With the discrepancies
15:58between what actually happened
16:00in the circumstances
16:01of the accident
16:02between the driver
16:02and the third party's version
16:04of events,
16:05that coupled with the fact
16:06that the initial report
16:09said that there was
16:10no time needed off work,
16:11which suddenly changed
16:12to having to take time off.
16:14There was enough building here
16:15to justify us wanting
16:17to take a closer look
16:18at this claim.
16:19So First Group
16:21got its engines rolling.
16:22We instructed
16:23a forensic engineer
16:24to have a look at the car
16:25just to see whether
16:27the damage that was being
16:28alleged was correct
16:29and could have caused the injuries.
16:31His findings were
16:32that it was a glancing blow
16:34and not the bumper-to-bumper
16:36impact that the third party
16:37is alleging had happened.
16:39Now, the key there
16:40is that in order
16:41to sustain a soft tissue injury,
16:43you really do need
16:44some sort of transfer of energy.
16:47Otherwise, you're not
16:48going to have that movement
16:49to cause the injury
16:49in the first place.
16:51The second thing
16:52that the forensic engineer
16:53has picked up
16:54is that the vehicle
16:56being written off
16:57wasn't caused
16:58by the severity of the impact.
17:00It was more to do
17:01with the fact
17:01that the vehicle
17:02was quite old
17:02and had quite a low value.
17:05You'll find that
17:06in a lot of instances
17:07if the vehicle is old
17:08and isn't worth very much,
17:10you can probably write it off
17:11by sneezing on it
17:12a lot of the time.
17:13But the vital proof
17:15to help First Group
17:16fight this claim
17:16was yet to come.
17:18We also had
17:18the best evidence
17:19we can get
17:20from the CCTV footage.
17:22Once I'd reviewed
17:23the CCTV,
17:25my mind was made up
17:26much like the claimant's
17:27accident circumstances
17:29it turned out.
17:34Based on what I'm seeing here
17:36and the lack of any
17:38real movement
17:38of the vehicle,
17:39it's hard to see
17:41how any of the injuries
17:43could have been sustained
17:44from this collision.
17:46In fact,
17:47it's impossible,
17:47not hard to see.
17:49No, you haven't missed it.
17:51That was the impact
17:53the claimant said
17:54had caused so many injuries.
17:56When you watch it back
17:57the impact
17:58is very slight.
18:00The vehicle doesn't move
18:01at all,
18:02let alone being
18:03shunted forward.
18:05That just didn't happen.
18:07We send all the evidence,
18:08the CCTV,
18:10the forensic evidence,
18:11the photos showing
18:12there's no damage
18:12to the bus,
18:13all goes on
18:14to the claimant's
18:15solicitors.
18:16Surely there's enough
18:17there for them
18:18to drop this claim.
18:19No,
18:20they litigated.
18:23Unbelievable,
18:24given the weight of evidence.
18:25But why let hard facts
18:27get in the way of justice?
18:28In this case,
18:30only one of the claimants
18:31actually issued proceedings.
18:33In multiple occupancy
18:35situations like this,
18:36that's not entirely unusual.
18:38It gives the other claimants
18:39an opportunity
18:39to test the waters
18:41and sort of evaluate
18:43the certainty
18:44of their case getting through.
18:45It also gives them
18:46the opportunity
18:47to see what sort of defence
18:49that we're going to put up
18:50for the claims
18:51to build their case
18:52for a later date.
18:54So now we've got
18:55one claim litigated,
18:57two claimants
18:58sitting in the wings,
18:59the fight is on.
19:00Given the evidence available,
19:02you'd think
19:03some sense would prevail.
19:05On the day of the trial,
19:07there were a number of tactical
19:08maneuverings carried out
19:09by the other side
19:10to try and swing things
19:12in their favour,
19:13the strangest of which
19:14was to try and ban
19:15the CCTV evidence
19:16from the trial
19:18through to trying
19:19to stop the photos
19:20showing there was
19:21no damage to the bus.
19:23First group must have been
19:24more than a tad frustrated.
19:26This went before the judge.
19:28He said he wasn't really fussed
19:30about seeing the photos
19:31of the damage to the bus,
19:32but the CCTV evidence
19:34was the most critical
19:36piece of information
19:37there was
19:37and he said
19:38he wasn't prepared
19:39to let the trial run
19:40without seeing that.
19:41It was there,
19:42it was available,
19:43why would he not
19:44want to see it?
19:45The credibility of their case
19:46rapidly came into question.
19:49They'd used words
19:49such as the wheel being mangled.
19:52It wasn't mangled,
19:53it was scraped.
19:55When we put that to us,
19:56he said,
19:56oh, I've chosen
19:57the wrong word,
19:58which is a bit coincidental
20:00really,
20:01seeing as the other
20:02two claimants
20:02giving witness evidence
20:03use exactly the same word,
20:05which would suggest
20:06that they had discussed
20:08this between them
20:09before the actual trial.
20:11We looked at her
20:12medical history,
20:14no attendance at the GP
20:15following the accident
20:16and yet every cough,
20:18sneeze, cold,
20:20bruised elbow,
20:21regular health checkups,
20:22she would go to her GP.
20:24So she's in an RTA,
20:26gets a whiplash injury
20:27and doesn't go to see her GP.
20:30The evidence was shaky,
20:32then first group
20:33called on its big guns.
20:35The final nail in the coffin
20:36was when one of the witnesses
20:37took the stand,
20:39still maintaining
20:40that the vehicle
20:40had been shunted forwards.
20:42We put the CCTV evidence
20:44and showed her that
20:45and said,
20:46are you sure?
20:47She had to rapidly
20:49backtrack on that
20:50and say,
20:51clearly not.
20:52So it really did show
20:54that that piece of evidence,
20:56the vehicle being shunted forward,
20:58just wasn't true.
21:00They were never going to get home
21:01on that one.
21:02And luckily for first group,
21:04the judge agreed.
21:06He came to the decision
21:07that the claim just could not stand.
21:09He dismissed the whole case.
21:11So, all good,
21:13case is done and dusted.
21:15No, it's not.
21:17There is no way
21:18we were going to let this person
21:19or any of these claimants
21:21have a free run at this claim.
21:24We went straight back
21:25to the solicitors
21:25and said,
21:26we want to go back to court
21:27and push for a finding
21:29of fundamental dishonesty,
21:30which would then
21:31incur quite a hefty cost penalty
21:34against the claimant.
21:35You can't just let people
21:36get away with these things.
21:40The solicitors,
21:41having seen the case
21:42and the CCTV evidence,
21:44were obviously not happy
21:45about going back to court
21:46because they didn't have
21:47a great chance of winning.
21:50So, they made us an offer
21:51for our costs.
21:53Tried to haggle a little bit.
21:56We were having
21:56absolutely none of it.
21:58We wanted the full lot
21:59or we were going back to court.
22:01And in the end,
22:02they just had to give in.
22:09Still to come.
22:10Time is of the essence
22:12for a poorly pooch
22:13out for walkies.
22:155.21, the policy had been set up.
22:17But at 5.26,
22:19just five minutes later,
22:21the puppy with a broken leg
22:23was already in the veterinary practice
22:24seeking treatment.
22:32HMP Garth in Lancashire
22:34houses long-term
22:36and high-security prisoners.
22:37Its staff oversee
22:39more than 800 inmates
22:40and know that bored prisoners
22:42can latch on to the type of scams
22:44that got them banged up
22:45in the first place.
22:47PE instructor Lee Double
22:49works with many of the men
22:51in the gym.
22:51The following case
22:52features one prisoner
22:53who is keen to use
22:54the exercise equipment.
22:56But fraud,
22:57rather than fitness,
22:58was his end goal.
22:59The claimant said
23:00that he came into the gym,
23:02that he typed his age
23:04into a running machine
23:05and it set off really quickly.
23:07With that,
23:07he fell but clung
23:09onto the bar
23:10on the treadmill.
23:11The treadmill carried on
23:12spinning,
23:13pulling his jogging bottoms off
23:15and his underwear off,
23:17causing abrasions
23:17to his thigh
23:18and shins
23:19and eventually
23:20it spat him out
23:21of the machine.
23:23This sounds nasty,
23:25but Lee was sceptical.
23:27I was suspicious
23:28about the claim
23:28because I didn't recognise
23:29the prisoner's name
23:31as a gym attendee.
23:33I checked the date
23:34he'd given us
23:34and it didn't match
23:35with the dates
23:36of the classes
23:37off of that particular wing.
23:39I checked the class list
23:41and he had never appeared
23:42on a list,
23:43hadn't appeared
23:43on our computer system
23:44that he'd been in the gym.
23:46And above all else,
23:47I didn't recognise him
23:48or none of the PE staff
23:50recognised him
23:50as a gym goer.
23:52So was this a phantom
23:53visit to the gym then?
23:55Prison governors,
23:56Steve Pearson,
23:57acknowledges inmates
23:58can be inventive.
24:00We encounter these
24:01on a reasonably
24:02regular basis.
24:03I think sometimes
24:04there's a culture
24:05within the prisons
24:06of men
24:06almost being bored
24:08and deciding
24:08to use litigation
24:09as a hobby.
24:11I think from time
24:12to time we get people
24:13who are opportunistic,
24:15who try and push
24:16and bend the rules
24:17and it's our job
24:18to make sure
24:18we follow our procedures
24:19to make sure
24:20that they can't do that.
24:21The story presented
24:22of the treadmill terror
24:23was full of holes.
24:25He claims
24:26that there was
24:26four members of staff
24:27on duty that day
24:28so a question I asked him
24:30if he was unsure
24:31how to operate
24:32the piece of equipment
24:33why didn't he ask
24:34a member of staff
24:35how to do so?
24:37A good question.
24:38Also,
24:39if he wasn't expected
24:40at the gym,
24:41how enough
24:41did he get there?
24:43The prisoners
24:44are escorted
24:45from their residential unit
24:47straight up to the gym
24:48so there's no way
24:49that he could have got in
24:50without one of us knowing.
24:52The prisoners said
24:53that he'd actually
24:54left the wing by himself
24:56and said that the gates
24:57were open
24:57between the residential unit
25:00and the gymnasium
25:01and that he'd just walked in
25:02which is impossible.
25:04So if the prisoner
25:06did somehow
25:06get himself to the gym,
25:08could he have injured himself
25:10in the way he alleged?
25:12It's highly unlikely
25:13the accident occurred
25:14how he said it would have been
25:15because the machine
25:17takes a little while
25:18to build up to the speed
25:19that you type into it
25:21so it doesn't go from zero
25:22straight up to your target speed.
25:24It builds up gradually.
25:27We've always got PE staff
25:29on the gym floor
25:30to hang on to a running machine
25:32while it carries on going
25:33for five minutes.
25:35It's nigh on impossible.
25:36The gym staff
25:37would have been attentive,
25:39would have stopped the machine
25:39and offered him medical help
25:41straight away.
25:42So nothing really stacked up
25:44from him telling me
25:46how he got to the gymnasium
25:48in the first place
25:48to the events inside the gym.
25:50It just wouldn't have
25:52possibly happened.
25:54But our fitness fanatic
25:55who claims to have fallen
25:56and not just lost
25:57his jogging bottoms
25:58but also his underwear
25:59was undeterred
26:01and keen to complete
26:02his workout.
26:03He then said that
26:05after he received his injuries
26:06he then went on
26:07to a row machine
26:08and continued to row
26:09for a few minutes
26:10which just wouldn't
26:10have been impossible
26:11given the level of injuries
26:12he said he received.
26:14Healthcare would have been notified,
26:16they would have attended to him
26:18and there would have been
26:19a record on his medical history
26:20that he'd received injuries
26:22and there wasn't nothing.
26:23The prison service
26:25knew it had some strong evidence
26:26and waited for its day in court.
26:29I was invited to give my evidence
26:31and question the prisoner
26:35on what he alleged to happen
26:37in the gym
26:38and explained that
26:39there's no way
26:40that could have happened.
26:42The judge when summing up
26:43in court
26:44said to the prisoner
26:46that his case was very weak
26:48and had lots of holes in it
26:49and she warded in our favour.
26:52Given the inmates leaky story
26:54the result was perhaps inevitable
26:56but stretched prison staff
26:58have more pressing demands
26:59on their time.
27:00When the judge found in our favour
27:02I was very pleased
27:03but also a little bit annoyed
27:05that the case had got that far
27:07because the incident
27:09had never occurred
27:10and it put a lot of staff
27:11under a lot of stress
27:12at the time.
27:13In terms of how much money
27:14was saved
27:15we saved
27:15I guess about £10,000
27:17by defending this claim
27:19£10,000 of taxpayers' money.
27:22Given the fact
27:22that this is the public purse
27:24and we know
27:25how stretched that can be
27:26and making sure
27:27that we spend money
27:28on stuff that's good
27:29rather than giving money
27:30on spurious claims.
27:37In the fight against fraud
27:38insurers are using
27:40every bit of tech
27:41at their disposal.
27:42One way of monitoring
27:44a vehicle
27:44is to use an on-board system
27:46called telematics.
27:47This shows where
27:49and when it's been driven
27:51how fast
27:52and how safely
27:53so anything out of the ordinary
27:55is easily spotted.
27:58Insure the Box
27:58is a company
27:59which insists
28:00on such a little black box
28:01for its policyholders.
28:03As Simon Rule
28:04its head of financial crime
28:06illustrates
28:06this extra layer
28:08of information
28:08can prove vital
28:10when assessing claims.
28:12A policyholder
28:13reported to us
28:14that they had
28:16driven
28:16at low speed
28:17into the back
28:18of another vehicle.
28:21Because it was
28:22such a low impact incident
28:23the level of damage
28:25was relatively minor.
28:27As you would expect
28:27there were some
28:28small dents
28:29and scratches
28:29to the bumper
28:30to light clusters
28:33and a bulb
28:34had actually been
28:34dislodged as well.
28:36Based on the information
28:38it had received
28:39Insure the Box
28:40wasn't expecting
28:41a big claim.
28:42We were rather surprised
28:44then to receive
28:45a few days later
28:46a claim from
28:47the second party
28:48of the accident
28:49asking for
28:50about £4,000
28:51worth of damages
28:52to their car
28:53to be repaired.
28:54Usefully
28:55the policyholder
28:56had other evidence
28:57gathered within
28:57the black box
28:58of his car.
28:59We were able
29:00to tell
29:01using the box data
29:02the speed
29:03prior to the accident
29:05as well as
29:06the level of G-forces
29:08that were involved
29:08in the impact itself.
29:11And also
29:12the box is able
29:13to tell us
29:14from a little gimbal
29:15that's inside there
29:16the impact
29:18on the X, Y
29:19and Z axes
29:20so we knew
29:20the vehicle
29:21remained upright
29:21it was just going
29:23in a forward direction
29:24and there was
29:25no side impact.
29:25The driver claiming
29:27had no idea
29:28the insurers
29:29had so much detail
29:30about the accident
29:31his naivety
29:33soon becomes clear.
29:35To our surprise
29:36a further claim
29:37came through
29:38from the second party
29:39and this time
29:40it was for bodily injury
29:43but in actual fact
29:44it wasn't just
29:44for the driver
29:45they now claim
29:47that there was
29:47a passenger
29:48in the car
29:49at the same time
29:50and this person
29:52had never been mentioned
29:53in any of the details
29:54given to us
29:55by our policy
29:55holder
29:56and the photographs
29:57didn't show
29:57anything either.
30:00So we now
30:01have received
30:02two claims
30:03from the owner
30:03of the second vehicle
30:05we've received one
30:06for what we consider
30:08to be excessive
30:08damage to their car
30:09and we've also
30:10now received
30:11a personal injury claim
30:13so in total
30:13this is worth
30:14about nearly
30:14£14,000
30:18but of course
30:19at this time
30:19we haven't received
30:20much information
30:21from the owner
30:22of the second vehicle
30:24so we contacted
30:25them and said
30:25well we require
30:27further information
30:27from you
30:28to provide evidence
30:29for your substantive claim
30:32Any results
30:33would be interesting
30:35We actually received
30:37from their solicitors
30:38an engineer's report
30:39which they hoped
30:40would substantiate
30:41their claim
30:42showing excessive damage
30:43to the car
30:44which we hadn't seen
30:45recorded
30:46through the original
30:47pictures and statement
30:48made by our own
30:49policyholder
30:50when we examined
30:52the engineer's report
30:53it was quite interesting
30:54because they were
30:55noting on there
30:56that the damage
30:57to the rear end
30:58of their claimant's vehicle
31:00was far more
31:01than we had seen
31:03in the photographs
31:04and it actually
31:05had looked like
31:06they had actually
31:08created or caused
31:09further damage
31:10post-incident
31:11to actually create
31:14a value
31:14for this particular claim
31:16looking at the photo
31:17of the second vehicle
31:19that was taken
31:19at the time
31:20of the accident
31:20then the photo
31:22that was sent in
31:23following the engineer's report
31:24you could see
31:25quite a difference
31:26and not surprisingly
31:28ensure the box
31:29rejected the claim
31:30you think this may be
31:32the end of the matter
31:33but no
31:34this particular crash
31:35seemed to encourage
31:36more motorists
31:37to jump on the bandwagon
31:39we then received
31:40a claim
31:41from somebody else
31:42a third car
31:43this one apparently
31:45was actually
31:46in front of the party
31:47that our policyholder
31:49had hit
31:49that was quite a shock
31:50for us to receive
31:51so long after the incident
31:53a new claim
31:54from a new party
31:56the new kid on the block
31:57had ambition
31:59the third party
32:01actually submitted
32:02a claim to us
32:02for about a thousand pounds
32:04worth of damage
32:05to the rear end
32:06of their vehicle
32:07so what they were trying
32:09to tell us
32:09was that our policyholder
32:11had hit the second vehicle
32:13which in turn
32:14had pushed into
32:15their vehicle
32:16the third vehicle
32:17so on this occasion
32:19we had not just one
32:20but two parties
32:22who thought
32:23they could use
32:24the opportunity
32:25to make
32:26excessive
32:28and exaggerated claims
32:29so therefore to us
32:31this now became
32:32a fraudulent claim
32:33rather than
32:34a genuine claim
32:37what we simply do
32:39is write to the parties
32:40and inform them
32:41that in actual fact
32:42we do not believe
32:43that the incident
32:44occurred in the way
32:45in which they have described
32:46or that the level of damage
32:48they have claimed for
32:49was actually sustained
32:51and therefore we repudiate
32:52their claims
32:53but this case
32:55was not going away
32:56and the audacity
32:57of the parties involved
32:58was bold
32:59to say the least
33:01there was a further
33:02surprise for us
33:03that we really
33:03weren't expecting
33:04from the owner
33:05of the third vehicle
33:07having repudiated
33:08their claim
33:09they had then decided
33:11to go and seek
33:11legal counsel
33:13and then decided
33:14that they wanted
33:15to sue us
33:15for the damage
33:16that they had incurred
33:17this was the driver
33:19that was not mentioned
33:20at all
33:20during the incident
33:21the one who provided
33:23no evidence whatsoever
33:24a bit of a phantom
33:26really
33:26but ensure the box
33:28was then forced
33:29to follow his lead
33:30as a result
33:30we then went to the court
33:32to appear before a judge
33:33and we were able
33:34to provide
33:35all the evidence
33:36that we had
33:38such a minor case
33:39that had been jumped on
33:40by opportunists
33:41ended up in court
33:43where finally
33:44some justice
33:45was served
33:45the judge looked
33:46at all the evidence
33:47and found in the favour
33:50of ensure the box
33:52and actually told
33:53that this third party
33:54this third car owner
33:55actually not only
33:57would not receive payment
33:58for their claim
33:59but actually
34:00they were charged
34:01with fundamental dishonesty
34:03and ordered to pay
34:04all of our costs
34:06it was a good
34:07and welcome result
34:09this also sends a message
34:11to people
34:11who might feel
34:12that they can use
34:14such situations
34:16to actually
34:17exaggerate a claim
34:19and receive
34:20greater compensation
34:21than they are
34:22actually entitled to
34:23for both of those
34:25parties involved
34:26in this case
34:27neither of them
34:28received any payment
34:30for any claim
34:30and in actual fact
34:32for the third car owner
34:33he ended up
34:35having to pay
34:35our legal costs
34:37which far out well
34:39weighed the value
34:40of his claim to us
34:47a bouncy new puppy
34:49who can resist
34:51they're enthusiastic
34:52and loyal
34:53but sadly
34:54their young bones
34:55are vulnerable
34:56to fractures
34:57and breaks
34:57puppies can be
34:59notoriously accident prone
35:01but some owners
35:02methods of recouping
35:03vets fees
35:04can be a tad
35:05unorthodox
35:07insurer Agria
35:08deals with thousands
35:09of cases each year
35:10the first interaction
35:12in this case
35:13was with a breeder
35:15who had set up
35:17a short-term
35:19insurance policy
35:20to cover
35:21a French bulldog
35:22puppy that she'd sold
35:23to a new owner
35:25the next interaction
35:26we have in this case
35:27is where the policyholder
35:29so the owner
35:30of the puppy
35:31that the breeder
35:32set the insurance up for
35:33submits a claim form
35:34and we start to assess it
35:36on the 25th of July
35:38the claim was for lameness
35:39and the puppy had damaged
35:41its front left leg
35:42while playing in the park
35:43with other dogs
35:44on the same day
35:45that the insurance
35:47had been set up
35:48looking at the details
35:49of the claim
35:50the policy was taken out
35:51on the 19th of June
35:54and the incident
35:55also occurred
35:56on the 19th of June
35:58when the puppy
35:58damaged its leg
36:00it's difficult to know
36:01at this stage
36:02if this was fortuitous
36:03or suspicious
36:04but it was certainly
36:06going to cost a lot
36:08the puppy had broken
36:09its front left leg
36:10had gone to the veterinary
36:12practice
36:12and had immediately
36:13been referred
36:14to a specialist
36:15to repair
36:16quite an awkward fracture
36:18and the bill that we received
36:19was over 3,500 pounds
36:23it wasn't surprising
36:24that the puppy
36:25had been referred
36:25to a specialist
36:26depending on where
36:27the break is on the leg
36:28it can affect
36:30how the bone grows
36:31as the puppy gets older
36:32so being referred
36:34to a specialist
36:34and those sort of costs
36:35isn't uncommon at all
36:37but
36:38and there was a big but
36:40the thing that set
36:41the alarm bells ringing
36:42really loudly
36:43was the timings
36:44in this case
36:45so at 5.21
36:47the policy had been set up
36:48but at 5.26
36:50just five minutes later
36:52the puppy
36:53with a broken leg
36:54was already
36:55in the veterinary practice
36:56seeking treatment
36:57with these facts
36:59and they were definitive
37:00points in time
37:01the claims assessor
37:03escalated the claim
37:04to our claims manager
37:05who decided
37:07to probe further
37:08can we just ask you
37:09a few questions
37:10around the time
37:11of setting up the policy
37:12and the accident
37:13if that's okay
37:14yeah of course you can
37:15so you went for a walk
37:16did you say
37:17with all the other puppies
37:18or just
37:18one of the adults
37:20and two or three
37:22of the puppies
37:22and you say
37:24you were out
37:24in the park
37:25were you
37:25yeah
37:26and can you roughly
37:27remember
37:28sort of what time
37:28of day that was
37:29so when you're out
37:31in the park
37:31and the accident
37:32happened
37:32you say
37:33the puppy
37:34fell downstairs
37:36what happened
37:37after that
37:38well
37:38he was limping
37:39so
37:40we all were fat
37:42yeah
37:44he carried on
37:45limping
37:46and he obviously
37:47couldn't put any weight
37:48on his front leg
37:49probably
37:51so
37:51we stayed with the puppies
37:53and the other dogs
37:54and the daughter
37:55and took him
37:56to the vets
37:57they couldn't do anything
37:58immediately then though
38:00it was late
38:01so
38:01they said
38:02take him home
38:03watch him
38:04and then
38:04bring him back
38:06the day after
38:06and that's when
38:07they x-rayed
38:08and everything
38:08the problem
38:09I have
38:10you know
38:11the policy
38:12was actually
38:12set up
38:13at 20 past 5
38:14so
38:15we've got
38:16you know
38:18your daughter
38:18was in the practice
38:19at 26 minutes
38:20past 5
38:21in this situation
38:23where the policy
38:24was taken out
38:25and 5 minutes
38:26later
38:26it's being used
38:27the puppies
38:28at the vet
38:28having treatment
38:30there's undoubtedly
38:31intent
38:31intent by the
38:32policyholder
38:33probably the breeder
38:34to actually
38:36defraud
38:37an insurance company
38:37of the cost
38:38of that veterinary treatment
38:39aside of the fact
38:40that the policy
38:42was taken out
38:42only 5 minutes
38:43before the puppies
38:44started to have
38:45treatment at the vets
38:46one of the other areas
38:47of concern
38:49was that
38:50all the veterinary bills
38:52were in the breeder's name
38:54in the breeder's name
38:55and bills
38:56for the breeder's address
38:58but it transpired
39:00that the breeder
39:00was a lot closer
39:01to the case
39:02than anyone
39:03had realised
39:04is it your
39:05daughter
39:06or you purchased
39:08the puppy
39:08from
39:09yes
39:10we did
39:10yeah
39:11okay
39:11and my daughter's
39:12had two
39:13decided to breed us
39:14the daughter
39:16of the policyholder
39:17was the breeder
39:18she had provided
39:19the dog
39:19to her father
39:20and all the vets
39:21bills and paperwork
39:22were in her name
39:24following this conversation
39:25our suspicions were
39:26that the puppy
39:28was the last
39:29one in the litter
39:29and either the breeder
39:31couldn't sell it
39:32or the breeder
39:32was keeping it
39:33to bring on herself
39:35when the injury occurred
39:36so you were out
39:37in the park
39:38she was setting up
39:38the policy
39:39at 20 past 5
39:41you know
39:42in the space
39:42of 5 minutes
39:43the policy was set up
39:45well no
39:46I mean
39:46she was in the car
39:47we must have been
39:48nearly back at the car
39:49and she finished that off
39:51I presume
39:53so she was sitting
39:54in the car
39:54decided to
39:55set up the policy
39:56no she sat in
39:58and she said
39:58I'll finish the paperwork
39:59off here
40:00while you walk the dog
40:02right at what
40:03at 20 past 5
40:05yes
40:07within 5 minutes
40:08broke his leg
40:09and you're in the practice
40:10getting the puppy weighed
40:13do you think that's possible
40:18I don't know
40:19that must have been
40:21a super speedy walk
40:22a very swift accident
40:24and presumably
40:25the vet's practice
40:26was in the park
40:27the course of events
40:28being described
40:29was fiction
40:31you think it's possible
40:33that within 5 minutes
40:34of the policy
40:36being set up
40:37you being in the car
40:38in the park
40:39and the puppy
40:40hurting itself
40:40and getting to the vets
40:42and having the puppy weighed
40:43in 5 minutes
40:45well I don't know
40:46we were buying a puppy
40:47the insurer's policy
40:49was offered by
40:50I don't know
40:51but you must know
40:54unless one of the timings
40:55is on somewhere there
40:56no we've got
40:58we've got our evidence
40:59from our records
41:00and evidence
41:00from the medical history
41:02from the vets
41:04and we've got
41:05the practice
41:06has actually also
41:07informed us
41:08that the puppy
41:10sadly fell down the stairs
41:11I really don't know
41:14like I say
41:14everybody was upset
41:16the puppy was hurt
41:17so
41:17you know
41:18I remind you
41:19obviously under terms
41:19and conditions
41:20of policy
41:21that we must have
41:22accurate information
41:25the nature of how
41:26the puppy
41:27really received
41:28its injury
41:28was in question
41:29as well as
41:30the bionic timing
41:31of the events
41:33you must be aware
41:34that it would have
41:35taken longer
41:36than 5 minutes
41:36between the puppy
41:38hurting himself
41:38and getting to
41:39and setting up
41:40the policy
41:41possibly yeah
41:42so obviously
41:43under our terms
41:44I repeat to you
41:45that you know
41:46if we suspect
41:47or it is proven
41:48that claim
41:48involves any form
41:49of dishonesty
41:49we are entitled
41:51to you know
41:51not pay a claim
41:53so I say
41:54it is a concern
41:55that the information
41:56that we've been
41:57provided with
41:57isn't correct
41:58is it?
41:59it was as I thought
42:00as I remembered it
42:01it will be declining
42:03this claim
42:03on those rounds
42:04fair enough
42:05so I appreciate
42:06your time
42:07but thank you very much
42:08but I am disappointed
42:09typically
42:10it's complicated
42:11no really
42:11ok bye bye
42:13ok thank you mister
42:15the costly vets bill
42:17of £3,500
42:18would not be covered
42:20and this daughter
42:21and father duo
42:22will live to regret
42:23trying to claim
42:24for an accident
42:25that happened
42:26before the policy
42:27was set up
42:28there are various
42:29implications
42:30for the policy
42:31holder
42:31and for the breeder
42:33so breeder wise
42:35we will advise
42:36the kennel club
42:37that this breeder
42:39has acted fraudulently
42:40we will also
42:42advise the
42:44insurance fraud
42:45investigation group
42:47IFIG
42:47that the policy
42:49holder
42:49has potentially
42:50been fraudulent
42:51and they will
42:52include that policy
42:53holder
42:53on their files
42:55and finally
42:56we will stop
42:57the breeder
42:58activating any more
42:59insurance policies
43:00for their new owners
43:01so that breeder
43:02has lost a valuable
43:03tool
43:04in their whole
43:05breeding program
43:33in their own
43:36to be able to
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