- 8 hours ago
Rogue Claimers - Season 2 Episode 17
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Short filmTranscript
00:06Insurance fraud has reached epidemic levels in the UK.
00:10It's costing us more than £1.3 billion every year.
00:14That's almost £3.6 million every day.
00:18Deliberate crashes, bogus personal injuries, even phantom pets.
00:24The fraudsters are risking more and more to make a quick killing.
00:27And every year it's adding around £50 to your insurance bill.
00:32But insurers are fighting back, exposing just under 15 fake claims every hour.
00:37Armed with the latest fraud-busting technology.
00:40Subject 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.
00:55Instead of getting away with it, even more of these fraudsters are getting caught out.
01:01This is Rogue Claimers.
01:08Today, a chip shop con man claiming he can't work due to an injury is spotted cooking up a storm.
01:15We had surveillance of the claimant working and also leaving the house.
01:20And these were two of the key facts that he confirmed he couldn't do within his claim for damages.
01:26CCTV is the undoing of an opportunistic fast food delivery driver trying to supersize his claim.
01:33There's nobody in that vehicle at the time that it's hit.
01:36Certainly not the driver who was seen coming out of the premises.
01:40And again, no passengers in any of the seats either.
01:44And older drivers are targeted in a car park crash scam, but the judge sees the claimers for what they
01:49really are.
01:51Part of the claimant's evidence was that our insured driver had chased her around the vehicle.
01:56But our insured demonstrators' walking aid didn't confirm that no point has he chased anybody in the last ten years.
02:07Slips, trips and falls are common.
02:10There are laws to protect workers and companies have insurance in place to cover any incidents.
02:17But there are some employees who experience a genuine injury, but exaggerate it to such an extent that they shoot
02:24themselves in the foot.
02:27Our first character demonstrated a clear case of con and chips to insurer Aksa, despite claiming he was housebound.
02:37We insure a furniture shop, and in January 2013, a claim was received from an employee of our customer,
02:46who alleged that he was asked to lift a large tabletop weighing 80 to 90 kilograms, and he damaged his
02:52back as a result.
02:55The claimant was alleging that this injury irritated a previous problem he had, with a prolapsed disc in his back,
03:02making it worse.
03:04This was a pretty significant value claim. He was claiming 248,000 special damages, plus 20,000 for general damages.
03:14It appeared the claimant was really suffering. He wasn't able to work at all. He wasn't earning, and he claimed
03:20he was housebound.
03:22In addition to the amounts that he was seeking from us, Aksa Insurance, he was also receiving mortgage interest payments
03:31from the DWP,
03:32as a result of not being able to work, and therefore not being able to pay his mortgage.
03:37With this particular case, our customer obviously accepted responsibility, but there were question marks over the veracity of the claim,
03:46and the claimant's credibility, which led us to investigate the matter further.
03:52Aksa's instincts about the high amount being requested, and the reliability of the claimant, seem spot on.
03:59During the course of the validation process, we received intelligence to suggest that the claimant was actually working for another
04:08business,
04:09and he clearly confirmed to us that he was unable to work as a result of the injuries he sustained
04:14whilst employed by our customer.
04:17Given the significant value of this claim, and the potential for it to perhaps rise further, we decided to instruct
04:24surveillance on this gentleman.
04:28Secret filming would determine what the claimant was realistically capable of doing, and it proved very revealing.
04:36We had surveillance of the claimant working, and also leaving the house,
04:42and these were two of the key facts that he confirmed he couldn't do within his claim for damages.
04:47The subject out to subject vehicle over to driver's side.
04:51Driver's door open, subject in in as driver.
04:56It transpired that our fraudster was very selective about when he used his crutches.
05:02On visits to the hospital, for example, they came out.
05:06Perhaps he wanted medical professionals to see him struggling.
05:13But just one hour later, it's a different matter as he stops for petrol.
05:19Towards the exit of the garage.
05:22Subject now towards the subject vehicle.
05:26The crutches are no longer necessary.
05:30In in in as driver.
05:35Subject vehicle now towards the exit.
05:39He goes left, left, left, left on the original.
05:43But for another appointment, they're back.
05:45As a friend hands them to him as he gets out of a taxi.
05:51Mr Subject now out the vehicle, placed on the jacket.
05:58We instructed the AC Beechcroft to assist with this investigation, as they're one of our legal partners, and they have
06:04significant expertise in this area of fraud.
06:07We felt that the case was very strong and the evidence was compelling.
06:12We had worked very hard with AXA to put the case in a position where we were able to successfully
06:18defend the claim.
06:19So the matter proceeded to trial, and during the course of that trial, the evidence was submitted, and our submissions
06:27were made to the court.
06:28Although the surveillance footage had been illuminating, what happened in court added another element of intrigue to our chip shop
06:35con man.
06:36His solicitors applied to the court to remove themselves from the court record.
06:42This was done following our application to amend the defence to plead that his claim was fundamentally dishonest.
06:49The proceedings continued, and he was supposed to comply with a number of court orders and court directions and take
06:58part in his claim.
07:00He didn't do that.
07:01We decided to push the matter forward and request contempt of court proceedings against the claimant, which the court accepted.
07:11The claimant hadn't managed to give the court what had been requested, and his unreliability persisted.
07:18There were certain things that he was supposed to comply with.
07:21He was supposed to provide witness evidence, he was supposed to attend the hearing, and he didn't do anything.
07:28By not showing up, it just showed a clear disregard for the judicial system and the legal process, and it
07:35was evident that the judge looked uncarnely upon that.
07:39This fraudster couldn't get his act together, and his lies and lack of respect for the legal process did him
07:45no favours.
07:49His acts of contempt were born out of the fact that he had signed a statement of truth that his
07:58evidence was true, when in fact it was not.
08:01The secret filming had clarified that.
08:04He was found guilty of contempt of court, and the reasons for this were that he had alleged that he
08:11had not been able to work since the accident, that he was unlikely to be able to work for the
08:17next ten years, that he was unable to drive his vehicle, and that it was in fact his wife that
08:22was driving the car, and that he couldn't think of any work that he was capable of doing.
08:28The surveillance told a very different story. It doesn't look like his wife driving here. And isn't this him behind
08:36the counter in the chip shop?
08:38The result of this claim was very significant, in that we were able to reject a very high value claim,
08:45and prevent fraudster from being paid something he's not entitled to.
08:49He received a contempt of court finding against him, which sentenced him to 16 months in prison, which is one
08:56of the longest sentences achieved for a contempt of court finding, where the maximum sentence is two years and a
09:02fine.
09:07You'd think being filmed blatantly lying, losing his solicitors, being sentenced and fined, would all be a bit of a
09:14deterrent. But this fraudster's tenacity knew no bounds. He appealed his imprisonment. This was dismissed.
09:23Given the value of this claim, and the extent of exaggeration that the claimant was pursuing, and the lengths he
09:31was prepared to go to, to try to deceive us into making a payment he wasn't entitled to, pursuing this
09:37avenue sends a very strong message to any would-be fraudster that wants to try a fraud of this nature,
09:43and it acts as a significant deterrence.
09:53Later, a first-time buyer, making a claim for a damaged telly, tripped himself up with photos that prove he
10:00wasn't insured.
10:01How do you think that looks to the insurer?
10:04Um, um, quite bad, yeah.
10:09And what do you mean by quite bad?
10:13Um, what do you mean by the insurer has been taken out?
10:28Car parks seem an unlikely target for a fraud ring.
10:32But if you're a chancer, hunting for lots of vehicles reversing in and out of spaces, then they're the perfect
10:38spot.
10:39One audacious gang deliberately picked daytime shoppers of a certain age.
10:46The fraudsters made sure their cars appeared just in time to get hit by innocent motorists, who thought their access
10:53was clear.
10:58Elby was the insurer which identified the crime gang ruthlessly preying on older drivers.
11:05In a short period of time, we had five claims reported to us, which had similarities in the fact that
11:11these were all elderly policyholders had taken place around car parks and at low speed.
11:17When the claims were reviewed, there were immediate worries about the number of people in the cars being hit.
11:24Personal injury claims were being received for more occupants than our policyholders had reported were present in a third party
11:30vehicle at the time of the accident.
11:33Due to our concerns in relation to the number of personal injury claims being made, this caused us to carry
11:38out a full fraud investigation into the claims.
11:41This investigation revealed one common vehicle crossed over into two of these incidents that were investigating.
11:48This particular car was a key part of the jigsaw.
11:52Investigations into this vehicle revealed that it was owned by an accident management company.
11:57This same accident management company was representing claimants across all five of these accidents.
12:03Claims management companies are there to help people when they've had an accident who perhaps don't want to deal with
12:08their own insurance company.
12:10Not like on this occasion where we've got them helping facilitate insurance fraud.
12:15Once we realized this connection with the claims management company crossing all five of these accidents, our suspicions were raised
12:21that this is probably going to be part of an organized fraud rig.
12:24LV was keen to identify those involved to stop any more unsuspecting motorists falling victim.
12:31Situations like this, innocent motorists and on this occasion elderly motorists were being put at risks by these fraudsters.
12:38But those claiming were getting impatient and put the pressure on.
12:42The other driver's solicitors weren't prepared to wait for their money and decided to issue court proceedings in order to
12:49force us to pay the claims.
12:50At this point, we instructed our solicitors to defend the claims brought against us.
12:55Kiyos, solicitors which specialize in insurance law, is the firm used by LV.
13:01LV were approached by their insured driver who had been reversing in the car park
13:07and he was really distressed about the fact somebody had presented a personal injury claim against him and felt really
13:13strongly that he wasn't at fault for the collision.
13:15He'd checked his mirrors, the way was clear for him to reverse, there was no vehicle behind him when he
13:20set off.
13:21And then when he's had the accident, it was minuscule, it was just the tapping of bumpers.
13:27So for Liverpool Victoria to be presented with a personal injury claim for months worth of whiplash, obviously their insured
13:34driver was really quite distressed about the whole thing.
13:37So on that basis, they decided that they would defend the claim as fraudulent.
13:42LV and Kiyos were convinced this was worth defending.
13:47They jump up and down with net complaints on a bumper tap, then yeah, it screams that there's something wrong
13:54with the claim.
13:56The court case was to prove a real test for the flimsy allegations being made by the claimant who'd been
14:02hit.
14:03The first one that went to trial, the claimants failed to attend, they refused to respond to the allegation, which
14:09made it really easy for us.
14:11The judge saw our evidence, assessed our insured and was quite happy that their evidence stood and this was a
14:16fraudulent claim.
14:18We then had another two accidents that we'd case managed together and they were heard together at court in January
14:25of 2019.
14:27At those ones, the claimants did attend and were absolutely adamant that they had had no part in this.
14:34This was a genuine accident.
14:36We'd reversed into them, would cause them an injury, would cause vehicle damage.
14:41They needed a credit hire vehicle whilst their vehicle was being repaired.
14:45But this didn't cut much weight in the courtroom.
14:48In fact, it instantly became clear that the claimant's version of events couldn't possibly be true when the pensioner who
14:55was insured by LV stood up to give evidence.
14:58He had a walking aid, so whilst he was being cross-examined, he had to have his walking aid whilst
15:03he was giving his evidence.
15:04And part of the claimant's evidence was that our insured driver had chased her around the vehicle.
15:11So that it was quite reasonable for our insured at this point to demonstrate his walking aid and confirm that
15:17no point has he chased anybody in the last ten years.
15:19Which I think the judge found quite humorous.
15:23But also, seeing somebody there unable to do these things, it just completely undermined our evidence.
15:29So the judge went with the defence, which was that this was an organised fraud, and that it was done
15:35deliberately to obtain money from insurance companies.
15:40In all, Kiel's and LV unravelled 23 linked claims.
15:45The similarities across those claims were in relation to the insured drivers, who varied from between 60 years old and
15:53our eldest drivers, 102.
15:55The people that lose out on these cases are the individuals that are targeted.
16:01For the fraudsters, they might receive £3,000, £5,000, £10,000 in compensation.
16:06But for the defendant, they lose their ability to drive in a reasonable manner on the road.
16:13They're frightened that they're being targeted, they're nervous.
16:16They doubt themselves and their own ability to reverse out of a parking space.
16:20And on top of all that, they're then asked to go to court, be cross-examined, to spend a year
16:26of their life cooperating with us to provide the evidence.
16:29And if they're, for whatever reason, their evidence isn't accepted, then they'd lose out on their no-claims discount on
16:36their insurance and face increased premiums.
16:39All because they went to the supermarket to do the shopping.
16:42But the unwholesome gang targeting older road users got its comeuppance.
16:48Not only did we identify an organised crime gang putting elderly people at risk, but we also hit them where
16:53it hurts.
16:54And we were able to recover £100,000 from the fraudsters.
17:00After the two in January went to court, not only were we awarded the cost of defending it, but the
17:06court found that it was such a heinous act that they gave us £25,000 in exemplary damages, which the
17:14claimant has to pay themselves.
17:17For LV, Kios, and Sarah in particular, it was a great and hugely satisfying result.
17:26For me personally, defending insurance fraud claims is hugely satisfying.
17:32These people are people, they're people's parents, they're people's grandparents.
17:37They're people that have just set about their normal day-to-day business travelling on the road, and before they
17:42know it, they've fallen victim to a fraudster.
17:45So for me, I genuinely enjoy being able to take these people to court and look in the whites of
17:50their eyes and ask them whether they are fraudsters and seeing that the answer is yes.
18:07With more than 5 million CCTV cameras in the UK, whether you're out and about or at work, someone somewhere
18:15is watching you.
18:18It might feel like it's a case of Big Brother, but the presence of CCTV can have lots of positive
18:24benefits.
18:25Keeping vandals away, helping solve crimes, and for insurers, it can be an ironclad eyewitness when there are disputes.
18:34And for one takeaway, it was invaluable to one of their delivery drivers.
18:41Our customer called us to report the accident the day after it happened.
18:45On first report, it seemed like a very run-of-the-mill incident.
18:48The customer explained to us that whilst pulling into a takeaway premises where he's undertaken some evening work as a
18:55delivery driver,
18:57he's clipped a parked and unattended vehicle that's also parked outside the front of the takeaway.
19:02The other vehicle also belonged to a takeaway delivery driver, somebody that he works with, so obviously after hitting it
19:09has gone in to inform them.
19:12Admiral's customer had taken all the right steps following the incident, and it was a set of circumstances Ben knows
19:18all too well.
19:20It's a sort of accident that happens many times every day up and down the country, just a bit of
19:26driver error.
19:27We were just waiting for the claim to come in for the damage to the other vehicle.
19:32And sure enough, some time later, Admiral was contacted by a solicitor representing the owner of the other car.
19:40We received a notification from a solicitor acting on behalf of not only the third-party vehicle owner,
19:45but also three people claiming to be occupants inside the vehicle at the time of the collision as well.
19:50It gave a slightly different circumstance to that that was reported by our insured.
19:55It was a bit of a mystery. Admiral's customer said the car was empty when it was clipped. Yet...
20:02The floor injury notifications were all for soft tissue injuries.
20:06Then the case was reserved just in excess of £20,000.
20:10But there was something else that was entirely different to the story Admiral had been told.
20:15The solicitor detailed an actual collision, so both vehicles driving. The allegation is that we've collided with the third-party
20:22vehicle caused an injury to the driver and to the three passengers.
20:27So not parked either?
20:29The damage to the third-party vehicle is to the rear driver's side.
20:33And so it's possible from the circumstances that we received from the solicitor that that could be consistent with a
20:40glancing blow as two vehicles pass one another.
20:45But with two differing tales, the red flag was raised.
20:48We always look to check the number of claims that we've received versus the number of occupants that were noted
20:54in any particular vehicle at the time that the claim was reported.
20:57On this occasion, there was a mismatch.
21:01Admiral's customer declares reversing into a stationary car with zero occupants.
21:08The solicitor representing the owner of the car he hit submits claims for four occupants.
21:15The vehicle was parked and unattended, yet there were injury notifications for four occupants.
21:21So that is what has prompted the referral into the fraud department for the claim to be investigated.
21:26After calling the customer, who reiterated the vehicle was not only parked, but empty.
21:31They went on to also explain to us that there was CCTV available to confirm their version of events.
21:41An impartial video referee.
21:44Admiral could finally determine what was fact and what was fiction.
21:48So this footage is shot from a camera on the doorway of a takeaway where the accident has taken place.
21:54So as you'll see clearly from the footage, the vehicle that we've hit is parked and unattended.
21:59There's nobody in that vehicle.
22:00So we can see our insured reverse their vehicle.
22:03This is where the incident takes place.
22:05They cause damage to the rear driver side of the third party vehicle.
22:11Next you can see our insured exit their vehicle, examine the damage to the third party car.
22:17And gone into the takeaway to inform the person who owns that vehicle that he's in fact hit their parked
22:22car.
22:23After that, the owner and who would have been the driver of the third party vehicle coming out to the
22:28premises and inspecting the damage to their vehicle.
22:31What you can also see is that there are no other occupants.
22:35There's nobody in that vehicle at the time that it's hit.
22:39Certainly not the driver who was seen coming out of the premises.
22:43And again, no passengers in any of the seats either.
22:47Not only that, but after their colleague leaves, the driver is seen taking numerous photos of the damage to his
22:54car.
22:56It's very clear which version of events has happened.
23:00It was quite a story that had been cooked up.
23:03And it's something Ben is seeing more of.
23:05There has been an increase in exaggeration over the last few years.
23:10The third party has seen an opportunity to make some money, so has decided to collude with individuals that are
23:17known to him to say that they were in the vehicle at a time when in fact they weren't.
23:22Armed with the CCTV footage, Ben delivered the bad news and the claim was dropped.
23:27We challenged the claim.
23:29That was followed up by furnishing the solicitor with a copy of the CCTV.
23:34Whilst it took several months for them to confirm that they were off record and no longer instructed to pursue
23:41the claims, it wasn't a difficult case to win.
23:45So they didn't get a slice of that settlement cash.
23:54Still to come, a cat lover comes a cropper with a claim when she wasn't covered.
23:59The policy had been taken out online exactly 118 minutes after the cat had been seen at the vet.
24:19When it comes to moving house, there's a lot to organise and it can be a stressful time.
24:25Our next man, a first-time mover, had a lot on his plate.
24:29But that's no excuse for his actions when things went wrong.
24:35ICOG is a specialist claims management company that uses various techniques to weed out the genuine claims from the bogus
24:41ones.
24:43This claim came to us quite simply. It was accidental damage to a TV.
24:48The claim advised us that the TV had fallen off a wall in the middle of the night and came
24:53down with a whopping crash.
24:56The claim would have been worth around £600.
25:00We were instructed for two reasons.
25:04One, it was a recent inception. In other words, the policy had only just been taken out.
25:08But also, the policyholder didn't have any previous insurance leading up to that point.
25:14Having no previous insurance is a little bit unusual.
25:17Particularly, you know, from a contents point of view.
25:20Because then you've got absolutely none of your own belongings or furniture covered in case there's any accident.
25:26But that wasn't the only thing Liz found strange about this case.
25:30When I was speaking to the policyholder, there were some odd sort of behaviours in the conversation.
25:36He was bringing humour into the situation, which I didn't necessarily think was appropriate for what we were discussing.
25:44When I was moving, I put the TV up on the wall because it's the safest case though, really.
25:50I thought it was.
25:52I was the way it wasn't going to be getting hit by it.
25:56And I think in the case, that happened pretty long enough for wall pumping.
26:01So overnight, when I was upstairs, sleeping, it came off the wall and landed straight on the cabinet.
26:08Mm-hmm.
26:12DIY wasn't this man's strength, but he was also vague about his timeline, which didn't inspire confidence.
26:20So when did this happen?
26:22Erm, I'm not sure. I don't remember what the day was.
26:25Are you able to sort of check a diary or something? Just see?
26:28Erm, I don't know the timing. Er, I think it was probably somewhere around the line to the 15th, 15th.
26:36Because it wasn't too much longer after I took the came-up. I don't know.
26:43And can you remember what day of the week it was?
26:46I haven't. It was just moving. It's just, everything's just spurred into one big mastery.
26:54So you think it was around the 15th to the 16th?
26:58Er, probably later than that. Er, I think I said it came up around the 15th or 16th. I'm not
27:03sure that everything is later than that.
27:06You initially said you thought it was the 15th or 16th.
27:10Yeah, like I said, we were just moving everything just spurred into one big mess, but, er, I don't know.
27:15So you started moving on the 11th.
27:18Yeah.
27:18When did you sort of finally move in?
27:21Er, yesterday.
27:22OK.
27:25That's quite a long time to take to move everything?
27:28Yeah, because it was, you know, like, quite a long distance and we've only got a small car, so I
27:32was trying to make all the moves in a very small vehicle taking time.
27:37You finally moved, erm, yesterday. Where have you been staying?
27:42I've been staying in, let's see, just having to find the time to make the move forward and forward.
27:47OK, so up until yesterday you'd been staying on the streets?
27:51Yeah.
27:53Can you describe, erm, how you found the TV?
27:56Erm, just falling off the wall because, er, they were being a large fan.
28:01Er, I've come downstairs and it's been a space flat on the, the sidebar that somebody's in my cabinet.
28:07Er, mm-hmm.
28:09Which was, er, heartbreaking.
28:11But if he was at home in bed and had the TV falling off the wall in the middle of
28:16the night, surely it couldn't have happened at the property where the insurance had been taken out?
28:21Because he'd just told me he'd been sleeping at his previous property.
28:25Yeah.
28:26So it started moving on the 11th.
28:28Yeah.
28:29Finally moved in, you say yesterday, which was the 10th of July.
28:33Yeah.
28:34And, just looking back, I'd set up the, erm, the insurance on the 18th.
28:39Well, it would have been, it wasn't directly after the insurance, it probably would have been the 20, like, er,
28:45the 26 o'clock from the time I ran in.
28:48Mm-hmm.
28:49I'm not, I'm still not quite sure about the opportunity.
28:52Can you remember what day of the week you set the insurance up so I can reform that?
28:57Er, I, I'll have looked on the calendar, yeah.
29:00You said you'd got up in the morning and found the TV had fallen?
29:03No, the, the, the TV fell and woke me up on itself, like, the, the bank, uh, the reform.
29:10And what time was that?
29:12Erm, about, like, three, half three in the morning.
29:15To be honest, I don't think straight away that it dawned on him the information that he'd, he'd given me.
29:21And he was just quite open about when he'd moved in and when, you know, when he'd taken up the
29:26policy.
29:28The doubts about whether the damage to the TV was even covered by insurance was one issue.
29:34Another was about to emerge.
29:36We were sent three photographs, erm, along with the, the claim.
29:40And along with the red flag of it being a recent inception, there, there was another story to be told
29:45with the photographs.
29:47Digital images contain metadata.
29:50This gives information about the location, date and time a picture is taken.
29:56When we, when we looked into the metadata with these photographs, normally what we try and do is use that
30:01information to help corroborate the account that we've been, we've been given by the policyholder.
30:06However, in this case, it did cause further doubt on the, on the case itself.
30:10One was clearly taken after the policy had been taken out.
30:14However, the other two photographs had metadata showing that they'd been taken four days before the policy had been taken
30:21out.
30:22So that suggested to me that the incident had happened before the policy had been accepted.
30:27And therefore there would be no cover in place for the damage to the TV.
30:31Time for more questions.
30:34Just out of, uh, of interest, what is your understanding of the term metadata?
30:39Um, not at all.
30:41Okay.
30:42Metadata is something that's attached to all digital photographs.
30:46In most cases it doesn't appear on screen, but because it's a digital, it has a date and a timestamp
30:52on it.
30:54Um, and if we were to look at the metadata of the photographs that you've sent in, what, what do
30:59you think that would tell us?
31:01Um, I don't know.
31:03The conversation wasn't going well for this claimant.
31:07What I want to do is to share with you, um, some of the, the information that I've got in
31:12front of me.
31:13Mm-hmm.
31:14So I've got the date of the incident logged as the, the 30th of June.
31:19That's where you went online and made the claim.
31:22Yeah, yeah.
31:23And I concur with you that the policy was taken out on the 18th of June.
31:28Yeah.
31:28So, I mean, that was quite a long gap between the two, which I'm surprised that you didn't remember it
31:35was so long.
31:35But on, on two of the pictures that you've sent in, the metadata is saying the 14th of June.
31:43Okay.
31:44How do you think that looks to the insurer?
31:47Um, um, quite bad, yeah.
31:52Yeah.
31:53And, and what do you mean by quite bad?
31:56Um, that just happened before the insurance has been taken out.
32:00Um, I mean, the metadata is not something that can be altered once a photograph has been taken.
32:06Yeah.
32:06Yeah.
32:07So what would you like to say about that?
32:09Yeah.
32:10Well, we got the insurance to replace the TV.
32:13And is that what happened?
32:14Yeah.
32:15The accident did happen on the 14th of June.
32:18And you took the policy out on the 18th.
32:21And you waited almost two weeks before you made the claim.
32:24We weren't going to make the claim to begin with.
32:27We were just weighing up all of our options and seeing where we should go and what we
32:31could do.
32:32And, yeah, there was a few people who said we just came on the insurance.
32:36It's not usual for policyholders, even when they're faced with such, such strong evidence,
32:42to, to be as open as this policyholder was with what had happened.
32:47But he must have realised his actions were not going to result in a replacement telly.
32:52At the end of the call, it was made very clear to the policyholder what the next steps would
32:56be, that I would compile my report with the evidence that he'd submitted, and the report
33:02would be going back to the insurer, recommending that, at the very least, that the claim be
33:06declined, but also the potential that it get registered on the fraud register, where
33:12any insurers can see people that have made fraudulent claims.
33:16The implications aren't just for that claim.
33:18They are ongoing.
33:20And, you know, there can be repercussions for, for several years as regards raise premiums,
33:26you know, and finding difficulty getting insurance cover.
33:41There are more than 10 million moggies living with owners across Britain.
33:46Cats may be independent, but they still need regular checks, and treatment can be expensive.
33:51For some owners, paying for a pet insurance policy is an unwanted additional cost.
33:57Direct Line dealt with a cat owner who learned the hard way that a policy is only valid if
34:02it's in place before the need to make a claim.
34:05This was a pet insurance policy, which was taken out to cover a British short hair cat.
34:10It was taken out on the 8th of January at 1.56pm.
34:15Later on that month, on the 25th of January, a claim was made on that policy.
34:20The claim was for a broken tooth, which the owner had first noticed on the 11th of January,
34:25and was then operated on on the 12th of January.
34:29The cat owner called Direct Line to make the claim, and it sounds like there were complications
34:34during the vet's appointment.
34:53What happened was her heart stopped during surgery, so they had to give her adrenaline and resuscitate
34:59her and stuff.
35:00And she was back with her, so...
35:02Good God!
35:04Poor thing!
35:05It's just the surgery of the tooth.
35:08What a nightmare!
35:10The cost of the surgery and the adrenaline that was required to resuscitate the cat was
35:15just over £300.
35:17And it can't be a reason that we wouldn't look to at least have a look at that for you.
35:22Obviously what we need to establish from the information from the vet is that there isn't
35:27prior information in respect of that particular tooth that had.
35:30There wasn't evidence it was broken before or anything like that, but the vet's details
35:33will cover all of that for us.
35:34We carried out some additional validation inquiries with the vet who had performed the operation.
35:40Hello, please, good morning.
35:42Speaking.
35:43Hi, I'm calling from Direct Line Insurance.
35:45I'm just calling all of regards to an mutual client, please.
35:48Right, okay.
35:49So you've had to claim in for the broken tooth.
35:52I believe you're claiming from the 8th of January.
35:55I just wondered if you could tell me what time the appointment was on the 8th of January, please.
36:018th of January, broken tooth.
36:0411.58, so at almost midday.
36:09Yeah.
36:10And that's what time the actual appointment was, or when they called to make it?
36:15Um, no, that's when they were seen by the vet, at 11.58.
36:21Okay.
36:22And do you know when that appointment was made?
36:25I think it was originally 8.15 in the morning.
36:30Right.
36:30And they moved it to 11.30, but obviously they weren't seen till midday.
36:37The policy had been taken out online exactly 118 minutes after the cat had been seen at the vet.
36:45This is what we call a pre-inception loss, where somebody takes out a policy after the event in order
36:50to cover a loss that has already happened.
36:54We wrote to the policyholder, advising that we wouldn't be paying out for this claim as we continued to make
37:00investigations.
37:00Um, we asked for further information from her to clarify the times that the policies were taken out and when
37:06the cat was seen at the vets.
37:09As we never received a response from her, and with the evidence that we had from the vets alongside when
37:15the policy was taken out,
37:16we felt that we had enough still to reject the claim and to cancel her policy.
37:21So we sent out a further letter advising of the action that we were taking.
37:25This did get a response by phone.
37:28So I made this phone call just on a whim just to see if I might be able to claim.
37:34Um, and they said, well, we'll look into it. We'll register the claim for you.
37:39Um, it is possible.
37:40And I said, okay.
37:41So when I got the letter claim, I wouldn't be able to claim.
37:44I thought, well, that's fair enough.
37:46I honestly didn't think I would be able to anyway.
37:49I just thought I'd try, just in case.
37:52Um, but now I'm getting a letter saying I need to call and discuss it or it will be cancelled.
37:59But Direct Line didn't appreciate the cat owner chancing her luck.
38:02She hadn't been covered and she had tried to claim.
38:07The next course of action was to see whether she had any other policies with us.
38:12We found out that she did have a live motor policy.
38:14So after the fraud that was detected on the pet claim,
38:18we did write to her advising that we would be cancelling all policies with us.
38:22This may sound harsh, but if she's tried it on with one policy,
38:26then what's to stop the claimant doing the same with others?
38:29We then received a response from the policy holder to our letter saying that we were going to cancel the
38:34insurance policy.
38:35However, she then challenged the decision that we'd made.
38:38And she said that the visit to the vets on the 8th of January was in relation to the cat
38:43having its claws clipped
38:44and was nothing to do with the broken tooth.
38:48Since she'd provided us with new information, we did follow up on that and we discussed the matter with the
38:53vet once again.
38:55She's now come back saying on the appointment on the 8th, she was never told that there was anything wrong
39:00with the pet's tooth.
39:02Now, reading your notes, it seems to contradict because it looks like the appointment has been made for the tooth.
39:06And there's been notes on there saying owner noticed the tooth factured and that's what you've recommended.
39:13But before I go back to the customer, I just want to kind of get your opinion on it and
39:15make sure there's not anything I'm missing.
39:32It was very clear from their records that the appointment was for a broken tooth and as well they'd also
39:43taken blood samples on that day in preparation of the surgery.
39:47Her claw clipping claim was knocked into touch and Direct Line believed its cancellation of all her policies was appropriate.
39:55She was quite upset that we were going to cancel her motor policy and this seemed to be her main
40:00issue.
40:01In that same call, she was quite adamant that she wasn't trying to reject the decision that we'd made on
40:08the pet claim,
40:08but she just didn't want us to cancel the motor policy.
40:12I'm just worried. I'm worried that, you know, something's going to go against me when I just feel like I've
40:18done anything wrong.
40:20I mean, I don't disagree with any of you. I did go to the vet in the morning and I
40:24did, you know, a few hours later take out insurance.
40:27I'm not denying any of that. You know, but I went to the vet to have a nail cut.
40:32Yes.
40:34I am worried because at the minute, you know, you're saying they're going to look into it. That's fine. You
40:41know, I haven't got anything to hide. I'm not worried about me.
40:43I'm worried about this policy being cancelled and I read somewhere else that if there's any other policies underwritten with
40:52the same concern.
40:52No, that's my car insurance. You know, I can't have my car insurance cancelled and I need my cat to
40:59be insured.
41:00But the claimant wasn't going to get anywhere. In fact, Derek Lang took the matter further.
41:05The policyholder had acted fraudulently by knowingly claiming for something that had occurred prior to inception of the policy.
41:12She then provided further false information in order to support that. And on that basis, we had enough to report
41:17this matter to the police.
41:21The police interviewed her under caution and it was at this point that she did admit to committing the fraud
41:27and said that was due to suffering from financial difficulties at that time.
41:33She received a police caution for this, which will remain on her records, and we also cancelled the policy.
41:39The cat owner had chanced her luck and failed, losing her insurance policies and receiving a rap on the knuckles
41:46from the police.
41:47This should be a message to other people thinking of committing this type of fraud, that no matter what type
41:53of policy it is or how large the fraud is,
41:57that we have validation processes in place to thoroughly investigate and detect fraud.
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