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Rogue Claimers - Season 2 Episode 21
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00:06insurance 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
00:25are 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
00:34just under 15 fake claims every hour armed with the latest fraud busting
00:39technology it's a subject out of vehicle including covert surveillance systems
00:44sophisticated data analysis techniques and specially trained fraud investigators
00:49oh they're catching these chances red-handed instead of getting away with
00:56it even more of these fraudsters are getting caught out
00:59this is road claimers
01:08today a tech scam goes down the pan that baby a drop that Samsung phone down the toilet and
01:17being washed away a dangerous driver gets caught out we were quite uh quite horrified these actions
01:24were uh reckless and investigators uncover how an organized crime ring goes to great lengths to
01:31scam insurers one of the vehicles had had the mileage reduced by 200,000 we can see that they're
01:38they're getting greedier they're getting braver
01:46an insurance policy that includes accidental damage does exactly what it says on the tin
01:50after all an accident is an accident even if it's a mishap by a minor and if it's your phone
01:58that's
01:58lost or damaged then an insurance policy can give you peace of mind
02:05assurant is a mobile phone insurance company providing repair or replacement of devices for their
02:11customers every 20 seconds
02:16andy morris has worked for the company for more than 12 years so there's no i lost my phone story
02:22that he hasn't heard
02:25the claim was for a Samsung s8 uh with the market value of about 480 pounds
02:32so this particular claimant contacted our agents and said that their baby had dropped uh their
02:40Samsung phone down the toilet and it'd been washed away
02:46so is it damaged
02:49no it's uh happened the baby dropped in the toilet
02:54so it's damaged
02:56no i don't have the phone it's gone inside on the toilet
02:59so it's impossible to take it out because i don't see the phone inside
03:03right so when did this happen
03:07i don't know me the morning
03:09this morning
03:14ok was your sim card in the phone
03:20so what sim was in the phone
03:24there was no sim in the phone
03:30he stated that he'd taken out the sim card of this particular phone
03:34because his baby used the phone to watch videos and play games and listen to music
03:40it sounds like the claimant's baby was quite tech savvy
03:44but would the claim progress any further
03:48whilst this wasn't a typical claim
03:50we do understand that accidents do happen
03:52however there was some bits of information that just didn't seem plausible to us
03:59the first thing that was suspicious about this case was we know the physical dimensions
04:04of this phone are bigger than the u-bend in other words it was physically impossible
04:10for this phone to be flushed down the u-bend of the toilet
04:13so that was the first building block in place and there were plenty of others to build a tower
04:19that might eventually topple
04:22the claimant had claimed that they'd lost the phone or the baby had lost the phone at eight o'clock
04:27that morning
04:27we had identified through data usage records
04:31that the particular phone that the claimant was claiming for
04:35and the particular sim card
04:38was being used the afternoon
04:40to make telephone calls
04:42presumably calling an emergency plumber
04:46so when our investigations team
04:49identified that the
04:50phone and the sim card were being used
04:53seven hours later to make telephone calls
04:55we then looked at the manufacturer's warranty to see
04:58how long the phone would be
05:00effectively water resistant for
05:03our investigations team identified that
05:05it's only potentially for 30 minutes or 45 minutes
05:11so not seven hours swimming around a sewer
05:14and remarkably
05:17seven hours later
05:19the sim card was back in the phone
05:21and the phone was being used to make telephone calls
05:24seems pretty unbelievable to me
05:27what we've done is to check the usage of the mobile phone
05:30so with you saying that it happened in the morning time
05:34and we've got on your plane phone that happened at about eight o'clock
05:36your mobile phone is still connecting to the network
05:40with the sim card
05:42up until three o'clock that day
05:44no I don't know
05:46I don't know because I don't be at home
05:47I come next day at home
05:49I don't know what happened
05:50if you've got that sim card
05:52and you've got that sim card in another phone
05:54because you've been at work
05:55and you've not been home all day
05:57how is it when I'm looking at that phone
05:59and I'm tracking it
06:00I can see that those two are together
06:03I don't know
06:04because for me
06:05it's saying that that sim card wasn't in another phone
06:08it was in that phone
06:09and that's received
06:10that's received some sort of usage
06:12up until three o'clock on that day
06:15and with the phone being flushed down the toilet in the early morning
06:18that phone is only waterproof for up to 30 minutes
06:21before it gets corroded by the water damage
06:24so it shouldn't be able to connect to the network
06:26and what we've also done as well
06:29is we've looked into the dimensions of the phone
06:31that phone
06:32it wouldn't be possible for it to go around the U end of the toilet
06:36what can I do now?
06:38he'd done enough already
06:39the claim ultimately was rejected
06:42and went down the drain
06:46so we wouldn't look into sending a replacement phone
06:49based on that information that we've got there
06:51the claim would be rejected
06:54and I don't take the phone
06:55we would also look into cancelling the insurance as well
06:59because you no longer have the phone
07:00you no longer have the insurable interest on your contract
07:03so that would be cancelled with immediate effect
07:08so tell me what can I do?
07:10I don't take the phone in
07:11yes, so we're not sending a replacement phone
07:15sorry?
07:16we're not sending another phone
07:19all right, no problem
07:19okay, do you have any other questions to make?
07:23no, no, no, no
07:25claim dumped
07:26but the incident wouldn't be forgotten
07:28it is fraud
07:30and the fact that they had provided false and misleading information
07:34would go against their records for any future claims
07:47our roads are shared by millions of vehicles
07:50from lorries to motorbikes and buses
07:53but it's cars that make up the bulk of our British traffic
07:56with more than 40 million motors on our A roads, B roads and motorways
08:04in our ever-increasing fast pace of life
08:06being in a rush when you're behind the wheel can have consequences
08:11many crashes are due to recklessness and road rage
08:14with research indicating that half of all drivers
08:17go above the speed limit in urban areas
08:23first group has a fleet of almost 6,000 buses
08:26out and about on a daily basis
08:28on a regular route
08:30one of its vehicles was involved in an incident
08:36claimant was the driver of the estate vehicle
08:39that was following the bus
08:40it was in a residential area
08:43he then said that the bus pulled out
08:45whilst his own car was stationary
08:47and the bus hit the front of his car
08:50causing quite extensive damage
08:51and he blamed the bus driver fully for the accident
08:55the damage to his car was to the front and the near side front
09:00and the damage to the bus was to the offside rear by the engine cover
09:04we received a claim for the damage to the third party's car
09:08from their insurers that totaled over 3,800 pounds
09:12and then a few weeks later we received a claim from the driver's solicitors
09:16saying he suffered a soft tissue injury to his back
09:19an injury to the back could be worth in the region of say 4,000 pounds
09:24the claim was close to costing first group nearly 8,000 pounds
09:28and given what had happened a payout was likely
09:31that was until Paul started to investigate
09:35the circumstances alleged by the driver of the estate car
09:38didn't add up at all to what our bus driver was saying
09:41normally even if one party is not quite telling the truth
09:45the circumstances sort of match up a little bit
09:47but here they were completely different
09:51the bus driver's recollection was that the car behind had tried to overtake him
09:56it's clearly that something was amiss
09:59and one of them was clearly not telling the truth
10:02and it was down to us to establish who that was
10:06luckily Paul had the help of an onboard camera
10:09and not just one of them
10:10our buses have up to 17 cameras both internally and externally
10:15so we were expecting to see in the CCTV footage
10:19that the bus was pulling out, moving over to its right
10:23and basically pulling in front of his path
10:25and hitting his stationary car
10:28what we did see was totally different to that
10:30the bus is driving in a residential area with a 30 mile an hour limit
10:35it goes around a corner, there's a few cars behind it
10:39the first of those is the claimant's estate car
10:44and as soon as the bus rounds the bend
10:46the claimant goes and overtakes the bus, accelerates quite hard
10:53he doesn't actually have a clear look at what's approaching from the opposite direction
10:57if he had done he would have seen the approaching car coming in the opposite direction
11:02on his side of the road
11:03that car has to swerve over to its left
11:06and mount the pavement to avoid a head-on collision
11:10and the driver of the estate car then moves over to the left
11:14and hits the rear of the bus as it passes
11:18and it's a very dangerous manoeuvre
11:21it's clear that the estate driver has made up the circumstances to suit himself
11:25and try and put in a fraudulent claim for the injuries he says he suffered
11:31we were quite horrified actually at the actions of the driver of the estate car
11:36it could have been quite a serious accident
11:38his actions were reckless, could have injured himself
11:43plus the driver of the other vehicle and the passengers on the bus
11:47with the footage flying in the face of the claimant's version of events
11:51it was passed on to the solicitors who'd put in his personal injury claim
11:56they wrote back fairly swiftly saying that in view of the footage
12:00they were no longer able to act for the driver of the estate car
12:04and they wouldn't be pursuing a claim for him
12:07first group also got in touch with his insurers
12:10we made a strong denial of liability and forwarded details of our losses
12:15which totalled over a thousand pounds
12:18they in fact paid our losses in full
12:21and the final outcome proved that this overtaker was also a faker
12:26we never heard from the claimant again
12:29he didn't pursue a claim via any other solicitors
12:31I think he eventually saw sense and just dropped the claim
12:35in this case, the camera didn't lie, even if the claimant did
12:41the main principle of insurance is utmost good faith
12:45and if their own insured is found to be lying
12:48then they could well take further action against them
12:57later, the brakes are put on after a burglary
13:00insurance is not insuring you or compensating you immediately
13:04it was something that's already happened
13:17us Brits do like a getaway
13:19with around 95 million trips taken in the last year alone
13:23there are plenty of jet-setters
13:25but just a quarter of travellers have travel insurance
13:29so if anything goes wrong, like a medical emergency
13:32or a lost possession
13:33footing the bill can make things very expensive indeed
13:40Seega is one of the leading providers of claims and travel assistance
13:44and has been offering services for more than 40 years
13:48it has a dedicated special investigations unit
13:50which has an ear for sounding out whether a claim is spurious or not
13:57the customer called us upon returning back from their trip to Thailand
14:01and told us that once she got home and unpacked
14:02she realised that she'd left an earring in the hotel
14:06she said she'd emailed the hotel
14:07and was currently waiting in response
14:10the email chain actually started within hours of when she told us
14:14that she'd noticed the loss
14:15this meant that the claim was coverable under the policy
14:18how much of the year are in store?
14:21my boyfriend bought them for me last year
14:24as a birthday present
14:25and I think there are about 600
14:27ok and did you say you have reported it to the hotel?
14:29yes
14:30ok, I think we've all had a claim set up in the hotel
14:33no that, that was another pair from last year
14:35oh, from the first?
14:37mmm, that was in January
14:39when I went to Berlin
14:40ok, ok
14:42ok, and where were you visited the hotel?
14:43Thailand
14:44I set the claim up for you now, obviously we'll need to see what the hotel say.
14:48Yep. 650, I just got the receipt out, sorry.
14:52OK, so I'm going to send you that claim form.
14:54What we're going to need back is the receipt.
14:56We'll also need to make sure that you've bought it to the hotel,
14:59and we'll need your original booking travel date.
15:02OK.
15:02If you've got any period, just ring and let us know.
15:05At face value, the circumstances surrounding the claim seem genuine.
15:09So this claim could have been done and dusted in no time.
15:12In most instances, we'll look to try and pay these claims as quickly as we can.
15:15There's no reason to hold up a genuine customer's claim.
15:18But on this occasion, because the customer had made the previous claim
15:21within the last seven-month period for a missing earring,
15:24we felt it was necessary to look into this in more detail.
15:29So Chris put in a call to find out about the previous claim.
15:33Have you ever made any hotel insurance claims at all in the past?
15:36Not that I can think of. Oh, I did when I was at college.
15:40OK.
15:41About a million years ago.
15:42Have you ever lost any other jewellery or any other gadgets at all in the past?
15:47Um, no, I haven't. I mean, my phone was old at the end of the night.
15:52Jewellery, no. Well, nothing that was of any value.
15:54This was the only other thing other than my watch,
15:56and I don't normally take my watch on holiday.
15:58OK.
16:01When she referred to two claims that she'd previously made under this policy,
16:05not the earring claim, we naturally became concerned.
16:08Have you ever lost any earrings in the past?
16:12I think I did, yeah. It was on a winter holiday.
16:17OK.
16:18I went on a winter holiday.
16:21I think it was either this Christmas or the Christmas before.
16:25OK.
16:27Um, that's right, it was. It was Christmas in London.
16:33And we had an overnight stay at a hotel in London.
16:38That's right.
16:40And I ran there for one night.
16:43And yes, of course, I tried to claim that I couldn't,
16:47because my insurance states that I had to be there for more than two nights.
16:52Right, OK.
16:52To have an insurance to kick in.
16:55Gosh, yeah, that was.
16:56OK, yeah.
16:58So what was it that you lost there?
17:01It was, yeah, it was, it was an earring.
17:04An earring, OK.
17:05Yeah.
17:06And what type of earring was it that went missing on that occasion?
17:10It was, it was a bit of a cheaper, older earring, um, that I had.
17:15OK.
17:16That was a gold-plated earring.
17:18Gold-plated, OK. And how old was that earring?
17:21Gosh, that would have been six, seven years old.
17:25OK.
17:25First year, first day, eight years old now.
17:28Oh, was that earring recovered at all?
17:30No, it wasn't. No.
17:33You asked her about her previous claim, and she told us that the earrings were a set of gold-plated
17:37earrings that had been bought a number of years ago.
17:39She had changed the description of the earrings and the time that they were purchased.
17:43When Sieger pulled up the documents from her previous claim, it found carbon copy receipts that matched both her January
17:49claim and her recent one.
17:52We knew that the earrings that she was now claiming for were the same earrings that she'd previously claimed for.
17:57So Chris listened to the original call she made in January.
18:03Now, I've, er, I've had a chance to review the previous claim that you made when you said that the
18:07earrings were purchased in July 2015.
18:10Yeah.
18:10You told me that the earring that went missing in January was a gold-plated earring, which was six or
18:15seven years old.
18:17Yeah.
18:18Um, why is that information so different?
18:20Um, I, I mean, I apologize. I, I, I believe that they were from older, perhaps it was earrings that
18:28he bought me last year, so.
18:31Now, I have to ask, are these the same earrings that you claimed for in January?
18:36And I must say that it is better to be open and honest at this stage.
18:39Would this information result in a confession?
18:43Are these the same earrings?
18:45Yeah, I would like to, yeah, I, I did, um, I did, um, I did leave them, I, at Christmas
18:51at some point.
18:52Um, I wanted to claim for them because there was a special birthday present and I've got one of them,
18:58um, and, yeah, I do apologize.
19:01Yeah.
19:02Okay, so, so this, this actual incident hasn't actually occurred in Thailand.
19:06Is that, is that right in saying the actual earrings that you're claiming for today were the ones that were
19:10lost in January?
19:12Yes, for that.
19:12Yeah.
19:13Okay.
19:14The e-mail that, uh, you've provided in support of the claim, is that something that you've e-mailed them
19:19about?
19:20I did.
19:21Yeah, now I did ask them.
19:22Okay.
19:22Is that something that you've done in support of the claim to substantiate it then?
19:27I have.
19:29Okay.
19:30Um, well, in terms of moving forward, unfortunately we're not going to be in a position to, uh, to make
19:35any payments in respect to the claim.
19:37Um, I can confirm that it has been declined.
19:38We don't condone false claims or any sort of fraudulent activity.
19:42Okay.
19:43No, I understand.
19:45Okay.
19:46Well, thank you very much.
19:49Bye-bye.
19:49Bye-bye.
19:51Having been unable to claim for the earring seven months earlier, the claimant clearly didn't want to take no for
19:56an answer.
19:58While the customer's previous claim may have been genuine, that doesn't give her the excuse to fabricate circumstances and falsely
20:04obtain loss reports in order to substantiate this claim.
20:07And given the potential ramifications, you'd hope she wouldn't do this again.
20:18On road claimers, we see it all, including versions of events that are based on fantasy rather than reality.
20:26Claim forms can read like Hollywood scripts, ringing drama out of the most minor of prangs.
20:33Sorting fact from fiction can seem like mission impossible, but thanks to modern technology, more of these exaggerated claims are
20:40being exposed.
20:44And there's no plot in the shadowy world of insurance fraud that AXA hasn't seen.
20:51In January 2018, we received notification of an injury claim from a claimant alleging that our customer had driven into
20:59him and smashed his head against the windscreen.
21:01Alleging that we'd injured his knee, his head, his back and his hand.
21:08In my experience, it's probably the first case I've seen where it's been alleged that we've run somebody over, essentially.
21:16The incident said to have taken place on a petrol forecourt.
21:22It was sounding like a scene from a Hollywood hit, a flaming row at a petrol station with the claimant
21:28being mowed down by a monster truck.
21:33And the settlement figure was reaching blockbuster proportions too.
21:37The claim that was being presented was worth in the region of Ā£9,500 to include legal costs.
21:42At this point, there were no suspicions, but we hadn't had a report of the incident from our customer.
21:50Considering he was alleged to have run someone over, it was unusual that AXA's customer hadn't been in touch.
21:57So it contacted him to get his version of a vent.
22:01A customer denied them in full and said that he hadn't run over the claimant and that this incident was
22:08a result of an altercation between the two.
22:10And that as he attempted to drive off, the claimant punched his windscreen.
22:14So in situations like this, it often tends to be one word against another.
22:19AXA needed something to verify what had happened and ideally something impartial.
22:26Unbeknown to the man who was claiming to have been run over, there was a secret witness in AXA's customer's
22:31car, a dash camera, and it had recorded it all.
22:36We asked our customer to send us the dash cam footage so that we could view it.
22:40And following the view of that footage, it was clear that this incident hadn't happened as the claimant was alleged.
22:47Warning. The following dash cam footage carries an EE certification. Extreme exaggeration.
22:54Please be aware, a windscreen was harmed in the making of this film.
23:00It shows the customer having some kind of verbal altercation with the claimant.
23:12And then as the customer pulls his vehicle forward at a negligible speed, you hear the thud of the windscreen
23:19being hit by the claimant with his hand.
23:24I want your details. I want your details mate. You just tried to run me over. I want your details.
23:31And the grays is that he's clearly claiming as a result being knocked over, probably as a result of hitting
23:36the windscreen.
23:37The account of being deliberately run over was starting to show massive flaws.
23:42From the content of the footage, it clearly contradicts what the claimant is alleging, that we've driven at him and
23:51knocked him onto the bonnet and then onto the windscreen.
23:53That clearly doesn't happen from the footage. The dash cam would have caught that and it just simply didn't.
23:58The camera never lies. You just tried to run me over.
24:02Surely this irrefutable evidence would stop the claimant performing any more proverbial stunts.
24:08We exchanged our evidence to include the dash cam footage, but still at that point they decided to pursue the
24:16matter to trial and allow a judge to make a finding.
24:19This was certainly risky.
24:21In my opinion, it was quite foolhardy to try to take this one to trial.
24:25During the findings, the judge concluded that this incident hadn't occurred as stated and deemed the claimant fundamentally dishonest.
24:34With this ruling, the judge was able to add fuel to the fire.
24:38The judge also awarded us just under Ā£7,000 of cost, which the claimant paid back in full.
24:44Our scammer was stumped at the pumps by a watchful eye.
24:50I can't impress enough how valuable such dash cam footage can be in instances like this and help us disprove
24:57fraudulent claims.
24:57In addition to us loading into the insurance fraud register, we decided that we weren't going to take it any
25:02further.
25:03The claimant clearly acted out of frustration and anger and has paid the price.
25:07And hopefully a Ā£7,000 bill will deter this scammer from attempting a sequel.
25:14If the claimant tried something like this again, it's likely that the consequences will be much harsher and could even
25:19carry a prison sentence if he's caught again.
25:28Still to come, a serious work injury.
25:32She alleged that the pain left her bed bound for two days.
25:37But when insurers find she's not that ill.
25:40We think this was one of the most brazen attempts at fraud that one would see.
25:45Her hopes of a payout are left dangling.
26:00If you have a prized possession, you may consider insuring it.
26:04But choosing a policy that covers the what-ifs in life is something policyholders need to decide for themselves.
26:10And they have no crystal ball to predict when they might need it.
26:15Of course, if you had a Rembrandt in your possession, you may feel the need for comprehensive cover.
26:22So when an incident happened to one of RSA's customers, he was glad he was covered by an insurance policy.
26:29Our insurer went to his outside dustbins early on a Sunday morning to discover that his locked garage had been
26:38broken into.
26:39And his motorcycle and accessories and two bicycles had been stolen.
26:44The two bicycles were valued at Ā£450 and Ā£1,100.
26:51Luckily, he didn't need to worry.
26:53Because he'd only taken out the policy the day before with us online and then had this unfortunate incident the
27:02very next day.
27:03Well, this was a real stroke of good fortune.
27:05It certainly was, but RSA found it all a bit too fortunate.
27:11This did raise our suspicions and we thought we'd just do a bit more digging into this case.
27:18Unearthing something very interesting.
27:20We thought we'd inquire of the police and we asked them for a copy of their report.
27:27He told the police that the theft could have happened at any time between the Friday night and the Sunday
27:33morning.
27:34Whereas he told us that he locked the garage on Saturday night and specifically can recall doing so.
27:43The difference in the alleged timing of the event would have in itself caused great suspicion.
27:53And we would have suspected that the policy was taken out after the event had already occurred.
28:00Which is not how it works.
28:02You clearly can't take a policy out against an event that has already happened.
28:08Insurance is all about us underwriting a risk of something potentially happening.
28:15Not insuring you or compensating you immediately into something that's already happened.
28:21Not only did RSA think the customer set up his policy after the burglary,
28:26it also discovered something even more surprising.
28:30Another insurer seemed to have a record of exactly the same incident that he's reported to us.
28:37He followed up with the insurers and found that the claim was for the identical two bicycles.
28:44Far from being in competition with each other, insurers work closely together and share information among themselves.
28:53The previous theft from the garage had happened a matter of weeks before him.
28:59So the claimant either had multiple bikes in his garage and a string of bad luck with thieves.
29:05Or he wasn't telling the truth.
29:07When we interviewed him, he admitted that he had made a claim for the theft of his motorcycle and the
29:14accessories,
29:15but said he had not made a claim for the two bicycles.
29:18Despite us confronting him with the facts, he still maintained that the bicycles had been stolen on this occasion
29:26and he had not been paid out for them previously by another insurer.
29:31Unwilling to back down and insisting he hadn't received a payout, RSA had to take drastic action.
29:39This claim to us was dishonest in its entirety, so we voided the policy under the fraud condition and we
29:50reported him.
29:51He was arrested and charged with fraud by false pretenses.
29:55He subsequently appeared at court where we pleaded guilty.
30:01He received a fine of Ā£105 and a conditional discharge.
30:07So for now, he avoided prison, but needs to stay on the straight and narrow for 12 months.
30:14Whilst it's difficult to speculate exactly what drove him to do this,
30:19I'm guessing he was naive in thinking that insurers wouldn't speak to each other
30:26and he thought that having been paid out easily on his first claim,
30:30he could just claim again for the same items and get away with it.
30:34As a result of his greed in attempting to get paid twice,
30:39he's now ended up with a criminal record and he will be placed by us on the insurance fraud register
30:45and that will cause him real difficulties in getting insurance cover in the future.
30:57Sick leave is an entitlement for most, especially if there's been a mishap at work.
31:03But with half a million workers suffering from musculoskeletal conditions,
31:08back injury claims can be harder to verify.
31:13When a receptionist was injured at work, her claim landed on the desk of Rob Lee at Aviva.
31:20The claimant alleged that she'd suffered a back injury at work whilst undertaking some heavy lifting.
31:27She was a receptionist in an apartment block and so one would not ordinarily expect her to be undertaking heavy
31:34lifting.
31:35But claims to have had to lift heavy laundry bags as part of her work and not to have been
31:40trained how to do this.
31:42And professional laundry bags hold a minimum of Ā£15 in them, which is the equivalent of lifting an average bicycle.
31:49This claim was for an alleged back injury suffered during the course of work.
31:55She alleged that the pain left her bed bound for two days.
32:00If the claim was approved, the total cost will be a sizeable amount, a whopping Ā£19,000.
32:08So Rob immediately called up her medical report.
32:12The medical report concluded that the claimant appeared to have suffered a lower back injury,
32:18which impacted her lumbar spine and that she had also had an impact on her mood.
32:25Rob had concerns though.
32:27When the claim came in, we had cause to look at it because it didn't come in for some four
32:31months after the alleged incident.
32:34And Rob also knew an employer would have followed due process.
32:39She had been injured at work and it was unusual that she hadn't mentioned it at all in any way
32:44to her employer
32:45or used the process in place for recording such injuries or incidents at work.
32:50Something wasn't right and Rob would need to do some heavy lifting of his own.
32:54At that point we undertook further investigations.
32:58Those investigations included looking at her employer records, looking at any publicly available social media
33:06and taking any witness statements.
33:08It immediately came to light that the claimant had left her employment two days after the alleged incident
33:14citing fatigue but not mentioning the accident at all.
33:19And conducting social media profiling revealed something very surprising.
33:25Our investigations then showed that in fact two weeks after the alleged incident she was filming for a reality TV
33:34show.
33:35And the claimant's contribution was utterly heroic given the fact she had a crippling injury.
33:47Bungee jumping and in the following episode a spot of jet skiing.
33:53This is certainly not the sort of behaviour or activity one would expect somebody with a severe back injury to
34:00undertake.
34:00Having seen all of this evidence we didn't need to see anything more in order to know that this was
34:05a false claim and we declined the claim.
34:07But Aviva decided that this was a case to really put its back into.
34:12We think this was one of the most brazen attempts at fraud that one would see.
34:20So we notified the Insurance Fraud Enforcement Department and we worked with them to pursue a criminal conviction for fraud.
34:28At trial she pleaded guilty to fraudulent misrepresentation.
34:34The judge handed down a 10 month custodial sentence suspended for two years.
34:39And in his remarks he cited that this was a foolish enterprise on the claimant's part.
34:46Aviva was more than satisfied with the severity of the custodial sentence in this matter.
34:51It's not something she'll bounce back from easily.
34:54The claimant will have now a criminal record for fraud which will make it difficult for her both in terms
35:01of seeking future employment but also of course gaining insurance going forward.
35:07It sends out an especially strong message to any potential fraudulent claimants.
35:13To put oneself on television within weeks or days of having allegedly suffered a severe injury is about as brazen
35:24as it can get.
35:36With fraudulent claims on the rise insurers must stay ahead of emerging patterns to avoid paying out on dishonest losses.
35:44The following case involves a crime ring that used dozens of vehicles in staged collisions over a number of years
35:51to siphon tens of thousands of pounds from multiple insurers.
35:56When Direct Line grew suspicious a massive investigation was launched with the code name Operation Illinois.
36:04There was a series of 14 claims. They only began to raise suspicion once we'd seen a few of them
36:11together.
36:12Looking back over past records a pattern was revealed between certain crashes.
36:18One of the main things was the location that they were happening.
36:21They were all happening around North London and they quite often happened at T junctions as well.
36:28A few of the accidents actually happened in the exact same spot.
36:33The claims were spread across two years.
36:38One of the claims was typical.
36:41Three cars having a collision at a T junction in North London.
36:47A BMW, a Mercedes and an Audi.
36:50So the cost of that claim was in the region of Ā£30,000.
36:53This claim was actually settled at the time.
36:57These were canny fiddlers though.
37:00Aware that insurance firms scrutinised higher value claims, they deliberately avoided some of the usual traits of a stage crash
37:07claim.
37:08All of the claims that were made were just for vehicle damage, so no bodily injury or hire, which you
37:14would expect to see in accidents of this severity.
37:17No dubious whiplash, no higher cars.
37:21Ironically, the absence of these things actually helped direct line to make connections between the suspicious claims.
37:28They also had another shared factor, which immediately raised alarm bells.
37:33The vehicles involved had all had the mileage altered by quite a substantial amount, the highest of which was the
37:39Audi, which the mileage had been reduced by 130,000 miles.
37:48If you had a vehicle that had done, say, 200,000 miles, the market value of that vehicle is significantly
37:54reduced.
37:55Just because of wear and tear on the vehicle, the more parts are going to need replacing.
37:59If the mileage is a lot lower on it, the vehicle would be in better condition, therefore the market value
38:04is significantly increased.
38:07That means a claim can be worth more than they paid for the car.
38:11Pure profit for the gang.
38:13And this was multiplied by three cars.
38:16Clocking mileage on a vehicle is actually quite difficult to do, especially on a lot of newer vehicles.
38:21Actually requires specialist software and coding to be able to go in and do it.
38:26Rachel was dealing with a sophisticated operation.
38:29But when it comes to detection, the methods are surprisingly straightforward.
38:34An old car with a low mileage is ripe for scrutiny.
38:38You can look at the MOT history of any vehicle online.
38:42So we can have a look and if the mileage was more at a previous MOT and then it's reduced
38:47later on, then it's obviously been clocked.
38:50We also looked at the sale adverts for the vehicles.
38:54So if it's being sold at a certain time and it's got the mileage noted on the advert, and again,
38:58that decreases later down the line, it's obvious that the vehicle's been clocked.
39:03So the mileage fiddling was a clear hallmark of this gang's work.
39:07And when Direct Line delved into the people involved in these crafty crashes, the jigsaw started to take shape.
39:16The female Audi driver in one of the earlier pranks was working with a male accomplice.
39:22And they both figured in the gang's last and most audacious stunt, smashing up a Mercedes and a Maserati.
39:31This followed the same pattern as it happened around the same area with similar circumstances.
39:37One vehicle pulling out of a T-junction and causing the other two to collide.
39:42By now, it's a textbook crash for the gang.
39:45But this time they'd wound up the glamour with the luxurious Maserati and wound down the clock further than ever.
39:52One of the vehicles in this incident had had the mileage reduced by 200,000.
39:59When we compare this to accidents that had happened earlier on, even just the year before, they were clocking in
40:05the region of 60,000 miles.
40:07We can see that they're getting greedier, they're getting braver and they're increasing the amount of financial gain for themselves.
40:14But not for much longer.
40:16We interviewed all parties involved in this accident and they all alleged not to have any prior knowledge of one
40:21another.
40:22However, the investigations that we'd carried out into the previous accidents proved otherwise as there were strong indefinite links between
40:28all of them.
40:30When it came to the interview, one of the female suspects stood out as being particularly forgetful.
40:36She was acting very nervous, she avoided eye contact and she was continually asking why a statement was necessary.
40:43There were a number of inconsistencies in what she had stated and what had been reported by the other parties
40:49involved.
40:50Her description of the accident location, for example, she said that she could only see trees.
40:56However, when we visited it, it's actually a residential area with lots of houses around.
41:02She mentioned that the accident location was well lit so she could see what was happening ahead of her.
41:08However, there's no street lighting in this area and the accident happened at nearly 11pm at night.
41:16She also said the weather at the time was dry.
41:19However, the other parties involved had all said that it was raining at the time.
41:24This was hardly credible.
41:27All three of the claims were rejected and nothing was paid out for them.
41:32Once we'd rejected the claims, the parties just walked away and that rejection wasn't challenged,
41:38which just cements our concerns that this wasn't a genuine claim as that would have caused severe financial loss to
41:44them.
41:46Whilst the organised crime network was having difficulty getting its story straight,
41:50all the insurers affected by the gang were acting in tandem.
41:55Because of the amount of money involved, the impact this was having across the industry
42:00and also the level of evidence we'd obtained, it was a good case to refer on to the police.
42:05Given this gang was operating on busy roads, the police response was positive.
42:11They interviewed six suspects which had been involved in our investigations.
42:16As a result of those interviews, charges were brought against two of those who were both insured with us.
42:22They were the forgetful woman who'd already been interviewed and a male accomplice.
42:27They were involved in numerous accidents across the operation
42:30for claims that were in the value of over tens of thousands of pounds.
42:36The man was charged and pleaded guilty to two counts of fraud by misrepresentation.
42:41He was sentenced to 100 hours of unpaid community service
42:45and also had to pay compensation back to us.
42:50His partner in crime, the forgetful fraudster, pleaded guilty to one count of fraud by misrepresentation.
42:56She was given a curfew and ordered to pay compensation.
43:01This is the first time that I've seen mileage clocking to this level form a major part of an operation
43:07and it's just evidence of fraudsters evolving and trying different tactics
43:11to try and make financial gain where they can.
43:15The insurance industry also evolved, so working together with other insurers
43:19as well as the police were able to disrupt this sort of criminal activity.
43:23We'll see you next time.
43:25We'll see you next time.
43:31We'll see you next time.
43:47We'll see you next time.
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