- 2 hours ago
Rogue Claimers - Season 2 Episode 22
Category
🎥
Short filmTranscript
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 subject out the 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 this is Road Claimers
01:08today undercover filming exposes a greedy opportunist attempts to boost this payout by
01:15more than 300,000 pounds in this case these allegations were clearly proved to be falsified and
01:23exaggerated based on the surveillance footage that we obtained a chance that attempts forgery to sign
01:30off his own claim we had good reason to believe that this document could have actually been doctored
01:35provided and provided to us they've confirmed to me over the phone that they have not sent that laughter to
01:39you
01:42and dash cam footage sets the record straight when a case of road rage escalates into a fraudulent claim
01:49you can see the Ferrari driver has got his arm out of the window so he's actually only driving with
01:54one hand here at the same time being very keen to gesture to our van driver as to exactly what's
01:59going on
02:05it isn't just the everyday types of insurance policy which many of us have that can be targeted by fraudsters
02:12employers have insurance in place to protect their staff but these policies are also vulnerable to
02:18unscrupulous opportunists travelers provides insurance for councils and local authorities and
02:24recently dealt with a claim that had come from one of their insured employees we were presented with a
02:29personal injury claim for a claimant who alleged that he injured his elbow while he was working as a
02:35refuse worker he picked up a recycling bin from outside someone's house which was weighted down with
02:40bricks and he alleges that he injured his right elbow causing a tear in the tendon of his right elbow
02:45there's no denying that collecting rubbish is a physical job that carries risks and the claimant's
02:51injuries would have a long-lasting impact on his life he did seek some medical attention and he
02:56actually underwent surgery for the issues associated with his elbow the surgery is unsuccessful and it
03:02left him with difficulties with moving the arm around and that caused him to be unable to continue to work
03:08for a period of about three years if the claimant is unable to earn a living this is a case
03:13where
03:14compensation is inevitable we accepted liability for the incident he had not received manual handling
03:21training which he was supposed to have received so there's a degree of liability on on us as an
03:25insurer to compensate him for genuine injuries we were willing to settle this case we offered him
03:31eighty thousand pounds this was rejected unhappy with the offer he'd been given he submitted his claim and it
03:39made interesting reading the extent of the injuries grew significantly with allegations of regional pain
03:47syndrome he alleged that he wore a collar and cuff for four hours a day which allowed him to rest
03:54his
03:54elbow he said that he avoided using his arm as much as he could because it would swell and cause
03:59him
03:59difficulties and and quite significant amount of pain as well there were allegations of a loss of
04:04pension and that he also needed assistance with paying rent and those kind of things so the value of
04:10claim came through at three hundred and seventy five thousand pounds this this breaks down as a loss of
04:16earnings claim because he allegedly wasn't able to work adaptations to his vehicle being able to purchase
04:21an automatic vehicle and uh and the adaptations he needed for the steering wheel and he claimed for
04:27time for his girlfriend for caring for him in general household chores washing cleaning ironing those kind of
04:33things before reaching for the checkbook travelers wanted to be sure that the claim was a legitimate
04:39one so the case was referred to aiden my role as an investigator is to is to review cases where
04:46we
04:47have concerns of potential exaggeration or misrepresentation of the claim then the case will be referred
04:53into me and i will undertake further inquiries into them into those people and it didn't take aiden long
04:58to start digging up information that raised questions during the investigation we got his
05:03medical records which showed that he had a long-standing issue with his right elbow so this wasn't
05:08anything new to him it was a an injury that he was aware of and there was quite a significant
05:14amount of evidence to show that he'd he'd had treatment for it before but it appeared to be
05:19unsuccessful so this injury just appeared to make that worse but we had doubts around that as well
05:26about the extent of the injury and that it was potentially using the pre-existing conditions
05:32to show that he was actually more injured than he was suggesting suspicious that the claimant might
05:38be playing on his pre-existing condition in the hope of a payout aiden took decisive action
05:43surveillance is used as as part of a a wider investigation tool um often online inquiries will
05:49be conducted first and then we'll do a period of surveillance someone's to really fact check what their
05:55allegations are and to also ensure that there's no exaggeration or misrepresentation if the claim was
06:02a legitimate one then the footage should back it up in the surveillance we'd expect to see him kind
06:09of really protective of his injury unable to use his arm in in really any other capacity than having
06:15it in a in a collar and cuff um not able to carry shopping really kind of protective and as
06:22it caused
06:22him a lot of pain and that's really what he alleged so you'd expect him to be quite tentative around
06:26that
06:26injury okay look closely
06:32the first day of surveillance shows him driving from his home address this is in spite of him
06:38alleging he's not able to drive subsequent investigations showed that he was actually on
06:44a driving ban for drink driving at the time this footage was taken this footage is really surprising
06:49um we didn't expect to see him uh driving at all i mean based on his allegations he said that
06:54he
06:55wasn't able to so uh this footage was really key in um in confirming our suspicions so not only did
07:03the
07:03claimant have a blatant disregard for his drink driving ban it now appeared he was adding insurance fraud
07:09to his list of crimes you can see here at various times in the footage that he is carrying uh
07:15items
07:16in his right hand he carries a couple of shopping bags and some papers underneath his right elbow
07:21this is also shown by him favoring his left arm to use his mobile phone
07:26whilst carrying some shopping bags in his right arm if someone was suffering significant pain in their
07:32elbow as he alleges you'd expect him to switch hands so he'd be carrying items in his left hand
07:37and using his phone in his right after looking at the surveillance all i can see is inconsistencies
07:44um at no stage does he wear the collar and cuff that he says he wore and it doesn't appear
07:49to
07:49affect him he doesn't seem to be suffering with any pain whilst he's using his right arm
07:53he just appears to be living a normal life um there just don't seem to be any issues at all
08:02in this case his allegations were clearly proved to be
08:06falsified and exaggerated based on the surveillance footage that we obtained
08:11but as damning as the footage was it was just the beginning
08:18the surveillance footage wasn't the only concern on this matter after looking at his dwp records we
08:24were able to show that he continued to work as a roofer despite alleging he was not able to
08:28further into our investigations we looked at his medical records within that there was an entry to
08:35say that he'd been assaulted by a co-worker whilst at work so our inquiries into that led us to
08:41get the
08:41metropolitan police report which showed that he'd been assaulted whilst on a construction site again
08:46this was during the period where he said to us that he wasn't able to work so the claimant was
08:51in a far
08:52better state of health than he'd have travelers believe and was earning money but the revelations
08:57didn't end there another part of our investigations was into the financial background we looked at the
09:04insolvency register which showed that he'd been made in insolvent as a result of an unpaid hire bill
09:10we made some further investigations into this and it showed that he'd hired a tipper truck a commercial
09:16vehicle and actually haven't paid the hire bill and also parts of the congestion charge not been paid
09:23there's only one reason why you'd hire a vehicle like this and that would be for the purposes of
09:28work it's not a vehicle you'd commute in it's a large flatbed tipper truck lorry that's really used in
09:34the construction industry the claimant was clearly in financial difficulty but chancing his arm with a
09:41fraudulent insurance claim had only added to his problems the evidence against him was substantial
09:47we had footage of him driving a vehicle when he said he wasn't able to
09:51we had statements from his employers saying that he was working when he wasn't able to
09:56with the police report showing he was assaulted whilst he was at work and saying that he wasn't
10:01able to work and a clear financial motivation to exaggerate his claim based on the fact that he was
10:07now a bankrupt at this stage we disclosed all of the evidence we had to his solicitors we provided
10:13them absolutely everything and told them that we were unwilling to make any offers and settlement of
10:18this claim and that we were going to take this right the way through to trial his solicitors
10:22dropped him as a client they no longer wanted to represent him anymore and he was going to bring
10:28his own claim against his employer he subsequently did not attend the trial the judge struck the claim
10:35out completely if the claimant thought ignoring this would make it go away then he was mistaken
10:42based on the quality of the evidence that we'd had and the gross exaggeration of this claim we
10:48decided this we need to involve the appropriate authorities and refer this case to the city of london
10:54police the evidence aiden and his team had gathered was so strong that justice was swift he was charged
11:01with conspiracy to commit fraud and was sentenced at the old bailey he received a two-year suspended
11:10sentence he was ordered to undertake a rehabilitation course he was on a curfew for two months and he was
11:17ordered to pay back 17 500 pounds under the proceeds of crime act the sad reality is that cases like
11:24this where greed gets the better of people with genuine claims are increasingly common i was pleased
11:30that we'd managed to catch a fraudster there's no denying that there's a genuine injury here and we
11:34were willing to settle his claim we made him an offer to do so but he'd so grossly exaggerated his
11:40case
11:40that he turned himself into a criminal and a fraudster later investigators see straight
11:52through a bogus claim for compensation it's highly unusual that a customer who had had such serious
11:59injuries would want to have a picture taken of themselves from an x-ray table
12:15companies do have safeguards in place to double check cases are genuine but tcs claims face threats
12:22from a customer who simply wouldn't accept his ham-fisted forgery attempts were not credible
12:28sophie babbage and her team are used to taking it on the chin the customer contacted us to report
12:33that they lost their mobile phone whilst in a shopping center
12:38the phone was an iphone 7 valuing around 549 pounds do you want to talk to me through what's
12:44happened obviously i was at shopping center and my phone was in my pocket then i checked my pocket
12:52again it wasn't there and i tried my friend was next to me i tried to call in my phone
12:56and it was off
12:57okay so it was in your was it a back pocket it wasn't my um jacket pocket your jacket pocket
13:03okay
13:05we had no reason at this stage to believe that it was anything other than a genuine claim
13:09to support any claim for a lost or stolen mobile phone and we would request proof of ownership
13:14so that could be in the form of a receipt and packaging and we would also request the relevant
13:20reference number from the police so a lost property number or crime reference number and we would also
13:25request proof of the phone being blacklisted so that would be confirmation of the time and date in
13:30which the phone has actually been blocked it is important to blacklist the phone and so that
13:34ensures that it's blocked and there can be no unauthorized use in support of the claim the customer
13:39did provide proof of blacklisting this was in the form of a letter from the network provider
13:43this confirmed the date and time which the phone was blocked which we also used as proof of ownership
13:49but the letter sent in by the customer was not quite as it seemed
13:53part of our claims process is to review the authenticity and the validity of any documents
13:58actually provided to us on this particular occasion and we did notice that there were some inconsistencies
14:05with what we'd see in a normal letter from a network provider there was no addressee in terms of mr
14:12or mrs the imei wasn't actually the correct number of digits the memory size of the mobile phone wasn't
14:19actually a memory size that exists and it was not official there's no letterhead and the logo was
14:24significantly smaller than we'd usually see there wasn't much about this letter that was authentic
14:29good reason to go back to the client we did ask for further information from the customer we asked
14:36for the email chain for which the proof of blacklisting was actually attached to to which the customer
14:41responded that they had deleted this and this was no longer available it seemed unusual that the customer
14:47would have deleted the email chain and we couldn't gain access to that what we would usually see in
14:51those sorts of circumstances is that the customer would be able to contact the network provider again
14:56and actually get a copy of that email chain unfortunately that wasn't available on this particular occasion
15:02with no concrete evidence from the man claiming tcs claims went direct to his phone supplier
15:08as part of our investigation we did contact the network provider during that call the network provider
15:13was able to confirm that they had not issued a letter to the customer that was claiming
15:17and the imei that had been provided and documented in that letter wasn't matched to the customer in
15:23question do you say that you had actually sent a letter out to the customer no it hadn't been it
15:28hadn't
15:28been sent so no letters have been sent from your company to that customer in relation to this
15:36this query is that right yeah that imei number was never used with the customer's mobile number never
15:45used with that mobile number okay as a result of the conversation that we had with the network provider
15:51and then confirming that they had not issued a letter and the imei wasn't listed to our particular
15:56customer this confirmed that the phone hadn't been blacklisted and the conditions of our policy hadn't been met
16:02we had good reason to believe that this wasn't a valid claim and in fact the document could have
16:06actually been doctored and provided to us a tricky phone call followed have a listen for any signs of
16:13remorse everything that we we have gone through and all of the all the steps we've taken it does
16:18confirm that this this document has been falsified they've confirmed to me over the phone that they
16:22have not sent that letter to you like i said this document has been falsified another as a result of
16:29this
16:29that is actually classed as misrepresenting your claim which is a form of insurance fraud we won't
16:35be looking to move any further with the claim the claim is being formally declined the other consequence
16:39of this is actually the policy itself we are looking at voiding for misrepresentation of it you
16:45will also have to make for future insurance companies aware that a policy has been uh avoided or or
16:51cancelled well my phone's gone now so i can't get my phone back like i said we won't be proceeding
16:56any
16:57further with the claim that's up to yourself the customer did become quite agitated and unhappy with
17:03the outcome of the claim and he made several threats with regards the action that he could take
17:08but our decision remained that the policy would be voided and unfortunately the claim couldn't be
17:20fulfilled like i said i will confirm everything with you in writing but you've got that that um but
17:30this is like you said what we're looking at from here okay this man was not happy but he failed
17:36to
17:36acknowledge his part in his policy being cancelled the efforts he went to creating a false document
17:41completely backfired as he naively assumed no checks would be made now he's been caught out
17:47he'll struggle to find phone insurance again in addition to repudiating the claim and voiding the
17:53policy from inception the customer's details was also uploaded to a database which is accessible by
17:59other insurance companies and to make them aware that we had actually had this claim submitted
18:11cars are expensive to run and even costlier to crash a prank in a high-end vehicle costs significantly
18:18more than in a family saloon but that's exactly what our insurance policies cover
18:24but fraud departments know that not all accidents are as they appear and direct line recently handled
18:29a case with a surprising twist this claim was presented to us as a straightforward road traffic
18:35accident albeit with two unusual vehicles our customer was driving a van and the vehicle he'd collided
18:41with was actually a ferrari a high performance car like a ferrari is quite possibly the last thing
18:49you'll want to be driving into the model in question can cost almost a quarter of a million pounds
18:54so this was not going to be a small claim the collision resulted in minimal damage to the ferrari
19:00it needed a new bumper some fixing of the lights badge etc the collision resulted in 23 000 pounds for
19:07the vehicle repairs and in excess of 50 000 pounds for a higher vehicle whilst the ferrari was off the
19:13road
19:13as you can see this was a significant claim for the both the vehicle damage and the higher charges
19:19so almost 75 000 pounds but as with many accidents on the road the drivers in question had differing
19:26accounts of what had caused the collision the circumstances were described to us as the ferrari
19:31had had to slow in busy traffic and our customer had been unable to stop in his van and had
19:36collided
19:36with the back of the ferrari sounds plausible enough but not according to the driver of the van
19:44we contacted our customer for his version of events and he told us a totally different story
19:48he said he had been cut up by the ferrari on the dual carriageway and the ferrari had then pulled
19:53right in front of him in an aggressive manner gesturing out of his window and slamming on his
19:58brakes repeatedly this is poles apart from the ferrari driver's story fortunately our driver was able to
20:06avoid a collision on a couple of occasions but the third time the ferrari driver came to a dead stop
20:11and our driver was unable to stop before he collided with the rear the ferrari driver got out of his
20:16car
20:16and remonstrated with the van driver our customer said that the ferrari driver was acting very
20:21aggressively he was gesturing to him out of a window and even after the accident he continued to rant and
20:26rave and swear at him our customer suggested that they use a lay-by further down the road to exchange
20:31details as they exchange details in the lay-by our customer said the ferrari driver was still very
20:37aggressive towards him and still swearing repeatedly at him at this stage we have no way of determining
20:43who's telling the truth here historically a case like this would have been almost impossible to get
20:49to the bottom of but over the last few years more and more motorists have been installing dash cams in
20:55their vehicles and it's estimated that a third of the uk's drivers now have them fortunately for direct
21:01line their customer had one fitted to his van and to say it painted the ferrari driver in a bad
21:07light
21:07would be an understatement the footage clearly shows the ferrari driver pulling in front of the van
21:17and then slowing down dramatically it's quite dangerous the way he's slowing down here
21:23ferrari man isn't content to do this just once and his grasp of the highway code is questionable to say
21:29the least then he does it again at this point you can see the ferrari driver has got his arm
21:35out of
21:35the window so he's actually only driving with one hand here at the same time being very keen to gesture
21:40to our van driver as to exactly what's going on he's a real charmer isn't he he's slowed down once
21:46again in a very dangerous fashion causing the the van to get very close to the back of the ferrari
21:51and at this point he actually slams on the brakes causing the van to drive into the back of the
21:55ferrari
21:57this footage from the point of view of the van driver shows the ferrari driver was not struggling
22:02to slow down in traffic as he claimed and instead was stopping of his own accord and when the collision
22:08that he appeared to be trying to induce finally happened he ramped it up yet another gear
22:15the ferrari driver is so angry that he walks out into the path of oncoming traffic
22:20and is very lucky not to get hit by a passing lorry
22:23and see how angry he is when he gets out of the car shouting and swearing remonstrating with our
22:31driver as if it's his fault when clearly the ferrari driver has caused this accident in the first place
22:37but that's as far as his luck went because despite his efforts to pin the blame for the accident on
22:42the
22:43van driver as far as direct line was concerned the evidence from the dash cam was crystal clear
22:49this wasn't an accident caused by our customer the ferrari driver wasn't slowing down as a result of
22:54slow moving traffic but he was deliberately brake testing standing on his brakes gesturing out of the
22:59window and inducing an accident that our client was totally unresponsible for based on the extremely
23:06revealing evidence direct line refused to pay out the dash cam footage didn't lie it couldn't be argued
23:12with and it meant that we could decline the claim in full we didn't make any payments for the damage
23:18to the ferrari which came to 23 000 pounds and we also weren't going to make any payment for the
23:23higher
23:24charges which were in excess of 50 000 pounds this case highlights the importance of honesty when it
23:30comes to making an insurance claim for ferrari man the dash cam footage was damning it's really
23:38important when you put a claim in that you give a true version of events especially as you don't
23:43actually know who's filming and who's watching both insurers and the police are using dash cam footage
23:48more and more as evidence of bad and dangerous driving
23:58still to come pet insurers are left scratching their heads when they find themselves dealing with
24:03the time-traveling pooch at 8 19 the puppy and the owner were in front of the vet having a
24:10consultation
24:11and that was an hour before the owner told us that the incident happened at 9 30 to 10 30.
24:31every year more than half a million british jet setters claim on their travel insurance
24:37the total value of these claims is climbing year on year sega is a charles taylor company that provides
24:43claims and travel assistance it's called on from all four corners of the globe the claim was for
24:49medical expenses as a result of an injury sustained in pakistan now i was talking in pakistan and there
24:56was a very good accident yeah yeah quite bad one to be honest you know a car rolled twice and
25:01then you
25:02know we rested on a ditch oh yeah yeah i had injuries in my back issues and uh that's me
25:10and also you
25:12the upper back like neck and stuff how are you feeling now are you any better well uh but i'm
25:18still limping to be honest uh but i was uh off for almost three months you know from danbury but
25:23somehow i traveled uh back you know in the pain uh you know in sort of a medical condition my
25:29dad
25:30had to upgrade me and into the you know the business class right because of the space and everything
25:35yeah okay we can definitely look to consider that that's not an issue at all
25:38oh i mean i've got the doctor's notes and stuff uh that my gp gave me okay as much as
25:44you've got
25:44now that will always help us to assess the claim no problem from the claimant's description this sounds
25:50like a serious accident the customer was claiming for 1100 pounds for a flight upgrade in addition to 500
25:57pounds medical cost we presume that the customer needed a flight upgrade due to the injuries he sustained
26:04but there was doubt about this case because of the length of time it took the customer to contact
26:09sega we did have our concerns with regards to the claim from the outset because the incident happened
26:15in january but he didn't actually register the claim until june you would have thought that given
26:21he was considerably out of pocket that he would actually want to have claimed his money back sooner
26:25than this the claimant had submitted some very odd photographic evidence that rather than help
26:30raise yet more questions about the validity of his case the customer provided medical reports and
26:36invoices to support his claim in addition to photographs of both the car and himself on the
26:42x-ray table it's highly unusual that a customer who had had such serious injuries would want to have
26:48a picture taken of themselves the medical report itself was extremely vague it didn't actually go into
26:55any detail with regards to the injuries sustained or how the injuries had actually happened we would
27:01have expected the doctor to have actually made reference to a road traffic accident
27:06but bizarrely there was no sign of anything like that or any evidence from the emergency services
27:12who you would have expected to have been called to the accident the police weren't even mentioned and
27:18we would have expected a police report at the very least confirming the details of the accident
27:24in fact there was very little evidence of anything when we asked the customer to provide evidence of
27:30how he paid for the medical bills he told us that it was obtained from a relative and there wasn't
27:35any
27:35money trail for this given yet another blank there was only one way siga could proceed at this stage we
27:43had
27:43no evidence of the cash paid for the treatment we had no police support to support the incident and we
27:49had
27:50nothing from the doctor to confirm how the injuries were sustained we felt it necessary to interview the
27:56customer over the telephone to give him the opportunity to provide us with everything that had happened
28:01and to validate the claim when you were in pakistan were you admitted to hospital yes yes okay yeah
28:11and why did the doctor advise you that you would need to be admitted because of the injuries how long
28:18were you admitted in the hospital for that night and also the next night after
28:26okay did they carry out any investigations or tests investigations maybe the scans and you know
28:34the reports after that that's all i don't know i'm not a medical professional so i wouldn't know
28:40you know no no sure throughout the telephone interview the customer was confident and cooperative
28:45with any questions that were raised to him so after these scans and reports were carried out
28:51what did the doctor advise you do they recommend anything to you i mean recommend the same thing
28:58that you need to take painkillers it's a complete bed rest you need you know at least for four to
29:04five
29:04be complete bed rest that's a fair bit of time but was what he was telling siga true given the
29:11customer
29:11had only been in hospital for two days with soft tissue injuries we found this grossly disproportionate
29:17to what we would expect the claimant was adamant he was still suffering i mean you still as i said
29:25it still affects me it affects my uh the cricket i played a friendly cricket on every sunday
29:29you know the the gym uh i can't really do gym properly the only thing i do is just walk
29:34the
29:34school when we asked for further medical reports to support the claim the customer told us that he
29:42wouldn't be able to provide us with this because that's not how they work over there would you be
29:46able to obtain something from them to confirm that it was a road traffic accident you had suffered from
29:53uh for now uh i mean i don't know because i can't travel back to this now you know as
29:59i said you
29:59know that's probably the procedure that's that's how they work but you know it's not in my hands in
30:04other words you know sure he's polite and has an answer for everything but he's not providing any
30:10concrete proof when we asked why the police weren't contacted or called to the scene he said that he had
30:16spoken to his cousin who told him not to because the police were corrupt can you explain why you
30:22have not reported my cousin told me the police there is quite corrupt you know the the moment
30:26they get the case you know they'll come up and ask you ask them for more money then we'll do
30:31this
30:31you know then we'll do that you know they'll disturb the driver they'll disturb his family and stuff like
30:38this over there is different you know it's not the same as we live in he's suggesting that nothing
30:44was properly documented in pakistan but siga wasn't giving up and pressed him on his glaring
30:50omission in not contacting them when the accident actually happened just curious to why you hadn't
30:56contacted the emergency medical assistant i was in a mental state of force up until end of april yeah
31:06i was in a medical like sort of trauma so i mean my mental health my physical and all not
31:14just that
31:14even but my financial condition now right now they're really bad you know so we have a man who was
31:21involved
31:22in a serious road accident miles away from home he failed to call the police or the emergency line
31:28provided by his insurers who help in cases like this he managed to fly back despite his injuries
31:34but didn't report the incident for a further six months even though he'd suffered physically and
31:39mentally there was no written evidence of bills paid or that the accident had even happened it's hardly
31:45surprising that siga wanted to look into this case in a little bit more detail we felt it necessary to
31:52appoint one of sega's overseas investigators to validate the claim at the hospital the medical
31:58director of the hospital confirmed with our overseas investigator that the customer was seen as an
32:04outpatient and the cost actually totaled 3970 pakistan rupees this amounted to just 30 pounds yes it's not
32:13quite the 500 pounds he was claiming for from this point on things continue to unravel the hospital
32:20director showed our overseas investigator a copy of an invoice and a copy of the test that you would
32:27expect from the hospital however the header of the letter was very different to the one that the
32:32customer had provided us with he confirmed that this didn't originate from the hospital and it was
32:37indeed fake in addition to that on the prescription invoice that he had sent to us it didn't have an
32:43email address and the hospital director confirmed that all invoices have an email address given what sega had
32:50uncovered and the investigation in pakistan there really wasn't a case at all we now knew that he
32:57wasn't admitted to hospital for two days the invoice was fake and the prescription was fake in summary we
33:04now knew that this was a fraudulent claim so we wrote to him declining his claim and referred him to
33:10the
33:10fraud condition in his policy worthy it was hardly surprising that we didn't hear from the customer again
33:17the customer was certainly not a master criminal whilst it appears that the customer had been an
33:23outpatient in hospital the customer had clearly exaggerated the claim and the cost incurred sega were
33:30very happy with this outcome because we have a zero tolerance approach to ford
33:46buses are targets for opportunistic scammers and there are people out there who put the lives of
33:51passengers at risk to fake an insurance claim bus operator first group deals with attempts like this
33:58so often that it has a team in place to investigate suspicious cases we were presented with a claim
34:05from a third party that alleged that our bus changed lanes and collided with the near side front of a
34:10vehicle a crash between a 12 ton bus and a car is never going to end up well for the
34:17car and the
34:18driver was claiming to be badly affected by the accident both physically and mentally
34:24as a result of the collision the third party alleged that she sustained injuries to her neck to her
34:29shoulder she had a fear of travel and she couldn't sleep the claimant also alleged that she couldn't
34:35do her shopping she couldn't do domestic chores personal care they were also restricted and resulting in
34:40her having to have physiotherapy this all added up to a hefty sum we estimated the cost of the claim
34:47to
34:47be in the region of 12 000 pounds this would be made up of the claims injury uh high charges
34:52the
34:52damage to the vehicle and also her legal costs in serious accidents costs as high as these aren't
34:59uncommon however in this case there was a slight problem that made first group suspicious the estimate
35:07of 12 000 pound was quite substantial considering that the damage the vehicle was no more than minor
35:11scraping and there was no damage to our bus and that wasn't the only thing that didn't add up
35:18the driver uh told us that he was at the traffic lights um as the lights changed he went to
35:24pull
35:24off and for some unknown reason the third party just veered into the side of his bus
35:29with conflicting accounts of what happened first group launched an investigation to establish whether
35:34the claims for personal injury could be legitimate we were presented with engineering evidence and this
35:40just verified our concerns that the damage was no more than minor scraping to her vehicle to be
35:46absolutely certain there was one final check to be made but even this flew in the face of what the
35:51claimant would have first group believe the next step for us was to download the cctv footage
35:59we expect them to see the vehicle in the right hand lane pull off from the traffic lights and for
36:05our
36:05bus to start veering into their lane but it's not what happened looking at the cctv footage you can
36:14clearly see that the third party allegations are a complete fabrication the third party is at the
36:20traffic lights with our bus and as they both start to pull off for no reason the third party's just
36:25steered right into the side of our vehicle even though the claimant was clearly at fault for the
36:35collision she then had the nerve to remonstrate with the bus driver who done absolutely nothing wrong
36:48cctv proved to be an extremely valuable tool in this incident um but cctv is not just used to validate
36:53liability it can also be used to spot unusual behaviors of individuals at the scene of the accident
37:01with buses having numerous cameras both inside and out the claimant was naive to think she could
37:06ever get this claim through so having reviewed all the evidence we had no intention of paying
37:12out on this claim repudiated the claim in full and eventually the third party dropped their claim
37:20decision but if she thought that would be the end of it the claimant could be sorely mistaken
37:24because this isn't necessarily going to be the case first group have a zero tolerance approach to
37:29fraud it is rather disappointing when someone makes an attempt to defraud our company and whilst
37:35this case might have concluded for the third party for the time being it hasn't for us
37:50some spurious claims are trickier to detect than others but the golden rule with insurance is that
37:56a policy must be taken out before the need to claim arises the policyholder first contacted us to advise us
38:03that her new puppy which she'd only got the day before had had an accident and broken its leg
38:11she said she'd been out with her dogs and this is a very new dog and they've been playing in
38:16the park
38:17and she'd heard a squeal from one of her dogs and turned around and one of the bigger dogs had
38:22run
38:22into the puppy unfortunately the dog had to be put down so the policyholder called us to tell us
38:30uh there'd been an incident uh and the claim came in at uh 4 14 on the 7th of december
38:37what type of
38:38policy did you have in place um well i haven't got any policy yet that was just the breeder when
38:42i picked him up she just activates whatever they activate i can't i just can't believe what's just
38:48happened he's just he's just been in the field and one of my cocker's that just ran straight into
38:56him and smashed his elbow oh and the vet said it's just too bad to fix and they just put
39:01him down
39:02oh oh i'm sorry to hear that tragically the owner had lost her new puppy and was faced with a
39:09vet's bill
39:10of 1177 pounds with young puppies it's it's very feasible that accidents happen and happen quite
39:17quickly in the new home they're in a new environment they're getting used to the new environment and as
39:23importantly owners are getting used to them normally the process is and it happens with the vast majority
39:28of our 20 000 breeders is that when a sale is agreed between the breeder and a new owner the
39:35breeder would
39:36tell the new owner that there's free insurance available and get their approval to to set the
39:41insurance up and send their data down to the insurance company and that's usually done up to
39:4510 days before or at the time that the puppy is rehomed so everything's above board the pup is insured
39:51we know it's insured the breeder knows it's insured and the owner of the pet have the protection that
39:56it's designed to have and seemingly this is what the owner thought was the case with her pup
40:01she called to advise us that the incident had happened between 10 and 11 in the morning uh the
40:07day that the policy had been activated and also just to ask us whether uh the incident would be
40:12covered on the insurance well i picked it up from the breeder who then registered it's saying that the
40:17cover was from is on from the 7th of december which was the day that it died now was he
40:24actually
40:24covered that day or not yeah let's just see what time this was set up it says the policy was
40:29set up at
40:308 19. sorry to have to ask you when was it that the dog had his accident well it would
40:36have been
40:38it would have been about i suppose 10 11 it was in the morning okay well to make a claim
40:46we would
40:46need the history from the vets anyway so if it was that's fine do you want me in that case
40:51to send a
40:51claim form to you if you can yeah i'll pop the claim form in the post for you yeah okay
40:58yeah i've
40:59never done this before so oh dear i've never had a claim when i've got eight dogs and i've only
41:04got
41:04one dog insured and i am thinking gosh maybe i should get all the others insured now considering
41:11she had so many dogs the owner was lucky it was the one that was insured that had been injured
41:17however
41:17when the claim form arrived it threw up a few questions the times of the incident didn't
41:23quite match so the times on the claim form were 9 30 to 10 30 as opposed to the call
41:28where she stated 10
41:29to 11. so in terms of investigating this claim where the inception of the policy and the incident happened
41:37very close together on the same day we started to put our full investigation in place another call was
41:45made to the pet owner to double check the facts do you know roughly what time that he went you
41:50took
41:50him i can't i thought it was about sort of half past nine ish um it was it was early
41:56in the morning it
41:57was it was an a.m for the morning time because i i've done breakfast and then i took them
42:02as soon as
42:03i had breakfast i took the dogs out for a walk so i would say it was in the morning
42:07definitely in the
42:07morning about 9 30 ish ish 10 i don't know you might be thinking does half an hour really make
42:14a
42:14difference when an animal is in pain and needs treating but a call to the vets to firm up a
42:19timeline helped nail down the real story i know that unfortunately um the puppy broke his leg on
42:25the 7th of december yeah do you have a record of the appointment time right so on the appointment it
42:32says booked at 8 19 on 7 12 17 arrived at 8 19 so that was when they arrived so
42:40they they didn't
42:41sort of book it beforehand they just turned up okay so i can give you a like a screenshot if
42:48that
42:48yeah is that information yeah is that okay if you email that through okay the evidence that we had from
42:55the veterinary screenshot clearly showed that it was a fraudulent claim uh at 8 19 the puppy and the owner
43:01were in front of the vet having a consultation and that was an hour before the owner told us that
43:08the incident happened at 9 30 to 10 30. interesting timing this information cleared some confusion but
43:16raised questions about who opened the policy the time of the appointment was before the policyholder
43:22had told us the incident happened in actual fact it was a minute before the policy was set up
43:28up with the policy being set up virtually at the same time that the owner was in the veterinary
43:34practice with the puppy um then obviously the policyholder couldn't have set up the policy
43:38and in actual fact the breeder who sold her the puppy set the policy up for her so we suspected
43:43that the puppy had an accident um policyholder called the breeder breeder set the policy up as
43:49quickly as possible at the same time that the owner was heading to the veterinary practice
43:53which meant that the breeder was colluding with the owner to defraud us this meant consequences for
43:59both parties having discovered fraud and the fact that the condition was pre-existing the start of
44:04the policy uh there were three implications for the the owner and the breeder for the owner um the claim
44:10was declined and the policy was cancelled and shut down for the breeder we ejected the breeder from the
44:16agro breeder club so no longer did the breeder have the facility to use our free cover
44:21and for both the breeder and the owner because they colluded to defraud us we included them on
44:27the ifig uh database uh which is a database uh shared between insurers of of suspected and and known
44:34fraudsters after our last contact with the policy holder uh when we declined the claim and explained
44:41why we were declining the claim uh we heard nothing from them they've been caught out you know they
44:46tried it on probably a little bit opportunistically uh when the accident happened so not very premeditated
44:52and obviously very keen to get the animal treated but they were caught out and embarrassment means
44:58you know we will never hear from them again
45:01so
Comments