- 2 weeks ago
Rogue Claimers - Season 2 Episode 7
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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 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 this is Road Claimers
01:08today a devious driver hopes treacherous conditions will disguise his deliberate
01:14attempts to hit an innocent motorist was obvious to us that this was an
01:18opportunistic attempt to cash in a man falsely claiming on his holiday insurance is stopped in
01:25his tracks as his deception is uncovered we were satisfied that the medical
01:30certificate was false which meant that the customer must have forged the doctor's
01:34signature on the medical certificate and the digital information in a picture
01:39catches out a chancer who claims they've lost valuable jewelry at a funeral is there anything
01:45you want to tell me about that day today no danger okay it's showing me that it takes
01:51three days after you're telling me you've lost the bracelet
01:59freezing temperatures create icy slippery surroundings wheels can't grip and cars may struggle to stop but
02:07as we're about to witness not all the motorists braving sub-zero conditions are out for the journey
02:14the company marker study specializes in car insurance and smelt a rat with this case we first heard
02:21about this accident when our policyholder reported it to us on the telephone he said that it had been
02:26behind the third party vehicle at traffic lights and when they turned green they both pulled away he
02:32said that the third party vehicle then slammed his brakes on for no apparent reason causing the
02:37policyholders vehicle to hit the rear of that car the policyholder said he became immediately
02:42suspicious as there was no reason for that party to stop as he did and that he had dashcam footage
02:48available that backed up his version of events the man whose car had been hit was looking for damages
02:55he was claiming for the damage to his vehicle and for a whiplash injury he claims that he sustained in
03:01the event he said that at the time of the collision he was traveling at around 15 miles per hour
03:07or so
03:08and that our policyholder just collided with the rear of his car the value of the third party claim was
03:13around six thousand pounds in total including solicitors charges we were also told that there
03:19was a passenger in the third party vehicle and whilst we hadn't received a claim from that person we
03:24fully anticipated that one would be forthcoming with shocks like this there can be an assumption that
03:30the driver in the car at the rear is a fault the policyholder shared the dashcam footage with us and
03:36upon review it was quite clear that the policyholders version of events was the correct one it was
03:44quite clear that the third party had pulled away from the lights and was traveling at a very low speed
03:49but decided to slam their brakes on for no apparent reason there was nothing in front of that vehicle
03:55that would cause them to do so when we reviewed the footage it was obvious to us that this was
04:00an
04:01opportunistic attempt to cash in and that the third party was trying to use the dangerous weather
04:06conditions to his advantage the on-board camera in the policyholders car revealed something else
04:17about the one he'd hit which seemed to have a short circuit what was curious from the dashcam footage
04:24was that despite breaking heavily the main brake lights on the third party vehicle did not appear
04:30to display the hazard lights on the car in front are working as marker study was busy investigating the
04:41validity of the claim the man who had been hit was getting impatient and ramped matters up a gear
04:48because we hadn't paid the claim no into our investigation the third party solicitors
04:52has decided to issue county court proceedings against our insured we therefore instructed
04:57dwf solicitors to defend the matter on our behalf senior associate colin bushel dealt with the
05:03defendant the man who'd crashed into the car the dashcam footage was key evidence and he was intrigued
05:09by how selective the claimants car lights appeared to be there are instances whereby brake lights can be
05:16disengaged by claimants deliberately to assist in the fraud being carried out interestingly on the claimant
05:22vehicle there is a third brake light in the rear windscreen which on closer inspection had been
05:28lighting up but was obscured from the defendant because there was a lot of snow on the rear of the
05:33car
05:36another key feature of of the case all the other facts of this matter related to the weather and
05:42the driving conditions at the time March 18 there was quite poor weather and there was visibly a lot
05:48of snow and slush and potentially ice on the road creating the conditions for a prang or greater
05:55opportunities for less honest motorists looking to make a quick buck but this scammer didn't know he'd been
06:04filmed our insurer client were very keen to be proactive with the evidence the dashcam footage
06:12from their perspective was irrefutable the claimants unfortunately took a view that the evidence could
06:18be disputed and effectively repudiated or dismissed the the footage and was happy to proceed on his
06:25version of events ie he was traveling at 15 miles an hour and we crashed into the rear of his
06:29car
06:30the crashed into claimant was clearly confident he had a good case but DWF wasn't convinced we were
06:37able to advise the policyholder that in our view based on the dashcam footage alone he had very good
06:44prospects of defending the case and then actual fact we could blame and pin liability on the claimant for a
06:51deliberate action there was a chance for both parties to have their day in court we alleged that
06:57it was fraud so we bring a case based on the dashcam footage to say that the claimant has deliberately
07:03induced the accident for the purpose of bringing a personal injury claim the matter proceeded to a
07:09trial and the court was asked to assess specifically the three elements which were the vehicle damage and
07:17the excess itself and then an assessment of exemplary damages his gamble didn't pay off he ended up paying
07:26out the third party was ordered to repay the full cost of damage to our policyholders vehicle which
07:32was around sixteen hundred pounds and an award for exemplary damages of four thousand pounds was made
07:38together with the repayment of our full costs of the case without the dashcam footage this could have
07:46had a very different outcome the dashcam footage provided irrefutable evidence that the policyholders
07:52version of events was correct and that this was a fraudulent claim the old days of one person's word
07:57against another are becoming a thing of the past potential fraudsters should be aware that with the
08:04prevalence of dashcam footage and other technologies now the likelihood that they'll get away with their
08:09scan is much much lower than it perhaps used to be so be warned later chances claiming in the clink
08:22face
08:23the full force of the law even behind bars claims are often fraudulent and we shouldn't be wasting
08:32tax payers money making a safe settlement we should be defending this governor's taken no prisoners
08:48jewellery often has sentimental value it could have been a gift or inherited from a loved one but chains
08:56break and rings slip off just make sure unlike our next character that you're actually claiming for
09:03the thing you've lost and don't supply evidence to incriminate yourself insurers will use companies to
09:09help verify such claims and icog handles cases that require closer scrutiny we were initially appointed by
09:17the insurers on this claim for a gold bracelet that was missing after the policyholder went to a
09:22funeral after the funeral he went to the wake took off his coat and realized his gold bracelet was missing
09:28what a shame on such an emotional day policyholder provided proof of purchase the receipt stated he paid
09:36725 pounds for the item however we understand that that was a sale price so the claim value was set
09:42at
09:421 500 as that was the cost to replace the bracelet today a picture of the bracelet and a copy
09:49of the
09:49receipt was sent to the insurers and it was these that made them pass on the case to icog they
09:55had
09:56run some checks on the photographs provided which showed that the date of the photograph was taken after
10:02the date of loss the insurance suspicions were that the policyholder still owned the item and was able to
10:09take a photo of it after the date that he claimed he lost it because he still has it digital
10:14photos contain
10:15a footprint known as metadata this highlights the time date and place the picture was taken
10:22we looked through and reviewed the case file and we verified that the metadata was in fact after the
10:28date of loss and that gave us the evidence we needed to discuss these concerns with the policyholder
10:34is there anything to ask you to start by talking me through what's happened
10:38i was at my cousin's funeral um i was at i had the bracelet on because i've never taken it
10:45off
10:46um then we was in there for just over the hour i suppose and then we went to football club
10:52for the wake
10:55um i took my coat off because it was a very cold day and that was when i realized that
11:01my bracelet had gone
11:02when would have been the last time that you remember having your bracelet
11:08when was the last time i remember seeing the bracelet well that would have been when i was getting ready
11:13to go to the funeral
11:14okay so what sort of time would that have been
11:18that was probably about
11:22quarter to eleven
11:24half ten quarter to eleven something like that
11:26okay so around ten thirty to quarter to eleven
11:31yeah and that was at home was it
11:34yeah
11:34okay fine and how often would you normally wear the bracelet
11:39i never take it off love
11:40never take it off at all
11:42never take it off the only time i ever take it off was when i've been in hospital for an
11:46operation
11:47immediately after noticing that your bracelet was missing what did you do at that point
11:53um i was a little bit concerned i sort of started walking around the wife was walking around with me
11:58to see if we could see where it was
12:00very upset because it was um
12:04a present for me 60th birthday
12:06oh right
12:07um so it had sentimental value obviously
12:10you know we then went back to the creme
12:12by the time we got back to the creme
12:13and they would um sort of walk those up then so um yeah
12:19despite the poignant circumstances of the loss questions had to be asked
12:24you've sent a photo in to us of the of the bracelet when when was that taken
12:44that can be a very sensible precaution
12:54i'll be completely honest with you there are a couple of concerns with the claim
13:00what do you think those concerns might be
13:04i wouldn't know what it is
13:06the photo that you sent in of the bracelet
13:11okay
13:11is there anything you want to tell me about that photo
13:16like what
13:19anything at all
13:20and i was like saying to you before i've got photos of all my joy
13:25do you know what um metadata is on a digital photograph
13:29do i know what what is sorry
13:31metadata on a digital photograph
13:35no
13:36we gave him the opportunity to um give us an honest answer about the photographs
13:41metadata on a digital photograph is basically like um an electronic signature
13:46so it will give me various things including the type of device used to take the photo
13:53the date and time it was taken
13:56okay
13:57it will give me um the location it was taken depending on what settings are set
14:03okay
14:03given that is there anything you want to tell me about that photo
14:09no danger
14:11okay
14:21either he still doesn't get it or he is pretending he doesn't understand
14:26so have you still got the bracelet
14:29no i haven't
14:30no i haven't
14:31okay so how have you managed to take a photo of it three days after you've told me that you've
14:35lost it
14:37how have i managed to take the photograph and i told you i've lost it
14:41yeah so the photograph is showing that it was taken on the 19th of november this year
14:49okay
14:50and you're telling me that you lost the bracelet on the 16th of november
14:55which is three days before this photo was taken
14:58yes
15:00okay so how have you managed to take a photo of a bracelet that you're telling me you don't have
15:05well i can't answer that question
15:08the call handler is polite but insistent
15:11what it looks like is that you've still got that bracelet
15:15no i haven't i haven't got the bracelet
15:18okay on further conversation he then stated that his wife
15:22had actually lost her bracelet on the day of the funeral and not his
15:27well i'll tell you
15:29i'm perfectly honest with you i haven't got the bracelet i have lost the bracelet that is the truth
15:34that is on my children's life i haven't got the bracelet um the bracelet that was actually lost
15:41at the funeral um was my wife's bracelet
15:46talk me through so it was actually your wife's bracelet that was
15:50it was my right yes um it was it was lost um and then um which i was going to
15:59claim for
15:59which i didn't claim for obviously um i have i have lost my bracelet i've lost my bracelet so
16:06i thought well i'll put that through and the money i got off that i'll buy my wife another bracelet
16:10and
16:11that's the truth right but insurance doesn't work in the way he wanted
16:16he was trying to fit it in with what he now knew we knew which was that the date of
16:20loss
16:21was incorrect
16:24originally the the claim was for his bracelet um when he started to alter his account uh he changed
16:31it to his wife's bracelet was lost on the day of the funeral and not his which again causes even
16:38more concerns because now we're changing the item that's been lost it's possible his wife did lose
16:43her bracelet could this have triggered thoughts of cashing in what was the the the value of her
16:50bracelet do you know my bracelet the value of that was about um 425 430 something like that i think
17:00okay so could that be the reason why you've tried to claim for this license
17:04sorry could that be the reason why you've tried to claim for your bracelet instead compared to the
17:10original claim that's over a thousand pounds less we see that the change in value was potentially
17:16emotive for making this claim there is a bit of a difference between her bracelet valued at 430
17:22pounds and his at 1500 pounds the one he persists in telling the call handler has gone
17:29yeah well my but i haven't got my bracelet that's that's the point i haven't got my place that i
17:34have lost it when did you lose it uh well it was after obviously it was after the 19th
17:41but that's a bracelet you said that you don't ever take off but you sent us a photo of it
17:45in a box
17:47yeah well i've i've taken a photograph of all my joy as i say anyway so yeah but this one
17:54wasn't
17:54taken three years ago this one was taken three days after you told us it was lost yeah yeah
18:01surely he must realize now that he's on a very sticky wicket we've got three options that everyone
18:06has with with any claim the the first option is to proceed with the claim um proceeding with the claim
18:13comes with uh two potential outcomes so in this case if you decided to proceed with the claim based on
18:20the evidence that you've provided the insurers unlikely to recommend a decline on the claim
18:26which would go down on your policy um and they potentially refer it over to the police to to
18:32investigate further the other option they've got if you decide to proceed it could just go ahead and
18:40settle the claim in this instance and in my experience i doubt that would be what's happening
18:47um your other option is to withdraw the claim we then offer that withdrawal to the insurers and
18:55they make a decision on whether they would be happy to accept it as you've been honest now with me
19:00today about the the circumstances um i can try and fight that for you and and kind of put in
19:07a good
19:08word if you like with the insurers to see whether they would be happy to accept the withdrawal of
19:12the claim and then take it no further you know i'd be happy to have a conversation with them
19:18based on your honesty today okay so what would you like me to do if you had put in a
19:26claim for
19:26jewelry worth 1500 pounds but the bracelet loss wasn't even yours and it was actually worth considerably
19:32less what would you do perhaps he finally realizes he's made a grave mistake
19:42okay although the policyholder offered a withdrawal of the claim we've returned our report with the
19:48recommendation that they invoke the fraud condition on the policy we're obviously empathetic with the
19:52situation um with the funeral and the the account that he provided unfortunately that that doesn't
19:58excuse him for attempting to commit fraud
20:06still to come an athlete's claim for devastating injuries caused by a pothole is scuffered when he's
20:13caught on camera ripping it up at the rugby pitch he wasn't a spot a bystander or a spectator in
20:19the game
20:20he was you could see him tackling you could see him passing the ball you could see him running it
20:25was very
20:25clearly that he was a strong participant in the game confined space strict routine some inventive
20:40inmates may rebel against the constraints and seek out opportunities to try and cash in in buckinghamshire
20:47hmp woodhill houses remand prisoners and those with short sentences and as we'll discover people
20:54behind bars don't need much time or even space to pull a fast one it's something governor nicola
21:00marfly is aware of as she's taking no prisoners claims are often fraudulent and we shouldn't be
21:08wasting taxpayers money making a safe settlement we should be defending against this backdrop claimants
21:16must have a watertight case if they're attempting a claim mick spellman is the head of safety and
21:21segregation at hmp woodhill and knows the prison and its inmates well i received an email from the
21:28litigation department that there was a litigation claim against the establishment regarding a former
21:32resident here at um claiming that he'd slipped on on wet condensation in his cell causing lots of
21:39facial injuries um and that was as a direct result of the condensation that built up because his cell was
21:45next to the shower block on the unit that he was housed in and that there was a lack of
21:49ventilation
21:50in the cell it sounds like the prisoner was a bit of a mess after the accident there was some
21:56dental
21:56damage that had occurred some um nose damage as well and also some soft tissue damage around his face
22:02but this account wasn't met with great sympathy it was deemed a little leaky
22:08i was very skeptical i've never seen condensation in a cell uh in any of the cells at woodhill i
22:14knew
22:14that win quite well because i've served as an officer for three years myself i've never seen
22:19condensation in in that cell or any other mick believed this inmates account was implausible
22:25as little can slip through the net part of a prison officer's role is that each cell within the
22:31establishment is checked each day by a prison officer to ensure that the fabric of the cell is in good
22:36order so we're making sure that the the war the taps are working as they should be the windows open
22:42up and there's been no tampering of any wall space or holes that were in there etc and the expectation
22:48would be if there was any faults such as water leakage that were reported that day to works to come
22:54and repair mick had his own theories as to what could have caused the impression of condensation
23:01windows in the gel which sit over a triangular alcove are perspex rather than glass
23:07when i looked at some of the photos that had been taken which the claimant was saying was water
23:11on the inside of the cell from the perspex when you look closely to me it became apparent that
23:17prisoners sometimes used to burn it with a lighter which would cause it to bubble up so when
23:21you look closely actually although it may look like initially water it was in fact burn marks in my
23:26own experience there was probably one of several reasons if there was a build-up of water on there
23:31that would be where the claimant perhaps has left the windows open and it's rained and rain has then
23:36come through the window and speckled onto the back of the triangle some of the men do tie washing lines
23:41up inside the cell which hang over the triangle so as a result of that water can sometimes drip from
23:47the clothing that's drying there and underneath the triangle there's some hot water pipes and some of
23:53the men do actually put their clothes over the hot water pipes as well for them to dry their clothes
23:57which could have caused water or the claimant may have just spilled water on the triangle by
24:02accident given the doubts about the supposed accident governor nicola was adamant the claims
24:08should be fought litigation were in touch with me we then had to discuss whether or not we were
24:14going to try and defend this and straightway i said yes the following court case threw up some
24:20interesting evidence about the slippery inmate it became apparent that he had a pre-existing
24:25medical condition which would result in sometimes in falling onto the cell floor and through our own
24:33medical reports we knew that it had received injuries as a result of that so on the rating of
24:39probability it was probably quite likely that the facial injuries were caused as a result of his
24:44medical condition rather than there actually being water or build up condensation within the cell
24:49it also appeared the prisoner had a loose grasp of dates it was disclosed that there was discrepancies
24:56between the date of him actually having these medical falls and the date that he was claiming that
25:01he'd fallen as a result of the condensation and there was a lots of confusion with regards to the
25:06claimant with the dates that were inconsistent to the reports that we had within the establishment
25:10i was really pleased that our colleagues our staff team were able to go to court and give compelling
25:15evidence based on their own memory of things and also the written documentation that they'd seen
25:20the tide of truth was flowing against the accident prone prisoner i was thrilled to hear that it was
25:27dismissed and that saved us in the region of fifteen thousand pounds saved taxpayers fifteen thousand
25:32pounds and i was delighted we will acknowledge when we get it wrong and sometimes it will be absolutely
25:38appropriate to pay compensation but what we will not do is be a soft touch where people see us
25:44as an easy option for free cash
25:52flicking through brochures deciding where to go it's all part of the fun of planning a break
25:58sunshine somewhere exotic if you can afford it there is so much choice but there are those
26:04who tarnish a trip deliberately in an attempt to make a claim sega is a claims and travel assistance
26:11provider its fraud team had their work cut out catching a prolific phantom traveler and master faker
26:19the customer took out a single trip policy with our insurer clients and he contacted our claims department
26:27as he needed to make a claim for cancellation of a trip due to the fact he had sprained his
26:32ankle
26:35a holiday hobbling around would have been no fun but at least the claimant was lucky enough to have
26:40travel insurance to cover his expenses the value of the claim was approximately four and a half thousand
26:47pounds the figure was linked to the fact that this was a long-haul trip what's the reason for your
26:54claim
26:54does it is consolation uh it's how it's due to travel last monday
27:02uh month
27:05i just got my hand from last jogging
27:08what can we find here but when did you actually help this accident
27:13it happened to me on sunday
27:17i wanted to show because i love this job here remember i was going to learn to the
27:23you know gp and the walking center
27:26and i believe and um i don't know what's good from this one
27:30the front
27:31okay
27:32i want this one i'd be enjoying looking at you to get to see what you know
27:36did they like x-ray or anything like that
27:39did they do what
27:40did they x-ray it
27:42did they do what they do
27:47as part of our standard claims procedure we ask the customer to provide us certain pieces of
27:58documentation to support the claim for a cancellation claim for injury we normally
28:04need a medical certificate from the customer's gp and also documentation to prove that the holiday
28:11has been cancelled as claimed
28:14so that's all been logged um what i'll do is i'll send out the claims documents to you now
28:20email um
28:21it goes out by post
28:23no problem
28:24i'll just advise you on the documents in case you have any questions on it
28:29so first of all there is a certificate that you need to give to your doctor that i'm sending you
28:33and the doctor will have to complete that
28:36okay
28:37then you'll need to send in the booking confirmation for the
28:41flight and the accommodation because we need to confirm your travel dates as well as the date
28:46you booked the trip
28:48okay
28:49you also need to get a letter from the respective companies confirming you didn't attend and if there's
28:57any refund available or not
28:59okay
29:00we waited a few weeks and the customer then sent through his documentation
29:05as part of our standard claims validation process for claims of this value our claims advisor did
29:12decide to call the booking agent to try and validate the claim
29:16when speaking with the booking agent our claims advisor established that the booking agent couldn't
29:21find any record of this particular booking that was despite the fact that the booking agent double
29:27checked their internal records the booking agent confirmed that the reference number was completely unknown to them
29:34alarm bells were ringing so the handler referred the claim to see the special investigations unit
29:41the investigator picked up the referral and decided to make some additional queries with the booking agent but
29:48also with the airline as well
29:49we provided the airline with the unique booking reference that was actually on the booking invoice
29:56they confirmed to us that they had no record whatsoever of this passenger
30:02so that's both the booking agent and the airline who have no idea who this fictitious traveler is
30:09for the sake of completeness we decided to contact the gp surgery where the customer's gp
30:16certificate had been sent to us which confirmed details of his sprained ankle we were very concerned
30:22when we received the facts from the gp surgery confirm that there was no way that the doctor in
30:29question could have seen the customer at the time he claimed to have been and seen the doctor on the
30:35basis that the doctor was actually on annual leave at that time furthermore the customer wasn't even a
30:41patient of this particular doctor who purportedly signed the medical certificate fake flight bookings
30:48and bogus visits to the doctor the phantom traveler was really digging himself into a hole based on the
30:54information the gp surgery had provided to us we were satisfied that the medical certificate was false
31:01which meant that the customer must have forged the doctor's signature on the medical certificate
31:09at this stage we were wholly satisfied that all the documentation the customer provided us was
31:15indeed fraudulent and if the tricky traveler had tried it on with seager he could have form insurers
31:23and their representatives do share intelligence to prevent fraudulent claims and we established that
31:30the same customer had in fact made three separate claims with three other insurers all of which
31:36appeared to be identical to this current cancellation claim he pursued against us the customer had
31:43also sent them fake booking agent details fake flight details and a fake medical certificate it was time
31:51for this fraudster to face the music due to the overwhelming level of evidence we had to prove this
31:59was a fraudulent cancellation claim we refused the claim on the grounds of fraud we contacted our
32:06insurer client with the evidence that we had obtained and they referred the matter to the police
32:12the police collated all the evidence from the different insurance companies and the matter ended
32:19up in court would the outcome signal the end of this chance of spurious holiday claims
32:24the customer ended up receiving 16 months in prison for insurance fraud
32:36it's clear that the customer went to great lengths to try and commit fraud against numerous different
32:41companies but eventually justice was served
32:52running cycling in fact any competition involves sheer stamina rigorous training and dogged determination
33:02our next character has them all plus sheer audacity as he tries to cash in on a fall while still
33:09managing to compete the insurance firm travelers was the company who had to beat him and he certainly
33:15gave it a run for its money travelers were presented with a claim for our customer a council as a
33:21result of a claimant falling in a pothole whilst out jogging
33:25the council admitted liability for the injuries and we made an early offer to try and compensate this gentleman
33:31for his injuries the offer was in excess of ten thousand pounds but the offer was turned down by the
33:36claimant's solicitors who didn't believe it was enough after that settlement offer was rejected we requested
33:43the claimant's gp records within those records there were notes that he was discussing with his gp
33:50about training for triathlons this was in direct contrast to the information he provided to the
33:57medical examiner that we based our settlement from so there were some real inconsistencies in
34:02the evidence that was provided but after our athlete had fallen over the pothole the unlucky man suffered
34:08another trip the severities of the injuries sustained to the claimant were increased as a result of a fall
34:16down the stairs he said had fallen and had broken his wrist and this was caused by the ankle injury
34:22that he'd sustained in our incident he said that his ankle had given way and that had caused the fall
34:28this case was gathering pace it's at this stage we were presented with a care claim and a loss of
34:36earnings claim for um for the claim he said that he wasn't able to work and when he did return
34:41to work
34:42that he was only put on on light duties he also told us that his wife was providing substantial care
34:48for him on a daily basis and presented a financial claim for that as well overall it it was roughly
34:55a
34:55hundred thousand pounds in total uh covering off all the uh injury claim the loss of earnings and the
35:02care claim presented by his wife we were surprised having initially given this claim a value of of roughly
35:10ten thousand pounds for that to be increased tenfold really suggested that there was something a
35:17little bit untoward going on here so this further raised our suspicions time to investigate the
35:23background of the man claiming one of the first things we did was look on social media to see what
35:29we could find about him we were able to see that he played for a local rugby club and that
35:34he was running
35:35triathlons and various endurance events pretty regularly throughout the time that he said that
35:41he was not capable of doing so we actually looked through other associated account accounts that were
35:46linked to him and we were able to find pictures of the claimant playing rugby so when he says in
35:54his
35:54statement i'm not capable of playing rugby that gives us an opportunity to go okay let's go and find
36:00some evidence to discredit him and prove that he's a liar and we were able to do so in this
36:06case the
36:07precision outlined in the athlete's account proved very useful in the claimant's witness statement he
36:12was very specific about certain dates that he wasn't able to do things particularly to do with playing
36:19rugby so that really gave us an opportunity to really pin down our evidence and look for pictures
36:26of that game online we were able to find them and it showed the claimant in in full flight he
36:31wasn't
36:32a bystander or a spectator in the game he was you could see him tackling you could see him passing
36:37the
36:37ball you could see him running it was very clearly that he was a strong participant in the game what
36:43was
36:43unusual about this as well as he said the reason that he couldn't participate in the game was because
36:48he had a plaster cast on his wrist but it very clearly shows in the in the evidence that we
36:53have that
36:53there was simply no plaster cast there at all the fraud team at travelers check social media as a
36:59matter of course something the claimant may not have considered if there's some red flags that show
37:05up on the claims that are being made and what we do is look at all open source so it's
37:11if people have
37:12set their privacy settings to open there's a lot of data that you can get it's an excellent tool for
37:18us
37:18it is surprising how much people put on social media that is available so and i think especially
37:24with if people are trying to make a fraudulent claim they they forget or they don't think that
37:30maybe that that information is as easily available as it is the social media investigations helped put
37:37travelers on the winning side some of the social media investigations led us to a fitness tracking app
37:44which showed data on the claimant about his runs about how many miles he was doing his cycling that
37:51he was able to do this really gave us almost a weekly and monthly update as to how much exercise
37:59the claimant was doing which was very regular he was training for triathlons and endurance events
38:08we found some of the results pages from the half marathon marathon and endurance events that the
38:14claimant was competing in this allowed us again to get a detailed estimate of the times that he was
38:20completing the events in the length of the events and the the severity of the events that he was
38:25competing in someone with an injured ankle and broken wrist would surely not even be able to enter
38:31these types of events after reviewing all the evidence we discussed this matter with our legal
38:37teams and decided to give the claimant an opportunity to withdraw his claim we shared the evidence
38:44that we'd gathered and we're really surprised when the claimant decided not to withdraw his claim
38:50so in response to the claimant's refusal to withdraw his claim we pursued a defense for fundamental
38:57dishonesty what this means is that whilst there was a genuine element to the claim the exaggeration
39:04and the lies that were told were fundamental to this case being completely dishonest fundamental
39:10dishonesty gives us as an insurer the opportunity to discredit the whole claim and get the claim
39:18struck out the case continued to make its way through the legal process but not without doubts from
39:24the claimants team shortly before this case went to trial we were approached by the claimant solicitors
39:30to try and settle this matter for 50 000 pounds this is a 50 reduction in the amount that they'd
39:38originally stated the claim was worth this was rejected and we were determined to see this case through
39:45to trial because based on the evidence and the information that we had we believed this was the
39:51right thing to do we felt it was really unfair that the local council who was our customer in this
39:55case
39:56would have to pay for an exaggerated claim it was really important to run this case to trial
40:03as we wanted justice to be served and for the claimant to be cross-examined and for the truth
40:08to be shown in this matter now it was travelers showing dogged determination and the company needed it
40:14as it was thrown a curveball at the 11th hour on the day of the trial we were approached by
40:20the claimant
40:21solicitors and they tried to settle the case for 20 000 pounds this was a substantial reduction in the
40:29hundred thousand pounds they'd originally said the claim was worth we rejected their offer we were
40:35confident that our evidence would prove the claim to be dishonest and that the claimant was a liar
40:42the finishing line was in sight
40:45we were successful at trial it was found that the claimant had a genuine claim which was there was
40:51never any doubt over but it was found to be so grossly exaggerated and dishonest to such an extent
41:00that the whole claim was struck out the claimant was ordered to pay back nearly 13 000 pounds that we'd
41:09already paid to him over the period of the claim which he has now done
41:15there was an entirely genuine element to this claim the claimant had fallen over the way that he
41:21described and we were happy to settle the claim but ultimately driven by greed and dishonesty this whole
41:29claim was struck out and he was awarded nothing the success was due to so much information about the
41:36claimant being so readily available social media information is is really key for uh investigators
41:4410 or 15 years ago this this kind of information wasn't available but now it's commonplace for
41:50investigators to to use this kind of evidence to discredit dishonest claimants it's important for us
41:57to take these cases to trial when we have the evidence of fraud because we want to protect our
42:03customers and we want to send a message that fraud just does not pay
42:12for us to check it out
42:34for us
42:35we are
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