FRAUD INSIGHT: After the event…

  • Immediate concerns about the legitimacy of a claim following a burglary

  • The evidence proved deliberate misrepresentation from inception

  • Saving insurers a potential outlay of £25,000.00

A claim was submitted by a policyholder with respect to a burglary allegedly discovered on the morning of Thursday, 28 November 2019 in the region of £20,000.00 – £30,000.00.

Initial concerns 

Concerns were immediately raised as the policyholder had only called in to set the policy up the morning before, on Wednesday, 27 November 2019. The policyholder had a previous policy that was cancelled in February 2019 due to the non-payment of premiums. In the first instance, our Property Adjuster, Rachel was appointed to deal with the claim and she met with the policyholder at the risk address on 6 December 2019.

Rachel held significant concerns regarding the veracity of the claim presented, including:

  • Very recent policy inception. The policyholder was uninsured for nine months until the day before the alleged burglary.
  • Social media activity suggested that the theft was discovered on or before 27 November 2019.
  • Documentation almost exclusively in the form of photographs. No receipts, valuations, or any other documentation was available.
  • The loss list included two Rolex watches whereas the policyholder previously mentioned just one during FNOL. The policyholder provided screenshots of a text message conversation between her and a jeweller. In the conversation, the jeweller advised that they had no record of having sold any Rolex watches to her, however, and at the conclusion of the conversation, the same jeweller offered to provide a letter confirming that she purchased two Rolex watches.

The matter was subsequently escalated for investigation, and assigned to our investigator, Paul who undertook a thorough investigation, including a recorded interview with the policyholder at her home. Overall, the policyholder interviewed poorly and the loss was not at all in keeping with her lifestyle.

The investigation 

Enquires with the police confirmed that there were two different burglaries reported at the property. The first on the morning of 27 November 2019 and the second on the morning of 28 November 2019. At the first crime, the policyholder explained how the back door was open together with all windows and that the entire upstairs of the house had been trashed. Crucially, the policyholder explained how jewellery, cash and electrical items had been taken overnight. The policyholder explained to the investigating police officer that she had CCTV footage of the next-door neighbour carrying out the theft in the early hours of 27 November 2019.

In her signed statement to us, the policyholder provided identical information although she alleged that the burglary was discovered on the morning of 28 November 2019 (after the policy had been incepted), and not on the 27 November as she had explained to the police. She insisted that nothing at all had occurred on 27 November 2019 and that nothing in particular had prompted her to take the policy out.

The police also logged a second crime report about a second alleged burglary that was reported on 28 November 2019. The policyholder reported that the burglary occurred using a key stolen by the neighbour, but later she revealed that her neighbour had been given a copy of the key sometime before. Crucially, the policyholder explained that only a TV and her son’s Apple iPhone were stolen in the second burglary. Nothing else.

In her signed statement, the policyholder alleged that her CCTV footage related to one solitary burglary that was discovered on the morning of 28 November 2019. However, our investigative officer found that no CCTV footage was available concerning the incident which occurred between 27 November 2019 and 28 November 2019 as the policyholder had already taken the CCTV system out to investigate how to download footage for the burglary which occurred before inception.

The evidence against the policyholder appeared irrefutable and proved deliberate misrepresentation from inception, at the time of submitting the claim, and at the time of providing a signed statement. 

The results 

The transcript of the conversation between the policyholder and insurer on the morning of 27 November 2019 made it very clear that something had already occurred (see transcript below). The social media activity on 27 November 2019 also supported the fact that there had already been a burglary, but despite that, the policyholder gave somewhat absurd explanations/excuses as to what the social media posts and comments related to.

We believed that nothing at all occurred overnight on 27 November 2019 – 28 November 2019 and that the policyholder simply reported a second burglary to obtain a crime reference number after inception.

We highlighted to the police that we believe the second report to be a false report which is a crime in itself.

Regardless of when the burglary occurred, we were also convinced that the loss list was, on the whole, a work of fiction. The policyholder described to the police that the burglar removed `a bag of goodies`. We would challenge anybody to fit a 60 inch TV in a bag along with everything else on the comprehensive loss list. It was also suspicious that the policyholder started her loss-list with relatively inexpensive items such as Apple earphones, before adding the Rolex watches, multiple diamond jewellery items, and £3000.00 in cash much later.

It was clear that the policyholder had suffered a burglary whilst uninsured, arranged insurance following the incident, and then presented a claim immediately, providing false evidence and testimony when presenting her claim. The claim was declined on the grounds of fraud and the policy subsequently cancelled.

The combined efforts of our adjuster Rachel and investigator Paul successfully prevented an attempted fraud, saving insurers a potential outlay of £25,000.00.

Salient extract from sales call on 27 November 2019 

Policyholder: “Just in general, because I have to be sure of everything, just in general, hopefully, nothing will ever happen, but how quick, how quick do you access this if anything does happen?”

Sales advisor: “Sorry how quick can you…?”

Policyholder: “How quick does that policy act er activate?”

Sales advisor: “So I can get it up and running for you today, so you are on cover today.”

Policyholder: “Ok, so if anything happened today or in 6 hours or 5 hours whatever I’m covered?”

Sales adviser: “Yes, has something already happened?”

Policyholder: “No, I just, I have to ask this question, I’ll tell you why, I’m dyslexic and find it hard to understand things, before I sign up to stuff, I double-check everything.”

Sales adviser: “Yeah I can get you on cover today.”

Policyholder: “Okay”

Sales advisor: “But if something does happen you will have to go through the full claims process.”

The policyholder again apologises stating that she must check everything and make sure she is covered. She then provides her bank details to set up monthly direct debit payments.

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