Insurance broker jailed for fraud

Insurance broker jailed for fraud

The woman exploited her role working in the insurance industry to make false medical claims

She used the names of friends, family and herself to make 31 fraudulent claims, worth £142,334

In one claim, she pretended to have a daughter and lied that she’d suffered injuries at the Manchester Arena terrorist attack

To substantiate the claims, she forged NHS documentation and letters from Her Majesty’s Court Service

On Tuesday 18th September 2018 a woman was sentenced after she made 31 fraudulent insurance claims for unexpected overheads encountered by medical professionals, including one where she stated that her daughter had sustained serious injuries in the terror attack at M.E.N Arena in Manchester.

Following an investigation by the City of London Police’s Insurance Fraud Enforcement Department (IFED), Susan Pain, 51, of Kirkby, Liverpool, pleaded guilty and was sentenced to two years at Liverpool Crown Court, for fraud by false representation.

IFED became aware of Pain’s fraudulent activity in July 2017, after a referral from AXA Insurance. Pain worked as a Director for an insurance broker that sold policies underwritten by AXA, overseeing a section of the company that insured people in the medical and dental professions against unexpected overheads caused by sickness, maternity, family emergencies and jury service.

AXA began investigating Pain after they noticed discrepancies in one of the claims she’d processed. Pain made the claim under her own name, believing that she would avoid detection because she was known professionally by her former name Susan Raufer.

She claimed for loss of earnings due to her daughter sustaining multiple serious injuries in the terror attack at Manchester Arena, and having to undergo two major operations.

In reality, Pain had no children and AXA soon found out that the claim was false as they were unable to trace the victim. After this, AXA conducted a complete review of the claims processed by Pain and they discovered a number of other discrepancies.

Between March 2010 and July 2017, Pain made a total of 31 fraudulent insurance claims in the names of friends and family, plus some in her own name.

In one of the claims, Pain posed as an orthodontist who had taken a leave of absence because their daughter required open heart surgery and the hospital was far away from their home.

In several other claims, she also used various types of cancer as the medical condition that the family member of the medical professional had suffered.

Most of the claims were for loss of earnings because someone related to the medical or dental professional had become seriously ill or was injured, but there were also claims for Jury Service and maternity leave.

To substantiate her claims, Pain forged the signatures of the supposed claimants and also provided supporting documentation, including NHS procedure documents, NHS ‘MAT B1 forms for maternity leave and forged letters from Her Majesty’s Court Service for Jury Service.

In total, Pain falsely claimed £142,334. To launder the money, she asked her friends and family, whose names she’d used to make the claims, to receive the money into their bank accounts through cheques and BACS transfer.

Her friends and family were oblivious to Pain’s fraudulent activity and that she was using their names. They only agreed to receive the money because she had told them that the money was for her bonus at work and that she would obtain a tax advantage if the money was paid into their accounts.

After some analysis by a financial investigator in IFED, they discovered the money had been returned to Pain. They confirmed that no fraudulent activity was carried out by any of the family or friends who had received the money from Pain’s false claims.

Detective Constable Ant Andrews, who the led the investigation for IFED, said:

“Pain exploited the tragic terror attack at the MEN Arena, as well as other examples of human suffering, to make a financial gain.

“She betrayed the trust she had with her friends and family, using their details to make the false claims, then lying to them so she could receive the money she’d stolen.

“She is now paying a significant price for her fraudulent activity, not just with the sentence handed down by the court, but also with the loss of her job and reputation.”

Carolyn Scott, Head of Household and Lifestyle at AXA Insurance, said:

“Ms Pain took advantage of a position of trust to deceive her employer and defraud AXA. She used details of extremely upsetting events and circumstances to make fraudulent claims for her own personal gain. We alerted IFED once we suspected fraudulent activity and are very happy with the outcome today. Cases like this prove that collaboration can ensure fraudsters are brought to justice.”