The Special Investigation Unit of RJN Investigations was notified by the Ventura County District Attorney’s Office as to the successful prosecution in the case of the people of California Vs. J. Garcia. In this case, the claimant was alleging to have suffered from injuries to multiple body parts throughout the course of his employment. The examiner detected several initial red flag indicators and as such, authorized a surveillance level investigation. The surveillance investigation found the claimant to be extremely active which included competing in soccer leagues while showing no signs of hesitation or discomfort. When he was questioned during his deposition taken within Ventura County, the claimant was specifically asked if he still played soccer. The claimant stated that he had not played soccer for over a year. Furthermore, he indicated that he stopped playing soccer while he was still employed. The RJN SIU formally referred the case to the Ventura County District Attorney’s Office as well as the California Department of Insurance Fraud Division. Upon completion of their criminal investigation, the claimant was formally charged and entered a not guilty plea during his arraignment. At his most recent court appearance, the claimant accepted a plea deal in which he changed his not guilty plea to guilty of count 1 Insurance Code 1871.4(a). As part of his plea deal, count 2 will be dismissed and the claimant will be sentenced to 5 years of formal probation. The claimant is scheduled to be formally sentenced on 06/12/2019 at which time a restitution figure will be assigned by the Judge.
ABOUT R.J.N. SIU:
Formed in 1996, the SIU Division was created to assist California employers, small size insurance carriers and TPA firms in securing professional assistance so as to detect, investigate and prosecute insurance fraud. To date, the unit has trained well over 2,750 examiners and the documented referrals by this unit have resulted in over 190 convictions for workers’ compensation insurance fraud in California.