The Special Investigative Unit of RJN Investigations, Inc. was formally notified by the Ventura County District Attorney’s Office in regard to the successful prosecution of a custodian employed by the Simi-Valley Unified School District. In this particular case, the claimant alleges to have sustained injuries to his right shoulder while pulling trash bags out of the cans. The claimant sought medical treatment and subsequently filed his claim. During initial treatment, the claimant admitted to owning and operating his own personal business. A Surveillance investigation was quickly authorized, and RJN Investigations obtained video of the claimant lifting furniture, pushing heavy machinery and working. When questioned, the claimant indicated to investigators that his business was still in operation, however because of his injuries, he was no longer doing any of the work himself, rather his family was completing his jobs. Surveillance was provided to his medical doctor, who in turn changed his medical opinion of the claimant returning him back to work with no restrictions. 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. During his most recent court date, 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. The claimant was ordered to pay restitution in the amount of $24,000.00 which has already been turned over by the claimant. The claimant is scheduled to be formally sentenced on 06/19/2019 when it is expected his felony guilty plea will be reduced to a misdemeanor as part of his plea agreement.
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.