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 alleged to have sustained 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. During the surveillance coverage, the claimant was found to be extremely active which included participating in soccer leagues. When the claimant was questioned during his deposition, the claimant was specifically asked if he still played soccer to which the claimant stated that he had not played soccer in over a year. Furthermore, he indicated that he stopped playing soccer while he was still employed with the insured. 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 recent court appearance in June, 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 was dismissed and the claimant was sentenced to 5 years of formal probation. Furthermore, during formal sentencing, the claimant was ordered to pay restitution to Pacific Compensation Insurance in the amount of $27,881.14. Additionally, he was ordered to serve 30 days in County Jail.
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.