The Special Investigation Unit of RJN Investigations was formally notified by the Orange County District Attorney’s Office Worker Compensation Fraud Unit as to the issuance of a felony arrest warrant for the claimant. In this particular case, the claimant worked as a Teacher for the Orange County Department of Education. The claimant alleged that on January 25th, 2018, a disruptive student intentionally stomped on her left ankle which resulted in injuries to her left foot and ankle. During medical evaluation, the claimant was determined Temporarily Totally Disabled based on her subjective complaints to the doctor. The claim was initially accepted, however significant red flags were discovered soon after. The alleged incident was captured by the employer’s mounted, closed-circuit video surveillance system and the recording clearly did not corroborate the claimant’s version of events. In fact, the video recording was drastically different from the claimant’s description of the alleged injury. As such, the video evidence was provided to the treating doctors and based on their review, substantial changes in medical opinion were indicated. It was noted the claimant did not have her foot stomped and appeared that she falsified the existence or extent of her injury. In compliance with the regulations set forth by the California Department of Insurance, the RJN SIU formally referred this case to both the Orange County District Attorney’s Office as well as California Department of Insurance Fraud Division. Upon completion of the criminal investigation by the OCDA, a felony arrest warrant was issued for the claimant. On July 24th, 2019, the claimant was formally arrested at her school work site. She was booked into County Jail and subsequently posted bail in the amount of $25,000.00. The claimant is scheduled to be Arraigned on August 21st, 2019.
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 195 convictions for workers’ compensation insurance fraud in California.