On September 20th, 2019, the Special Investigative Unit of RJN Investigations, Inc. was formally notified by the Orange County District Attorney’s Office regarding the successful prosecution in the case of People of California vs. R. Natividad. In this particular case, the claims examiner detected contradictory information regarding the AOE/COE aspects of the claim. The examiner proactively assigned the RJN SIU Department to conduct investigative measures. In the course of that investigation, which entailed interviews and analyzing CCTV video footage, evidence was obtained that directly contradicted the claimant’s allegations of a work related injury. In accordance with the regulations set forth by the California Department of Insurance Fraud Division, the case was formally referred to that agency as well as to the Orange County District Attorney’s Office Workers’ Compensation Fraud Unit. Upon completion of a joint criminal investigation, the claimant was formally charged with one felony count in violation of Penal Code Section 550(a)(1) as well as one felony count in violation of Insurance Code Section 1871.4(a)(1). After attending several preliminary hearings, the case moved forward to a jury trial. Upon completion of all of the testimony, the jury came back with a guilty verdict in regard to both felony counts. As part of his sentence, on August 29th, 2019, the Superior Court of California County of Orange ordered the claimant to pay restitution to the City of Costa Mesa in the amount of $75,427.67. The court specifically ruled that this restitution was due to cover the cost of the investigation of the workers’ compensation fraud, over-payment of salary and medical benefits.
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 3,000 examiners and the documented referrals by this unit have resulted in over 195 convictions for workers’ compensation insurance fraud in California.