On January 29th, 2020, the Special Investigative Unit of RJN Investigations, Inc. was formally notified by the Sonoma County District Attorney’s Office regarding the filing of six felony counts against the claimant and her sister. In this particular case, the claimant alleges to have suffered a seizure and claimed it to be work related. As her medical condition deteriorated, her sister acted as a caregiver, would assist her in activities of daily living and for transportation. The sister also spoke on behalf of the claimant during medical examinations and during her deposition. Surveillance performed by the RJN SIU secured significant video evidence showing the claimant engaged in various outside activities in direct contradiction to her statements to the doctors and in her deposition. During the surveillance, the claimant was also found to be driving unassisted. The video evidence was subsequently provided to the Panel QME, who issued a supplemental report that stated in part the following:
“She says this cognitive problem happened within several weeks of the injury and that she’s been this way for years, and you just don’t see that kind of functioning – I have not in my 40 years of clinical practice either that setting or in somebody that age who doesn’t have some underlying terrible neurological disease…It just doesn’t make clinical sense…”
In compliance with the regulations set forth by the California Department of Insurance, the RJN SIU formally referred the case to their Fraud Division as well as to the Sonoma County District Attorney’s Office. Upon completion of their criminal investigation, the claimant and her sister were formally charged with six felony counts. Their arraignment will take place within the next 30 days.
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 3,500 examiners and the documented referrals by this unit have resulted in over 195 convictions for workers’ compensation insurance fraud in California.