The Special Investigation Unit of RJN Investigations, Inc. was formally notified by California Department of Insurance Fraud Division as to the filing of criminal charges based upon a documented referral submitted to their office. In this particular case, the claimant alleged to have suffered a work-related injury to his back while lifting a box. Over the course of the claims handling, records pertaining to the claimant’s prior medical history were obtained which revealed a history of injury and complaints involving the same body part. The claimant made material misrepresentations during his AOE/COE statement when he denied any prior back injuries. Moreover, the claimant denied any previous injuries or complaints regarding his back to the treating doctor. In compliance with the regulations set forth by the California Department of Insurance, the RJN SIU formally referred this case to their Fraud Division as well as to the Los Angeles County District Attorney’s Office. Upon completion of a criminal investigation conducted by the Fraud Division, the claimant was formally charged with three felony counts in violation of Insurance Code Section 1871.4(a)(1). As a result, a felony arrest warrant has been issued with bail set at $90,000.00.
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.