On June 24th, 2020, the Special Investigative Unit of RJN Investigations, Inc. was notified that the Orange County District Attorney’s Office had filed felony insurance fraud charges based upon a documented referral submitted. In this case, the claimant worked as a Police Officer with the City of Santa Ana. Back in October of 2017 he was injured in a collision while pursuing a suspect in a stolen vehicle and went out on disability. Based primarily on his subjective complaints to the treating doctor and to the claim’s examiner, he remained off work while being paid his full salary for 18 months due to the listed restrictions by the doctor. As the claimant did not appear to be getting any better despite all medical treatment provided, the City then authorized surveillance and the claimant was found to be “engaged in physical activities well beyond what the doctor had imposed”. The claimants’ deposition was then promptly secured in Orange County. The claimant’s testimony made under the penalty of perjury in the deposition directly contradicted the physical activities captured on the sub-rosa video tape.
Upon completion of the RJN SIU level Investigation and in compliance with the California Department of Insurance, the case was then formally referred to their Fraud Division as well as to the Orange County District Attorney’s Office. Upon completion of the criminal investigation performed by the Orange County District Attorney’s Office, the claimant was formally charged with four felony counts of insurance fraud. His arraignment will take place next month. If convicted, he faces eight years in state prison.
“Worker’s compensation fraud costs honest, hardworking business and governmental agencies more than $30 billion a year” District Attorney Todd Spitzer said in a statement “We cannot allow those who commit worker’s compensation fraud to go unpunished.”
ABOUT R.J.N. SIU:
Formed in 1996, the RJN SIU Division was created to assist California employers, governmental agencies, 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.