On July 24th, 2020, the Special Investigative Unit of RJN Investigations, Inc. was advised as to the felony insurance fraud charges filed by the Los Angeles County District Attorney’s Office based upon a documented referral submitted. In this particular case, the claimant was employed as a city equipment operator who alleged to have suffered an upper extremity injury while working. In the course of an AOE/COE level investigation, it was determined that the claimant’s hobbies included riding ATV’s, riding off road vehicles and going boating. A surveillance investigation performed by the RJN SIU secured video evidence of the claimant engaged in activities contradicting his statements to the treating doctors. The examiner then secured medical documentation reflecting that the claimant was involved in an off-road vehicle accident just prior to his alleged workers’ compensation claim that resulted in emergency medical treatment to his upper extremities. The claimant was not truthful about this accident to the treating doctors or in his deposition taken under the penalty of perjury. As such, in accordance with the regulations set forth by the California Department of Insurance, this case was formally referred by the RJN SIU to their Fraud Division as well as to the Los Angeles County District Attorney’s Office Workers’ Compensation Fraud Unit. Upon completion of a criminal investigation, the claimant was formally charged with one felony count of Insurance Code Section 1871.4(a)(1), one count in violation of Penal Code Section 664-118(a) and one count in violation of Penal Code Section 550(b)(3). At the claimant’s arraignment on July 8th, 2020 he entered a not guilty plea. His next hearing is scheduled for August 27th, 2020.
ABOUT R.J.N. SIU:
Formed in 1996, the SIU Division was created to assist California private employers, public entities, 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.