The Special Investigative Unit of RJN Investigations, Inc., has been notified regarding the filing of felony insurance fraud charges based upon a documented referral submitted. In this particular case, the claimant was employed as a firefighter with the County of Ventura, who is alleging to have sustained injuries as a result of a work-related accident occurring back on February 3rd, 2019. After five months of medical treatment, there was no noted improvement and the claimant informed his treating doctor that he was still “crippled by the pain.” The claims examiner then proactively authorized the RJN SIU to initiate surveillance measures. In the course of this surveillance, extensive video evidence was secured depicting the claimant performing a wide variety of physical activities including working out at the gym, utilizing weights and a stationary bicycle. Additional surveillance then found the claimant to be engaged in physical activities such as paddle boarding and working out in a gym utilizing weights and a stationary bicycle. While performing all of the activities captured during the surveillance level investigation, the claimant was receiving his full salary while out on disability. The overall current cost of this claim to the County of Ventura is $ 148,177.00. During the claimant’s subsequent deposition, he made several material misrepresentations under the penalty of perjury that directly contradicted his activities captured on videotape. As the SIU level investigation continued, social media research established evidence that the claimant was also working as a personal trainer. 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 Ventura County District Attorney’s Office Workers’ Compensation Fraud Unit. Upon completion of a criminal investigation performed by the Ventura County District Attorney’s Office, the claimant was formally charged with two felony counts of workers compensation insurance fraud and one felony count of perjury. His arraignment will be held next month.
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.