On August 17th, 2020, the Special Investigative Unit of RJN Investigations, Inc. was notified that the Los Angeles 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 Janitor for the City. The claimant alleges to have sustained injuries as a result of a motor vehicle accident while working his route. The claimant subsequently retired as a result of his injuries. The claimant continued treatment as well as subjective complaints. A surveillance investigation was authorized and subsequently performed by the RJN SIU. Video evidence was obtained showing the claimant active and potentially working in contrast to what he was telling his doctors. It was discovered that the claimant was operating his own personal construction company. During his deposition, the claimant was questioned and testified multiple times that he has not completed any construction or handyman work since 2011 which was in direct contrast to the surveillance obtained. Surveillance video was subsequently provided to the claimant’s treating doctors who modified their opinions and stated that the claimant should be able to return to work with no restrictions at all based on the video. 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 Los Angeles County District Attorney’s Office. Upon completion of the criminal investigation performed by the Los Angeles County District Attorney’s Office, the claimant was formally charged with two felony counts of insurance fraud. The claimant is scheduled to appear for a Preliminary Hearing on 10/08/2020.
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.