The Special Investigative Unit of RJN Investigations, Inc. was notified regarding the filing of criminal charges based upon a documented referral submitted. In this particular case, the claimant was employed as an invasive cardiovascular technician who allegedly suffered a back injury while transferring a patient. Due to complaints of ongoing and worsening pain, the claimant eventually stopped working and remained off work. Given the amount of time the claimant was off work, the examiner assigned surveillance on the case to the RJN SIU. During the surveillance level investigation, substantial video evidence was obtained depicting the claimant engaged in physically demanding yard work, which directly contradicted his prior complaints reported to the industrial physician. Furthermore, in his subsequent deposition, the claimant made multiple material misrepresentations regarding his physical abilities, denying that he was engaged in any such activities captured on the subrosa video evidence. In compliance with the regulations set forth by the California Department of Insurance, the RJN SIU formally referred this case to both the CDI Fraud Division as well as the Sacramento County District Attorney’s Office. Upon completion of a criminal investigation by the CDI Fraud Division, the claimant was formally charged with one felony count in violation of Insurance Code Section 1871.4(a)(1), one felony count in violation of Insurance Code Section 1871.4(a)(2) and one felony count in violation of Penal Code Section 550(a)(1). An arraignment hearing is scheduled for the claimant to take place on September 17th, 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.