The Special Investigative Unit of RJN Investigations, Inc., has been recently notified by the Imperial County District Attorney’s Office regarding the filing of felony insurance fraud charges. In this particular case, the claimant worked as a City employee in the Maintenance Department. He suffered a work-related injury and began to receive medical treatment. As the claim progressed, the employer received a tip indicating the claimant may be running his own landscaping company. The claims examiner proactively assigned the case to the RJN SIU to conduct surveillance. In the course of the surveillance level investigation, several hours of video evidence were obtained depicting the claimant to be operating a residential landscaping business. In his subsequent deposition, he denied working or receiving any income. As the SIU investigation continued, checks for landscaping services from various homeowners paid to the claimant during the timeframe he was receiving TTD benefits were secured. In accordance with the regulations set forth by the California Department of Insurance, the case was then formally referred by the RJN SIU to their Fraud Division as well as to the Imperial County District Attorney’s Office. Upon completion of a detailed criminal investigation performed by the Fraud Division, the Imperial County District Attorney’s Office formally charged the claimant with violation of Insurance Code Section 1871.4(a)(1) and in violation of Penal Code Section 118. The claimant was arraigned at the Imperial County Superior Court on September 8th, 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.