On October 22nd, 2020, the Special Investigative Unit of RJN Investigations, Inc., was notified by the San Bernardino County District Attorney’s Office regarding the successful prosecution in the case of People of California vs. S. Serna. In this case, the claimant was employed as an Instructional Aide with a Southern California School District. In the course of her claim, the examiner detected red flag indicators and as such, assigned surveillance to the RJN SIU. In the course of that surveillance, over 2 hours of video evidence was obtained, depicting the claimant performing a wide variety of outside physical activities, showing no restrictions or utilization of artificial support. The video evidence was subsequently shown to the Qualified Medical Evaluator, who then made significant changes in his initial medical opinion and concluded the following in his report:
“I do not see that a re-evaluation of this patient would serve any specific purpose…”
In compliance with the regulations set forth by the California Department of Insurance Fraud Division, the case was then formally referred by the RJN SIU to their Fraud Division as well as to the San Bernardino County District Attorney’s Office. Upon completion of a detailed criminal investigation by the San Bernardino County District Attorney’s Office, the claimant was formally charged with one felony count in violation of Insurance Code Section 1871.4(a)(1). At the claimant’s most recent criminal hearing, she entered into a plea-bargaining agreement in which she pleaded no contest to felony violation of Insurance Code Section 1871.4(a)(1). As part of the plea-bargaining agreement, the court ordered her to pay restitution to the School District in the amount of $16,408.00.
ABOUT R.J.N. SIU:
Formed in 1996, the RJN SIU Division was created to assist California employers, small size 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 200 convictions for workers’ compensation insurance fraud in California.