On November 6th, 2020, the Special Investigative Unit of RJN Investigations, Inc. was notified that the Los Angeles County District Attorney’s Office had filed 6 felony insurance fraud charges based upon a documented referral. In this case, the claimant worked as a residential counselor who sustained injuries while breaking up a fight. The claimant sustained injuries to her left shoulder, neck and low back. Investigation determined that the claimant had a history of injuries to the same body parts. When questioned, the claimant denied any prior work related, auto accidents and/or injuries to the same body parts in contrast to the medical records that were subsequently secured. She also declined to provide an accurate history to her treating doctors as well. The material misrepresentations made by the claimant impacted the claim particularly when it came to apportionment. As such, upon completion of the RJN SIU level Investigation and in compliance with the California Department of Insurance, the case was then formally referred to the Commerce Regional 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 six felony counts of Insurance Fraud. At her arraignment on November 5th, 2020 she entered a not guilty plea.
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 3,750 examiners and the documented referrals by this unit have resulted in over 200 convictions for workers’ compensation insurance fraud in California.