On February 8th, 2021, the Special Investigative Unit of RJN Investigations, Inc. established that multiple felony charges were filed based upon the submission of a documented referral.
In this case, the claimant alleged he sustained an injury to his left middle finger after a pallet full of carrots weighing approximately 100 pounds slipped and smashed his left middle finger on October 11, 2018. The claimant received first aide care the same day and was discharged by October 18, 2018 with no restrictions. Almost a month later, the claimant returned for additional treatment with reported worsening symptoms. The claimant reported tremendous weakness in his left wrist and hand. In February 2019, the claimant’s statement was also obtained in which he denied prior motor vehicle accidents or injuries to his left hand and wrist, or upper extremity. In February 2019, subpoenaed Medical records from Van Guard Medical Group contradicted the claimant’s statement, indicating the claimant was involved in a motor vehicle accident on October 21, 2018. On October 25, 2018, the claimant was seen by seen in the emergency room as a result of the motor vehicle accident of 10/21/2018. He complained of pain and numbness from the neck down his entire left arm. He advised he has been unable to move his left arm since the motor vehicle accident on 10/21/2018. The claimant never mentioned he was involved in an industrial injury prior to this MVA. Additionally, medical records show the claimant had a history of left shoulder pain for over two years prior to the alleged injury on October 11, 2018.
As such and in compliance with the regulations set forth by the California Department of Insurance, the RJN SIU formally filed the case with their Fraud Division as well as with the Kern County District Attorney’s Office. Upon completion of their criminal investigation, the claimant was formally charged with five felony counts in violation of Insurance Code Section 1871,4(a)(1), one felony count in violation of Penal Code 550(a)(1) and one felony count in violation of Penal Code Section 550(b)(3). At this time, a warrant for the claimant’s arrest was issued with a bail amount of $70,000.
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 200 convictions for workers’ compensation insurance fraud in California. In just the last 3 years we have secured $ 685,599.00 in court ordered restitution on behalf of our valued clients.
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