On February 22nd, 2021, the Special Investigative Unit of RJN Investigations, Inc. was notified by the Riverside County District Attorney’s Office regarding the filing of three felony charges based upon submission of a documented referral.
In this particular case, the claimant was employed by the Department of Social Services as an In-Home Care Provider. The claimant alleged to have suffered a workplace injury, alleging that a wheelchair fell onto his left ankle. It was not until five months later that the incident was reported to the employer. In the course of the investigation, it was discovered that the claimant self-procured medical treatment at a hospital emergency room shortly after the alleged injury. Records pertaining to this self-procured treatment were later secured and reflect that the claimant had in fact stated that he injured his left ankle while dancing, an otherwise non-industrial injury contrary to the wheelchair incident as alleged. The claimant never informed the treating industrial doctor regarding the emergency room medical treatment to his left ankle. As the investigation continued, it was further discovered that the claimant had a prior criminal record for falsifying timesheets while previously working under the same employer. In compliance with the regulations set forth by the California Department of Insurance, the RJN SIU formally filed this case with their Fraud Division as well as with the Riverside County District Attorney’s Office. Upon completion of a criminal investigation performed by the Riverside County District Attorney’s Office, the claimant was formally charged with three felony counts, specifically violation of Insurance Code Section 1871.4(a)(1), violation of Penal Code Section 550(b)(3) and Penal Code Section 550(b)(2). Upon filing these charges, a felony arrest warrant was issued.
ABOUT R.J.N. SIU:
Formed in 1996, the RJN SIU Division was created to assist California employers, 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. In just the last three years, we have secured $685,599.00 in court ordered restitution on behalf of our valued clients.
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