On April 12th, 2021, the Special Investigative Unit of RJN Investigations, Inc., learned that the San Bernardino County District Attorney’s Office had filed felony insurance fraud charges based upon submission of a documented referral. In this particular case, the claimant worked as a full-time school custodian. He alleged that while walking down a ramp carrying full trash bags, he slipped and fell to the ground injuring his right knee. This alleged incident took place during the evening hours with no witnesses. Over the next 30 days, the claimant changed his story regarding the events leading up to the injury several times. It was subsequently determined that there were outdoor video cameras in the general area of the accident and the video from those cameras were supplied to the RJN SIU. An analysis of the video evidence found absolutely no evidence of the claimant ever falling to the ground on the date and time he alleged. In one of his earlier statements, the claimant stated that he was on the ground in pain for at least 1-2 minutes. In accordance with the regulations set forth by the California Department of Insurance, the RJN SIU then formally referred this case to their Fraud Division as well as with the San Bernardino County District Attorney’s Office Workers’ Compensation Fraud Unit. Upon completion of a detailed criminal investigation performed by the District Attorney’s Office, the claimant was formally charged with 2 felony counts of violation of Insurance Code Section 1871.4(a)(1) and one Felony count in violation of Penal Code Section 550(a) (1). Upon filing the criminal charges, a felony arrest warrant was then 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 $ 701,686.00 in court ordered restitution on behalf of our valued clients.