On May 28th, 2021, the Special Investigative Unit of RJN Investigations, Inc. was notified that the Los Angeles County District Attorney’s Office has arrested and filed felony insurance fraud charges based upon a documented referral submitted. In this case, the claimant worked as a Health Care Provider in Los Angeles County. The claimant alleges to have sustained injuries to his neck, upper and lower back, knees and right ankle while trying to transfer a patient. The claimant did not file the claim until almost 2 months after he was terminated. The claimant was subsequently deposed at which time he provided information on 2 co-workers who witnessed the event that led to his injuries. Both witnesses were questioned and stated that the statements made by the claimant were completely false and never occurred. Furthermore, records were obtained from the alleged date of injury in which the claimant did in fact seek treatment. However, the records indicate that the claimant sought medical treatment for preexisting Gastric symptoms. At no point in the records were there any mentions of pain involving the body parts or injuries the claimant alleged. 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 California Department of Insurance 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 arrested and charged with two felony counts of insurance fraud. His arraignment is scheduled to occur on June 1st, 2021, at which time the claimant will be notified of the charges against him and enter a plea. Additional hearings will be scheduled once the claimant enters a 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 3,500 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 three years, we have secured $ 894,120.00 in court ordered restitution on behalf of our valued clients.
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