On July 9th, 2021, the Special Investigative Unit of RJN Investigations, Inc., learned that felony charges had been filed in reference to a documented referral submitted. In this particular case, the claimant worked as a manager for a major coffee chain. Just one month after his unwitnessed workers’ compensation injury, the SIU investigation determined that he had filed a fictitious business statement for a food market in Los Angeles County. The claimant denied any secondary employment or income to the claims examiner and subsequently began to receive TTD benefits. After receiving medical benefits for over a year and showing minimal improvement, the claims examiner authorized a surveillance level investigation. In the course of this surveillance, video evidence was obtained of the claimant working at the market he was found to own. In his deposition taken in Los Angeles County after the surveillance was completed, the claimant denied having any subsequent employment or income after his date of injury with the insured. In the course of the SIU level investigation, bank records were secured which documented significant income deposited into the claimant’s bank account while at the same time collecting TTD benefits. In compliance with the regulations set forth by the California Department of Insurance, the RJN SIU then formally filed this case with their Fraud Division as well as with the Los Angeles County District Attorney’s Office. After an extensive criminal investigation by the Los Angeles County DA’s Office, the claimant was formally charged with one count in violation of Penal Code Section 550(b)(3) and one count in violation of Penal Code Section 118(a). The claimant’s next criminal hearing is scheduled to take place in August 2021.
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 $ 894,120.00 in court ordered restitution on behalf of our valued clients.