On October 27th, 2021, the Special Investigative Unit of RJN Investigations, Inc., learned that the Riverside County District Attorney’s Office held the arraignment of the claimant charged with three felony counts.
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. In the course of the investigation, it was discovered that the claimant secured medical treatment via a hospital emergency room visit just prior to the alleged injury. Those medical records reflect that the medical treatment pertained to his left ankle that he stated he injured while dancing. The claimant never informed the examiner nor the treating doctors regarding the emergency room medical treatment to his left ankle. As the investigation continued, it was discovered that the claimant had a prior criminal record for falsifying timesheets from a prior employer. In compliance with the regulation 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). At the claimant’s preliminary hearing held on 10/25/2021 he entered a not guilty plea. His next hearing will be scheduled within the next 45 days.
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 4000 examiners and the documented referrals by this unit have resulted in 200 convictions for workers’ compensation insurance fraud in California. In just the last three years, we have secured $ 930,236.00 in court ordered restitution on behalf of our valued clients.