On November 15th, 2021, the Special Investigative Unit of RJN Investigations, Inc. was notified that the Imperial County District Attorney’s Office had filed felony insurance charges based upon a documented referral submitted. In this particular case, the claimant alleged to have suffered a work-related injury to his right knee while conducting fire ground training. During the claimant’s deposition, he made material misrepresentations when he denied any prior knee problems. The claimant also denied any prior knee injuries to the industrial provider as well. Records pertaining to the claimant’s past medical history were later obtained and revealed prior injuries and complaints involving the same body part as alleged. In compliance with the regulations set forth by the California Department of Insurance, the RJN SIU formally referred this case to their Fraud Division. Upon completion of a criminal investigation conducted by the Fraud Division, the Imperial County District Attorney’s Office formally charged the claimant with one felony count of Insurance Code Section 1871.4(a)(1), one felony count of Penal Code Section 550(b)(1), one felony count of Penal Code Section 550(b)(2) and one felony count of Penal Code Section 118(a). At the claimant’s arraignment, he entered a not guilty plea. His next hearing is scheduled to take place on December 2nd, 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 4,000 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 $930,236.00 in court ordered restitution on behalf of our valued clients.
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