The Special Investigative Unit of RJN Investigations, Inc., was informed of the successful prosecution in the Case of People of California vs. E. Esparza.
In this particular case, the claimant was employed as a janitor and alleged that while mopping the floor, she slipped and fell, resulting in various injuries. Based upon red flag indicators detected by the claims examiner, a surveillance investigation was subsequently authorized. Although the claimant alleged to a Panel Qualified Medical Examiner that she required a cane to ambulate, the surveillance investigation yielded video evidence of the claimant ambulating without a cane. The examiner then secured prior medical records via subpoena which revealed that just one month prior, the claimant received medical treatment for one of the same body parts that she never revealed to the treating doctors or the claims examiner. In accordance with the regulations set forth by the California Department of Insurance, the case was then formally referred to their Fraud Division as well as to the Santa Clara County District Attorney’s Office. Upon completion of their investigation, the claimant was formally charged with 10 criminal counts involving Insurance Code Section 1871,4(a)(1), Penal Code Section 550(b)(1), Penal Code Section 550(b)(3) and Penal Code Section 118(a).
After attending several criminal hearings, the claimant entered into a plea-bargaining agreement. The claimant was then formally sentenced by Santa Clara Superior Court Judge Saban to 8 months in County Jail, 5 years formal probation and ordered to pay restitution in the amount of $38,409.00.
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 3 ½ years, we have secured $968,645.00 in court ordered restitution on behalf of our valued clients.
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