On February 15th, 2022, the Special Investigative Unit of RJN Investigations, Inc. was notified that the Ventura County District Attorney’s Office has arrested and filed one felony charge based upon a documented referral submitted to their office. In this case, the claimant worked as a Room Attendant in Ventura County and alleged to have sustained injuries to her right arm and back while working her normal customary duties. The claimant subsequently went on disability and was receiving TTD checks in the amount of $693.34 biweekly. During this time, a surveillance investigation was initiated, and the claimant was observed conducting custodial activities for a secondary employer over a three-month span while also continuing to collect TTD payments. When questioned by her doctors, the claimant indicated that she had not worked since her injuries. During a deposition, the claimant again testified that she had not worked since sustaining her injuries. Records were secured from the secondary employer which proved that she misrepresented her work activities while continuing to cash her TTD benefits without reporting the income. 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 Ventura County District Attorney’s Office. Upon completion of the criminal investigation performed by the California Department of Insurance Fraud Division, the file was presented to the District Attorney who elected to move forward with criminal charges. The claimant was arrested, arraigned and entered a plea of Not Guilty. She is now scheduled to appear in court on February 23rd, 2022.
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 210 convictions for workers’ compensation insurance fraud in California. In the last 3 ½ years we have secured $ 968,645.00 in court ordered restitution on our Insurance Fraud Convictions on behalf of our valued clients.
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