Riverside County District Attorney’s Office Charge Teacher with Workers’ Compensation Insurance Fraud

On March 8th,2022, the Special Investigative Unit of RJN Investigations, Inc. learned that the Riverside County District Attorney’s Office had filed felony insurance charges based upon a documented referral submitted. In this particular case, the claimant was employed as Special Education Teacher who allegedly suffered an injury to her left thumb and left hand.  Due to her ongoing complaints, the claimant remained off work on total temporary disability. Given the claimant’s complaints of difficulty with activities of daily living, the claims adjuster assigned surveillance on the case to the RJN SIU. During the surveillance level investigation, substantial video evidence was obtained of the claimant which depicted her clearly utilizing her left hand in a normal manner. The video evidence secured was then provided to the primary treatment physician for review and comment. Upon review of the subrosa video evidence, the PTP made significant changes to his medical reporting. In compliance with the regulations set forth by the California Department of Insurance, the RJN SIU formally referred this case to both the CDI Fraud Division as well as Riverside County District Attorney’s Office. Upon completion of a criminal investigation conducted by the Riverside County District Attorney’s Office, the claimant was charged with one count in violation of Insurance Code Section 1871.4(a)(1). She is scheduled for an arraignment hearing to take place on March 28th, 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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