On June 21st, 2022, the Special Investigative Unit of RJN Investigations, Inc. was informed of the successful prosecution in the Case of People of California v. J. Davis, Jr.
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 was 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 in violation of Insurance Code Section 1871.4(a)(1), Penal Code Section 550(b)(3) and Penal Code Section 550(b)(2).
After several criminal hearings, the claimant agreed to a plea deal in which he pled guilty to one felony count in violation of Insurance Code Section 1871.4(a)(1) and the other two counts were dismissed. The claimant was sentenced to 24 months formal probation and ordered to pay back restitution in the amount of $14,824.00.
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 4000 examiners and the documented referrals by this unit have resulted in 210 convictions for workers’ compensation insurance fraud in California. In just the last 3 ½ years, we have secured $1,199,102.00 in court ordered restitution on behalf of our valued clients.
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