The Special Investigative Unit of RJN Investigations, Inc. was notified that the Los Angeles County District Attorney’s Office was successful in securing a plea deal in which the claimant agreed to repay $15,090.00 in restitution fees to the School District. In this case, the claimant worked as a Teacher’s Aide and alleged to have sustained injuries to the back while working in a normal and customary capacity. Based on the claimant’s subsequent medical treatment, the claimant’s complaints caused the medical providers to place the claimant on restrictions and limitations. A surveillance investigation was subsequently performed which secured footage of the claimant running, squatting, crouching, carrying multiple bags and items, carrying a chair over both shoulders, setting up a massage table, performing medical personnel tasks such as wrapping legs and arms at a sporting event and massaging players. The video was provided to the claimant’s treating doctors who altered the medical opinions of the claimant. 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 Los Angeles County District Attorney’s Office. Upon completion of the criminal investigation performed by the District Attorney, the matter was referred for an Office Hearing within the District Attorney Office. Subsequently, a plea deal was extended to the claimant and an agreement was reached to repay restitution versus undergo a criminal trial and face possible jail time. The claimant has agreed to repay $15,090.00 in restitution to the school district.
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 just the last 3 ½ years, we have secured $1,214,192.00 in court ordered restitution on behalf of our valued clients.
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