On July 26th, 2022, the Special Investigative Unit of RJN Investigations, Inc. was notified of the successful prosecution in this case in Ventura County. The claimant was found guilty of Insurance Code Section 1871.4(a). Furthermore, the claimant admitted to the following two felony counts of Insurance Code Section 4.421(a)(8) CRC and Insurance Code Section 4.421(a)(9) CRC. As part of the conviction, a restitution amount has been stipulated at $26,710.32. Sentencing is currently scheduled for 09/08/2022. 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 and 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. After being arrested, and attending multiple court hearings, the claimant subsequently admitted that and changed her original plea to guilty.
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 215 convictions for workers’ compensation insurance fraud in California. In just the last 3 ½ years, we have secured $1,240,090.00 in court ordered restitution on behalf of our valued clients.
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