On September 9th, 2022, the Special Investigative Unit of RJN Investigations, Inc. was notified that the Los Angeles County District Attorney’s Office has arrested and filed two felony insurance fraud charges based upon a documented referral submitted. In this case, the claimant worked as a Teacher in Los Angeles County. The claimant alleges to have sustained injuries to his hand while playing with children. The claimant would subsequently file a claim and initiate treatment. Based on his complaints, his doctors placed him on TTD disability. A surveillance investigation was authorized and completed by RJN Investigations. During the course of the surveillance, the claimant was observed active and working out with weights at a gym displaying no signs of hesitation or discomfort. During this time of surveillance, the claimant’s treating doctors had restrictions of no use of the right hand and wrist. He also reported that he avoids heavy lifting. A deposition would occur, and the claimant would testify that he does in fact go to a gym, however he made material misrepresentations in contrast to the activities he was observed doing during the surveillance efforts at the gym. Upon completion of the RJN SIU level Investigation and in compliance with the California Department of Insurance Fraud Division, the case was then formally referred to both the Commerce CDI Office as well as to the Los Angeles County District Attorney’s Office. Upon completion of the criminal investigation performed by the Los Angeles County District Attorney’s Office, the claimant was formally arrested, and advised as to the charges against him at which time he entered a plea of Not Guilty. His next scheduled criminal hearing is set to occur on 10/18/2022.
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 215 convictions for workers’ compensation insurance fraud in California. In just the last three ½ years, we have secured $1,240,090.00 in court ordered restitution on behalf of our valued clients.
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